Yoder-Wise Ch 3 Legal/Ethical Issues, Chapter 08: Communication and Conflict Yoder-Wise: Leading and Managing in Nursing, 7th Edition, Chapter 15: Making Decisions and Solving Problems Yoder-Wise: Leading and Managing in Nursing, 7th Edition, Chapter...

24. Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. retains accountability for the care of the patient. b. worked the same shift as Leslie. c. has passive accountability for delegation. d. retains accountability for the outcomes of care for the patient.

ANS: D Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

16. Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to provide quality patient care, and they express their concerns to senior management. The CEO of Valley Hospital makes the following statement: "We need to contain costs because our funding has been decreased." This is a good example of which of the following conditions that propel a situation toward conflict? a. Incompatible goals b. Role conflicts c. Structural conflict d. Competition for resources

ANS: A Conflicts arise in four areas: goals, facts, approaches, and values. Conflicts among goals arise from competing priorities such as the provision of quality patient care and containment of costs.

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions may not apply in this situation? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

ANS: A (Elements of malpractice: Duty owned the patient: failure to monitor a patient's response to treatment. Breach of the duty owed: failure to communicate change in patient status to the primary healthcare provider. Foreseeability: failure to ensure minimum standards are met, Causation: failure to provide adequate patient education. Injury: fractured hip and head concussion after a patient fall. Damage: Additional hospitalization time, future medical and nursing care needs and costs. ) By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

9. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. identify the root causes of problems. b. list possible solutions to problems. c. help leaders select the best options. d. evaluate the outcomes of decisions made.

ANS: A A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

22. Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations? a. The task and the outcome are relatively simple and defined. b. It is unlikely that the group will reach a consensus. c. A decision has to be discussed thoroughly. d. A number of options need to be considered.

ANS: A An autocratic style is appropriate when rapid decision making is required and in situations where the task and the potential outcome are well-defined.

A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse: a. Had previously reported the complaint, in writing, to hospital administration. b. Had threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

ANS: A An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law. the first exception is a public policy exception, this exception involves cases in which an employee is discharged in direct conflict with established public policy. Under this exception, an employer may not discharge an employee if it would violate the state's public policy doctrine or a state or federal statute, some examples include discharging an employee for serving on a jury, reporting employer's illegal actions (better known as whistle blowing, or the disclosure of information regarding misconduct within a workplace that either is illegal or endangers the welfare of others) and filling a workers' compensation claim. most states and the District of Columbia recognize public policy as an exception to the at will rule. What hack is this question???????

3. The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. What factor can increase stress and escalate conflict? a. The use of avoidance b. An enhanced nursing work force c. Accepting that some conflict is normal d. Managing the effects of fatigue and error

ANS: A Avoidance as a conflict-management style prolongs conflict and tends to escalate conflict.

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

ANS: A Beneficence refers to doing what's good for the patient; in this situation, doing what's good means providing care to the patient with the best likelihood of recovery.

2. The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would: a. involve the rehab staff in the decision. b. involve the sales representative. c. make the decision alone. d. involve administration in the decision.

ANS: A In a shared decision model, the decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction.

13. The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process? a. Assessment/Data collection b. Planning c. Data interpretation d. Generating hypotheses

ANS: A In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining if there is a problem or problems.

5. Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Sarah is experiencing which type of conflict? a. Intrapersonal b. Interpersonal c. Organizational d. Professional

ANS: A Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with that person's sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. Some issues present a conflict over comfortably maintaining the status quo and taking risks to confront people when needed, which can lead to interpersonal conflict.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. Privacy. b. Confidentiality. c. Veracity. d. Informed consent.

ANS: A Privacy protection includes protection against unwarranted intrusion into the patient's affairs.

A colleague asks you to give her your password access so that she can view her partner's healthcare record. This request violates the patient's right to: a. Privacy. b. Confidentiality. c. Undue authorization of treatment. d. Protection against slander.

ANS: A Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient's solitude. Privacy standards limit how personal health information may be used or shared and mandate safeguards for the protection of health information. Institutions can reduce potential liability in this area by allowing access to patient data, either written or oral, only to those with a "need to know." Persons with a need to know include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and patient advocates. Others wishing to access patient data must first ask the patient for permission to review a record. confidentialyity: is the right to privacy of the health record.

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child's physician of his concerns about deterioration in the child's status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for: a. Professional negligence. b. Assault. c. Avoidance. d. Murder.

ANS: A Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child's condition.

14. Which of the following would be most in line with Hersey model and concepts? a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

ANS: A The Hersey model/framework suggests that when ability (skills, job knowledge) and willingness are strong, the involvement of the delegator is less.

14. A good nursing decision maker is one who: a. uses various models to guide the process based on the circumstances of the situation. b. adopts one model and uses it to guide all decision making. c. decides not to use any models because they are all useless. d. develops a new model each time a decision has to be made.

ANS: A The decision model that a nurse uses depends on specific circumstances. Is the situation routine and predictable or complex and uncertain? Is the goal to make a decision that is "just good enough" (conservative) or one that is optimal?

7. After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. observe to make sure the conflict has been resolved. b. fire both staff nurses. c. reassign both staff nurses. d. reassign the nurse manager.

ANS: A The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care.

14. A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. b. horizontal violence involves those with similar status but little power in the larger context. c. interprofessional collaboration reduces unresolved conflicts. d. all conflicts involve some level of disagreement.

ANS: A The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers: a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

ANS: A The purposes of the ADA are to eliminate discrimination against persons with disabilities and to provide consistent, enforceable standards to address discrimination in the workplace. The Americans with Disabilities Act of 1990 provides protection to persons with disabilities and is the most significant civil rights legislation since the Civil Rights Act of 1964. the purpose is to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities and to provide clear, strong, consistent, enforceable standards addressing discrimination in the workplace.

4. The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain: a. accountable. b. responsible. c. authoritative and liable. d. responsible and task-oriented.

ANS: A When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, "accountability rests within the decision to delegate while responsibility rests within the performance of the task" (Anthony and Vidal, 2010, p. 3).

With regard to nursing practice, nurse managers are held responsible for (select all that apply): a. Practicing within legal guidelines established under state law and nurse practice acts. b. Ensuring that nursing staff under their supervision are currently licensed to practice. c. Referring all errors in nursing judgment to state discipline boards. d. Ensuring that physicians are properly licensed to provide care on patient care units.

ANS: A, B Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid licensure.

1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have:(Select all that apply.) a. identified what assumptions were underpinning the issues. b. considered why it was important to make this change or the context for the change. c. considered how this change might affect staff relationships. d. attained a majority consensus of all staff.

ANS: A, B, C Taking a majority consensus is not a step in the critical thinking process. Points A, B, and C are "what," "why," and "how" questions that are part of effective critical thinking processes.

1. Nurses entering the work force today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.) a. Nurse-physician relationship b. Nurse-nurse relationship c. Nurse-patient relationship d. Nurse-chief nursing officer relationship e. Nurse-auxiliary personnel relationships

ANS: A, B, C, D, E By nature, conflict is potentially present in all interpersonal situations. The nurse manager should create an environment that recognizes and values differences in staff, physicians, patients, and communities.

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that (select all that apply): a. Consent must not be coerced. b. The patient has a right to choose not to consent. c. The patient must sign the consent because the doctor wants him to sign. d. Witnessing a consent is related only to the voluntary nature of the signature.

ANS: A, B, D Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing a consent means attesting to the voluntary nature of the patient's signature.

1. An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) a. teaching self-catheterization to a patient with paraplegia who has limited English. b. basic care for a patient with a head injury who is rapidly deteriorating. c. one-to-one observation with a suicidal patient. d. assessment of patients being admitted through the Emergency Department. e. basic hygienic care for a patient who is post MI and stable.

ANS: A, B, D Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In addition, stability, critical thinking, time, and safety are factors that are considered in assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient with limited English requires critical thinking; basic care for a patient who is rapidly deteriorating exemplifies concern with stability; and assessment of patients through Emergency is related to the factor of time. An exception to safety and stability in which patients may be delegated to UNPs is when patients are placed on suicide precautions

4. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: a. routine problems. b. crisis situations. c. managers who prefer a "telling" style. d. followers who cannot agree on a solution.

ANS: B An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

20. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. accountability. b. authority. c. role performance. d. assignment.

ANS: B Authority refers to the right to do and may be designated by law, educational preparation, or job description.

Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

ANS: B Autonomy refers to the right to choose freely, which is inherent in informed consent.

2. Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a. risk taking seems to be unavoidable. b. people see events differently. c. personal and professional priorities do not match. d. the ways in which people should act do not match the ways in which they do act.

ANS: B By definition, conflict involves a difference in perception between two or more individuals.

8. During staff-development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. the amount of paperwork required to complete care. b. the complexity of care required by patients. c. earlier discharge practices. d. the numbers of other disciplines present on a given unit.

ANS: B Complexity of client care, a multilevel nursing model (registered nurses, mixed with LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining the care required and outcomes desired and/or mandated, and in matching needs with various abilities and authority of regulated and unregulated healthcare providers. The nurse manager should ensure that staff is clinically competent and trained in their roles in patient safety.

18. John is a circulating nurse in the operating room. He is usually assigned to general surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies the doctor's preference cards before each patient. The fourth patient comes into the room and John prepares a site for a biopsy using a Betadine solution. The surgeon prefers another solution. He notices what John has done and immediately corrects him by rudely insulting John. What is the appropriate approach to conflict resolution in this example? a. Collaboration b. Compromising c. Avoiding d. Withdraw

ANS: B Compromise involves negotiation or an exchange of concessions and supports a balance of power.

1. A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: a. group decision-making options. b. perceptions of incompatibility. c. increases in group cohesiveness. d. debates, negotiations, and compromises.

ANS: B Conflict involves disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Conflict may result from the interaction of interdependent people who perceive incompatibility and the potential for interference.

10. An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the operating room. The manager should: a. select the least expensive brand. b. use a decision-making tool to evaluate brands. c. ask the nursing staff which brand they prefer. d. select the vendor the institution usually buys from.

ANS: B Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options are known.

22. Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. active delegation. b. passive delegation. c. passive accountability. d. active responsibility.

ANS: B Delegation of functions that are normally considered part of or an essential part of the practice of a licensed person through a position description is considered passive delegation.

9. The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

ANS: B Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation.

11. With delegation, responsibility and accountability remain with the: a. physician. b. professional who delegates. c. individual who receives the delegation. d. individual who previously performed the task.

ANS: B Even though the delegatee (the one who receives the delegation) receives direction from the professional who delegates a task and must have the authority to complete it, the delegator retains accountability for the overall outcome and completion of the activity. The delegatee has responsibility (obligation to engage in the task) and authority for the task.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

ANS: B Known as vicarious liability, the doctrine of respondeat superior makes employers accountable for the negligence of their employees, using the rationale that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.

A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. Compromised agency. b. Moral distress. c. Moral sensitivity. d. Moral dilemma.

ANS: B Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers. nurse managers can best assist nurses experiencing moral distress by remembering that such distress may be lessened through adequate levels of knowledge regarding nursing ethics and its application, acknowledging that such distress does occur and serving as an advocate for nurses.

21. High-quality decisions are most likely to be made in nursing situations when: a. team leaders make the crucial decisions. b. individuals are advised of the problems. c. group size is neither too small nor too large. d. members are passively involved.

ANS: C Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is: a. Employing additional staff to assist with orientation processes. b. Cross-educating staff members to other areas of the institution. c. Transferring patients to units where the staffing pattern is optimal. d. Orienting staff members to all patient care areas as part of their general orientation to the institution.

ANS: B Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and: a. Compensate for previous injuries. b. Eliminate these risks before anyone else is harmed. c. Supersede the need for staff members to file incident reports. d. Discipline staff members who have been involved in previous incident reports.

ANS: B Risk management involves taking proactive steps to identify and eliminate risks and liability.

While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. Discuss that statute law provides for patient autonomy and refusal of treatment. c. Remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. Acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

ANS: B Statute law states that the patient must be given sufficient information, in terms he or she can reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine of informed consent is the right of the patient to informed refusal. Patients must clearly understand the possible consequences of their refusal.

16. Decision making is described by the nursing educator as the process one uses to: a. solve a problem. b. choose between alternatives. c. reflect on a certain situation. d. generate ideas.

ANS: B The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

18. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. incompetence of the UNP. b. failure to follow-through. c. skills but no motivation. d. lack of accountability.

ANS: B The nurse should maintain open lines of communication and seek information, and the UNP should know how, when, and what to report. Communication of delegation of tasks includes specific information about what is being delegated, expected outcomes, and deviations (which includes what immediate action needs to be taken). This 2-way communication and follow-through allows patient care to be altered, if necessary, in a timely manner.

6. The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: a. frustration, competition, negotiation, and action. b. frustration, conceptualization, action, and outcomes. c. frustration, cooperation, collaboration, and action outcomes. d. frustration, conceptualization, negotiation, and action outcomes.

ANS: B Thomas (1992) determined that conflict proceeds through these four stages in this particular order.

10. Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas' stages of conflict? a. Frustration b. Conceptualization c. Action d. Outcomes

ANS: B Thomas' Stages of Conflict include conceptualization, which involves different ideas and emphasis on what is important or not or about what should occur.

20. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: a. the policy was too lengthy and inundated readers with too much detail. b. the policy made decisions for other departments in the company. c. the staff did not believe that the new policy would be effective. d. testing should not be done in the lab.

ANS: B Two primary criteria make for effective decisions. First, the decision must be of a high quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who are responsible for its implementation must accept the decision. Higher quality decisions are more likely to result if groups are involved in the decision-making and problem-solving process. Taking ownership of the process and outcome provides a smoother transition in changes.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

ANS: B Under the law, the state in which the patient resides and not the state where the nurse holds his or her license determines the state nurse practice act that is considered.

6. During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. supportive behavior by the leader and immature followers. b. the development level of the followers and the behavior based on the situation. c. well-developed followers combined with a strong leader who acts quickly. d. the leader's ability to evaluate personnel and communicate that evaluation.

ANS: B When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions, or "telling" behavior. Leaders need to behavior differently and use different leadership styles in different situations.

19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makesvisits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: a. determine Evelyn's educational background and preparation for this role. b. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

ANS: B When delegating tasks, in addition to specifying the task to be completed, outcomes, priorities, time lines, deviations, report time frames, monitoring, and resources, asking the delegatee to give examples of each is helpful in ensuring that communication is clear and has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to determine the knowledge and skill level of the UNP in relation to the skill and the patient before delegating.

13. Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

ANS: B When span of control (number of individuals for whom a manager is responsible) is compromised by geographic factors such as lack of proximity, instability in patients' conditions, or lack of experience, the span of control that is being delegated may lead to unsafe care.

You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. The teen is underage and should be referred to the family general practitioner. c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. d. Treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

ANS: C All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.

A patient refuses a simple procedure that you believe is in the patient's best interest. The two ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice. b. Veracity and fidelity. c. Autonomy and beneficence. d. Paternalism and respect for others.

ANS: C Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence to doing good (performing a procedure that will benefit the patient).

3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: a. evaluate problem solutions. b. critique the ideas of others. c. generate as many solutions as possible. d. identify only practical and realistic ideas.

ANS: C Brainstorming encourages creativity when one is beginning to problem-solve and avoids premature shutting down of ideas through early evaluation. The goal is to generate ideas, no matter how seemingly unrealistic or absurd.

11. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. According to Thomas' four stages of conflict, in which stage could the nurse have been more effective? a. Frustration b. Conceptualizing c. Action d. Outcomes

ANS: C By walking away, the nurse is engaged in an action or a behavioral response, which is the action stage of conflict that is outlined in the four stages of conflict (Thomas, 1992). In this stage, the nurse might have used more effective strategies, such as clarifying Mr. Hill's views on feeding his wife and engaging in dialogue with Mr. Hill to clarify his concerns and attempt to reach a common goal.

12. Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. consistently submits her budgets on time. b. gets along well with her staff and with other managers. c. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. d. actively solicits ideas regarding scheduling from her staff.

ANS: C Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.

8. A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will generate: a. creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers. b. creativity, a staid atmosphere, a weak team spirit, and motivation of its workers. c. creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. d. a bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

ANS: C Differences in ideas, perceptions, and approaches, when managed well, can lead to creative solutions and deepened human relationships. Work on conflict suggests that complete resolution of conflict is counterproductive to the achievement of organizational goals, organizational change, and cohesiveness of employees.

16. An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."

ANS: C If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leader's behavior as explaining or persuading, which, is characterized as "selling." The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. Two nursing practice acts. b. Two nursing practice acts in most states. c. At least one nursing practice act. d. One nursing practice act and a medical act.

ANS: C In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards.

7. The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. acknowledging the arrival of the second UNP on the unit. b. providing clear directions to both UNPs. c. matching tasks with qualified persons. d. receiving reports from the prior shift.

ANS: C In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

9. Jane has transferred from the ICU to the CCU. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates which type of conflict? a. Organizational b. Intrapersonal c. Interpersonal d. Disruptive

ANS: C Interpersonal conflict transpires between and among nurses, physicians, members of other departments, and patients.

15. From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. high-level cognitive process. b. process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. high-level cognitive process that includes creativity, problem solving, and decision making. d. discussion that guides the nursing process.

ANS: C It is generally accepted by many authors and researchers that this statement best defines critical thinking.

22. Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian's relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian's relationships can be more satisfying for Jillian and her team members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation, Lee and Jillian are demonstrating: a. similar conflict management strategies. b. escalation of conflict. c. avoidance and compromise strategies. d. competing and compromise strategies.

ANS: C Jillian is demonstrating avoidance by staying away from meetings to discuss her team relationships, and Lee is demonstrating compromise by offering coaching in return for Jillian's being able to engage in more satisfying relationships.

17. Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? a. Collaborating b. Avoiding c. Negotiating d. Accommodating

ANS: C Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.

17. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making models did Justin use in making his decision? a. Subjective model b. Objective model c. Optimizing model d. Satisficing model

ANS: C Optimizing is a decision style in which the decision maker selects the option that is best, based on an analysis of the pros and cons associated with each option. A better decision is more likely when using this approach, although it takes longer to arrive at a decision.

11. Select the statement that best defines the difference between problem solving and decision making: a. decision-making skills require critical thinking; problem-solving skills do not. b. problem-solving skills require critical thinking; decision-making skills do not. c. decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. d. problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.

ANS: C Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook: a. Under the doctrine of apparent agency. b. Under the doctrine of respondeat agency. c. Based on the employee's or the employer's expectations. d. Based on the theory that the handbook creates an explicit contract.

ANS: C The handbook is an implied contract and frames the employment contract.

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. The ethical principle that you are most directly reinforcing is: a. Justice. b. Fidelity. c. Paternalism. d. Respect for others.

ANS: C The principle of paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. Paternalism becomes undesirable when the entire decision is taken away from the employee. justice: treating all persons equally and fairly fidelity: keeping one's promises or commitments, respect for others: highest principle. respect for others acknowledges the right of individuals to make decisions and to live by these decisions.

2. The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed for the nursing care of the patient. d. Create a task analysis of critical behaviors for the individual.

ANS: C To delegate effectively, the charge nurse must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed.

6. To solve a problem, the nurse manager understands that the most important problem-solving step is: a. the implementation phase. b. identification of numerous solutions. c. accurate identification of the problem. d. evaluation of the effectiveness of problem resolution.

ANS: C To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

21. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: a. passive delegation. b. passive accountability. c. active delegation. d. active responsibility.

ANS: C When a position description contains functions that are considered to be the normal practice of the person in that role, then it is considered a passive delegation act. When Sarah decides what is best for the patients in her care in terms of who should perform the care and then holds the person accountable, she is engaging in active delegation.

23. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. accountability. b. responsibility. c. assignment. d. delegation.

ANS: C When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

ANS: C ethical principles: Autonomy, Beneficence, Nonmaleficence, Veracity, Justice, Paternalism, Fidelity, Respect for others. Fidelity refers to promise keeping or upholding one's promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner. Veracity: telling the truth and demands that the truth be told completely. autonomy: address personal freedom and self-determination, the right to choose what will happen to oneself as well as the accountability for making individual choices.

1. You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey model, would be to: a. have a list of tasks to be accomplished and tell each member of the team what he or she must do. b. encourage people to discuss their frustrations in providing this care. c. ignore them—they've done it before. d. provide minimal direction and let them come to you with questions.

ANS: D According to the Hersey model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less ("delegating behavior").

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. Is limited to the temporary agency. b. Is restricted to the RN. c. Could include the RN, the agency, and your institution. d. May depend on the patient's belief regarding the employment relationship.

ANS: D Apparent agency may apply here because your liability and that of your institution could be established if it can be shown that the patient believes that the RN was an employee of yours and of your institution. Apparent agent/apparent authority refers to the doctrine whereby a principal becomes accountable for the actions of his or her agent, it is created when the person (agent) holds himself or herself out as acting in behalf of the principle, in the instance of the agency nurse, the patient cannot ascertain where the nurse works directly for the hospital or is working for different employer. this principle applies when it can be shown that a reasonable patient believed that the healthcare worker was an employee of the institution.

23. What exemplifies the predominant style of conflict management for staff nurses? a. Sarah and Jonas, two RNs, disagree about the best approach to assisting a family that has complex needs. They decide that they will consult with family and together will decide what is best. b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with Nancy, who wants a day off next to a 3-day break. c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating that she has already helped out for 2 days by staying late for Lindsay. d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

ANS: D Avoidance and accommodation are the predominant conflict management styles of nurses. Accommodating involves neglecting one's own needs while trying to satisfy the needs of another.

20. The head nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new procedure based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with: a. lateral violence. b. horizontal violence. c. confrontation. d. bullying.

ANS: D Bullying involves aggressive or destructive behavior or psychological harassment of a recipient who is in a position of power differential with the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviors as incivility or intimidation.

13. Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most creative conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating

ANS: D Collaboration, although time consuming, is the most creative stance. The collaboration technique involves both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

21. Which of the following exemplifies the predominant conflict management style of nurse managers? a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit. b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs. c. During management meetings, George, the head nurse on nephrology, dominates meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to miss the management meetings. d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

ANS: D Compromise involves trading and negotiation and is the predominant conflict management style of managers.

19. Factors that influence the ease with which conflict is resolved include all except which of the following? a. Level of interdependence of the parties b. Interprofessional collaboration c. Expression of one's own needs and ideas d. Avoidance of the issue or concern

ANS: D Conflict involves a level of interdependence and is a condition for conflict but not necessarily for continuance of the conflict. Expression of one's ideas and concerns is considered assertive and effective in resolving conflict if the concerns and needs of the other are also considered. Interprofessional collaboration has been shown to be effective in resolving conflict. Avoidance tends to prolong and sometimes escalate conflict.

18. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department? a. Replace staff only with qualified applicants. b. Determine what the problem or problems are before hiring new staff. c. Consult with the human resources department and develop a plan for hiring new staff. d. All listed are appropriate to consider.

ANS: D Decision making involves a goal-oriented consideration of many options that are objectively weighed according to their possible risks, consequences, and positive outcomes. The options should be ranked in the order in which they are likely to result in the desired goals or objectives. The solution selected should be the one that is most feasible and satisfactory and has the fewest undesirable consequences. In this instance, all of the options listed might be considered and weighed.

15. In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

ANS: D Delegation communication includes what is being delegated (and what is not), outcomes, specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be consulted. Communication also includes conveying recognition of the authority to do what is expected.

12. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3 months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

ANS: D Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action. Do nothing may also be utilized when the individual is not able to do anything for the particular situation or issue.

5. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. prevented conflict. b. formed highly cohesive groups. c. used majority rule to arrive at decisions. d. encouraged equal participation among members.

ANS: D Groups are more likely to be effective if members are involved, the group is cohesive, communication is encouraged, and members demonstrate some understanding of the group process. The nurse leader or manager should provide a nonthreatening and positive environment in which group members are encouraged to participate actively.

1. The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to: a. use creativity. b. obtain support from the 7-3 shift. c. use institutional research. d. identify the problem.

ANS: D Identification of a problem is the first step in problem solving and occurs before any other step. The most common cause for failure to resolve problems is the improper identification of the problem/issue; therefore, problem recognition and identification are considered the most vital steps.

7. A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: a. stay out of it. b. inform the nursing supervisor. c. fill out a notification form (incident report). d. assess the risk to the client and the agency before proceeding.

ANS: D If the situation is subjective, nonroutine, and unstructured or if outcomes are unknown or unpredictable, the nurse leader and manager may need to take a descriptive or behavioral approach. More information (such as degree of risk to the client and to the agency) needs to be gathered to address this situation effectively.

5. The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. complexity of the task and the age of the delegatee. b. potential for benefit and the complexity of the task. c. potential for benefit and the number of staff. d. complexity of the task and the potential for harm.

ANS: D In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity involved, and level of critical thinking required to achieve desired outcomes.

4. The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: a. identify the conflicting facts. b. be determined to resolve the conflict. c. schedule a meeting time for resolution. d. have a clear understanding of the differences between the parties in conflict.

ANS: D It is important for each person in the conflict to clarify the conflict as "I see it" and how "it makes me respond" before all the persons involved in the conflict can define the conflict, develop a shared conceptualization, and resolve their differences.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

ANS: D Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth. This belief is an example of: a. Justice. b. Fidelity. c. Beneficence. d. Nonmaleficence.

ANS: D Nonmaleficence refers to "doing no harm." For a nurse manager following this principle, performance evaluation should emphasize an employee's good qualities and give positive direction for growth. Destroying the employee's self-esteem and self-worth would be considered doing harm under this principle.

24. In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict isarising from which of the following? a. Staffing practices b. Increased participation in decision making c. Allocation of resources d. Tolerance of incivility

ANS: D Organizational conflict arises from discord related to policies and procedures (such as staffing policies and practices and allocation of resources), personnel codes or conduct or accepted norms of behavior (such as incivility), and patterns of communication. A major source conflict in organizations stems from strategies that promote more participation and autonomy of staff nurses.

15. Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in: a. decreased frustration between the maintenance worker and her. b. a good relationship with the maintenance department. c. eventual resolution of the problem without further intervention. d. decreased productivity on her part.

ANS: D Productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships.

12. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. The outcome as depicted by Thomas' conflict stages can be considered to be: a. compromising. b. confronting. c. constructive. d. destructive.

ANS: D Resolution was absent because the nurse did not have time to effectively deal with the issues in the conflict. This can lead to negativity, increased frustration, and further distancing between individuals or groups, including between patients and nurses.

17. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what does is an appropriate action by the charge nurse? a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

ANS: D The charge nurse and Sally have a well-established relationship and Sally has the expertise towork effectively with David; therefore, the charge nurse would need to provide little guidance but would need to communicate that they are available if needed. Hersey refers to this leader behavior as "delegating."

24. The agency in which you are a nursing leader makes a decision to reduce the number of RN positions in favor of PN positions because agency data suggest that the clients in the agency can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding and without restructuring, some clients might not receive services at all. You provide this information on this decision to the staff and ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as: a. paternalistic. b. shared. c. reasoned d. informative.

ANS: D The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager.

19. When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving? a. Not using a problem-solving model b. Not considering a number of alternatives c. Poor evaluation of outcomes d. Incorrect problem identification

ANS: D The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with "why?".

3. A key advantage that a charge nurse has in terms of delegating is that: a. clients receive less attention because too many staff make it difficult to coordinate care. b. nurses report less pressure to perform necessary tasks themselves. c. administration can predict overtime more accurately. d. team skills can be used more effectively.

ANS: D The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform "what is needed now." As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.

23. Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? a. Ask for requests for vacation time in advance, and post the times. b. Post the completed vacation schedule. c. Post a tentative schedule, and request feedback. d. Post a blank schedule, and ask staff members to fill in their times by a given date.

ANS: D This is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

10. You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

ANS: D When ability and willingness are strong, the involvement of the delegator is needed less.

8. In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unlicensed assistant is available to assist. You must decide which patient situation you will take and where the new graduate RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves: a. a higher order thinking process. b. selecting the best option for reaching a predefined goal. c. optimizing. d. satisficing.

ANS: D With this approach, the decision maker selects an acceptable solution, one that may minimally meet the objective or standard for a decision. This approach allows for quick decisions and may be the most appropriate when lack of time is an issue.