Management Flashcards
1
Q
In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross
Hospital reduces the number of its nursing managers. Within a year the number of adverse
events on the units has doubled. This may be attributable to:
a. The overload of work for staff nurses.
b. Inability of staff at the bedside to make good choices.
c. A change in reporting systems.
d. Fewer clinical leaders and advocates for necessary resources.
A
D
2
Q
Traditional approaches to ensuring patient safety have focused on:
a. Assigning blame.
b. Finding solutions to systems issues.
c. Instituting best practices in response to errors.
d. Hiding errors from potential litigation.
A
A
3
Q
What is the primary purpose of nursing standards?
a. To inform performance appraisals at the unit level.
b. To identify the desired level of performance.
c. To inform the courts in relation to negligence and malpractice cases.
d. To educate other health care professionals about the role of the nurse.
A
B
4
Q
During review of back injuries, it is determined that mechanical lifts and transfer belts are
not being properly used. In addressing this concern, the unit manager:
a. Meets individually with nurses, who are observed using the lifts incorrectly, to
review the correct procedure.
b. Consults with the staff about the review to determine how best to proceed.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting adverse events to ensure that appropriate
reporting is occurring.
A
B
5
Q
The nursing manager changed the current model of implementing nursing rounds of patients
each day at 1200 hours to implementing interdisciplinary rounds of patients at 1000 hours.
This change reflects:
a. A patient-centred care initiative.
b. Delegation of responsibility from nursing to other health care professionals.
c. Lack of consultation among the nursing staff.
d. An inappropriate time to complete patient rounds and will probably not work.
A
A
6
Q
Which of the following represents an activity that supports patient-centred care?
a. Posting of visiting hours on the entrance way to each hospital unit
b. Regular staff surveys to monitor organizational satisfaction
c. Reserved parking spots at the main hospital entrance for physicians
d. Creating e-health stations on each inpatient unit
A
D
7
Q
After consulting with practice environments about quality and safety concerns in health
care, the Dean of Health Programs at a Canadian university develops:
a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care professionals to develop software for reporting of
adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners
that emphasizes collaborative learning teams.
A
D
8
Q
In designing a high-quality, safe health care environment, the primary emphasis needs to be
on:
a. Evidence-informed practice.
b. Informatics.
c. Staffing.
d. The patient.
A
D
9
Q
As a patient care advocate, you regularly coach patients in how to stay safe in health care by
educating them about:
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a health care environment and using a hand
sanitizer.
d. Following closely the directions and orders of health care providers.
A
A
10
Q
What is the focus in a culture of safety?
a. Employee safety.
b. Investigating who is making health care errors.
c. Effective systems and team work
d. Professional nursing standards and ethical codes
A
C
11
Q
Which attribute is a common feature of a culture of safety?
a. Voluntary reporting of incidents.
b. Organization behaviour.
c. Individual-focused policies.
d. A nonpunitive approach to adverse event reporting and analysis.
A
D
12
Q
Which of the following depicts a nursing-sensitive outcome?
a. Programming that increases individual nurse competency to offer smoking
cessation programs.
b. Implementation of informatics at the patient’s bedside.
c. Staff–manager conferences to review reporting of adverse events.
d. Patient council meetings to review food, recreation, and nurse–patient relations.
A
A
13
Q
Having team “huddles” each day on the nursing unit is a reflection of:
a. Nurses’ need to socialize.
b. Creating a culture of safety.
c. Ensuring distribution of equal workloads.
d. The manager`s need to talk with staff nurses on a daily basis.
A
B
14
Q
Approximately what percentage of Canadian hospital admissions can be expected to include
an adverse event?
a. 5
b. 7.5
c. 10
d. 12.5
A
B
15
Q
Having access to information, evidence, and research is an important driver for quality and;
a. Nurse safety.
b. Patient safety.
c. Organizational policy development.
d. Patient-centred care.
A
B
16
Q
Which of the following represents a potential use of nurse-sensitive outcomes?
a. Informing best practices.
b. Accountability for nursing behaviours.
c. Performance appraisals.
d. Maintaining the status quo.
A
A
17
Q
Which of the following is a CPSI safety competency?
a. Practise patient-centred care.
b. Optimize human and environmental factors.
c. Analyze nurse-sensitive outcomes.
d. Assess nurse staffing and skill mix.
A
B
18
Q
On the basis of a review of increased falls with injury and increased use of restraint during
evening hours, you as the unit manager are most likely to:
a. Review daytime and evening staffing mixes.
b. Schedule continuing education for all staff members.
c. Review the safety of ambulation devices.
d. Continue your current practices and procedures.
A
A
19
Q
As the nurse was about to administer an oral mediation, the patient states, “That pill is the
wrong colour.” The nurse goes back to the medication administration area to check the
medication and realizes that it is indeed the wrong pill. Does this situation require the
completion of an adverse event report?
a. No; there was no actual error.
b. No; it was the patient who stopped an error from occurring.
c. Yes; an error almost occurred, and close calls are to be reported.
d. It is up to the nurse to decide whether to complete an adverse event report.
A
C
20
Q
Which of the following is the CPSIs flagship program?
a. Patients Are First.
b. Safer Healthcare Now.
c. Safe Healthcare for All.
d. Patient Safety Culture Improvement.
A
B
21
Q
Organizational changes that promote systems thinking, collective accountability, and
team-based care are examples of:
a. Activities that promote patient-centred care.
b. Accreditation standards that hospitals must meet.
c. Outdated practices that are not grounded in current evidence.
d. Quality improvement initiatives.
A
A
22
Q
Robert, an experienced nurse, discovered a medication order was incorrectly translated.
The pharmacist filled the medication and sent it to be administered to the patient. When the
medication arrived Robert questioned the dose and consulted with the nurse manager. The
order was clarified with the physician and changed to the correct dose. When reviewing the
incident the nurse manager determined the near miss was related to which of the following?
a. Individual error.
b. System error.
c. An individual and system error.
d. Attributed to increased workload.
A
C
23
Q
Gail, a senior nursing student, consults with her preceptor about a patient who has refused
his medication. When speaking with the patient he expresses that he does not believe the
medication is helping with his pain level. From a nursing sensitive outcome, which
outcomes are addressed in this situation? (Select all that apply.)
a. Quality of nursing care.
b. Symptom management.
c. Patient satisfaction.
d. Functional status.
A
B, C
24
Q
Gathering information on patient outcomes leads to which of the following? (Select all that
apply.)
a. Evaluating different approaches to care.
b. Increasing quality of nursing care.
c. Decreasing nursing autonomy.
d. Having a positive impact at the individual, unit, and organization levels.
A
A,B,D
25
Rose a new nursing graduate chose hospital X for its culture of safety. Which of the
following attributes contribute to this culture of safety? (Select all that apply.)
a. Trusting and open communication
b. Organizational learning
c. A system rather that an individual approach to safety
d. Teamwork
A,B,C,D
26
Which of the following contribute to improved patient safety? (Select all that apply.)
a. Leadership capability.
b. Patient involvement in own care.
c. Data collection.
d. Increased staff mix.
A,B,C
27
The manager in the coronary care unit believes that the most important ethical
considerations in performance evaluations are that they include the employee’s good
qualities and that they give positive direction for professional growth. This belief is an
example of:
a. Justice.
b. Fidelity.
c. Beneficence.
d. Nonmaleficence.
D
28
Normative ethics is concerned with the:
a. Broader theory and meaning of morality.
b. Foundation and scope of moral values, words, and practice.
c. Standards that most people use to guide their behaviours.
d. Relationship of ethical principles to real-life moral issues.
C
29
A patient refuses a simple procedure that you believe is in the patient’s best interest. The
two ethical principles that are directly in conflict in such a situation are:
a. Fidelity and justice.
b. Veracity and fidelity.
c. Autonomy and beneficence.
d. Paternalism and respect for others.
C
30
Three gravely ill patients are candidates for the only available bed in the intensive care unit.
As the supervisor, you assign the bed to the patient with the best chance of recovery. This
decision reflects which of the following ethical principles?
a. Beneficence.
b. Autonomy.
c. Veracity.
d. Nonmaleficence.
A
31
Which ethical principle is primarily involved in informed consent?
a. Veracity.
b. Autonomy.
c. Beneficence.
d. Nonmaleficence.
B
32
Which of the following is a key area of ethical nursing practice?
a. Nursing process.
b. Therapeutic relationship.
c. Decision-making model.
d. Embodied knowledge.
B
33
Which question reflects the essence of relational ethics?
a. “What can I do to maintain my professional practice?”
b. “What should I do for others?”
c. “What techniques can I use to empower my colleagues?”
d. “What ethical decision-making model will work best for me?”
B
34
The nurse manager organizes interprofessional team meetings on a weekly basis. This action
is demonstrating which aspect of relational ethics?
a. Embodied knowledge.
b. Interdependent environment.
c. Engaged interactions.
d. Mutual respect.
D
35
According to relational ethics, what is critical in the development and maintenance of the
roles and actions of the nurse manager?
a. Time management skills.
b. Professional relationships.
c. Understanding of biomedical ethics.
d. Comprehension of the Quebec Nurses Association’s Code of Ethics for nursing.
B
36
Which of the following is a criticism of the principle of autonomy?
a. It is not culturally sensitive.
b. It can lead to focus on the needs of one person at the expense of the needs of
others.
c. It is not applicable with entire groups.
d. It can be viewed as advancing professional directives rather than patient desires.
B
37
Autonomy is best promoted through which of the following, in taking a relational approach
to autonomy?
a. Specific roles within the relationship.
b. Social change.
c. Protecting an individual’s freedom of choice.
d. The necessity of treating everyone fairly.
B
38
Sue, a staff nurse, consistently arrives 15 minute late for her shift, and the nurse manager
has talked to her about it several times. Sue does not take the comments seriously because
there are two other nurses who also arrive late all the time, and the unit manager does not
reprimand them. In this situation, the nurse manager is violating the ethical principle of:
a. Beneficence.
b. Nonmaleficence.
c. Justice.
d. Autonomy.
C
39
Which element of the Code of Ethics of the International Council of Nurses is reflected in
the following statement: “The nurse manager sets policies and procedures to guide ethical
nursing practice?”
a. People.
b. Practice.
c. Profession.
d. Coworkers.
C
40
Which element of the Code of Ethics of the International Council of Nurses is reflected
when the nurse manager establishes a system for performance appraisals?
a. People.
b. Practice.
c. Profession.
d. Coworkers.
B
41
What is reflected when a nurse feels a lack of clarity or is unable to know even what the
moral problem is, whereas at the same time feeling uneasy or uncomfortable about the
situation?
a. Moral distress.
b. Moral uncertainty.
c. Ethical dilemma.
d. Ethical distress.
B
42
A patient’s husband asks to speak with the nursing manager. He is visibly upset and tells the
nursing manager that while at the corner store, he overheard two nurses discussing his
wife’s health issues and is certain that others around him also heard the discussion. This is
an example of:
a. Ethical distress.
b. An ethical violation.
c. Moral inappropriateness.
d. An ethical dilemma.
B
43
Sally, a fourth year nursing student, was assigned to a maternal child unit. Upon reporting
for an assignment she was informed her patient would be having an abortion because of
severe medical issues with the unborn child. She approached her preceptor immediately and
asked to be reassigned to another patient because Sally was opposed to abortion for any
reason. This is an example of:
a. Competent nursing care.
b. Staffing availability.
c. Conflict of conscience.
d. Fatigue.
C
44
Michael a novice nurse has been assigned to four medically ill patients. There is a nursing
staff shortage on his unit and more experienced nurses have as highly acute a workload as
he does. As the shift progresses he becomes more distraught and unable to provide the type
of care he knows his patients need. Michael is experiencing:
a. Moral distress.
b. Moral fatigue.
c. Values conflict.
d. Therapeutic relationship.
A
45
Mr. and Mrs. Bennett are attending a consult for reproductive assistance. Although there is a
positive chance the method will result in a pregnancy, they are not able to cover the cost of
the procedure. This situation denies which of the following ethical principles?
a. Autonomy.
b. Nonmaleficence.
c. Justice.
d. Beneficence.
C
46
To perform treatment on a patient not requiring a formal written consent a nurse must
conduct which of the following? (Select all that apply.)
a. Asking permission to do a treatment.
b. Explaining the procedure.
c. Stopping the procedure if patient is uncomfortable.
d. Confirming understanding of the treatment.
A,B,C,D
47
Nursing management actions and decisions are guided by (Select all that apply.)
a. The law.
b. Ethical principles.
c. Leadership style.
d. Professional accountabilities.
e. Staff preferences.
A,B,D
48
Which of the following are core elements of relational ethics? (Select all that apply.)
a. Mutual respect.
b. Justice and beneficence.
c. Informed consent.
d. Interdependent environment.
A,D
49
According to Leininger (2002), “cultural imposition” is a major concern in nursing because
nurses have a tendency to impose their values, beliefs, and practices on people of other
cultures. The discussion topic most likely to be without cultural imposition would be:
a. Abortion.
b. Wound management.
c. Blood transfusion.
d. Advance directives.
B
50
Cultural diversity is the term used to describe a vast range of cultural differences. Events
have symbolic meanings for the nurse manager and the staff. The event that would be most
likely to provide symbolic meaning to a nurse manager and staff is:
a. The formation of a task force to commemorate a New Year’s celebration in the
Western tradition.
b. A project to provide Christmas gifts to the children in a daycare program.
c. Celebration of National Nurses’ Week with the focus on cultural care.
d. The formation of a task force to develop a poster for the unit depicting religions of
the world.
C
51
One of the staff nurses on your unit makes the comment, “All this time I thought Mary was
Black. She says she is Jamaican.” The best response would be:
a. “Who cares what she is?”
b. “What did you think when you learned she was Jamaican?”
c. “Why did you assume she was Black?”
d. “We have never had a Jamaican on this unit before.”
B
52
As a nurse manager, you notice that Sharon, an Aboriginal licenced practical nurse aide, is
visibly upset. When you ask her if something is wrong, she becomes tearful and says, “Why
is it that when Nick and I work together in giving patient care, he jokes about my being ‘a
little fat Eskimo’?” The nurse manager’s best response is, “Do you think he
a. Is sensitive to your culture?”
b. Wants to learn more about you?”
c. Has been hurt and wants to hurt others?”
d. Is stereotyping you without thinking?”
D
53
The nurse manager of a unit is asked by a family member of a dying Inuit patient if it is
possible to for the patient’s eight-member family to recite the rosary by the patient’s
bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting
behaviour related to:
a. Acculturation.
b. Ethnocentricity.
c. Cultural diversity.
d. Cultural sensitivity.
D
54
A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the
nurse manager about seeing his “acupuncture doctor” for treatment of his migraine
headache. The best response to this patient would be:
a. “How long have you been using acupuncture treatment?”
b. “Do you think acupuncture relieves your pain satisfactorily?”
c. “What have you told your heart specialist about your migraines and treatment?”
d. “Have you tried nonprescription pain medication or been given a prescription drug
for your headaches?”
A
55
Maintaining a culturally diverse staff is an important function of a nurse manager who
works in the hospital of a large medical centre. According to Health Canada (2008), which
cultural group represents about 2% of registered nurses employed in Canada? The chapter
states 3% p. 11.
a. Men.
b. Aboriginal.
c. French Canadian.
d. African Canadian.
B
56
Because an increasing number of Aboriginal patients are being admitted, a nurse manager
designs a staff-development program for her staff to help them understand Aboriginal
culture. A nurse should understand that culture is determined by which of the following?
a. Behaviour.
b. Love for people.
c. Shared vision.
d. Rapid time passage.
A
57
The nurse manager for a unit’s culturally diverse staff creates a staff-development program
so that the professional nursing staff members can enhance their understanding of cultures
on the basis of published literature. The literature reveals that what characteristics are
inherent in a culture?
a. It develops over time.
b. It maintains a strong work ethic.
c. It changes easily.
d. It develops quickly.
A
58
Which principle of The Canada Health Act is frequently not upheld in rural and remote
areas of the country?
a. Comprehensiveness.
b. Public administration.
c. Accessibility.
d. Portability.
C
59
Within the deaf community, there is considerable disagreement about the use of SEE
(Signed Exact English) and ASL (American Sign Language). This is indicative of:
a. Dominant versus nondominant behaviours.
b. The need to recognize diversity within groups.
c. The effect of cross-culturalism.
d. How language separates subgroups.
B
60
When interviewing a candidate for a nursing position who has an Aboriginal background, a
non-Aboriginal nurse recognizes that the candidate’s lack of eye contact reflects the
candidate’s:
a. Lack of confidence.
b. Professional behaviour.
c. Cultural sensitivity.
d. Ethnicity.
D
61
Recognizing that the Aboriginal candidate’s lack of eye contact is different from her own,
the non-Aboriginal nurse is exhibiting
a. Acculturation.
b. Cultural sensitivity.
c. Ethnocentrism.
d. Transculturalism.
B
62
A non–English-speaking patient arrives at the nursing unit. The nurse knows that when
patient communication is hampered by the inability to communicate in the same language, it
may lead to:
a. Inequities in accessing health care services.
b. Inability to obtain health insurance.
c. A decrease in patient morbidity.
d. Lack of portability with health care coverage.
A
63
At Health Centre XYZ, staff members on the rehabilitation unit have a head nurse who is
intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on
the unit dictate that mistakes are hidden and that areas of concern related to the functioning
of the unit are discussed in privacy and are never openly discussed during periodic
meetings. New staff members are quickly made to realize that silence is expected. The
situation described is an example of:
a. Ethnicity.
b. Work environment.
c. Work culture.
d. Marginalization.
C
64
Which of the following enables people to make sense of situations that they may encounter
that differ from their circle of familiarity?
a. Paradox.
b. Prejudices.
c. Power.
d. Position.
B
65
During performance appraisal, you praise Xia for her attention and care to nursing details.
You suggest that her care would be further enhanced by greater acknowledgement of
patients’ feelings. Xia bursts into tears and leaves the office. Later, you learn that in Xia’s
culture, criticism is perceived as akin to failure. You reflect on how you could modify your
approach in the future to acknowledge different cultural interpretations of feedback. Your
response is indicative of:
a. Bias.
b. Cultural awareness.
c. Cultural diversity.
d. Ethnocentricity.
B
66
Individuals living with asthma, who also live in poverty, are much less likely to seek early
care than to go to emergency rooms for assistance. This example reflects:
a. Stereotyping.
b. Cultural diversity.
c. Ethnocentricity.
d. Transcultural care.
D
67
Serena, RN complains to you that a male nurse from a different culture sits very close
during charting and leans toward her when speaking. In responding to Serena, you consider
that differences across cultures that are relevant to this situation include:
a. Eye contact.
b. Personal space.
c. Harassment.
d. Expressions of feeling.
B
68
A new graduate registered nurse joins your unit. After a few weeks, she complains about
some of her peers on the unit and compares their practices negatively to what she learned in
her nursing program. She also is vocal about how she has learned so much here that she did
not in her program. She is best described as:
a. Having cultural sensitivity.
b. Experiencing cultural diversity.
c. Experiencing cultural marginality.
d. Experiencing acculturation.
C
69
In caring for a patient from an East Indian culture, staff members express frustration that
many friends and family members are in the room at any one time, which interferes with
care. As the nurse manager, you provide leadership in understanding that this behaviour of
the family and friend network reflects:
a. Lack of understanding of the seriousness of the patient’s illness.
b. Lack of communication between family members.
c. The social organization of friendships and family networks in East Indian culture.
d. Lack of caring about the hospital environment by the friends and family.
C
70
Monique, one of your registered nurses, tells you that she cannot understand why Jim, an
Aboriginal patient, wants to have a smudge ceremony. Monique’s response is based on her:
a. Cultural marginality.
b. Circle of familiarity.
c. Cultural understanding.
d. Acculturation.
B
71
In coaching Monique to become more culturally sensitive when a patient has requested a
smudge ceremony at the bedside, you suggest which of the following?
a. “Explain to Jim that there is no smoking in the hospital.”
b. “Inform Jim that fires are not allowed in the hospital.”
c. “Insist that he give you his tobacco because it is unhealthy for him.”
d. “Ask him what he means by a ‘smudge ceremony’ and what meaning it has for
him.”
D
72
A constructivist perspective of culture recognizes which of the following influence an
individual’s understanding of culture? (Select all that apply.)
a. Social context.
b. Is changeable.
c. Political understanding.
d. Economic status.
A,B,D
73
To ensure cultural safety regarding the use of language it is essential to address which of the
following? (Select all that apply.)
a. Uses common points of reference in practice.
b. Count on a word for word translation.
c. Ensure linguistic equivalence in both languages.
d. Think any translator is adequate.
A,C
74
New immigrants to Canada have a limited understanding of the Canadian health care
system. Nurse leaders must ensure that staff use effective communication to ensure patients
have the knowledge to understand their rights to health care. Good communication can be
achieved through which of the following? (Select all that apply.)
a. Understanding one’s own prejudices.
b. Allowing time for interpreting and clarifying information.
c. Presuming openness exists between people of different cultures.
d. Recognizing providing care to diverse groups is a dynamic and complex
experience.
A,B,D
75
As a nurse manager, you have to be effective in managing a culturally diverse staff. Which
of the following attributes of a nurse manager would assist you in addressing the cultural
needs of your staff? (Select all that apply.)
a. Stereotyping of others.
b. Respect for others.
c. Positive reinforcement.
d. Knowledge about your staff.
e. Age bias.
f. Disrespect for others.
B,C,D
76
A nurse manager was orienting new staff members with regard to computerized charting. To
understand computerized charting, staff members must understand informatics. Which of
the following are the core concepts in informatics?
a. Hardware, software, competency, and printers.
b. Data, information, knowledge, and wisdom.
c. Decision making, data gathering, data analysis, and reporting.
d. Wireless technology, voice recognition, and handheld devices.
B
77
The nursing manager of a surgical unit has been asked by administration to evaluate patient
outcomes after cardiac catheterization. Using data about patient outcomes after cardiac
catheterization for the past 6 months so as to modify practice is an example of:
a. Gathering information.
b. Cost-effective care.
c. Meeting standards.
d. Evidence-informed practice.
D
78
The clinic nurse has just accessed a patient’s chart on the computer. The resident comes
over and asks her to stay logged on because he needs to add a note to that patient’s chart.
What should she say?
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
d. “I’m sorry, but you will have to enter the information using your own password.”
D
79
A home health nurse has been assigned to cover a 500-km2
area of remote Alberta. Mrs.
Banister has just been discharged home and will need daily contacts for the next week.
Because it is not possible to visit Mrs. Banister in person every day and see all the other
patients, the nurse gives her a laptop computer with Internet meeting software installed.
Each morning, both dial in at an agreed-upon time and discuss her progress. The home
health nurse assesses whether the patient needs to be seen that day. This type of technology
is called:
a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.
C
80
Nurses need to know how to operate a computer, compare data across time, and look for
patterns in patient responses to treatments. These are examples of which of the following?
a. Canadian Nursing Informatics Association standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.
C
81
The chief nursing officer understands that to be able to compare data across patient
populations and sites, it is important that nurses use:
a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Consistent nursing languages.
D
82
Leaders in nursing must advocate for information and knowledge systems that support
nursing practice. How is this best accomplished?
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.
A
83
You are in the process of designing a patient education program that will provide education
and monitoring for patients with hypertension. To support your planning, you obtain and
present patient data from which of the following?
a. A clinical database.
b. Biomedical technologies.
c. Email.
d. Internet sources.
A
84
As the head nurse involved in determining which patient surveillance systems to acquire for
your unit, one of your aims is to avoid adverse events through the implementation of
appropriate technology. What does this particular aim recognize?
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot
provide.
d. Physiologic monitoring systems enable detection of early changes before an
adverse event occurs.
D
85
As a nurse manager in a multisite facility, you are comparing the effectiveness of prompted
voiding training programs for staff by examining the effect of prompted voiding on the
frequency of incontinence in patients. To do this, you access an NMDS, which allows you
to:
a. Retrieve standardized information regarding patient care and trends.
b. Access medical diagnoses and pharmacologic interventions.
c. Learn sociodemographic and population-based trends.
d. Find information on public funding and private health insurance revenues.
A
86
As a nurse manager representative on a team to select a clinical information system, you
would be particularly concerned if the favoured system has which of the following
characteristics?
a. It involves screen displays that are best configured for nonclinical users.
b. It requires an upgrade to servers in the facility.
c. It requires staff orientation and training during implementation
A
87
When assessing the appropriateness of adopting personal digital assistants (PDAs) for a
nursing unit, you need to consider which of the following advantages?
a. Lower cost in relation to personal computers.
b. Small display screen.
c. Font size.
d. Speed of operation.
A
88
A nurse manager is excited by the possible use of speech recognition (SR) systems for
documentation of patient care, especially during crisis situations when staff members need
to focus on performing rapid assessments and implementation of procedures. She learns,
however, that SR systems would be impractical at this point for this. What characteristic
would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely in a pressured
situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.
B
89
For a nurse manager, one challenge is to orient new staff to the agency’s policies and
procedures, and also to provide training across various shifts. Which of the following would
be a cost-effective and effective learning strategy?
a. Development of new learning modules and software to support document retrieval.
b. Email distribution to staff home email addresses regarding important policies.
c. Preparation of digital video disks (DVDs) that can be viewed on computers at the
nursing station during “down times.”
d. Linking policies and procedures to the network for access when required at the
point of care.
D
90
What is the most critical factor in ensuring nurses’ comfort and knowledge in the use of
technology in health care regardless of age, education level, or area of practice?
a. Confidence in using technology.
b. Adequacy and substance of professional development.
c. Repeated training sessions.
d. Peer and leader support.
B
91
Peggy, a nurse leader on a busy medical surgical unit, is concerned that the rapid expansion
in use of EHRs and clinical decision support systems may lead to leaked patient information
and breach of confidentiality. She decides to form a nurse led committee to address these
concerns. Which of the following must be addressed to prevent breach of confidentiality?
(Select all that apply.)
a. Assign a password that uniquely identifies a user to the system by name and title.
b. Ensure nurse confidentiality through ongoing discussion.
c. Ensure nurses understand privacy legislation that applies to them, and their work
setting.
d. Monitor individual nurses.
A,B,C
92
Nurses rely on technology to lessen the number of adverse events that are well documented,
yet are challenged in keeping the unique therapeutic relationship between nurse and patient
with increasing use of technology. What approaches can be used to ensure the therapeutic
relationship is preserved (Select all that apply.)
a. Involving patients in decisions about their own care.
b. Actively listening while conducting electronic charting.
c. Showing patients what is being documented.
d. Repeatedly monitoring equipment while documenting.
A,B,C
93
As a nurse manager, you want to institute point-of-care devices on your unit. The rationale
that you provide to support the point-of-care devices includes which of the following?
(Select all that apply.)
a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Improving discharge planning.
d. Increasing confusion with nursing workflow.
A,B,C
94
The number of adverse events such as falls and pressure ulcers on your unit is increasing.
An ideal staffing plan to address this issue would include which of the following?
a. Increasing the total number of staff on the unit.
b. Increasing the staff and registered nurse (RN) hours per patient.
c. Increasing the total number of staff and implementing 12-hour shifts.
d. Increasing the number of RNs and number of RNs with experience on the unit.
D
95
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an
average occupancy rate of 34 beds. To prepare the staffing, the chief nursing officer
computes the occupancy as being;
a. 90%.
b. 85%.
c. 75%.
d. 60%.
B
96
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time.
When calculating paid nonproductive time, the nurse manager considers:
a. Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.
C
97
An important aspect of managing the costs on a unit is to plan accurately for staffing needs.
Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular
staff.
C
98
A nurse manager must consider a number of external variables when preparing the
personnel budget and projecting the unit’s staffing needs. An external consideration is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.
D
99
A nurse manager must also consider a number of internal variables that will affect staffing
patterns. Which of the following is an internal variable to be considered?
a. Organizational staffing policies.
b. Provincial/territorial licensing standards.
c. Canadian Nurses Association guidelines.
d. Consumer expectations.
A
100
A nurse manager uses many sources of data when planning the unit’s workload for the year.
Which of the following data must be considered in the planning?
a. Hours of operation of the unit.
b. Trends in the numbers of acutely ill patients on the unit.
c. Maximum work stretch for each employee.
d. Weekend requirements.
B
101
Scheduling is a function of implementing the staffing plan by assigning unit personnel to
work specific hours and specific days of the week. To retain nursing staff, the nurse
manager must schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.
C
102
The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Accounts for interpretation of benefits and compensation.
A
103
A busy neurologic intensive care unit and a step-down unit are most likely to use which
patient classification system?
a. Factor evaluation.
b. Prototype evaluation.
c. Canadian National Database of Nursing Quality Indicators.
d. Agency for Healthcare Research and Quality (AHRQ) system.
A
104
Factor evaluation systems involve classification systems in which:
a. Financial data are used to determine staff-to-patient ratios.
b. Diagnosis-related groups are used to determine the numbers of acutely ill patients
on a unit.
c. Interventions and time required for interventions are combined to determine the
levels that are required.
d. Financial resources and nursing interventions are combined to determine patient
contact hours.
C
105
Staff members on your unit raise concern that the number of acutely ill patients on the unit
is rising and responsiveness in addressing these needs through appropriate staffing is
lacking. They point to increased incidences of adverse and sentinel events on the unit. To
address this concern, the best action for your hospital organization is to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those
of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because the number of acutely ill patients is variable.
B
106
A particular classification system assigns revenue according to the functional capacity of
patients and the progression of patients during their stay in rehabilitation units. More
independent patient activities such as prompted voiding require higher staff utilization than
do dependent activities but do not result in increased staff resources. This is an example of:
a. Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgements about staffing.
B
107
In the past year, you have noticed an increase in patient falls on your unit. In reading studies
related to staffing and patient outcomes, you realize that you will need to plan for:
a. Higher patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.
D
108
In evaluating mortality rates, the head nurse on the cardiac unit is surprised to find that they
are higher on the weekend than on weekdays. In exploring the reasons for this apparent
anomaly, the head nurse focuses on:
a. Availability of diagnostic personnel.
b. Availability of physicians.
c. Communication with on-call providers.
d. Numbers of acutely ill patients.
C
109
What does a nurse staffing plan take into account?
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff.
d. The occupancy load of a unit.
B
110
As the unit manager you post the staffing plan and compliance reports. This initiative is
aimed at:
a. Maintaining unit morale.
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.
A
111
To maintain patient safety, studies suggest that scheduling should avoid which of the
following?
a. Rotating shifts.
b. Weekends.
c. Eight-hour shifts.
d. Mandatory overtime.
A
112
In a job interview for a staff position, which of the following indicates your knowledge of
patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”
C
113
To reduce reliance on overtime hours, an organization develops a strategy for floating
nurses during staff shortages. To maximize patient safety and reduce costs, the health care
organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased numbers of acutely ill
patients.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.
A
114
To project staffing needs and to avoid understaffing, it is important that nurse managers
consider which of the following?
a. Maximum productive hours.
b. Average nonproductive hours.
c. Minimum benefit hours.
d. Maximum vacation time.
B
115
Your health care organization has a decentralized system for scheduling. As part of this
process, after you have developed a draft schedule, you may need to:
a. Seek budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.
D
116
Patient classification systems have been developed in an effort to give nurse managers the
tools and language to describe the acuity of patients. “Sicker” patients receive higher
classification scores, indicating that more nursing resources are required to provide patient
care. Which of the following describes a factor evaluation system?
a. Subjective and descriptive.
b. More objective.
c. Uses broad categories to predict patient-care needs.
d. Patient-care needs based on diagnosis-related groups.
A
117
Which of the following decrease the risk of patient mortality rates? (Select all that apply.)
a. Staff burnout.
b. Positive leadership support.
c. Increase of casual or temporary positions.
d. Staffing numbers and levels.
B,D
118
The growth in evidence on nursing-sensitive indicators has been accompanied by significant
controversy regarding the level of nurse staffing required for various groups of patients,
primarily in acute-care hospitals. Two major approaches to sufficient staffing have been put
forward in Canada. These are? (Select all that apply.)
a. Mandated nurse-patient ratios
b. Increased numbers of registered nurses
c. Development of a staffing plan for a period of time
d. Better staff mix
A,C
119
Eschiti and Hamilton (2011) learned that support services and numbers of nonnurse staff are
greatly diminished on off-peak shifts leading to increased mortality rates. Which of the
following factors influence the risk to patients in off-peak times (weekends and evenings
and night shifts)? (Select all that apply.)
a. Rotating shifts
b. Mandatory overtime hours
c. Good staff mix
d. Nurse fatigue
B,D
120
In reviewing the job description of a nurse manager, the staff members become aware that a
nurse manager’s role is complex. Which of the following duties are required of a nurse
manager? (Select all that apply.)
a. Responsibility for nursing benchmarks.
b. No responsibility for knowledge of staffing benchmarks.
c. Responsibility for planning staffing of unlicensed assistive personnel only.
d. Preparing a unit budget.
e. Changing staffing plans on the basis of service needs.
A,D,E
121
The nurse manager schedules evaluations of staff members by using a newly developed
performance appraisal tool. The development of a performance appraisal tool should include:
a. The organizational mission and philosophy and the position requirements.
b. A generalized overview of the duties of a position.
c. A skills checklist and accreditation requirements.
d. An ordinal scale that ranks all employees.
A
122
Joshua, a new graduate, reviews the employee evaluation for his new position. The first
section requires that he list his own specific objectives to be accomplished. This is an example
of:
a. The traditional rating scale.
b. Learning goals or management by objectives.
c. A forced distribution scale.
d. A behaviourally anchored rating scale (BARS).
B
123
Joshua notes that the next section of the evaluation tool is specific to the organizational
philosophy and has a four-point ordinal scale that describes performance from “always meets
expectations” to “does not meet expectations.” This type of evaluation is most commonly
known as:
a. A BARS.
b. Management by objectives/learning goals.
c. The forced distribution scale.
d. A traditional rating scale.
D
124
On your unit, despite efforts to build a strong sense of team, conflict between some of the staff
is ongoing. Nonetheless, you want to proceed with developing a systematic and effective
performance appraisal system. Which of the following approaches would be most appropriate
for you to implement?
a. Peer review.
b. A combination of tools.
c. Anecdotal notes.
d. Rating scale.
B
125
Which of the following is a strategy that clinical nurse educators can use to ensure
understanding and retention of information in newly hired staff nurses?
a. Provide written information of all orientation topics.
b. Evaluate whether there is fit between learner and organizational values.
c. Develop a range of strategies that cover a variety of learning styles.
d. Organize group sessions for orientation to increase cost effectiveness.
C
126
Which of the following might best conclude an interview?
a. “Thank you for your interest. Someone will be in touch with you soon.”
b. “Before you go, we will make sure that we have your contact information. Thank
you for coming.”
c. “I will be in contact with all candidates by telephone by next Friday. It has been a
pleasure to meet you.”
d. “We have several excellent candidates so I am not sure about the outcome of the
interview, but I will let you know. Thank you for coming.”
C
127
In addressing the primary challenge in recruitment of new staff, which of the following
interview questions might be asked?
a. “Could you review your resume for us, highlighting your certifications and
experience?”
b. “If we were to ask your references, what would they list as your strengths?
Weaknesses?”
c. “We have a number of older adult patients on this unit. If you noticed another staff
member addressing one of these patients impatiently, how would you respond?”
d. “Tell us about your work and academic experiences and qualifications.”
C
128
The biggest challenge in the recruitment of staff is:
a. Finding well-qualified candidates who can function well within a particular work
culture.
b. Recruiting individuals with the appropriate qualifications and experience.
c. Screening out candidates who are unable to function well within a team.
d. Determining whether candidates have had previous negative experiences in a work
environment.
A
129
Anecdotal notes:
a. Should be completed only when there are performance concerns.
b. Can be used to support and justify fairness in termination discussions.
c. Are unnecessary if the evaluation instrument is thorough.
d. Need to be completed at the end of a performance period.
B
130
An outpatient clinic advertised for registered nurse positions. Before authorizing a position
opening, the nurse manager should:
a. Review the position description and performance expectations for the opening.
b. Place an advertisement in the local newspaper and on the telephone job line.
c. Review all current applications on file.
d. Look for employees within the system who might best fill the position.
A
131
Yasmine is a likable and popular staff member. Despite occasional complaints from patients
about inappropriate comments and rough handling of patients, Yasmine continues to receive
positive performance appraisals. This is an example of:
a. A halo effect.
b. Rare conflict.
c. Role ambiguity.
d. Evaluator bias.
A
132
The validity of comments and ratings related to performance is enhanced by which of the
following:
a. Maintenance of anecdotal notes over the entire evaluation period.
b. Quantity of information gathered for appraisal purposes.
c. Agreement of the employee with the ratings and comments.
d. Whether other individuals have contributed to the observations.
A
133
A nurse manager in the intensive care unit works with his staff to develop an appraisal
instrument that includes quantitative data and respects standards for a registered nurse
working on that unit. What type of appraisal is this?
a. Rating scale.
b. Collaboratively based appraisal system.
c. Narrative instrument.
d. BARS.
D
134
The primary disadvantage of a BARS is that it is:
a. Situation specific.
b. Well understood by the staff.
c. Too generalized.
d. Expensive to develop.
D
135
Marcia, a nurse manager, discusses her concerns about the hospital’s employee appraisal
system with her work group, noting that all it includes is one rating scale, which means
nothing unless the manager is effective in her job. Marcia’s concerns reflect which best
practices associated with performance appraisal?
a. Rating scales are too generalized to be considered valid or reliable.
b. The effectiveness of any appraisal system is tied directly to the skills and
communication abilities of the manager.
c. BARS are considered superior to simple rating scales in terms of performance
appraisal.
d. Rating scales need to be designed by users to be well accepted.
C
136
During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has
difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In
responding to Alysha, Joanne needs to consider:
a. Alysha’s level of confidence.
b. Whether mentoring is included in the position description.
c. Whether mentoring is an essential component of the position description.
d. Whether mentoring can be accurately observed and measured.
B
137
The final section of a performance appraisal is a rating scale. This scale is very detailed and
relates to competency standards specific to surgical patients. The scale is a summary of
performance directly observed or documentation reviewed and is specific to patient care
situations in which the employee has been involved. This type of evaluation is most
commonly known as:
a. A traditional rating scale.
b. Management by objectives/learning goals.
c. A forced distribution scale.
d. A BARS.
D
138
John’s performance was satisfactory during the first month, but after that time he was very
inconsistent in the provision of nursing care. One month before the end of the rating period,
he cared for a very wealthy and influential patient, who is a close friend of the clinical
manager. This patient donated new furniture for the staff lounge in John’s name to show
appreciation for his care. Joshua’s subsequent performance appraisal resulted in outstanding
ratings in all areas. This is an example of:
a. A performance rating based on justifiable evidence.
b. A bias related to recent events.
c. The effect of personality on the appraisal of performance.
d. The effective use of a BARS.
B
139
As a manager, you are interested in developing behavioural questions for an interview. You
know that there is team conflict at times on your unit. Which of the following questions would
satisfy your interest in behavioural questions?
a. “Tell me about a time you were involved in a conflict related to a project. What
was your role in the conflict? In the resolution of the conflict?”
b. “If you were to employ one strategy for managing conflict, what would it be?”
c. “What is your preferred style of conflict resolution?”
d. “How effective are you in working in a group? In dealing with conflict?”
A
140
Which of the following strategies might be effective in empowering staff?
a. Communication book in which new information on policies and processes is
communicated and mistakes are highlighted.
b. Monthly staff meetings during which a portion of the agenda is devoted to sharing
ideas and presentations on best practices for implementation on the unit.
c. Once-yearly summative evaluations based on what the manager likes best about
each individual.
d. Immediate discussion of errors in care and with involved staff with direction as to
how errors are to be prevented in the future.
B
141
The chief nursing officer establishes a shared governance model to help empower the nursing
staff, thus empowering the organization. Common characteristics of empowered organizations
are:
a. Shared values, high salaries, and a human focus.
b. Shared values, flexibility, and a human-capital focus.
c. Commitment to communication, high salaries, and flexibility for evaluations.
d. Creation of community and of effective stress management in the midst of
divergent goals.
B
142
Nora, a new nurse manager, writes certain assumptions regarding the organization’s
objectives into her budget. Her supervisor tells her that the objectives implied in her
assumptions are not entirely consistent with the organization and that she needs to clarify
these objectives with her supervisor. Nora apologizes and says she had more latitude with the
budget where she previously worked. This is an example of:
a. Role complexity.
b. Role ambiguity.
c. Role conflict.
d. Time-dependent roles.
B
143
A survey of staff satisfaction is conducted. The results indicate that staff members are
satisfied, are loyal to the organization, and believe that they have reasonable control in their
individual responsibilities. The findings best exemplify:
a. Clarity in roles and valuing of contributions.
b. Satisfaction but not empowerment.
c. Effective coaching of new staff.
d. Role attachment.
A
144
You have hired Bumika as a new staff member on your unit. Although she is an experienced
intensive care unit nurse, this is her first educator role. A month into her new position she
confides that she feels really incompetent in her new position and bursts into tears. Your
response is based on application of your understanding of:
a. Role acquisition.
b. Role conflict.
c. Role complexity.
d. Performance appraisal.
A
145
An environment that fosters misunderstanding and that hinders effective communication leads
to:
a. Role conflict.
b. Role ambiguity.
c. Role clarity.
d. Role certainty.
B
146
Nurse Managers are increasingly being held accountable for nurse retention. Which of the
following actions should a nurse manager focus on to retain nurses? (Select all that apply.)
a. Support and encourage employees.
b. Clarify the organization’s mission.
c. Be unclear about expectations.
d. Select the right person for the right position.
A,B,D
147
In staff development which of the following would support retention of nurses? (Select all
that apply.)
a. Residency-type programs for new graduates.
b. Preceptorship program.
c. Nonexistent ongoing staff development plan.
d. Orientation to the role and the organization.
A,B,D
148
Coaching is an approach that retains nurses. Which of the following are coaching behaviours?
(Select all that apply.)
a. Is costly.
b. A learned process.
c. Promotes optimal performance.
d. Is a personal approach.
B,C,D
149
During the performance appraisal session, what should the manager do? (Select all that
apply.)
a. Maintain a relaxed and professional manner.
b. Inquire about the employee’s personal life and how it is affecting performance.
c. Allow the employee to express opinions orally and in writing.
d. Plan to give specific examples only for poor performance.
A,C
150
A new graduate is asked to serve on the hospital’s quality improvement (QI) committee.
The nurse understands that the first step in quality improvement is to:
a. Collect data to determine whether standards are being met.
b. Implement a plan to correct the problem.
c. Identify the standard.
d. Determine whether the findings warrant correction.
C
151
The chief executive officer asks the nurse manager of the telemetry unit to justify the
disproportionately high number of registered nurses on the telemetry unit. The nurse
manager explains that nursing research has validated which statement about a low
nurse-to-patient ratio?
a. “It promotes teamwork among health care providers.”
b. “It increases adverse events.”
c. “It improves outcomes.”
d. “It contributes to duplication of services.”
C
152
A nurse manager wants to decrease the number of medication errors that occur in her
department. The manager arranges a meeting with the staff to discuss the issue. The
manager conveys a philosophy of total quality management (QM) by:
a. Explaining to the staff that disciplinary action will be taken in cases of additional
errors.
b. Recommending that a multidisciplinary team assess the root cause of errors in
medication.
c. Suggesting that the pharmacy department explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year
without penalty.
B
153
The nurse educator of the pediatric unit determines that vital signs are frequently not being
documented when children return from surgery. According to QI, to correct the problem the
educator, in consultation with the patient care manager, would initially do which of the
following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care for
postoperative patients.
d. Document which staff members are not recording vital signs, and write them up.
B
154
A nurse is explaining the pediatric unit’s QI program to a newly employed nurse. Which of
the following would the senior nurse include as the primary purpose of QI programs?
a. Evaluation of staff members’ performances.
b. Determination of the appropriateness of standards.
c. Improvement in patient outcomes.
d. Preparation for accreditation of the organization by The Joint Commission.
C
155
Before beginning a continuous QI project, a nurse should determine the minimal safety level
of care by referring to which of the following?
a. The procedure manual.
b. Nursing care standards.
c. The litigation rate of unsafe practice.
d. Job descriptions of the organization.
B
156
The nurse gives an inaccurate dose of medication to a patient. After assessment of the
patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of
the medication error and calls the physician to report the occurrence. The nurse who
administered the inaccurate medication understands that:
a. The error will result in suspension.
b. An incident report is optional for an event that does not result in injury.
c. The error will be documented in her personnel file.
d. Risk management programs are not designed to assign blame.
D
157
The nurse manager is concerned about the negative ratings that her unit has received on
patient satisfaction surveys. The first step in addressing this issue from the point of view of
quality improvement is which of the following?
a. Assemble a team.
b. Establish a benchmark.
c. Identify a clinical activity for review.
d. Establish outcomes.
C
158
With the rise of workplace violence in the emergency department, the nurse manager
decides that she should work with the risk manager in violence prevention. The nurse
manager should:
a. Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behaviour.
d. Hire more police security.
B
159
The nurse manager is performing a root-cause analysis related to medication administration
errors with insulin. A root-cause analysis is very similar to the QI process except that a
root-cause analysis is:
a. Retrospective.
b. Prospective.
c. Legislated for completion with all near-miss events.
d. Conducted by only one person.
A
160
Hospital ABCD is a Magnet hospital. This designation has been applied to Hospital ABCD
because it:
a. Facilitates active staff participation in decision-making related to quality nursing
care.
b. Has implemented a graduate nurse orientation program.
c. Espouses commitment to excellence in patient care.
d. Is establishing career ladders for nurses.
A
161
In determining the relationship between injury-producing falls and proposed preventive
measures as part of the QI process, a QI team might turn to which of the following for
confirmatory evidence?
a. Best Practice Guidelines (BPGs).
b. North American Nursing Diagnosis Association (NANDA).
c. National Quality Institute.
d. Agency for Healthcare Research and Quality.
A
162
As a nurse manager, you know that the satisfaction of patients is critical in making QI
decisions. You propose to circulate a questionnaire to discharged patients, asking about their
experiences on your unit. Your supervisor cautions you to also consider other sources of
data for decisions because:
a. The return rate on patient questionnaires is frequently low.
b. Patients are rarely reliable sources about their own hospital experiences.
c. Hospital experiences are frequently obscured by pain, analgesics, and other factors
affecting awareness.
d. Patients are reliable sources about their own experiences, but are limited in their
ability to gauge clinical competence of staff.
D
163
An example of an effective patient outcome statement is:
a. “Eighty percent of all patients admitted to the emergency department will be seen
by a nurse practitioner within 3 hours of presentation in the emergency
department.”
b. “Patients with cardiac diagnoses will be referred to cardiac rehabilitation
programs.”
c. “The hospital will reduce costs by 3% through the annual budget process.”
d. “Quality is a desired element in patient transactions.”
A
164
Patient perceptions are useful in:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Establishing priorities among possible changes to care identified in QI.
d. Establishing blame for poor-quality care.
C
165
A nursing unit is interested in refining its self-medication processes. In beginning this
process, the team is interested in how frequently errors occur with different patients. To
assist with visualizing this question, which organizational tool is most appropriate?
a. Histogram.
b. Flowchart.
c. Fishbone diagram.
d. Pareto chart.
A
166
The outcome statement “Patients will experience a 10% reduction in urinary tract infections
as a result of enhanced staff training related to catheterization and prompted voiding” is:
a. Physician sensitive and nonmeasurable.
b. Measurable and nursing sensitive.
c. Precise, measurable, and physician sensitive.
d. Patient care centred and nonmeasurable.
B
167
Your institution has identified a recent rise in postsurgical infection rates. As part of your QI
analysis, you are interested in determining how your infection rates compare with those of
institutions of similar size and patient demographics. Such a determination is known as:
a. Quality assurance.
b. Sentinel data.
c. Benchmarking.
d. Statistical analysis.
C
168
At Hospital Ajax, staff members are reluctant to admit to medication errors because of
previous litigation and a culture that seeks to assign blame. This culture demonstrates:
a. QM principles that emphasize customer safety.
b. a deep concern with improvement of quality and processes.
c. effective employee orientation and development in relation to QM.
d. goals that are inconsistent with QM.
D
169
Which of the following is not a principle of high reliability organizations?
a. Sensitivity to operations.
b. Preoccupation with failure.
c. Commitment to resiliency.
d. Reluctance to simplify.
e. Indeference to expertise.
E
170
The ability to compare data across health care sectors or organizations, such as hospital
acquired infection or hand hygiene rates may be hindered by?
a. Reluctance to share information.
b. Fear of reduced funding.
c. Fear of reduced reputation.
d. Differences in terminology.
D
171
The QI process begins with:
a. identifying implications for practice.
b. identifying the aim.
c. team assembly.
d. sustaining the improvements.
B
172
Examples of sentinel events include (Select all that apply.)
a. Forceps left in an abdominal cavity.
b. Patient fall, with injury.
c. Short staffing.
d. Administration of morphine overdose.
e. Death of patient related to postpartum hemorrhage.
A,B,D,E
173
A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse
manager. The staff members want to keep their old procedures, and they resist the changes.
Conflict arises from:
a. Group decision-making options.
b. Perceptions of injustice.
c. Increases in group cohesiveness.
d. Debates, negotiations, and compromises.
B
174
Two staff nurses are arguing about working on holidays. In trying to resolve this conflict,
the nurse manager understands that interpersonal conflict arises when:
a. Risk taking seems to be unavoidable.
b. People see events differently.
c. Personal and professional priorities do not match.
d. The ways in which people should act do not match the ways in which they do act.
B
175
The nurse manager is aware that conflict is occurring on her unit; however, she is focused
on preparing for a provincial health department visit, so she ignores the problem. A factor
that can increase stress and escalate conflict is:
a. The use of avoidance.
b. An enhanced nursing workforce.
c. Accepting that some conflict is normal.
d. Managing the effects of fatigue and error.
A
176
The nurse manager decides to use a mediator to help resolve the conflict among staff. Which
of the following is a basic strategy for truly addressing this conflict?
a. Identify the conflicting facts.
b. Be determined to resolve the conflict.
c. Schedule a meeting time for resolution.
d. Have a clear understanding of the differences between the parties in conflict.
D
177
Ylena, a staff nurse on your unit, witnesses another nurse striking a patient. Ylena wants to
remain friends with her colleague and worries that confrontation with her colleague or
reporting her colleague will destroy their relationship. Ylena is experiencing which type of
conflict?
a. Intrapersonal.
b. Interpersonal.
c. Organizational.
d. Professional.
A
178
The chief nursing officer plans a series of staff development workshops for the nurse
managers to help them deal with conflicts. The first workshop introduces the four stages of
conflict, which are:
a. Frustration, competition, negotiation, and action.
b. Frustration, conceptualization, action, and outcomes.
c. Frustration, cooperation, collaboration, action, and outcomes.
d. Frustration, conceptualization, negotiation, action, and outcomes.
B
179
A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the
class that conflict in an organization is important and that an optimal level of conflict will
generate which of the following?
a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its
workers.
b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. Creativity, a problem-solving atmosphere, growth, and motivation for its workers.
d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.
C
180
Jane has transferred from the intensive care unit to the critical care unit. She is very set in
the way she makes assignments and encourages her new peers to adopt this method without
sharing the rationale for why it is better. This is a good example of a process and procedure
that creates ________ conflict.
a. Organizational.
b. Intrapersonal.
c. Interpersonal.
d. Disruptive.
C
181
Two nurses on a psychiatric unit come from different backgrounds and have graduated from
different universities. They are given a set of new orders from the unit manager. Each nurse
displays different emotions in response to the orders. Nurse A indicates that the new orders
include too many changes; Nurse B disagrees and verbally indicates why. This step in the
process is which of the following in Thomas’s (1992) four stages of conflict?
a. Frustration.
b. Conceptualization.
c. Action.
d. Outcomes.
B
182
Mrs. Gordon, aged 68, was hospitalized after a stroke. The speech therapist recommended
that oral feeding be stopped because of her dysphagia. During visiting hours, Mr. Gordon
fed his wife some noodles. The nurse noticed this and stopped Mr. Gordon from feeding his
wife, telling him it was the doctor’s decision. An hour later, the nurse returned and found
Mr. Gordon feeding his wife again. The nurse tried to stop him again. Mr. Gordon refused
and claimed that the clinical staff was trying to starve his wife; he also threatened to get
violent with the nurse. The nurse decided to walk away and documented the event in Mrs.
Gordon’s chart. According to Thomas’s (1992) four stages of conflict, in which stage could
the nurse have been more effective?
a. Frustration.
b. Conceptualizing.
c. Action.
d. Outcomes.
C
183
Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly
arguing and blaming each other for mistakes, and a resolution has not occurred in months.
To solve the existing conflict, which is the most desirable conflict resolution?
a. Avoiding.
b. Competing.
c. Compromising.
d. Collaborating.
D
184
A nurse educator is giving a workshop on conflict. During the sessions he makes various
statements regarding conflict. All of the following statements are true except:
a. “Conflict can decrease creativity, thus acting as a deterrent for the development of
new ideas.”
b. “Conflict can arise over the most trivial issues.
c. “A variety of definitions of conflict are known.”
d. “All conflicts involve some level of disagreement.”
A
185
The nurse manager performs his role in a way that he believes empowers his staff; however,
the staff feel smothered by his micromanagement approach. This is a good example of
which of the following conditions that propel a situation toward conflict?
a. Incompatible goals.
b. Role conflicts.
c. Structural conflict.
d. Competition for resources.
A
186
Kala, a unit manager, in discussing a role the hospital’s chief executive officer would like
her to perform, makes the following statement, “I will sit on the hospital task force on
improving morale if you send me to the hospital’s leadership training classes next week, so I
can further develop my skills and thus be more effective.” Which of the following conflict
management styles is Kala using?
a. Collaborating.
b. Avoiding.
c. Negotiating.
d. Accommodating.
C
187
Marcus is a circulating nurse in the operating room. He is usually assigned to general
surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the
routines and studies the doctor’s preference cards before each patient. The fourth patient
comes into the room, and Marcus prepares a site for a biopsy by using a Betadine solution.
The surgeon prefers another solution. He notices what Marcus has done and immediately
corrects him by rudely insulting him. Which of the following is the most appropriate
approach to conflict resolution in this example?
a. Collaboration.
b. Compromising.
c. Avoiding.
d. Withdraw.
B
188
Successful resolution of conflict yields constructive outcomes and leads to:
a. Inhibition of movement.
b. Improved team functioning.
c. Diminished resolutions.
d. Lower employee satisfaction levels.
B
189
The head nurse and a staff nurse are having a conflict over how to use and apply a new
procedure for dressings in the medical/surgical unit. The staff nurse wishes to use the new
procedure, which is based on newly released nursing research. The head nurse wishes to use
a protocol that has been used in the department for a number of years. The head nurse later
makes comments to other staff on her unit about the credibility of the staff nurse. This
behaviour is associated with:
a. Lateral violence.
b. Horizontal violence.
c. Confrontation.
d. Bullying.
D
190
Which of the following exemplifies the preferred conflict management style of nurse
managers?
a. Elizabeth, the head nurse on neurology, finds that Tom, the RN on duty at night, is
irritable in relation to any suggestions or new ideas, and so she comes in to work
after Tom leaves the unit.
b. The technology committee has recommended a clinical system for implementation
on the nursing unit. Staff members are anxious about the change. Stefano, the head
nurse, asks staff for ideas on how to meet the technology goals and to meet staff
needs.
c. During management meetings, George, the head nurse on the nephrology unit,
dominates meetings and decisions. Lou, the head nurse on the cardiac stepdown
unit, begins to miss the management meetings.
d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The
head nurse, Rajib, agrees as long as Ann agrees to be involved in assisting to
mentor evening staff in the use of the new clinical information system.
D
191
Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several
days to discuss concerns about Jillian’s relationships with her team members. Lee hopes to
offer Jillian coaching so that Jillian’s relationships can be more satisfying with her team
members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this
situation, Lee and Jillian are demonstrating:
a. Similar conflict management strategies.
b. Escalation of conflict.
c. Avoidance and compromise strategies.
d. Competing and compromise strategies.
C
192
Which of the following best exemplifies the accommodation style of conflict management
for staff nurses?
a. Leni and Jonas, two RNs, disagree with the best approach to assisting a family that
has complex needs. They decide that they will consult with family and together
will decide what is best.
b. Jennifer needs to switch a shift to attend a family function. She arranges to trade
with Nancy, who wants a day off next to a 3-day break.
c. Alexis asks Melody to stay late for the third day in a row. Melody refuses, stating
that she has already helped out for two days by staying late for Alexis.
d. Lara asks Lourdes to switch shifts with her because Lara wants to attend a concert.
Lourdes would prefer not to but does to enable Lara, who is new in town, to be
with her friends.
D
193
In trying to achieve Magnet status for the hospital, the chief nursing officer establishes a
shared governance model to help nurses experience job satisfaction. However, some nurses
who have enjoyed working with less autonomy resist this change, which thus creates
organizational conflict. Organizational conflict arises from which of the following?
a. Flat organizational structure.
b. Clarity in role responsibilities.
c. Increased autonomy through self-governance.
d. Less participation in decision-making.
D
194
Congruence is described as an alignment of one’s real and ideal self, resulting in a greater
ability to be authentic and self-actualize/thrive in one’s life roles (Rogers, 1959).
Self-compassion is: (Select all that apply.)
a. A positive view of one’s self.
b. Clarifying your own values and beliefs.
c. One’s ability to receive and respond constructively to feedback.
d. The ability to get along with others.
C
195
There are time when avoiding conflict can be effective. Which of the following are
appropriate for avoiding conflict? (Select all that apply.)
a. Facing trivial and/or temporary issues.
b. There is no chance to obtain what one wants or needs.
c. Give time for people to “cool down.”
d. To give up forever.
A,B,C
196
The way in which nurses respond to conflict has changed very little in the past 20 years.
What are the two most often (based on research) ways nurses use when faced with conflict?
(Select all that apply.)
a. Collaborating
b. Avoidance
c. Compromising
d. Accommodation
B,D
197
Nurses entering into the workforce today are faced with which of the following relationships
that could create organizational conflict? (Select all that apply.)
a. Nurse–physician relationship.
b. Nurse–nurse relationship.
c. Nurse–patient relationship.
d. Nurse–chief nursing officer relationship.
e. Nurse–auxiliary personnel relationships.
A,B,C,D,E
198
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.
C
199
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.
D
200
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.
A
201
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.
B
202
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.
C
203
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.
D
204
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.
B
205
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.
C
206
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.
D
207
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.
C
208
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.
A
209
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.
A
210
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.
C
211
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.
B
212
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.
D
213
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
C
214
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.
D
215
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.
A
216
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.”
B
217
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.
A
218
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.”
D
219
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.”
B
220
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.
B
221
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.
D
222
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.”
A,B,C,D
223
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.
A,C,D
224
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.
A,B,C,D
225
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.
A,B,D
226
Your health care organization places a high value on workplace safety and integrates this
into all aspects of administrative and patient care processes. As a unit manager, you
thoroughly endorse this direction, and during the selection and hiring of new staff, you
consistently:
a. Refuse to hire applicants who are pushy during interviews.
b. Thoroughly follow up with all references before offering a position.
c. Ask applicants during the interview whether drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories.
B
227
Jay, a newly graduated registered nurse (RN), has just begun work on an acute care nursing
unit. As a nurse manager, you know that new graduates are most likely to experience:
a. Aggression.
b. Horizontal violence.
c. Physical violence.
d. Vertical violence.
B
228
In which of the following situations would you, as the head nurse, be concerned about
potential safety issues?
a. Jordan comes to your office to complain about inadequate staffing on the unit. He
says that he is concerned because he attributes a recent incident to the staffing
levels.
b. Heinrich, a long-standing RN on the unit, has begun to miss work regularly. He
calls in but is vague about his reasons for the absences.
c. Carla, RN, has just ended a relationship with Jake, RN, and he will not leave her
alone. You are meeting with Jake today because colleagues on night shifts have
reported that Jake seems to have been intoxicated last night and the previous night.
d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been
much more animated since becoming friendly with a couple of other RNs on the
unit.
C
229
Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively
telling others that you are incompetent, you do not know what you are doing in relation to
patient care, and that you lie to the staff about attempts to get more staffing. Through
telephone calls and conversations during breaks, she is recruiting other staff to her position.
Delaney confides that most staff members find you fair, honest, and knowledgeable.
Marjorie’s behaviour can best be characterized as:
a. Political action.
b. Bullying.
c. Building alliances.
d. Disgruntlement.
B
230
During coffee and other breaks, Rosalie, the new RN, is excluded from conversations with
the other staff. When she approaches other staff on the unit to ask questions, they turn and
walk off in the other direction. The behaviour of the staff is characteristic of:
a. Dislike.
b. Lack of trust in Rosalie’s abilities.
c. Horizontal violence.
d. Cultural incompetence.
C
231
Sabotage is an example of which type of violence?
a. Threatening behaviour.
b. Written threat.
c. Harassment.
d. Verbal abuse.
C
232
Caroline asks family members to leave while she cares for the 16-year-old victim of a recent
car accident. The father screams at her and tells her that she has no right to ask his family to
leave, and that if she continues to do so, he will “throw her out of the room.” Caroline is
shaken and tells her head nurse, who tells her that this kind of thing is just part of the job.
The guidance of the head nurse:
a. Is reasonable. No physical violence was involved.
b. Is related to why incidents of violence in health care are probably underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse.
B
233
You are part of a multidisciplinary team that is charged with designing a workplace safety
plan for your health care organization. This team has been established in response to
increases in reports of violence and aggression. You begin designing the safety plan by:
a. Surveying staff about levels of satisfaction with the workplace and management,
collegial, and patient relations.
b. Offering training sessions in self-defence.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviours with potential for violence.
A
234
In the emergency department waiting room, you notice a patient sitting, with his head in his
hands, who has been waiting for about 5 hours for relief of his headache. When you
approach him to ask him how he is doing, he says, “I can’t believe that I have to wait this
long for help! Do you know what it is like to be in pain for 10 hours?” Your response to him
would be:
a. “It is frustrating to wait when you are in pain and when you are expecting to
receive relief right away.”
b. “Don’t talk to me. If you are going to be rude, then you will not receive treatment
here.”
c. “We are very busy and don’t have enough staff to deal with problems such as
yours.”
d. “Perhaps you should go elsewhere. We do not have time for you here, as many
more sick patients are waiting.”
A
235
At 3 a.m., a man walks into your emergency department. He paces back and forth in the
waiting area before he approaches staff to ask if he can see his wife, who is a patient on
another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps
his hand in his jacket pocket. A best initial response would be to:
a. Assess your situation and your surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are over.
d. Remain calm as there is no potential for violence here.
A
236
The Canadian Nurses Association (CNA) cites studies that suggest that intimidating and
disruptive behaviours in the nursing profession contribute to:
a. Low morale.
b. Preventable adverse outcomes.
c. An increase in power for leaders.
d. Citations of leaders for not addressing workplace violence.
B
237
Residents in a new long-term care facility attend meals in a large dining hall. In reviewing
reports of aggression and violence, you note that behaviours such as hitting or attempts to
hit staff are increasing. Further investigation suggests that this behaviour occurs most often
at mealtimes. A possible intervention would be to:
a. Seat residents with the highest potential for violence next to those with the lowest
potential for aggression.
b. Feed residents earlier in the day.
c. Restrain residents who are violent or aggressive during meal times.
d. Establish a smaller dining area that is away from the main area that is for residents
who have potential for aggression/violence.
D
238
Many inaccurately believe workplace violence to be related specifically to:
a. Verbal abuse.
b. Physical injury.
c. Incivility.
d. Harassment.
B
239
As indicated by Shield and Wilkins for Statistics Canada (2014), abuse in the health care
setting is most often perpetrated by someone who:
a. Is male.
b. Has more experience.
c. Consistently works day shifts.
d. Has high coworker support.
A
240
In addressing a high staff turnover rate that results from violence on a nursing unit, you are:
a. Confirming the high correlation between managerial incompetence and violence.
b. Demonstrating awareness that workplace violence, if present, has significant costs.
c. Aware that staff and manager experiences contribute to high turnover.
d. Aware that violence is a rare but present factor in the workplace.
B
241
A patient who has a history of involvement with drugs and weapons comes up to you in the
hallway and asks you a question regarding directions in treatment. When you respond, he
moves closer in to you and puts both hands up on either side of your neck. No one else is in
the hallway. Your best response at this point is to:
a. Yell at him to stop.
b. Calmly ask the patient to remove his hands.
c. Hit the patient in the midsection.
d. Use pepper spray.
B
242
Canadian knowledge of the scale of workplace violence in health care remains incomplete
because:
a. Collected data are inflated.
b. No consistent system of data collection for workplace violence exists.
c. Data is collected only in relation to physical injuries.
d. The classification of workplace violence is unclear.
B
243
Reza, RN, works as a staff nurse in the mental health department; Sharon works as a data
entry clerk in the admissions department; Sarah is an emergency room physician; and
Donna is a housekeeper in the geriatrics department. Which of these four is most at risk for
violence: and aggression?
a. Reza.
b. Sarah.
c. Sharon.
d. Donna.
A
244
Reza, RN, works as a staff nurse in the mental health department; Sharon works as a data
entry clerk in the admissions department; Sarah is an emergency room physician; and
Donna is a housekeeper in the geriatrics department. Which of the four is most likely to be a
perpetrator of violence?
a. Reza.
b. Sarah.
c. Sharon.
d. Donna.
A
245
A safety and security plan is important to a health care organization because it:
a. Specifies preventive measures in relation to violence.
b. Provides direction as to changes in facilities that protect staff.
c. Establishes expectations in relation to behaviour and tolerance of violence.
d. Establishes policies and practices that guide prevention of violence and
expectations in the workplace.
D
246
Aishwarya is involved in intervening when a patient attempts to harm herself on the unit.
During the interaction, the patient slaps Aishwarya across the face. It is important that the
head nurse:
a. Offer Aishwarya immediate education and training in self-defence.
b. Assist with follow-up documentation and offer access to counselling.
c. Provide access to a lawyer.
d. Encourage Aishwarya to perceive the incident as a normal part of care.
B
247
Various descriptions of types of violence are available. Which form includes the use of
power which differentiates itself from other terms?
a. Horizontal violence.
b. Bullying.
c. Lateral violence.
d. Interpersonal conflict.
B
248
According to the Government of Ontario, Ministry of Labour health care report (2017),
workplace violence “accounted for what percentage for all lost-time injuries in the health
care sector?
a. 10%
b. 20%
c. 12%
d. 5%
C
249
A poll conducted by the Canadian Federation of Nurses Unions (CFNU) there were 16, 617
claims between the years 2006–2015. This is over double the rate reported by police and
correctional service officers in the same time period. The two most often reported
incidences of violence are? (Select all that apply.)
a. Verbal by physician.
b. Verbal by patient.
c. Verbal by nurse colleague.
d. Verbal by family member.
B,C
250
Many theories exist as to why horizontal violence takes place in nursing. Which of the
following are thought to be contributing factors to violence in nursing? (Select all that
apply.)
a. Worker burnout.
b. Hierarchical structure.
c. Feminism.
d. Lack of supports.
A,B,C,D
251
In designing a new health care facility, it is particularly important to pay close attention to
safety elements related to violence and aggression in which of the following settings?
(Select all that apply.)
a. Emergency.
b. Psychiatry.
c. Gerontology.
d. Maternity-pediatric.
A,B,C
252
John is part of an interdisciplinary care team on a surgical unit. Interdisciplinary care teams:
a. Increase fragmentation of care.
b. Improve quality of patient care.
c. Increase duplication of services.
d. Need to include licenced and unregulated care providers.
B
253
The nurse manager is setting up the room assignments for the unit. One patient on the unit is
in critical condition and is going to require more care than the others. Before delegating a
task, a nurse manager should:
a. Delegate the admission assessment to the licenced practical nurse.
b. Review the employee’s performance assessment for the most recent period.
c. Assess the amount of guidance and support needed in a particular situation.
d. Create a task analysis of critical behaviours for the patient.
C
254
A key advantage that a nurse manager has in terms of delegating is that:
a. Patients receive less attention because too many staff members make it difficult to
coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.
D
255
The nurse on the shift from 2300 to 700 hours is assigning a component of care to an
unregulated care provider. The night nurse should remain:
a. Accountable and responsible.
b. Accountable and liable.
c. Authoritative and liable.
d. Responsible and task oriented.
A
256
The night nurse understands that certain factors need to be considered before tasks are
delegated to others. These factors include which of the following?
a. Complexity of the task and the age of the delegate.
b. Potential for benefit and the complexity of the task.
c. Potential for benefit and the number of staff.
d. Complexity of the task and the potential for harm.
D
257
During a fire drill, the nurse manager becomes very assertive and directive in her
communications with staff. This type of situational leadership depends on:
a. Supportive behaviour by the leader and immature followers.
b. The relationship with the followers and the type of behaviour of the leader.
c. Well-trained followers, combined with a strong leader who acts quickly.
d. The leader’s ability to evaluate personnel and communicate that evaluation.
B
258
The unit manager is working in a large metropolitan facility and is told that two unregulated
care providers are to be assigned to work with her. Delegation begins with:
a. Acknowledging the arrival of the second unregulated care provider on the unit.
b. Providing clear directions to both unregulated care providers.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.
C
259
Although interdisciplinary health care teams are the ideal in Canada, which of the following
is an identified barrier to interdisciplinary collaboration?
a. Power equalities.
b. Overlapping scopes of practice.
c. Lack of legislative authority.
d. Lack of professional association support.
B
260
Who is accountable when a registered nurse performs a “transfer of function” from a
physician activity?
a. The physician.
b. The director of nursing.
c. The nurse.
d. The institution.
C
261
In some provinces, a restricted activities or controlled acts model is currently in place. A
main distinction between this model and the model of licensure that is still used in most
other provinces is that:
a. Each health care provider is registered to conduct specific tasks.
b. Specific acts are licenced.
c. Acts cannot be shared among health care providers unless they are registered.
d. Nurses are bound by exclusive scopes of practice.
B
262
Which of the following exemplifies accountability for a nurse manager?
a. Consistently submitting budgets on time.
b. Consistently performing the responsibilities outlined for nurse managers at the
institution.
c. Explaining why registered nurse coverage was reduced on nights to the Nursing
Practice Committee after serious patient injury.
d. Actively soliciting ideas regarding scheduling from staff.
C
263
Which of the following is a benefit of the controlled acts model over the licensure model?
a. Decreased flexibility in allowing patients choice in their care provider.
b. Limited range of professional responsibility.
c. No firm boundaries.
d. Recognition that scope of practice is static.
C
264
Although benefits of the controlled acts model are advantageous and arguably necessary, the
legislative reform to recognize overlapping competencies has caused:
a. Role clarity.
b. A decrease in “turf” competition among health care providers.
c. A difficulty in optimizing skill mix.
d. Static boundaries for health care providers.
C
265
In delegating to an unregulated care provider in a home health setting, which of the
following represents the most appropriate delegation communication?
a. “You will be taking care of Mrs. Srivastava. Mrs. Srivastava needs assistance with
her bath.”
b. “You will need to help Mrs. Srivastava get into and out of her shower. Ensure that
you check the condition of her feet, and let me know if you have any concerns
when you check in.”
c. “I am not sure that you know how to do this, but I am giving you Mrs. Srivastava.
She is quite obese and needs skin care.”
d. “Mrs. Srivastava needs help to get into and out of her bathtub. Her bath will need
to be completed by 10:00. When you are helping her to dry, please check between
her toes and toenails, and phone me by 10:30 if you notice nail discoloration or
redness.”
D
266
Which of the following is a domain of the National Interprofessional Competency
Framework?
a. Quality improvement.
b. Interprofessional conflict resolution.
c. Contextual issues.
d. Interdisciplinary communication.
B
267
According to the National Interprofessional Competency Framework, which domain is
considered relevant in every situation?
a. Role clarification.
b. Team functioning.
c. Patient-centred care.
d. Collaborative leadership.
C
268
Which of the following is considered a system-relevant barrier to primary care and public
health collaboration?
a. Lack of common agenda.
b. Power and control issues.
c. Resource limitations.
d. Relationship challenges.
B
269
Which of the following is considered an organizational facilitator to primary care and public
health collaboration?
a. Shared protocols.
b. Role clarity.
c. Education and training.
d. Philosophy and personal identity.
A
270
Sammi, a registered nurse, is part of an interdisciplinary team that provides care to patients
with acute cardiac interferences. The team has not been functioning optimally and Sammi is
aware that this may cause a(n):
a. Increase in the cohesiveness of the team.
b. Escalation of turf protection.
c. Increase in the quality of patient care.
d. Decrease in workplace stress.
B
271
When there is lack of role clarity within an interdisciplinary health care team, health care
providers tend to:
a. Work more closely together for role clarity.
b. Move away from their own disciplinary silos.
c. Revert to what is familiar and what they know in relation to health care roles.
d. Increase communication to enable a sharing of role expectations.
C
272
When there is lack of role clarity, health care providers tend to remain in their own
disciplinary silos. Which of the following would counteract this tendency?
a. Rearranging team membership.
b. Assigning a team leader.
c. Engaging licencing organizations to increase scope of practice details.
d. Practising patient-centred care.
D
273
In transferring a patient, Leslie, an unregulated care provider, uses improper technique. The
patient is injured, and as a result a lawsuit is launched in which both Neha, the delegator,
and Leslie, the delegatee, are named. Neha is named in the suit because she:
a. Retains responsibility for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.
D
274
One strategy to facilitate clarity about team members and the team process is to:
a. Ensure a range of personality styles on the team.
b. Establish colocation of the team.
c. Appoint a physician as the team leader.
d. Engage a variety of health care providers on the team with different levels of
power.
B
275
The rationale for the shift to interdisciplinary teams for health care delivery in Canada is
related to: (Select all that apply.)
a. The aging of the population.
b. Increased utilization of unregulated care providers.
c. Nurse shortages.
d. An increase in acute illness and comorbidity.
e. Increasing specialization of health care providers.
A,C,D
276
Barriers to initiating interprofessional collaboration are many. Which of the following
apply? (Select all that apply.)
a. Practice protection.
b. Regulatory mechanisms.
c. The concept is well accepted.
d. Outdated legislation.
A,B,D
277
The controlled acts model is structured so that those outside a particular profession are not
necessarily restricted. The controlled acts model has several benefits over the licensure
model. Which of the following is not a benefit over the licensed manner? (Select all that
apply.)
a. It allows professionals to perform to the range of their competency and abilities.
b. It places greater emphasis on standards and competence.
c. It increases flexibility in allowing patients more choice in providers.
d. Perform particular services or functions within professions.
A,B,C
278
What is an intraprofessional team is composed of? (Select all that apply.)
a. A mix of same discipline with different levels of education.
b. Members of same discipline.
c. Members of different disciplines.
d. Members of different disciplines with extended levels of education.
A,B
