Practice Questions - Exam 2 Leadership

An interdisciplinary team is evaluating the hospital's care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital's clinical indicator, which would be: (select all that apply) a. aspirin order within 24 hours of discharge. b. patient teaching related to stopping smoking completed prior to discharge. c. beta blocker administered upon arrival. d. support of employer to modify stress in workplace. e. patient's willingness to adhere to a strict cardiac diet after discharge.

A, B, C Clinical indicators are measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished. National benchmarks are established according to guidelines related to quality care for patients admitted with heart attack and include: aspirin within 24 hours of admission, angiotensin receptor blocker at discharge, stop smoking instruction given, and beta blocker administered upon arrival and discharge. These are all measurable.

Which functions can be delegated only to another RN with appropriate experience and training? (select all that apply) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel e. Formulation of nursing diagnosis "potential for fall"

A, B, C, E Nurses CANNOT delegate what they EAT: Evaluation Assessment Teaching + Nursing Diagnosis

Which factors would be considered in the first steps in developing an effective patient classification system? (select all that apply) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients

A, B, E The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.

An RN working in a long-term care facility routinely supervises nurses' aides and licensed practical nurses. The facility is considering unionization. The RN has been correctly informed that she: A.can vote in the union election because nurses who serve in supervisory roles are not considered part of the management team B.will not be allowed to vote in the union election because she is considered part of the management team C.will not have to pay union dues because she serves in a supervisory position D.is ineligible for collective bargaining activities that deal with unfair labor practices

A.can vote in the union election because nurses who serve in supervisory roles are not considered part of the management team Rationale: A is correct because serving as a supervisor of nurses' aides and licensed practical nurses is considered part of the nurse's professional role and she is not considered management. B is incorrect because nurses who perform routine supervisory duties are not considered to be part of the management team. C is incorrect because the nurse will be a union member and will be required to pay union dues. D is incorrect because this nurse is eligible for representation through collective bargaining.

The healthiest form of communication is the ________ style.

Assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.

Which of the following would have the greatest influence on the success of a health care organization? A.Effective protocols B.Clear goals and objectives C.A transactional nurse manager D.Human skills

B.Clear goals and objectives Rationale: B is correct because clearly stated goals and objectives that are measurable, observable, and realistic are necessary to achieve the strategic plan and contribute to the success of the organization. A is incorrect because although effective protocols increase efficiency and effectiveness, the goal and objectives must first be established so team members realize what they are working to meet. C is incorrect because the transactional leader who is committed to the day-to-day operations of the organization must be able to clearly identify the organization's goals and objectives to be successful. D is incorrect because human skills represent the ability to work with people in an effective leadership role; although human skills are important to the success of any organization, leaders must first be able to conceptualize the organization's goals and objectives if they are to work effectively with people.

The hospital's nursing administration wants to implement a policy that all wound care be implemented and monitored by the hospital's certified enterostomal nurse because of a high rate of hospital-acquired wound infections. The nursing administrator refuses to hire an outside consultant suggested by the nurse managers, stating, "We can do this ourselves; no one needs to know our problems." The nursing administrator is adhering to which management theory? A.Open systems B.Closed systems C.Chaos theory D.Participative theory

B.Closed systems Rationale: B is correct because closed system theory incorporates the belief that the organization should not be contaminated by outside influences. A is incorrect because with an open system, internal and external forces are mutually influential, resulting in change. C is incorrect because chaos theory is based on the belief that because of the complexity of health care systems, expected variations occur and have to be managed; however, in this case, the administrator is not considering appropriate options for managing an undesirable variation. D is incorrect because participative theory encourages staff input in decision making, and in this case, the administrator is making all decisions.

The nursing shortage escalates, and certain geographic areas must institute delivery models that require fewer numbers of registered nurses. Which type of nursing delivery models would be appropriate? A.Total patient care and primary nursing B.Team nursing and functional nursing C.Total patient care and functional nursing D.Primary care and team nursing

B.Team nursing and functional nursing Rationale: B is correct because one advantage of team and functional delivery models is that quality, comprehensive care can be provided with more ancillary staff. A is incorrect because total patient care and primary nursing use RNs to implement all aspects of care. C is incorrect because although functional nursing allows ancillary staff to perform tasks within their scope of practice, total patient care requires an all RN staff that performs all aspects of care. D is incorrect because although team nursing allows a team leader who is an RN to coordinate care among diverse levels of team members, primary nursing requires RNs to perform all tasks related to care.

A patient understands that the hospital where he is currently having a procedure done is "Joint Commission" accredited. The patient asks the nurse how accreditation ensures that patients receive the best care possible. The nurse informs the patient that there are several quality initiatives required by The Joint Commission in order for the hospital to be accredited. One of these quality initiatives is known as: A.Pareto charts B.never events C.National Hospital Quality Measures D.PDSA cycle

C. National Hospital Quality Measures Rationale: C is correct because The Joint Commission initiated the performance measurement and improvement initiative known as "National Hospital Quality Measures" intended to support organizations in their quality improvement efforts as well as supplement their accreditation process. A is incorrect because Pareto charts are bar graphs, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem, and are used in analyzing quality improvements initiatives but not required as part of The Joint Commission Accreditation process. B is incorrect because Never Events were initiated by The Centers for Medicare and Medicaid and are serious adverse events during an inpatient stay that should never occur or are reasonably preventable through adherence to evidence-based guidelines. D is incorrect because the PDSA cycle is one type of quality improvement model and not specified as required by The Joint Commission.

A quality improvement team was collecting data to determine how nurses use their time and to identify areas to improve nurses' efficiency. The team found that 60% of nurses' time was spent charting, 30% was spent in direct patient care activities, and 10% was spent on patient and family teaching. Which type of chart would best support the data collected by the quality improvement team? A.Cause and effect B.Flowchart C.Pareto D.Time plot

C.Pareto Rationale: C is correct because the Pareto chart is a graphic tool that helps break a big problem down into its parts and then identifies which parts are the most important or common. A is incorrect because a cause-and-effect diagram lists all potential causes of a problem, arranged by categories. B is incorrect because a flowchart provides pictures of the sequence of steps in a process and does not identify the causes of the problem. D is incorrect because a time plot graphs data points as they occur over time but does not identify the major causes of variation.

A patient receives care for heart failure on a nursing unit in which the interprofessional team members—including nurses, physicians, and therapists—are committed to including the patient and spouse in change of shift reports and to seeking their input in all decisions affecting the patient's care. What type of care model is represented in this unit? A.Functional care B.Primary care C.Patient-centered care D.Case management

C.Patient-centered care Rationale: C is correct because patient-centered care is to provide care that is respectful of and responsive to individual patient preferences, needs, and values and that patients and family members are involved in all care decisions. A is incorrect because functional care is the provision of care by nursing and nursing ancillary staff rather than by personnel from across departments. B is incorrect because primary nursing care is delivered by an all RN staff. D is incorrect because case management is a model of care delivery in which an RN case manager coordinates the patient's care throughout the course of an illness but does not supervise daily care activities.

In determining the competencies of staff to whom the RN may delegate, the RN should review the annual staff competencies required by: A.licensing bodies such as the American Nurses Association B.certifying bodies such as the American Association of Critical-Care Nurses C.accrediting agencies such as The Joint Commission D.third-party payers such as private insurance and Medicaid

C.accrediting agencies such as The Joint Commission Rationale: C is correct because various regulatory and accrediting agencies such as The Joint Commission require written documentation of staff competencies. A is incorrect because the American Nurses Association develops the scope and standards of practice for RNs but is not involved with documented competencies of staff. B is incorrect because certifying bodies such as the American Association of Critical-Care Nurses validate that nurses who successfully complete the certification examination are qualified and knowledgeable about practice in a defined area of nursing, but specific competencies may not be documented at the local agency. D is incorrect because third-party payers do not establish nor document competencies of professional nurses.

An RN enjoys caring for complex patients in acute care and is interested in returning to school for a graduate degree as a generalist to gain greater autonomy over care decisions at the bedside for those patients with multifaceted dynamic health status. This nurse should consider a career opportunity such as: A.flight nursing B.faith community nursing C.clinical nurse leader D.case manager

C.clinical nurse leader Rationale: C is correct because the clinical nurse leader is a master's-prepared generalist at the bedside who plans and coordinates care for complex patient scenarios. A is incorrect because flight nursing does not require a graduate degree, and although patients cared for have multifaceted health status, the context of practice is often in the field. B is incorrect because parish nurses practice in a faith-based community, and a graduate degree is not necessary. D is incorrect because case managers do not necessarily have to be nurses and are responsible for coordinating all aspects of care and are not providing bedside care.

A nurse establishes a "roadmap" for diagnostic tests, activities, and treatments that standardize care and increase safety while promoting excellence of care in the acute care setting. The nurse is operating in the role of: A.occupational health nurse B.informatics nurse specialist C.quality manager D.community health nurse

C.quality manager Rationale: C is correct because the quality manager assesses opportunities for process improvement, implements changes, and measures outcomes, which often produce critical pathways or algorithms to define safe quality outcomes of care. A is incorrect because the occupational health nurse institutes programs of health promotion and disease prevention for employees and assists with immediate health needs as necessary for an occupational group. B is incorrect because the informatics nurse specialist focuses on management and processing of health care information. D is incorrect because community health nursing is not delivered in the acute care setting.

A charge nurse assigns two RNs to provide care as a team for laboring patients. What are the supervisory needs of each of these RNs? A.Because they have equal status, each RN is responsible for supervising the other RN B.Supervision is not necessary because each RN is responsible and accountable for his or her own practice. C.RNs cannot delegate to other RNs, so supervision is not possible in this situation D.The charge nurse who made the assignment is responsible for supervising each of the RNs

D. The charge nurse who made the assignment is responsible for supervising each of the RNs Rationale: D is correct because the RN in a management position defined by the organization supervises RNs under his or her jurisdiction. A is incorrect because when one RN is working with another RN and neither RN is in a position to supervise the other, the RN in the management position (e.g., team leader, charge nurse, nurse manager) is responsible for supervising these RNs. B is incorrect because although each RN is responsible and accountable for his or her own practice, the RN charge nurse is in a position to supervise the RNs during the shift. C is incorrect because RNs in a supervisory position do provide supervision for other RNs.

Which of the following would have the highest priority when one is determining to whom to delegate a task? A.How many times the person has performed the task B.Whether the employee wants to perform the task C.The amount of time needed to complete the task D.The credentials of the person to whom the task is being delegated

D.The credentials of the person to whom the task is being delegated Rationale: D is correct because unless the task is within the scope of practice of the delegate, then experience, desire to perform the task, and ensuring adequate time and supervision are not considered. A is incorrect because although experience is important to establish competency, the delegatee must have the appropriate credentials and scope of practice to perform the skill. B is incorrect because this is not a criterion for delegation. C is incorrect because although the delegatee must have sufficient time to complete an assigned task, the priority is to determine whether the task to be delegated is within the scope of practice for the delegatee.

Collective bargaining is a method of: A.forcing nurses to pay dues to unions with no related benefit. B.guaranteeing that nurses will be treated with respect by physicians. C.ensuring that nurses will have adequate support from nursing assistants to perform all non-nursing duties. D.equalizing power between employees and employers that strengthens the employees' position to negotiate for wages and benefits.

D.equalizing power between employees and employers that strengthens the employees' position to negotiate for wages and benefits. Rationale: D is correct because collective bargaining allows for employees to band together and increase their negotiation power. Typical goals in collective bargaining activities are to establish formal agreements between employees and management for wages and health and retirement benefits. A is not correct because nurses as union members will have benefits related to their collective strength to negotiate with employers and resolve conflicts. B is not correct because the union cannot guarantee how individual physicians will treat individual nurses. C is not correct because a typical union contract would likely not include a provision that nurses will not have to perform any non-nursing duties.

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

a. Appeal to emotion An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.

According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Authoritative b. Closed systems c. Open systems d. Trait

a. Authoritative Autocratic/authoritative management style revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization.

An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent

a. Autocratic The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency.

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

a. RN The patient's condition is not stable; therefore, the skills of an RN are required.

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection

a. Referent Referent power comes from the followers' identification with the leader. Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her.

The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph? a. Time plot b. Pareto chart c. Flowchart d. Cause-and-effect diagram

a. Time plot A run plot, or time plot, graphs data in time order to identify any changes that occur over time.

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

a. Total patient care In total patient care nurses provide all aspects of patient care.

A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary

a. Transactional The transactional leader is concerned with the day-to-day operations of the facility.

In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance

a. Unfreeze Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change.

A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using: a. a patient classification system to determine safe staffing levels. b. diagnostic-related groups for Medicare billing. c. case management to coordinate care. d. clinical pathways to determine care.

a. a patient classification system to determine safe staffing levels. Patient classification systems group patients according to care needs to determine safe staffing levels.

Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a union authorization card. If signed, the card: a. authorizes the union to serve as his or her legal representative. b. indicates that the person is requesting additional information about collective bargaining. c. indicates the nurse desires to share information about grievances. d. gives permission for union dues to be deducted from pay.

a. authorizes the union to serve as his or her legal representative. A signature on a union authorization card indicates that the nurse gives the union the right to serve as legal representation.

A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse: a. can be represented by the union because charge nurses are not considered part of the management team. b. is part of the management team, so union participation would be a conflict of interest. c. can file a grievance that will be arbitrated automatically by the union. d. is ineligible for collective bargaining activities that deal with unfair labor practices.

a. can be represented by the union because charge nurses are not considered part of the management team.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of: a. direction and communication. b. task. c. person. d. circumstances.

a. direction and communication. The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back.

Physical therapists are represented by a union, nurses are represented by a separate union, and pharmacists have yet another union within a single agency. This type of union representation is known as: a. occupational unionism. b. industrial unionisms. c. union shop. d. power sharing.

a. occupational unionism. Occupational unionism indicates separate unions for each occupation in an agency.

A nurse gives Dilantin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "Everyone just pushes the medicine slowly. No one checks for compatibility. There isn't even a compatibility chart on the unit." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition

b. Appeal to common practice An appeal to common practice occurs when the argument is made that something is okay because most people do it.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance

b. Filtration Filtration is the unconscious exclusion of extraneous stimuli in communication.

A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the: a. Institute for Safe Medication Practices. b. Institute of Medicine. c. National Committee for Quality Assurance. d. The Joint Commission.

b. Institute of MedicineThe Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional

b. Primary The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present.

A nurse is interested in working in a large trauma center that is unionized but does not want to join the union or pay fees. She accepts the position but is not required to join or pay fees to the union based on which law? a. National Labor Relations Act b. Right-to-work law c. National Labor Relations Act d. Taft-Hartley Act

b. Right-to-work law The right-to-work law prohibits membership or payment of union dues or "fees" a condition of employment, either before or after hiring.

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d Electronic messaging

b. Spoken word Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.

A concern that nurses were being asked to perform tasks that went beyond the state's nurse practice act was brought to the union's attention. Nurses were informed that either mediation or binding arbitration will be used to resolve the issue. A novice nurse asks about the difference between these techniques and is informed that: a. mediation is sanctioned by the National Labor Relations Board (NLRB) to formally discuss concerns with management and labor. b. binding arbitration is a formal discussion between labor and management in which the arbitrator's recommendations are compulsory. c. mediation uses a trained person to negotiate a legally binding plan. d. binding arbitration requires both labor and management to participate in discussions on the least destructive approach to allow self-governance by employees.

b. binding arbitration is a formal discussion between labor and management in which the arbitrator's recommendations are compulsory. *Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator's recommendations.

The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a: a. nurse manager. b. case manager. c. coordinator of patient-centered care delivery. d. team leader in team nursing care delivery.

b. case manager. The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.

b. confusing cause and effect. Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together.

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is: a. Pareto chart. b. control chart. c. deployment chart. d. top-down flowchart.

b. control chart. The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process.

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is: a. total patient care. b. functional nursing. c. team nursing. d. primary nursing.

b. functional nursing. In functional nursing members of the team are assigned specific tasks such as assessment or medication administration.

The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions.

b. gather information. *The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem-solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation.

A group of RNs wish to seek union representation that would protect all workers in the agency including nonlicensed assistive personnel and non-nursing employees such as nutritionists and dietary workers. The type of union being sought is the strongest collective group and is known as a(n): a. occupational union. b. industrial union. c. union shop. d. right-to-work bargaining organization.

b. industrial union. An industrial unionism is a single union for all workers in the agency.

A nurse is responsible for determining the incidence rates of hospital-acquired diarrhea on a pediatric ward after receiving reports that five children admitted with uncontrolled asthma had developed diarrhea while hospitalized. The nurse is working in the role of: a. quality management. b. infection control. c. occupational health. d. forensics.

b. infection control.

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a: a. root cause. b. sentinel event. c. variation in performance. d. causal factor.

b. sentinel event. A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN's license be suspended. d. call the pharmacy and ask for replacement medications for the patients.

b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervene and identify concerns with the LPN/LVN.

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a: a. deployment flowchart. b. top-down flowchart. c. Pareto chart. d. control plot.

b. top-down flowchart. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. Risk of falling is great in later stages of Huntington's disease due to chorea movements.

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." When explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism, the instructor states: a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process.

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.

c. Continual supervision is being provided until the RN determines competency. This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence.

A nurse tallies the patient satisfaction surveys and approves the use of an agency nurse because of the high census. This nurse is involved in which nursing role? a. Change agent b. Educator c. Manager d. Coordinator

c. Manager The manager is the one who assesses the need for staffing and must justify this in a substantial way. Through this approach, the manager indirectly provides care for patients and families.

A group of nurses interested in unionizing decides to contact the largest union in the United States representing registered nurses, which is the: a. American Nurses Association. b. United American Nurses. c. National Nurses United. d. National Labor Relations Board.

c. National Nurses United. In 2009, the National Nurses United became the largest union representing nurses RNs as a result of a merger between the United American Nurses, California Nurses Association, National Nurses Organizing Committee, and Massachusetts Nurses Association.

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a: a. cause-and-effect diagram. b. run chart. c. Pareto chart. d. flowchart.

c. Pareto chart. Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized.

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

c. Tell me what day of the week today is. The patient must be able to name the day of the week rather than use answer yes or no.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance.

c. blocking. Blocking occurs when the nurse responds with noncommittal or generalized answers.

The RN who identifies the best resources at the lowest cost to achieve optimal health outcomes for the client is fulfilling the role of: a. informatics specialist. b. educator. c. case manager. d. quality manager.

c. case manager. The role of the case manager includes coordination of resources to achieve the best outcomes based on quality, access, and cost.

Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair wages and ensure client safety. To form a core support group of nurses, the union organizer can conduct meetings to gather initial information: a. away from the worksite with a group of managers to learn both sides of the situation. b. at the worksite with staff nurses who are respected leaders. c. in homes or local businesses with staff nurses. d. after photographing management meeting to discuss their strategies to decrease interest in unionization.

c. in homes or local businesses with staff nurses. The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances.

A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike.

c. is participating in a sympathy strike, which, if done correctly, is legal. A sympathy strike occurs when a union stops work to support the strike of another union.

One difference between a leader and a manager is that a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization.

c. manager focuses on coordinating resources. The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.

Nurses in a unionized hospital are paid "compensatory pay" when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance.

c. mediation. Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding.

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin's change is: a. unfreeze. b. moving. c. refreeze. d. resistance.

c. refreeze. In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation.

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy. b. positiveness. c. supportiveness. d. accommodation.

c. supportiveness. Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position.

A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance

d. Circumstance Right circumstance involves the delegation of tasks that do not require independent nursing judgments.

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling

d. Controlling Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality.

A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

d. Give spur-of-the-moment recognition to an employee who has accomplished a goal. To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.

A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate

d. Legitimate The coordinator of the committee has an official position within the organizational committee.

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system. Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a: a. Pareto chart. b. control chart. c. top-down flowchart. d. deployment chart.

d. deployment chart. A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety.

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is: a. team. b. primary. c. partnership. d. modular.

d. modular. Modular (or geographic) assignments are based on a geographic location in the nursing unit.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. UAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies.

d. the nurse practice act and state regulations related to delegation override the organization's policies. The state's nurse practice act is the deciding factor regarding what can legally be delegated.

A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: a. the RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. since the LPN is licensed, they practice professional nursing. d. to determine what tasks can be safely delegated, the RN must first assess the patient.

d. to determine what tasks can be safely delegated, the RN must first assess the patient. The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical.