chapter 25

Question 1

The most important approach that a nurse manager can take with an emotionally troubled
employee is to:

a. Act as a therapist for the employee.
b. Adjust the standard of care to assist the employee.
c. Assist the employee in obtaining professional help.
d. Adjust the employee’s work schedule to decrease stress.

Answer 1

C

Question 2

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit
is that:

a. Using replacement personnel with new ideas may be beneficial.
b. Salary costs are lower because personnel are fewer, and outcome is favourable.
c. Absence on the part of the rest of the staff is decreased.
d. Unacceptable patient care may result.

Answer 2

D

Question 3

In keeping with guidelines of the organization, the nurse manager documents staff problems.
Documentation of disciplinary problems should:

a. Include a plan to correct them and to prevent future occurrences.
b. State a detailed history of past problems that are related to the current one.
c. Be written at the convenience of the manager.
d. Accumulate until the evaluation period begins.

Answer 3

A

Question 4

Before terminating an employee, a nurse manger must:

a. Be an expert in all legal aspects of employment termination and discipline
practices.
b. Know the organization’s specific policies for addressing disciplinary problems and
employment termination.
c. Function as a counsellor for problem employees.
d. Do everything to assist and protect the employee by adjusting standards and
policies.

Answer 4

B

Question 5

A nurse manager understands that the typical first step in handling an employee with a
disciplinary problem is to:

a. Provide a verbal reprimand.
b. Prepare a written reprimand.
c. Counsel the employee regarding the problem.
d. Give the employee the day off without pay.

Answer 5

C

Question 6

The chief nursing officer understands that clinical incompetence is best prevented by which of
the following?

a. A flexible protocol for evaluating competency skills.
b. A standardized clinical skills checklist.
c. A newly established peer review process.
d. A formalized competency program with established standards for practice.

Answer 6

D

Question 7

A nurse manager understands that the second step in handling an employee with a disciplinary
problem is to document the incident. Which of the following is best for documentation of
personnel problems?

a. Use of the performance appraisal on an annual basis.
b. Notes made immediately after an incident that include a description of the incident,
actions taken, plans, and follow-up.
c. A tally sheet of medication errors and other specific problems that will be used at
annual review.
d. Copies of reports, placed in the employee’s file, of all unusual occurrences
involving the employee.

Answer 7

B

Question 8

The nurse manager places a staff member on probation because of reports of chemical
dependency. The nurse manager should be aware that which of the following statements is
true regarding chemical dependency?

a. The chemically dependent employee usually hides any changes in behaviour.
b. When confronted with the issue, the affected employee is usually relieved to have
someone to talk to about the problem.
c. The chemically impaired nurse affects the entire health care organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the
chemically dependent employee in the most general terms.

Answer 8

C

Question 9

The chief nursing officer reviews the policy about “progressive discipline process.” The
progressive discipline process includes which of the following?

a. The manager is a counsellor and friend to the employee.
b. The manager should reprimand and suspend the employee as a last resort.
c. The manager should rehire the employee after a reasonable length of time.
d. The manager should terminate the employee if the problem persists.

Answer 9

D

Question 10

A nurse manager must be familiar with the agency’s policies regarding employment
termination. Termination procedures include which of the following?

a. Following specific procedures at other organizations.
b. Having an attorney present at the termination meeting.
c. Having adequate written documentation to support the action.
d. Having a friend present during the termination meeting.

Answer 10

C

Question 11

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the
expectations of his team. Which of the following behaviours are most likely to signal that
Nathan is intending to resign from his position on the unit?

a. Increased absenteeism over the past month.
b. Increased attempts to discuss his concerns with his colleagues.
c. Testing of workplace guidelines.
d. Frequent defensiveness.

Answer 11

A

Question 12

All of the following are grounds for immediate dismissal except:

a. Failing to pursue further medical help for a patient, after which the patient dies.
b. Selling narcotics obtained from the unit supply of narcotics.
c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a
staff member.
d. Grabbing the unit manager and threatening further physical harm after a poor
performance appraisal.

Answer 12

A

Question 13

Nurses generally experience difficulty in identifying behaviours and actions that could signal
chemical dependency in a coworker. Which of the following is not a behavioural change that
occurs with chemical dependency?

a. Personality and behavioural changes.
b. Job performance changes.
c. Changes in educational involvement and pursuit.
d. Absenteeism.

Answer 13

C

Question 14

Aurora, RN, is a self-admitted drug addict and has abused codeine heavily. Aurora and the
unit manager decide that changes have to occur. Aurora enrolls in an addiction program, and
the manager has her transferred to a drug-free area. What other strategies might be
appropriate?

a. The manager could refer Aurora to the human resources department.
b. The manager could assist in monitoring Aurora’s progress.
c. The manager could counsel Aurora if Aurora has formed a trusting relationship
with her.
d. Aurora needs to be asked not to involve her family in the recovery program
because this is a work-related situation.

Answer 14

B

Question 15

Incivility is a disruptive behaviour or communication that creates negativity in the
environment and interferes with quality of patient care and safety. The manager can
implement steps that help to alleviate uncivil behaviour on a unit. Which of the following
would not be an appropriate first step?

a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s
file.
c. Providing verbal admonishment.
d. Terminating the staff member.

Answer 15

D

Question 16

In which order should the strategies below occur in progressive discipline?

a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s file.
c. Providing verbal admonishment.
d. Terminating the staff member.

a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D

Answer 16

C

Question 17

When progressive discipline is used, the steps are followed progressively only for repeated
infractions of the same rule. On some occasions, the breaking of rules is so serious that the
employee is:

a. Transferred to another unit.
b. Suspended indefinitely.
c. Asked to attend a union grievance meeting.
d. Terminated after the first infraction.

Answer 17

D

Question 18

You need to terminate Gregory, who has had a long-standing history of conflict with you and
the staff and who recently was charged with theft of patient belongings. You consult the
human resources department, and together you develop a plan, which includes:

a. A private meeting with Gregory, a human resources representative, and you to
deliver the news and deliver the employment termination notice and all other
documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired and that his paperwork will be
sent to him at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is
available, should he become upset or agitated.

Answer 18

A

Question 19

The nurse manager notices that Tia, a staff nurse, has been absent 2 to 3 days per month for
the past 3 months. What is the manager’s best response?

a. “Why are you absent from shifts every month?”
b. “I am concerned that you have been absent 3 days this month.”
c. “Your attendance record is not very good. Do you want to talk about it?”
d. “I am changing your shift rotation as it is obvious that you are not able to
consistently implement your scheduled shifts.”

Answer 19

B

Question 20

Susan, a new graduate, is upset that so many staff members have been absent lately from the
unit. She declares to you that all absenteeism could be eliminated with proper management.
Your response is based on understanding that:

a. Not all absenteeism is voluntary.
b. High personal control contributes to absenteeism.
c. Direct discussions with employees who have high levels of absenteeism are not
recommended.
d. All absenteeism is related to personal issues and needs.

Answer 20

A

Question 21

The nursing director calls a meeting with one of the new unit managers. She is very concerned
about a report of substance abuse on the manager’s unit, and she reviews the procedures
involved in dealing with chemically dependent staff. Which of the following statements would
not be included in the discussion?

a. “As a manager, you need to be aware of professional regulatory reporting
requirements.”
b. “As a manager, you should check with the human resources department regarding
chemically dependent employees and employment practices.”
c. “As a manager, you check the nurse practice acts for the province in which the
nurse resides.”
d. “As a manager, you should realize that the nurse is a professional embarrassment
and should be kept out of sight of other staff.”

Answer 21

D

Question 22

The education consultant for the hospital is presenting a workshop on “Documentation: A
Manager’s Responsibility.” Which of the following points concerning documentation of
personnel problems would she not include in her PowerPoint presentation?

a. “Documentation cannot be left to memory. A notation must be placed in the
personnel file.”
b. “Documentation should avoid discussion of the problem.”
c. “Documentation should include what was done about the problem when it
occurred.”
d. “Documentation needs to include date, time, and place.”

Answer 22

B

Question 23

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious
problem on the unit. Which of the following points would they have probably discussed?

a. Employee morale is at a high level.
b. Care will suffer and standards will be lowered.
c. Existing staff have experienced little effect from the absenteeism.
d. Replacement staff usually needs little supervision.

Answer 23

B

Question 24

Although the Health Professions Acts and professional nursing standards and competencies
vary across Canada, the underlying expectation is that members of any health care profession
recognized in Canada have on overarching mandate to:

a. Maintain competence.
b. Uphold nursing practice standards.
c. Duty to report.
d. Protect the public.

Answer 24

D

Question 25

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the
nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it
is obvious that Sarah’s peers are covering for her. Which of the following might Joyce include
in her meeting with the nurses? (Select all that apply.)

a. “It is a nurse’s professional responsibility to maintain quality control.”
b. “All instances of clinical incompetence are to be reported.”
c. “It is not considered being disloyal when one nurse reports another for poor care.”
d. “Patient care is the number one concern. Meeting standards is mandatory and
necessary.”

Answer 25

A,B,C,D

Question 26

Role strain can result in which of the following manifestations? (Select all that apply.)

a. Withdrawal from interaction.
b. Feeling of belonging.
c. Job dissatisfaction.
d. Decreased commitment to the team.

Answer 26

A,C,D

Question 27

A nurse’s emotional transference from past trauma may affect their ability to function within a
clinical setting. A manager must be attuned to a nurse’s level of emotional well-being. Which
of the following could demonstrate a nurse who is exhibiting signs of past trauma? (Select all
that apply.)

a. Hostility toward others.
b. Addictive tendencies.
c. Maladaptive perfectionism.
d. Testing of workplace guidelines.

Answer 27

A,B,C,D

Question 28

Many employers have moved from a progressive discipline approach to a nonpunitive
approach. The value of this approach is? (Select all that apply.)

a. Enables both parties to attain their dignity.
b. Takes longer to determine an actable outcome.
c. Minimizes ambiguity related role stress.
d. Shifts the responsibility to act from the manager to the employee.

Answer 28

A,B,D