Nursing Leadership Exam 2

Which statement about a national Patient Bill of Rights is accurate? A) Not yet been enacted by the federal government B) Became the law of the land C) Became legally binding in every state D) Has not been beneficial to patients

Ans: A Feedback: Although there has been significant progress in the field of patient rights since 1960, there is still no comprehensive federal legislation directed at the granting and protection of patient rights.

Which activity best demonstrates a nursing unit manager's attention to the ethics standards of practice required of that position? A) Membership on the institution's ethic board B) Terminates a staff member for absenteeism C) Assures staff and patients that unit decisions are ethically sound D) Holds membership in the local and state American Nurses Association (ANA)

Ans: A Feedback: ANA standards for ethics related to nurse administrators identifies participants on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes as a criteria measurement. The remaining options while addressing ethical behaviors on the administrator's part are not as directly identified by the ANA.

What does the morale principle of autonomy govern? A) A person's right to make his or her own decision B) The obligation to do good and prevent harm C) Doing what is right and fair D) Truth telling

Ans: A Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for one's choice. None of the other options addresses this concept.

Collecting data about the ethical problem and identifying who should be involved in the decision making process is accomplished in which phase of the MORAL decision- making model? A) Massage the dilemma B) Outline options C) Review criteria and resolve D) Affirm position and act

Ans: A Feedback: Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. Outline options: Identify alternatives, and analyze the causes and consequences of each. Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. Affirm position and act: Develop the implementation strategy.

There are many terms used to describe moral issues faced by nurses, including moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which statement describes how moral uncertainty occurs? A) Occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is B) Occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action C) Occurs when an individual witnesses the immoral act of another but feels powerless to stop it D) Occurs when being forced to choose between two or more undesirable alternatives

Ans: A Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives.

Which assessment must the RN do initially when assigning tasks to non-licensed personnel (NAP)? A) Evaluating the NAP's skills and knowledge level B) Assessing which tasks the NAP is interested in assuming C) Evaluating how patients rate the NAP's performance D) Assessing how team members like working with the NAP

Ans: A Feedback: The manager must be knowledgeable about the skills and knowledge of all members of the health-care team. While the other options are factors regarding general NAP utilization, initially skills and knowledge levels take priority.

Which action on the part of a manager demonstrates the mark of a great leader? A) Acknowledging the accomplishment of staff members at the unit's staff meeting B) Providing onsite in-services on new equipment for the staff C) Including funds in the unit's budget of staff development D) Stressing the importance of patient safety to all new employees

Ans: A Feedback: The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments. While the other options are appropriate, they are not identified as being the mark of a great leader but rather an efficient manager.

What occurs when a manager has the false assumption that delegation may be interpreted as a lack of ability on the subordinate's part to do the job correctly or completely? A) Underdelegating B) Overdelegating C) Improper delegating D) Inappropriate delegating

Ans: A Feedback: Underdelegating occurs when a manager has a false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely.

Which leadership role is associated with advocacy? A) Create a climate where advocacy and its associated risk-taking are valued B) Give subordinates and patients adequate information to make informed decisions C) Ensure that rights and values of patients supersede those of the health-care providers D) Seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict

Ans: A Feedback: A leadership role associated with advocacy is to create a climate where advocacy and its associated risk-taking are valued. Management functions include the following: give subordinates and patients adequate information to make informed decisions; ensure that rights and values of patients supersede those of the health-care providers; and seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict.

Which management function is associated with advocacy? A) Awareness of current legislative efforts affecting nursing practice and organizational and unit management B) Role modeling proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives C) Participation in professional nursing organizations and other groups that seek to advance the profession of nursing D) Assertively advocating on behalf of patients and subordinates when an intermediary is necessary

Ans: A Feedback: A management function associated with advocacy is awareness of current legislative efforts affecting nursing practice and organizational and unit management. Leadership roles include the following: role models' proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives; participates in professional nursing organizations and other groups that seek to advance the profession of nursing; assertively advocate on behalf of patients and subordinates when an intermediary is necessary.

What document permits a registered nurse to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful? A) A state nursing license B) Institutional licensure C) ANA certificate D) ANA practice standards

Ans: A Feedback: In general, a license is a legal document that permits a person to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful. A state nursing license allows for the practice of nursing in a specific state. Some professionals have advocated shifting the burden of licensure, and thus accountability, from individual practitioners to an institution or agency. Proponents for this move believe that institutional licensure would provide more effective use of personnel and greater flexibility. The ANA is not capable of permitting a person to practice nursing.

The nurse witnesses a patient sign an operative permit form. Legally, what does the nurse's signature imply? A) Observed the client sign the consent form B) Is certain the client understands the proposed procedure C) Believe the client is capable of understanding the proposed procedure D) Assumes the client has had an adequate evaluation to agree to the procedure

Ans: A Feedback: Informed consent is obtained by a physician; therefore, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. The other options are the responsibilities of the professional performing the procedure.

What is one way to promote open communication between patients and practitioners? A) Involving health-care consumers as active members of the health-care team B) Promoting the creation of cultures of patient safety in health-care organizations C) Establishing a federal leadership locus for advocacy of patient safety and health- care quality D) Building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs

Ans: A Feedback: One way to promote open communication between patients and practitioners is involving health-care consumers as active members of the health-care team. Pursing patient safety initiatives prevent medical injury by promoting the creation of cultures of patient safety in health-care organizations; establishing a federal leadership locus for advocacy of patient safety and health-care quality; and building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs.

Which statement is true regarding political action committees (PACs)? A) They attempt to persuade legislators to vote in a particular way B) They are comprised of volunteers who are interested in politics C) Their focus is the passage of specific pieces of legislature D) They appear to have little influence with law makers

Ans: A Feedback: PACs of the Congress of Industrial Organizations attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular law or paid agents of the group that wants a specific bill passed or defeated. Currently, PACs appear to have a significant amount of influence on law makers and the legislative process.

A state Nurse Practice Act is an example of which source of law? A) Statutes B) Constitution C) Administrative D) Judicial

Ans: A Feedback: Statutes are the only laws made by official enactment by the legislative body.

How is the action of advocacy described? A) Informing others of their rights and making certain they have sufficient information to make decisions B) Learning about the need for a decision and then making a good decision for other people C) Supporting an individual's right to make a decision even when they do not have accurate information D) Protecting the rights of patients in accordance with the law

Ans: A Feedback: The advocate informs others of their rights and makes certain they have sufficient information to make decisions. The remaining options are incorrect when describing the action associated with advocacy.

Whose rights do the legislative controls of nursing practice primarily protect? A) Patients B) Subordinates C) Managers D) Administrators

Ans: A Feedback: The legislative controls of nursing practice primarily protect the rights of patients. Protection of those identified by the other options while important is the primary focus of the nursing practice legislative bodies.

How is the question of whether a nurse acted with reasonable care generally proven? A) The expert testimony of nursing witnesses B) The defendant's explanation of what the nurse did C) The trial judge, after checking the outcome of prior similar court cases D) The testimony of expert medical witnesses

Ans: A Feedback: The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. The other options are not considered qualified to testify to this matter.

Which task is a management function associated with quality control? A) Periodic evaluation of unit mission and philosophy B) Making out the daily patient care assignments C) Creating a yearly budget D) Distributing holiday staffing policies

Ans: A Feedback: Unit mission, philosophy, goals, and objectives are the blocks on which policies and standards rest. All these must be in place to measure whether quality is being achieved on the unit. The other options are not related to quality control.

What is an example of an unintentional tort? A) Professional negligence B) Assault C) Battery D) False imprisonment

Ans: A Feedback: While professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts.

What is a common cause of a manager to underdelegation? A) A high degree of trust in subordinates B) A democratic leadership style C) A need for perfectionism D) Sufficient time to accomplish unit goals alone

Ans: C Feedback: A manager with a need for perfectionism and control may believe that another person will not complete a task. Trust in subordinates and a democratic leadership style would support effective delegation. Delegating should not be based on the issue of time exclusively.

Which factor should be considered when assessing the quality of ethical problem solving? Select all that apply. A) Outcomes B) Decision-making process C) Multiple alternatives D) Data gathering

Ans: A, B Feedback: Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving, because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. If a structured approach to problem solving is used, multiple alternatives are analyzed, and data gathering is adequate, then, regardless of the outcome, the manager should feel comfortable that the best possible decision was made at that time with the information and resources available. The satisfaction of the involved parties is not a reliable factor.

Which characteristic of an organization has influence on the ethical decisions its managers' make? Select all that apply. A) Purpose B) Societal role C) Societal constraints D) Values

Ans: A, B, C Feedback: The manager's ethical obligation is tied to the organization's purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps to define the purposes of various institutions, and the purposes, in turn, help to ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. The organization's societal status should not be considered when making ethical decisions.

Which statement is true regarding criminal law cases? Select all that apply. A) Incarceration is a likely consequence of being found guilty of a criminal offense B) Intentionally giving an overdose of a potent narcotic is a criminal offense C) A guilty verdict requires evidence beyond a reasonable doubt D) Most malpractice cases are tried in criminal court

Ans: A, B, C Feedback: In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. Most malpractice cases are tried in civil court.

Which action demonstrates appropriate management regarding legal issues? Select all that apply. A) Remains current on all institutional policies and procedures B) Delegates with consideration to appropriate scopes of practice C) Requires physical proof of appropriate professional licensure each year D) Provides yearly in-services on the operation of newly acquired equipment

Ans: A, B, C Feedback: Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures delegating to subordinates wisely, looking at the manager's scope of practice and that of the individuals he or she supervises, and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. In-services should be held frequently especially when related to issues that affect care delivery. The reliance on peers for advice in such matters is not prudent; the institution's legal advisor is much better prepared for this task.

What is the responsibility of a charge nurse who discovers that a medication error was made on the previous shift? A) Share that information with the charge nurse on the previous shift B) Document the incident as per hospital policy C) Write a memo to the nurse who made the error requesting incident report be written D) Write a note in the client's chart that an incident report will be completed

Ans: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Since policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the client's chart.

Which statement concerning autonomy and the employee is true? Select all that apply. A) It is a form of personal liberty B) Its legal equivalent is self determination C) It is based on a person's right to make a choice D) It is supported by the process of progressive employee discipline

Ans: A, B, C, D Feedback: A form of personal liberty, autonomy is also called freedom of choice or accepting the responsibility for one's choice. The legal right of self-determination supports this moral principle. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has the choice to meet organizational expectations or to be disciplined further. If the employee's continued behavior warrants termination, the principle of autonomy says that the employee has made the choice to be terminated by virtue of his or her actions, not by that of the manager. Therefore, nurse-managers must be cognizant of the ethical component present whenever an individual's decisional capacity is in question. To take away a person's right to self-determination is a serious but sometimes necessary action.

A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, and a causal relationship between breach of duty and injury. What else must be included? Which element is necessary to prove professional negligence? Select all that apply. A) Breach of duty B) Presence of injury C) Ability to foresee harm D) Causal relationship

Ans: A, B, C, D Feedback: A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, a causal relationship between breach of duty and injury, and the ability to foresee harm. Intent to cause injury is not a requirement.

Which intervention demonstrates that the nurse-manager is to advocate for patients in common areas of concern? Select all that apply. A) Staffing a unit with sufficient care providers B) Orienting staff to safely use a new patient lift C) Providing an in-service on culturally meeting end-of-life needs D) Arranging for patient consultations with members of the financial office

Ans: A, B, C, D Feedback: Common areas for managers to advocate for patients include distribution of resources; use of technology; end-of-life decisions; and health-care reimbursement. While aesthetics is an important consideration, it is not a common area for managers to act as advocators

Which are common areas requiring nurse-patient advocacy? Select all that apply. A) Securing patient consents B) Preventing medication errors C) Facilitating access to health-care services D) Respect for patient dignity and cultural values

Ans: A, B, C, D Feedback: Common areas requiring nurse-patient advocacy include inadequate patient consents; medical errors; access to health care; and respect for patient dignity and cultural values. While hospitalization is expensive, education on this subject is not considered a nursing advocacy role.

Which situations is a nurse-manager illegally responsible for reporting? Select all that apply. A) Suspected incidents of elder abuse B) Examples of substandard medical care C) Client-reported incidents of child abuse D) Confirmed case of a communicable disease

Ans: A, B, C, D Feedback: In addition, the manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Disagreements are not mandated reportable situations.

A verdict of suspension or loss of licensure represents what type of law? A) Criminal B) Civil C) Administrative D) Judicial

Ans: C Feedback: A verdict of suspension or loss of licensure represents administrative law. This type of law is not based on any of the other options.

Managerial advocacy has resulted in which profession of nursing characteristics? Select all that apply. A) Ethical code B) Legal recognition C) Nurse Practice Acts D) Professional licensing

Ans: A, B, C, D Feedback: Managers must be advocates for the nursing profession. It was nurses who pushed for accountability through state nurse practice acts and state licensing. Nurse-leaders collaborated on defining the profession, achieving legal recognition of the profession and establishing a culture for professional nursing which has continued to the present time. Advocating for professional nursing is a leadership role. Professional issues are always ethical issues. When nurses find a discrepancy between their perceived role and society's expectations, they have a responsibility to advocate for the profession. This includes speaking out on consumer issues, continuing and expanding attempts to influence legislation, and increasing membership on governmental health policy-making boards and councils. Only then will nurses be able to influence the tremendous problems facing society today.

Which characteristic associated with being a patient increases the need for advocacy? Select all that apply. A) Loss of physical freedom as a result of extended hospitalizations B) Decreased independence due to physical or psychosocial limitations C) Physical or psychosocial limitations negatively impacted autonomy D) Illness tends to make an individual more vulnerable to unethical activities

Ans: A, B, C, D Feedback: Patient advocacy is necessary because disease almost always results in decreased independence, loss of freedom, and interference with the ability to make choices autonomously. In addition, aging, as well as physical, mental, or social disability may make individuals more vulnerable and in need of advocacy. It is not true that cognitive function is impaired as a result of chronic and/or acute illness.

Which strategies would demonstrate an understanding of effective preparation for a television interview to discuss issues affecting nursing today? Select all that apply A) Be focused on key points. B) Introduce statistics that support the key points C) Repeat key points several times during the interview D) Provide background material related to the key points

Ans: A, B, C, D Feedback: The best strategies for a television interview are to be prepared and to stick to three or four key points that will drive home your message, and repeat them during the interview. Concentrating on popular points is not necessarily where the focus should be directed.

Which strategy demonstrates an understanding of the management's role as advocate for their subordinates? Select all that apply. A) Staff representatives on all unit committees B) Monthly "brown bag lunches" with the staff C) Requests revising criteria for granting a "leave of absence" D) Working with primary care providers to expand standing nursing orders

Ans: A, B, C, D Feedback: The following are suggestions for creating an environment that promotes subordinate advocacy: Invite collaborative decision making; get to know staff personally; "go to bat" for staff when needed; and promote nurse autonomy. Rather than anticipating educational needs, the manager advocates by asking for and then respecting their suggestions by planning accordingly.

21. Which nursing intervention demonstrates attention to the nursing values central to patient advocacy? Select all that apply. A) Assuring the patient that their wishes will be respected regarding the care they receive B) Identifying the patient's religious dietary practices when discussing a prescribed diet C) Answering the patient's questions regarding the alternatives to a proposed procedure D) Suggesting to a patient that a social services consult would help with discharge needs

Ans: A, B, C, D Feedback: The nursing values central to advocacy emphasize caring, autonomy, respect, and empowerment. While appropriate, comforting a patient is not an act of advocacy in this situation.

A nurse-manager has been asked to write an article for the newspaper addressing a health-care issue of local concern. Which statement demonstrates the nurse understandings the appropriate way to response to such a request? Select all that apply. A) "I'll include the latest data on the subject." B) "When will you need to have the final draft of my article?" C) "Are you comfortable with me focusing on 3 key points related to this topic?" D) "That isn't my field of expertise but I will contact a peer with that knowledge."

Ans: A, B, C, D Feedback: Tips of effective interaction with the media include respecting and meeting their deadlines, having key facts ready to include, limiting key points to two or three, and not being afraid to say you lack that specific expertise. One should assume, until proven otherwise, that the reporter will be fair and accurate in his/her reporting.

How can nurses act as advocates? Select all that apply. A) Helping others make informed decisions B) Directly intervening on behalf of others C) Providing consent to treat for the cognitively impaired patients D) Making health-care decisions for those who are not able to do so

Ans: A, C, D Feedback: Nurses may act as advocates by either helping others make informed decisions, by acting as intermediary in the environment, or by directly intervening on behalf of others. Advocates do not make decisions or provide consent but rather educate patients so they can be informed.

Which action is considered a leadership role associated with delegation? A) Creating job descriptions for all personnel B) Providing formal recognition or reward for completion of delegated tasks C) Demonstrating sensitivity to how cultural phenomena affect transcultural delegation D) Reprimanding employees who demonstrate overt resistance to the tasks they are delegated

Ans: C Feedback: Factors such as communication, space, social organization, timing, environmental control, and biologic variations affect delegation to a culturally diverse staff and should be modeled as a leadership role. The other choices are all management functions.

Which statement correctly identifies the composition of a letter to a legislator? Select all that apply. A) Identify yourself as a constituent in the first paragraph B) State your reason for writing in the second paragraph C) Sign the letter and include your contact information D) Address the legislator by title

Ans: A, C, D Feedback: Personal letters are more influential than formal letters, and the tone should be formal but polite. The letter should also be concise (not more than one page). Be sure to address the legislator properly by title. Establish your credibility early in the letter as both a constituent and a health-care expert. State your reason for writing the letter in the first paragraph, and refer to the specific bill that you are writing about. Then, state your position on the issue and give personal examples as necessary to support your position. Offer your assistance as a resource person for additional information. Sign the letter, including your name and contact information. Remember to be persistent, and write legislators repeatedly who are undecided on an issue. Display 6.5 displays a format common to letters written to legislators.

Professional organizations generally espouse standards of care that have what relationship to those required by law? Select all that apply. A) Higher than those required by law B) The same as those required by law C) Are established after those required by law D) Are established prior to those required by law

Ans: A, D Feedback: Professional organizations generally espouse standards of care that are higher than those required by law. These voluntary controls often are forerunners of legal controls. The standards are written by health-care professionals while laws are written by legislatures.

Which characteristic is most important when the nurse-manager is considering staff for a delegated role? A) Years of experience B) Willingness to grow professionally C) Aversion to risk taking D) Pervious experience with similar tasks

Ans: B Feedback: Identify which individuals can complete the job in terms of capability and time to do so. Remember that it is a leadership role to stretch new and capable employees who want opportunities to learn and grow. Also look for employees who are innovative and willing to take risks. It is also important that the person to whom the task is being delegated considers the task to be important. Years of experience and exposure to similar tasks are not as important as interest in professional growth.

Which term is used to identify a person's feelings of powerlessness to stop unethical behavior in another person or institution? A) Moral conflict B) Moral outrage C) Ethical relativism D) Ethical universalism

Ans: B Feedback: Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture. Ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences.

Which member of the health-care team is often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting wants and goals? A) Physicians B) Nurses C) Nurse practitioners D) Social workers

Ans: B Feedback: Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. The nature of the patient contact of a nurse is more direct and involves more time than the other members of the health-care team.

What defines the legal boundaries of nursing at the state level? A) The state's Attorney General B) The Nurse Practice Act C) The ANA standards of practice D) The ANA Code for Nurses

Ans: B Feedback: The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level. The other options lack the comprehensiveness and focus of a state's Nurse Practice Act.

What is the role of the American Nurses Association Code of Ethics and Interpretive Statements? A) Outlines minimum levels of ethical behavior that nurses must maintain B) Functions as a guide to the highest standards of ethical practice for nurses C) Is a legally binding document that directs a nurse's ethical and moral behavior D) Mandates the ethical behavior prerequisite for maintaining a nursing licensure

Ans: B Feedback: The ANA Code of Ethics outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse in order to achieve and maintain the highest standards. The document is not legally binding nor is it a mandate of behavior.

Which ethical framework would most likely be used to arrive at the nurse's decision to work overtime in spite of previous social plans? A) Utilitarianism B) Duty based C) Rights based D) Intuitionism

Ans: B Feedback: The duty framework says that some things should be done just because there is a duty to do them or refrain from doing them. Utilitarianism states that the good of the many outweighs the wants or needs of the individual. The remaining options are not relevant to the situation.

What is the first step the manager takes when a subordinate is having difficulty carrying out a delegated task? A) Take over the task so the employee will not become demoralized B) Be available to the employee as a role model and resource for the task C) Assign another more experienced employee to help with the task D) Re-assign the employee a different, less complex task

Ans: B Feedback: A manager should be available to the employee to help identify solutions to problems encountered with a delegated task and should encourage the employee to persevere. Taking back a task that was originally delegated is an absolute last resort. Reassigning and co-assigning the task are options that are not initially considered.

What is the most important consideration for the manager when identifying the appropriate person to whom to delegate a specific task? A) Whose turn it is to delegate a task B) The qualifications of the person regarding the task C) The fiscal cost of delegating the task D) Whether the person has experience with similar tasks

Ans: B Feedback: Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task.

Which behavior will best minimize a nurse's risk for a malpractice claim? A) Always carry a personal liability insurance policy B) Always function with the state's nursing practice act C) Ask for assistance when engaged in complicated procedures D) Devote time to establishing an effective nurse-patient relationship

Ans: B Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. While the other options present reasonable advice, they will not necessarily help in the avoidance of a malpractice claim.

Which statement best describes the impact that the concept of respondeat superior has on the issue of nursing liability? A) It allows for joint liability among physicians, nurses, and health-care organizations B) It supports the sharing of blame among all involved sources of health-care services C) It encourages legal intervention when health care is thought to be substandard D) It implies that the institution is responsible for the acts of its employees

Ans: B Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. While the other options may be true statements, the correct option describes the more nurse-related implication of the concept.

Which factor has the greatest impact on the need for nurses to possess excellent delegation skills? A) Increase in patient acuity levels B) Decrease in patient hospitalization time C) Increase in the use of NAP D) Decrease in nurse-to-patient ratios

Ans: C Feedback: With the increased use of NAP in patient care, the need for nurses to have highly developed delegation skills has never been greater. The impact of acuity levels, nurse- patient ratios, and hospitalization stays does not have as great an impact as does the correct option.

What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice? A) This will prevent them from getting sued B) Laws are fluid and subject to change C) It will protect the agency from a lawsuit D) It will ensure that correct procedure is carried out

Ans: B Feedback: When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. While the other options are correct, they do not describe the most encompassing reason that nurse-managers need to keep aware of current legislature affecting nursing practice.

Protecting patient confidentiality respects the client's right to A) self-esteem B) self-defense C) self-determination D) self-incrimination

Ans: C Feedback: Confidentiality is a foundation of both medical and nursing ethics, and it respects the client's right to self-determination. While the other options are worthy of respect, they are not associated with confidentiality.

Which statement by the nurse-manager demonstrates an understanding of the need to provide effective guidance to those a project has been delegated? A) "Don't be afraid to let me know if you feel the project is overwhelming you." B) "What do you suggest we do to address the problems that exist with the project?" C) "I can give you a few solutions for the issues you have been having with the project." D) "Do you want more time to complete the project?"

Ans: C Feedback: If the worker is having difficulty carrying out the delegated task, the leader-manager should be available as a role model and resource in identifying alternative solutions. Leaders should encourage employees, however, to attempt to solve problems themselves first, although they should always be willing to answer questions about the task or to clarify desired outcomes as necessary. Suggesting solutions or removing the person from the task prematurely does not demonstrate an understanding of effective guidance.

Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A) Ethical controls are clearer and philosophically impartial B) Ethical controls are much clearer and individualized C) Legal controls are clearer and philosophically impartial D) Legal controls are much less clear and individualized

Ans: C Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.

When a manager appropriately recognizes the successful completion of a delegated team task, what is the primary reward for the manager? A) Less involvement in uncomplicated tasks B) A staff that is familiar with team-related delegated tasks C) Professional recognition as a leader D) Staff that is growing as professional caregivers

Ans: C Feedback: Leaders are often measured by the successes of those on their teams. Therefore, the more recognition team members receive, the more recognition will be given to their leader. Spending less time on uncomplicated tasks is not the primary gain for the nurse- manager. It is the staff that benefit from the exposure to team work and professional growth.

Which task would the director of a home health agency not delegate another staff RN? A) Assigning home health aides to specific patient care B) Serving on a diabetic study committee of community resources C) Meeting with the agency's administration regarding budget cuts D) Reviewing staff time cards for completion and accuracy

Ans: C Feedback: Management responsibilities associated with budgeting would not be delegated to another RN on the staff. The other options could be appropriately delegated to another RN.

What must managers delegate to another RN in order to assure completion of a task? A) Time and space B) Leadership and creativity C) Authority and responsibility D) Personnel and knowledge

Ans: C Feedback: Managers must delegate the authority and the responsibility necessary to complete the task. Nothing is more frustrating to a creative and productive employee than not having the resources or authority to carry out a well-developed plan. Qualities like leadership, knowledge, and creativity are not transferable. The remaining option choices are resources that are provided rather than delegated.

What statement concerning the delegating of tasks by the nurse to unlicensed assistive personnel (NAP) is true? A) One can safely assume that the NAP has at least a high school diploma as a minimum hiring criterion B) All unlicensed assistive personnel have achieved at least minimum standardized training pursuant to the Omnibus Budget Reconciliation Act of 1987 C) No federal or community standards have been established for training the broad classification of NAP D) The nurse is protected from liability when allowing the NAP to perform only those tasks the employee includes in the job description

Ans: C Feedback: No federal or community standards have been established for the training of the NAP. The Omnibus Budget Reconciliation Act relates to certified nursing assistants only. The hiring policies of institutions vary regarding the employment qualifications of the NAP and many institutions do not have distinct job descriptions for NAP that define their scope of practice.

Which restraining force occurs when a subordinate "tests the water" to determine what the consequences are of not completing a delegated task? A) Failure of delegator to see subordinate perspective B) Subordinate incapable of completing the task C) Subordinate inherent resistance to authority D) Overdelegation of specificity of the task

Ans: C Feedback: One cause of subordinate resistance to delegation is an inherent resistance to authority. Some subordinates simply need to "test the water" and determine what the consequences are of not completing delegated tasks. The remaining options do not represent the behaviors described.

Which ethical principle associated with an adult child is legally given the right to make medical decisions for a cognitively impaired parent? A) Justice B) Fidelity C) Paternalism D) Beneficence

Ans: C Feedback: Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat "equals" equally, and treat "unequals" according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good.

Which statement is true regarding the general delegation liability of the registered nurse (RN)? A) It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification B) It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates C) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks D) It is avoided entirely by delegating tasks to only other licensed personnel

Ans: C Feedback: Proper delegation practices that include assessment and evaluation help protect the RN from liability. The other statements are not true.

Much of the difficulty people have in making ethical decisions results from a lack of formal education about problem solving. Research at the University of Pennsylvania found what percentage of the nurses and social workers reported having no ethics training? A) 15 B) 20 C) 25 D) 30

Ans: C Feedback: Research done at the University of Pennsylvania found that nearly 25% of the nurses and social workers reported having received no ethics training.

What is an inappropriate reason for delegation? A) To empower subordinates by "stretching" them in their work assignment B) To free the manager to address more complex, higher-level unit needs C) When the task is not a challenge for the manager D) Because someone else is better qualified to do the task that needs to be done

Ans: C Feedback: That the manager is not challenged by a task is not a valid reason for delegating that task to another. The other options are all appropriate reasons to delegate tasks to qualified staff.

Which statement regarding the responsibility of a manager in advocacy is accurate? A) Advocacy is a management function and not a leadership role B) Managers advocate only as needed to meet organizational goals C) Managers should advocate for patients as well as subordinates D) Professional advocacy is not a primary concern for most managers

Ans: C Feedback: Advocacy is helping others to grow and self-actualize. The manager must be an advocate for patients, subordinates, and the nursing profession. The remaining statements are not accurate descriptions of the manager's role as advocate.

A doctor orders a medical procedure that the staff nurse has reason to believe will harm the patient. Which statement accurately states the legal consequences of carrying out, or refusing to carry out, the procedure? A) The staff nurse cannot be held legally liable for any harm to the patient if the procedure is carried out with due care B) The nurse may lose his or her license by refusing to carry out the procedure C) The nurse can be held legally liable for any harm if the procedure is carried out without question D) The nurse can be held accountable for practicing medicine without a license

Ans: C Feedback: All nurses have personal liability, which means that every person is liable for his or her own conduct. None of the remaining options describes that liability or its outcomes accurately.

Malpractice or professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner. How many components must be present for an individual to be found guilty of malpractice? A) Three B) Four C) Five D) Six

Ans: C Feedback: Five components must be present for a professional to be held liable for malpractice: duty to use care, failure to meet standard of care, foreseeability of harm, direct relationship between failure to meet the standard of care and injury can be proved, and injury.

Which situation presents an example of inappropriate delegation? A) Temporary authority is given to support completion of a delegated task B) The person to whom a task is delegated considers it a challenge C) The employee is given exact instructions on completing the task D) Regular updates on the task are exchanged with the manager and the employee

Ans: C Feedback: If an employee has the skills necessary to complete a task, that employee should be able to carry out the task with autonomy and be provided with the authority and resources necessary. Depending on the complexity of the project, the manager should meet with the employee for updates. One of the goals of delegation is to challenge employees into learning new skills.

Who plays a primary role in ensuring that workers have reasonable, working schedules? A) Unions B) Top administrators C) Managers D) Federal government

Ans: C Feedback: In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates. The other options play a role in such situations but the manager has the primary responsibility.

What element must be included in the process of securing informed consent? A) A timeline of when the treatment is expected to occur B) Written information on what the post procedure outcomes will be C) Information regarding the risks involved in the proposed procedure D) An explanation of the nature of all associated treatment provided by the nurse

Ans: C Feedback: Informed consent can be given only after the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it. Timeline and nursing responsibilities are not components that are included. Outcomes are identified as expected or desired; no guarantees are given.

Which factor has the greatest influence on a legislator? A) Form letters from group members B) Individual phone calls from constituents C) Meeting with a strong collective political group D) A personal visit by an individual constituent

Ans: C Feedback: Legislators and policy makers generally are more willing to deal with a group rather than individuals; thus, joining and supporting professional organizations allow nurses to become active in lobbying for a stronger nurse practice act or for the creation or expansion of advanced nursing roles.

Which characteristics are required of a reasonable and prudent nurse? A) Years of clinically focused nursing experience B) Specialized nursing skills C) Average nursing judgment and skills D) Earned advanced nursing degree

Ans: C Feedback: Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. The other options describe qualifications not required of a reasonable and prudent nurse.

What is the first step in quality control? A) To take corrective action when standards have not been met B) To collect data to determine whether standards have been met C) To determine criteria and standards D) To determine who will measure the standard

Ans: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance or making corrections is impossible if standards have not been clearly established.

What component of professional negligence is represented when a nurse fails to look up an unfamiliar medication before administering it? A) Duty to use due care B) Failure to meet standard of care C) Foreseeability of harm D) A direct relationship between failure to meet the standard of care (breach) and injury can be proved

Ans: C Feedback: The nurse must have reasonable access to information about whether the possibility of harm exists not fulfilling this responsibility may result in a foreseeable harm to the client. None of the remaining options are relevant to this criterion.

Periodically during the day the RN checked with the team members to determine whether they are having difficulty completing their assigned tasks. This describes which manager role? A) Skills evaluation B) Patient safety C) Effective delegation D) Micromanagement

Ans: C Feedback: This manager provided the team with the autonomy to complete the work and was available should any need arise. This describes effective delegation. This action is not related to any of the other options.

Patients were often denied basic human rights until when? A) 1940s B) 1950s C) 1960s D) 1970s

Ans: C Feedback: Until the 1960s patients had few rights; in fact, patients before then often were denied basic human rights. Conditions improved by the 1970s.

Which statement is true regarding the implications of a Good Samaritan law for a registered nurse? Select all that apply. A) A nurse has a legal responsibility to provide emergency services B) Such laws are universally worded so as to minimize state-to-state differences C) In order for protection to apply, the nursing care cannot be considered negligent D) A nurse who provided out-of-scope care is not protected by the Good Samaritan law

Ans: C, D Feedback: Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to stop if they believe they can help. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. However, not being paid for your services alone will not provide Good Samaritan law protection. Good Samaritan laws apply only if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Protection under Good Samaritan laws varies tremendously from state to state. In some states, the law grants immunity to RNs but does not protect LVNs or LPNs. Other states offer protection to anyone who offers assistance, even if they do not have a health-care background. Nurses should be familiar with the Good Samaritan laws in their state.

What managerial action is important when supporting the delegation of a task to a subordinate? A) Always requiring a maximizing quality outcome B) Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned C) Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations D) Occasionally providing learning or "stretching" opportunities for employees

Ans: D Feedback: "Stretching" provides growth opportunities for employees, builds employee self-esteem, and helps prevent boredom and de-motivation. The other options are not actions that are supportive of the staff and the delegation process.

Who bears the ultimate responsibility for ensuring that the nursing care provided by team members meets or exceeds minimum safety standards? A) The patient's primary healthcare provider B) The facility's Director of Nursing C) The unit's nursing manager D) The team's RN

Ans: D Feedback: The team's RN always bears the ultimate responsibility for ensuring that the nursing care provided by his or her team members meets or exceeds minimum safety standards. This is not the role of any of the other positions mentioned.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a leadership role? A) Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramifications B) Identifies outcomes in ethical decision making that should always be sought or avoided C) Uses established ethical frameworks to clarify values and beliefs D) Role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard

Ans: D Feedback: A leadership role is role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard. Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramification, identifies outcomes in ethical decision making that should always be sought or avoided, and uses established ethical frameworks to clarify values and beliefs are examples of management functions.

Which statement regarding ethical decision making is true? A) Outcomes are the basic criterion for evaluating ethical decision making B) Only desirable alternatives are identified when solving ethical dilemmas C) Critical ethical decisions are made quickly so the situation does not worsen D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Ans: D Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. The remaining options are not true statements regarding the ethical decision-making process.

Which statement best describes ethics? A) How our lives and relationships are led in our reality B) How people make decisions they see as legally and morally appropriate C) The conflict, power, and interdependency associated with the way we live D) What our conduct and actions should be regarding what is right and good

Ans: D Feedback: Ethics is the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are.

Which ethical framework involves an individualized decision-making framework? A) Duty based B) Rights based C) Utilitarian D) Intuitionist

Ans: D Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of people. Duty based is a duty to do something to refrain from doing something. Rights- based individuals have basic inherent rights that should not be interfered with.

The practice of allocating organs for transplantation based on a person's "worth to society" is an example of what ethical principle for decision making? A) Autonomy B) Beneficence C) Utility D) Justice

Ans: D Feedback: Justice: Seek fairness, treat "equals" equally, and treat "unequals" according to their differences. Autonomy: Promotes self-determination and freedom of choice. Beneficence: Actions are taken in an effort to promote good. Utility: The good of the many outweighs the wants or needs of the individual.

Which organization is actively engaged in clarifying the delegation parameters for RNs? A) American Hospital Association (AMA) B) The federal government C) National League for Nursing (NLN) D) State Boards of Nursing Licensure

Ans: D Feedback: State Boards of Nursing Licensure is responsible for clarifying the delegation parameters for RNs. None of the other options are involved in this process.

A member of the team reports that they have been given too much to do and are not going to be able to complete the work on time. What action will the RN take to effectively manage this situation? A) Assign the work to another team member B) Take on the responsibility of the tasks C) Have the team member perform only the necessary tasks D) Examine the workload and assist the individual in reprioritizing

Ans: D Feedback: The manager should help the overwhelmed employee reprioritize the workload with the goal of making it manageable for that employee. None of the other options realistically assist the team member in managing time and prioritizing effectively.

What is an ethical dilemma? A) A problem that can be solved using empirical data B) A situation that has clearly delineated facts for decision making C) A problem that when handled effectively has a mutually agreed-upon solution D) A situation that requires choosing between two or more undesirable alternatives

Ans: D Feedback: The most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives. The problem is not generally solved with a solution that is mutually satisfying nor does it lend itself to empirical or delineated facts.

What cultural phenomena must be considered for the biopsychosocial differences between racial and ethnic groups that have susceptibility to disease and physiologic differences? A) Space B) Social organization C) Environmental control D) Biologic variations

Ans: D Feedback: The phenomenon Biologic variations refers to the biopsychosocial differences between racial and ethnic groups, such as susceptibility to disease and physiologic differences. None of the other options are associated with managing these differences.

The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect? A) Unethical conduct B) Maleficence C) Paternalism D) Utility

Ans: D Feedback: The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficence behavior on the part of the insurance company. Paternalism would be characterized by the insurance company making treatment decision without the patient having input.

The Patient's Bill of Rights established by which body has the most legal authority? A) A health-care organization B) A professional medical organization C) A regulation professional nursing organization D) A specific state

Ans: D Feedback: A bill of rights that has become law or state regulation has the most legal authority because it provides the patient with legal recourse. A bill of rights issued by health-care organization and professional associations is not legally binding but may influence federal or state funding and certainly should be considered professionally binding.

What component of professional negligence is represented when a patient experiences a seizure resulting from a medication error? A) Duty to use due care B) Failure to meet standard of care C) Foreseeability of harm D) A causal relationship

Ans: D Feedback: A direct causal relationship between failure to meet the standard of care (breach) and injury can be proved when a patient is harmed because proper care is not given. None of the remaining options are relevant to this criterion.

Which situation is a reality for whistle-blowers? A) Retaliation against them is illegal B) Fellow workers are supportive of them C) Federal and State law protects them D) They are often afraid to speak out

Ans: D Feedback: Although whistle-blower protection has been advocated for at the federal level and has been passed in some states, many employees are reluctant to report unsafe conditions for fear of retaliation. Nurses should check with their state association to assess the status of whistle-blower protection in their state. Retaliation and resentment still exist against these individuals in many situations.

What statement is true concerning nurses as a political body? A) They are very committed to both their profession and the political process B) Many are active members of the American Nurses Association (ANA) C) Their primary focus is to speak out on consumer health-related issues D) They have not yet recognized the full potential of political activity

Ans: D Feedback: As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes. The remaining options are not true of nurses in general.

Even after a lengthy discussion concerning the ramifications, a patient wants to leave the hospital against medical advice (AMA). What would the nurse do in the role of patient advocate? A) Encourage the patient to wait until morning to leave the hospital B) Ask family members to help talk the patient out of the decision C) Call the security guard to escort the patient off hospital property D) Make sure the patient has appropriate follow-up appointments

Ans: D Feedback: As advocate for this patient, you have made sure he is informed of the ramifications of leaving AMA; however, it is a patient's right to refuse treatment. The other options fail to recognize the patient's right to make autonomous choices.

An RN is a supervisor in an organization that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. How does the RN practice TQM on the unit? A) Encouraging employees to think of a unit slogan B) Developing a quota system for number of patients cared for C) Explaining to the staff that "if it's not broke, don't fix it" D) Promoting teamwork rather than individual accomplishments

Ans: D Feedback: In TQM, team efforts are favored over individual accomplishments. Slogans, quota systems, and maintaining the status quo work against quality in this philosophy.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a management function? A) Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision making C) Accepts that negative outcomes occur in ethical decision making despite high- quality problem solving and decision making D) Identifies outcomes in ethical decision making that should always be sought or avoided

Ans: D Feedback: Management function identifies outcomes in ethical decision making that should always be sought or avoided. Leadership roles include the following: Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings; accepts that some ambiguity and uncertainty must be a part of all ethical decision making; accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making.

How is the legal expansion of nursing roles accomplished? A) The expansion of job descriptions in an agency B) Written contracts between the nurse and the client C) A written agreement between the nurse and the physician D) Revision of the Nurse Practice Act

Ans: D Feedback: RN scope of practice is always determined by the Nurse Practice Act and any expansion of roles must occur through legislated changes in that statute. None of the remaining options are sufficient to expand nursing roles legally.

Which standard of the American Nurses Association (ANA) Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients? A) II B) III C) IV D) V

Ans: D Feedback: Standard V of the ANA Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients. This issue is not addressed in the other options.