2020 exam 4

Question 1

Contained in this deck

Answer 1

Yodel-Wise chapter 27, 28, 29, 30

giddens chapter 45

Question 2

The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of:

a. Acceptance.
b. Negotiation.
c. Discrepancy.
d. Internalization.

Answer 2

ANS: c. Discrepancy.

Role discrepancy is an experience that includes a gap between what is expected and what is occurring and can lead to disillusionment, discomfort, and frustration. If the unit manager values the relationship and sees the differences between performance and expectations as correctable, then the manager is likely to stay in the role.

Question 3

An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of:

a. Expectations.
b. Opportunities.
c. Responsibilities.
d. Lines of communication.

Answer 3

d. Lines of communication.

No matter what role an individual is in, multiple relationships exist with individuals including supervisors and peers. Roles incorporate patterns of structured interactions between the manager and people in these groups. Organizational charts provide information about relationships and lines of communication in the organization.

Question 4

During an employment interview for the manager’s position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year.
The nurse executive is:

a. Unaware of the turnover rate and difficulties with the medical director.
b. Lying about the problems and hoping to resolve them by hiring the applicant.
c. Denying that the agency has a turnover problem with staff or medical directors.
d. Minimizing the challenges of the position to make a positive impression on the applicant.

Answer 4

d. Minimizing the challenges of the position to make a positive impression on the applicant.

During the dating phase or preview period in the role transition process, the potential employer attempts to
make a favorable impression, which may result in minimizing the challenges of the position.

Question 5

The new head nurse on telemetry has been in the position for 3 months. The head nurse and the administrator disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should:

a. Develop policies consistent with the head nurse’s prior workplace.
b. Attend a workshop on how to deal with difficult people.
c. Decide to give the position 3 more months and then leave if things do not improve.
d. Schedule a series of meetings with staff and the administrator to clarify expectations.

Answer 5

d. Schedule a series of meetings with staff and the administrator to clarify expectations.

During role transition, it is important for the manager to negotiate the role by writing down the manager’s expectations of the role and determining the expectations of others (staff, supervisors) in order to clarify expectations and reduce or ameliorate role ambiguity and role strain. Weinstock (2011) suggests that it takes up to a year to understand the role, system, and boundaries in a new position.

Question 6

A nurse manager in one hospital values a colleague who is a few years older and has more experience in nursing management. The colleague works in another hospital, but they meet for lunch once a month. In these meetings, they share their feelings about nursing management and their lives. The function of a mentor that is missing in the relationship is:

a. Sponsorship.
b. Role modeling.
c. Social interaction.
d. Mutual positive regard.

Answer 6

a. Sponsorship.

Sponsorship involves building the competency of the mentee through exposure or by creating opportunities for achievement in order for the mentee to develop a reputation of competence.

Question 7

The new nurse manager feels pulled between the expectations of staff, the demands of hospital administrators,and family obligations. According to Hardy (1978), unrelieved role stress and strain will lead to:

a. Frustration and anger.
b. Alienation of family and friends.
c. Low productivity and performance.
d. Physical symptoms and acute illness.

Answer 7

c. Low productivity and performance.

Unrelieved role stress and strain leads to focusing energy into negative thoughts and feelings, which can leave the manager fatigued and therefore less likely to be productive or to perform well.

Question 8

The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being near retirement, the former nurse manager wanted to be employed at the hospital and was offered a position on the same unit. The former nurse manager complains often about how infrequently the current nurse manager is available on the unit and argues with physicians and co-workers. Clients have complained about the attitude of the nurse. The behavior of the former nurse manager can be best explained as being caused by:

a. Overwork in the staff nurse position.
b. Inadequate mentoring in the new role.
c. Anger as a stage of the grieving process.
d. Demotion as a threat to personal identity.

Answer 8

c. Anger as a stage of the grieving process.

When an employment relationship ends or changes unexpectedly, grieving occurs. One of the phases in grieving is anger.

Question 9

A nurse is interviewing for a manager’s position. Which of the following actions is considered a role preview?

a. Formal commitment of the employment contract
b. Improving role performance
c. Touring the unit
d. Disillusionment about the expectations of the job

Answer 9

c. Touring the unit

Touring the unit enables the candidate to assess further whether this organization will assist in growth and also to make a positive impression on the potential employer.

Question 10

The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs.
The main purpose of mentoring is:

a. Promoting staff retention.
b. Promoting staff attrition.
c. Developing new role expectations.
d. Promoting staff supervision.

Answer 10

a. Promoting staff retention.

Mentoring has been identified as important to staff retention.

Question 11

A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3 years, has a particular interest in technology and seems to be very enthused about working with software and hardware at home. She speaks with Nathan and asks him if he would lead investigation of software applications on the unit.
This is an example of:

a. Opportunity.
b. Delegation.
c. Role negotiation.
d. Role transition.

Answer 11

a. Opportunity.

Nathan’s nurse manager recognizes Nathan’s interest in technology as an opportunity for the unit and as an untapped resource that can be used to meet unit goals.

Question 12

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage. Sarah’s actions are important in avoiding role:

a. Ambiguity.
b. Transition.
c. Development.
d. Negotiation.

Answer 12

a. Ambiguity.

Clarification of implicit and explicit expectations regarding the role assists in avoiding role ambiguity and role strain.

Question 13

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
After beginning her new position, Sarah finds that she spends a great deal of time in direct patient care. Her staff begins to complain that they are never able to find her when they need her, and that some aspects of her responsibilities fall behind, such as scheduling.
Sarah is most likely:

a. Lacking an understanding of the nurse management role.
b. Attempting to prove her clinical skills to the nursing staff.
c. Experiencing difficulty in unlearning old roles.
d. Lacking enjoyment in her new role.

Answer 13

c. Experiencing difficulty in unlearning old roles.

Role transition involves transforming one’s identity. Although any of the answers listed might be correct, as a new manager, her confidence in her clinical skills suggests that she is having difficulty in the transformation process and in unlearning her role as a clinician.

Question 14

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
A strategy that may help to make the transition to her management role and to respond to relationships and situations in her new position is:

a. Avoiding discussion of her personal beliefs with staff until she is ready to do so.
b. Finding a network of clinicians with interests similar to her own.
c. Researching clinical literature to maintain her clinical assessment skills for the unit.
d. Recognizing her strong commitment to care in the management process through journaling.

Answer 14

ANS: D

d. Recognizing her strong commitment to care in the management process through journaling.

During the transition period, it is important to recognize, use, and strengthen values and beliefs, translate these for staff, and adapt behaviors to the situation. Understanding personal and professional beliefs and values assists in helping the manager respond to situations and relationships.

Question 15

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
Sarah finds that she has begun to think negatively about the way nursing care is delivered on her nursing unit. She often wishes that she was back on her old unit and in her familiar staff nurse role. This behavior:

a. Is natural when assuming a new position.
b. Diverts energy from internalization of Sarah’s new role.
c. Is justified if practices are deficient on the new unit.
d. Reflects Sarah’s astuteness as a clinician.

Answer 15

b. Diverts energy from internalization of Sarah’s new role.

By focusing on the weaknesses of the unit, Sarah may lack the energy to internalize the new role—a step that is critical to being an effective leader. As a new manager, Sarah must learn how to access resources in the organization.
Approaching the organization as a foreign culture, Sarah can keenly observe the rituals, accepted practices, and patterns of communication within the organization. This ongoing assessment promotes a speedier transition into the role of manager.

Question 16

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager’s role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes.
The success of Amy’s coaching depends on:

a. Clarity of Amy’s information.
b. Organizational support for the mentor relationship.
c. The congruence of Amy’s beliefs with Sarah’s beliefs.
d. Willingness of Sarah to receive feedback.

Answer 16

d. Willingness of Sarah to receive feedback.

Coaching provides information about how to improve performance and learning aspects of the role. Coaching requires willingness on the part of the mentee to accept feedback.

Question 17

In addition to providing coaching, a nurse mentor may provide counseling to the mentee. For counseling to be successful, the mentor must:

a. Provide a quiet environment away from the unit.
b. Keep the focus on technical and management responsibilities.
c. Assure confidentiality.
d. Present assignments that stretch the intellectual and technical ability of the mentee.

Answer 17

c. Assure confidentiality.

Counseling provides opportunity for the mentee to share personal concerns. For counseling to be successful, confidentiality must be assured.

Question 18

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
After a year, Sarah successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive. Amy advises her that this is not possible because Sarah will need:

a. A graduate degree.
b. At least a nursing diploma.
c. 24 months of experience.
d. 5 years of successful experience.

Answer 18

c. 24 months of experience.

Nurses with baccalaureate preparation and holding a nurse executive position with at least 24 months of experience can take the examination to become a certified nurse executive.

Question 19

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive’s expectations of her and of the unit that she has been hired to manage.
Sarah finds that she is comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to effect a strong commitment to quality clinical care on the unit. At this point, Sarah has likely attained this role:

a. Development.
b. Acceptance.
c. Symmetry.
d. Internalization.

Answer 19

d. Internalization.

Role internalization is achieved when the manager experiences performance of the role as being congruent with his or her own beliefs. Role acceptance refers to accepting the contract and making a public announcement of the acceptance.

Question 20

19. As a new manager, you reflect on what professional development would be most valuable to assist you in
    taking on this role. Which of the following would you most likely identify?

a. Opportunities to hone clinical skills that are used most often on the unit that you will manage.
b. A workshop on conflict management and communication skills.
c. Attendance at a conference on global health care economics.
d. Attendance at a workshop on survey tool development and statistical measurement.

Answer 20

b. A workshop on conflict management and communication skills.

Patrician et al. (2012), in a qualitative descriptive study that explored the professional development needs of nursing leaders, developed a number of recommendations that were based on what charge nurses indicated about their needs. The recommendations included education and orientation to the role, managing performance and development of staff, and communication skills.

Question 21

John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy’s role theory, John is experiencing:

a. Stress.
b. Role stress.
c. Role strain.
d. Role exploration.

Answer 21

c. Role strain.

According to Hardy, role strain is the subjective feeling of distress that occurs when role stress or a social condition of conflicting demands or difficult conditions is present.

Question 22

Seth is hired as the nurse manager for a surgical unit. After a year, the hospital reorganizes, and his position is lost. In leaving the unit, it is important for Seth to:

a. Engage in clarifying why the hospital did not state its expectations for the unit at the time of hiring.
b. Hire a lawyer to represent his interests during this unexpected role transition.
c. Seek counseling to deal with his shock and anger.
d. Negotiate a reasonable settlement.

Answer 22

d. Negotiate a reasonable settlement.

When role transition occurs as a result of restructuring, the unit manager should request and negotiate reasonable compensation and assistance, even if it is not offered initially by the employer.

Question 23

After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost containment orientation of the facility. At this point,
Maryanne is in which stage of role transition?

a. Internalization
b. Acceptance
c. Development
d. Discrepancy

Answer 23

d. Discrepancy

At this point, Maryanne is still experiencing discomfort and disillusionment with the gap between what she expected and what others expect of her in the performance of her role as manager. She is considering the significance and fit of the relationship for her, which is consistent with role discrepancy.

Question 24

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following?

a. Self-check list to assess competencies that have been strengthened
b. Discussions that focus on what the new graduates have yet to learn
c. Fixed target dates for acquisition of competency and transition to RN role
d. Frequent formal meetings to provide feedback on performance and areas to be strengthened

Answer 24

a. Self-check list to assess competencies that have been strengthened

Transition to the new role is facilitated through reflection and ongoing development of awareness of strengths (as compared with a focus on weaknesses) and of weaknesses. The value of the employee may not depend on quickness in making the role transition.

Question 25

Who of the following might be the BEST mentor for Becky, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience?

a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of head nurse in an interim capacity because of the incumbent’s illness.
b. Leslie, who has been a clinical educator at the institution for a number of years. She has tired of her role and aspires to become a nurse manager. She looks at mentorship as an opportunity to understand the role better.
c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation.
d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader on surgery for 15 years.

Answer 25

c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation.

A mentor needs to have sufficient professional experience and organizational authority so that he or she can mentor the career of the mentee. Mentors need competencies that include interpersonal and communication effectiveness, risk taking and creativity, and ability to inspire change.

Question 26

As a result of Amy’s coaching, Sarah, a nursing graduate of 5 years, completes a ROLES assessment. This assessment is helpful in (select all that apply):

a. Identifying her clinical knowledge.
b. Role development.
c. Areas of conflict in expectations.
d. Expected work time commitments.

Answer 26

ANS: B, C, D
b. Role development.

c. Areas of conflict in expectations.
d. Expected work time commitments.

A ROLES assessment is useful in identifying, confirming, and visualizing responsibilities, opportunities, lines of communication, expectations of self and others for the position, and support. This is particularly useful in identifying areas of conflict in expectations, including conflict between the manager’s own expectations and those of staff and supervisors and in negotiating role expectations.

Question 27

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to:

a. Ask the nurse if she is okay during report.
b. Refer the nurse to the employee assistance program.
c. Ask the nurse to meet with you for a few minutes before she leaves for the day.
d. Write a note to the nurse advising her that her work attendance must improve.

Answer 27

c. Ask the nurse to meet with you for a few minutes before she leaves for the day.

Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions.

Question 28

The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to:

a. Plan a social event and include the agency and traveling nurse staff members.
b. Plan unit-based social events for your remaining permanent staff members.
c. Request hospital-based “floating” nurses to substitute for the temporary staff.
d. Implement team nursing.

Answer 28

a. Plan a social event and include the agency and traveling nurse staff members.

Social support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive

Question 29

As a nurse manager, the one activity you should not overlook is:

a. Posting the yearly rotation schedule.
b. Reviewing vacation requests.
c. Scheduling staffing for holidays 6 months in advance.
d. Anticipating staff sick days.

Answer 29

b. Reviewing vacation requests.

Free time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self-time is less than 10% of wake time, stress levels increase.

Question 30

A nurse manager has decided that she must institute some personal time management steps to survive work and home life. Her first step should be to:

a. Determine what takes up so much of her time and energy.
b. Organize her personal and work spaces.
c. Purchase a handheld personal digital assistant to help remind her of important meetings.
d. Determine her personal and professional goals.

Answer 30

d. Determine her personal and professional goals.

Personal time management refers, in part, to “the knowing of self.” Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent.

Question 31

A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress management strategy would be to:

a. Start taking yoga lessons.
b. Make an appointment to meet with a psychiatrist.
c. Start jogging 5 to 6 miles every day.
d. Plan to go out for a drink with fellow nurses after work every day.

Answer 31

a. Start taking yoga lessons.

Stress relief techniques include 30 minutes of exercise five times a week, as well as techniques such as yoga that relieve mental stress.

Question 32

The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel:

a. More empowered.
b. More communicative.
c. Less stressed.
d. More powerless and devalued.

Answer 32

d. More powerless and devalued.

Change can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved.

Question 33

The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be:

a. The death of a loved one.
b. Perfectionism.
c. Getting married.
d. Losing a job.

Answer 33

b. Perfectionism.

Losing a job, the death of a loved one, and getting married are examples of external stress.

Question 34

The staff development educator presents a series of programs on stress management to the nurse managers.
Research has indicated that an individual’s ability to deal with stress is moderated by psychological hardiness.
Psychological hardiness is a composite of:

a. Commitment, control, and challenge.
b. Commitment, powerlessness, and passivity.
c. Commitment, control, and passivity.
d. Decreased isolation, challenge, and passivity.

Answer 34

a. Commitment, control, and challenge.

Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit.

Question 35

The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to
keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff.
What is a strategy that would assist the manager to manage the information overload effectively?

a. Ignore messages unless they are labeled as important.
b. Determine who is most likely to send useful or important information or requests.
c. Check e-mail messages once a day.
d. Encourage face-to-face meetings rather than e-mail.

Answer 35

b. Determine who is most likely to send useful or important information or requests.

Reduction of stress related to information overload requires the development of information-receiving and information-sending skills. Information-sending skills include determining most common sources of useful data, labeling files and folders to which e-mail messages can be directed, deletion of e-mails, and focusing on the most important pieces.

Question 36

In helping nurse managers to manage their time, the chief nursing officer suggests that they:

a. Maintain a perfectionistic attitude.
b. Set up a complaint list.
c. Have good negotiation skills.
d. Have good information literacy skills.

Answer 36

d. Have good information literacy skills.

Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

Question 37

Which of the following statements would best define stress? Stress is:

a. The comfortable gap between how we like our life to be and how it actually is.
b. Everyday life, both the highs and the lows.
c. A consequence or response to an event or stimulus that can be positive or negative.
d. Identical to distress.

Answer 37

c. A consequence or response to an event or stimulus that can be positive or negative.

Stress is defined as a gap between how we would like our lives to be and how they actually are and as a consequence or response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individual’s interpretation of the event

Question 38

In a job interview for a nursing position, Marley can be assured that which of the following will occur?

a. Both eustress and distress
b. Only eustress
c. Only distress
d. Neither eustress nor distress

Answer 38

a. Both eustress and distress

Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses.

Question 39

Which one of the following statements has been proven to be true?

a. Recent research has found that women do not have a unique physiologic response to stress.
b. Both men and women interpret the same stressor in the same manner without regard to past experiences.
c. Stress influences the immune system in one complex manner.
d. Stressors that are identical do not necessarily have similar effects on each individual.

Answer 39

d. Stressors that are identical do not necessarily have similar effects on each individual.

Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

Question 40

An example of role stress occurs when:

a. The director of the ICU and the manager of the surgical unit wish to hire the same new employee.
b. Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.
c. The nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal.
d. Line managers believe that support staff use their technical knowledge to intrude on their authority.

Answer 40

b. Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.

Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

Question 41

A staff nurse approaches the unit manager and indicates to her that because of her father’s death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress.

a. Internal source
b. Familial
c. Burnout
d. External

Answer 41

d. External

External stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

Question 42

Sources of occupational stress in nursing include all except which of the following?

a. Authoritarian leadership
b. Concern about moral wrongdoing by colleagues
c. Multiple changes in a short time
d. Rotating shifts

Answer 42

a. Authoritarian leadership

Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts, and workload are all sources of work-related stress for nurses.

Question 43

Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it
as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is:

a. Both a positive stressor and a negative stressor.
b. Occurring only because of age.
c. Positive in both cases.
d. Harmful in both cases.

Answer 43

a. Both a positive stressor and a negative stressor.

Some researchers have determined that stress is a person-environment process in which the person appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation. Stress can be viewed as positive (eustress) or negative (distress).

Question 44

Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months’ severance
pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress?

a. The younger man will feel more stress.
b. The two men may or may not feel the same amount of stress.
c. The older man will feel more stress.
d. Neither man will experience any stress.

Answer 44

b. The two men may or may not feel the same amount of stress.

The response to similar stressors does not always result in a similar experience of stress in individuals. Responses are mediated by the appraisal of the event as well as by factors such as gender, personality, lifestyle, and age.

Question 45

Social stressors are considered a major factor in the stress nurses experience in the healthcare system.
Which of the following is not considered to be a social stressor?

a. High amounts of stress in the nursing home environment
b. Changes in the current healthcare system such as nursing strategies
c. Disruptive behavior coming from physicians and other healthcare workers
d. Stress triggers such as self-criticism and overanalyzing

Answer 45

d. Stress triggers such as self-criticism and overanalyzing

Personal stress triggers such as self-criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors.

Question 46

After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two elderly patients. You are concerned that Rama is evidencing which state?

a. Hardiness
b. Depression
c. Role ambiguity
d. Depersonalization

Answer 46

d. Depersonalization

A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one’s body, feeling as if one is a machine or robot, an “unreal” feeling that one is in a dream or that one “is on automatic pilot.” Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion.

Question 47

“Stress-buffering” behaviors can be elicited to reduce stress. All of the following behavioral coping responses
can be used by nurse managers to reduce and manage stress except:

a. Distancing oneself from work.
b. Using cognitive reframing to change irrational thoughts.
c. Refusing a request to sit on a committee to evaluate scheduling software.
d. Exercising regularly.

Answer 47

a. Distancing oneself from work.

Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

Question 48

The education consultant at St. Joseph’s Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by:

a. Aiding individuals in identifying positive stressors.
b. Helping people realize that negative thinking causes emotional distress.
c. Eliminating negative stressors.
d. Replacing positive self-statements with negative irrational beliefs.

Answer 48

b. Helping people realize that negative thinking causes emotional distress.

Cognitive reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change “I’ll never …” to “I can …” or “She always …” to “Sometimes she … .” It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful.

Question 49

Time management is very essential for the nurse manager. Which of the following is not a good time-management technique?

a. Decide what not to do.
b. Learn to say “No.”
c. Learn to delegate.
d. Break down your workload into large manageable tasks.

Answer 49

d. Break down your workload into large manageable tasks.

To manage time successfully, it is important to break down your workload into smaller, manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project.

Question 50

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose
of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful.

1. Distribute an agenda.
2. Distribute minutes.
3. Select team members.
4. Start on time.
5. Keep the meeting focused and directed toward accomplishing the set objectives.

Select the correct order from the following options:

a. 1, 2, 4, 5, 3
b. 4, 1, 2, 5, 3
c. 3, 1, 4, 5, 2
d. 3, 4, 2, 1, 5

Answer 50

c. 3, 1, 4, 5, 2

Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

Question 51

High levels of work-related stress affect all but which of the following? (Select all that apply.)

a. Job satisfaction
b. Absenteeism and turnover
c. Nurses’ health
d. Client welfare

Answer 51

ANS: A, B, C, D

a. Job satisfaction
b. Absenteeism and turnover
c. Nurses’ health
d. Client welfare

Many writers and researchers have found that these work-related areas are adversely affected by stress.

Question 52

A new graduate is seeking a new position in nursing and wants to “sell” herself effectively. The best strategy
is to:

a. Create a résumé.
b. Practice interviewing.
c. Call the personnel offices.
d. Create a curriculum vitae.

Answer 52

a. Create a résumé.

A résumé provides a customized overview of details of your professional background that relates specifically to
a position for which you are applying. Résumés advertise your skills to a prospective employer.

Question 53

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as:

a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.

Answer 53

c. Steady state.

Career styles that are marked by selecting and staying in a role throughout a career are characterized as steady state.

Question 54

The nurse executive at the local hospital began working there 20 years ago and has risen to the highest designation in nursing. This career style is known as:

a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.

Answer 54

a. Linear.

The linear career style, as described by Friss (1989), refers to vertical advancement in an organization and is of interest to those with a desire to gain organizational knowledge and different perspectives on nursing.

Question 55

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states. This career style is known as:

a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.

Answer 55

d. Entrepreneurial/transient.

The entrepreneurial/transient career style, as described by Friss (1989), is appealing to nurses who enjoy variety in experiences.

Question 56

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency. After 2 years, he was promoted to a managerial position and now has returned to another
hospital as a new director of nursing. This career style is known as:

a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.

Answer 56

b. Spiral.

The spiral career style, as described by Friss (1989), involves an in-and-out and up-and-down approach to opportunities.

Question 57

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to
take a certification exam. Certification is designed to recognize:

a. Basic knowledge in a specified area.
b. Advanced practice in functional roles.
c. Special knowledge beyond basic licensure.
d. Continued competence as a registered nurse.

Answer 57

c. Special knowledge beyond basic licensure.

Certification is an expectation in some settings for career advancement in advanced practice or in specialized areas and goes beyond basic preparation.

Question 58

Which of the following situations is most likely to result in a productive, whole work situation?

a. Amy, RN, 5 years of experience in the emergency department. Amy accepts a position working with older
clients in a home health agency because she has relocated and this is the only full-time position available.

b. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care.
c. Louise, RN, 10 years of experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges.
d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

Answer 58

c. Louise, RN, 10 years of experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges.

The whole of any work situation is composed of two elements: person and position. A productive, whole work situation results when a person’s talents and strengths are successfully blended with expectations of the position.
Of the situations described previously, the one most likely to result in a productive, whole work situation is that of Louise, who, although her experience has not been in home health, is interested in both the roles and the responsibilities of the position, as well as the target group being served. She also considers the group being served as an area in which she demonstrates strength.

Question 59

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse has to update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to:

a. Have a listing of facts about your professional life.
b. Provide potential employers with information about where you are in your career.
c. Respond quickly whenever a position becomes available.
d. Be certain you can recall facts for a prospective position.

Answer 59

b. Provide potential employers with information about where you are in your career.

A curriculum vitae provides an all-inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career.

Question 60

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal
data file is to:

a. Create an opportunity to be interviewed.
b. Have a listing of facts about your professional life.
c. Have a tool in place for marketing yourself.
d. Create a document that lists your skills.

Answer 60

b. Have a listing of facts about your professional life.

A personal data file enables storage and recall of career-specific details that can be retrieved and shaped for a specific purpose using cut-and-paste approaches rather than creating whole new documents.

Question 61

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills?

a. Résumé
b. Annual evaluations
c. Portfolio
d. Patient advocacy project

Answer 61

c. Portfolio

A portfolio enables prospective employers to view evidence of significant achievements and responsibilities that would be pertinent to the position.

Question 62

During performance appraisal interviews, Joanne’s nurse manager notices Joanne’s excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne’s nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be:

a. “Nursing administration is rewarding. What experiences would help you along this path?”
b. “You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn’t advise going in that direction.”
c. “You seem to find teaching others very rewarding. Have you considered that as a possible career path?”
d. “You are too inexperienced to consider administration. Work for a few years, and then consider administration.”

Answer 62

c. “You seem to find teaching others very rewarding. Have you considered that as a possible career path?”

Joanne evidences excitement about teaching patients, and although administration could be a rewarding path for her, education might be a better option for her to consider. Looking at job aspects that are rewarding is helpful in determining which career direction to pursue.

Question 63

Knowing your professional strengths is important to:

a. Finding your fit in positions and a career path.
b. Maintain a professional status.
c. Act in a manner that is legal and ethical.
d. Understand the role expectations of a position.

Answer 63

a. Finding your fit in positions and a career path.

Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally.

Question 64

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path?

a. You are pressured to do so by your supervisor.
b. The organization has no other suitable candidate for the position.
c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge.
d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

Answer 64

d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

Although giving into organizational or supervisory pressure may bring an enhanced learning and organizational profile, what is to be gained needs to be assessed against your career goals, interest, and aspirations. Increasing and expanding your skill set within defined career interests is a valid reason to consider a chance opportunity.

Question 65

Steady state styles would be most likely in which of the following situations?

a. Small hospital, in an isolated rural setting, with limited hierarchy
b. Large urban teaching hospital
c. Health network with several organizations
d. Travel nurse agency

Answer 65

a. Small hospital, in an isolated rural setting, with limited hierarchy

Steady state career styles (career-long commitment to a particular position) are more likely in rural settings, where commitment to the community is high and alternative career opportunities are limited.

Question 66

On your curriculum vitae, which of the following is the recommended approach for listing employment and
educational history information?

a. 1979 RN Diploma
1985 BScN 2002 MN

b. 2002 Mount Rush Health Center Staff Nurse
1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager

c. 2007 MN
2005 BScN

d. 1997 Sturgeon County Hospital Head Nurse
2002 Sturgeon County Supervisor 2007 Sturgeon County Director

Answer 66

c. 2007 MN
2005 BScN

Information that is included in the body of the curriculum vitae should always be in reverse chronological order so that the most recent and, presumably, most relevant job information appears first.

Question 67

Which of the following needs revision on a résumé or CV?

a. John Jones
87 Highway Drive
City, MI 79110
jjones@gmail.com

b. M. Howes
Anyway Highway
City, MO 77700
(H) 777-777-0000
e-mail: mh@gmail.com

c. Dr. L. Jones
99 Carway Drive
City, NY 84003
(H) 999-999-0000
(Cell) 999-000-9999

d. Tanya Jones
67 Honeywell Drive
City, MO 66907
beerhog@hotmail.com

Answer 67

d. Tanya Jones
67 Honeywell Drive
City, MO 66907
beerhog@hotmail.com

When including Web or e-mail addresses, it is important to use addresses that are not overly casual or that communicate personal information.

Question 68

The primary difference between a résumé and a CV is that a résumé:

a. Reflects your skills, knowledge, and background in relation to a specific position.
b. Offers a detailed listing of positions held and where positions were held.
c. Includes a long and detailed explanation of academic and work experience.
d. Provides contact information and focuses on your background, in general.

Answer 68

a. Reflects your skills, knowledge, and background in relation to a specific position.

A résumé is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the résumé and the CV. Résumés are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held.

Question 69

A functional résumé focuses on:

a. Experience and skills gained in positions.
b. Positions held and specific roles in the positions.
c. Academic qualifications and achievements.
d. Relating skills and experience to qualifications in a specific position.

Answer 69

a. Experience and skills gained in positions.

Functional résumés highlight skills and experience gained rather the details of specific positions. As with résumés in general, skills and experiences are customized to create an image of an individual in a particular position.

Question 70

A cover letter and a résumé together should be no longer than ________ page(s).

a. Two
b. One
c. Four
d. Three

Answer 70

d. Three

Two pages is recommended for a résumé and one for a cover letter.

Question 71

During an interview for a manager’s position, you find the supervisor and staff unfriendly. Responses to
questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate?

a. There is no need for you to do anything further. You likely will not be offered the position anyway.
b. You should file a complaint with Human Resources about the supervisor’s lack of interviewing skills.
c. You should send a thank-you note to the interviewer, indicating appreciation for her time.
d. You should call and leave a voicemail, indicating your disinterest in the position.

Answer 71

c. You should send a thank-you note to the interviewer, indicating appreciation for her time.

Even if you are disinterested in the position or think that the interview has gone badly, an appropriate followup is a thank-you note to the interviewer. This recommended follow-up creates a positive impression and may leave open the possibility of future interactions.

Question 72

A well-written letter of resignation is critical to:

a. First announce your intent to resign.
b. Formally signal discontent in your current position.
c. Maintain a positive relationship with your former organization and colleagues.
d. Fulfill your legal obligations as a departing employee.

Answer 72

c. Maintain a positive relationship with your former organization and colleagues.

A well-written resignation letter outlines your intent to leave the organization and your appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well-written letter maintains a positive relationship with the organization.

Question 73

In preparing for a fair interview process as a hiring manager, you should:

a. Put water out for the candidates.
b. Ensure that you know the names of all candidates.
c. Dress comfortably and professionally.
d. Prepare a schedule of questions to be asked of all candidates.

Answer 73

d. Prepare a schedule of questions to be asked of all candidates.

Although providing water, knowing names, and dressing appropriately sets a professional and respectful tone for the interview, developing a schedule of questions to be asked of all candidates is important for gathering comparative data and ensuring equitable treatment.

Question 74

To enhance team leadership skills for your team leaders, you arrange opportunities for:

a. Certification.
b. Continuing education.
c. Graduate courses.
d. Volunteerism.

Answer 74

b. Continuing education.

Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills.

Question 75

Professional associations:

a. Set regulatory requirements and establish entry requirements for nursing.
b. Offer graduate programs for clinical and career advancement.
c. Provide opportunities for career networking and support.
d. Are open to all individuals who meet the criteria for membership.

Answer 75

c. Provide opportunities for career networking and support.

Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests.

Question 76

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas’ professional development, you
would focus on (select all that apply):

a. Certification for the ICU environment.
b. Discussions about how Thomas can fit with role expectations and relationships.
c. Possible specializations within the ICU environment.
d. Encouraging him to lead changes that leave long-term impacts after his retirement.

Answer 76

ANS: C, D
c. Possible specializations within the ICU environment.

d. Encouraging him to lead changes that leave long-term impacts after his retirement.

Thomas is a mid career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid career professionals.

Question 77

An example of a career is (select all that apply):

a. Employment in short-term contract jobs in business, nursing, and whatever is available.
b. Involvement in an area of practice that is regulated.
c. Continuous employment in the same position and the same arrangement for 20 years.

d. Moving into and out of nursing positions in various cities while pursuing travel and education that develop
understanding of global health.

Answer 77

ANS: C, D
c. Continuous employment in the same position and the same arrangement for 20 years.

d. Moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

Career refers to progression of skills, consistency, knowledge, and/or status. This movement through nursing life is predicated on having a vision of a career as opposed to a series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or spiral. Deepening skills in one area is an example of a steady state career style, whereas moving into and out of positions in various cities can characterize an entrepreneurial style. Involvement in a regulated field defines a professional interest but not necessarily a career.

Question 78

Nursing professionals in the twenty-first century will accomplish most of their work:

a. Through teams of internationally prepared professionals.
b. In teams and through group work.
c. Through long-term, secure jobs.
d. In competitive environments and work groups.

Answer 78

b. In teams and through group work.

The future is about teams and group work. Competition will be out and collaboration will be in. Job security will be out and career options will be in. Our brightest and best may leave more often than they do at present to pursue career options internationally.

Question 79

Based on studies of workplace environments for nurses and future projections, the workplace of the future will be:

a. Less intense because of more technology.
b. About the same as it is now.
c. More intense because of more technology.
d. Fluctuating between intense periods and less intense periods.

Answer 79

c. More intense because of more technology.

Technology will continue to revolutionize health care and contribute to complexity compression. In addition to access to knowledge, electronic records, and current applications of technology, technology will include robotics, which will change how chronic disease can be managed, and bioengineering will make possible interventions that do not yet exist.r

Question 80

Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you:

a. Refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective.
b. Work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health care and prescriptions for immediate needs.
c. Ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery.
d. Address the health of those who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying.

Answer 80

a. Refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective.

Referral to a food bank addresses the needs of a specific population, while exemplifying an important leadership strength: thinking long-term, acting short-term. The project that involves mothers will teach mothers about nutrition and engage them in preparation of low-cost, healthy meals while promoting longer-term changes in healthy eating.

Question 81

You notice that wait times in your Emergency Department are growing longer, because of factors such as increases in the numbers of persons with chronic disorders, discharge of patients into the community at a higher level of acuity, and limited resources for transfer of inpatients. You begin to think about an application that would use your knowledge of the Emergency Department but also software and business applications and wonder if this would reduce wait times. You have not encountered anything similar to this idea. According to the Wise Forecast Model©, you are in what phase?

a. Wild thinking
b. Act widely
c. Think wildly
d. Learn widely

Answer 81

c. Think wildly

The second step in the Wise Forecast Model© is to think wildly. Step two is designed to create connections
among disparate thoughts. This thinking might be seen as the start of innovations.

Question 82

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. What would be a healthy response to this situation?

a. Salvage as much of the original planning as possible so as to reduce expenditures.
b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions.
c. Abandon the current planning in favor of addressing the new trends.
d. Continue with the current planning because trends come and go.

Answer 82

b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions.

Stability and total chaos are the ends of a continuum. Moving in some way between those two ends suggests
that we live in a constant state of disequilibrium in which we strive toward stability while recognizing we experience chaos. As we continue to move from “traditional” practices to evidence-based ones and from a heavy focus on tertiary care to one that values primary care, we can assume that we might experience more chaos. Chaos can lead to new learning and new, innovative solutions. As nurses, it is important to be able to function in an evolving environment.

Question 83

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. As a manager in this situation, your staff experience a gap between what they expected (the original re-design of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what?

a. Eustress
b. Distress
c. Stress
d. Compression

Answer 83

c. Stress

Selye described stress as being on a continuum between stress that is positive (eustress) and stress that is negative (distress). Because individuals perceive the same event differently, from the information that is given, it is not possible to determine whether the nurses experience the events as eustress or distress; what is most likely is that the nurses are experiencing stress, which is what occurs when there is a gap between expectations and what is actually occurring.

Question 84

As a nurse manager, it is important to become a “future thinker.” Which is an example of
a “future thinker”?

a. Keeping traditional practices
b. Moving toward evidence-based practices
c. Finding less need for more knowledge
d. Believing that macromarketing will be a necessity

Answer 84

b. Moving toward evidence-based practices

Future forecasts include evolutions in power, structure, and knowledge; rapid change in the healthcare system;
the demise of macromarketing; and increased evidence-based practice.

Question 85

As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed the questions that you would like addressed and searched the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing?

a. Compression complexity
b. Distress
c. Information lag
d. Technology advancement

Answer 85

a. Compression complexity

This situation exemplifies complexity compression, a term that means many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some
other new change. This compression can be distracting or useful.

Question 86

Nursing research has indicated that the foundation for becoming a nursing leader is the ability to:

a. Write effectively.
b. Speak two or three languages.
c. Focus on day-to-day priorities.
d. Think futuristically.

Answer 86

d. Think futuristically.

Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is
becomes a critical strategy. A vision can range from that of an individual to that of a group or to a whole
organization.

Question 87

The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling?

a. Her clinical expertise
b. Affection for tradition
c. Her employability
d. Her busy professional life

Answer 87

c. Her employability

Being employed is no longer sufficient; we must be employable. A portfolio outlines achievements and experiences that communicate employability.

Question 88

Your unit has a number of patients who have undergone limb amputation. In working with the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to amass information in a number of areas with which you previously had little familiarity. According to the Wise Forecast Model©, you are

a. Acting wildly.
b. Learning wildly.
c. Engaging in interprofessional care.
d. Increasing your complexity compression.

Answer 88

b. Learning wildly.

The first step, learn widely, means that we must extend our sources of knowledge beyond our role and clinical
areas of interest. In fact we must extend our learning beyond nursing and health care. Widely might encompass another discipline such as architecture or engineering.

Question 89

The starfish analogy is exemplified in which of the following?

a. A unit manager resigns after continued tension between the administration and her regarding implementation of primary nursing. The primary nursing project dies.
b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers.
c. Alana, a new graduate, promotes continence care based on evidence. When she presents her ideas, senior staff refuses to consider it.
d. The head of a community health service moves on to another position. Programs are disbanded.

Answer 89

b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers.

The starfish analogy points to the connectivity that we have with one another and how we influence and are in
fluenced by others all the time. This affords many opportunities for leadership that are dependent not on formal titles but on opportunities to shape the work at hand.

Question 90

Which of the following will require greater attention in the future?

a. Chronic disorders
b. Obstetrical outcomes
c. Prevention of hospital-based errors
d. Team conflict resolution strategies

Answer 90

a. Chronic disorders

Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on prevention, personal
accountability, and innovations such as robotics in the management of chronic illnesses.

Question 91

Which of the following strategies is most important in developing a strong vision?

a. Seeking out evidence to support trends and out-of-the-box thinking
b. Spending time with others with whom we discuss ideas
c. Setting up focus groups to provide information on current realities
d. Being honest and open about what we think for the future

Answer 91

d. Being honest and open about what we think for the future

Regardless of how we go about developing our vision (gathering evidence, testing ideas with others), honesty
and openness are foundational to a strong vision.

Question 92

To move beyond stereotypical thinking and toward thinking about the future, which of the following would
be most consistent with thinking wildly in the Wise Forecast Model©?

a. Listing everything that we know about our current situation
b. Defining which practices will remain unchanged and which will change
c. Asking someone with a great deal of experience to share ideas about best practice
d. Challenging current and future practices with questions of “what if?”

Answer 92

d. Challenging current and future practices with questions of “what if?”

Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild idea.

Question 93

Which aspect of our tradition and history in nursing may impede our movement towards future-oriented thinking?

a. Lack of confidence
b. Focus on the discipline of nursing
c. Focus on details in the everyday practice
d. Mistrust of trends and new evidence

Answer 93

c. Focus on details in the everyday practice

Because of our history of attention to details, we may need to challenge ourselves in developing our ability for leadership. Moving from micromanaging to focusing on setting expectations for those for whom we are accountable may feel uncomfortable. However, that movement reinforces our ability to deal with longer-term issues.

Question 94

A stroke unit experiences numerous changes related to implementation of new technology, a changed
nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show
signs of reluctance to implement any more changes. This exemplifies:

a. A poor relationship between leaders and staff.
b. Lack of knowledge regarding the importance of changes.
c. Striving to achieve stability in the midst of great disequilibrium.
d. The importance of chaos in promoting adherence with established practices.

Answer 94

c. Striving to achieve stability in the midst of great disequilibrium.

Stability and chaos are at opposite ends of a continuum. When chaos is present, change occurs but life may
seem uncontrollable. Resisting further change is a move toward establishment of equilibrium.

Question 95

A stroke unit experiences numerous changes related to implementation of new technology, a changed
nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show
signs of reluctance to implement any more changes. The phenomenon experienced by the staff is termed:

a. Eustress.
b. Care process.
c. Stereotypical thinking.
d. Complexity compression.

Answer 95

d. Complexity compression.

Complexity compression refers to many changes occurring simultaneously before time is sufficient to assimilate the change.

Question 96

A business condition that may assist forecasting but add to the complexity of change is:

a. Consulting with professional groups about change.
b. Researching about trends on futuristic sites.
c. Asking patients to examine options for change.
d. Building profit projects and sustainability into planning.

Answer 96

c. Asking patients to examine options for change.

Stalk and Butman suggests that asking the customer for feedback on options may assist with forecasting.
Adopting this strategy runs counter to current practice and would increase the complexity of healthcare planning and forecasting.

Question 97

A number of changes are introduced to a unit, including changes to familiar clinical procedures and the use of PDAs to enable bedside documentation. You, as unit manager, anticipate which of the following will contribute most to complexity compression?

a. Meaning of the change
b. Pace of changes
c. Previous experiences with change
d. Confidence of the leader in the value of the change

Answer 97

b. Pace of changes

Complexity compression is a term that means that many changes are happening almost simultaneously and
before one practice can be firmly implanted in our minds, we are already addressing some other change

Question 98

In order to plan long term, you consider what the client of the future will look like. Which of the following
client profiles would best capture shifting demographics and trends in health care?

a. Younger, knowledgeable about health options
b. Female, uses emergency care services for parents and children
c. Older, one or more chronic disorders, diverse background
d. Male, various occupationally generated disorders, diverse ethnic background

Answer 98

c. Older, one or more chronic disorders, diverse background

The client base is aging and more people will be living with chronic disorders. Persons will travel more and
there will be increased need to speak two or more languages to address the needs of a mobile global
population.

Question 99

You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given,
as well as with the idea that “working means no more essays, tests, or assignments!” She indicates that she
has no intention of touching a book, journal, or health information Website for a “long time.” Which of the following would be your best response?

a. The expectations and design of educational programs means that new graduates are better prepared for the workforce.
b. The new graduate will still have to learn, but it will be job-specific learning.
c. An ideal learning plan for nurses emphasizes followership.
d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.

Answer 99

d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of
knowledge for practice.

Knowledge will change dramatically, requiring that we all be dedicated learners. With or without state law, continuing education will be mandatory and essential.
Knowledge will evolve from the intensity of the current information evolution so that we will access content
with meaning and applicability for our work.

Question 100

A necessary leadership strength for nurses of the future is:

a. Inspiring others to work their best to create the future.
b. Understanding the nuances of fundraising to make up funding shortfall.
c. Guarding the tendency of other professions to encroach on nursing roles.
d. Adapting work life to an aging nursing workforce.

Answer 100

a. Inspiring others to work their best to create the future.

Senge said that all leadership is really about is people working at their best to create the future. Predictions of
the future highlight the importance of interprofessional teams and of a shift towards understanding the importance of health care.

Question 101

Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is:

a. “With many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of the nursing employment market.”
b. “The job market for nurses will be diminished with funding cuts to hospitals.”
c. “The employment prospects for nurses are positive with many options to choose from. Flexibility and adapt ability are essential to income security.”
d. “It is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors.”

Answer 101

c. “The employment prospects for nurses are positive with many options to choose from. Flexibility and adapt ability are essential to income security.”

Employment for nurses continues to be positive, although roles will change in a rapidly changing environment,
which will increase options. With the number of options available and sporadic work opportunities, nurses will
need to be flexible and able to adapt rapidly. Job security will be out; career options will be in.

Question 102

In developing curricula that will address needs based on forecasts for the future, nursing educators need to
contemplate (select all that apply):

a. Prevention strategies.
b. Leadership skills and knowledge.
c. Violence de-escalation strategies.
d. Strategies for job security.

Answer 102

ANS: A, B, C
a. Prevention strategies.

b. Leadership skills and knowledge.
c. Violence de-escalation strategies.

Future forecasts suggest that health factors such as obesity that are implicated in the development of chronic disorders will increase, as will chronic disease. Leadership skills have been identified as a key competence for nurses of tomorrow, and competence with technology will be needed as technology continues to revolutionize health care. Rather than emphasizing job security, nurses will need to be prepared to be in an environment
with many options and episodic employment.

Question 103

A patient states, “I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which response by the nurse would be an example of interpersonal therapeutic communication?

a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So, all in all, you feel as though you had a rather poor night’s sleep?”
d. “Can you give me an example of what you mean by a ‘bad nightmare’?”

Answer 103

d. “Can you give me an example of what you mean by a ‘bad nightmare’?”

The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient’s comment.

Question 104

The nurse is admitting a patient to the medical/surgical unit. Which communication technique would be considered appropriate for this interaction?

a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
b. “Why do you think you had so much difficulty adjusting to this change in your life?”
c. “You will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”

Answer 104

d. “I’d like to sit with you for a while to help you get comfortable talking to me.”

Because the patient is newly admitted to the unit, allowing the patient to become comfortable with the setting a technique that can assist in establishing the nurse-patient relationship. It helps build trust and convey that the nurse cares about the patient.

Question 105

The nurse is seeking clarification of a statement that was made by a patient. What is the best way for the nurse to seek clarification?

a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that…”
d. “Tell me everything from the beginning.”

Answer 105

c. “Am I correct in understanding that…”

Clarification ensures that both the nurse and patient share mutual understanding of the communication. The distracters encourage comparison rather than clarification and present implied questions that suggest the nurse was not listening.

Question 106

A nurse is conducting a therapeutic session with a patient in the inpatient psychiatric facility. Which remark by the nurse would be an appropriate way to begin an interview session?

a. “How shall we start today?”
b. “Shall we talk about losing your privileges yesterday?”
c. “Let’s get started discussing your marital relationship.”
d. “What happened when your family visited yesterday?”

Answer 106

a. “How shall we start today?”

The interview is patient centered; thus, the patient chooses issues. The nurse assists the patient by using communication skills and actively listening to provide opportunities for the patient to reach goals. In the distracters, the nurse selects the topic.

Question 107

The nurse and the patient are conversing face to face. What communication technique is being demonstrated?

a. Linguistic
b. Paralinguistic
c. Explicit
d. Metacommunication

Answer 107

a. Linguistic

Conversing face to face, reading newspapers and books, and even texting are all common forms of linguistic communication. Paralinguistics include less recognizable but important means of transmitting messages such as the use of gestures, eye contact, and facial expressions.

Question 108

The nurse is working with a patient diagnosed with posttraumatic stress disorder related to childhood sexual abuse. The patient is crying and states, “I should be over this by now; this happened years ago.” Which response(s) by the nurse will facilitate communication? (Select all that apply.)

a. “Why do you think you are so upset?”
b. “I can see that this situation really bothers you.”
c. “The abuse you endured is very painful for you.”
d. “Crying is a way of expressing the hurt you’re experiencing.”
e. “Let’s talk about something else, since this subject is upsetting you.”

Answer 108

ANS: B, C, D

b. “I can see that this situation really bothers you.”
c. “The abuse you endured is very painful for you.”
d. “Crying is a way of expressing the hurt you’re experiencing.”

Reflecting and giving information are therapeutic techniques. “Why” questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

Question 109

A patient is admitted to the intensive care unit for congestive heart failure.
Using the situation–background–assessment–recommendation (SBAR) format, put the following statements in the order in which the nurse should report changes to the health care team.

a. Our patient was admitted 2 days ago with heart failure and has been receiving furosemide (Lasix) for diuresis, but his urine output has been low.

b. I think that our patient needs to be evaluated immediately and may need intubation and
mechanical ventilation.

c. This is the nurse on the surgical unit. I am calling about our patient in room 3. After assessing him, I am very concerned about his shortness of breath.
d. Today, our patient has crackles audible throughout the posterior chest and his O2 saturation is 89%. His condition is very unstable.

Answer 109

ANS:
C, A, D, B

The order of the nurse’s statements follows the SBAR format. The nurse explains the situation by identifying herself, then gives the immediate background of the patient. She then assesses the patient and gives her recommendation.