RN Management 2

Question 1

Which of the following indicates safe delegation?

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

Answer 1

A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager’s unit is fully staffed and patients are stable.

Question 2

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would:

a. Provide a detailed explanation of what she needs to do with ICP monitoring.
b. Tell her when she needs to provide an update about David’s status.
c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting.
d. Advise her that you are available if she needs you.

Answer 2

Advise her that you are available if she needs you.

Question 3

Question 3
Which of the following exemplifies accountability? Karen, the nurse manager on 5E:

a. Consistently submits her budgets on time.
b. Consistently performs the responsibilities outlined for nurse managers at her institution.
c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.
d. Actively solicits ideas regarding scheduling from her staff.

Answer 3

Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.

Question 4

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her?

a. “How do you usually do this kind of dressing?”
b. “The dressing needs to be done today and tomorrow with the supplies on this cart.”
c. “Here is what you need for the dressing, and I will show you what needs to be done.”
d. “I know you know what you are doing. Let me know if you have any problems.”

Answer 4

c. “Here is what you need for the dressing, and I will show you what needs to be done.”

Question 5

Functions such as “delegates tasks to assistive personnel” that are outlined in a position description for an RN Team Leader would be considered:

a. Active delegation.
b. Passive delegation.
c. Passive accountability.
d. Active responsibility.

Answer 5

Passive delegation

Question 6

A key advantage that a nurse manager has in terms of delegating is that:

a. Clients receive less attention because too many staff make it difficult to coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.

Answer 6

d. Team skills can be used more effectively.

Question 7

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

Answer 7

c. Matching tasks with qualified persons.

Question 8

Question 8
Determination of Evelyn's educational preparation and certification (Question 18) is related to the concept of:
Select one:
a. Accountability.
b. Authority.
c. Role performance.
d. Assignment.

Answer 8

b. Authority.

Question 9

Question 9
The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is \_\_\_\_\_ care.
Select one:
a. Delegating
b. Assigning
c. Sharing
d. Authorizing

Answer 9

Assigning

Question 10

Question 10
You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team’s work, your best strategy, based on the Hersey and Blanchard model, would be to:
Select one:
a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do.
b. Encourage people to discuss their frustrations in providing this care.
c. Ignore them-they’ve done it before.
d. Provide minimal direction and let them come to you with questions.

Answer 10

d. Provide minimal direction and let them come to you with questions.

Question 11

Question 11
The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should:
Select one:
a. Delegate the admission assessment to the LPN.
b. Review the employee’s performance assessment for the most recent period.
c. Assess the amount of guidance and support needed in a particular situation.
d. Create a task analysis of critical behaviors for the individual.

Answer 11

c. Assess the amount of guidance and support needed in a particular situation.

Question 12

Question 12
With delegation, responsibility and accountability remain with the:
Select one:
a. Physician.
b. Professional who delegates.
c. Individual who receives the delegation.
d. Individual who previously performed the task.

Answer 12

b. Professional who delegates.

Question 13

Question 13
In Question 18, before assigning Evelyn to Mrs. N.’s care, the most appropriate action of the care coordinator would have been to:
Select one:
a. Determine Evelyn’s educational background and preparation for this role.
b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.
c. Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator.
d. Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

Answer 13

b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.

Question 14

Question 14
In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication?
Select one:
a. “You will be taking care of Mrs. S. Mrs. S. needs assistance with her bath.”
b. “You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in.”
c. “I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care.”
d. “Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness.”

Answer 14

d. “Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness.”

Question 15

Question 15
Ali, an RN on your unit, is consistently late to work and makes remarks such as "Do you really want me to do that?" when patients and care are assigned to her. You have spoken with her frequently about her:
Select one:
a. Ability.
b. Skills.
c. Attitude.
d. Personal issues.

Answer 15

c. Attitude.

Question 16

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

Answer 16

d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

Question 17

Sarah (Question 21) provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of:
Select one:
a. Accountability.
b. Responsibility.
c. Assignment.
d. Delegation.

Answer 17

c. Assignment.

Question 18

The nurse on the 11-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain:
Select one:
a. Accountable and responsible.
b. Accountable and liable.
c. Authoritative and liable.
d. Responsible and task-oriented.

Answer 18

a. Accountable and responsible.

Question 19

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah, the delegator, and Leslie, the delegatee, are named. Sarah is named in the suit because she:
Select one:
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.

Answer 19

a. Retains responsibility for the care of the patient.

Question 20

Question 20
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed:
Select one:
a. Passive delegation.
b. Passive accountability.
c. Active delegation.
d. Active responsibility.

Answer 20

c. Active delegation.

Question 21

Question 21
During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of:
Select one:
a. The amount of paperwork required to complete care.
b. The complexity of client care.
c. Earlier discharge practices.
d. The numbers of other disciplines present on a given unit.

Answer 21

b. The complexity of client care.

Question 22

Question 22
Which of the following would be most in line with Hersey and Blanchard’s concepts?
Select one:
a. The team of caregivers on day shift is familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.
b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients.
c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project.
d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

Answer 22

a. The team of caregivers on day shift is familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.

Question 23

Question 23
During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on:
Select one:
a. Supportive behavior by the leader and immature followers.
b. The development level of the followers and the type of behavior of the leader.
c. Well-developed followers combined with a strong leader who acts quickly.
d. The leader’s ability to evaluate personnel and communicate that evaluation.

Answer 23

The development level of the followers and the type of behavior of the leader.

Question 24

Question 24
The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the:
Select one:
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.

Answer 24

Complexity of the task and the potential for harm.

Question 25

Question 25
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N., and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler, and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of:
Select one:
a. Incompetence of the UNP.
b. Failure to follow through.
c. Skills but no motivation.
d. Lack of accountability.

Answer 25

Failure to follow through.

Question 26

Chapter 9
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:
Select one:
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?”

Answer 26

“How long have you been using acupuncture treatment?”

Question 27

A new graduate RN 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:
Select one:
a. Having cultural sensitivity.
b. Experiencing cultural diversity.
c. Experiencing cultural marginality.
d. Experiencing acculturation.

Answer 27

Experiencing cultural marginality.

Question 28

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on those of other cultures. The discussion topic most likely to be without cultural imposition would be:
Select one:
a. Abortion.
b. Wound management.
c. Blood transfusion.
d. Advance directives.

Answer 28

Wound management.

Question 29

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, “Why is it that when John and I work together in giving patients care, he jokes about my being “a little fat Mexican”? The nurse manager’s best response is, “Do you think he:
Select one:
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?”

Answer 29

Is stereotyping you without thinking?”

Question 30

At Health Center XYZ, staff members on the rehab 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 tub rooms 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:
Select one:
a. Ethnicity.
b. Work environment.
c. Work culture.
d. Marginalization.

Answer 30

Work culture.

Question 31

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program for her staff to help them understand the Hispanic culture. A nurse should understand that culture is determined by which of the following?
Select one:
a. Behavior
b. Love for people
c. Shared vision
d. Rapid time passage

Answer 31

Behavior

Question 32

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:
Select one:
a. Task force formed to commemorate a New Year’s celebration in the Western tradition.
b. 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. Task force to develop a poster for the unit depicting religions of the world.

Answer 32

Celebration of National Nurses’ Week with the focus on cultural care.

Question 33

During managers’ meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say:
Select one:
a. “I wonder if we should consider changing our policy on performance appraisals? What do you think?”
b. “Sean, your approach to appraisal is completely off track and does not reflect available evidence.”
c. “The system that has been developed needs to be implemented. We have already spent enough time in discussion.”
d. “Forget about change in this policy. It is fine as it is.”

Answer 33

“I wonder if we should consider changing our policy on performance appraisals? What do you think?”

Question 34

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 acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of:
Select one:
a. Bias.
b. Cultural awareness.
c. Cultural diversity.
d. Ethnocentricity.

Answer 34

Cultural awareness.

Question 35

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects:
Select one:
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.

Answer 35

The social organization of friendships and family networks in East Indian culture.

Question 36

Sarah, one of your RNs, tells you that she can’t understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching her, you suggest which of the following?
Select one:
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 and what meaning it has for him.

Answer 36

“Ask him what he means by a smudge and what meaning it has for him.”

Question 37

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to:
Select one:
a. Diabetes.
b. Cardiovascular disease.
c. Cancer.
d. Asthma.

Answer 37

Diabetes.

Question 38

In discussions with another unit manager, you share your concern that staff on the unit try to take advantage of your understanding of their unique needs and ask for special treatment in scheduling and days off. Your concern is related to:
Select one:
a. Cultural insensitivity.
b. Indistinguishable phenomena.
c. Social capital.
d. Stereotyping.

Answer 38

Social capital.

Question 39

In Question 12, you are exhibiting:
Select one:
a. Acculturation.
b. Cultural sensitivity.
c. Ethnocentrism.
d. Transculturalism.

Answer 39

Cultural sensitivity.

Question 40

Individuals living with asthma, who also live in poverty, are much less likely to seek early care but go to emergency rooms for assistance. This example reflects:
Select one:
a. Stereotyping.
b. Cultural diversity.
c. Ethnocentricity.
d. Transcultural care

Answer 40

Transcultural care

Question 41

Maintaining a culturally diverse staff is an important function of a nurse manager who works in the hospital of a large medical center. Based on the US Bureau of Labor Statistics Bulletin 2307, which cultural group had the lowest percentage of employment as registered nurses in the United States?
Select one:
a. Caucasians
b. Asians/Pacific Islanders
c. Blacks
d. Hispanics

Answer 41

Asians/Pacific Islanders

Question 42

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating:
Select one:
a. Cultural awareness.
b. Cultural sensitivity.
c. Acculturation.
d. Cultural marginality.

Answer 42

Acculturation.

Question 43

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 to say:
Select one:
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.”

Answer 43

“What did you think when you learned she was Jamaican?”

Question 44

Rajib, RN, asks you, a senior staff member, about your mother, who is a patient on another unit. This question reflects:
Select one:
a. Lack of concern for your cultural orientation.
b. Lack of understanding about his role.
c. Caring and concern for you.
d. How individuals in his culture relate to persons in authority.

Answer 44

How individuals in his culture relate to persons in authority

Question 45

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her:
Select one:
a. Cultural marginality.
b. Circle of familiarity.
c. Cultural understanding.
d. Acculturation.

Answer 45

Circle of familiarity.

Question 46

arah, 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 Sarah, you consider that differences across cultures that are relevant to this situation include:
Select one:
a. Eye contact.
b. Personal space.
c. Harassment.
d. Expressions of feeling.

Answer 46

Personal space.

Question 47

The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristics are inherent in a culture. It:
Select one:
a. Develops over time.
b. Maintains a strong work ethic.
c. Changes easily.
d. Develops quickly.

Answer 47

Develops over time.

Question 48

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to:
Select one:
a. Acculturation.
b. Ethnocentricity.
c. Cultural diversity.comm
d. Cultural sensitivity

Answer 48

Cultural sensitivity

Question 49

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's:
Select one:
a. Lack of confidence.
b. Professional behavior.
c. Cultural sensitivity.
d. Ethnicity.

Answer 49

Ethnicity.

Question 50

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of:
Select one:
a. Dominant versus nondominant behaviors.
b. The need to recognize diversity within groups.
c. The impact of cross-culturalism.
d. How language separates subgroups

Answer 50

The need to recognize diversity within groups.

Question 51

In discussions with another unit manager, you share your concern that staff on the unit try to take advantage of your understanding of their unique needs and ask for special treatment in scheduling and days off. Your concern is related to:
Select one:
a. Cultural insensitivity.
b. Indistinguishable phenomena.
c. Social capital.
d. Stereotyping.

Answer 51

Social capital.

Question 52

Chapter 2
A survey of safety practices and attitudes at hospital XYZ finds that staff members have concerns about their safety and that of patients. Results from the manager subgroup are likely to be:
Select one:
a. Similar to staff evaluations of safety.
b. More positive about safety than staff.
c. Less positive about safety than staff.
d. Less positive than senior executives about safety.

Answer 52

More positive about safety than staff.

Question 53

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at US University develops:
Select one:
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 to develop software for reporting of adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams

Answer 53

An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

Question 54

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety on your unit. Your initial focus is on the two encounters that the Chasm series identified as most likely to generate concerns about patient safety. As a result, you initiate which of the following?

Select one:

a. Questions on the pre-admission history that specifically explore details of substance use
b. Careful monitoring of all patients who are ambulating postoperatively
c. Rigorous patient teaching related to deep breathing and coughing
d. Systematic follow-up with patients to ensure that they understand details of surgery

Answer 54

Questions on the pre-admission history that specifically explore details of substance use

Question 55

As a patient care advocate, you regularly coach patients as to how to stay safe in health care by educating them about:
Select one:
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 healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.

Answer 55

The need to understand and record all medications being taken.

Question 56

As a result of the Joint Commission assessment, a healthcare facility loses it accreditation. What is the primary consequence for this institution?
Select one:
a. Loss of funding
b. Organizational shift to profit status
c. Practices continue as usual
d. Staff morale and care standards remain high

Answer 56

Loss of funding

Question 57

As the case manager in a home health service, you are interested in trying the Institute for Healthcare Improvement TCAB project in your service. In considering this application, you need to particularly consider:
Select one:dd
a. Reliability of data gathered by the project.
b. Applicability of the project to your setting.
c. Lack of patient-centeredness in the project
d. The focus of the project on resource issues.

Answer 57

Applicability of the project to your setting.

Question 58

Before the IOM report was issued, "To err is human" adverse events were considered:
Select one:
a. A normal risk.
b. Rare.
c. A reflection of some organizations.
d. Related to systems errors.

Answer 58

Rare

Question 59

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. As a nurse, you would:
Select one:
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.

Answer 59

Suggest that an interpreter explain the procedure to the client and answer any questions.

Question 60

A logical response to the final step of the STAR Approach to Patient Safety might be to:
Select one:
a. Seek further learning.
b. Finish the care that was started.
c. Think about what needs to be done.
d. Concentrate on the task at hand.

Answer 60

Seek further learning.

Question 61

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:
Select one:
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.

Answer 61

After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.

Question 62

How would you prepare your unit for a Joint Commission visit?
Select one:
a. Commit staff resources over a six-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate answers to questions.
c. Prepare a manual that outlines orientation procedures, and ensure that all safety issues are addressed.
d. Ensure that review of patient outcomes and of responses to outcome data is ongoing.

Answer 62

Ensure that review of patient outcomes and of responses to outcome data is ongoing.

Question 63

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduces the number of its managers and flattens its organizational structure. Within a year, the number of adverse events on the units has doubled. This may be attributable to:
Select one:
a. The overload of 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.

Answer 63

Fewer clinical leaders and advocates for necessary resources.

Question 64

In complying with Crossing the Quality Chasm, you ensure that:
Select one:
a. Patients are actively encouraged to make decisions related to care.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credential

Answer 64

Patients are actively encouraged to make decisions related to care.

Question 65

In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
Select one:
a. Evidence-based practice.
b. Informatics.
c. Staffing.
d. The patient.

Answer 65

The patient.

Question 66

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be:
Select one:
a. Setting up a nursing team meeting to review practices.
b. Calling the family to inform them of the practice.
c. Initiating a multidisciplinary and family meeting to focus on Mary’s needs
d. Restraining Mary to satisfy the family’s wishes.

Answer 66

Initiating a multidisciplinary and family meeting to focus on Mary’s needs.

Question 67

On the basis of a review of increased falls with injury and increased restraint use during evening hours, as the unit manager, you most likely would:
Select one:
a. Review daytime and evening staffing mixes.
b. Schedule continuing education for all staff members.
elizac. Review the safety of ambulation devices.
d. Continue your current practices and procedures.

Answer 67

Review daytime and evening staffing mixes

Question 68

The culture of blame and punishment of errors tends to encourage a culture of:
Select one:
a. Perfectionism.
b. Learning.
c. Safety.
d. Trust.

Answer 68

Perfectionism.

Question 69

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. Using this model might involve councils or committees that dialogue openly regarding quality and:
Select one:
a. Consist of administrative and patient representatives.
b. Are interdisciplinary and intersectional
c. Are composed of senior executives and managers.
d. Are composed of patients and patients’ families.

Answer 69

Are interdisciplinary and intersectoral.

Question 70

The STAR approach to patient safety encourages:
Select one:
a. Focus and reflection.
b. Continuing education.
c. Multidisciplinary approaches.
d. Patient feedback.

Answer 70

Focus and reflection.

Question 71

To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?
Select one:
a. Programming that builds individual nurse competency into smoking cessation
b. Implementation of informatics at the bedside
c. Staff-manager conferences to reviewed reporting of adverse events
d. Patient councils to review food, recreation, and nurse-patient relations

Answer 71

Programming that builds individual nurse competency into smoking cessation

Question 72

To increase safety in patient care areas of the Hospital, the executive begins by:
Select one:
a. Asking the community what the safety issues are.
b. Consulting with a management expert about staffing schedules.
c. Ensuring that the senior nursing officer attends the board meetings.
d. Instituting improved practices to reduce needle-stick injuries.

Answer 72

Ensuring that the senior nursing officer attends the board meetings.

Question 73

Traditional approaches to ensuring patient safety have focused on:
Select one:
a. Assigning blame.
b. Finding solutions to systems issues.
c. Instituting best practices in response to errors.
d. Hiding errors from potential litigation.

Answer 73

Assigning blame.

Question 74

Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)?
Select one or more:
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand
d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn’t know what the doctor meant by colostomy.

Answer 74

Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement.
Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand
d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn’t know what the doctor meant by colostomy.

Question 75

Which philosophical statement would be MOST consistent with that of a learning organization?
Select one:
a. We believe that sustainable funding is a key factor in service.
b. Our staff members are valuable.
c. We believe in people.
d. We believe that change is essential to good service and quality patient care.

Answer 75

We believe that change is essential to good service and quality patient care.

Question 76

You notice that Sally, a student on your unit, is giving information to an anxious young teen, who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation went and:

Select one:

a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent’s parents.

Answer 76

Encourage her to ask the patient if he has questions or concerns about the procedure.

Question 77

Chapter 20
A healthcare organization is committed to improving patient outcomes as part of the quality improvement (QI) process and examines its executive structure and organizational design. This approach recognizes which model of QI?
Select one:
a. Donabedian
b. Benchmarking
c. Employee involvement and innovation
d. QSEN

Answer 77

Donabedian

Question 78

A method commonly used in Quality Assurance to monitor adherence to established standards is:
Select one:
a. A Pareto chart.
b. Brainstorming.
c. Patient interviews.
d. Chart audit.

Answer 78

Chart audit.

Question 79

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:
Select one:
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.

Answer 79

Identify the standard.

Question 80

A nurse is explaining the pediatric unit’s quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?
Select one:
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 on Accreditation of Healthcare Organizations (JCAHO)

Answer 80

Improvement in patient outcomes

Question 81

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 total quality management philosophy by:
Select one:
a. Explaining to the staff that disciplinary action will be taken in cases of additional errors.
b. Recommending that a multidisciplinary team should assess the root cause of errors in medication.
c. Suggesting that the pharmacy department should explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year without penalty.

Answer 81

Recommending that a multidisciplinary team should assess the root cause of errors in medication.

Question 82

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?
Select one:
a. Histogram
b. Flowchart
c. Fishbone diagram
d. Pareto chart

Answer 82

Histogram

Question 83

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:
Select one:
a. NANDA.
b. AHRQ.
c. NIOSH.
d. Nursing process.

Answer 83

NANDA.

Question 84

An example of an effective patient outcome statement is:
Select one:
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.

Answer 84

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.

Question 85

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:
Select one:
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.

Answer 85

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Question 86

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:
Select one:
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.

Answer 86

Goals that are inconsistent with QM.

Question 87

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:
Select one:
a. Procedure manual.
b. Nursing care standards.
c. Litigation rate of unsafe practice.
d. Job descriptions of the organization.

Answer 87

Nursing care standards.

Question 88

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes which model of QI?
Select one:
a. Donabedian
b. Continuous quality improvement
c. Employee involvement
d. QSEN

Answer 88

Donabedian

Question 89

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:
Select one:
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.

Answer 89

Facilitates active staff participation in decision making related to quality nursing care.

Question 90

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because:
Select one:
a. Total organizational involvement is critical to QI.
b. Data generated by a single, separate department are generally flawed.
c. Monitoring and commitment to QI can come only from senior level managers.
d. Staff resent suggestions for improvement that originate outside of their unit.

Answer 90

Total organizational involvement is critical to QI.

Question 91

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?
Select one:
a. NDNQI
b. NANDA
c. NIOSH
d. AHRQ

Answer 91

NDNQI

Question 92

Patient perceptions are useful in:
Select one:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Assisting to establish priorities among possible changes to care identified in QI.
d. Establishing blame for poor-quality care.

Answer 92

Assisting to establish priorities among possible changes to care identified in QI.

Question 93

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? It:
Select one:
a. Promotes teamwork among healthcare providers.
b. Increases adverse events.
c. Improves outcomes.
d. Contributes to duplication of services.

Answer 93

Improves outcomes.

Question 94

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following?
Select one:
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.

Answer 94

Call a meeting of all staff to discuss this issue.

Question 95

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:
Select one:
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

Answer 95

Risk management programs are not designed to assign blame.

Question 96

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to:
Select one:
a. Assemble a team.
b. Establish a benchmark.
c. Identify a clinical activity for review.
d. Establish outcomes.

Answer 96

Identify a clinical activity for review.

Question 97

The outcome statement “Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding” is:
Select one:
a. Physician-sensitive and nonmeasurable.
b. Measurable and nursing-sensitive.
c. Precise, measurable, and physician-sensitive.
d. Patient care-centered and nonmeasurable.

Answer 97

Measurable and nursing-sensitive.

Question 98

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?
Select one:
a. Flowchart
b. Histogram
c. Narrative
d. Line graphs

Answer 98

Flowchart

Question 99

With the rise in 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:
Select one:
a. Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behavior.
d. Hire more police security.

Answer 99

Hold staff accountable for safe practices.

Question 100

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. This is known as:
Select one:
a. Quality assurance.
b. Sentinel data.
c. Benchmarking.
d. Statistical analysis.

Answer 100

Benchmarking.

Question 101

CHAPTER 17
When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed:
Select one:
a. Unfreezing.
b. Nonlinear.
c. Cybernetic.
d. Linear.

Answer 101

Nonlinear

Question 102

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as:
Select one:
a. Trusted, quiet.
b. Flexible, informal.
c. Credible, legitimate.
d. Communicative, personable.

Answer 102

Credible, legitimate

Question 103

The nurse manager frequently interacts with staff and other hospice facility employees. Communication was purposeful because the manager assessed current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathered available staff members to address similar learning needs. Many times, staff members were found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are:
Select one:
a. Dialogue, team learning.
b. Resilience, personal mastery.
c. Shared vision, systems thinking.
d. Mental models, teachable moments.

Answer 103

Dialogue, team learning

Question 104

The clinical coordinator expects the position description of the new wound care specialist to change nurses’ responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to:
Select one:
a. Select one of the change models.
b. Use Lewin’s model and principles of change.
c. Apply both planned and nonlinear approaches.
d. Form a task force of nursing staff and wound care specialists.

Answer 104

Apply both planned and nonlinear approaches

Question 105

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to:
Select one:
a. Consciously evaluate invisible mental models.
b. Allow for individual outcomes.
c. Encourage cooperative activities.
d. Operate between order and disorder.

Answer 105

Consciously evaluate invisible mental models.

Question 106

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will:
Select one:
a. Preserve the status quo.
b. Diminish facilitators and reinforce barriers.
c. Weigh the strength of forces.
d. Strengthen facilitating forces.

Answer 106

Strengthen facilitating forces.

Question 107

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in:
Select one:
a. Coordination.
b. Resistance.
c. Anticipation.
d. Participation.

Answer 107

Participation

Question 108

The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is:
Select one:
a. Developing awareness.
b. Experiencing the change.
c. Integrating the change.
d. Perceiving awareness.

Answer 108

Integrating the change.

Question 109

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejectors is to:
Select one:
a. Encourage teamwork.
b. Transfer to a different unit.
c. Require attendance at staff meetings.
d. Delegate the roles and tasks of change.

Answer 109

Delegate the roles and tasks of change.

Question 110

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:
Select one:
a. Repeat the benefits of the change.
b. Share change experiences early in the process.
c. Initiate frequent interactions among staff.
d. Provide select information to the staff.

Answer 110

Share change experiences early in the process.

Question 111

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change?
Select one:
a. Unfreezing
b. Experiencing the change
c. Integrating the change
d. Refreezing

Answer 111

Unfreezing

Question 112

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach?
Select one:
a. Linear
b. Nonlinear
c. Facilitative
d. Integrative

Answer 112

Linear

Question 113

In Question 12, staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process?
Select one:
a. Persuasion
b. Knowledge
c. Confirmation
d. Decision

Answer 113

Knowledge

Question 114

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from a learning sessions on IV care, and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effect." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change?
Select one:
a. Generating self-renewal
b. Choosing the solution
c. Diagnosing the problem
d. Building a relationship

Answer 114

Building a relationship

Question 115

You follow up with Elizabeth (Question 14) and discover that she is really quite angry about the information sessions because she feels that you are implying that “what she has been doing all these years means that she is incompetent and doesn’t care about her patients.” Your response to her indicates that:
Select one:
a. Elizabeth will never adopt the change.
b. Elizabeth is insecure in her practice.
c. Elizabeth requires more information about the practice.
d. Change involves emotions rather than intellect.

Answer 115

Change involves emotions rather than intellect.

Question 116

Which of the following would be the most effective response to a nurse expressing frustration about change happening on the unit?
Select one:
a. “I understand how you feel, but you are going to have to change.”
b. “It is unfortunate that you feel this way. Others seem quite excited about the new information.”
c. “It is difficult sometimes to change what we know very well. Sometimes it can be frightening.”
d. “Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety.”

Answer 116

“It is difficult sometimes to change what we know very well. Sometimes it can be frightening.”

Question 117

Staff members who are resistant to change because of comfort with the status quo are considered an example of a(n):
Select one:
a. Early adopter.
b. Late adopter.
c. Laggard.
d. Resister

Answer 117

Laggard.

Question 118

After speaking with a nurse previously resistant to change, you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. This type of campaign is bestdescribed as:
Select one:
a. Political.
b. Marketing.
c. Military.
d. Cooptation.

Answer 118

Political.

Question 119

Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is:
Select one:
a. Linear.
b. Nonlinear.
c. Sabotaged.
d. Neutralized.

Answer 119

Nonlinear.

Question 120

Resistance is most likely when change:
Select one:
a. Is not well understood.
b. Involves many layers in an organization.
c. Involves nonprofessional workers.
d. Threatens personal security.

Answer 120

Threatens personal security.

Question 121

As the unit manager on the unit that is leading changes to heparin locks, you find that a nurse is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. This nurse might be considered an:
Select one:
a. Engager.
b. Innovator.
c. Informal change agent.
d. Informant.

Answer 121

Informal change agent.

Question 122

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches. On the basis of this feedback, you:
Select one:
a. Assume that the system is doing what it needs to do.
b. Provide reassurance to staff that the unit has achieved its goals in implementation of the system.
c. Ask some of the staff if they have had similar experiences with the system.
d. Consult chart audit data and end user consultation reports to determine if errors and problems are occurring

Answer 122

Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

Question 123

The situation in Question 22 is best captured in which theory of change?
Select one:
a. Chaos
b. Planned change
c. Cybernetics
d. Innovation-decision process

Answer 123

Cybernetics

Question 124

Sarah, RN, is one of your most enthusiastic staff and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah’s suggestion would be:
Select one:
a. “That is a great suggestion, but we have no resources for such an expensive undertaking right now.”
b. “Perhaps you can keep that in mind as we redesign our charting system.”
c. “We have too many seniors as patients, and you know that they don’t use technology.”
d. “There is a great group here that meets to look at technology pilots. Let’s see if you can join them and discuss your idea further.”

Answer 124

There is a great group here that meets to look at technology pilots. Let’s see if you can join them and discuss your idea further.”

Question 125

Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the “old system” would have been just fine. In facilitating change, your best approach to Edith would be to:
Select one:
a. Put her in the pilot planning group for the change.
b. Determine if she has considered retirement.
c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
d. Avoid discussion of the change, and trust that with sufficient training and information, she will change.

Answer 125

Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.

Question 126

Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.)
Select one or more:
a. “What is working well for you during bedside reporting?”
b. “What has not worked for you today?”
c. Is there someone on your team who deserves special recognition for her efforts in the implementation?
d. Did you have a good vacation?

Answer 126

a. “What is working well for you during bedside reporting?”
b. “What has not worked for you today?”
c. Is there someone on your team who deserves special recognition for her efforts in the implementation?
d. Did you have a good vacation?

Question 127

CHAPTER 18
A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning:
Select one:
a. As a team.
b. Independently.
c. Interdependently.
d. As a group.

Answer 127

As a group.

Question 128

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:
Select one:
a. Conflict.
b. Task clarity.
c. Commitment.
d. A designated leader.

Answer 128

Commitment.

Question 129

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:
Select one:
a. If there are no agreements, each member will make up his or her own procedures without consensus.
b. People are naturally difficult and will not work well together without such agreements.
c. People will naturally ask for agreements about how to be together.
d. A way to eliminate nonproductive team members must be available.

Answer 129

If there are no agreements, each member will make up his or her own procedures without consensus.

Question 130

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members:
Select one:
a. Do not volunteer unwanted information.
b. Actively listen to each other.
c. Listen to the person who believes he or she is an expert.
d. Do not speak unless they are absolutely sure they are correct in their views.

Answer 130

Actively listen to each other.

Question 131

The chief nursing officer decided that the nurse managers need a series of staff development programs on team-building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is:
Select one:
a. Lack of clarity in the mission.
b. Lack of control of the environment.
c. Fear that one can’t handle the consequences.
d. Fear that the boss will not like one’s work.

Answer 131

Fear that one can’t handle the consequences.

Question 132

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone:
Select one:
a. Work together in a respectful, civil manner.
b. Use avoidance techniques when confronted with a conflict.
c. Develop a personal friendship with each other.
d. Socialize frequently outside of work.

Answer 132

Work together in a respectful, civil manner.

Question 133

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes:
Select one:
a. Commitment.
b. Control.
c. Willingness to cooperate.
d. Communication.

Answer 133

Commitment.

Question 134

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, “We will speak supportively,” prevents:
Select one:
a. Side conversations during meetings.
b. Gossip and backbiting.
c. Feedback when one member of the group disagrees with the discussion.
d. Voting negatively on motions.

Answer 134

Gossip and backbiting.

Question 135

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication:
Select one:
a. Is a reflection of self-analysis.
b. Is a result of thoughtful consideration.
c. Consists of thoughts, ideas, opinions, emotions, and feelings.
d. Focuses on the sender of the message.

Answer 135

Consists of thoughts, ideas, opinions, emotions, and feelings.

Question 136

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?
Select one:
a. Speed up your internal processes so that you can process more data.
b. Realize that the first words of the sender are the most important.
c. Be prepared to make an effective judgment of the communication sender.
d. Cultivate a desire to learn about the other person.

Answer 136

Cultivate a desire to learn about the other person.

Question 137

The nurse manager was upset with the staff nurse and said, “You did not understand what I said.” Which element in the communication process was she referring to?
Select one:
a. Feedback between receiver and sender
b. A message channel
c. A receiver who decodes the message
d. A set of barriers that may occur between sender and receiver

Answer 137

A set of barriers that may occur between sender and receiver

Question 138

The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, "What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?" The correct response is which of the following options?
Select one:
a. Active listening and feedback
b. Cues from nonverbal communications
c. Content and context clues
d. Reliance on paralanguage

Answer 138

Active listening and feedback

Question 139

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn’t even know why the conflict started or what it was about. This is an example of:
Select one:
a. How expectations and objectives need to be made clear in team situations.
b. The need to encourage open discussion of disagreements in opinions.
c. The importance of involving all staff in discussions in group settings.
d. The enduring nature of first impressions

Answer 139

The enduring nature of first impressions.

Question 140

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that:
Select one:
a. Two very outspoken members tend to dominate discussions in meetings.
b. This behavior is indicative of a high level of communication among her staff.
c. Staff members are very committed to the team and have strong opinions.
This actually was marked as the correct answer on the test
d. Ongoing discussion outside of meetings is conducive to creativity.

Answer 140

staff members are very committed to the team and have strong opinions

Question 141

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to:
Select one:
a. Therapeutic communication with patients.
b. Effective communication in the workplace.
c. Increased emphasis on sender-receiver dyads.
d. Generational differences in communication.

Answer 141

Effective communication in the workplace.

Question 142

The SBAR system of communications is one of the most used communication systems in health care because:
Select one:
a. It deals with all aspects of communications in patient care except with the physician.
b. The nurse is on the same communication level as administration.
c. It focuses on a system in which information is provided and gleaned in an honorable way.
d. It honors an unstructured transfer of information.

Answer 142

It focuses on a system in which information is provided and gleaned in an honorable way.

Question 143

Marcy, a new staff nurse, is very concerned about “fitting in” on the rehabilitation unit. She addresses her concerns and speaks with the head nurse. The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group. Which of the following statements would she not include in her talk? “Staff members who feel included:
Select one:
a. Are more cooperative.”
b. Are harder workers.”
c. Are part of the 50% who feel their strengths are used.”
d. Bring enthusiasm and commitment to the group.”

Answer 143

Are part of the 50% who feel their strengths are used.”

Question 144

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams:
Select one:
a. Can create a form of synergism in which the outcome is greater than the sum of the individual performances.
b. Do not necessarily need goals, objectives, vision, and a clearly stated purpose.
c. Do not always have effective communication patterns.
d. May or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

Answer 144

Can create a form of synergism in which the outcome is greater than the sum of the individual performances.

Question 145

“I really wish that my supervisor would realize and acknowledge all the things I do well…” In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on:
Select one:
a. New staff.
b. Care assignments with which the individual is not familiar.
c. Making corrections.
d. The strengths of the individual rather than the weaknesses.

Answer 145

The strengths of the individual rather than the weaknesses.

Question 146

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or operationally define trust? Trust:
Select one:
a. Can be described as a belief that although the nurse is capable of helping in times of distress, the nurse is unlikely do so.
b. Is the basis by which leaders facilitate the activities and progress of a team.
c. Is very critical in teams and interdisciplinary teams.
d. Is an important aspect of interpersonal relationships.

Answer 146

Can be described as a belief that although the nurse is capable of helping in times of distress, the nurse is unlikely do so.

Question 147

Healthcare agencies and hospitals expect their practitioners to be effective team members. Two key players in the healthcare team are nurses and physicians. Which of the following statements accurately defines the roles and responsibilities of nurses and physicians?
Select one:
a. Doctors are the hub of the team, whereas nurses are peripheral members.
b. Nurses are considered to be the hub of the team, and doctors are peripheral members.
c. Doctors focus on the holistic needs of the patient, whereas nurses focus on the condition that caused the patient to seek healthcare services in the first place.
d. Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients.

Answer 147

Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients.

Question 148

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, which of the following basic rules was she talking about?
Select one:
a. Listening actively
b. Being compassionate
c. Being flexible
d. Committing to resolution

Answer 148

Committing to resolution

Question 149

Which of the following would not be a characteristic of an effective team nurse leader?
Select one:
a. An autocratic perspective
b. Excellent communication skills
c. Awareness of everyone's abilities
d. A genuine interest in team members

Answer 149

An autocratic perspective

Question 150

Which of the following is not a necessary requirement for formation of a team? In forming a team, the leader should keep in mind that the team:
Select one:
a. Should include only members with similar personalities.
b. Is responsible for creating its own vision.
c. Should decide the goals and objectives.
d. Should encourage participants to be actively involved.

Answer 150

Should include only members with similar personalities.

Question 151

What is not a key concept in a well-functioning team?
Select one:
a. Absence of disagreement or conflict
b. Special work that is understood and supported by all
c. Willingness to work together respectfully
d. Dedication to a mission

Answer 151

Absence of disagreement or conflict

Question 152

Bennis, a researcher and writer, posits that effective leaders share three fundamental qualities. Which of the following is not a fundamental quality?
Select one:
a. A guiding vision
b. Passion
c. Integrity
d. Motivation

Answer 152

Motivation

Question 153

Examples of sentinel events include (select all that apply):
Forceps left in an abdominal cavity
patient fall, with injury
administration of morphine overdose
death of a patient r/t postpartum hemorrhage

Answer 153

Forceps left in an abdominal cavity
patient fall, with injury
administration of morphine overdose
death of a patient r/t postpartum hemorrhage

Question 154

CHAPTER 13
Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on:
Select one:
a. Licensure status.
b. Experience in the agency.
c. Leadership capabilities.
d. Education and expertise.

Answer 154

Education and expertise.

Question 155

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's:
Select one:
a. Clinical expertise.
b. Leadership ability.
c. Communication style.
d. Conflict-resolution skills.

Answer 155

Clinical expertise.

Question 156

When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
Select one:
a. The case method.
b. Functional nursing.
c. Primary nursing.
d. Nurse case management.

Answer 156

Functional nursing.

Question 157

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the:
Select one:
a. Nursing care plan.
b. Physician's orders.
c. Critical pathway.
d. Clinical practice guidelines.

Answer 157

Critical pathway.

Question 158

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager’s major goal during this hospitalization is to:
Select one:
a. Implement the care MAP on admission.
b. Provide direct nursing care throughout the hospitalization.
c. Supervise the nursing staff members who implement the care MAP.
d. Prevent additional hospitalizations resulting from complications of the client’s disease.

Answer 158

Prevent additional hospitalizations resulting from complications of the client’s disease.

Question 159

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective?
Select one:
a. Functional method
b. Case management method
c. Primary care method
d. Team method

Answer 159

Case management method

Question 160

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
Select one:
a. Baccalaureate
b. Associate
c. Diploma
d. LPN/LVN

Answer 160

Baccalaureate

Question 161

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the:
Select one:
a. Department.
b. Unit.
c. Staff.
d. Patient.

Answer 161

Patient.

Question 162

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with certain tasks. What type of design constitutes a partnership care delivery model?

Select one:

a. RN and LPN/LVN
b. RN and RN
c. RN and medication assistants
d. RN and certified nurses’ aides

Answer 162

RN and certified nurses’ aides

Question 163

The case method of care delivery could be best justified in which of the following scenarios?
Select one:
a. Stable patient population with long-term care and family needs
b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures
c. Pediatric intensive care unit that heavily involves families as well as patients
d. Home healthcare environment with patients at varying levels of acuity

Answer 163

Pediatric intensive care unit that heavily involves families as well as patients

Question 164

During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
Select one:
a. Case method
b. Team nursing
c. Functional nursing
d. Nurse case management

Answer 164

Case method

Question 165

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says 'that is not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is:
Select one:
a. Differentiated practice.
b. Team nursing.
c. Functional nursing
d. Case management

Answer 165

Functional nursing.

Question 166

The model outlined in Question 12 might be particularly effective in:
Select one:
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient-provider conflict.
d. Developing competence and confidence in unskilled workers.

Answer 166

Developing competence and confidence in unskilled workers.

Question 167

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is:
Select one:
a. Rotation of task assignments.
b. Frequent opportunities for in-service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.

Answer 167

Rotation of task assignments.

Question 168

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model:
Select one:
a. Can be effective in recognizing individual strengths and backgrounds of staff.
b. Promotes autonomy and independence for the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

Answer 168

Can be effective in recognizing individual strengths and backgrounds of staff.

Question 169

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:
Select one:
a. Be able to effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to her supervisor.

Answer 169

Be able to adapt to daily changes in staffing.

Question 170

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in:
Select one:
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Time period of accountability.
d. Levels and types of assessment.

Answer 170

Time period of accountability.

Question 171

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that:
Select one:
a. It is the role of the primary nurse to make alterations based on assessment data and input.
b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore, is able to alter the care plan.
c. Neither the primary nor the associate should make changes without first consulting you as the manager.
d. It really does not matter who alters the nursing care plan as it depends on situation and time to do so.

Answer 171

It is the role of the primary nurse to make alterations based on assessment data and input.

Question 172

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
Select one:
a. Similar to those in functional nursing.
b. Not of significance in either model.
c. Low by comparison with functional nursing.
d. High when compared with functional nursing.

Answer 172

High when compared with functional nursing.

Question 173

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level:
Select one:
a. Is increased.
b. Is decreased.
c. Is relinquished.
d. Remains the same.

Answer 173

Is decreased.

Question 174

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to:
Select one:
a. Implementation of an all-RN staff complement.
b. Significant changes in the physical structure of units.
c. Orientation of staff to new roles and responsibilities.
d. Testing and piloting technology at the bedside.

Answer 174

Significant changes in the physical structure of units.

Question 175

When hiring a case manager for a rehabilitation setting, you would most likely consider a:
Select one:
a. Registered nurse with a master’s degree.
b. Physiotherapist with a background in stroke rehabilitation.
c. Social worker with a background in counseling.
d. Health professional with advanced background who is client and outcome focused.

Answer 175

Health professional with advanced background who is client and outcome focused.

Question 176

Case managed care may enhance profit in a for-profit health organization by:
Select one:
a. Minimizing costs in high resource consumption areas.
b. Combining licensed and non-licensed care providers in delivering patient care.
c. Increasing reimbursement from third-party payers.
d. Reducing the amount of technology used to support clinical decision making.

Answer 176

Minimizing costs in high resource

Question 177

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency?
Select one:
a. Advanced beginner
b. Competent
c. Proficient
d. Novice

Answer 177

Competent

Question 178

In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to:
Select one:
a. Find it difficult to recruit new staff.
b. See rapid turnover of staff on your unit.
c. Find nurses who exemplify interest in quality care.
d. Find limited interest in excellence in the nursing environment.

Answer 178

Find nurses who exemplify interest in quality care.

Question 179

CHAPTER 25
Your healthcare 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:
Select one:
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 if drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories.

Answer 179

Thoroughly follow up with all references before offering a position.

Question 180

history of conflict with you and the staff, and who recently was charged with theft of patient belongings. You consult Human Resources, and together, you develop a plan, which includes:
Select one:
a. A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired, and that his paperwork will be sent to him at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is available, should he become upset or agitated.

Answer 180

A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related.

Question 181

In which of the following situations would you, as the head nurse, be concerned about potential safety issues?
Select one:
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. Henry, 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 nights 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.

Answer 181

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 nights have reported that Jake seems to have been intoxicated last night and the previous night.

Question 182

Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent and 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 of the staff find you fair, honest, and knowledgeable. Marjorie's behavior can best be characterized as:
Select one:
a. Political action.
b. Bullying.
c. Building alliances.
d. Disgruntlement.

Answer 182

Bullying.

Question 183

During coffee and other breaks, Rosalie, the new RN, is shut out of 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 behavior of the staff is characteristic of:
Select one:
a. Dislike.
b. Lack of trust in Rosalie's abilities.
c. Horizontal violence.
d. Cultural incompetence.

Answer 183

Horizontal violence.

Question 184

While working with an aggressive patient, it is important for the nurse to:
Select one:
a. Speak firmly.
b. Call the individual by name.
c. Place herself between the patient and the door.
d. Ignore threats against her.

Answer 184

Place herself between the patient and the door.

Question 185

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:
Select one:
a. Is reasonable. No physical violence was involved.
b. Is related to why statistics on violence in health care are likely underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse.

Answer 185

Is related to why statistics on violence in health care are likely underreported

Question 186

You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization. This team has been established in response to increases in reports of violence and aggression. You begin by:
Select one:
a. Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations.
b. Offering training sessions in self-defense.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviors with potential for violence.

Answer 186

Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations

Question 187

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:
Select one:
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.”

Answer 187

“It is frustrating to wait when you are in pain and when you are expecting to receive relief right away.”

Question 188

At 3 AM, 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:
Select one:
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 closed.
d. Remain calm as there is no potential for violence here.

Answer 188

Assess your situation and your surroundings.

Question 189

Linda, a staff nurse on nights, yells at Ali, another RN, and tells Ali that she is stupid and can’t get anything right. In responding to this situation as head nurse, it is critical that you:
Select one:
a. Require that Linda attend anger management classes.
b. Investigate to see if Ali did anything to aggravate Linda.
c. Call both immediately into the office in the morning to discuss the situation.
d. Respond to Linda in a way that is consistent with organizational processes and with similar situations.

Answer 189

Respond to Linda in a way that is consistent with organizational processes and with similar situations.

Question 190

Residents in a new long-term care facility attend a large dining hall for meals. In reviewing reports of aggression and violence, you note that behaviors such as hitting, or attempting, to hit staff are increasing. Further investigation suggests that this behavior occurs most often at mealtimes. A possible intervention would be to:
Select one:
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.

Answer 190

Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence.

Question 191

You note that Unit 64 has had a high turnover rate of staff during the past year. In investigating this situation, an important source of data might include:
Select one:
a. Employee evaluations.
b. Level of experience of staff.
c. Exit interviews with staff.
d. Selection processes and decisions.

Answer 191

Exit interviews with staff.

Question 192

In selecting the appropriate action in Question 13, it is important that:
Select one:
a. All documentation is reviewed.
b. Usual processes for discipline are followed.
c. Confidentiality is assured.
d. An incident report is filed.

Answer 192

Confidentiality is assured.

Question 193

In addressing the staff turnover rate in Question 13, you are:
Select one:
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.

Answer 193

Demonstrating awareness that workplace violence, if present, has significant costs.

Question 194

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:
Select one:
a. Yell at him to stop.
b. Calmly ask the patient to remove his hands.
c. Hit the patient in the mid section.
d. Use pepper spray.

Answer 194

Calmly ask the patient to remove his hands.

Question 195

Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding that:
Select one:
a. Her perception is accurate.
b. Yelling is more likely associated with aggression.
c. Violence is signaled by a variety of behaviors.
d. She is mostly accurate in her thinking.

Answer 195

Violence is signaled by a variety of behaviors.

Question 196

Joe and Carol, two of the RNs on Unit 22, are discussing recent incidents on the unit that have involved patients and visitors uttering threats or making demeaning remarks to staff during evening hours. Joe observes that unless someone shoots at him, he is not concerned because “words can’t hurt you.” Joe’s remarks:
Select one:
a. Illustrate common misperceptions about the nature of violence.
b. Accurately depict the difference between violence and aggression.
c. Are partially correct because verbal remarks do not cause injury.
d. Reveal possible issues that Joe relates to violence in his personal life

Answer 196

Illustrate common misperceptions about the nature of violence.

Question 197

Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression?
Select one:
a. Becky
b. Sarah
c. Sharon
d. Donna

Answer 197

Becky

Question 198

In Question 19, which of the four is most likely to be a perpetrator of violence?
Select one:
a. Becky
b. Sarah
c. Sharon
d. Donna

Answer 198

Becky

Question 199

A safety and security plan is important to a healthcare organization because it:
Select one:
a. Lays out preventive measures in relation to violence.
b. Provides direction as to changes in facilities that protect staff.
c. Establishes expectations in relation to behavior and tolerance of violence.
d. Establishes policies and practices that guide prevention of violence and expectations in the workplace.

Answer 199

Establishes policies and practices that guide prevention of violence and expectations in the workplace.

Question 200

Sarah is involved in intervening when a patient attempts to harm herself on the unit. During the interaction, the patient slaps Sarah across the face. As a head nurse, it is important that you:
Select one:
a. Offer Sarah immediate education and training in self-defense.
b. Assist with follow-up documentation and offer access to counseling.
c. Provide access to a lawyer.
d. Encourage Sarah to see the incident as a normal part of care.

Answer 200

Assist with follow-up documentation and offer access to counseling.

Question 201

23 In designing a new healthcare 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.)
Select one or more:
a. Emergency
b. Psychiatry
c. Gerontology
d. Maternal-child

Answer 201

Emergency, Psychiatry, Gerontology

Question 202

CHAPTER 23
A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from:
Select one:
a. Group decision-making options.
b. Perceptions of incompatibility.
c. Increases in group cohesiveness.
d. Debates, negotiations, and compromises.

Answer 202

Perceptions of incompatibility.

Question 203

Two staff nurses are arguing about working on holidays. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when:
Select one:
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.

Answer 203

People see events differently.

Question 204

The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. A factor that can increase stress and escalate conflict is:
Select one:
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.

Answer 204

The use of avoidance.

Question 205

The nurse manager decides to use a mediator to help resolve the staff’s conflict. A basic strategy for truly addressing this conflict is to:
Select one:
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.

Answer 205

Have a clear understanding of the differences between the parties in conflict.

Question 206

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

Answer 206

Intrapersonal

Question 207

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:
Select one:
a. Frustration, competition, negotiation, and action.
b. Frustration, conceptualization, action, and outcomes.
c. Frustration, cooperation, collaboration, and action outcomes.
d. Frustration, conceptualization, negotiation, and action outcomes.

Answer 207

Frustration, conceptualization, action, and outcomes.

Question 208

After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to:
Select one:
a. Observe to make sure the conflict has been resolved.
b. Fire both staff nurses.
c. Reassign both staff nurses.
d. Reassign the nurse manager.

Answer 208

Observe to make sure the conflict has been resolved.

Question 209

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 do the following: Generate:
Select one:
a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers.
b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.
d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

Answer 209

Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.

Question 210

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

Answer 210

Interpersonal

Question 211

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

Answer 211

Conceptualization

Question 212

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

Answer 212

Action

Question 213

In Question 11, the outcome as depicted by Thomas' conflict stages can be considered to be:
Select one:
a. Compromising.
b. Confronting.
c. Constructive.
d. Destructive

Answer 213

Destructive.

Question 214

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

Answer 214

Collaborating

Question 215

A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except:
Select one:
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.

Answer 215

Conflict can decrease creativity, thus acting as a deterrent for the development of new ideas.

Question 216

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

Answer 216

Decreased productivity on her part.

Question 217

The CEO of Bow Valley Hospital makes the following statement: “The reason we can’t hire any more staff is the lack of government funding.” 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

Answer 217

Incompatible goals

Question 218

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, “I will sit on the hospital taskforce 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

Answer 218

Negotiating

Question 219

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

a. Collaboration
b. Compromising
c. Avoiding
d. Withdraw

Answer 219

Compromising

Question 220

Factors that influence the ease with which conflict is resolved include all except which of the following?

a. Level of interdependence of the parties
b. Importance of the outcome
c. Perceived fairness of the process of resolution
d. Experience and education level of those in conflict

Answer 220

Experience and education level of those in conflict

Question 221

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 based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with:

a. Lateral violence.
b. Horizontal violence.
c. Confrontation.
d. Bullying.

Answer 221

Bullying.

Question 222

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

Answer 222

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.

Question 223

Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian’s relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian’s relationships can be more satisfying for Jillian and her team members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation, Lee and Jillian are demonstrating:

a. Similar conflict management strategies.
b. Escalation of conflict.
c. Avoidance and compromise strategies.
d. Competing and compromise strategies.

Answer 223

Avoidance and compromise strategies.

Question 224

Which of the following best exemplifies a preferred style of conflict management for staff nurses?

a. Sarah 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. Lindsay 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 Lindsay.
d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

Answer 224

Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

Question 225

In trying to achieve Magnet™ status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change, thus creating 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 Less participation in decision making

Answer 225

Less participation in decision making