PROF FINAL SATA

CHAP 20 A hospital is experiencing a high nursing turnover rate. One manager suggests offering sign-on bonuses to fill positions. Why would the nurse executive veto this suggestion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Sign-on bonuses only attract newly licensed nurses. 2. The bonus schedule adversely impacts the current salary schedule. 3. Current nurses can be discouraged by this program. 4. Sign-on bonuses do not recognize achievement and loyalty. 5. Sign-on bonuses do not attract enough nurses to make it worth the time to set them up and advertise them.

Correct Answer: 3,4 Rationale 1: Sign-on bonuses are attractive to many nurses, both newly licensed and experienced. Rationale 2: Sign-on bonuses do not affect the current salary schedule. Rationale 3: Nurses currently working at the facility can be discouraged when newly hired nurses are given big amounts of money just for taking the job. Rationale 4: Sign-on bonuses are awarded just for taking the job. They do not recognize such attributes as experience, achievement, and loyalty. Rationale 5: Sign-on bonuses can attract a significant number of applicants and are a quick fix for shortages.

CHAP 10 Which situations are examples of the nurse directing rather than delegating? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse manager asks a staff nurse to participate in a standing hospital committee. 2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an IV. 4. A nurse tells an assistant to move a client into the hallway during severe weather. 5. A nurse reminds assistants of standard protocol for evacuation in case of fire.

Rationale 1: This is delegation. Rationale 2: This situation is a crisis, so this is direction. Rationale 3: This is a crisis situation, so this is direction. Rationale 4: This is a crisis situation, so this is direction. Rationale 5: Because this crisis is not occurring, this is delegation.

CHAP 25 A nurse who has just returned from two weeks of time off following minor surgery says, "I'm so glad to be back to work. I'm sick of watching television. I can't believe I missed the stress here." What are possible explanations for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Lack of stress can cause boredom. 2. Stress can be motivational. 3. Apathy can occur if stress is absent. 4. Eustress occurs when stress is decreased too much. 5. A balance between stress and coping is essential.

Correct Answer: 1,2,3,5 Rationale 1: A certain amount of stress is stimulating. Without stress boredom can occur. Rationale 2: A moderate amount of stress can motivate a person to perform. Rationale 3: A person who is accustomed to stress may become apathetic if stress is removed. Rationale 4: Eustress is positive stress. Rationale 5: If there is not enough stress, the person feels "out of balance."

CHAP 23 A highly intoxicated client is brought to the emergency department. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 3. Ask the paramedics to place the client in leather restraints. 4. Enter the room calmly, with a smile. 5. Give the client 20 minutes or so to calm down before the assessment begins.

Correct Answer: 1,2,4 Rationale 1: The nurse should remove any potential weapons. Rationale 2: A stethoscope hung around the neck is a convenient "handle" for anyone who would like to gain control of the nurse. Rationale 3: The nurse should not ask the paramedics to perform this intervention. Rationale 4: Being calm and pleasant can help defuse potentially violent situations. Rationale 5: The nurse should not wait 20 minutes to see a client who is highly intoxicated.

CHAP 19 The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "What is causing you to be late?" 2. "When you are late it throws the pace of the entire unit off and client care suffers." 3. "Does it not bother you that your lateness makes everyone else's job more difficult?" 4. "You have been late three times this week and that is not acceptable." 5. "What are you going to do to avoid being tardy again?"

Correct Answer: 1,2,4,5 Rationale 1: The manager should investigate why the nurse is being tardy. Rationale 2: The impact on client care is always the most important aspect of meeting job expectations. Rationale 3: Accusing the nurse of not caring about others in the workplace is not appropriate at this point. Rationale 4: The employee must first know that the tardy behavior is unacceptable. Rationale 5: The manager should develop a plan for behavior change that the nurse can agree to.

CHAP 17 Which job behaviors would the nurse executive consider troublesome no matter which unit employed the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse made two medication errors today that resulted in poor client outcomes. 2. A nurse was tardy twice last month due to car trouble. 3. A manager reports that a nurse used a piece of equipment that had been taken out of service for malfunction. 4. A nurse did not report to work for 2 days and did not call in the absence. 5. A physician calls to complain that a nurse was rude.

Correct Answer: 1,3,4 Rationale 1: Medication errors are serious no matter where they occur. Rationale 2: This might or might not be a problem, depending on the unit. Rationale 3: Using malfunctioning equipment is a serious problem, no matter where it occurs. Rationale 4: Not calling to report intended absence is a serious problem. Rationale 5: This might or might not be a problem, depending on the situation

CHAP 16 A nurse has agreed to work on the Baylor plan. The nurse should arrange day care for which shifts? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A 12-hour shift on Saturday 2. An 8-hour shift on Monday 3. An 8-hour shift on Sunday 4. A Thursday shift once a month 5. Shifts every weekend

Correct Answer: 1,5 Rationale 1: 12-hour weekend shifts are part of the Baylor plan. Rationale 2: Weekday shifts are not included in the Baylor plan. Rationale 3: In the Baylor plan weekend shifts are 12 hours. Rationale 4: Weekday shifts are not included in the Baylor plan. Rationale 5: Under the Baylor plan the nurse works 12-hour shifts every weekend and is paid for a standard work week.

CHAP 22 A hospital on the Gulf Coast of the United States would list which situations among its top vulnerabilities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Flooding 2. Hurricane 3. Earthquake 4. Tornado 5. Industrial accident

Correct Answer: 1,2,4,5 Rationale 1: Flooding would be a big concern for a hospital on the gulf coast. Rationale 2: Hurricane would be a big concern for a hospital on the gulf coast. Rationale 3: Earthquakes may occur on any fault line, but this is not a primary concern on the gulf coast. Rationale 4: Tornadoes often accompany hurricanes and would be a big concern on the gulf coast. Rationale 5: Industrial accidents would be of concern related to the large oil production capacity of the gulf waters.

CHAP 17 A unit secretary is chronically late returning from breaks. The rest of the secretary's work is excellent and he is always helpful and supportive of nurses and client families. The nurse manager has discussed the lateness with him, but it has not stopped. Thinking this might be an attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Offer the secretary a free lunch if he can go 1 week without being late. 2. Ignore the behavior. 3. Place a large alarm clock in the break room and set it each time the secretary takes a break. 4. Plan to be away from the secretary's area during his break times. 5. Tell the secretary that one more late return will result in a written critical incident report.

Correct Answer: 2,4 Rationale 1: This is a reward, not extinction. Rationale 2: Extinction occurs when the stimulus to continue the behavior is removed. In this case, the secretary will no longer get the manager's attention. Rationale 3: This is a not the way an adult should be disciplined. Rationale 4: If the manager is not there to see the lateness and "reward" the employee with attention, perhaps the behavior will stop. Rationale 5: If the manager is correct and this is an attention-seeking behavior, a written critical incident is reinforcing the behavior.

CHAP 7 Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Reward power 2. Information power 3. Legitimate power 4. Expert power 5. Referent power

Correct Answer: 2,4,5 Rationale 1: A leader may not have reward power unless the leader is also the manager. Leaders can be formal or informal. Rationale 2: A leader may have information power. Rationale 3: A leader may not have legitimate power unless the leader is also the manager. Leaders can be formal or informal. Rationale 4: A leader may have expert power. Rationale 5: A leader may have referent power.

CHAP 6 A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The cost of providing care has decreased. 2. There has been a decrease in client deaths. 3. The average length-of-stay for clients has increased. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.

Correct Answer: 2,4,5 Rationale 1: Increasing RN-to-client ratio generally increases costs. Rationale 2: Increasing RN-to-client ratio has been shown to decrease client mortality. Rationale 3: Increasing RN-to-client ratio generally decreases length of stay. Rationale 4: Increasing RN-to-client ratio generally increases quality of care. Rationale 5: Increasing RN-to-client ratio generally results in few infections.

CHAP 19 A nurse has complained to the human resources (HR) director regarding unfair treatment by the nurse's manager. The nurse describes receiving a written warning, unlike other nursing staff who exhibit similar behaviors but are not reprimanded. Which concerns would the HR director discuss with the hospital chief nursing officer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The unusual management styles within the department 2. Confronting the manager's direct supervisor about allowing this situation to occur 3. The apparent inconsistencies in discipline within the unit 4. The potential for litigation that arises from this complaint 5. The need to terminate this problem employee

Correct Answer: 3,4 Rationale 1: This is not just an unusual management style. Rationale 2: The manager's direct supervisor may be unaware that the incident happened. The supervisor should be apprised of the complaint, but not confronted with an accusation of allowing the behavior. Rationale 3: There is apparently an inconsistency in discipline that should be investigated. Rationale 4: If this situation goes to court, the hospital could be found liable for the actions of the manager. Rationale 5: The HR director should not categorize this employee as a problem until a full investigation of the situation has been conducted.

CHAP 20 The nurse manager charged with hiring staff for a new nursing unit explains the unit's rigid structure and scheduling policies to all potential applicants. The manager is most likely to lose the interest of applicants of which generations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Traditionals 2. Baby boomers 3. Generation X 4. Generation Y 5. Nurses in general do not like structure and rigidity in scheduling.

Correct Answer: 3,4 Rationale 1: Traditionals in general like structure and are more likely to work well with inflexible schedules. Rationale 2: Baby boomers in general do fairly well with structure and rigid scheduling. Rationale 3: Generations X in general does not like structure and is interested in flexible scheduling. Rationale 4: Generation Y in general does not like structure and is interested in flexible scheduling. Rationale 5: Some nurses thrive in an environment with lots of structure and a predictable, somewhat rigid schedule.

CHAP 21 A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I know. It's a shame that all the old ways are changing." 2. "Why would you want to bully a new nurse? They are all so naïve and cute." 3. "The Joint Commission does not tolerate disruptive or abusive behavior." 4. "The American Nurses Association does not approve of bullying behaviors." 5. "New nurses bring new ideas. Why would you bully them?"

Correct Answer: 3,4,5 Rationale 1: Agreeing with the nurse only serves to reinforce the behavior. Rationale 2: A statement about the new nurse being naïve and cute is a bullying behavior. Rationale 3: The Joint Commission recommends a zero tolerance policy regarding disruptive or abusive behavior. Rationale 4: The ANA recommends several strategies to combat these behaviors. Rationale 5: New ideas are brought by new nurses. Bullying of any segment of the profession is wrong.

CHAP 1 The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I don't see why everyone can't just get along." 2. "Generation X nurses are just lazy." 3. "Our Generation Y nurses help keep us all up on new technology." 4. "The most loyal of all my nurses are the traditionalists." 5. "I expect that our next manager will come from my group of baby boomers."

Correct Answer: 3,4,5 Rationale 1: The four generations have different values, work ethics, and skills. Conflict is inevitable. Rationale 2: The manager should not stereotype the members of a generation. Rationale 3: Generation Y is technically savvy. Rationale 4: Traditionalists are typically loyal and respectful of authority. Rationale 5: Baby boomers typically value professional and personal growth.

CHAP 21 A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Tell the nurse to go home for the rest of the day. 2. Have the nurse call the physician back and demand an apology. 3. Document the facts of the encounter. 4. Privately tell the physician that the behavior was bullying. 5. Confront the physician during rounds and demand an explanation.

Correct Answer: 3,4,5 Rationale 1: There is no reason for the nurse to go home. Rationale 2: The manager should not anger both parties more by creating another immediate encounter. Rationale 3: The facts of the encounter must be documented. Rationale 4: The manager should name the behavior. Rationale 5: The manager should speak to the physician in a civil manner.

CHAP 9 The nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

Correct Answer: 3,4,5 Rationale 1: Thinking ahead in conversation interferes with the ability to listen and comprehend. Rationale 2: Eye contact does not mean the nurse is listening. Rationale 3: When many people are talking at one time, it is difficult to listen and comprehend. Rationale 4: Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. Rationale 5: Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

CHAP 17 A nurse executive is trying to convince the hospital management team that a clinical ladder system would work well in nursing. Which points should the nurse include in this argument? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Clinical ladders keep very good nurses at the bedside. 2. These programs prove to be worth their cost. 3. These programs reveal substandard nurses quickly so they can be terminated. 4. Similar programs have been shown to improve nurse job satisfaction. 5. Quality of client care increases with these programs.

Correct Answer: 1,2,4,5 Rationale 1: Nurses with excellent clinical skills are promoted, but not into management. They stay at the bedside. Rationale 2: Evaluation of established programs has shown substantial positive fiscal impact. Rationale 3: Terminating nurses is not the focus of the clinical ladder program. Rationale 4: Improvement of job satisfaction has been shown to be a result of clinical ladder programs. Rationale 5: The programs have been shown to increase quality of client care.

CHAP 24 A nurse is interested in the possibility of collective bargaining in the workplace. What will the nurse find when researching this possibility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most nurses do not work under collective bargaining agreements. 2. As the nurse is a manager, collective bargaining would be of no interest. 3. The National Labor Relations Board (NLRB) has addressed collective bargaining in nursing. 4. The nurse works in a state hospital, where collective bargaining is not possible. 5. The cost of the dues or "fees" associated with collective bargaining is more than could be gained from joining.

Correct Answer: 1,3 Rationale 1: This is a true statement. Rationale 2: The nurse manager may not be included in the collective bargaining agreement but certainly would have an interest in the process. Rationale 3: The NLRB has addressed many issues that directly impact collective bargaining and nursing. Rationale 4: Whether or not collective bargaining is used depends on the state in which the nurse works. Rationale 5: The fee schedule is set by the union, and the value of unions differs.

CHAP 8 A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the unit comanager when making a decision.

Correct Answer: 1,4 Rationale 1: A history of ineffective trial and error solutions to problems tends to make the manager rigid. Rationale 2: Generally, fear of risk taking is characteristic of a rigid management style. Rationale 3: Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. Rationale 4: Using old ways of thinking to solve new problems is characteristic of rigid management. Rationale 5: Rigid managers typically prefer to make decisions independently.

CHAP 14 A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is a higher turnover rate of nursing staff on the medical unit. 2. Costs were incurred during a recent remodeling of the medical unit. 3. The client acuity on the critical care unit is higher. 4. The critical care manager is a better manager than the medical unit manager. 5. More staff on the medical unit received premium pay this year.

Correct Answer: 1,4,5 Rationale 1: A higher turnover rate will increase personnel costs because of the need for more personnel to train new employees. Rationale 2: The costs of remodeling are not included in the personnel budget. Rationale 3: Increased client acuity generally makes personnel costs rise. Rationale 4: Better management tends to mean a more stable staff, which decreases expenditures. Rationale 5: Premium pay increases personnel costs.

CHAP 21 What characteristics would cause the manager to classify an employee as marginal? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The employee works only when client census calls for additional staff. 2. The employee's work does not improve with coaching. 3. The employee just made an error for which discipline has already been done twice. 4. The employee has worked at the facility for less than 1 month. 5. The employee does not mix well with the other staff, but stays on the margins of the group.

Correct Answer: 2,3 Rationale 1: An employee who works only on a prn basis is not necessarily a marginal employee. Rationale 2: A marginal employee does not take instruction well. Rationale 3: An employee whose work does not improve after discipline is a marginal employee. Rationale 4: Length of employment has little to do with being classified as marginal. Rationale 5: Marginal does not mean staying at the margins of the social group.

CHAP 17 During strategic planning, the committee finds a need to develop a succession plan for the facility. What committee findings would draw attention to this need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. More nurses are electing to move into management positions. 2. Many of the facility's senior nursing managers indicate they will likely retire within 5 years. 3. The nursing shortage in the area continues to worsen. 4. Salaries continue to rise, making profitability low. 5. Many of the nurses moved into leadership positions fail.

Correct Answer: 2,3 Rationale 1: The issue with succession is not having enough nurses in place to effectively fill management positions. Rationale 2: In general, nursing is experiencing retirement of many experienced and excellent nurses, both from the bedside and from management. Rationale 3: As the nursing shortage worsens or continues, fewer nurses will be available to fill management openings. Rationale 4: Succession planning is not focused on salary or profitability. Rationale 5: Succession planning is not focused on why some nurses who are moved to leadership positions fail.

CHAP 12 A serious conflict between a nurse and a nursing assistant erupted into a shouting match in the hallway. The nurse attempted to slap the nursing assistant. What conflict responses are appropriate for the assistant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Accommodating 2. Withdrawal 3. Avoiding 4. Smoothing 5. Negotiation

Correct Answer: 2,3 Rationale 1: When the conflict becomes violent, accommodation is no longer appropriate. Rationale 2: When safety is at risk, withdrawal is a valid response. Rationale 3: When safety is at risk, avoiding is a valid response. Rationale 4: When the conflict becomes violent, smoothing is no longer appropriate. Rationale 5: When tempers are high and the situation is dangerous, negotiation is not possible.

CHAP 22 Health care providers are preparing for a worldwide outbreak of H1N1 influenza. How would this outbreak be classified in planning literature? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A man-made disaster 2. As a pandemic 3. As a health disaster 4. As a natural disaster 5. As an epidemic

Correct Answer: 2,3,4 Rationale 1: H1N1 occurs naturally and is therefore a natural disaster. Rationale 2: If H1N1 spreads around the world, it is a pandemic. Rationale 3: H1N1 that spreads around the world would be a health disaster. Rationale 4: H1N1 is naturally occurring and is therefore a natural disaster. Rationale 5: If the illness spreads around the world, it is considered a pandemic.

CHAP 22 Why is postdisaster follow-up an essential part of disaster planning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. To assure staff members of their personal safety 2. To evaluate the performance of those involved 3. To initiate any improvements needed 4. To evaluate the overall effectiveness of the plan 5. To complete critical incident forms

Correct Answer: 2,3,4 Rationale 1: This is not the reason for the follow-up. Rationale 2: Evaluating the performance of those involved helps to identify areas of need. Rationale 3: Follow-up helps to identify areas where improvement is needed. Rationale 4: The plan itself should be evaluated for effectiveness. Rationale 5: This is not an appropriate use of critical incident forms.

CHAP 2 The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Experts in hospital physical design 2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices

Correct Answer: 2,3,4,5 Rationale 1: Experts in hospital physical design are considered a resource rather than stakeholders. Rationale 2: Employees of the hospital are considered stakeholders. Rationale 3: Physicians are considered stakeholders. Rationale 4: Administrators are considered stakeholders. Rationale 5: Community representatives are considered stakeholders.

CHAP 10 The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I'll be glad to work on this task." 2. "I will need some education on the accreditation process before I can accept this task." 3. "I don't have time to add that to my work." 4. "Please tell me more about what this assignment entails." 5. "I'm not interested in working on this project."

Correct Answer: 2,4 Rationale 1: The manager should not accept a task until it is clear. Rationale 2: The manager should be clear about not having the required skill set, but should indicate willingness to take the job if education is provided. Rationale 3: The problem is that the manager is not confident of his or her skills, not that time is not available. Rationale 4: The manager should clarify the task before accepting or refusing it. Rationale 5: Working on accreditation would help this nurse manager in career advancement.

CHAP 23 The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. When addressing the client, use powerful body language. 2. Remain calm and speak in a moderate tone. 3. Approach the client with an aggressive "I'm in charge" attitude. 4. Speak in simple terms. 5. Allow the client to speak.

Correct Answer: 2,4,5 Rationale 1: Powerful body language may be interpreted as threatening. Rationale 2: A calm manner and moderate tone are calming to the client. Rationale 3: Aggression or aggressive attitudes can escalate this client's hostility. Rationale 4: The nurse should use simple terms when talking to this client. Rationale 5: The client should be allowed to speak, and the nurse should respectfully listen.

CHAP 15 Which information is an example of what should be included in the position description for the RNs who will staff a newly opened hospital unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Base salary is $22.00 per hour with a 10 percent shift differential for hours worked after 7:00 p.m. 2. Communicates changes in client condition to appropriate staff 3. Will accrue sick time at a rate of 4 hours per month 4. Reports directly to the nurse manager of the unit 5. Must maintain ACLS certification

Correct Answer: 2,4,5 Rationale 1: Salary is not included in this document. Rationale 2: Tasks required to carry out the duties involved in the position are included. Rationale 3: Benefit package is not a part of the position description. Rationale 4: The position description should indicate the person to whom the employee will report. Rationale 5: Professional qualifications for the position are included in this statement

CHAP 1 To be effective in today's health care system, the nurse manager must be aware of which trends? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. An environment that does not change 2. Decreasing resources 3. Adequate staffing 4. Increasing numbers of retirees 5. Complicated technology

Correct Answer: 2,4,5 Rationale 1: The only trend that is consistent is the rapidly changing system. Rationale 2: Nurse managers must be aware of the responsibility of doing more with fewer resources. Rationale 3: Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care. Rationale 4: Increasing numbers of retirees, both from nursing and as an aging population, have placed strain on the health care system. Rationale 5: Complicated technology forces the nurse manager to keep up with the ever-present changes within the health care system.

CHAP 13 Which activities are similar enough that they could be grouped to better manage time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Restocking the medication cart 2. Discussing a diet request with a new client 3. Calling for extra linen from laundry 4. Search the Internet for an unfamiliar client diagnosis 5. E-mailing a colleague a question about the schedule

Correct Answer: 4,5 Rationale 1: Restocking the medication cart takes attention to detail. This task should not be combined with other tasks. Rationale 2: The nurse should pay full attention to the client and not combine this with other activities. Rationale 3: Calling for extra linen is unlike any other task in this list and would not make a suitable fit for task combination. Rationale 4: While the nurse is logged into the computer, searching for a client diagnosis on the Internet would combine well with e-mailing a colleague. Rationale 5: The nurse could easily e-mail a colleague and search for information about a client diagnosis while logged into the computer in one session

CHAP 14 An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Were any unexpected bonuses awarded? 2. Did agency personnel hours exceed the number predicted in the budget? 3. Were new employees hired at lower wages? 4. Did the number of client days exceed the predicted budgeted amount? 5. Were fewer nursing hours worked than were predicted?

Correct Answer: 1,2 Rationale 1: An expected bonus that was not budgeted could result in an unfavorable rate variance. Rationale 2: Agency personnel hours are higher than hospital employee hours. If the number of hours exceeded the budgeted amount, an unfavorable rate variance would occur. Rationale 3: If new employees are hired at work hours at a lower rate than that of other employees, a favorable rate variance would occur. Rationale 4: Client day variations result in volume variances, not rate variances. Rationale 5: Fewer nursing hours worked would result in an efficiency variance, not a rate variance.

CHAP 16 A health care facility has adopted automated scheduling across all client care areas. When presenting this decision to nursing staff, the nurse executive should include which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "This system will allow nurses to spend more time with those clients who need us the most." 2. "We expect that using this system will help us improve client outcomes." 3. "There will be little financial gain to the institution, but we are committed to improving our scheduling." 4. "Using this Baylor plan will help us improve client outcomes." 5. "This system will allow nurses to choose shifts and clients."

Correct Answer: 1,2 Rationale 1: Automated systems match nursing time to client need more effectively. This allows the nursing care to match the amount of care needed. Rationale 2: Automated scheduling systems do improve client outcomes. Rationale 3: Automated scheduling often results in improved financial outcomes. Rationale 4: The Baylor plan is not an automated scheduling system. Rationale 5: The automated system does not allow nurses to choose shifts or clients.

CHAP 23 Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, "I'm sorry you are upset. What can I do for you?" The visitor continues to complain more loudly. What should the other nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Quietly direct other people out of the room. 2. Leave the room and call security. 3. Say, "Who are you?" 4. Move toward the visitor and say, "Keep your voice down." 5. Stay next to the other nurse.

Correct Answer: 1,2 Rationale 1: Isolating a person who is angry and aggressive helps by taking away part of the audience. This is also a strategy to protect others. Rationale 2: It may be that the visitor is just upset and will calm down quickly with the other nurse's verbal intervention, but that is not assured. Rationale 3: This question may further infuriate the visitor because the nurses don't know him or his mother. Also, one nurse should carry the conversation. Rationale 4: The nurse should not make a move toward the visitor or demean him. Rationale 5: The nurse should move away and out of the room to call security.

CHAP 17 A nurse manager is investigating the application of the principles of equity theory to rewarding staff. Which options are rewards that the manager could influence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Job satisfaction 2. Prestige 3. Pay 4. Ability 5. Effort

Correct Answer: 1,2 Rationale 1: Job satisfaction is a reward that the manager could influence. Rationale 2: The prestige associated with a job is a reward the manager could influence. Rationale 3: Pay is a reward the manager could influence. Rationale 4: Ability is typically seen as a contribution to the job by the employee. Rationale 5: Effort is a job contribution by the employee

CHAP 19 A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client's cardiac rhythm after the medication was administered, the surgical nurse states, "I don't know." What actions should be taken by the unit's nurse manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Meet with the ICU nurse to discuss the situation. 2. Meet with the surgical nurse to discuss the situation. 3. Give a written warning to the surgical nurse for not following policy. 4. Give a written warning to the ICU nurse for not following policy. 5. Meet with the nurses together and issue an informal verbal warning to both.

Correct Answer: 1,2 Rationale 1: The manager should meet with the ICU nurse to determine if policy was followed in delegating medication administration. Rationale 2: The manager should meet with the surgical nurse to determine if the nurse was aware of the policy requiring monitoring the cardiac rhythm. Rationale 3: Until the manager meets with this nurse, it is unclear if a warning is indicated. Rationale 4: Until the manager meets with this nurse, it is unclear if a warning is indicated. Rationale 5: Until the manager has more facts, it is unclear whether a warning is necessary and, if so, what kind of warning is required.

CHAP 24 A nurse has been hired as a new nurse manager at a hospital that has union representation. Which union-related activities should this manager expect will be included in the role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Actively helping to administer any grievance procedures 2. Participating in issues related to disciplining employees 3. Encouraging union membership 4. Being certain that all disputes within management are public 5. Avoiding collective bargaining

Correct Answer: 1,2 Rationale 1: The nurse manager should help to administer grievance procedures and should participate in issues about disciplining employees. Rationale 2: The nurse manager should help to administer grievance procedures and should participate in issues about disciplining employees. Rationale 3: The nurse manager should not encourage or discourage union membership. Rationale 4: Disputes within management should be confidential. Rationale 5: The nurse manager must participate in the activities of collective bargaining.

CHAP 26 A nurse knows that both experiences and a plan are important when building a résumé. Which attributes are the most important for the plan part of this endeavor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Flexibility 2. Long term 3. Focused on one career path 4. Includes frequent contact with the nurse's current mentor through the years 5. Designed around a fixed retirement date

Correct Answer: 1,2 Rationale 1: The nurse's plan must be flexible to account for the rapidity of change in today's health care environment. Rationale 2: The plan developed as a young nurse should be long term. The desires of the far distant future must be planned for today. Rationale 3: The nurse should be open-minded about the career path but should point the path toward the eventual goal. For example, the nurse may wish to be the nurse executive of the hospital but may eventually end up a nurse executive in a health care conglomerate. Rationale 4: Mentors often come and go through a nurse's career. The current mentor may change to a different one as years go by. Rationale 5: The nurse may find that early retirement is possible and desirable, or may choose to work long past the date considered when younger.

CHAP 25 The supervisor of critical care services tells the unit manager, "We must cut costs, so I am asking you to arrange your day so that you provide care to two or three clients and cover for lunch and rest breaks. Also don't forget that your budget estimates are due next week, as are your preliminary schedules for the winter holidays." Two days later, the nurse manager is stressed and exhausted. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Think through the roles being required. 2. Confront the supervisor and ask for clarification of status. 3. Try to improve work organization. 4. Tell the supervisor, "I can't work this hard, Get someone else to be manager." 5. Call in sick for a day to rest.

Correct Answer: 1,2 Rationale 1: There is role conflict present. Is this nurse to provide care or complete managerial tasks? Rationale 2: The supervisor must be confronted and must understand that the two roles being asked of this nurse are in conflict. Rationale 3: Often nurses who are overloaded believe they can continue to carry the current load "if only I could get more organized." Rationale 4: The real problem here is conflicting role expectations, not the nurse's inability to work hard. Rationale 5: Calling in sick is not going to change the expectations when the manager returns to work.

CHAP 20 The management staff is investigating ways to decrease absenteeism that will also help to promote greater job satisfaction over the long term. Which suggestions should they consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We could convert a specified number of unused sick days to vacation days." 2. "Is there a way we could convert unused sick time to retirement credit?" 3. "I think we should stop putting a limit on how many sick days an employee can accumulate." 4. "We should think up some penalty for using more than a given number of sick days in a year." 5. "I think we should stay with our policy of taking away holiday time if the employee uses a sick day in the same week."

Correct Answer: 1,2,3 Rationale 1: Conversion of unused sick days to vacation days eliminates the feeling that employees are going to "lose sick days," which they consider a benefit. Rationale 2: Converting unused sick time to retirement credit helps to eliminate the feeling that employees are going to "lose sick days," which they consider a benefit. Rationale 3: When there is a limit on how many sick days can be accumulated, the employee may feel that a benefit has been taken away and may take unneeded sick days to prevent losing that benefit. Rationale 4: Penalties may work to discourage the use of sick time, but will not promote job satisfaction. Rationale 5: A policy of taking away holiday time based on a sick day being taken is punitive to good employees. It may also encourage an employee to come to work when sick. It is not a good way to promote job satisfaction

CHAP 13 A nurse manager has felt overwhelmed by work the last few months. After putting in many hours of unpaid overtime, the workload is beginning to stabilize. The nursing supervisor asks the manager to take on a new task that is exciting and stimulating. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Consider how much work will be added to the current workload. 2. Tell the supervisor no. 3. Talk with the supervisor about decreasing another work responsibility if this project is accepted. 4. Accept the assignment and plan to continue to work very hard until it is completed. 5. Accept the assignment, but only if additional salary is offered.

Correct Answer: 1,2,3 Rationale 1: The manager must be realistic about how much work can be done. Rationale 2: If the project is too much for the manager to take on, the manager should say no. The manager must be aware of the consequences of declining the assignment. Rationale 3: If the manager would like to take on the new project, it may be necessary to decrease another job responsibility. The manager should discuss this possibility with the supervisor. Rationale 4: The manager should be aware of the consequences of overloading one's self. Accepting the assignment and continuing the current work pace may be dangerous to the manager and to others. Rationale 5: Additional salary does not make additional time. If the nurse does not have sufficient time to commit to the project, additional salary will not be helpful.

CHAP 19 The manager is contemplating terminating a nurse. What should the manager consider regarding the expectations of the job prior to proceeding with termination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Did the nurse receive and sign for a copy of the appropriate job description when hired? 2. Was the nurse apprised of the criteria on which evaluation would be based? 3. Have any changes to policy and procedure been discussed with the nurse and made available in writing? 4. Was the nurse hired using the same documentation as others hired at the same time? 5. Have others hired during the same time period been successful?

Correct Answer: 1,2,3 Rationale 1: The manager must have documentation that the nurse knew the expectations of the job. Documentation that the nurse received the job description is required. Rationale 2: The nurse must be told in advance of the criteria on which evaluation will be based. Rationale 3: Changes to policy and procedures change practice. These changes must be made known to the staff. Rationale 4: Just because the documentation is commonly used doesn't make it legal or correct. Rationale 5: While the success of others hired at the same time is interesting, it is not essential knowledge for the manager.

CHAP 22 A hospital administrator receives a call that mass casualty shootings have occurred at several different locations within the city. Early information indicates that up to 50 victims may be arriving at the hospital starting within minutes. What action should the administrator take? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Mobilize the hospital incident command system. 2. Notify other administrators and order a rapid needs assessment in all critical areas. 3. Authorize the implementation of the hospital's disaster plan. 4. Call the emergency department and ask the charge nurse if the department has received any clients. 5. Conduct a risk assessment to see if the hospital is vulnerable to attack.

Correct Answer: 1,2,3 Rationale 1: This is a disaster situation and incident command is essential. Rationale 2: A rapid needs assessment is essential so that quick action can be taken to fill as many of those needs as possible. Rationale 3: The administrator must be proactive in initiating the disaster plan. Rationale 4: If this is a real disaster, it is unlikely that the charge nurse has time to come to the phone. Rationale 5: This risk assessment should have already been done.

CHAP 22 A hospital's disaster management team is reviewing the disaster plan after reading about a hospital that was destroyed by a tornado's direct hit. What questions should team members ask themselves? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "What are our current capabilities for evacuation?" 2. "Do we have sufficient resources in any other areas to continue operations if this happens to us?" 3. "Are there physical training needs that we have not filled?" 4. "What education should we provide to the staff and community?" 5. "Would we eventually rebuild if the hospital was destroyed?"

Correct Answer: 1,2,3,4 Rationale 1: Evacuation of clients, visitors, and staff should be of primary interest to this team. Rationale 2: The team should consider its resources. What would happen if the hospital campus was damaged? Where are other resources available? Rationale 3: Training for a disaster is essential. Rationale 4: Education about disasters and training for a disaster are two different topics. Training involves physical skills as well as learning. Rationale 5: This is a valid question, but is outside the scope of a disaster plan.

CHAP 22 An emergency department has been notified that hundreds of injuries have occurred following the collapse of bleachers at a football game. The emergency department nurses should prepare to make which types of assessments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Physical 2. Self 3. Situational 4. Family 5. Community

Correct Answer: 1,2,3,4 Rationale 1: Physical assessment skills will be necessary as victim's injuries are assessed. Rationale 2: The nurse must be able to conduct a self-assessment of abilities to manage a victim and of personal reaction to the disaster. Rationale 3: The nurse must be making situational assessments at all times during the disaster to ensure a flow of clients, equipment, personnel, and information. The nurse must also assess the safety of the situation. Rationale 4: Victim families are also involved in the disaster. The nurse must assess the families' coping abilities. Rationale 5: The nurse will not be involved in community assessment at the time of the disaster, but may be called on for this skill in the days and weeks to follow.

CHAP 23 As part of a presentation on health care workplace violence, the speaker says, "Injuries to nurses from violent acts in the workplace are probably underreported." What rationale should the speaker offer for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. 5. Most violence against nurses is initiated by physicians, and nurses are afraid to report them.

Correct Answer: 1,2,3,4 Rationale 1: The definition of workplace violence may not be clear. Rationale 2: Reporting policies may not be in place. Rationale 3: For many years, violence was tolerated in health care. Rationale 4: Some believe that being the target of a violent act is the result of poor job performance. Rationale 5: Most violence against nurses is from clients.

CHAP 14 The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The average daily census for the facility over the last year 2. Current community wage ranges for employee classifications 3. Changes in accrediting body or legislative regulations 4. Number of nurses terminated for cause over the last year 5. Current staff mix across the hospital

Correct Answer: 1,2,3,5 Rationale 1: Average daily census will be valuable information in developing this year's budget. Rationale 2: Wage ranges in the market are critical information for the budget committee. Rationale 3: Regulation changes often result in an increase in cost. Rationale 4: Information regarding number of nurses terminated for cause will not be helpful to the budgeting committee. Rationale 5: Staff mix for all departments is necessary for this committee.

CHAP 12 Which statements would alert a nurse manager that a unit conflict has become disruptive? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I won't stop until I have gotten her fired." 2. "He doesn't fight fairly." 3. "I've almost forgotten what started this, I just focused on beating her." 4. "I am going to win this argument." 5. "He is so wrong, he just has to go."

Correct Answer: 1,2,3,5 Rationale 1: Conflict that is focused on reduction, defeat, or elimination of the opponent is disruptive. Rationale 2: Competitive conflict follows a set of rules. When rules are ignored, the conflict becomes disruptive. Rationale 3: Focus on defeating the opponent is disruptive. Rationale 4: In competitive conflict the focus is on winning, not on defeating or eliminating the opponent. Rationale 5: An urge to eliminate the competitor is reflective of the competition becoming disruptive.

CHAP 21 The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse may harm a client. 2. Other nurses on the unit may become disgruntled by having to cover for this nurse. 3. The nurse may never become a good employee. 4. The manager may be terminated. 5. The morale of the unit may decline.

Correct Answer: 1,2,3,5 Rationale 1: Marginal work may result in harm to clients. Rationale 2: A marginal employee increases the workload on other, more competent employees. Rationale 3: If marginal work is allowed to continue, the nurse may never change. Rationale 4: It is unlikely that a manager would be terminated because of one marginal employee. Rationale 5: Having a marginal employee who must be constantly coached and watched may negatively affect the morale of other staff and the entire unit.

CHAP 13 What are reasons that nurses fail to manage time effectively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses do tasks they enjoy doing before the ones they do not enjoy. 2. Nurses do things that bring the most immediate closure first. 3. Nurses respond on the basis of who wants something. 4. Nurses do uninteresting jobs before interesting jobs. 5. Nurses work on things in the order of their arrival.

Correct Answer: 1,2,3,5 Rationale 1: Nurses are like anyone else in that they tend to do things they enjoy before they do things they do not enjoy. Rationale 2: Nurses (and others) often do those things that they can get done most quickly first. They feel satisfaction with having one thing done and out of the way. Rationale 3: Nurses tend to prioritize based on who wants something done—for example, if a client wants something that is a priority over the nurse manager needing a report. Rationale 4: It is generally more time efficient to tackle uninteresting jobs first and get them completed before starting interesting jobs that may absorb more of the nurse's time. Uninteresting jobs are likely to be completed as quickly as possible. However, it is not human nature to do what is not interesting first. Rationale 5: Nurses tend to work on things "as they come up" and often end up working on unplanned tasks before planned tasks. This is related to the unpredictable nature of working with people who are ill

CHAP 20 A nurse manager has recently been transferred from obstetrics to pediatrics. The manager consistently stays in the office, does not relieve staff for lunches, and rarely assists staff when the unit is busy. Lately, the manager has noticed an increase in staff absences. Which options may contribute to the situation on this unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The manager has a lack of confidence in personal ability to provide care to pediatric clients. 2. The manager is unable to confront staff regarding absences. 3. The manger is not supervising the work of the unit. 4. The staff is consciously taking advantage of the manager. 5. The manager has a lax attitude toward absenteeism.

Correct Answer: 1,2,3,5 Rationale 1: The manager just transferred from a different unit and may be uncomfortable with skills needed to care for pediatric clients. Rationale 2: Confronting the staff about absences may be difficult for a new manager. Rationale 3: If the manager consistently stays in the office, supervision is minimal. Rationale 4: It is difficult to say that the staff is consciously taking advantage of the manager, but this may be occurring on a subconscious level. Rationale 5: The manager's own absence culture may be very tolerant.

CHAP 15 A nurse manager lists several preferences for hiring employees. The human resources manager would advise this manager that which practices do not meet the bona fide occupational qualification (BFOQ) regulation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I like to hire all female nurses to work in labor and delivery and postpartum." 2. "I hire only strong young men as transport workers." 3. "I prefer to hire nurses who have served in the military." 4. "I only hire nurses who are bilingual for work in the emergency department." 5. "I prefer to hire women as unit clerks."

Correct Answer: 1,2,3,5 Rationale 1: There is no legal reason to hire only females in labor and delivery and postpartum. Rationale 2: There is no reason an older male or a female could not be hired as a transporter. Rationale 3: It is not legal to ask questions regarding military service prior to hire. Rationale 4: Being bilingual is a qualification necessary for work in some emergency departments. The nurse could not hire based on national origin, just on the basis of speaking more than one language. Rationale 5: There is no reason a man could not be successful as a unit clerk.

CHAP 20 The night nurse on the pediatric unit has resigned. The night staff is pleased, because this nurse constantly complained about workload and alienated most staff members. What consequences may result from the loss of this nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Use of agency nurses. 2. Opportunity for overtime. 3. Increase in enthusiasm. 4. A resignation spiral in which more nurses resign 5. Unit performance improves.

Correct Answer: 1,2,3,5 Rationale 1: Unfortunately, agency nurses may need to be used if the position goes unfilled. This is a costly problem. Rationale 2: There may be an opportunity for overtime work for those who desire it. Rationale 3: Without the constant distraction of a complaining nurse the enthusiasm for the job may increase. Rationale 4: Since the nurse who resigned was not liked and was classified as a "complainer" it is unlikely that this resignation will trigger a resignation spiral. Rationale 5: When a nurse who alienates coworkers and complains frequently leaves, the performance of the unit may improve.

CHAP 16 The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The chief nurse officer (CNO) decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Current licensure to practice within the state 2. Orientation to the facility and the unit 3. Certification as an agency nurse 4. Documentation of malpractice insurance 5. Documentation of ability to work unsupervised in the environment

Correct Answer: 1,2,4 Rationale 1: An agency nurse must have a current licensure to practice in the state in which the requesting organization resides. Rationale 2: The agency nurse must be oriented to both the facility and the agency. Rationale 3: There is not a certification for agency nurses. Rationale 4: Either the nurse or the supplying agency must have documentation of malpractice insurance that covers the nurse. Rationale 5: The nurse must be supervised by an in-house nurse and cannot work unsupervised.

CHAP 14 A hospital's budget is incremental. Which statement by the nurse manager reflects use of this type of budget? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The finance department sent me the budget worksheet with last year's expenses." 2. "We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?" 3. "I have to justify all our activities as if we have never done them before." 4. "I like this type of budget preparation because it is fairly simple and straightforward." 5. "In order to create next year's budget, I am to start at 80 percent of what we budgeted last year."

Correct Answer: 1,2,4 Rationale 1: Developing an incremental budget may begin with documentation of the previous year's actual expenses. Rationale 2: The disadvantage of an incremental budget is that managers quickly learn to spend all that is in their budget for a specific line item. If budgets are based on the previous year's performance, having budgeted money left over means it is likely that the current year's budget will be cut. Rationale 3: Justification of all activities and expenditures is a characteristic of a zero-based budget. Rationale 4: Incremental or line-item budgeting is fairly simple and straightforward. Rationale 5: Starting with a decreased budget is a form of zero-based budget

CHAP 25 A staff nurse is late for work for the second time this week. When the manager mentions the tardiness, the nurse says, "I'm so sorry. I've just got so much going on with my impending wedding. I am so stressed." Which responses by the manager would help this nurse cope? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Good stress can be just as bad as negative stress." 2. "We need to get you back in balance." 3. "Your personal issues should not interfere with work." 4. "Weddings are fun, but they can be stressful as well." 5. "If you are late again, I am going to write you up.

Correct Answer: 1,2,4 Rationale 1: Good stress can be just as hard on the body as negative stress. Rationale 2: A balance should exist between stress and the ability to handle it. Rationale 3: The nurse realizes this fact, apologized, and offered an explanation for the tardiness. Rationale 4: Acknowledging the nurse's situation may help with coping. Rationale 5: A threatening response will not decrease the nurse's stress.

CHAP 11 A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 3. Other group members will quietly complete the noncompliant member's work. 4. The remainder of the group will ignore the noncompliant member. 5. The group members will extend patience and understanding to the noncompliant member.

Correct Answer: 1,2,4 Rationale 1: If rational argument does not work, group members may resort to manipulation of the deviant member. Rationale 2: When lack of compliance increases or slows the remainder of the group, attacks are likely to occur. Rationale 3: Group members are not likely to do the work assigned to another member. Rationale 4: This ignoring behavior is a final step of frustration with the noncompliant member. Rationale 5: Patience and understanding will be extended only for a little while before the other group members result to strategies that are neither patient nor understanding

CHAP 23 A geriatric client in a long-term-care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 3. The client suddenly becomes alert and oriented. 4. The client raises his fist. 5. The client says, "I know where there is a gun."

Correct Answer: 1,2,4 Rationale 1: The client may be about to flee the room, or may be blocking the nurse's exit. Rationale 2: A blank stare could be related to pathology such as dementia or may signal a violent episode. Rationale 3: Alertness and orientation do not signal impending violence. Rationale 4: Preparing for battle signals impending violence. Rationale 5: It is fairly unlikely that a geriatric client in a long-term-care facility has access to a gun. The nurse must be aware of the statement, but should consider the context.

CHAP 23 A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. The behavior has never been violent, but today it is becoming more threatening. The nurse just came into the station and said, "My nurse assistant is stupid. I'm not going to put up with that much longer. She needs to be put in her place." How should the manager respond to this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 3. The manager should explain that this is a good nurse who has difficulty tolerating stress. 4. Security should be notified of the behaviors. 5. The manager should warn other staff to stay clear of this nurse for the rest of the shift.

Correct Answer: 1,2,4 Rationale 1: The nurse should be removed from the situation. Rationale 2: This behavior should be documented. Rationale 3: Making excuses for this nurse is not appropriate. The nurse's temper is escalating and may grow out of control. Excuses violate the zero-tolerance policy. Rationale 4: As the behaviors are escalating, security should be notified. Rationale 5: The nurse should not be allowed to remain on the unit for the rest of the shift.

CHAP 23 During orientation a newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says, "Well, I guess you should call 911." What is incorrect about this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 3. The nurse should never call 911 from the hospital. 4. The nurse should have been told to follow the reporting policy. 5. The nurse should have been reported as suspicious for asking the question.

Correct Answer: 1,2,4 Rationale 1: The person conducting the orientation should be aware of the policy and relay the information accurately and with certainty. Rationale 2: Notification of security is essential. Rationale 3: There could be instances in which a nurse should call 911 from the hospital. In a small hospital with no full-time security, calling 911 may be the immediate response. Rationale 4: The hospital must have a bomb threat reporting policy. This would be a good time to introduce it to the orientation group. Rationale 5: There is no reason to report the nurse.

CHAP 16 The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Contracting with outside agency nurses 2. A decentralized float pool 3. Using nonlicensed personnel as substitutes for nurses 4. Establishing an internal float pool of nurses who are cross trained 5. Developing a float pool of nurses shared with another hospital in the system

Correct Answer: 1,2,4,5 Rationale 1: Agency nurses can be used as supplements, but their cost can be significant. Rationale 2: A decentralized float pool provides personnel who usually work only for one nurse manager or only on one unit. Rationale 3: Nonlicensed personnel cannot be used as substitutes for nurses. Rationale 4: This can be an effective way to provide supplementary staff. Rationale 5: This is an innovative idea that creates a system-wide internal float pool.

CHAP 13 A colleague frequently forwards funny e-mails to everyone on her contact list. The nurse manager does not have time to look at the e-mails and is aggravated when they appear. How should the manager handle this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Set the e-mail filter to divert the messages to a spam folder. 2. Tell the sender that the manager is not allowed to get personal e-mails at work. 3. Forward the e-mails back to the sender. 4. Send the colleague an e-mail that reads, "Stop wasting my time with these e-mails." 5. Delete the messages without opening them.

Correct Answer: 1,2,4,5 Rationale 1: If the e-mail can be filtered so that the recipient only has to look at them if desired, they are not as aggravating. Rationale 2: Using a corporate policy to explain reluctance to get these e-mails will save face for the sender and the recipient. Rationale 3: This action takes time and is rude. Rationale 4: Unless the colleague is a dear friend, this e-mail is confrontational and may unnecessarily embarrass the colleague. It may also damage a working relationship. Rationale 5: There is no rule that says that all messages have to be opened. When the message appears, delete it.

CHAP 20 A nurse who is obtaining a bachelor's degree in nursing is formulating a project regarding nurse's job satisfaction. The nurse is aware that research has shown job satisfaction is related to which factors in the working environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Appropriate staffing 2. Involvement in organizational decision making 3. Ability to work overtime 4. Being recognized for a job well done 5. Good relationships among staff

Correct Answer: 1,2,4,5 Rationale 1: Nurse retention may be a result of enhancing the work environment. Appropriate staffing is a positive indicator of a healthy work environment. Rationale 2: Involvement in organizational decision making improves the overall work environment for nurses. Rationale 3: Being able to work overtime is not universally important. Rationale 4: Recognition for doing one's job well is an important component of job satisfaction. Rationale 5: Good staff relationships improve the work environment.

CHAP 17 A nurse manager has scheduled several on-the-job instruction sessions. Why would the nurse choose this format? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It is very cost-effective. 2. Travel expenses are minimized. 3. The professional educators used are experts in adult learning. 4. Transfer-of-learning issues are eliminated. 5. The learners are motivated to learn.

Correct Answer: 1,2,4,5 Rationale 1: On-the-job instruction is one of the most cost-effective methods. Rationale 2: When training is on-the-job there is no need to leave the facility campus. Rationale 3: No professional educators are necessary. Rationale 4: Since the nurse is learning while doing the skill or procedure, there is no issue with transfer of learning. Rationale 5: Since the nurses are learning something they are actively doing, they are motivated to learn.

CHAP 18 An experienced ICU nurse manager is orienting a newly hired nurse manager to the organization. The ICU manager makes occasional notes in a small notebook. The new manager asks why the ICU manager is taking notes. What are the most likely rationales for this behavior? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It saves me time in the long run," 2. "Taking notes helps me to address issues immediately so they do not escalate." 3. "Although this looks time consuming, it is just how I learned to manage." 4. "It helps me to remember what to address in staff meetings." 5. "Having notes helps protect me when evaluations are written."

Correct Answer: 1,2,4,5 Rationale 1: Taking notes does save time for the manager when evaluations are written or if other issues come up on the unit. Rationale 2: On a busy unit, the manager must rely on written notes as a reminder of issues that should be discussed with staff. Rationale 3: Note taking is quick and this statement does not provide rationale for why notes are taken. Rationale 4: Notes will help the manager remember what should be addressed in staff meetings. Rationale 5: Having notes about the incidents cited in evaluations helps to protect the manager in case a staff member disputes the situation.

CHAP 18 A nurse manager has been terminated for failing to follow institutional policy and procedures. Upon reviewing the manager's files, the supervisor discovers multiple unfinished employee evaluations from the last two years. The supervisor is faced with which concerns? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Finding someone with enough knowledge of the employee's work to complete the evaluation processes 2. How to share evaluation information with employees 3. The legal steps necessary to invalidate the in-process evaluations and begin new evaluations 4. Whether the care provided on the unit has been safe and effective 5. How long it has been since employees have had a valid evaluation

Correct Answer: 1,2,4,5 Rationale 1: The evaluator must have direct knowledge of the employee's work. The supervisor must find people who have that knowledge who are qualified to evaluate the work, whether the current evaluations are finished or new ones are started. Rationale 2: Evaluations must be shared with the employee. If these evaluations were not finished, it is likely they were not shared. Rationale 3: No legal steps are necessary to invalidate these in-process evaluations. Rationale 4: Without a valid evaluation process, the care on the unit has not been assessed. Rationale 5: Employees should be evaluated at least once a year.

CHAP 10 Which situations are examples of ineffective delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. 3. The nurse manager asks the staff nurse to collect information about a new type of hospital bed being considered for purchase. 4. The staff nurse asks the UAP to provide simple discharge instructions to a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

Correct Answer: 1,2,4,5 Rationale 1: The purpose of delegating attendance to a staff nurse is so the manager will not need to attend the meeting. When the manager does attend, the staff nurse's position is diminished. This is an example of underdelegation. Rationale 2: When someone of lower rank, in this case the unit clerk, delegates a task to someone of higher rank, in this case the nurse manager, a situation of reverse delegation has occurred. This is ineffective delegation. Rationale 3: The nurse manager has asked someone of lower rank to complete a task that is within that person's capabilities. This is effective delegation. Rationale 4: Provision of education requires nursing knowledge and judgment and cannot be delegated to a UAP. This is an example of overdelegation. Rationale 5: Bathing clients can be delegated to staff of lower rank. If the nurse is giving the bath for assessment purposes, this lack of delegation would be appropriate. If the nurse is not delegating baths because "I like to give bed baths," the lack of delegation is inappropriate

CHAP 22 A hospital has written a well-defined surge call-back system for employees to use in case of a disaster. What are key vulnerabilities of this system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Employees may be unwilling to come back into the disaster. 2. Employees may be personally affected by the disaster. 3. Many employees will request additional pay for shifts worked during disasters. 4. There may be no way to contact employees for call-back. 5. The employee may not physically be able to return to the hospital.

Correct Answer: 1,2,4,5 Rationale 1: There is no assurance that employees will respond by returning to work once a disaster has happened. Rationale 2: It is impossible to know if employees will be personally affected by the disaster. For example, if the employee's home is destroyed by a wildfire, that employee would have pressing family needs. Rationale 3: This may occur, but is not a key impediment. Rationale 4: If utilities such a telephone and cell phone towers are destroyed, there may be no way to contact the employee to come back to the hospital. Rationale 5: There may be physical impediments such as washed out roads, snow-packed roads, or debris-covered roads that prevent employees from returning to the hospital

CHAP 11 A nurse manager is using Homans's framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another. 3. Compare the group to a similar group from the last accreditation cycle. 4. Review the group's final report. 5. Ask a team member how the work of the group is proceeding.

Correct Answer: 1,2,5 Rationale 1: Activities are an essential component of a group system that should be evaluated. Rationale 2: Interaction is an essential component of a group system that should be evaluated. Rationale 3: The essential elements of Homans's framework are activities, interaction, and attitudes. Comparing to a previous group would give little information on any of these aspects of group dyanmics. Rationale 4: If the group has completed its work, team building is no longer a consideration. Rationale 5: Team member attitudes are one of the three elements of Homans's framework.

CHAP 26 A nurse has an interview with the nurse recruiter at a large metropolitan hospital. During the nurse's education, clinical practice was conducted in smaller facilities. Which topics would be good for the applicant to focus on during the interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Information regarding the position and the organization 2. The nurse's past experiences 3. Salary 4. Benefits 5. The nurse's strengths and weaknesses

Correct Answer: 1,2,5 Rationale 1: During the interview, the nurse should obtain information about the position and organization. Rationale 2: During the interview, the nurse should describe experiences and education. Rationale 3: Once the job has been offered or the interviewer inquires about the applicant's interest in the job, then it is appropriate to discuss salary. Rationale 4: Once the job has been offered or the interviewer inquires about the applicant's interest in the job, then it is appropriate to discuss benefits. Rationale 5: During the interview, the nurse should identify personal strengths and weaknesses.

CHAP 25 A newly hired registered nurse is having difficulty focusing and performing nursing tasks. The nurse manager has noted a decrease in the nurse's performance. When meeting with the nurse, the manager learns the nurse has recently gotten married and moved into a new home. The client load in the unit has returned to normal levels from very high levels and another newly hired nurse was terminated for disruptive behavior. The nurse reports that "everyone has been so nice and they try to help me." Which situations are most likely causing this nurse's stress? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Marriage 2. Purchasing a new home 3. Decreased workload 4. Assistance from other nursing staff 5. The coworker who was terminated

Correct Answer: 1,2,5 Rationale 1: Even though getting married is a happy time, the wedding can be very stressful to plan. Adapting to married life can also be stressful. Rationale 2: Purchasing a new home is very stressful. Rationale 3: Typically, a reduced workload is not stressful. Rationale 4: Assistance from other nursing staff should not be stress inducing. Rationale 5: Working alongside a noncompliant coworker who is terminated can be very stressful.

CHAP 8 A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes of a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning

Correct Answer: 1,2,5 Rationale 1: Exposure to new ideas and a fresh environment outside the facility increases creativity. Rationale 2: Freedom is necessary to support the creative process. Rationale 3: Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. Rationale 4: Making creativity an assignment is a sure way to stifle it. Rationale 5: Being receptive to new ideas encourages creativity.

CHAP 16 A nursing supervisor requests information technology support for posting all nursing scheduling online. What justification can the supervisor provide for this request? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. If schedules are posted online they are open for all to see. 2. Posting schedules online will promote fairness in shift assignments. 3. It is easier to change the schedule if it is posted online. 4. If the schedule is posted online, all shifts must be 12-hours shifts. 5. Open shift scheduling is easier to maintain if all schedules are online.

Correct Answer: 1,2,5 Rationale 1: Posting schedules improves transparency. Rationale 2: If everyone can see the schedule it is more likely that shift assignments will be fair. Favoritism would be difficult to hide. Rationale 3: There is little difference between a written schedule and an online schedule in ease of change. Rationale 4: There is no requirement that all shifts must be 12-hour shifts. Rationale 5: If schedules are online it is easier for nurses to see open shifts that they might wish to work.

CHAP 25 A nurse supervisor is aware that nurses in the facility have been under a great deal of stress while working through a major change in the ownership of the hospital. Which nurses would the supervisor be most concerned might develop compassion fatigue? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Emergency department nurses 2. Outpatient diagnostic procedure nurses 3. Nurses working in the trauma surgery unit 4. Nurses working in geriatrics 5. Nurses working in obstetrics

Correct Answer: 1,3 Rationale 1: Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Emergency department nurses fall in this category. Rationale 2: Outpatient nurses may be somewhat sheltered from caring for trauma patients, which is a major cause of compassion fatigue. Rationale 3: Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Trauma surgery nurses fall into this category. Rationale 4: Nurses working in geriatrics are not at as great a risk for compassion fatigue as other nurses. Rationale 5: Generally, the risk for compassion fatigue is not as high in nurses working in obstetrics.

CHAP 26 The nurse has just interviewed with a nurse manager. The manager offers the nurse an opportunity to tour the unit and meet potential coworkers. Why is this a beneficial opportunity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It allows the candidate to learn more about the unit. 2. It allows the candidate to make a final determination about whether the unit is a good work environment. 3. It allows the candidate to make some assessment of coworkers. 4. It allows the candidate to determine nurse-to-client ratios. 5. It allows the candidate a first look at the types of clients served by the unit.

Correct Answer: 1,3 Rationale 1: This tour allows the candidate to see the unit in action and learn more about how it operates. Rationale 2: It is hard to make a logical determination about the unit on one visit, but the nurse will gain information that will be helpful. Rationale 3: The nurse is constantly assessing, and a tour allows contact with coworkers for this assessment. Rationale 4: One tour is unlikely to provide the candidate with this opportunity. Rationale 5: The candidate should be aware of the types of clients served by the unit prior to applying for the position.

CHAP 12 Two staff nurses are in conflict about the summer vacation schedule. The nurse manager is contemplating assigning both nurses to a task that will require frequent contact with each other, hoping that they will resolve the issue themselves. What should the manager consider before making this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. What is the anxiety level of the nurses in regard to the vacation schedule? 2. Have the nurses ever worked together before on a project? 3. Will the conflict decrease the efficiency of the unit while the nurses are self-solving the issue? 4. How intense is the conflict about vacation scheduling? 5. Are the nurses talking to the rest of the staff about the conflict?

Correct Answer: 1,3,4 Rationale 1: If there is high anxiety about the issue, assigning the nurses to a task together is likely not a good idea. Rationale 2: Whether or not the nurses have worked together before is not a critical consideration. Rationale 3: If the efficiency of the unit is in jeopardy, the manager should intervene. Rationale 4: If the conflict regarding vacation scheduling is intense, the nurse manager should abandon this plan. Rationale 5: It is likely that the rest of the staff already knows about the conflict and that the nurses involved have discussed it. This is not a factor in deciding on a plan.

CHAP 15 A nurse manager and a human resources (HR) manager are developing an interview guide for registered nurse positions in critical care units. How should this document be structured? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The questions should be specific to the registered nurse position. 2. Questions should be general enough that they will guide the interview for any critical care unit. 3. Sufficient room should be allowed between the questions so that notes on the interview can be written directly on the guide. 4. Questions should require independent answers and should not be leading. 5. The document should allow space for demographic information such as name, gender, and age.

Correct Answer: 1,3,4 Rationale 1: Questions should be specific to the job responsibilities of a registered nurse. Rationale 2: The questions should be specific to the unit for which the nurse is being hired. For example, a nurse skilled in adult critical care may not be prepared to work in a neonatal intensive care unit. Rationale 3: If notes are taken directly on the guide, it will also serve as a written record of the interview. This written record may be retained or may be destroyed after the position is filled. Rationale 4: Leading questions often have very obvious answers and will not give the interviewers a true impression of the applicant. Rationale 5: Asking about age and making decision based on gender is not legal.

CHAP 24 A nurse who works in a hospital with a collective bargaining unit requires disciplining. Which actions by the nurse manager are critical? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Coaching the nurse as appropriate 2. Letting the collective bargaining unit handle any disciplinary needs 3. Reviewing policy and procedures with the nurse 4. Discussing expectations that were not met 5. Directing any questions the nurse has to the union representative

Correct Answer: 1,3,4 Rationale 1: The manager is responsible for many of the same activities as in any situation. Coaching is included in these responsibilities. Rationale 2: The manager is responsible for discipline in the unit just as in any other situation. Rationale 3: A review of policy and procedures is part of all disciplinary issues. Rationale 4: Discussing unmet expectations is a part of all disciplinary issues. Rationale 5: The manager should answer questions that pertain to the actions for which the nurse is being disciplined.

CHAP 11 Which activities are expected from the nurse manager as team leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Offering constructive criticism 2. Settling all employee conflicts 3. Encouraging group discussions 4. Facilitate group processes 5. Foster team dependence

Correct Answer: 1,3,4 Rationale 1: The nurse manager is expected to evaluate the outcomes of the team and to offer constructive criticism about needed improvement. Rationale 2: The nurse manager as team leader would not settle all conflicts, but should be aware of most and get involved when necessary. Rationale 3: The nurse manager encourages group discussion. Rationale 4: The leader's influence on group processes may be the determining factor in whether or not the group is effective. Rationale 5: Fostering interdependence is more appropriate for the team leader as it creates cohesiveness among members.

CHAP 20 A nurse manager strongly believes that nurses should seek advanced educational degrees. The manager encourages this attitude in staff nurses. What are the dangers of this practice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses who achieve an advanced degree are more mobile. 2. Staff nurses may have a higher degree than the manager. 3. Staff members may need time off to attend school. 4. Staff members may resign to attend school full time. 5. Salaries are higher for nurses with advanced degrees.

Correct Answer: 1,3,4 Rationale 1: The nurse with an advanced degree has greater job opportunity and is more mobile. Rationale 2: This may be the case, but should not be a problem. Rationale 3: Scheduling around several nurses who have school schedules can be difficult. Rationale 4: There is a chance that nurses may resign in order to attend school on a full-time basis. Rationale 5: While salaries are higher for nurses with advanced degrees, the manager should know well in advance that a staff member is in school and should have opportunity to budget for those salaries

CHAP 17 In order to develop a succession-planning program as rapidly as possible, the management team has elected to divide the processes up among team members. Which assignments would be expected? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Identify the most important things that managers do." 2. "Find out how much managers in the local area hospitals are paid." 3. "Decide which current nurses would make good managers." 4. "Analyze management training opportunities." 5. "Research generational change theory."

Correct Answer: 1,3,4 Rationale 1: This is identification of core competencies and is the first step in designing a succession plan. Rationale 2: Salary determination is not part of the succession plan. Rationale 3: Identifying potential recruits is part of a succession plan. Rationale 4: Providing opportunities for development and growth is a key part of a succession plan. Rationale 5: This is not a part of succession planning.

CHAP 17 A nurse manager often uses negative reinforcers as part of operant conditioning in order to inhibit undesirable behaviors. What often results from this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The employee ducks into a client room each time the manager is seen. 2. The undesirable behavior vanishes permanently. 3. No improvement in the frequency of the undesired behavior is seen. 4. The employee calls in sick more often. 5. The manager must constantly monitor the situation.

Correct Answer: 1,3,4,5 Rationale 1: Avoidance behavior can be a result of use of negative reinforcers. Rationale 2: The undesirable behavior may go away temporarily, but it often returns. Rationale 3: Often negative reinforcers, or punishment, do not result in a decrease in the undesired behavior. Rationale 4: Calling in sick is a way of avoiding the punishment. Rationale 5: If the manager stops monitoring the situation and does not consistently employ the negative reinforcer, the behavior resurfaces.

CHAP 21 Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Chart review on effectiveness of pain control 2. Increase in clients with conditions requiring pain medications 3. Increase in use of doses of as-needed narcotics that results in wastage 4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others 5. Narcotic containers that look as if they have been altered

Correct Answer: 1,3,4,5 Rationale 1: If many clients report their pain is not controlled, diversion may be occurring. Rationale 2: An increase in clients requiring pain medications is likely census related. Rationale 3: If the nurse has a choice of doses and is trying to divert medications, a smaller dose might be given resulting in a larger wastage that is then diverted. Rationale 4: If one shift is giving much more pain medication that the other, it may be because someone is diverting drugs on that shift. It may also mean that inadequate pain control is being given on the other shift because someone is diverting drugs. Rationale 5: Altering the container is a method of diversion.

CHAP 21 A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Continue to be persistent in your work with these nurses." 2. "You can fire them at any time." 3. "Be fair and consistent with them." 4. "You must continuously assess the rest of your staff as you work with these two nurses." 5. "You must continue to address the issues with these nurses as they arise."

Correct Answer: 1,3,4,5 Rationale 1: Persistence is a key to being perceived as fair and just. Rationale 2: Termination practices are governed by strict procedures that must be followed to protect both the manager and the institution. Rationale 3: Fairness and consistency are keys to being perceived as just. Rationale 4: The manager must be aware of the impact of marginal nurses on the remainder of the staff. Rationale 5: The manager cannot ignore any issues that arise with these nurses

CHAP 14 The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Sick days 2. Weekend days 3. Vacation days 4. Holidays 5. Bereavement days

Correct Answer: 1,3,4,5 Rationale 1: Sick days are benefit days. Rationale 2: Weekend days are not benefit days. Rationale 3: Vacation days are benefit days. Rationale 4: Holidays are benefit days. Rationale 5: Bereavement days are benefit days.

CHAP 26 In an activity log, a nurse records attendance at an education seminar as, "Class on arrhythmia recognition, State College, taught by Sue Smith, RN." What else would be valuable for the nurse to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The exact title of the seminar or event 2. Which colleagues attended with the nurse 3. Who paid for the course and what it cost 4. The date 5. Any certifications achieved

Correct Answer: 1,3,4,5 Rationale 1: The exact title should be included in the activity log. Rationale 2: The names of those who attended with the nurse are not necessary. Rationale 3: Keeping track of expenses is important for tax purposes. Rationale 4: The date of the course is important to include. Rationale 5: It is important to keep track of certifications.

CHAP 18 An organization has changed its performance appraisal process and is conducting training for managers. What topics should the trainer include in the agenda for this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. What a reasonable job performance should look like 2. How to conduct a disciplinary meeting 3. How to complete the evaluation form 4. How to give the employee feedback on evaluation 5. Use of anecdotal notes

Correct Answer: 1,3,4,5 Rationale 1: The manager must be able to differentiate reasonable job performance from unreasonable job performance. Rationale 2: Discipline is not a part of the evaluation process. Rationale 3: The evaluation form becomes a part of the employee's permanent file and is legally discoverable. It must be completed accurately and completely. Rationale 4: Feedback is important and must be offered and documented. Rationale 5: Anecdotal notes or critical incident notes are a vital part of the evaluation process

CHAP 26 A nurse with an associate degree in nursing is interested in obtaining more education but is unsure if it is wiser to obtain a baccalaureate degree in nursing or to pursue certification. The answers to which questions would assist the nurse in making a decision? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Am I interested in nursing management? 2. Which goal can be accomplished at the least expense? 3. Do I want to go to graduate school? 4. What are my future options in my current position? 5. Is either option available online?

Correct Answer: 1,3,4,5 Rationale 1: The nurse should determine interests prior to deciding which degree to pursue. Rationale 2: The expense it will take to achieve the goal should not be the primary factor determining which one to choose. Rationale 3: The nurse should think about future educational goals when deciding upon a degree. Rationale 4: The nurse should identify current advancement possibilities when considering further education. Rationale 5: Online education is available for many degrees and certifications. This information may make the decision clearer.

CHAP 14 The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The FTE factor for an LPN hired this month 2. The current wage range for RNs working on the units 3. The names of all unit clerks working in the unit 4. The level of licensure of a nurse working on the unit 5. The fact that two RNs have retired this year

Correct Answer: 1,3,4,5 Rationale 1: The position control sheet includes the names and FTE factors for each individual employed by the unit. Rationale 2: Wage ranges are not included in this information. Rationale 3: The names of all unit employees are part of the position control sheet. Rationale 4: The position control sheet categorizes those working on the unit by position. Therefore, the licensure level of the nurse would be indicated. Rationale 5: Resignations are recorded on this sheet.

CHAP 12 Conflict has arisen within the hospital regarding who will staff a proposed high-acuity unit. The nurse executive and other administrators have purposefully not intervened in this conflict. Why is that strategy appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Conflict draws attention to an issue. 2. The administrators do not like conflict management. 3. Conflict can stimulate new ideas about how to manage the high-acuity unit. 4. Conflict about the unit will help to identify the compromises necessary to make it a viable part of the hospital system. 5. Conflicts about staffing may make current staff members reexamine their own performance.

Correct Answer: 1,3,4,5 Rationale 1: There may be a reason that administration would desire that attention be brought to the new unit. Conflict will bring that attention. Rationale 2: Whether or not the administrators like conflict management probably has little to do with their decision. Rationale 3: Conflict can stimulate thought and new ideas. Rationale 4: Any new program or unit comes at a cost and the cost-benefit ratio must be explored. Conflict can help others identify the compromises and costs associated with starting this unit. Rationale 5: Staff members who wish to be considered for staffing the new unit may improve their own performance and effectiveness.

CHAP 11 A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurse who each have 7 to 8 years of experience 2. Nurses who work on different units throughout the hospital 3. Staff nurses who are interested in learning about the task of the group 4. Staff nurses who work with one another on a daily basis 5. Staff nurses who are all between 35 and 40 years of age

Correct Answer: 1,3,4,5 Rationale 1: This group has similar backgrounds, which will likely mean they have shared values regarding nursing. Rationale 2: Working in proximity with the others increases cohesiveness. Rationale 3: People who have specific needs that can be satisfied by involvement with the group are more cohesive. Rationale 4: Those who must interact to achieve their goals and tasks are likely to be cohesive when working in a group. Rationale 5: Similarity in age increases cohesiveness.

CHAP 7 The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Identify what she really wants 2. Keep her focus on her unit, not the entire organization 3. Prioritize her needs in order of importance 4. Identify her current resources 5. Determine who stands in the way of what she wants

Correct Answer: 1,3,4,5 Rationale 1: To increase power, the nurse must first identify what she really wants. Rationale 2: Focus should be on the entire organization, not just the specific unit where the nurse currently works. Rationale 3: The nurse should prioritize her needs and goals in the order of their importance to her and to the organization. Rationale 4: The nurse must be aware of what resources exist and how she can obtain the resources she needs. Rationale 5: The nurse should identify who or what stands in the way of her achieving what she wants.

CHAP 5 The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

Correct Answer: 1,3,4,5,6 Rationale 1: The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization. Rationale 2: Once the decision to make a change has been made, the nurse manager should not act as a resister. Rationale 3: The nurse manager may be in the role of one who supplies information about the needed change. Rationale 4: The nurse manager may act as a liaison between the committee and the staff. Rationale 5: The nurse manager fulfills the role of support person for staff adapting to the change. Rationale 6: The nurse manager may act as discussion leader, both in formal and informal discussions.

CHAP 21 A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The unit clerk groans when the instructor enters the nursing station with the students. 2. A nurse quietly says, "Please do not assign a student to me today. I have two very sick clients who are going to require my full attention." 3. A nurse whispers, "Not students again today." 4. A nursing assistant asks the students how long they have been in school. 5. A transport worker says, "Just great, more students to get in the way today."

Correct Answer: 1,3,5 Rationale 1: Any action that indicates the students are unwelcome is not civil. Rationale 2: This nurse has not been uncivil, but is stating a fact about the acuity of clients. Rationale 3: This whisper is not civil, despite the level at which it is spoken. Rationale 4: This is a valid statement and is civil. Rationale 5: The intent of this remark is probably not civil.

CHAP 13 Which statements indicate that a nurse manager is using time reactively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We were so busy yesterday that I did not get the schedule completed." 2. "I knew that we would be busy over the holiday, so I ordered extra supplies." 3. "We have so many new graduates on our unit that our work is never caught up." 4. "I am putting a summary of a research article on the board each week since I realize many of the nurses do not read journals." 5. "I am really concerned about what the nursing supervisor said about our unit. I can't get it off my mind."

Correct Answer: 1,3,5 Rationale 1: Being too busy to get work done is reactive, not proactive. Rationale 2: The manager knew the unit would be busy and could control lack of supplies by ordering more. This is a proactive statement. Rationale 3: The manager should predict that new graduates require more time to complete tasks and should plan for that problem. Rationale 4: The nurse manager knows that nurses need to keep current and also knows that many of the nurses supervised do not read journals. A proactive solution to this problem has been proposed. Rationale 5: A proactive approach would be to ask the supervisor for clarification about the remark.

CHAP 20 The human resources (HR) department is considering motivating employees to maintain good attendance by changing some organizational practices. Which items should HR consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Offering a discount on the cost of on-site child care for employees with good attendance records 2. Encouraging managers to involve employees in the decision making on the unit 3. Banning an employee with more than two absences in a pay period from working overtime in the next pay period 4. Working with managers to change the culture of the units on which absences are frequent 5. Entering the names of employees who have no absences in a 3-month period in a drawing for a paid day off

Correct Answer: 1,3,5 Rationale 1: On-site child care is a motivating factor in itself. Adding a discount to those with good attendance is an additional motivating factor. Rationale 2: Shared decision making is a change to the job itself. Rationale 3: This policy would serve as punishment for those seeking overtime wages and is a change in organizational practice. Rationale 4: This is an example of changing the absence culture. Rationale 5: A reward for having no absences is a change in organizational practice.

CHAP 18 An organization has adopted the peer review process of evaluation. The manager shares which information with staff? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Begin to work on a portfolio that shows how you have met your work goals for this year." 2. "All of you will be called on to review each of the other nurses working on the unit." 3. "If you are a member of a peer review committee, you will submit a written evaluation to me." 4. "The evaluation will be based solely on the input of the peer committee." 5. "This change has occurred as a result of our move to self-governance."

Correct Answer: 1,3,5 Rationale 1: The portfolio is a part of the peer review system of evaluation. Rationale 2: Generally, the peer review process involves two to four nurses reviewing the work of a peer. All nurses may be involved at some point, but not all nurses will review the work of every nurse. Rationale 3: The members of the peer review committee submit a written evaluation to the manager. Rationale 4: The manager also completes an evaluation. Rationale 5: Peer review is often used in self-governance models.

CHAP 13 A nurse is participating in time-management education. This week's assignment is to compile a list of personal goals. Which of these goals should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I will lose 10 pounds by Christmas." 2. "My family will have more fun." 3. "I will read for pleasure for 1 hour every day after work." 4. "I will not be late for work." 5. "We will save $200 monthly for the next 12 months for a car down payment."

Correct Answer: 1,3,5 Rationale 1: This is a measurable, time-defined goal. Rationale 2: This is not a measurable goal and has no time component. Rationale 3: Pleasure reading is a personal goal. This statement is measurable and has a time frame. Rationale 4: Not being late for work is a job-related goal. Rationale 5: Saving for a car down payment is a personal goal. This statement is measurable and has a time component.

CHAP 24 A nurse manager is conversing with a colleague at a national meeting. The colleague states, "I've just never understood why a nurse would want to join a union." What responses by the manager would explain the attraction of unionization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It's usually a combination of factors such as low wages and high nurse-to-client ratios." 2. "Low wages cause so much job dissatisfaction that the nurses unionize." 3. "Having to work with supervisors as staff when nurses call in is one reason." 4. "Many nurses have supervisors who think they understand what it's like to work on the unit every day." 5. "Many nurses are frustrated because communication between nurses and administration is so poor."

Correct Answer: 1,4,5 Rationale 1: Unionization becomes an attractive option when a combination of factors causes dissatisfaction. Low wages alone are not usually the cause, but low wages associated with other factors such as high client acuity and ratios may cause nurses to seek unionization. Rationale 2: Unionization is an attractive option when a combination of factors causes dissatisfaction. Low wages alone are not usually the cause. Rationale 3: Supervisors and managers working and assisting as staff would improve nurse/management relations and assist with communication. Rationale 4: Supervisors who assume they know what issues are concerning to the staff do not help create trust in the work environment. Rationale 5: Ineffective communication is often the reason for job dissatisfaction, which can make unionization an attractive option.

CHAP 15 Unrest and employee turnover have resulted in a unit being critically understaffed. The human resources department and nurse manager are attempting to recruit new nurses for the unit. How should the history of this unit be presented? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The facts of the history should be presented while maintaining the confidentiality of those involved. 2. The history should briefly be mentioned as "some minor problems with staffing." 3. The history should not be mentioned. 4. The recruiters should focus on the positive work environment of the rest of the facility. 5. Steps being taken to correct problems on the unit should be outlined and explained.

Correct Answer: 1,5 Rationale 1: The facts should be presented honestly and as completely as possible without breaching confidentiality. Rationale 2: Unrest and employee turnover cannot honestly be categorized as minor problems with staffing. Rationale 3: It would not be fair to hire a nurse into this unit without providing some history. Rationale 4: Focusing on the rest of the facility is not a fair representation of the work environment a nurse could expect on this unit. Rationale 5: Candidates should be made aware of the problems and what is being done to correct them.

CHAP 11 A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The group manager has line authority in relation to the group members individually. 2. The group manager has line authority in relation to the other nurses in the group, but not in relation to the other disciplines in the group. 3. The group manager has no line authority in this group. 4. The group manager has line authority in relation to all members of the group except the physician. 5. The group manager has line authority in relation to all member of the group collectively.

Correct Answer: 1,5 Rationale 1: The manager of a group has line authority within that group. The authority extends to individual members and to the members collectively. Rationale 2: The group manager has line authority in relation to all members of the group. Rationale 3: The group manager has line authority in relation to all members of the group. Rationale 4: The group manager has line authority in relation to all members of the group. Rationale 5: The group manager has line authority in relation to the group members as a group.

CHAP 20 A nurse manager has reduced absenteeism by increasing each nurse's job responsibilities. Why is this strategy effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses who feel their job is important realize that others depend upon their presence at work. 2. A nurse who is given additional work responsibilities must work harder to prevent termination. 3. Nurses who have greater responsibilities do not stress over minor responsibilities any longer. 4. A nurse with less responsibility is always less motivated. 5. Having greater responsibilities enriches the job experience.

Correct Answer: 1,5 Rationale 1: When employees feel they are making a real contribution they take greater ownership in their work. Rationale 2: Preventing termination is not the reason this strategy is effective. Rationale 3: Generally, the greater the responsibility, the greater the stress over all aspects of the job. Rationale 4: Many nurses are very motivated even though they may not have as much responsibility as others. Rationale 5: Greater responsibilities often change the flavor of the job so that the nurse enjoys it more.

CHAP 12 Why does conflict help generate change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Conflict assists change to occur more rapidly than it would otherwise. 2. It brings more attention to an issue in need of change. 3. People get involved because conflict breeds curiosity. 4. If there is an existing conflict, a change must occur to stop the conflict. 5. Change is inevitable, and some people refuse to change, which causes conflict.

Correct Answer: 2,3 Rationale 1: Conflict does not necessarily speed up the change process. It may slow the process. Rationale 2: When conflict around a change occurs, more people become aware of the issue, and because of curiosity or interest, more people become involved in the process. Rationale 3: When conflict around a change occurs, more people become aware of the issue, and because of curiosity or interest, more people become involved in the process. Rationale 4: Conflict does not always occur as a resolution of conflict. In some instances, things stay the same. Rationale 5: The question asks about conflict causing change, not change causing conflict.

CHAP 17 A nurse manager is selecting nurses to serve as teachers in on-the-job instruction. What qualifications should these nurses hold? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. At least one nursing degree higher than those being taught 2. Willingness to teach new nurses 3. Ability to explain procedures accurately and clearly 4. Formal instruction in educational methodology 5. Experience as a clinical preceptor

Correct Answer: 2,3 Rationale 1: On-the-job instruction is not formal education. There is no educational degree requirement. Rationale 2: Willingness to take on the role of teacher is essential. Rationale 3: Ability to teach is essential. Rationale 4: Instruction in methodology can be informal and provided by the manager. Rationale 5: The on-the-job instructor may or may not have experience as a clinical preceptor.

CHAP 25 A staff nurse on a busy outpatient surgery unit comes to the manager and says, "I don't know what is going on. I just feel unsettled and anxious." How should the manager interpret this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse is trying to establish a problem for which days off will be necessary. 2. The nurse may be suffering from free-floating anxiety. 3. The nurse may be overstressed. 4. The nurse has compassion fatigue. 5. The nurse is about to experience post-traumatic stress disorder.

Correct Answer: 2,3 Rationale 1: There is no indication that the nurse is trying to make up an illness to get time away from work. Rationale 2: Free-floating anxiety is anxiety that seems to have many alternating causes. Rationale 3: Stress can cause these feelings of anxiety or fear. Rationale 4: Compassion fatigue has much more serious symptoms than anxiety. Rationale 5: There is no evidence of post-traumatic stress disorder.

CHAP 23 A hospital's safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Reserving parking spaces closest to the facility for staff 2. Security cameras throughout the facility 3. Curved mirrors in the corridors 4. Using restraints on all confused clients 5. Requiring all personnel to take physical self-defense training

Correct Answer: 2,3 Rationale 1: While isolated or unlit parking can be a safety concern, there is no reason that staff should have the parking next to the facility. There are also concerns for visitor and client safety to consider. Rationale 2: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. Rationale 3: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. Rationale 4: Just because a client is confused does not indicate a tendency toward violence or a need for restraints. Rationale 5: While all staff should be trained regarding violence, physical self-defense training is not practical for every staff member.

CHAP 12 A nurse and a physician are in conflict over the treatment of a client. Which statements by the nurse reflect the best way to handle interprofessional conflict? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I think it would be better for the client to stay another day." 2. "This client needs an additional day to learn how to care for a complex wound." 3. "It will help this client manage her diabetes more effectively if she is assigned a diabetic educator." 4. "Research has shown that early ambulation helps to reduce the likelihood of pulmonary embolism." 5. "Do you not remember what happened when you sent that other client home too early?"

Correct Answer: 2,3,4 Rationale 1: "I" statements of what the nurse wants are not the best way to discuss options in an interprofessional disagreement. Rationale 2: Speaking from the vantage point of the client helps to support the nurse's position in this conflict. Rationale 3: Explaining what will best help the client helps to support the nurse's position in this conflict. Rationale 4: Using facts to support the nurse's point in the conflict is an important strategy. Rationale 5: This statement is confrontational and is unlikely to support the nurse's position in this conflict.

CHAP 11 A nurse manager is focused on team building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the group's context? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "How well has this group been able to relate to similar groups across the organization?" 2. "What are the group's current goals?" 3. "How have the members organized the group?" 4. "What is the general culture of the group?" 5. "How complex is the job the group has been assigned?"

Correct Answer: 2,3,4 Rationale 1: Knowing how well members relate to other groups is important but is not a part of the group context. Rationale 2: Goals are a part of the group context. Rationale 3: Organizational structure is part of the group's context. Rationale 4: It is important to assess the culture of the group, which is part of its context. Rationale 5: Job complexity is important but is not part of the group context.

CHAP 24 One of the areas of supervision defined by the National Labor Relations Board (NLRB) is "independent judgment." Which nurses fall into this category? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse who routinely reviews lab work and makes a clinical judgment of when to notify the physician 2. A nurse who works twice a month as charge nurse on an acute care unit 3. A nurse who makes team assignments as part of the charge nurse role 4. A nurse whose job includes choosing which assistants to place with which clients 5. A nurse who applies assessment findings when altering the plan of care for a client

Correct Answer: 2,3,4 Rationale 1: Routine clinical judgment in care of clients is not included in "independent judgment." Rationale 2: If the nurse is regularly scheduled as charge nurse, the nurse is considered to be using independent judgment to match staff skills to client needs. Rationale 3: If the nurse is matching staff skills to client needs, independent judgment is being used. Rationale 4: If the nurse is matching employee skills with client needs, independent judgment is being used. Rationale 5: Using assessment findings to alter the plan of care is clinical judgment, not independent judgment in the context of collective bargaining.

CHAP 18 The nurse manager is completing employee evaluations. Which practices should the manager use when doing these appraisals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Appraising staff nurses every 18 to 24 months 2. Sharing the appraisal with staff nurses verbally and in writing 3. Requiring the staff nurse to sign the appraisal 4. Allowing the nurse to make written comments on the appraisal 5. Advising the nurse of the right to appeal the appraisal

Correct Answer: 2,3,4,5 Rationale 1: A staff nurse should be appraised at least every 12 months. Rationale 2: The appraisal should be shared with the staff nurses both in writing and face-to-face discussion. Rationale 3: The nurse should sign the appraisal to indicate that it has been received. Rationale 4: The nurse should be allowed to make written comments on the appraisal. Rationale 5: The nurse does have the right to appeal the findings of the appraisal and should be advised of this right

CHAP 17 A nurse executive says, "I would really like to develop our current nurses so they can take a greater leadership role in the future." Why is this a good management plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Employees with a long history at the facility are easier to control. 2. This method of developing leaders has proved to be cost-effective. 3. The leadership development can be varied according to the needs of the nurse. 4. When leaders are developed from within, management is already aware of their strengths and weaknesses. 5. The specific needs of the organization can be served.

Correct Answer: 2,3,4,5 Rationale 1: Developing leaders from within is not a control strategy. Rationale 2: Cost-effectiveness comes from retaining high-performing nurses. Rationale 3: Many nurse leaders fail, not because they don't want to be a leader, but because they don't have the tools and skills they need. When a leader is developed from within, these tools and skills can be tailored to the individual. Rationale 4: When a nurse has worked at the hospital as a staff nurse, strengths and weaknesses are revealed. Rationale 5: Since the leaders are being developed from within, the organization can match strengths and interests to identified needs.

CHAP 13 A nursing supervisor warns the nurse manager, "Having access to electronic communication is not always a blessing." How should the manager interpret this warning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electronic communication wastes more time than it saves. 2. The manager does not have to be physically present in the facility for communication to take place. 3. If not used effectively, electronic communication can prevent the manager from getting rest. 4. Along with a flatter organization and easy access, the nurse manager's job responsibilities have increased. 5. In today's health care environment there is pressure to do more with less.

Correct Answer: 2,3,4,5 Rationale 1: Electronic communication can be a time waster, but if it is used effectively it save more time than it wastes. Rationale 2: The nurse manager is instantly available through cell phone or e-mail, but this is not always a positive. Easy availability allows nurses to avoid making decisions and the manager is never really "off call." Rationale 3: If nurses have instant contact with the manager and are not taught to solve problems, the manager may be called at all hours and on days off. This prevents the manager from getting needed rest. Rationale 4: Job enlargement has occurred, which means the nurse manager has greater responsibility and more employees to supervise. One reason this can occur is there is easier access to the manager during off-duty hours. Rationale 5: There is a need to do more with less in health care. Electronic communication makes the potential work place much bigger than it was previously.

CHAP 26 A nurse manager has a strong belief in the value of certification for staff nurses. Unfortunately, only two staff members are certified. How could the manager encourage the remaining staff to seek certification? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Make it a job requirement. 2. Obtain grant monies to fund purchase of materials for certification. 3. Support those who are seeking certification with study sessions and helpful study hints. 4. Work with administration to obtain a salary adjustment for those who become certified. 5. Role-model the behavior by becoming certified.

Correct Answer: 2,3,4,5 Rationale 1: If certification is made a requirement, then the stimulus to attend is not learning, but survival. Rationale 2: The cost of materials may be a barrier for some nurses. Rationale 3: Support by management takes down one common barrier to certification. Rationale 4: A workplace reward, such as a salary adjustment, is a good incentive to become certified. Rationale 5: The manager should also seek certification.

CHAP 22 A nurse is working with a hospital team to create an emergency response plan that will meet Joint Commission requirements. Which sections should be included in this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A method to predict when a disaster will occur through close attention to news and weather reports 2. A method to recognize that a disaster is imminent or occurring with plans to reduce the disaster's impact 3. A plan whereby policies and procedures as well as equipment and personnel are in place to handle disasters 4. Policies and procedures that operationalize actual activities during the disaster 5. Policies and procedures describing what will occur immediately after the disaster

Correct Answer: 2,3,4,5 Rationale 1: It is not possible to predict when a disaster will occur. Rationale 2: This section of the plan would address mitigation of the disaster. Rationale 3: This section would be titled "Preparedness." Rationale 4: This is the "response" section. Rationale 5: This is the "recovery" section.

CHAP 22 A nurse executive is assigned to a task force working on a surge system for the hospital in case of a disaster. This group should write strategies to cover which procedures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Post-incident follow-up 2. Supplies 3. Physical space 4. Management infrastructure 5. Personnel

Correct Answer: 2,3,4,5 Rationale 1: Post-incident follow-up is not a part of surge strategy. Rationale 2: How to get supplies, how to know how many supplies are on hand, and how to distribute supplies are all part of a surge strategy. Rationale 3: Allocation of physical space is a part of surge strategy. Rationale 4: Whom to notify, how to communicate with community officials and media, and how to notify staff are all part of surge strategy concerning management infrastructure. Rationale 5: How to notify staff of the disaster, how to allocate staff in a disaster, how to allocate and manage volunteers, and how to provide for all these personnel is a part of surge strategy.

CHAP 15 The hiring process to fill a nursing position has been slowed because the human resources department is involved in a recruitment effort for laboratory positions. A staff nurse says, "Why do we have to wait on HR? Why can't we just hire a nurse?" What rationale does the nurse manager provide for waiting until HR can be involved in filing the nursing position? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "HR makes all the final hiring decisions. I just suggest the candidate I would like to have to fill the job." 2. "HR will screen the applicants for us so we don't waste time interviewing people who are not qualified." 3. "HR makes certain that we are not doing anything illegal as we interview for this position." 4. "We can't hire a nurse until HR has done a criminal background check." 5. "HR has to check to be certain that the applicant has a valid license before we can offer the job."

Correct Answer: 2,3,4,5 Rationale 1: The final hiring decision is that of the manager with input from nursing supervisors as needed. Rationale 2: HR conducts the initial screening. Rationale 3: HR is responsible for assuring legal hiring practices are followed. Rationale 4: HR is generally responsible for conducting criminal background checks. Rationale 5: HR does confirm licensure.

CHAP 18 The supervisor is teaching managers about the use of critical incidents as part of the evaluation process. What information should the supervisor share? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Our primary focus for using these notes is to find out who is doing a poor job." 2. "Using these notes will help you identify little problems before they become big problems." 3. "You can expect some negative reactions from staff." 4. "It is okay to tell your staff that you cannot remember all the details of each encounter for evaluation and the notes will help." 5. "Having these notes will help you feel more confident in your evaluation of staff."

Correct Answer: 2,3,4,5 Rationale 1: The focus is on improving accuracy of the performance review. Rationale 2: Using notes forces the manager to deal with problems when they begin, rather after they have caused additional issues to arise. Rationale 3: When note taking is introduced, people tend to be suspicious and to react negatively. Rationale 4: Managers should be encouraged to be honest with staff about the note-taking strategy. Rationale 5: Having performance notes written across the evaluation period will help the manager have greater confidence in the evaluation process.

CHAP 18 Correct Answer: 1,2,4,5 Rationale 1: The evaluator must have direct knowledge of the employee's work. The supervisor must find people who have that knowledge who are qualified to evaluate the work, whether the current evaluations are finished or new ones are started. Rationale 2: Evaluations must be shared with the employee. If these evaluations were not finished, it is likely they were not shared. Rationale 3: No legal steps are necessary to invalidate these in-process evaluations. Rationale 4: Without a valid evaluation process, the care on the unit has not been assessed. Rationale 5: Employees should be evaluated at least once a year.

Correct Answer: 2,3,4,5 Rationale 1: The goal of evaluators is to decrease leniency errors. Rationale 2: The reason the manager doing evaluations reviews the critical incident file is to collect information to help the manager do the best evaluation appraisal possible. This helps to decrease the possibility of a lawsuit being filed against the manager for inaccurate evaluation. Rationale 3: Reviewing the critical incident file prior to the evaluation will refresh the manager's memory of the employee's overall performance and will increase and improve manager-employee communication. Rationale 4: Looking back at the employee's record for the evaluation period will help to decrease recency error. Rationale 5: Reviewing the employee's records over the evaluation period will help the manager write a more accurate evaluation.

CHAP 20 Hospital management is brainstorming ways to reduce absenteeism. Which suggestions from this session deserve further investigation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I think we should define excessive absenteeism by total time lost instead of absence frequency." 2. "Let's offer a salary increase for those with good attendance." 3. "Why not include attendance as part of the employee performance appraisal?" 4. "I don't think we are enforcing the absence policies we have now. That is the logical place to start." 5. "We need to start at the top and be certain all of our management employees maintain good attendance."

Correct Answer: 2,3,4,5 Rationale 1: Total time lost is not as sensitive an indicator of excessive absenteeism as absence frequency. For example, an employee might miss 30 days of work due to a scheduled surgery for which the manager could make scheduling adjustments. Another employee could miss a total of 30 days due to oversleeping, car trouble, or just deciding not to come to work. The difference in impact on the unit is obvious. Rationale 2: The idea of offering a salary increase should be further investigated. Rationale 3: The idea of using attendance as part of the employee performance appraisal may work, especially if the appraisal is tied to merit raises. Rationale 4: If absence policies currently in place are not being followed, employees develop the idea that absences are not a serious issue. Rationale 5: Employees model what they see in managerial staff. If the management level employees do not have good attendance, the staff begins to believe that absences are not a problem

CHAP 22 Which statements would the nurse manager interpret as indicating a nurse understands the critical thinking skills necessary for disaster management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It is just like critical thinking in the emergency department or critical care unit, only done faster." 2. "The nurse's prioritization will be different in a disaster." 3. "Clinical judgment skills will be an essential part of nursing's contribution to disaster management." 4. "Decision making will basically be done by following established protocols." 5. "The nurse's abilities will make the difference in successful management of a disaster."

Correct Answer: 2,3,5 Rationale 1: Critical thinking in disasters is different than in normal health care situations. For example, the triage system is reversed. Rationale 2: Normal prioritization will not be helpful in a disaster. Rationale 3: The nurse's clinical judgment will be essential in making rapid assessments and treatment decisions. Rationale 4: Disaster situations cannot be scripted with protocols. Decisions must be made quickly and accurately based upon the situation and may change in a moment-to-moment fashion. Rationale 5: Nursing will be a big part of management of a disaster and good nursing skills will make a difference.

CHAP 24 A grievance has been filed against a hospital. Which statement by the nurse executive reflects common reasons for grievances? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The nurses want more benefits than specified in the contract we just signed." 2. "I think there is a misunderstanding of one of the terms of the contract." 3. "I think this grievance is based on a term in the old contract that is not included in the new contract." 4. "The nurses want higher wages because the other hospital in town just raised their pay scale." 5. "This contract just is not going to work. We need to renegotiate.

Correct Answer: 2,3,5 Rationale 1: If the benefits provided are those specified in the contract, there are no grounds for grievance. Rationale 2: Misunderstandings are common causes of grievances. Rationale 3: Lack of familiarity with the contract is a common reason for a grievance. Rationale 4: It the nurses want higher wages, the contract should be renegotiated. A grievance is not indicated. Rationale 5: An inadequate agreement is a common reason for a grievance.

CHAP 21 A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nursing assistants 2. Physicians 3. Managers 4. Office personnel 5. Senior nurses

Correct Answer: 2,3,5 Rationale 1: Nursing assistants are often bullied, but are not the main bullies. Rationale 2: Physicians are among those reported as being the worst bullies. Rationale 3: Managers are among those reported as being the worst bullies. Rationale 4: Office personnel are not among those listed as being the worst bullies. Rationale 5: Senior nurses are among those listed as being the worst bullies.

CHAP 19 A nurse is being terminated due to continued violation of hospital policy. What statements by the manager are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Your actions have been degrading to the profession." 2. "You may wish to resign rather than being terminated." 3. "Human resources will answer any questions you may have about benefits." 4. "I'm sorry you could not be happy here." 5. "You are being terminated for the policy violations I have just outlined."

Correct Answer: 2,3,5 Rationale 1: The nurse manager should not make statements of opinion during the termination process. Rationale 2: In many cases, the nurse will choose to resign rather than being terminated. Rationale 3: The terminated employee may have rights to some benefits. The HR department should handle those questions. Rationale 4: The manager has no idea if the nurse was happy or not and should not be personally involved in the situation. Rationale 5: The manager should outline the violations that led up to the termination and should make it clear that the violations are the reason for the termination.

CHAP 11 The work of a task force is completed and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Plan on the leader presenting the report to administrators. 2. Share the report with the full task force prior to presenting it to administrators. 3. Send the report to administrators by e-mail. 4. Brief key administrators regarding the report prior to the administrative presentation. 5. Print and bind the presentation in a professional manner prior to presenting it to the full task force.

Correct Answer: 2,4 Rationale 1: It is often desirable for a few task force members with differing expertise to participate in this presentation. Rationale 2: The full task force should have opportunity to review and comment on the report draft before it goes to the administration. Rationale 3: The report should be presented to administrators in person. Rationale 4: The leader should meet with key administrators to bring particularly important findings or recommendations to light prior to presenting the report to the full administrative panel. Rationale 5: The document presented to the full task force should be legible, but should be a draft. Professional printing and binding should occur after the draft is finalized.

CHAP 23 A newly formed task force is addressing the prevention of violence in the health care organization. Which group of employees is most likely to experience violence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Private practice physicians 2. Nurses working in a geriatric unit 3. Nurses working in a pediatric clinic 4. Nurses whose work space includes large waiting rooms 5. Technicians working in the medical laboratory

Correct Answer: 2,4 Rationale 1: Physicians in private practice can control their practice environment. Physicians are not in the group that experiences the most violence. Rationale 2: Geriatric units are among the sites in which violence is most likely to occur. Rationale 3: Clinics are among the sites in which violence is least likely to occur. Rationale 4: Waiting rooms are among the most common sites of health care violence. Rationale 5: Medical laboratories are isolated areas and are not among the places where health care violence commonly occurs.

CHAP 19 The hospital's new management company has assigned a "leadership coach" to groups of current nurse managers. Which statements made by a manager would the coach interpret as indicating the manager does not value this opportunity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Why do I need a coach?" 2. "I've been a manager longer than our coach has been a nurse." 3. "I'm getting burned out with the way we manage." 4. "Another new program to waste our time." 5. "Coaching has helped my nurses improve their practice."

Correct Answer: 2,4 Rationale 1: This question would allow the coach to list the benefits of coaching. It does not indicate that the nurse doesn't value the experience. Rationale 2: A statement like this may well indicate that the manager does not think that the coach has any information that will be of benefit. Rationale 3: A manager who is burned out with current methods may be very willing to learn new methods. Rationale 4: When people go into a program thinking it is a waste of time, they often do not see its value. Rationale 5: If the manager has seen improvement in practice as a result of coaching, the manager is more likely to have a positive attitude toward the program.

CHAP 12 A physician criticizes the care provided by a nurse in an area where others are present. Which actions by the nurse would the manager interpret as a covert conflict behavior resulting from this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse says, "You can't talk to me like that." 2. The nurse avoids the physician in the hallway. 3. The nurse refuses to care for the physician's clients. 4. The nurse is no longer as careful in caring for this physician's clients. 5. The nurse is apathetic about the care of clients.

Correct Answer: 2,4,5 Rationale 1: Aggression is an overt conflict behavior. Rationale 2: Avoidance is a covert behavior. Rationale 3: Refusal is an overt act of conflict. Rationale 4: Not being as careful is a covert action. Rationale 5: Apathy is a covert conflict behavior.

CHAP 24 Which job responsibilities indicate that a nurse has supervisory capacity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse makes clinical judgments about client care. 2. The nurse assigns a nurse assistant to care for a team of clients. 3. The nurse discusses client care with the supervising physician. 4. The nurse hires staff to manage units. 5. The nurse retains responsibility for the actions of nurses assigned to provide client care.

Correct Answer: 2,4,5 Rationale 1: Both staff nurses and supervisory nurses make clinical judgments about client care. Rationale 2: If the nurse makes assignments to a nurse assistant, the nurse has supervisory capacity. Rationale 3: Both staff nurses and supervisors discuss client care with supervising physicians and other physicians. Rationale 4: Hiring staff to manage a unit is a type of assignment that indicates supervisory capacity. Rationale 5: If the nurse has responsibility for the actions of those to whom client care has been assigned, the nurse has supervisory capacity.

CHAP 11 The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I will assume responsibility for developing the mission and goals of the group." 2. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 3. "I realize there will be dissension; however, I prefer that we not take time from our agenda to address it." 4. "The meeting will be called to order at noon and be adjourned in 1 hour." 5. "It is important that each of you is fully engaged in the decision-making process."

Correct Answer: 2,4,5 Rationale 1: Since this is a command group, the mission and goals are set by the organization. Rationale 2: The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. Rationale 3: An effective leader elicits the expression of dissenting opinions. Rationale 4: The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. Rationale 5: Group cooperation and engagement should be promoted.

CHAP 18 An organization has elected to use a behavior-oriented self-evaluation system for nurses. Which statement would be included on the evaluation form? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Becomes BLS (basic life support) instructor within 1 year of employment 2. Maintains confidentiality of information 3. Achieves certification in specialty 4. Demonstrates care, respect, and compassion in all interactions 5. Works well on multidisciplinary teams

Correct Answer: 2,4,5 Rationale 1: This is a results-oriented statement. Rationale 2: This is a behavior-based statement. Rationale 3: This is a results-oriented statement. Rationale 4: This is a behavior-based statement. Rationale 5: This is a behavior-based statement.

CHAP 17 Which findings associated with an employee are likely to be considered when discussing performance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The employee states, "I have to work so that we can have insurance coverage for our disabled child." 2. The employee has been tardy on one occasion when an unexpected snow fell just before shift change. 3. The employee was involved in a motor vehicle accident last fall. 4. The employee found a purse containing $200 in the cafeteria and turned it in to security. 5. The employee made two work errors requiring incident reports in the last year.

Correct Answer: 2,4,5 Rationale 1: This statement relates more to motivation rather than to performance. Rationale 2: Punctuality is a performance measure. Rationale 3: Personal accidents that occur when the employee is not on shift are not considered as part of performance. Rationale 4: Honesty and trustworthiness are considered performance measures. Rationale 5: Work errors are considered performance measures.

CHAP 24 The nurses of a hospital have given notice of their desire to unionize. The nurse executive is meeting with all nurse managers to discuss their role. Which information should the executive provide for these managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We need to stop this if at all possible. I am counting on you to discourage nurses from joining the union." 2. "If the nurses on your unit want to organize, do not interfere." 3. "You cannot say anything about the union, but your actions can speak for you." 4. "We are not going to participate in this." 5. "I will keep you posted as we move through this process."

Correct Answer: 2,5 Rationale 1: Encouraging or discouraging union membership by a manager is an unfair labor practice. Rationale 2: Interference with the right to organize is an unfair labor practice. Rationale 3: Any act of domination or indication of preference regarding the union is an unfair labor practice. Rationale 4: Refusal to bargain collectively is an unfair labor practice. Rationale 5: The managers must be kept apprised of the process.

CHAP 16 The administration of a health care organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association (ANA) requirements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Registered nurses from across the facility were included on the committee that developed the system. 2. RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility. 3. The nurse's level of educational preparation will be considered in staffing decisions. 4. The number of clients and their acuity will be considered for staffing purposes. 5. When low census occurs the unlicensed assistant category will be first to be furloughed.

Correct Answer: 2,5 Rationale 1: The ANA requires that staffing systems be developed with input from direct-care registered nurses. Rationale 2: The ANA requirements state that the RN cannot be forced to work on a unit without "having established that he or she is able to provide professional care on such a unit." Rationale 3: The ANA requirements state that staffing will "reflect the level of preparation and experience of those providing care." Rationale 4: The ANA requirements state that staffing will be "based on the number of patients and patient-acuity level." Rationale 5: There is no mention of low census furlough in the ANA requirements for staffing systems.

CHAP 19 A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse manager wrote notes on the expectations discussed during disciplinary sessions. 2. The terminated employee's last evaluation discusses problems with performance, but no coaching is described. 3. When problems with the employee arose, the manager's average time of intervention was less than 1 day. 4. There are notes in the employee's record from human resources indicating the nurse manager had discussed issues with the HR director. 5. In one note, the manager describes the employee as "petulant, immature, and uncaring."

Correct Answer: 2,5 Rationale 1: The manager should keep notes on everything discussed regarding discipline. This would benefit the institution. Rationale 2: Even though coaching is done in short sessions, it should be documented. Rationale 3: Intervention in less than 1 day shows that the manager was aware of and quickly handling problems. Rationale 4: The HR director would be party to problems with employees. This does not violate confidentiality. Rationale 5: This note could be a problem for the institution as it is the manager's opinion, not a defensible fact.

CHAP 11 Which ground rule statements by the leader will help the group meeting stay on task and on time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We will wait until everyone who is going to attend is here before we call the meeting to order." 2. "We will always meet on the second Wednesday of the month at 1:00 p.m. as this is the time all members have indicated is most convenient." 3. "If you have information to distribute for discussion, please bring a copy for every member." 4. "We will limit verbal participation to designated key members each week." 5. "You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting."

Correct Answer: 2,5 Rationale 1: The meeting should start promptly when scheduled, even if some members have not arrived. It should start and end on time. Rationale 2: The team leader should arrange to meet in a convenient but quiet place to minimize interruptions and distractions. Rationale 3: Meeting time should not be used for reading information that could have been distributed earlier. This material should be distributed at least a week to 10 days before the meeting. Rationale 4: Everyone, not just "key players," should be encouraged to discuss issues during the meeting. Rationale 5: The meeting agenda should be distributed at least 1 week in advance.

CHAP 19 The manager has just terminated a nurse. What statement by the manager is appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You may go back to the unit to say good-bye to your coworkers." 2. "We have cleaned out your locker and have your personal belongings ready for you." 3. "I have notified security to escort you as you leave the building." 4. "As of this time, you are no longer an employee of this institution." 5. "Please do not discuss your termination with any other nurses."

Correct Answer: 3,4 Rationale 1: Directing the nurse back to the unit for good-byes is not a good idea. Rationale 2: The hospital should not be involved in cleaning out the employee's locker. Rationale 3: The terminated employee should be attended by the manager or by security at all times. Rationale 4: It must be very clear that termination has occurred and that the nurse is no longer an employee. Rationale 5: Once termination has occurred, the manager has no control over the employee's actions.

CHAP 14 The nurse manager is reviewing the previous month's budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Greater client acuity 2. Extravagant use of resources 3. Understaffing the unit 4. Low client acuity 5. Use of agency nurses to supplement staff

Correct Answer: 3,4 Rationale 1: Greater client acuity than allowed for in the budget would likely result in an unfavorable efficiency variance. Rationale 2: Using more resources than the budget allows would result in an unfavorable efficiency variance. Rationale 3: Understaffing the unit would mean fewer nursing salary hours. This would result in a favorable efficiency variance, but would not be a good long-term plan for quality of care. Rationale 4: If client acuity is lower, fewer staff members are needed. This would result in a favorable efficiency variance. Rationale 5: If agency nurses were used to supplement staff, the efficiency variance would be unfavorable.

CHAP 15 The nurse manager is conducting an interview for a position as a full-time RN in a critical care unit. Which statements by the nurse manager would be most effective in selecting a qualified nurse for this position? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I have 20 years of experience as a critical care nurse and I am an advanced practice nurse in adult medical-surgical nursing." 2. "We do lots of client teaching. Do you like doing client teaching?" 3. "Tell me about your past work experience." 4. "Please tell me about your most rewarding experience as a nurse." 5. "Have you ever cared for a client on a ventilator?"

Correct Answer: 3,4 Rationale 1: Questions should be focused on the candidate, not the person conducting the interview. Rationale 2: This is a leading question, which should be avoided. The obvious "correct" answer is "yes." Rationale 3: Information about past work experience is helpful in determining qualifications for the prospective job. Rationale 4: Asking about the most rewarding experience as a nurse may reveal much about the nurse's past. Rationale 5: Whether or not a candidate has cared for a client on a ventilator does not prove the applicant's ability.

CHAP 24 Which statements by a nurse manager would the supervisor interpret as indicating an understanding of why collective bargaining is complicated for nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "There just are not many union options for nurses." 2. "None of the unions available for nurses were developed specifically for nurses." 3. "The determination of who is eligible to join a union is complicated." 4. "In some institutions, nurses have formed their own unions." 5. "No nursing unions have the backing of national organizations like the AFL/CIO."

Correct Answer: 3,4 Rationale 1: Several organizations offer union options for nurses. Rationale 2: National Nurses United and United American Nurses are organizations specifically for nurses. Rationale 3: The determination of who is a supervisor is complicated in nursing. Rationale 4: Nurses in some institutions have formed their own unions. Rationale 5: Untied American Nurses is an AFL/CIO affiliate.

CHAP 13 As part of a new time management initiative, the nurse manager is creating a "to-do" list. How should the manger structure this list? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Focus on the events that are planned for each day. 2. Focus on the activities the manager expects for the day. 3. Block out time for the unexpected. 4. Be certain the list is flexible. 5. Do not create a "to-do" list for more than one day at a time.

Correct Answer: 3,4 Rationale 1: The focus should be on outcomes, not events. Rationale 2: The focus should be on outcomes, not activities. Rationale 3: The manager should leave enough uncommitted time to allow for unexpected occurrences to be handled. Rationale 4: Flexibility is of paramount importance in health care. Rationale 5: In some work environments, "to-do" lists may be better focused on what needs to be done each week. Adding a system to keep track of weekly or monthly standing meetings or appointments is also helpful.

CHAP 13 The nurse manager must attend to several tasks this afternoon. Which tasks would the manager categorize as urgent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Waiting for pharmacy to call back about a meeting time 2. Planning a staff meeting for next week 3. Assisting a family whose child is in the emergency department 4. Finding replacements for two staff members on the next shift who called in sick 5. Trying to organize the visitor take-out menus

Correct Answer: 3,4 Rationale 1: Waiting for a phone call is a time waster and would not be an urgent task. Rationale 2: Planning a staff meeting for next week in not urgent. Rationale 3: Assisting the family of a child in the ED is an urgent matter. Rationale 4: Finding replacement staff for the next shift is an urgent matter. Rationale 5: Organizing take-out menus is busy work.

CHAP 20 Which personal characteristics would increase a nurse's potential for voluntary turnover? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse holds an associate's degree in nursing. 2. The nurse walks to work each day. 3. Through task force meetings, the nurse has become friends with several nurses who work in different organizations in town. 4. The nurse has few personal ties to the city of current employment. 5. The nurse has worked at several job-fairs in the area as a hospital representative.

Correct Answer: 3,4,5 Rationale 1: A nurse who holds a higher degree is likely to be more mobile. Rationale 2: If the nurse lives within walking distance to the hospital he or she is less likely to voluntarily resign. Rationale 3: Having contacts in other health care organizations increases the nurse's likelihood of changing work sites. Rationale 4: If the nurse is geographically mobile, leaving for a "change of scenery" is attractive. Rationale 5: Attending job fairs, even as a hospital representative, opens up new contacts and possibilities of new jobs.

CHAP 25 Which factors increase the stress associated with interpersonal relationships in health care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Longer length of stay for clients 2. Few assistive personnel 3. Job redesign 4. New technology 5. Unrealistic expectations of other disciplines

Correct Answer: 3,4,5 Rationale 1: A shorter length of stay for clients is more likely to increase staff stress. Rationale 2: Having to supervise assistive personnel is very stressful. Rationale 3: Trying to do more with less is very stressful. Rationale 4: New technology can be very stressful during the learning curve. Rationale 5: Unrealistic expectations from anyone can increase the nurse's stress

CHAP 26 A nurse has two job offers. One will not be available for 6 months and the other is in an organization that the nurse does not think is a good fit. The client care in the second organization is not what the nurse would feel comfortable providing. What action should the nurse take in regard to the second organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Gracefully decline the job by saying he is moving out of state. 2. Accept the position and plan to resign as soon as the other position opens. 3. Thank the manager for the offer, but decline it. 4. Send a letter to the manager, thanking the organization for the offer. 5. Tell the manager that the client care in the organization was not what was expected.

Correct Answer: 3,4,5 Rationale 1: It is better to be honest and just decline the job. Rationale 2: It is not right to accept this position. The nurse believes the fit is not right and it is not fair to the organization to put the nurse through hiring and orientation, only to have the nurse leave. Rationale 3: It is best to decline the offer of a job in an organization where there is not a good fit. Rationale 4: Even though the organization is not a good fit today, it might be in the future. The nurse should not risk alienating a potential future contact. Rationale 5: The nurse should not be blunt or rude in the explanation, but should focus on the fit not being correct.

CHAP 18 An organization has begun using critical incidents as part of the evaluation process. The supervisor is meeting with a manager to review the manager's use of critical incidents since training last week. Which finding would concern the supervisor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Each nurse has one critical incident recorded and it is positive. 2. The manager is writing these notes in a handheld electronic device. 3. The manager's notes are all written at the same time on the same day. 4. There is no indication that the critical incidents recorded have been shared with staff. 5. One note states, "This nurse has an abrasive personality.

Correct Answer: 3,4,5 Rationale 1: The manager may be taking the advice of starting the process by writing and reviewing a positive critical incident with each nurse. Rationale 2: Each manager will develop his or her own style of recording notes that works best for the individual. Rationale 3: It is best that the note be recorded at the time of the occurrence. Rationale 4: The reason for critical incident recording is to improve practice. If the note is not shared with the employee, this improvement is less likely to occur. Rationale 5: Notes should focus specifically on what occurred, not on personal traits.

CHAP 13 A staff nurse frequently interrupts the nurse manager with problems that the staff nurse could solve. What should the manager say to correct this behavior? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am no longer going to interrupt my work for you." 2. "Let me see what I can do about the problem you are having." 3. "Is this a problem you can handle yourself?" 4. "You have the skills to solve this issue." 5. "I trust you to solve this problem."

Correct Answer: 3,4,5 Rationale 1: The manager should be available for solving problems outside the staff nurse's scope of accountability. Telling the nurse that interruptions will not be tolerated may result in the nurse not notifying the supervisor of a situation that requires the manager's expertise. Rationale 2: The manager should not take responsibility for solving the problem. It is the nurse's responsibility. Rationale 3: Refocusing the nurse's ability to handle the problem may make the nurse reassess the need for the manager's intervention. Rationale 4: Reminding the nurse that he or she has the skills to solve the issue may give the nurse enough courage to attempt independent problem solving. Rationale 5: A statement of trust in the nurse's judgment may give the nurse enough courage to attempt independent problem solving.

CHAP 22 As part of the disaster plan, the nurse executive is planning an education session on the core competencies for nurses established by the National Emergency Preparedness Education Coalition. Which topics should be included in the handout being written for this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cost control 2. Managing conflict with other disciplines 3. Communication 4. Handling the media 5. Technical skills

Correct Answer: 3,5 Rationale 1: Cost control is not one of the core competencies for nurses established by this group. Rationale 2: Conflict management is not one of the core competencies for nurses established by this group. Rationale 3: Communication is a core competency for nurses established by this group. Rationale 4: Handling the media is not one of the core competencies for nurses established by this group. Rationale 5: Technical skills are a core competency for nurses established by this group

CHAP 15 A nursing applicant is scheduled for an interview with the nurse manager. Prior to the day of the interview, the human resources (HR) department reports that the applicant's references would not recommend her for hire. How should the nurse manager proceed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Have HR call the applicant and cancel the interview. 2. Call the applicant, tell her that the references were poor, and cancel the interview. 3. Conduct the interview without telling the applicant that the references were poor. 4. Conduct the interview and tell the applicant that the references were poor. 5. Conduct the interview and see if the applicant spontaneously explains why the references might be poor.

Correct Answer: 3,5 Rationale 1: The interview should be conducted. Rationale 2: The manager should not reveal that the references were poor. The interview should be conducted. Rationale 3: The interview should be conducted. The fact that references were poor should not be revealed. Rationale 4: The applicant should not be told the references were poor. Rationale 5: The applicant may explain situations that could have resulted in poor references.

CHAP 12 The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses' concerns in favor of the doctors' concerns. Which strategies would facilitate this outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Accommodating 2. Compromising 3. Smoothing 4. Collaborating 5. Competing

Correct Answer: 4,5 Rationale 1: Accommodating is an unassertive tactic used when individuals neglect their own concerns in favor of others' concerns. Rationale 2: In a compromise, neither party gets what they want. Rationale 3: Smoothing is usually only effective for small problems and does not protect the interests of one party against the other. Rationale 4: Collaborating focuses on solving the problem and satisfying both parties' concerns. Rationale 5: Competing is a victory for one side and a loss for the other.

CHAP 26 A female nurse has an interview for a new job scheduled next week. What should the nurse plan to wear to this interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Scrubs 2. A neatly pressed lab jacket and white uniform 3. Capri length pants and sandals 4. Dark pants and a gray jacket 5. Simple jewelry

Correct Answer: 4,5 Rationale 1: It is seldom appropriate to wear scrubs to an interview. Rationale 2: It is seldom appropriate to wear a uniform and lab jacket to an interview. Rationale 3: Capri length pants and sandals are too casual for an interview. Rationale 4: Pants and a neutral-colored jacket are appropriate dress for an interview. Rationale 5: Simple jewelry is appropriate for an interview.

CHAP 13 Which strategies would decrease the amount of time the nurse manager spends with "drop-in" visitors to the manager's office? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Set office hours to eliminate those visits. 2. Keep the office door closed. 3. Arrange furniture so the desk faces the door. 4. Stand up to greet the visitor and remain standing. 5. Encourage appointments for routine matters.

Correct Answer: 4,5 Rationale 1: Office hours should be established to decrease drop-in visits, but the intent is not to totally eliminate them Rationale 2: Keeping the door closed is incorrect because a block of time when the door is open for accessibility and availability is needed. Rationale 3: If the desk faces the door, eye contact is made with passersby and anyone who is standing in the doorway, which invites interruption. Rationale 4: In order to redirect the drop-in visit, the nurse manager should stand up and remain standing throughout the encounter. This gesture is gracious yet obvious enough to encourage a short visit. Rationale 5: Encouraging appointments for routine matters is an effective solution. The manager should indicate that in order to have sufficient time to address the question, a block of time will be needed.

CHAP 19 A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Go to the cafeteria and confront the assistant. 2. Send a message with a nurse going to lunch for the assistant to return to the unit immediately. 3. Call the cafeteria and ask that they send the assistant back to the unit. 4. Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week." 5. Anticipate that the assistant will give an explanation for the lateness.

Correct Answer: 4,5 Rationale 1: The manager should take a few moments to prepare before this meeting occurs. Rationale 2: The manager should not include other staff in this issue. Rationale 3: The manager should not get cafeteria workers involved in this confrontation. Rationale 4: It is important to stay calm and to relate the facts. This assistant has been late twice already this week and is late again today. Rationale 5: The manager should anticipate that the assistant will offer a reason for the lateness. It will be up to the manager to decide if the explanation is reasonable.

CHAP 1 The organization that awards Magnet status would look for environments where which practices are the norm? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses are involved in decision making. 2. Rewards are focused on ideas that save money. 3. Once a decision is made, it stands. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health.

Correct Answer: 1 Rationale 1: Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions. Rationale 2: Money-saving ideas are not always good for staff or for clients. Rationale 3: Magnet-status organizations are flexible and encourage autonomy and independence. Rationale 4: Overtime is sometimes necessary, even in the most well-run facilities. Rationale 5: In Magnet organizations, staff members are encouraged to be involved in educational activities in the organization and the community.

CHAP 9 A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication.

Correct Answer: 1,2 Rationale 1: Grapevine communication is often rapid and complete. Rationale 2: Grapevine communication is often altered as is goes from person to person. Rationale 3: The grapevine is very prone to distortion—sometimes significant distortion. Rationale 4: Most people do believe or at least attend to the grapevine. Rationale 5: Grapevine communication crosses all levels of professionalism.

CHAP 6 A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents. 3. The system or process causing the incident is identified and corrected. 4. Improvements to the system are widespread. 5. Sufficient evidence is acquired so that management is comfortable in making needed changes.

Correct Answer: 1,2 Rationale 1: Professional disagreements often occur as root cause analysis is being conducted. Rationale 2: Often the root cause analysis takes up so much time and so many resources that no changes are ever made. Rationale 3: Root cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur. Rationale 4: Root cause analysis generally does not result in widespread system improvement. Rationale 5: Root cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident.

CHAP 9 Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112." 3. "Ambulate the clients on the south wing." 4. "Do you think you'll have time to do shampoos today?" 5. "It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon."

Correct Answer: 1,2 Rationale 1: Saying "Here are your directions" alerts the assistant that an important statement is going to be made. The instructions are clear and concise. Rationale 2: This is a clear and concise set of instructions. Rationale 3: This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? Rationale 4: This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. Rationale 5: The nurse should be clear regarding what should be done before instruction is provided.

CHAP 9 A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?" 3. "I think it is unfair to refuse my unit this opportunity based on the past." 4. "Why are you always so opposed to change on my unit?" 5. "If we don't offer alternative staffing patterns, we aren't going to be able to attract new hires.

Correct Answer: 1,2 Rationale 1: This is an example of using "fogging," or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. Rationale 2: Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisor's position, but also requires the supervisor to rethink the issue. Rationale 3: Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. Rationale 4: This approach is confrontational. Rationale 5: Threats, even veiled threats, are confrontational and should not be used.

CHAP 2 The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures. 4. Staffing has become less flexible as more nurses specialize in one aspect of care. 5. A recently updated organizational chart indicates the line authority for each position.

Correct Answer: 1,2,3 Rationale 1: Collaboration and work sharing are more closely identified with systems theory. Rationale 2: In the classical approach, work is divided into departments and specialties. Rationale 3: Standardization is a means of control of work, which is common in the classical organizational approach. Rationale 4: Specialization of labor is a common finding in classical theory. Rationale 5: Chain of command and line authority are characteristic of classical theory.

CHAP 5 A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well." 4. "To make this big change, we need to start making smaller changes now." 5. "There is going to be resistance, but I think it can be overcome."

Correct Answer: 1,2,3 Rationale 1: Fear of "rocking the boat" may prevent the manager from effectively leading the change. Rationale 2: Fear that no one will support the change may prevent the manager from effectively leading the change. Rationale 3: Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change. Rationale 4: The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent. Rationale 5: The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.

CHAP 5 Which statements by a hospital executive reflect power-coercive strategies to implement change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk." 4. "This change is the only logical action we can take." 5. "All our sister institutions in the association have already made this change."

Correct Answer: 1,2,3 Rationale 1: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, the federal government. Rationale 2: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, Medicare. Rationale 3: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, the accrediting body. Rationale 4: The empirical-rational model of change focuses on logical actions. Rationale 5: Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.

CHAP 8 Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions." 4. "I am strongest in making decisions when the problems are very unusual or unclear." 5. "I make good decisions when the situation is novel."

Correct Answer: 1,2,3 Rationale 1: Routine decisions are based on policies and rules. Rationale 2: Routine decisions are based on procedures. Rationale 3: Adaptive decisions are often modifications of well-known problems or solutions. Rationale 4: Solving unusual or unclear problems requires innovative decision making. Rationale 5: Novel situations require innovative decision-making abilities.

CHAP 8 Which statements by a nurse in the emergency department are examples of groupthink? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work." 4. "We need to consider the workload of the intensive care unit nurses." 5. "Does anyone else have any ideas to discuss?"

Correct Answer: 1,2,3 Rationale 1: Suppression of dissent and new ideas occurs with groupthink. Rationale 2: Stereotyping outsiders is a symptom of groupthink. Rationale 3: There is a strong tendency in groupthink to seek concurrence. Rationale 4: Considering the opinion of others is not a symptom of groupthink. Rationale 5: Leadership controls the discussion and numbers of topics to be discussed in groupthink.

CHAP 8 A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation.

Correct Answer: 1,2,3,4 Rationale 1: Many situations resolve themselves with time. Rationale 2: Support from the manager is important and may lead to self-solving of the problem. Rationale 3: Depending on the problem, the nurses may need information, time off, or problem-solving practice. Rationale 4: The manager should intervene if client care begins to suffer. Rationale 5: The manager must manage this situation.

CHAP 4 The vice president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses are not good managers. 5. Nurses often experience poor supervision in their own careers.

Correct Answer: 1,2,3,5 Rationale 1: Few nurses have the training necessary to be managers. Rationale 2: Entry-level education programs are designed to produce generalists, and most content is focused on bedside nursing skills. Rationale 3: Many managers depend on their own experience with former supervisors. Rationale 4: Nurses work as managers of their own practice and can become very good managers when sufficient education and support are provided. Rationale 5: Nurses may manage as they were managed and perpetuate poor management techniques.

CHAP 4 The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 4. Developing the unit budget 5. Delegation responsibilities

Correct Answer: 1,2,3,5 Rationale 1: Staff nurses are responsible for prioritizing care for the clients for whom they provide care. Rationale 2: Staff nurses act as liaisons between clients and other health care professionals. Rationale 3: Staff nurses work to coordinate care provided by other health care professionals. Rationale 4: Staff nurses may have input into budget development but do not have direct responsibility for the process. Rationale 5: Staff nurses have the responsibility of delegating tasks to nonprofessional staff.

CHAP 3 A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Administering oral medications to clients 5. Calling the physician to discuss the client's response to a new treatment

Correct Answer: 1,2,3,5 Rationale 1: The RN team leader is responsible for conducting the nursing care conference and reviewing the client's plan of care with the team. Rationale 2: The RN team leader guides the client care and helps to resolve any problems that may occur. Rationale 3: Developing and updating nursing care plans is the work of the RN team leader. Rationale 4: Typically the team leader is involved in indirect client care activities. Rationale 5: Communicating and collaborating with physicians is generally the responsibility of the team leader.

CHAP 2 The administration of a health care system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift. 5. The nurse executive communicates with managers mostly by email.

Correct Answer: 1,2,3,5 Rationale 1: The collaboration characteristic of a healthy work environment is "true collaboration." Lobbying for physician support is not true collaboration. Rationale 2: Effective decision making is a characteristic of a healthy work environment. If the staff nurse was comfortable making a decision without input, the nurse would not ask for help. Rationale 3: Recognition should be meaningful. Recognizing two nurses from each unit each week is not meaningful. Rationale 4: Appropriate staffing is a tenet of a healthy work environment. Rationale 5: While email is a convenient method of communication, it should not be the only method employed.

CHAP 10 In order to delegate, which must be present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 4. Responsibility for task completion on the part of the delegator 5. Authority of the delegate to accomplish the task as assigned

Correct Answer: 1,2,3,5 Rationale 1: The delegator and delegate share accountability to accomplish the task. Rationale 2: The delegator and delegate share accountability to accomplish the task. Rationale 3: The delegator must have the authority to assign the task. Rationale 4: The delegate takes on the responsibility for completion of the task. Rationale 5: Effective delegation transfers authority to the delegate to empower the delegate for success.

CHAP 10 During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency is increased by effective delegation. 3. If the manager has more time to focus on managerial duties, there is more chance of career advancement. 4. The nurse manager thinks unlicensed assistive personnel (UAPs) provide better bedside care than nurses. 5. The manager is interested in developing the entire staff to its maximum potential.

Correct Answer: 1,2,3,5 Rationale 1: The manager may be able to delegate some tasks to nurses if the nurses are not overloaded with client care that could be completed by unlicensed assistive personnel (UAPs). Rationale 2: If delegation is done effectively, unit efficiency is increased. Rationale 3: If the manager can get more done because delegation is effective there is a greater chance for career advancement. Rationale 4: There is no evidence that this is the case. Rationale 5: Development is stifled when the staff members are doing the wrong tasks.

CHAP 4 Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 4. Being empathetic with clients 5. Standardized first of shift assessments

Correct Answer: 1,2,3,5 Rationale 1: Transactional leadership uses personal reward as a method of maintaining the status quo. Rationale 2: Transactional leaders value policy and procedure. Rationale 3: Interpersonal dependence is valued by transactional leaders. Rationale 4: An emphasis on empathy, awareness, and persuasion is more characteristic of servant leadership. Rationale 5: Transactional leaders value standardization.

CHAP 3 As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required.

Correct Answer: 1,2,4 Rationale 1: Continuity of care may suffer when care is given by more than one person. Rationale 2: Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. Rationale 3: Team nursing does save on personnel costs. Rationale 4: The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. Rationale 5: Team nursing does reduce the numbers of professional staff required.

CHAP 10 Which situations would cause concern about liability with regard to delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 3. The nursing assistant asks a nurse to check the status of a client on the team. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment. 5. The charge nurse asks a staff nurse's opinion on the client's surgical incision.

Correct Answer: 1,2,4 Rationale 1: The LPN cannot usually work with central lines and cannot legally change the dressing for the RN. Rationale 2: Confidential information cannot be shared with individuals not directly involved in the client's care. Under normal circumstances, the nursing supervisor would not need information about a client's history. Rationale 3: It is acceptable for a nursing assistant to ask the nurse to check on a client. Rationale 4: Requesting that a nurse be given a difficult assignment is leaving the organization open to liability issues. Rationale 5: It is common and acceptable for nurses to ask other nurses for consultation on client care

CHAP 5 A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

Correct Answer: 1,2,4,5 Rationale 1: Modifying the change and compromising with resisters is a valid strategy. Rationale 2: Trying to change too much too fast can escalate resistance. Rationale 3: Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed. Rationale 4: Overcoming resistance is often necessary for change to occur. Rationale 5: In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.

CHAP 6 The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 3. The CQI coordinator has used the process in practice for over 2 years. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.

Correct Answer: 1,2,4,5 Rationale 1: The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation. Rationale 2: Quality measures should document that evidence-based practice was given. Rationale 3: Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure. Rationale 4: The monitor is written in the "positive," meaning that the process is desirable. Rationale 5: The process should have minimal or no unintended adverse effects.

CHAP 8 Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "I read a research article that reported that clients sleep better if they have been bathed right before bedtime." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too."

Correct Answer: 1,2,4,5 Rationale 1: This is an underlying assumption about why this change is being considered. Rationale 2: This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. Rationale 3: A research article report is not an assumption, but is based on evidence. Rationale 4: This is an assumption that might well be erroneous. Rationale 5: This is an assumption.

CHAP 10 A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 3. Delegation is required by state boards of nursing. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.

Correct Answer: 1,2,4,5 Rationale 1: When delegation is appropriate, work gets done in a timely manner and overtime decreases. Rationale 2: Delegation helps get work done efficiently and effectively. Absences tend to decrease in this environment. Rationale 3: Delegation is permitted by state boards of nursing, but it is not required. Rationale 4: Delegation results in care that is efficient and effective. Efficient and effective care results in increased patient satisfaction. Rationale 5: Delegation results in each part of the team working at their designated skill level. Nurses are not doing tasks that could be done by assistants. This results in increased productivity.

CHAP 2 A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 3. There may be unrest because of the high proportion of management positions filled from outside the organization. 4. There is continual upheaval as the organization responds rapidly to changes in the external environment. 5. Managers have limited knowledge of general management techniques.

Correct Answer: 1,2,5 Rationale 1: Coordination across functions can be complex and poor in a functional structure. Rationale 2: Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work. Rationale 3: Typically, in a functional structure, promotion occurs from within. Rationale 4: Typically, response to changes in the external environment is very slow in organizations with functional structure. Rationale 5: Many managers in functionally structured organizations rise "up the ranks" to their position; there is often very little formal management training.

CHAP 3 Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It ensures that the staff doesn't get overtime." 4. "It improves physician efficiency." 5. "It provides skilled care by skilled staff."

Correct Answer: 1,2,5 Rationale 1: Structure is necessary to ensure that care is coordinated. Rationale 2: Structure is necessary to ensure that all care responsibilities are covered. Rationale 3: While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. Rationale 4: The objective of structuring nursing care is not to ensure physician efficiency. Rationale 5: Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills.

CHAP 6 The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A client's hand is injured during an arterial blood gas draw. 2. A client's family is dissatisfied with the breakfast just served. 3. A client leaves the hospital against medical advice (AMA). 4. A client claims he is not ready to be discharged. 5. The family does not want a client to be transferred from the intensive care unit (ICU).

Correct Answer: 1,3 Rationale 1: Any reaction or injury associated with a diagnostic test must be reported as an incident. Rationale 2: The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed. Rationale 3: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. Rationale 4: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. Rationale 5: The physician and health care team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition.

CHAP 10 Which statements would be important for the charge nurse to make when delegating a responsibility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 2. "I have assigned you to be the unit's representative because I don't have enough time to go." 3. "I think your attendance at the task force meeting will be a good reflection on our unit." 4. "I chose you to attend the meeting because it seems as though you have the lightest assignment." 5. "I would like you to be the unit's representative on the client education task force committee."

Correct Answer: 1,3 Rationale 1: Key behaviors in delegating tasks are describing the task and providing the delegate with the benefit gained for the task. Rationale 2: Delegating should be done for the right reasons and not to dump tasks for purely personal reasons. Rationale 3: Key behaviors in delegating tasks are describing the task as well as the benefits to be gained. Rationale 4: The delegate should be assigned because the task meets the delegate's abilities. Rationale 5: The delegator should make the delegate aware of the reason for and the benefits gained from the delegation.

CHAP 9 The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 2. "I don't see why another position cannot be funded. We have met our budget each year for the last 3 years." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress." 4. "I can understand what you said about budget being tight, but we still need the position." 5. "Do you not understand how hard my nurses are working?"

Correct Answer: 1,3 Rationale 1: Negative assertion occurs when the speaker accepts some of the blame for the situation. Rationale 2: This is an example of negative inquiry. Rationale 3: Negative assertion is accepting some of the blame. Rationale 4: This is an example of fogging. Rationale 5: This is a confrontational statement and should be avoided.

CHAP 4 According to the behavioral view of leadership, how are leaders formed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. By being educated 2. From inborn traits 3. With training 4. Through life experiences 5. Through abilities

Correct Answer: 1,3,4 Rationale 1: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 2: Some researchers believe leaders are born with personality traits that make them successful in leadership. This is not part of behavioral theory. Rationale 3: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 4: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 5: Abilities may develop in a variety of ways. This is not a part of behavioral theory.

CHAP 5 A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the health care environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change.

Correct Answer: 1,3,4 Rationale 1: Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy. Rationale 2: The pros and cons of the change should be openly discussed. Rationale 3: Change is constant in health care. Rationale 4: Emphasizing the positive outcomes of the change is a strategy to reduce resistance. Rationale 5: The nurse manager should maintain support for and confidence in all staff.

CHAP 3 A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "If a client is not able to follow the critical pathway, a variance will be written." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge." 5. "Using critical pathways will help us reduce length of stay and costs to the client.

Correct Answer: 1,3,4 Rationale 1: Critical pathways are designed to direct the care of many disciplines. There is no reason to believe that physical therapy will no longer be available to help with client ambulation. Rationale 2: Variances are written when the client is not making progress according to the critical pathway. Rationale 3: The critical pathway orients staff to the outcomes that should be achieved by the client each day. Rationale 4: If the client has variance from the critical pathway, it may be revised. Rationale 5: Critical paths use resources appropriate to the care needed, and thereby reduce cost and length of stay.

CHAP 1 A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Open access to the blog may damage recruiting efforts. 2. Blogs are difficult to use and expensive to maintain. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organization's reputation may be altered by a blog. 5. Most nurses would likely not use the blog.

Correct Answer: 1,3,4 Rationale 1: Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news. Rationale 2: Blogs are inexpensive and easy to use. Rationale 3: As blogs becomes more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely. Rationale 4: The organization's reputation could be either enhanced or damaged by bloggers' comments. Rationale 5: Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog.

CHAP 4 The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The ability to be empathetic to clients and staff 2. Ability to sustain high energy for long periods of time 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique 5. Long history of leadership success

Correct Answer: 1,3,4 Rationale 1: Empathy is a characteristic of a servant leader. Rationale 2: The ability to sustain high energy is common in many leaders and is not particular to a servant leader. Rationale 3: An awareness of others and their needs is a characteristic of the servant leader. Rationale 4: The use of persuasion is characteristic of the servant leader. Rationale 5: A long history of leadership success is not unique to a servant leader.

CHAP 4 A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Where will the service be housed? 2. Why were the nurses asked to participate? 3. When will the service begin? 4. Who will provide the services? 5. How will money for the project be raised?

Correct Answer: 1,3,4 Rationale 1: Where is an important question in planning. Rationale 2: While it is important to ask "why" when planning, the correct "why" in this case is "Why are we providing this service?" Rationale 3: When is an important aspect of planning. The timeline for implementation is critical. Rationale 4: There are numerous possibilities for answering this question. It is important to consider when planning. Rationale 5: This question is not as essential for this committee. Finding money for the project would not be a nursing function.

CHAP 6 In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Investigating a complaint about nursing care from a client's spouse 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

Correct Answer: 1,3,4,5 Rationale 1: By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint. Rationale 2: Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous. Rationale 3: The nurse manager is in a position to discuss improvement of client care across disciplines. Rationale 4: The nurse manager can help make work more efficient by keeping staff members on task throughout the workday. Rationale 5: When staff members are tired from working overtime, they are more likely to make errors.

CHAP 8 Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

Correct Answer: 1,3,4,5 Rationale 1: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 2: There is no evidence to support that a decision made by an individual results in greater commitment. Rationale 3: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 4: The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. Rationale 5: Routine decisions are often made by individuals, with no group input necessary.

CHAP 7 Which strategy could be used by nurses to promote nursing's power image? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Maintaining expertise by attending continuing education events 2. Encouraging clients to write letters of praise for a job well done 3. Encouraging all disciplines to work towards organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies

Correct Answer: 1,3,4,5 Rationale 1: Nursing is a knowledge profession, and the nurse must maintain expertise in order to retain power. Rationale 2: Nurses must effect this image personally, not through their clients or other disciplines. Rationale 3: Today's health care environment requires collaboration across disciplines. The nurse who can effectively work with others toward organizational goals is powerful. Rationale 4: Working with and knowing people of influence helps to increase the nurse's power. Rationale 5: Asking questions serves a twofold purpose: the nurse is increasing his or her personal knowledge base, and the nurse is seen as being an interested and active participant in the work of the organization.

CHAP 3 What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. How to optimize use of nursing knowledge 2. The system used by competing hospitals 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment

Correct Answer: 1,3,4,5 Rationale 1: Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system. Rationale 2: The system used by competing hospitals is not of great importance in choosing the system for a new hospital. Rationale 3: The provision of safe and effective nursing care is the most important of all considerations. Rationale 4: Optimizing nursing skills is an important consideration when choosing a nursing care delivery system. Rationale 5: The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ.

CHAP 8 Which statements exemplify the attributes of critical thinking essential to nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am always curious about why we do things the way we do." 2. "I think we need to hurry up and make a decision." 3. "Can you help me understand your perspective a little better?" 4. "I don't think that your concern is necessarily pertinent to this issue." 5. "I don't think I can make that decision until I have more information."

Correct Answer: 1,3,5 Rationale 1: Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. Rationale 2: A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. Rationale 3: The critical thinker considers the possible alternative perspectives. Rationale 4: The critical thinker does not discount the concerns of others who have knowledge of the issue. Rationale 5: The critical thinker collects and analyzes the facts before considering any decision.

CHAP 2 A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Much of the care provided is based on standard operating procedure. 2. Information from the organization refers to the work done as "throughput." 3. There is a well-defined chain of command in the organization. 4. During interviews with staff, the words creativity and flexibility are often used. 5. The facility's organizational chart reveals departmentalization.

Correct Answer: 1,3,5 Rationale 1: Division of work, specialization, and standardization are valued in the classical theory. Rationale 2: Input, throughput, and output are terms used in systems theory. Rationale 3: The classically organized facility has a well-defined chain of command. Rationale 4: Creativity, flexibility, and fluidity are all prized components of the chaos theory. Rationale 5: Classical theorists developed the concept of departmentalization as a means to maintain control, reinforce authority, and provide a formal system for communication.

CHAP 2 A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these health care providers should ensure which resources are available? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electronic medical records (EMR) technology 2. A sufficient number of older adults who require long-term care 3. An understanding of the complexity of multiple-need clients 4. A robust marketing plan that describes the home's physical environment 5. A plan for compensation for the primary care provided

Correct Answer: 1,3,5 Rationale 1: For medical homes to be most effective, EMR should be implemented. Rationale 2: A medical home is not the same as a long-term-care facility. Rationale 3: One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions. Rationale 4: The medical home is not a bricks-and-mortar facility. Rationale 5: Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home.

CHAP 3 The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All persons caring for the client must have excellent communication skills.

Correct Answer: 1,3,5 Rationale 1: If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. Rationale 2: Physician, nurse, and client satisfaction is generally increased with primary care. Rationale 3: The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. Rationale 4: Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. Rationale 5: Excellent communication must exist between the primary nurse and associate nurse. This is often difficult.

CHAP 1 The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Preparing for a surge of casualties in case of a disaster 2. How to prevent disasters from occurring 3. How to fund disaster management 4. How to reduce disaster impact on clients and staff 5. How to identify risks for disasters

Correct Answer: 1,4 Rationale 1: One of the primary focuses of a disaster plan is how to care for the influx of clients. Rationale 2: Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan. Rationale 3: Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay. Rationale 4: There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact. Rationale 5: Risk identification is part of a safety plan.

CHAP 5 The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

Correct Answer: 1,3,5 Rationale 1: It is important to identify who is in control of the way things are being done currently. Rationale 2: Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change. Rationale 3: Early knowledge of who will lose in the change is essential to preparation. Rationale 4: Costs and benefits of the change should be assessed but are not a part of the political climate. Rationale 5: Political climate involves power, benefits, and losses.

CHAP 6 Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 2. The number of nurses who hold a bachelor's degree will increase by 10 percent this year. 3. Wait times in the emergency department will decrease by 15 percent this year. 4. Employee absences will drop by 10 percent this year. 5. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.

Correct Answer: 1,3,5 Rationale 1: No waste is an IHI goal. Rationale 2: Increasing the educational preparation of nurses is not an IHI goal. Rationale 3: No unwanted waiting is an IHI goal. Rationale 4: Employee attendance is not an IHI goal. Rationale 5: No needless pain or suffering is an IHI goal.

CHAP 5 A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I know that suggesting this change may backfire on me." 2. "I don't expect too much conflict or resistance to this change." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 4. "I think the status quo is just fine for now." 5. "This change is certainly going to be a challenge, but that's okay."

Correct Answer: 1,3,5 Rationale 1: This statement exemplifies the willingness to take risks that is necessary to become a change agent. Rationale 2: The nurse should always expect that change will be met with resistance and possible conflict. Rationale 3: Nurses should always look for ways to improve client outcomes. Rationale 4: Change occurs when people become uncomfortable with the status quo. Rationale 5: Accepting that change is challenging is part of being a change agent.

CHAP 6 Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse routinely changes nursing notes after a client is discharged. 2. A physician order is overlooked on a newly admitted client. 3. An unlicensed assistant drops a client. 4. A nurse does not complete an incident report after a medication error. 5. A nurse miscounts narcotics.

Correct Answer: 1,4 Rationale 1: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis. Rationale 2: Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error. Rationale 3: Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors. Rationale 4: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Rationale 5: Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.

CHAP A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There are problems with delegation. 2. There are problems with the skill set of the UAPs on the teams. 3. The LPNs on the team do not accept their position of being "in the middle." 4. Communication on the team or with the nurse manager is flawed. 5. RNs and LPNs struggle with who is in control and has the power on the team.

Correct Answer: 1,4 Rationale 1: If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective. Rationale 2: Problems with UAP skill sets can be overcome by education. This is not a common reason team nursing does not work. Rationale 3: While LPNs can be "in the middle" between the UAP and the RN, there is no indication that this is a common problem. Rationale 4: Poor communication is a common problem and can make the team approach ineffective. Rationale 5: There is no indication that this is a common issue.

CHAP 6 A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Newly hired radiology technicians 2. People who are visiting clients admitted within the last 2 days 3. Physicians who have admitting privileges 4. Nurses who have worked at the facility over 5 years 5. Vendors who supply disposable medical equipment to the hospital

Correct Answer: 1,4 Rationale 1: Internal customers include employees and departments within the organization. Rationale 2: Visitors are considered external customers. Rationale 3: Physicians are considered external customers. Rationale 4: Nurses are hospital employees and are therefore considered internal customers. Rationale 5: Vendors are not employed by the hospital and are considered external customers.

CHAP 5 A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I don't care what they say; I'm not giving care that way." 2. "I don't think this is going to work, but I'll probably come around to it sooner or later." 3. "I'm not crazy about this idea, but we do need to change how we are providing care." 4. "I bet I can make it very difficult for this change to occur." 5. "It won't be so bad. I like change."

Correct Answer: 1,4 Rationale 1: Rejecters often respond with active opposition. Rationale 2: This statement is characteristic of an early or late majority resister. Rationale 3: Acknowledging that change is necessary is characteristic of an early adopter. Rationale 4: Making the change more difficult is a form of sabotage, which is characteristic of a rejecter. Rationale 5: Innovators love change and thrive on it.

CHAP 2 The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Functional 2. Shared governance 3. Service-line 4. Parallel 5. Matrix

Correct Answer: 1,4,5 Rationale 1: A functional structure is a traditional organizational structure. Rationale 2: Shared governance is a new, more relationship-based organizational structure. Rationale 3: A service-line structure is a new, more relationship-based organizational structure. Rationale 4: A parallel structure is a traditional structure, even though it is more modern than a functional structure. Rationale 5: Matrix is a traditional structure.

CHAP 9 A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input via text message and promise to respond to texts immediately

Correct Answer: 2,3 Rationale 1: Generation X members do not like group problem solving and decision making. This is more the style of baby boomers. Rationale 2: Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. Rationale 3: Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. Rationale 4: Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. Rationale 5: Generation Y is more likely to want immediate feedback from e-mails or text messages.

CHAP 1 A health care organization has just achieved Magnet status. During the award ceremony the organization's chief executive officer should give primary praise for this achievement to which employees? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Medical staff 2. Nurse executive 3. Staff nurses 4. Managers in support services such as laboratory and radiology 5. Administrative professionals overseeing services such as accounting, billing, and medical records

Correct Answer: 2,3 Rationale 1: Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players. Rationale 2: While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. Rationale 3: Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence. Rationale 4: While these employees would be involved in this effort, Magnet status is focused on nursing excellence. Rationale 5: While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence.

CHAP 3 The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It is the most cost-effective way to manage a hospital. 2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing. 4. When the environment is better for nursing, it is also better for other disciplines. 5. Most of the strategies that improve the environment for nursing do not cost anything.

Correct Answer: 2,3 Rationale 1: Making the environment better for nurses may not be the most cost-effective strategy. Rationale 2: Research indicates that a better nursing environment is associated with lower mortality rates. Rationale 3: An environment that is better for nurses is associated with greater nurse satisfaction. Rationale 4: There is no evidence that improving the environment for nursing improves the environment for other disciplines. Rationale 5: There is little that can be done in a hospital environment that does not entail at least some cost.

CHAP 4 Which nurse has legitimate leadership authority in the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Staff nurse 2. Nurse manager 3. Case manager 4. Quality improvement coordinator 5. Education specialist

Correct Answer: 2,3 Rationale 1: Staff nurses are not seen as having legitimate leadership authority. Staff nursing is not a management or leadership role. Rationale 2: Nurse managers have legitimate authority conferred by the organization and described in job descriptions. Rationale 3: Case managers have legitimate authority conferred by the organization and described in job descriptions. Rationale 4: The leadership of the quality improvement coordinator is informal and stems from the nurse's knowledge. Rationale 5: The leadership of the education specialist is informal and stems from the nurse's knowledge.

CHAP 6 The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The CQI coordinator 2. The hospital CEO 3. The vice president in charge of finance 4. Members of the CQI team 5. The team leader

Correct Answer: 2,3 Rationale 1: The CQI coordinator is appointed by a member of the resource group. Rationale 2: The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. Rationale 3: The resource group is made up of senior management such as the CEO and vice presidents. Rationale 4: Team members are not part of the resource group. Rationale 5: The team leader is not a part of the resource group

CHAP 8 A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic.

Correct Answer: 2,3 Rationale 1: With decisions made under certainty, there is little if any risk. Rationale 2: When a decision is made under certainty, the possible alternatives are known. Rationale 3: When a decision is made under certainty, the conditions surrounding possible alternatives are clear. Rationale 4: If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. Rationale 5: Complex and dynamic decisions are those made under uncertainty.

CHAP 5 The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I would like to focus on completing this process so we can move on." 2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?" 5. "I think it does not really matter when we institute this change, as long as it is over quickly."

Correct Answer: 2,3,4 Rationale 1: Completing the process is not the major focus of the work. Rationale 2: Those involved in change should be certain that sufficient data is present to make an informed decision. Rationale 3: Persons working on this committee should be aware of obstacles they may face. Rationale 4: It is important to consider the opinions of the organization's stakeholders. Rationale 5: Getting the change instituted quickly is not the focus of committee work.

CHAP 4 The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse attended over 80 percent of staff meetings but offered little input into discussion. 2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous access catheter, the nurse used one of the devices the next time an IV was ordered. 5. When asked for an opinion on an issue dividing the unit, the nurse replies, "I don't know. What do you think?"

Correct Answer: 2,3,4 Rationale 1: Merely attending staff meetings is not a sign of good followership. Rationale 2: Active, positive participation shows good followership. Rationale 3: As long as the critique is private, this demonstrates that the nurse is engaged and thinking about the processes. Rationale 4: Taking the initiative to try out changes is considered good followership. Rationale 5: This is an example of dependent thinking, which is not good followership.

CHAP 7 Which statements reveal that the nurse being described has real power? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "She is so powerful. I have to admit I'm a little afraid of her." 2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation." 5. "She knows how to use her power to get what she wants."

Correct Answer: 2,3,4 Rationale 1: Real power does not come from fear. Rationale 2: Respect is one of the principles of principle-centered or real power. Rationale 3: Honor is one of the principles of principle-centered or real power. Rationale 4: Loyalty is one of the principles of principle-centered or real power. Rationale 5: Using power for one's own purposes is not part of principle-centered or real power.

CHAP 3 A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Seniority 2. Educational level 3. Experience 4. Nurse preference 5. Affordability

Correct Answer: 2,3,4 Rationale 1: Seniority does not mean competence. Rationale 2: Differentiated practice takes education (primarily associate's degree and bachelor's degree) into consideration when determining nursing responsibilities. Rationale 3: Experience is considered in differentiated practice. Rationale 4: Nurse preference is taken into consideration in differentiated practice. Rationale 5: While cost containment is always an issue, in true differentiated practice it is not a primary determinant of responsibilities.

CHAP 6 The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The hospital CEO 2. A representative from pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain 5. A representative from social services

Correct Answer: 2,3,4 Rationale 1: The CEO is not involved in the process of managing clients' pain and would not be part of this investigation. Rationale 2: As pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting. Rationale 3: As the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting. Rationale 4: The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group. Rationale 5: It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group.

CHAP 1 Which health care situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase.

Correct Answer: 2,3,4 Rationale 1: The philosophy of quality management is focus on the needs of the consumer. If there is no reason for the visitors to leave other than it after visiting hours, this is not focused on client need. Rationale 2: Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management. Rationale 3: Quality management empowers the employee to evaluate quality. Rationale 4: This nurse has seen a need and is working to improve the quality of service. This is quality management. Rationale 5: Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management.

CHAP 10 The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse manager is inexperienced and needs time to adjust. 2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills. 5. The unit is short staffed.

Correct Answer: 2,3,4 Rationale 1: There is nothing in this scenario to suggest that the nurse manager is inexperienced. Rationale 2: The unit clearly is having problems getting client responsibilities completed in a timely manner, resulting in stress and complaints. Reasons behind this might include distrust, poor communication, and a lack of delegation training. Rationale 3: When multiple client complaints are lodged against one unit, there is generally an overall problem with some aspect of the unit. Rationale 4: A lack of delegation training may result in chaos and client complaints. Rationale 5: There is no indication that the unit is short staffed.

CHAP 7 Which actions diminish the image of power for nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Wearing a crisp, clean uniform 2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question

Correct Answer: 2,3,4,5 Rationale 1: Appearance can add to or detract from power. Rationale 2: The nurse should be professional in all encounters. Using endearing terms is not professional. Rationale 3: Power plays are attempts to diminish or demolish the opponent. The use of power plays is inappropriate. Rationale 4: The nurse should be assertive, not aggressive. Rationale 5: The nurse should not accept orders at face value. The nurse should never implement an intervention without knowing why the intervention is being done, that it is appropriate for the particular client, and what the outcome of the intervention should be

CHAP 3 A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse will determine interventions for all the disciplines needed as part of the clients' care. 2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.

Correct Answer: 2,3,4,5 Rationale 1: Each discipline determines its own interventions. The disciplines collaborate to design care. Rationale 2: Collaboration with other disciplines is a critical component of case management. Rationale 3: A main emphasis of case management is building consensus with physicians caring for the clients. Rationale 4: The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work. Rationale 5: Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team.

CHAP 7 Which statement indicates that a nurse has the skills to be politically involved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse does not take credit for his or her own ideas but attributes them to others. 2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas

Correct Answer: 2,3,4,5 Rationale 1: Getting credit for one's own ideas indicates political savvy. Rationale 2: Being "in the loop" is a sign of political savvy. Rationale 3: Knowing how to deal with a difficult colleague is a sign of political savvy. Rationale 4: A politically savvy nurse's ideas get a fair hearing. Rationale 5: Knowing when and how to present ideas is being politically savvy

CHAP 6 Which situation would be included in reporting for Joint Commission mandatory national patient safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The average wait time in the emergency department has increased by 5 minutes over last year's average. 2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.

Correct Answer: 2,3,4,5 Rationale 1: Increased wait times are not included as a patient safety goal. Rationale 2: Improving staff communication is one of the Joint Commission's national patient safety goals. Rationale 3: Using medications safely is one of the Joint Commission's national patient safety goals. Rationale 4: Preventing infection is one of the Joint Commission's national patient safety goals. Rationale 5: Preventing mistakes in surgery is one of the Joint Commission's national patient safety goals.

CHAP 6 Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I'm not interested in this program." 2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

Correct Answer: 2,3,4,5 Rationale 1: Lack of interest on the part of nurses is not a reason EBP is not used. Rationale 2: Lack of time is a barrier to using EBP that is consistent across settings. Rationale 3: The need for autonomy over the nurse's own practice can be a barrier to using EBP. Rationale 4: Inability to find and assess evidence is a barrier to using EBP. Rationale 5: Lack of support from administration is a barrier to using EBP.

CHAP 7 As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ability to reward others 2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Being friendly, helpful, and likable

Correct Answer: 2,3,4,5 Rationale 1: Reward power is not a source of personal power. Rationale 2: Technical competence and knowledge are part of expert power. Expert power is a personal power. Rationale 3: Ability to access data is information power. Information power is a personal power. Rationale 4: Formal and informal links with people of influence are the basis of connection power. Connection power is a personal power. Rationale 5: Admiration and respect for an individual is based partly on the person's friendliness, helpfulness, and likability. Admiration and respect result in referent power. Referent power is a personal power.

CHAP 3 Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 2. The nurse provides the client with the URL for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Correct Answer: 2,3,4,5 Rationale 1: The chronic care model manages how care is delivered, not a specific disease. Rationale 2: Self-management is one of the six components of the chronic care model. Rationale 3: Decision support is one of the six components of the chronic care model. Rationale 4: Use of clinical information systems is essential to the chronic care model. Rationale 5: Use of community resources is one of the six components of the chronic care model.

CHAP 9 The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

Correct Answer: 2,3,4,5 Rationale 1: This topic is diffuse and hard to understand. More precise topics should be used. Rationale 2: Role understanding is essential to collaboration. It must include both roles. Rationale 3: Role understanding is essential to collaboration. It must include both roles. Rationale 4: Communication is the key to collaboration. Rationale 5: Listening is an essential part of communication.

CHAP 5 The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure.

Correct Answer: 2,3,5 Rationale 1: It is natural that the staff would discuss the change and its implications. Rationale 2: Adding the new work to the old work is a sign that the transition is not healthy. Rationale 3: This attitude is a sign that the transition is not healthy. Rationale 4: It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues. Rationale 5: Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.

CHAP 1 A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is no mechanism for complaint as the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association. 5. The client can make a public report through the Agency for Healthcare Research and Quality.

Correct Answer: 2,3,5 Rationale 1: The client can still voice concerns even after discharge. Rationale 2: These client satisfaction surveys are a good mechanism for discussing care issues. Rationale 3: Telephone calls are a means of discussing client care issues. Rationale 4: ANA is not a forum for complaints about care in a specific hospitalization. Rationale 5: The Agency for Healthcare Research and Quality has a mechanism for reporting care issues.

CHAP 10 A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Begin the instruction with a statement such as "It would be good if you could help me with this project." 2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in e-mail. 4. Introduce the generalities of the task with a promise that details such as a time line will follow shortly. 5. Discuss the importance of the task to the organization.

Correct Answer: 2,3,5 Rationale 1: The manager should use a more direct "I" statement such as, "I need for you to take the lead on this project." Rationale 2: Eye contact helps to ensure that the secretary is attending to the information presented. Rationale 3: Face-to-face communication will be necessary for explanation and questions. Rationale 4: It is important to have all the critical information available so that the delegate can make a logical decision about the task. Rationale 5: It is important to let the delegate know the importance of the task.

CHAP 4 Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "He helped me to understand the structure of the hospital's organization." 2. "I hope to be as good a manager as he is someday." 3. "He negotiated a pay increase for the RNs on the unit." 4. "His example has encouraged me to get to know people in other departments in the hospital." 5. "His assignments are always fair and appropriate for the client census."

Correct Answer: 2,4 Rationale 1: Clarification of organizational structure is part of the manager's job. Rationale 2: A leader uses interpersonal skills to influence others to accomplish a specific goal. Rationale 3: Negotiating pay is a role of the manager. Rationale 4: Leaders help to forge links among the organization's members. Rationale 5: Making assignments is a part of the manager's role.

CHAP 8 Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method

Correct Answer: 2,4 Rationale 1: Experimentation involves testing a theory to produce a prediction. Rationale 2: Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. Rationale 3: Satisficing involves choosing a solution to meet minimum standards of care. Rationale 4: Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. Rationale 5: The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved.

CHAP 4 The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Deciding on the skill mix necessary for direct client care 2. Selling the new system to the current emergency department staff 3. Comparing the actual results of the new system to the projected results 4. Telling staff what to do 5. Coaching the staff through the implementation of a new schedule

Correct Answer: 2,5 Rationale 1: Deciding on the skill mix would be part of organizing the project. Rationale 2: Convincing or "selling" the new idea is part of the directing phase. Rationale 3: This comparison is part of the controlling phase. Rationale 4: In today's environment the directing phase consists of guidance rather than telling the staff what to do. Rationale 5: Coaching and counseling are two major roles in the directing phase.

CHAP 6 A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices? 2. Can the manager find two or more research studies that support the use of the intervention? 3. Is the intervention one that the manager has seen used in the past? 4. Are the authors of the research articles well-known experts in the field? 5. Is the research study that recommends the intervention rigorous in design and execution?

Correct Answer: 2,5 Rationale 1: The size of the hospital is not significant in selecting evidence-based practice interventions. Rationale 2: Evidence-based practice is most reliable when more than one study has confirmed the results. Rationale 3: Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them. Rationale 4: While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field. Rationale 5: The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design.

CHAP 4 Which leadership activities exemplify a quantum leadership style? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The leader reports how outcomes were achieved. 2. The leader brings cookies and coffee to every early morning meeting. 3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access Internet sites about their disease process. 5. The leader often talks about the "vision" of the organization.

Correct Answer: 3,4 Rationale 1: In quantum leadership, the outcome is more important than how it was achieved. Rationale 2: This social emphasis is more likely to occur with a leader who is transactional. Rationale 3: Change is expected by the quantum leader. Rationale 4: Informational power is shared by the quantum leader. Rationale 5: Focus on vision is an attribute of a transformational leader.

CHAP 1 A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which manager statements would direct these nurses to the forms of strongest clinical evidence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We may find studies that use only one group of subjects." 2. "Look for articles that report on how to use evidence in other clinical situations." 3. "The studies we want are built around the scientific approach to solving problems." 4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness." 5. "Many articles will have information reported by someone who is an expert in the field."

Correct Answer: 3,4 Rationale 1: Studies using only one group of subjects are done in a quasi-experimental design. This is not one of the two strongest forms of evidence. Rationale 2: An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence. Rationale 3: Using the scientific approach results in statistical evidence, which is one of the two strongest forms. Rationale 4: Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence. Rationale 5: Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence.

CHAP 7 The nurse leader wishes to develop a culture of shared visioning for the health care organization. How should the nurse proceed with this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The leader should be a passive observer in meetings. 2. The leader should encourage a change to a more efficient top-down management system. 3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas. 5. The leader should use coercive primary power.

Correct Answer: 3,4 Rationale 1: The leader is not a passive participant in visioning. Rationale 2: Top-down management is outdated and is not a part of shared visioning. Rationale 3: Shared visioning requires that all those involved in the organization have a say in its future. Rationale 4: Shared visioning is a strategy that encourages innovation. Rationale 5: The leader encouraging shared visioning would not use coercive power.

CHAP 8 Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I would like to change the format we use for shift report, but I'm afraid it would upset staff members who have been here a long time." 2. "This is the decision I have made, and there is no room for discussion." 3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself."

Correct Answer: 3,4,5 Rationale 1: Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. Rationale 2: The leader who does not value input from staff will not promote creativity. Rationale 3: The leader who recognizes the staff's efforts and sacrifices is more likely to energize the staff. Rationale 4: Optimism is crucial to energizing staff and promoting creativity. Rationale 5: Humor is a good method to help energize staff and promote creativity.

CHAP 2 A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Any changes to processes in the facility will be approved at the vice president level. 2. Nurses who have made over five medication errors in the last 12 months will be terminated. 3. Outcome data will be analyzed to identify successful interventions. 4. The primary focus will be on a few major initiatives. 5. Previous quality improvement efforts may or may not be discarded.

Correct Answer: 3,5 Rationale 1: Decentralization empowers staff to implement process improvements. Rationale 2: Lean thinking focuses on the system rather than on individuals. Rationale 3: In lean thinking, the concentration is on interventions that improve outcomes. Rationale 4: This redesign strategy is called "big-dot focus" and may or may not reflect lean thinking. Rationale 5: Decentralization provides a quality improvement infrastructure that disregards only previous efforts that have not proven effective.

CHAP 9 The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I'm sorry, Doctor, but I need for you to repeat the dosage on that medication order." 2. "Doctor, what was the dosage on that medication you just ordered, and do you want the client to get up in the chair today?" 3. "How often did you want the furosemide given?" 4. "Uh, can you tell me if you need for this client to be NPO today?" 5. "Doctor, what rate did you want for the IV?"

Correct Answer: 3,5 Rationale 1: Saying "I'm sorry" discounts the message. Rationale 2: The nurse should focus on one point at a time. Rationale 3: This is a direct statement. Rationale 4: This statement is weak. Avoid "uh" and "um." Rationale 5: This is a direct statement, and it starts with a "name" that gets the physician's attention.

CHAP 7 Which action would help the nurse work with public officials to influence policies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Contact officials only when necessary to avoid becoming a bother. 2. Avoid social media contact with officials. 3. Address only one issue in each correspondence. 4. Depend on form letters for correspondence. 5. Always make an appointment before visiting an elected official.

Correct Answer: 3,5 Rationale 1: The nurse should build relationships with officials by keeping in touch. It is not savvy to make contact only when a need exists. Rationale 2: Email and Twitter are considered viable contact methods. Rationale 3: The nurse should focus the official's attention on one issue. Rationale 4: Handwritten letters get more attention than form letters. Rationale 5: Making an appointment is the best way to ensure that the official will be in the office, will have time to talk, and will be prepared to address the issue.

CHAP 2 As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Decrease the amount of time from client admission to the room to completion of the admission assessment." 2. "Increase client satisfaction survey scores regarding meals." 3. "Decrease the number of medication errors on the unit." 4. "Initiate intravenous therapy within 30 minutes of the order being taken." 5. "Use scanning mechanisms to record the numbers of supplies used."

Correct Answer: 4,5 Rationale 1: Decreasing the time from admission to assessment is an objective. There is no indication of how this is to be accomplished. Rationale 2: Increasing client satisfaction with better meals is an objective. There is no indication of how this would be accomplished. Rationale 3: Decreasing the number of medication errors is an objective. There are no strategies given for how this would be accomplished. Rationale 4: Initiating IV therapy within a specific time is a strategy. It is specific to the task and specifies an action to take. Rationale 5: Using scanning mechanisms is an example of how something would be done, so it is a strategy.

CHAP 5 Which statements by the nurse manager would demonstrate effective change management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If this approach doesn't work, at least we can say we've tried." 2. "Let's wait until the administration has completed their reorganization before we implement change." 3. "In order for this plan to work, everyone must agree to participate." 4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

Correct Answer: 4,5 Rationale 1: This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting. Rationale 2: This statement suggests that the manager may not be completely in favor of the change. In some cases the staunchest resister is the manager. Rationale 3: If the nurse manager waits until everyone agrees to be a participant in change, change will never occur. Rationale 4: All changes and actions that occur within an organization should flow from the mission and values. Rationale 5: It is important to acknowledge that change is difficult. Full support of the administration makes change easier.