TEST BANK for Effective Leadership and Management In Nursing, 9TH Edition by Eleanor J. Sullivan. Al

TEST BANK

TEST BANK FOR EFFECTIVE LEADERSHIP AND MANAGEMENT IN NURSING, 9TH EDITION, ELEANOR J. SULLIVAN

Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 1 Introducing Nursing Management 1) A nurse manager is participating in the healthcare organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend? 1. Cost of care 2. Access to care 3. Availability of care 4. Quality of care Answer: 1 Explanation: 1. While all of the options given are driving forces in today's healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality. 2. Access to care is controlled by the ability to pay. 3. Care will not be available if it cannot be funded. 4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

2) A nurse has been invited to discuss healthcare costs at a senior citizens' club. What information should the nurse plan to include in this discussion? 1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%. 2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers. 3. The United States spends more money on healthcare than any other country. 4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA). Answer: 2 Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross domestic product. 2. Implementation of PPACA and its regulations have not been formulated. 3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country. 4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation? 1. "I wonder if there was a break of sterility when this catheter was inserted." 2. "Thankfully we can treat this with an antibiotic." 3. "This could potentially cost the hospital a lot of money." 4. "I will talk to my unlicensed assistants about proper urinary catheter care." Answer: 2 Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection. 2. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation. 3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay. 4. The nurse has identified that improper care may result in poor outcomes for the client. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 4) Which healthcare situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase. Answer: 2, 3, 4 Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need. 2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management. 3. Quality management empowers the employee to evaluate quality. 4. This nurse has seen a need and is working to improve the quality of service. This is quality management. 5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

5) A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is no mechanism for complaint because the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association (ANA). 5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ). Answer: 2, 3, 5 Explanation: 1. The client can still voice concerns even after discharge. 2. These client satisfaction surveys are a good mechanism for discussing care issues. 3. Telephone calls are a means of discussing client care issues. 4. ANA is not a forum for complaints about care in a specific hospitalization. 5. The AHRQ has a mechanism for reporting care issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure? 1. The hospital closest to the client's home 2. The hospital that has done the greatest number of these surgeries in the last two years 3. The hospital chosen by the client's primary healthcare provider 4. The hospital with the highest performance ratings for this procedure Answer: 4 Explanation: 1. This may or may not be the best choice of hospital for this procedure. 2. Just because a hospital is high volume does not mean it is high quality. 3. This may or may not be the best hospital for this procedure. 4. The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

7) The quality management director of a large healthcare conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish? 1. We will compare outcome indicators with other healthcare conglomerates of similar size and organization. 2. Outcome data of hospitals within the organization will be compared to assess quality. 3. Each client care unit in the organization will establish specific unit goals for quality. 4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed. Answer: 1 Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges. 2. Because the hospitals with the organization are likely managed in a similar manner, this is not an example of benchmarking. 3. While establishing goals is a part of quality management, it is not benchmarking. 4. Setting up a quality monitor is a quality initiative, but it is not benchmarking. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 8) The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process? 1. "What outcomes are we expecting from this work?" 2. "Is anyone prepared to evaluate the statistics we will find?" 3. "What is the exact clinical issue with which we are dealing?" 4. "Where can we look for information?" Answer: 3 Explanation: 1. Assessing outcomes is the last step of the EBP process. 2. Evaluation of the evidence is step 3. 3. Identifying the clinical question is the first step in the EBP process. 4. Acquiring the evidence to answer the question is step 2. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

9) The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence? 1. Case study 2. Anecdotal 3. Nonexperimental design research 4. Statistical Answer: 2 Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical situations. 2. Anecdotal evidence is derived from experience. 3. Nonexperimental design research includes gathering factors related to a clinical condition. 4. Statistical evidence is built from a scientific approach. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

10) A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which of the following statements would direct these nurses to the forms of strongest clinical evidence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We may find studies that use only one group of participants." 2. "Look for articles that report on how to use evidence in other clinical situations." 3. "The studies we want are built around the scientific approach to solving problems." 4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness." 5. "Many articles will have information reported by someone who is an expert in the field." Answer: 3, 4 Explanation: 1. Studies using only one group of participants are done in a quasi-experimental design. This is not one of the two strongest forms of evidence. 2. An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence. 3. Using the scientific approach results in statistical evidence, which is one of the two strongest forms. 4. Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence. 5. Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 11) A healthcare system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism." Answer: 14 Explanation: There are 14 qualities or "Forces of Magnetism" that must be demonstrated to achieve Magnet status. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

12) Which organization would the hospital management team contact to pursue certification as a Magnet hospital? 1. Magnet Recognition Program 2. American National Magnet Commission 3. The Joint Commission 4. American Medical Association (AMA) Answer: 1 Explanation: 1. The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates healthcare organizations that provide nursing excellence. 2. The American National Magnet Commission is fictitious. 3. The Joint Commission accredits healthcare organizations, but does not award Magnet status. 4. The AMA does not award Magnet status. Magnet status is focused on nursing excellence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 13) A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing Answer: 3 Explanation: 1. Pediatric nursing is not likely to see as much growth as another specialty. 2. Psychiatric nursing is not likely to see as much growth as another specialty. 3. As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer. 4. Maternity nursing is not likely to see as much growth as another specialty. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Professional Practice Evaluation Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

14) The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation? 1. "There are more nurses retiring than are entering the profession." 2. "The demand for nurses is declining because of fewer hospital admissions." 3. "There are insufficient numbers of nursing faculty to teach interested students." 4. "Women still outnumber men in nursing." Answer: 2 Explanation: 1. The average age of the registered nurse (RN) is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession. 2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow. 3. Nursing faculty members are also aging and moving into retirement. 4. Women continue to outnumber men in the nursing profession. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 15) A healthcare organization has just achieved Magnet status. During the award ceremony, the organization's chief executive officer should give primary praise for this achievement to which employees? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Medical staff 2. Nurse executive 3. Staff nurses 4. Managers in support services such as laboratory and radiology 5. Administrative professionals overseeing services such as accounting, billing, and medical records Answer: 2, 3 Explanation: 1. Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players. 2. While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. 3. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence. 4. While these employees would be involved in this effort, Magnet status is focused on nursing excellence. 5. While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Professional Practice Evaluation Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 16) The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on

which technique? 1. Intuition 2. Personal clinical experience 3. Knowledge from nursing school 4. Current research Answer: 4 Explanation: 1. Intuition is not based in research and is not evidence based. 2. Clinical experience is useful when integrated with evidence-based practice but is not considered evidence based when used alone. 3. Knowledge from nursing school is very useful in client care but can become outdated if the nurse does not continually update that knowledge. 4. Current research is a good source of evidence-based practice strategies. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 17) Which strategy is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the internet. Answer: 4 Explanation: 1. Ensuring adequate training by itself is not enough. 2. Asking for opinions will do little to encourage the use of evidence-based practice. 3. Recognition for those willing to use evidence-based practice is an insufficient motivator. 4. There must be training, easy access, and recognition for using evidence-based practice in nursing. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

18) The organization that awards Magnet status would look for environments where which practices are the norm? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses are involved in decision making. 2. Rewards are focused on ideas that save money. 3. Once a decision is made, it stands. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health. Answer: 1, 5 Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions. 2. Money-saving ideas are not always good for staff or for clients. 3. Magnet-status organizations are flexible and encourage autonomy and independence. 4. Overtime is sometimes necessary, even in well-run facilities. 5. In Magnet organizations, staff members are encouraged to be involved in educational activities in the organization and the community. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 19) The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in healthcare. Which statement is a reason for this delay? 1. Medical records professionals do not like these records. 2. The use of these records is more expensive than the use of paper records. 3. There have been concerns about privacy and confidentiality. 4. The transition to EHRs is time consuming and tedious. Answer: 3 Explanation: 1. The preference of medical records professionals is not the reason these records have had a slow adoption. 2. The cost of the records is not a primary reason they have had slow adoption. 3. The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality. 4. The transition time to EHRs is not the primary reason they have seen a slow adoption. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

20) Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital? 1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications. 2. The nurse should get medications more quickly because the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked. 4. The nurse can expect that medication administration will be easier and carry less potential for error. Answer: 2 Explanation: 1. The nurse must still complete the six rights of medication administration to ensure client safety. 2. Robots should be able to get medications to the floor more quickly. 3. The administration of medication cannot be delegated to the nursing assistant. 4. There is no assurance that medication administration will be easier. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

21) A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Open access to the blog may damage recruiting efforts. 2. Blogs are difficult to use and expensive to maintain. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organization's reputation may be altered by a blog. 5. Most nurses would likely not use the blog. Answer: 1, 3, 4 Explanation: 1. Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news. 2. Blogs are inexpensive and easy to use. 3. As blogs become more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely. 4. The organization's reputation could be either enhanced or damaged by bloggers' comments. 5. Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

22) The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I don't see why everyone can't just get along." 2. "Generation X nurses are just lazy." 3. "Our Generation Y nurses help keep us all up on new technology." 4. "The most loyal of all my nurses are the traditionalists." 5. "I expect that our next manager will come from my group of baby boomers." Answer: 3, 4, 5 Explanation: 1. The four generations have different values, work ethics, and skills. Conflict is inevitable. 2. The manager should not stereotype the members of a generation. 3. Generation Y is technically savvy. 4. Traditionalists are typically loyal and respectful of authority. 5. Baby boomers typically value professional and personal growth. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

23) The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Preparing for a surge of casualties in case of a disaster 2. How to prevent disasters from occurring 3. How to fund disaster management 4. How to reduce disaster impact on clients and staff 5. How to identify risks for disasters Answer: 1, 5 Explanation: 1. One of the primary focuses of a disaster plan is how to care for the influx of clients. 2. Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan. 3. Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay. 4. There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact. 5. Risk identification is part of a safety plan. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

24) Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which individual is most strategically placed to handle how these changes are initiated? 1. Staff nurse 2. Nurse manager 3. Chief financial officer (CFO) 4. Chief executive officer (CEO) Answer: 2 Explanation: 1. The staff nurse will be instrumental in carrying out the changes but is not the most influential in directing them. 2. The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff's feelings while adequately and appropriately representing the needs and wants of the administration. 3. The CFO will certainly have some say in the financial support of any changes made but is unlikely to have sufficient knowledge of the daily operations of the unit to handle changes at that level. 4. The CEO is unlikely to have enough information about the daily unit activities to be effective in instituting these changes. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 25) To be effective in today's healthcare system, the nurse manager must be aware of which trends? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. An environment that does not change 2. Decreasing resources 3. Adequate staffing 4. Increasing numbers of retirees 5. Complicated technology Answer: 2, 4, 5 Explanation: 1. The only trend that is consistent is the rapidly changing system. 2. Nurse managers must be aware of the responsibility of doing more with fewer resources. 3. Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care. 4. Increasing numbers of retirees, both from nursing and as an aging population, have placed a strain on the healthcare system. 5. Complicated technology forces the nurse manager to keep up with the ever-present changes within the healthcare system. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Resource Utilization Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 26) The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends?

1. The average age of the nursing staff is 40. 2. The number of nurses under age 30 has increased in the last two years. 3. There are no nurses older than age 55. 4. All nurses older than age 45 are managers. Answer: 2 Explanation: 1. The average age of nurses is 46. 2. The number of nurses younger than age 30 is increasing. 3. This does not reflect national statistics. 4. This does not reflect national statistics. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment Evidence-Based Practice Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society. 27) To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ________% of nurses prepared at the baccalaureate or higher level by 2020. Answer: 80 Explanation: The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 28) A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations? 1. "We must find ways to increase our emphasis on critical thinking." 2. "The curriculum must focus on ways nurses can quickly and accurately acquire information." 3. "Our emphasis must change to improving nursing students' clinical reasoning skills." 4. "Our clinical practicums must be graded separately from our theory presentations." Answer: 3 Explanation: 1. Critical thinking is still emphasized, but another aspect of care should receive much more emphasis. 2. Carnegie focuses on application of knowledge rather than its acquisition. 3. This is a Carnegie recommendation. 4. Carnegie recommends integration of clinical and classroom teaching. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 29) A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now? 1. Nothing until the nurse has acquired enough bedside experience to become a manager

2. Time to see how these skills will be needed in the future 3. A manager who can help with skills transfer from school to work 4. A job working as a manager in a small hospital Answer: 3 Explanation: 1. All nurses are managers. 2. The nurse will use these skills on the first job. 3. The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care. 4. The newly licensed nurse does not have the skill set and experience to work as a manager. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. 30) Which manager statement reflects concern about the most important requirement for today's nurse manager? 1. "I am taking a day off tomorrow for my annual physical." 2. "I think this class will help me learn to be innovative." 3. "I am committed to being a good manager." 4. "I feel enthusiastic about our new plans for the units." Answer: 1 Explanation: 1. The most important work of the manager is to stay physically and mentally healthy. 2. Innovation is important, but not as important as other factors. 3. Commitment is important, but not as important as other factors. 4. Enthusiasm is important, but not as important as other factors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

31) Quality and Safety Education for Nurses (QSEN) is based on quality and safety targets of knowledge, skills, and attitudes (KSAs) for nursing education. Which targets are associated with QSEN competencies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Education 2. Teamwork 3. Autonomy 4. Quality improvement 5. Client-centered care Answer: 2, 4, 5 Explanation: 1. Education is not one of the KSAs. 2. Teamwork is one of the KSAs. 3. Autonomy is not one of the KSAs. 4. Quality improvement is one of the KSAs. 5. Client-centered care is one of the KSAs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 32) The nurse is using Evidence-based practice (EBP) to improve clinical quality. What steps should the nurse plan to include in this process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess the outcome 2. Discuss challenges 3. Identify the clinical question 4. Compare other models 5. Apply the evidence Answer: 1, 3, 5 Explanation: 1. Assessing the outcome is a step in EBP. 2. Discussing challenges is not a step in EBP. 3. Identifying the clinical question is a step in EBP. 4. Comparing other models is not a step in EBP. 5. Applying the evidence is a step in EBP. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 2 Designing Organizations 1) The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory? 1. Span of control 2. Line authority 3. Hawthorne effect 4. Adhocracy Answer: 3 Explanation: 1. Span of control is the number of individuals a manager can effectively supervise. 2. Line authority is a linear hierarchy through which activity is directed. 3. The Hawthorne effect is the tendency of people to perform as expected because of special attention. 4. Adhocracy is a fluid structure in which management, staff, and experts work together on teams. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions.

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2) A community-owned hospital has been purchased by a healthcare conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse? 1. "If our new bosses want a classical organization, we can expect a strong hierarchy." 2. "If we don't want to see lots of changes, we should hope our new bosses don't like chaos theory." 3. "If this new company is based on systems theory, there will be a lot of focus on how much work we can produce." 4. "If this new company is based on contingency theory, we will see lots of focus on how our environment impacts our work." Answer: 3 Explanation: 1. Classical organizational theory focuses on structure with a strong hierarchy. 2. Those who support chaos theory believe that organizational function and integrity must be guided by flexibility, fluidity, speedy adaptability, and cultural sensitivity. Change is inevitable and embraced. 3. Systems theory focuses on "input" or resources, "throughput" or the work done, and "output" or the product of the work. 4. Contingency theory posits that organization performance can be enhanced by matching an organization's structure to its environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-1: Differentiate between reductive and adaptive organizational theories. 3) During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement? 1. The nurse manager is not capable of performing all the duties expected of the role. 2. The nurse manager may have too many staff members to manage. 3. The nurse manager is burned out and needs time away from the unit. 4. The nurse manager is not educationally prepared for the role. Answer: 2 Explanation: 1. Span of control is not directly related to the number of duties expected. 2. Span of control addresses the number of employees a manager can effectively supervise. 3. Span of control issues may result in burnout, but there is no indication from this scenario that this is the case. 4. There is no indication that the nurse manager's level of education is insufficient for the role. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions.

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4) During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage? 1. The nurse will have to choose a provider from within the HMO. 2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges. 3. For an additional premium, the nurse can choose any provider. 4. By joining this HMO, the nurse is entitled to unlimited treatment and services. Answer: 1 Explanation: 1. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO. 2. The HMO system will not pay for services provided "out of network." 3. The ability to choose a provider who is "out of network" for an additional premium is a feature of point-of-service plans. 4. The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 2-2: Describe traditional and emerging structures in healthcare organizations.

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5) A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy? 1. The nursing department is responsible for writing the client's comprehensive care plan. 2. The dietary department is responsible for nutritional assessment. 3. All nursing tasks fall under the nursing department. 4. Physical and occupational therapy departments coordinate and evaluate activities of daily living. Answer: 1 Explanation: 1. In functional structure, individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a comprehensive care plan without input from other departments. 2. In functional structure, individual departments are grouped and responsible for specific tasks. The dietary department would be responsible for nutritional assessment in this structure, so this is not a weakness. 3. In functional structure, individual departments are grouped and responsible for specific tasks. All nursing tasks would be grouped under the nursing department, so this is not a weakness. 4. In functional structure, individual departments are grouped and responsible for specific tasks. Physical and occupational therapy would logically coordinate and evaluate activities of daily living, so this is not a weakness. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model. 6) A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method? 1. Concentric diversification 2. Conglomerate diversification 3. Capitation 4. Joint venture Answer: 4 Explanation: 1. Concentric diversification is expansion of services into new markets. 2. Conglomerate diversification is expansion into areas that differ from the original service. 3. Capitation is a fixed fee paid per enrollee for services in an HMO. 4. A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collegiality Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model. TestBankWorld.org

7) A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency? 1. Long-term care facility 2. Public health department 3. Temporary service agency 4. Home health agency Answer: 4 Explanation: 1. Long-term care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery. 2. The public health department's focus is usually community health, not individual primary care. 3. Temporary service agencies are used to provide healthcare organizations with professional and nonprofessional personnel when the latter are short staffed. 4. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 2-2: Describe traditional and emerging structures in healthcare organizations. 8) A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory? 1. Contingency theory 2. Closed-systems theory 3. Classical theory 4. Chaos theory Answer: 4 Explanation: 1. Contingency theorists study the environment in which the organization will exist and create the structure to match that environment. 2. Closed systems are self-contained and do not exist in organizations dependent on the interplay of people. Examples can be found in the physical sciences. 3. Classical leadership theory focuses on developing a well-structured and stable environment where chain of command and control are valued. 4. Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 2-1: Differentiate between reductive and adaptive organizational theories. TestBankWorld.org

9) What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure? 1. Adaptation and innovation are encouraged. 2. The medical staff has become autonomous from the organization. 3. Two lines of authority have been created. 4. Organizational structure is becoming much clearer. Answer: 1 Explanation: 1. Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation. 2. The medical staff is autonomous from the organization in parallel structure. This autonomy is reduced by service-line structure. 3. Parallel structure exists when there are two lines of authority in an organization. 4. Organizational structure is much clearer in a parallel structure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model. 10) Which structure is reflected by the statement, "Nursing practice is best determined by nurses"? 1. Hybrid 2. Shared governance 3. Matrix 4. Functional Answer: 2 Explanation: 1. Hybrid structure is typical of a growing institution and consists of both selfcontained units and functional units. Top administrators still make many of the decisions for the organization. 2. Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered. 3. Matrix structure combines functional structure and product structure into one overlapping structure. The dual authority created can be frustrating and confusing. Managers and administrators make many of the organizational decisions. 4. Functional structure is a traditional structure in which employees are grouped in departments by specialty. Most decisions are made by senior managers. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model.

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11) "We want to be the hospital of choice in the Midwest" is which type of statement? 1. Value statement 2. Mission statement 3. Vision statement 4. Philosophy statement Answer: 3 Explanation: 1. The value statement concerns the beliefs or attitudes esteemed by the organization's leaders. 2. The mission statement is a broad statement of the organization's reason for existence. An example is "Our mission is to improve the health of the people of the Midwest." 3. A vision statement describes the goal to which the organization aspires-in this case, to be the hospital of choice in the Midwest. 4. A philosophy statement reflects the organization's values, vision, and mission, so it is allinclusive. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions. 12) What is the best example of a pediatric unit's organizational culture? 1. All client rooms are private. 2. Nurses wear colorful scrubs. 3. The nurse-to-client ratio is 4 to 1. 4. The primary nursing model is used for care. Answer: 2 Explanation: 1. Organizational climate is based on physical attributes and policy and procedure. Private rooms are an example of organizational climate. 2. Organizational culture is based on norms and traditions such as nurses wearing colorful attire. 3. Organizational climate is based on physical attributes and policy and procedure. The nurse-toclient ratio is an example of organizational climate. 4. Organizational climate is based on physical attributes and policy and procedure. Using primary nursing models is an example of organizational climate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions.

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13) The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Functional 2. Shared governance 3. Service-line 4. Parallel 5. Matrix Answer: 1, 4, 5 Explanation: 1. A functional structure is a traditional organizational structure. 2. Shared governance is a new, more relationship-based organizational structure. 3. A service-line structure is a new, more relationship-based organizational structure. 4. A parallel structure is a traditional structure, even though it is more modern than a functional structure. 5. Matrix is a traditional structure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model.

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14) A nurse has accepted the position of vice-president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 3. There may be unrest because of the high proportion of management positions filled from outside the organization. 4. There is continual upheaval as the organization responds rapidly to changes in the external environment. 5. Managers have limited knowledge of general management techniques. Answer: 1, 2, 5 Explanation: 1. Coordination across functions can be complex and poor in a functional structure. 2. Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work. 3. Typically, in a functional structure, promotion occurs from within. 4. Typically, response to changes in the external environment is very slow in organizations with functional structure. 5. Many managers in functionally structured organizations rise "up the ranks" to their position; there is often very little formal management training. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Management Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model.

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15) The nurse's friend says, "I've been thinking about going to that healthcare clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate? 1. "Most of those retail clinics are not very good. I'd go somewhere else." 2. "That would be okay, but you have to pay extra for the convenience." 3. "If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care." 4. "I would use the clinic for myself, but not for my children." Answer: 3 Explanation: 1. Studies on the quality of care provided by these clinics have shown it to be comparable to care provided elsewhere. 2. Most retail clinics are less expensive than physician offices or emergency departments. 3. Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made. 4. There is no indication that the clinic is not appropriate for children. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 2-4: Explain how the ownership of and complex relationships among healthcare organizations impact nursing. 16) A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement? 1. The nurse is going to call the medical intern to assess the client. 2. The nurse is going to call the client's physician's on-call group. 3. The nurse is going to call a physician who cares for inpatients. 4. The nurse is going to call the emergency department and request that a physician see this client. Answer: 3 Explanation: 1. The medical intern is not a hospitalist. 2. The physician's on-call group is likely a group of physicians from the same office or organization of physicians with office practices. They are not hospitalists. 3. A hospitalist provides care only to hospital inpatients. 4. Emergency department physicians are not the same as hospitalists. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 2-4: Explain how the ownership of and complex relationships among healthcare organizations impact nursing.

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17) The healthcare institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy? 1. "We will increase client satisfaction by 15 percent." 2. "We will increase productivity by 10 percent on the surgical floor." 3. "We believe in honest communication." 4. "We believe clients are most important." Answer: 4 Explanation: 1. This statement specifies an outcome to be achieved. This is a goal. 2. This statement is specific to a particular unit and is an objective. 3. This is a statement of the organization's values. 4. The philosophy is a written statement that reflects the organization's values, vision, and mission. It is broader than a value statement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collaboration Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions. 18) The nurse works in a school clinic that is part of an integrated healthcare network. How would this nurse explain to parents and teachers the focus of care provided in the clinic? 1. Hospital focused 2. Primary care focused 3. Specialty care focused 4. Home care focused Answer: 2 Explanation: 1. The goal of an integrated healthcare network is to keep clients healthy and out of the hospital. 2. Primary care is the focus of integrated healthcare networks. 3. The goal of an integrated healthcare network is to keep clients healthy, thereby minimizing the need for specialty care visits. 4. The goal of an integrated healthcare system is to keep clients healthy so that more expensive options, like home care, are not needed. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 2-4: Explain how the ownership of and complex relationships among healthcare organizations impact nursing.

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19) A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these healthcare providers should ensure which resources are available? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Electronic medical records (EMR) technology 2. A sufficient number of older adults who require long-term care 3. An understanding of the complexity of multiple-need clients 4. A robust marketing plan that describes the home's physical environment 5. A plan for compensation for the primary care provided Answer: 1, 3, 5 Explanation: 1. For medical homes to be most effective, EMR should be implemented. 2. A medical home is not the same as a long-term care facility. 3. One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions. 4. The medical home is not a bricks-and-mortar facility. 5. Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 2-4: Explain how the ownership of and complex relationships among healthcare organizations impact nursing. 20) Which situation is an example of organizational culture? 1. Every Friday the administrator allows everyone to wear crazy hats while on the units. 2. The cafeteria opens at 7:00 a.m. for breakfast, 11:00 a.m. for lunch, and 5:00 p.m. for dinner. 3. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 4. ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift. Answer: 4 Explanation: 1. As this is a system-wide condition initiated by the administrator, it is an example of organizational environment. 2. These are set rules published for everyone, including visitors, and make up part of the organizational environment. 3. This is a system-wide "rule" established by administration and is part of the organizational environment. 4. The nurses have created this system of coverage informally as part of their daily work. This is an example of organizational culture and may vary from unit to unit. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions. TestBankWorld.org

21) A healthcare organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Any changes to processes in the facility will be approved at the vice-president level. 2. Nurses who have made more than five medication errors in the last 12 months will be terminated. 3. Outcome data will be analyzed to identify successful interventions. 4. The primary focus will be on a few major initiatives. 5. Previous quality improvement efforts may or may not be discarded. Answer: 3, 5 Explanation: 1. Decentralization empowers staff to implement process improvements. 2. Lean thinking focuses on the system rather than on individuals. 3. In lean thinking, the concentration is on interventions that improve outcomes. 4. This redesign strategy is called "big-dot focus" and may or may not reflect lean thinking. 5. Decentralization provides a quality improvement infrastructure that disregards only previous efforts that have not proven effective. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions. 22) The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Experts in hospital physical design 2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices Answer: 2, 3, 4, 5 Explanation: 1. Experts in hospital physical design are considered a resource rather than stakeholders. 2. Employees of the hospital are considered stakeholders. 3. Physicians are considered stakeholders. 4. Administrators are considered stakeholders. 5. Community representatives are considered stakeholders. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect TestBankWorld.org

workplace conditions. 23) The administration of a healthcare system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift. 5. The nurse executive communicates with managers mostly by email. Answer: 1, 2, 3, 5 Explanation: 1. The collaboration characteristic of a healthy work environment is "true collaboration." Lobbying for physician support is not true collaboration. 2. Effective decision making is a characteristic of a healthy work environment. If the staff nurse was comfortable making a decision without input, the nurse would not ask for help. 3. Recognition should be meaningful. Recognizing two nurses from each unit each week is not meaningful. 4. Appropriate staffing is a tenet of a healthy work environment. 5. While email is a convenient method of communication, it should not be the only method employed. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Environment Health Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions.

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24) As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Decrease the amount of time from client admission to the room to completion of the admission assessment." 2. "Increase client satisfaction survey scores regarding meals." 3. "Decrease the number of medication errors on the unit." 4. "Initiate intravenous therapy within 30 minutes of the order being taken." 5. "Use scanning mechanisms to record the numbers of supplies used." Answer: 4, 5 Explanation: 1. Decreasing the time from admission to assessment is an objective. There is no indication of how this is to be accomplished. 2. Increasing client satisfaction with better meals is an objective. There is no indication of how this would be accomplished. 3. Decreasing the number of medication errors is an objective. There are no strategies given for how this would be accomplished. 4. Initiating IV therapy within a specific time is a strategy. It is specific to the task and specifies an action to take. 5. Using scanning mechanisms is an example of how something would be done, so it is a strategy. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions.

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25) The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures. 4. Staffing has become less flexible as more nurses specialize in one aspect of care. 5. A recently updated organizational chart indicates the line authority for each position. Answer: 1, 2, 3 Explanation: 1. Collaboration and work sharing are more closely identified with systems theory. 2. In the classical approach, work is divided into departments and specialties. 3. Standardization is a means of control of work, which is common in the classical organizational approach. 4. Specialization of labor is a common finding in classical theory. 5. Chain of command and line authority are characteristic of classical theory. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Environment Health Learning Outcome: 2-5: Discuss how the organizational environment and culture affect workplace conditions. 26) Which situation is an example of a major weakness of service-integrated structure? 1. Two different units have purchased a demonstration model that could be used by both units. 2. The pharmacy has been asked to compromise on the times that medications are delivered to the units. 3. Nurse managers in several units are interviewing new graduates for staff positions. 4. The nurse manager of a unit is involved in a conflict between hospital management and the medical staff. Answer: 1 Explanation: 1. Duplication of resources is a major weakness of service-integrated structures. 2. Coordination across functions and the ability to coordinate, collaborate, and compromise are strengths of service-integrated structure. 3. One of the strengths of a service-integrated structure is that the same activities can occur in several units and can be unit specific. 4. When there are two lines of authority, as in the parallel structure, conflicts may occur at the department or unit level. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 2-3: Choose a practice setting based on a preferred professional practice model. TestBankWorld.org

27) Which situation reflects the primary service provided by home healthcare? 1. The physical therapy assistant performs range-of-motion exercises three times each week. 2. The nurse changes the client's abdominal dressing daily. 3. Oxygen is provided in the home and managed by a durable medical equipment company. 4. Diabetic testing supplies are delivered to the client's home each month. Answer: 2 Explanation: 1. Physical therapy is an important aspect of home healthcare but is not the major service provided. 2. Nursing care is the primary service provided by home health agencies. 3. Provision of durable medical equipment is an important aspect of home healthcare but is not the primary service provided. 4. Provision of medical supplies is an important aspect of home healthcare but is not the primary service provided. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 2-4: Explain how the ownership of and complex relationships among healthcare organizations impact nursing. 28) Which example of organizational structure depicts shared governance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. All the LPNs on the unit administer medications and complete dressing changes; all the RNs complete assessments and administer IV medications. 2. Clinical services are organized around clients with colostomies and colostomy teaching. 3. The nurse manager for the wound clinic reports to the vice-president of nursing and the vicepresident of outpatient services. 4. Nursing councils address profession-wide issues linked to client care standards. 5. RNs are accountable for the latest standards and knowledge in the field. Answer: 4, 5 Explanation: 1. If the LPNs on the unit administer medications and complete dressing changes, and the RNs complete assessments and administer IV medications, then this scenario depicts functional structure. 2. If clinical services are organized around clients with colostomies and colostomy teaching, then this scenario depicts service-line structure. 3. If the nurse manager for the wound clinic reports to the vice-president of nursing and the vicepresident of outpatient services, then this scenario depicts matrix structure. 4. If nursing councils address profession-wide issues linked to client care standards, then this scenario depicts shared governance. 5. If RNs are accountable to the latest standards and knowledge in the field, then this scenario depicts shared governance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 2-2: Describe traditional and emerging structures in healthcare organizations. TestBankWorld.org

29) Reductive theory focuses on which factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Factors that occur in changing environments 2. The nature of the work 3. Structures to achieve work 4. Dividing work into parts 5. Desire for social relationships Answer: 2, 3, 4 Explanation: 1. Factors that occur in changing environments are part of contingency theory. 2. Focusing on the nature of the work is part of reductive theory. 3. Focusing on structures to achieve work is part of reductive theory. 4. Factors that divide work into parts are part of reductive theory. 5. Focusing on the desire for social relationships is part of humanistic theory. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 2-1: Differentiate between reductive and adaptive organizational theories.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 3 Delivering Nursing Care 1) The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? 1. One nurse has responsibility for all the medications on the unit. 2. One nurse has responsibility for all the needs of three clients. 3. One charge nurse and one respiratory therapist have responsibility for all clients. 4. One nurse and one nursing assistant have responsibility for 10 clients. Answer: 1 Explanation: 1. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit. 2. Total client care is given by one nurse assigned to a few clients. 3. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. 4. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 2) The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital? 1. Critical pathways 2. Total client care 3. Team nursing 4. Functional nursing Answer: 3 Explanation: 1. Critical pathways are a set of strategies used by healthcare providers to attain expected outcomes. Critical pathways are not a nursing care delivery system, and there are insufficient data to determine if they are used in this scenario. 2. Total client care is given by one nurse. 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. 4. Functional nursing breaks down the assignments into tasks. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the TestBankWorld.org

disadvantages of each. 3) As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required. Answer: 1, 2, 4 Explanation: 1. Continuity of care may suffer when care is given by more than one individual. 2. Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. 3. Team nursing does save on personnel costs. 4. The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. 5. Team nursing does reduce the number of professional staff required. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-2: Describe the attributes of integrated models of care. 4) The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care? 1. Functional nursing 2. Team nursing 3. Total client care 4. Primary care Answer: 3 Explanation: 1. Functional nursing has the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. 2. Team nursing has the disadvantage of not having a professional nurse attending to all client care needs. 3. In total client care, one nurse cares for a client and is totally accountable for the client. This way the nurse can give continuous, holistic, and expert care. 4. Primary care is considered the client's first encounter with the healthcare system. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. TestBankWorld.org

5) The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Which of the following are disadvantages of this method? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All individuals caring for the client must have excellent communication skills. Answer: 1, 3, 5 Explanation: 1. If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. 2. Physician, nurse, and client satisfaction is generally increased with primary care. 3. The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. 4. Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. 5. Excellent communication must exist between the primary nurse and associate nurse. This is often difficult. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 3-2: Describe the attributes of integrated models of care. 6) A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system? 1. Primary nursing 2. Total nursing care 3. Functional nursing 4. Practice partnerships Answer: 4 Explanation: 1. The nurse providing primary nursing must be very autonomous. This is not the best environment for a newly licensed RN. 2. The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN. 3. In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role. 4. Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the TestBankWorld.org

disadvantages of each. 7) In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Practice partnerships 3. Case management 4. Primary nursing Answer: 3 Explanation: 1. Functional nursing does not focus on specific outcomes. 2. Practice partnership does not focus on specific outcomes. 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. 4. Primary nursing does not focus on specific outcomes. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 3-2: Describe the attributes of integrated models of care. 8) The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority? 1. Instruct physical therapy to increase treatments to four times daily. 2. Contact the family to discuss preoperative mobility problems. 3. Inform the case manager of variance in the critical pathway. 4. Discuss the problem with the client's surgeon. Answer: 3 Explanation: 1. Ordering an increase in physical therapy is not within the scope of nursing and would not be the priority action. 2. The family may have important information about the client's mobility, but this is not the priority action. 3. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. 4. Discussing the problem with the surgeon is not the priority action. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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9) A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is costeffective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Total client care 2. Functional nursing 3. Team nursing 4. Client-centered nursing Answer: 4 Explanation: 1. Total client care is costly and less efficient for nursing staff. 2. Functional nursing is cost-effective but lacks continuity of care. 3. Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction. 4. The focus of client-centered nursing is the promotion of efficiency, quality, and cost control. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 10) Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It ensures that the staff doesn't get overtime." 4. "It improves physician efficiency." 5. "It provides skilled care by skilled staff." Answer: 1, 2, 5 Explanation: 1. Structure is necessary to ensure that care is coordinated. 2. Structure is necessary to ensure that all care responsibilities are covered. 3. While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. 4. The objective of structuring nursing care is not to ensure physician efficiency. 5. Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each.

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11) Which is the most important consideration in choosing a structure for nursing care? 1. Client need 2. Efficiency 3. Cost 4. Timeliness Answer: 1 Explanation: 1. While all four options are important, client need takes precedence over the others because nursing provides a service to the client. 2. Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration. 3. Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration. 4. Timeliness of care can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 12) Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 2. The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease. Answer: 2, 3, 4, 5 Explanation: 1. The chronic care model manages how care is delivered, not a specific disease. 2. Self-management is one of the six components of the chronic care model. 3. Decision support is one of the six components of the chronic care model. 4. Use of clinical information systems is essential to the chronic care model. 5. Use of community resources is one of the six components of the chronic care model. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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13) What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decisions are best made by the clients who are served by a particular unit. 3. Clinical decisions are best made by nursing leaders for all units within that particular hospital. 4. Nurses working in a particular service area are best suited to make decisions for the clients in that area. Answer: 1 Explanation: 1. The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit. 2. Clinical decisions should be made by professional healthcare providers, with client input. 3. Decision making "from the top" is not reflected in the clinical microsystem structure. 4. Clinical microsystems involve a core team of caregivers, not all the nurses working in a particular service area. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 14) One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait? 1. The nurse commits a medication error and reports it to the charge nurse. 2. The nurse collaborates well with the rest of the healthcare team. 3. The nurse is able to think ahead to the client's next need. 4. The nurse who does not have good baseline knowledge of a client's disease process researches it on a day off work. Answer: 1 Explanation: 1. Moral agency is "doing the right thing." Reporting a medication error is the right thing to do. 2. Collaboration is a desirable characteristic but does not describe moral agency. 3. Systems thinking is a desirable characteristic but does not describe moral agency. 4. This is a description of clinical inquiry, not moral agency. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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15) Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use? 1. Flexibility 2. Strict adherence 3. Persistence 4. Resistance to change Answer: 1 Explanation: 1. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to achieve the desired effects. 2. Strict adherence to a set of rules or structure is not appropriate in today's healthcare environment, where adaptability is essential. 3. The nurse should be persistent in learning new roles, but persistence is not the best answer to this question. 4. Resistance to change is not a desirable skill in today's healthcare environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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16) What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. How to optimize use of nursing knowledge 2. The system used by competing hospitals 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment Answer: 1, 3, 4, 5 Explanation: 1. Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system. 2. The system used by competing hospitals is not of great importance in choosing the system for a new hospital. 3. The provision of safe and effective nursing care is the most important of all considerations. 4. Optimizing nursing skills is an important consideration when choosing a nursing care delivery system. 5. The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 17) A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion? 1. "There has been little change in nursing care delivery over the last few years." 2. "We must look to the nursing process for guidance in nursing care." 3. "Too much time is spent deciding on a system of care." 4. "Any system is okay, as long as the nurses follow it." Answer: 2 Explanation: 1. Nursing care delivery systems are in continual revision as nurses strive to find the perfect system for providing care to clients with varying degrees of need. 2. The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation. 3. A comfortable and efficient system for delivery of care is important to client outcomes. 4. The system must be safe, efficient, and effective. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. TestBankWorld.org

18) A nursing team consists of an RN, two LPNs, and two UAP. Which work would be completed by the RN? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reviewing the client's plan of care with the UAP 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Administering oral medications to clients 5. Calling the physician to discuss the client's response to a new treatment Answer: 1, 2, 3, 5 Explanation: 1. The RN team leader is responsible for conducting the nursing care conference and reviewing the client's plan of care with the team. 2. The RN team leader guides the client care and helps to resolve any problems that may occur. 3. Developing and updating nursing care plans is the work of the RN team leader. 4. Typically, the team leader is involved in indirect client care activities. 5. Communicating and collaborating with physicians is generally the responsibility of the team leader. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-2: Describe the attributes of integrated models of care. 19) The RN leader of a team overhears one of the UAP on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment? 1. As a need to be more involved in direct client care when this UAP is on the team 2. As a common disadvantage of the team approach to nursing 3. As an indication that this UAP should be reported for unprofessional behavior 4. As confirmation that UAP are poorly educated and do not work well on teams Answer: 2 Explanation: 1. The RN must focus on the work that requires RN skills. In some cases, this work consumes much of the shift. The RN should not ignore that work to placate the UAP. 2. Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing. 3. Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse. 4. There is no indication that this UAP is not educated or does not work well on a team. The UAP may not understand the roles on the team. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. TestBankWorld.org

20) A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons that team nursing is not successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There are problems with delegation. 2. There are problems with the skill set of the UAP on the teams. 3. The LPNs on the team do not accept their position of being "in the middle." 4. Communication on the team or with the nurse manager is flawed. 5. RNs and LPNs struggle with who is in control and has the power on the team. Answer: 1, 4 Explanation: 1. If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective. 2. Problems with UAP skill sets can be overcome by education. This is not a common reason that team nursing does not work. 3. While LPNs can be "in the middle" between the UAP and the RN, there is no indication that this is a common problem. 4. Poor communication is a common problem and can make the team approach ineffective. 5. There is no indication that this is a common issue. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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21) A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse will determine interventions for all the disciplines needed as part of the clients' care. 2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team. Answer: 2, 3, 4, 5 Explanation: 1. Each discipline determines its own interventions. The disciplines collaborate to design care. 2. Collaboration with other disciplines is a critical component of case management. 3. A main emphasis of case management is building consensus with physicians caring for the clients. 4. The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work. 5. Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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22) A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "If a client is not able to follow the critical pathway, a variance will be written." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge." 5. "Using critical pathways will help us reduce length of stay and costs to the client." Answer: 1, 3, 4 Explanation: 1. Critical pathways are designed to direct the care of many disciplines. There is no reason to believe that physical therapy will no longer be available to help with client ambulation. 2. Variances are written when the client is not making progress according to the critical pathway. 3. The critical pathway orients staff to the outcomes that should be achieved by the client each day. 4. If the client has variance from the critical pathway, it may be revised. 5. Critical paths use resources appropriate to the care needed, and thereby reduce cost and length of stay. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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23) At a strategic planning meeting the nurse executive recommends instituting client-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept? 1. "We have always had the client at the center of everything we do." 2. "We can't afford to hire more RNs." 3. "I'm concerned about the increased time and leadership our nurse managers will have to provide." 4. "I like the idea of centralizing all our care." Answer: 3 Explanation: 1. Client-centered care as a practice model is not the same as centering care around the client. 2. There would be fewer RNs in the client-centered care model. 3. The nurse manager's role in client-centered care requires considerable time. The nurse manager must be a strong leader. 4. Client-centered care is actually decentralized. Many of the tasks traditionally done by a central office, such as admission, are unit based. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 24) The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It is the most cost-effective way to manage a hospital. 2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing. 4. When the environment is better for nursing, it is also better for other disciplines. 5. Most of the strategies that improve the environment for nursing do not cost anything. Answer: 2, 3 Explanation: 1. Making the environment better for nurses may not be the most cost-effective strategy. 2. Research indicates that a better nursing environment is associated with lower mortality rates. 3. An environment that is better for nurses is associated with greater nurse satisfaction. 4. There is no evidence that improving the environment for nursing improves the environment for other disciplines. 5. There is little that can be done in a hospital environment that does not entail at least some cost. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. TestBankWorld.org

25) A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930? 1. Team nursing 2. Functional nursing 3. Total client care 4. Primary care Answer: 3 Explanation: 1. Team nursing evolved in the middle to late 1940s. 2. Functional nursing grew out of the nursing shortage caused by World War II. 3. The original model of nursing care delivery was total client care or the case method. During the 1920s, total client care was the typical delivery system, with much RN care being provided in the home. 4. Primary nursing was conceptualized and implemented during the late 1960s. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 3-2: Describe the attributes of integrated models of care. 26) A long-term care facility is considering implementing total client care. Prior to implementing this system, what must be available? 1. Enough RN staff to provide all the care to the residents 2. A group of licensed assistants who are good at taking direction 3. A strong nurse manager 4. RNs willing to assume 24-hour accountability for the care provided to residents Answer: 1 Explanation: 1. Total client care means that all the care for the clients or residents is provided by the RN. 2. Unlicensed assistants are not used in total client care. 3. While a strong nurse manager is always desirable, it is not strictly necessary to implement total client care. 4. 24-hour accountability is a part of primary nursing, not total client care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-2: Describe the attributes of integrated models of care.

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27) Which nursing care delivery situation best reflects the concept of a clinical microsystem? 1. A rural free clinic housed in a church gymnasium that is staffed by volunteer nurses and physicians 2. A walk-in clinic in a local discount store that is staffed by a nurse practitioner 3. An inpatient burn unit 4. A general medical-surgical unit in a mid-sized hospital Answer: 3 Explanation: 1. The free clinic likely does not have the support staff, equipment, and facilitative environment necessary for a clinical microsystem. 2. A walk-in clinic in a retail outlet does not have a tightly defined population to receive care and is not likely to function as a clinical microsystem. 3. The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care. 4. A general medical-surgical unit is less likely to have the components necessary to support a clinical microsystem. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 28) The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective? 1. More than 60% of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them. 2. Almost 70% of respondents accurately listed their discharge medication. 3. Close to 88% of respondents reported that invasive interventions were performed by an RN. 4. More than 30% of respondents reported that the nurse sometimes seemed rushed. Answer: 1 Explanation: 1. This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in client care. 2. This statistic indicates the RN is providing discharge instructions, which is correct use of RN knowledge. 3. Most invasive procedures are done by RNs, so this indicates correct use of skill sets. 4. The nurse will sometimes be rushed. This low percentage is likely not an indicator of problems. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

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29) The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses? 1. Diagnoses given to only a few clients 2. Diagnoses that carry high risk for the client and the provider 3. Diagnoses that have low reimbursement rates 4. Diagnoses that involve as few providers as possible Answer: 2 Explanation: 1. Case management is used for high-volume diagnoses. 2. Case management is used with high-risk diagnoses. 3. Case management is used with high-cost diagnoses. 4. The number of providers associated with a diagnosis is not a criterion for case management. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 30) The nurse is starting a new position as a staff member on a busy medical-surgical unit. The unit uses the team nursing model of care. Which skills will be used to make this model effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Caring 2. Delegating 3. Advocating 4. Communicating 5. Problem-solving Answer: 2, 4, 5 Explanation: 1. Caring is not a skill used to make the team nursing model of care effective. 2. Delegating is a skill used to make the team nursing model of care effective. 3. Advocating is not a skill used to make the team nursing model of care effective. 4. Communicating is a skill used to make the team nursing model of care effective. 5. Problem-solving is a skill used to make the team nursing model of care effective. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-2: Describe the attributes of integrated models of care.

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31) The nurse just left a healthcare agency that utilized the practice partnership model of care. When compared to team nursing, practice partnership offers which attributes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Working alone 2. Continuity of care 3. Less expensive for the organization 4. Accountability for client care 5. Coordinating implementation of care Answer: 2, 3, 4 Explanation: 1. Working alone is not an attribute of the practice partnership model of care. 2. Continuity of care is an attribute of the practice partnership model of care. 3. Less expensive for the organization is an attribute of the practice partnership model of care. 4. Accountability for client care is an attribute of the practice partnership model of care. 5. Coordinating implementation of care is not an attribute of the practice partnership model of care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-2: Describe the attributes of integrated models of care.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 4 Leading, Managing, Following 1) A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make the leadership of the less-experienced nurses most effective? 1. Strong belief that the leader is accountable for actions taken by those working on the unit 2. Authority to carry out actions necessary to move the work of unit staff forward 3. Efficiency in actions and in words 4. Ability to inspire the others to commit to the team's goals Answer: 4 Explanation: 1. A leader may have no formal accountability or authority. The manager has that authority. 2. The unit manager has the authority. The experienced nurse in this scenario may or may not be the unit manager. 3. A leader is not necessarily a good manager and may not be efficient. 4. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. This leader may or may not be the formal leader of the group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 2) According to the behavioral view of leadership, how are leaders formed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. By being educated 2. From inborn traits 3. With training 4. Through life experiences 5. Through abilities Answer: 1, 3, 4 Explanation: 1. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 2. Some researchers believe leaders are born with personality traits that make them successful in leadership. This is not part of behavioral theory. 3. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 4. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 5. Abilities may develop in a variety of ways. This is not a part of behavioral theory. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership TestBankWorld.org

Learning Outcome: 4-2: Evaluate different theories that explain leadership. 3) The vice-president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses are not good managers. 5. Nurses often experience poor supervision in their own careers. Answer: 1, 2, 3, 5 Explanation: 1. Few nurses have the training necessary to be managers. 2. Entry-level education programs are designed to produce generalists, and most content is focused on bedside nursing skills. 3. Many managers depend on their own experience with former supervisors. 4. Nurses work as managers of their own practice and can become very good managers when sufficient education and support are provided. 5. Nurses may manage as they were managed and perpetuate poor management techniques. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 4) The healthcare organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline? 1. One person cannot be the leader of all the specialty care units in an organization. 2. A person cannot be promoted to the role of leader. 3. Leaders have to be hired from outside the organization. 4. Nurses cannot serve as leaders over other nurses. Answer: 2 Explanation: 1. Leadership is not unit specific. 2. The organization cannot promote someone to the position of leader. A leader uses interpersonal skills to influence others to accomplish a specific goal. The organization can promote a person who may become a leader. 3. A leader cannot be "hired." 4. Nurses often develop strong leadership over other healthcare providers, including other nurses. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-1: Differentiate between leaders and managers.

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5) A community hospital has been purchased by a large healthcare conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory? 1. Contingency theory 2. Quantum leadership 3. Transactional leadership 4. Transformational leadership Answer: 4 Explanation: 1. According to contingency theory, the manager adapts leadership styles in relation to changing situations; these styles range from authoritarian to permissive. This is not the best choice for this situation. 2. Quantum leadership focuses on outcomes, and employees are directly involved in decision making. This is not the best choice for this situation. 3. Transactional leadership is based on the premise that individuals engage in social interactions expecting to give and receive rewards. This is not the best choice for this situation. 4. Transformational leadership is concerned with effecting revolutionary change in organizations and human service, not with the status quo. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 6) A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Where will the service be housed? 2. Why were the nurses asked to participate? 3. When will the service begin? 4. Who will provide the services? 5. How will money for the project be raised? Answer: 1, 3, 4 Explanation: 1. Where is an important question in planning. 2. Although it is important to ask "why" when planning, the correct "why" in this case is "Why are we providing this service?" 3. When is an important aspect of planning. The timeline for implementation is critical. 4. There are numerous possibilities for answering this question. It is important to consider when planning. 5. This question is not as essential for this committee. Finding money for the project would not be a nursing function. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration TestBankWorld.org

Learning Outcome: 4-5: Describe the management roles that nurses fill in practice. 7) The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Deciding on the skill mix necessary for direct client care 2. Selling the new system to the current emergency department staff 3. Comparing the actual results of the new system to the projected results 4. Telling staff what to do 5. Coaching the staff through the implementation of a new schedule Answer: 2, 5 Explanation: 1. Deciding on the skill mix would be part of organizing the project. 2. Convincing or "selling" the new idea is part of the directing phase. 3. This comparison is part of the controlling phase. 4. In today's environment, the directing phase consists of guidance rather than telling the staff what to do. 5. Coaching and counseling are two major roles in the directing phase. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 4-2: Evaluate different theories that explain leadership. 8) The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described? 1. Quantum 2. Transactional 3. Contingency 4. Transformational Answer: 1 Explanation: 1. Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. 2. Transactional leadership is based on the principles of social exchange theory. 3. Contingency theory suggests that managers adapt their leadership styles in relation to changing situations. 4. Transformational leadership emphasizes the importance of interpersonal relationships to inspire and motivate followers. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. TestBankWorld.org

9) The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely? 1. "I have made out a schedule of who will work to cover these shifts." 2. "I can work an extra shift tomorrow night. Who can cover tonight?" 3. "How can we work together to cover these shifts to help our coworker?" 4. "If you work overtime tonight I will authorize double your hourly pay rate." Answer: 4 Explanation: 1. Making out a schedule with no input from nursing is authoritative leadership. 2. Transformational leaders appeal to individuals' better selves rather than their self-interests. 3. Transformational leaders appeal to individuals' better selves rather than their self-interests. 4. Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 10) Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 4. Being empathetic with clients 5. Standardized first of shift assessments Answer: 1, 2, 3, 5 Explanation: 1. Transactional leadership uses personal reward as a method of maintaining the status quo. 2. Transactional leaders value policy and procedure. 3. Interpersonal dependence is valued by transactional leaders. 4. An emphasis on empathy, awareness, and persuasion is more characteristic of servant leadership. 5. Transactional leaders value standardization. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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11) The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse attended more than 80%of staff meetings but offered little input into discussion. 2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous (IV) access catheter, the nurse used one of the devices the next time an IV was ordered. 5. When asked for an opinion on an issue dividing the unit, the nurse replies, "I don't know. What do you think?" Answer: 2, 3, 4 Explanation: 1. Merely attending staff meetings is not a sign of good followership. 2. Active, positive participation shows good followership. 3. As long as the critique is private, this demonstrates that the nurse is engaged and thinking about the processes. 4. Taking the initiative to try out changes is considered good followership. 5. This is an example of dependent thinking, which is not good followership. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 4-3: Explore how followership is essential to leadership. 12) What is the most common skill shared by effective nurse leaders in leadership theories or models? 1. Critical care experience 2. Political knowledge 3. Communication 4. Informal power Answer: 3 Explanation: 1. Critical care experience is not necessary for effective leadership. 2. A leader may or may not have political knowledge but should have knowledge of and involvement in the community. 3. Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership. 4. An effective leader may have formal power only. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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13) An accreditation visitor observes the following situations in a healthcare organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership? 1. Nurses working in groups and managing themselves 2. Nursing leadership originating from a desire to serve and share 3. Two nurses sharing the management role 4. Nurses formally organized to make decisions regarding practice standards Answer: 4 Explanation: 1. Nurses working in groups managing themselves are an example of self-directed work teams rather than shared governance. 2. Servant leadership arises from a desire to serve and share. This leadership may or may not be shared. 3. Two nurses sharing the management role are an example of co-leadership. 4. Shared governance is a formal process. Decision making is done by designated nurse representatives. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Evidence-Based Practice Learning Outcome: 4-2: Evaluate different theories that explain leadership. 14) To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done? 1. Strategic 2. Organizational 3. Directive 4. Contingency Answer: 4 Explanation: 1. Strategic planning is prioritizing long-term goals. 2. Organizing is related to planning to get the work done. 3. Directing is related to planning to get the work done. 4. Contingency planning is a proactive response to problems that may interfere with getting work done. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 4-5: Describe the management roles that nurses fill in practice.

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15) A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers? 1. "You must work to develop your staff's competencies." 2. "Take your role on the strategic planning committee very seriously." 3. "Your most important role is to ensure client care accountability." 4. "Fiscal resource management is the most important aspect of your job." Answer: 3 Explanation: 1. Developing staff competencies is very important but not the most important consideration. 2. Strategic planning is very important but not the most important consideration. 3. Although the nurse manager has a variety of roles and tasks, the most important role is assuring quality client care. The nurse manager is accountable for quality care. 4. Managing fiscal resources is a very important task of the nurse manager but not the most important consideration. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-5: Describe the management roles that nurses fill in practice. 16) The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"? 1. Charge nurse 2. Staff nurse 3. Clinical nurse leader 4. Nurse executive Answer: 1 Explanation: 1. The charge nurse is unique to the healthcare setting and assists with shift-byshift coordination and promotion of quality client care as well as efficient use of resources. 2. The staff nurse is not formally a manager. This nurse is responsible for promotion of quality care for the shift worked. 3. The clinical nurse leader is not a manager but rather works as a resource to those providing direct care. This nurse may coordinate care at the bedside and works to integrate care. 4. The nurse executive is an upper-level manager and is responsible for quality care across the institution. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-5: Describe the management roles that nurses fill in practice.

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17) The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 4. Developing the unit budget 5. Delegation responsibilities Answer: 1, 2, 3, 5 Explanation: 1. Staff nurses are responsible for prioritizing care for the clients for whom they provide care. 2. Staff nurses act as liaisons between clients and other healthcare professionals. 3. Staff nurses work to coordinate care provided by other healthcare professionals. 4. Staff nurses may have input into budget development but do not have direct responsibility for the process. 5. Staff nurses have the responsibility of delegating tasks to nonprofessional staff. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-1: Differentiate between leaders and managers. 18) A staff nurse tells the manager, "I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark? 1. Leadership takes more energy than followership, so this nurse is taking the easy way out. 2. Followership is a valuable skill in nurses. 3. A nurse who is not willing to work to master the skills of leadership should not be retained on the unit. 4. Most people have difficulty developing leadership skills. Answer: 2 Explanation: 1. Active following takes skill, self-direction, and energy. There is no evidence that it is easier than leading. 2. In any situation where people must work together, followership is a valuable skill. 3. There is no indication that this nurse is not effective in the followership role and may be a valuable employee without leadership skills. 4. Leadership skills can be learned. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 4-3: Explore how followership is essential to leadership.

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19) The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role? 1. "I won't be able to increase my team's motivation. That has to come from within them." 2. "As a manager, I will be available for my team if problems with clients arise." 3. "One of my roles will be to make sure assignments are clear and understandable." 4. "I will still be responsible for the care being provided even if I am off the unit during the day to attend meetings." Answer: 1 Explanation: 1. Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. 2. Being available for consultation or help with assignments is one of the roles of the first-level manager. 3. First-level managers are responsible for supervising the work of non-managerial personnel and the day-to-day activities of a specific work unit or units. Clarity of assignment is part of this supervision. 4. First-level managers are responsible for attending meetings and may be away from the unit while retaining responsibility for the care being provided. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-1: Differentiate between leaders and managers. 20) Which nurse has legitimate leadership authority in the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Staff nurse 2. Nurse manager 3. Case manager 4. Quality improvement coordinator 5. Education specialist Answer: 2, 3 Explanation: 1. Staff nurses are not seen as having legitimate leadership authority. Staff nursing is not a management or leadership role. 2. Nurse managers have legitimate authority conferred by the organization and described in job descriptions. 3. Case managers have legitimate authority conferred by the organization and described in job descriptions. 4. The leadership of the quality improvement coordinator is informal and stems from the nurse's knowledge. 5. The leadership of the education specialist is informal and stems from the nurse's knowledge. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 4-1: Differentiate between leaders and managers. TestBankWorld.org

21) As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit three months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack? 1. Foundational thinking skills 2. Personal and professional accountability 3. Clinical practice knowledge 4. Effective communication skills Answer: 3 Explanation: 1. There is no evidence that this nurse lacks foundational thinking skills. 2. There is no evidence that this nurse lacks personal and professional accountability. 3. To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. Three months is not long enough for that to occur. 4. There is no evidence that this nurse does not have effective communication skills. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 22) A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating? 1. Adaptability 2. Initiative 3. Transparency 4. Optimism Answer: 3 Explanation: 1. Adaptability is flexibility in adapting to changing situations or overcoming obstacles. 2. Initiative is readiness to act and seize opportunities. 3. Transparency is displaying honesty, integrity, and trustworthiness. This nurse is not displaying these traits. 4. Optimism is seeing the up side in events. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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23) In a leadership training class, which statement by a student indicates learning has been successful? 1. "If I am to be successful in leadership, I should make sure no followers are friends." 2. "Most people would not be able to tell if I only pretend to be interested in them." 3. "Relationship building is essential to successful leadership." 4. "Leadership means I can delegate tasks I do not want to do." Answer: 3 Explanation: 1. Although the leader can show no favoritism, leaders can have friends among the group of followers. 2. The caring demonstrated in the leadership-followership relationship must be authentic. 3. Authentic caring in relationships is an important method of improving respect and competence as a leader. 4. Authentic leaders are willing to take risks and are not afraid to do any task. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 24) Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The manager helped me to understand the structure of the hospital's organization." 2. "I hope to be as good a manager." 3. "The manager negotiated a pay increase for the RNs on the unit." 4. "The manager's example has encouraged me to get to know people in other departments in the hospital." 5. "The manager's assignments are always fair and appropriate for the client census." Answer: 2, 4 Explanation: 1. Clarification of organizational structure is part of the manager's job. 2. A leader uses interpersonal skills to influence others to accomplish a specific goal. 3. Negotiating pay is a role of the manager. 4. Leaders help to forge links among the organization's members. 5. Making assignments is a part of the manager's role. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 4-1: Differentiate between leaders and managers.

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25) Which leadership activities exemplify a quantum leadership style? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The leader reports how outcomes were achieved. 2. The leader brings cookies and coffee to every early morning meeting. 3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access internet sites about their disease process. 5. The leader often talks about the "vision" of the organization. Answer: 3, 4 Explanation: 1. In quantum leadership, the outcome is more important than how it was achieved. 2. This social emphasis is more likely to occur with a leader who is transactional. 3. Change is expected by the quantum leader. 4. Informational power is shared by the quantum leader. 5. Focus on vision is an attribute of a transformational leader. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership. 26) The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The ability to be empathetic to clients and staff 2. Ability to sustain high energy for long periods of time 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique 5. Long history of leadership success Answer: 1, 3, 4 Explanation: 1. Empathy is a characteristic of a servant leader. 2. The ability to sustain high energy is common in many leaders and is not particular to a servant leader. 3. An awareness of others and their needs is a characteristic of the servant leader. 4. The use of persuasion is characteristic of the servant leader. 5. A long history of leadership success is not unique to a servant leader. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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27) The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal? 1. Obtain experience as a nurse manager. 2. Learn as much as possible about the hospital's organization. 3. Take a class in hospital administration. 4. Return to school to obtain a master's degree. Answer: 4 Explanation: 1. Experience as a nurse manager is not essential to the CNL role. 2. The CNL role is a unit-based role. 3. The CNL role is to coordinate care at the bedside and supervise the healthcare team. 4. CNLs are educated at the master's level. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 4-5: Describe the management roles that nurses fill in practice. 28) The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence? 1. Initiative 2. Transparency 3. Empathy 4. Conflict management Answer: 2 Explanation: 1. Initiative is the readiness to act and seize opportunities. 2. Transparency is displaying honesty and integrity. 3. Empathy is sensing others' emotions and understanding their perspective. 4. Conflict management is the ability to resolve disagreements. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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29) During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting? 1. Passive 2. Active 3. Dependent 4. Independent Answer: 3 Explanation: 1. The nurse is not passively participating. There is an indication that the work will be done. 2. The active follower would express ideas on how to achieve the goal. 3. This dependent "you make the decision and I'll do it" statement is characteristic of an ineffective follower. 4. An independent follower would express constructive criticism of plans. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-3: Explore how followership is essential to leadership. 30) The nurse is focusing on becoming a leader. What skills should the nurse continually develop? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Empowerment 2. Participation 3. Facilitation 4. Reflection 5. Communication Answer: 1, 3, 4, 5 Explanation: 1. Empowerment is a skill that should be developed for leadership. 2. Participation is not a skill developed for leadership. 3. Facilitation is a skill that should be developed for leadership. 4. Reflection is a skill that should be developed for leadership. 5. Communication is a skill that should be developed for leadership. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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31) Shared leadership is based on partnership, empowerment, and understanding boundaries. Which examples exemplify shared leadership in nursing? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Empowered scheduling 2. Self-directed work teams 3. Shared governance 4. Co-leadership 5. Autonomous participation Answer: 2, 3, 4 Explanation: 1. Empowered scheduling is fictitious and is not an example of shared leadership. 2. Self-directed work teams are an example of shared leadership. 3. Shared governance is an example of shared leadership. 4. Co-leadership is an example of shared leadership. 5. Autonomous participation is fictitious and is not an example of shared leadership. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 4-2: Evaluate different theories that explain leadership.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 5 Initiating and Managing Change 1) The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan? 1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty. 2. Include the staff in identifying problems related to teaching strategies. 3. Ask staff to assist in the development of a plan for implementing new teaching strategies. 4. Implement interventions to improve the teaching strategies currently used. Answer: 2 Explanation: 1. Bringing in an expert to talk to the faculty would be ineffective until the faculty is beginning to "unfreeze" their current beliefs about teaching. Introducing an expert at this time might do more harm than good. 2. The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase. 3. Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. 4. The faculty will likely not be receptive to new strategies until they have identified a need to change. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 5-2: Describe how different theorists explain change. 2) The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue? 1. The supervisor uses outcome data to evaluate the amount of change that has occurred. 2. The supervisor has gradually withdrawn from the role of change agent. 3. The supervisor has developed strategies to maintain the change. 4. The supervisor has determined if anyone in the group is sabotaging change efforts. Answer: 2 Explanation: 1. Evaluating the amount of change would occur before the final stage. 2. According to Lippitt's phases of change, the final stage is terminating the helping relationship. 3. Maintaining the change is the next to last of Lippitt's stages. 4. Looking for persons who may be sabotaging change efforts is not the last of Lippitt's stages. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 5-2: Describe how different theorists explain change.

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3) The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage? 1. Self-renewal occurs among all participants. 2. Solutions are identified to create change. 3. Resources are acquired to facilitate change. 4. Relationships are formed among all participants. Answer: 2 Explanation: 1. Self-renewal and stabilization occur during the final stage and are most like Lewin's refreezing stage of change. 2. Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins. 3. The first three steps of Havelock's theory are building a relationship, diagnosing the problem, and acquiring resources. These three steps are most like Lewin's unfreezing stage. 4. The first step of Havelock's model is building relationships among participants. This is one of the steps that are equivalent to Lewin's unfreezing stage. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 5-2: Describe how different theorists explain change. 4) A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment? 1. "The nursing staff will have the final decision on whether to change to this IV pump." 2. "Before we make the final decision, we will do a three-month 'test run' of the equipment to make sure we like it." 3. "I have looked at the pump and I like it." 4. "I have information to share with you about the new IV pump we are considering for the unit." Answer: 4 Explanation: 1. Telling the staff that they have the final decision is a way of persuading. 2. The decision to adopt or reject a change occurs after the knowledge and persuasion steps. 3. Giving a personal endorsement of the change would be persuasion. 4. The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 5-2: Describe how different theorists explain change.

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5) The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea? 1. Tell the staff that a change is coming, but that it is positive and they should not be worried. 2. Collect and analyze information about how the current system is working. 3. Mention in a staff meeting that the current system is causing a lot of trouble. 4. Identify how the manager would know if the change is benefiting the unit. Answer: 2 Explanation: 1. It is not a good idea to indicate that a change is coming until further planning is completed. 2. Assessment is the first step of the change process, just as it is the first step of the nursing process. 3. Planting the seed of discontent with the status quo occurs after the problem has been assessed. 4. Operational indicators of success are developed when the planning phase is near completion. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-3: Delineate steps in the change process. 6) A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I know that suggesting this change may backfire on me." 2. "I don't expect too much conflict or resistance to this change." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 4. "I think the status quo is just fine for now." 5. "This change is certainly going to be a challenge, but that's okay." Answer: 1, 3, 4 Explanation: 1. This statement exemplifies the willingness to take risks that is necessary to become a change agent. 2. The nurse should always expect that change will be met with resistance and possible conflict. 3. Nurses should always look for ways to improve client outcomes. 4. Change occurs when people become uncomfortable with the status quo. 5. Accepting that change is challenging is part of being a change agent. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collegiality Learning Outcome: 5-1: Explain why nurses have the opportunity to be change agents.

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7) Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy? 1. Normative-reeducative strategies 2. Lippitt's phases 3. Empirical-rational model 4. Power-coercive strategies Answer: 3 Explanation: 1. Normative-reeducative strategies focus on people's roles and relationships, perceptual orientations, and attitudes that influence their acceptance of change. 2. Lippitt's phases of change are a seven-step process of change that involves participants in every step of the process. 3. The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. In this instance, when the nurses have the knowledge to use the charting system and have a chance to try it, it will become clear that it is in their best interest to adopt the new system. 4. Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 5-4: Differentiate among change strategies. 8) Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor? 1. A power-coercive strategy 2. A normative-reeducative strategy 3. An empirical-rational model 4. A driving force Answer: 2 Explanation: 1. Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. This strategy may meet with resistance from the nursing staff. 2. In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity. 3. The empirical-rational strategies are most often effective when little resistance to the proposed change is expected, and the change is perceived as reasonable. This is likely not the case with the change described. 4. A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice TestBankWorld.org

Learning Outcome: 5-4: Differentiate among change strategies. 9) Which factor best represents a driving force in the process of change? 1. An ineffective nurse manager 2. An administration composed of long-term employees 3. A staff composed of long-term employees 4. A financial deficit of millions of dollars Answer: 4 Explanation: 1. An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes. 2. An administration of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. 3. A staff of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. 4. A budget in the red necessitates change and pushes participants in the desired direction. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 5-2: Describe how different theorists explain change. 10) When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response? 1. Laggards 2. Early adopters 3. Early majority 4. Innovators Answer: 3 Explanation: 1. Laggards dislike change and are openly antagonistic. 2. Early adopters are not as eager to change as are innovators but are still receptive to change. 3. The early majority prefers the status quo but eventually accepts change. 4. Innovators love change and thrive on it. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change.

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11) Which statements by the nurse manager would demonstrate effective change management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If this approach doesn't work, at least we can say we've tried." 2. "Let's wait until the administration has completed their reorganization before we implement change." 3. "In order for this plan to work, everyone must agree to participate." 4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration." Answer: 4, 5 Explanation: 1. This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting. 2. This statement suggests that the manager may not be completely in favor of the change. In some cases, the staunchest resister is the manager. 3. If the nurse manager waits until everyone agrees to be a participant in change, change will never occur. 4. All changes and actions that occur within an organization should flow from the mission and values. 5. It is important to acknowledge that change is difficult. Full support of the administration makes change easier. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. 12) The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action? 1. Research the options that will work best for the nursing staff and the hospital. 2. Speak positively of the change to ensure the most "buy-in" from the nurses. 3. Encourage the other administrators to choose the option that is easiest for the nurses. 4. Ensure that each nurse is aware of the change and why it is necessary. Answer: 1 Explanation: 1. Assessment is always the first action for a nurse in any situation. 2. This constitutes an intervention and is not the first action. 3. This constitutes an intervention and is not the first action. 4. This constitutes an intervention and is not the first action. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 5-3: Delineate steps in the change process. TestBankWorld.org

13) The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work? 1. The nurses involved will demonstrate management skills. 2. The nurses will agree with the change and present a united front for its adoption. 3. The change will guide nursing practice on the unit. 4. The change will lead to improved client care on the unit. Answer: 4 Explanation: 1. Demonstration of management skills is not the priority expected outcome. 2. Agreement and presentation of a united front is not the priority expected outcome. 3. It is hoped that the changes will guide nursing practice, but this is not the priority expected outcome. 4. All nursing responsibilities and changes have the expected outcome of improving client care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 5-3: Delineate steps in the change process. 14) The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment? 1. Nurses thrive on transition and work best in such circumstances. 2. Nurses are role models for reacting positively to change. 3. Nurses routinely interact with multiple disciplines. 4. Nurses are always acting in the client's best interest. Answer: 3 Explanation: 1. It is hard to prove that nurses thrive on transition. 2. Nurses have not always reacted positively to change. 3. Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care. 4. Nurses do act in the client's best interest, but this option is not as strong as another. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-1: Explain why nurses have the opportunity to be change agents.

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15) The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I would like to focus on completing this process so we can move on." 2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?" 5. "I think it does not really matter when we institute this change, as long as it is over quickly." Answer: 2, 3, 4 Explanation: 1. Completing the process is not the major focus of the work. 2. Those involved in change should be certain that sufficient data are present to make an informed decision. 3. Persons working on this committee should be aware of obstacles they may face. 4. It is important to consider the opinions of the organization's stakeholders. 5. Getting the change instituted quickly is not the focus of committee work. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. 16) Which action will have the greatest impact on the successful implementation of a planned change? 1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change Answer: 4 Explanation: 1. It is true that in some cases resisters are so disruptive that they must be disciplined. This is not the best method of assuring successful implementation of a change. 2. It is unlikely that everyone affected by the change will see it as positive. Attempts to ensure that everyone is happy with the change are generally a waste of energy and resources. 3. Rewards can be positive, but ignoring resisters is dangerous. 4. A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change.

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17) A proposed change in a healthcare organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use? 1. Empirical-rational 2. Normative-reeducative 3. Power-coercive 4. Empirical-reeducative Answer: 2 Explanation: 1. Empirical-rational strategy is used when little resistance to the proposed change is expected. 2. Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made. 3. Power-coercive strategy is the least likely to result in everyone agreeing with the change. 4. This is not one of the change strategies. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 5-4: Differentiate among change strategies. 18) The healthcare facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader Answer: 1, 3, 4, 5, 6 Explanation: 1. The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization. 2. Once the decision to make a change has been made, the nurse manager should not act as a resister. 3. The nurse manager may be in the role of one who supplies information about the needed change. 4. The nurse manager may act as a liaison between the committee and the staff. 5. The nurse manager fulfills the role of support person for staff adapting to the change. 6. The nurse manager may act as discussion leader, both in formal and informal discussions. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change. TestBankWorld.org

19) The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do? 1. Try to minimize the impact of the change when talking to this person. 2. Bypass this person and talk to the administrator who supervises him or her. 3. Pay attention to the people above and below this person on the organizational chart. 4. Try to find some information against this person to use as leverage. Answer: 3 Explanation: 1. The nurse manager should always be honest when discussing the change. 2. The nurse manager should not "jump" the chain of command to speak to this person's supervisor. 3. The people just above and just below this person will be important to the way this key player reacts to the change. 4. This tactic would not be ethical. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. 20) The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change? 1. "I must not get so bogged down in details that I lose focus on the ultimate goal." 2. "As we go through this process, I think I need to be flexible but persistent." 3. "Those who are resistant will probably accept it sooner or later with my support." 4. "I think the implementation will go much better if I stay available the whole time." Answer: 4 Explanation: 1. The ability to retain a big-picture focus while dealing with each part of the change is a desirable trait for a change agent. 2. The change agent must have sufficient flexibility to modify ideas when this will improve the change, but enough persistence to resist nonproductive tampering with the planned change. 3. It is likely that those who are resistant will adapt to the change if given enough time and support. 4. Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change.

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21) The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure. Answer: 2, 3, 5 Explanation: 1. It is natural that the staff would discuss the change and its implications. 2. Adding the new work to the old work is a sign that the transition is not healthy. 3. This attitude is a sign that the transition is not healthy. 4. It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues. 5. Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change. 22) The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance? 1. Resistance will keep the change from occurring at all. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance can negatively impact future client care. 4. Resistance allows others to take power from managers. Answer: 3 Explanation: 1. Resistance generally does not completely prevent change, but it may stall or delay it. 2. The late majority eventually does accept the change. 3. Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer. 4. Resistance is a normal part of change and does not mean that power has been diverted to the resisters. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 5-3: Delineate steps in the change process.

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23) The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned? Answer: 1, 3, 5 Explanation: 1. It is important to identify who is in control of the way things are being done currently. 2. Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change. 3. Early knowledge of who will lose in the change is essential to preparation. 4. Costs and benefits of the change should be assessed but are not a part of the political climate. 5. Political climate involves power, benefits, and losses. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change.

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24) The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen? 1. The manager distributes a handout explaining the new system and how to use it. 2. The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse. 3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff. 4. The manager threatens to transfer anyone who resists the change. Answer: 1 Explanation: 1. Giving information is the most common method of changing individuals' perceptions, attitudes, and values. 2. Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values. 3. While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values. 4. Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-5: Evaluate ways to handle resistance to change.

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25) Which statements by a hospital executive reflect power-coercive strategies to implement change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk." 4. "This change is the only logical action we can take." 5. "All our sister institutions in the association have already made this change." Answer: 1, 2, 3 Explanation: 1. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the federal government. 2. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, Medicare. 3. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the accrediting body. 4. The empirical-rational model of change focuses on logical actions. 5. Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. 26) A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I don't care what they say; I'm not giving care that way." 2. "I don't think this is going to work, but I'll probably come around to it sooner or later." 3. "I'm not crazy about this idea, but we do need to change how we are providing care." 4. "I bet I can make it very difficult for this change to occur." 5. "It won't be so bad. I like change." Answer: 1, 4 Explanation: 1. Rejecters often respond with active opposition. 2. This statement is characteristic of an early or late majority resister. 3. Acknowledging that change is necessary is characteristic of an early adopter. 4. Making the change more difficult is a form of sabotage, which is characteristic of a rejecter. 5. Innovators love change and thrive on it. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice TestBankWorld.org

Learning Outcome: 5-5: Evaluate ways to handle resistance to change. 27) A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well." 4. "To make this big change, we need to start making smaller changes now." 5. "There is going to be resistance, but I think it can be overcome." Answer: 1, 2, 3 Explanation: 1. Fear of "rocking the boat" may prevent the manager from effectively leading the change. 2. Fear that no one will support the change may prevent the manager from effectively leading the change. 3. Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change. 4. The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent. 5. The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change.

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28) A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Meet with the supervisor and discuss modifications of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change. Answer: 1, 2, 4, 5 Explanation: 1. Modifying the change and compromising with resisters is a valid strategy. 2. Trying to change too much too fast can escalate resistance. 3. Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed. 4. Overcoming resistance is often necessary for change to occur. 5. In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. 29) A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the healthcare environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change. Answer: 1, 3, 4 Explanation: 1. Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy. 2. The pros and cons of the change should be openly discussed. 3. Change is constant in healthcare. 4. Emphasizing the positive outcomes of the change is a strategy to reduce resistance. 5. The nurse manager should maintain support for and confidence in all staff. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change. TestBankWorld.org

30) Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action? 1. A residency program eliminates the hospital's liability if a novice nurse makes an error. 2. A residency program is established to make nursing education more like physician education. 3. The Institute of Medicine (IOM) has proposed residency programs for nurses. 4. A residency program ensures that nurses participate in lifelong learning. Answer: 3 Explanation: 1. There is no reduction of the hospital's liability for errors. 2. Residency programs for nurses are not being established to mimic physician education. 3. The IOM has made this proposal. 4. There is no assurance that nurses who participate in residency programs will engage in lifelong learning. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collegiality Learning Outcome: 5-1: Explain why nurses have the opportunity to be change agents. 31) A nurse leader is contemplating change on the unit. Which is the first step in the change process? 1. Defining costs/benefits 2. The problem has been clearly defined 3. Identify driving and restraining forces 4. Select and analyze data 5. Develop a plan for change Answer: 2 Explanation: 1. Defining costs/benefits are part of the second step. 2. The first step in the change process is to clearly define the problem. 3. Identify driving and restraining forces is part of the second step. 4. Selecting and analyzing data are part of the third step. 5. Developing a plan for change is a part of step four. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Diagnosis/Leadership Learning Outcome: 5-3: Delineate steps in the change process.

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32) The Institute of Medicine (IOM), has made recommendations for the nursing profession in its report "The future of nursing: Leading change, advancing health." Which recommendations will help nurses lead change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Engage in lifelong learning 2. Remove scope of Practice barriers 3. Implement nurse residency programs 4. Change the structure of the organization 5. Lead change to advance health Answer: 1, 2, 3, 5 Explanation: 1. Engaging in lifelong learning is an IOM recommendation that will help nursing lead change. 2. Removing scope of Practice barriers is an IOM recommendation that will help nursing lead change. 3. Implementing nurse residency programs is an IOM recommendation that will help nursing lead change. 4. Changing the structure of the organization is not an IOM recommendation that will help nursing lead change. 5. Leading change to advance health is an IOM recommendation that will help nursing lead change. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 5-6: Describe the nurse's role in planned and unplanned change.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 6 Managing and Improving Quality 1) Which situation is an example of the overall goal of quality management in today's healthcare activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department fires nonproductive employees. 4. The nurse wipes up a spilled drink before clients are allowed to enter a room. Answer: 4 Explanation: 1. The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive. 2. The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past. 3. The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive. 4. The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 2) As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step? 1. Benchmarking 2. Outcome standard 3. Indicator 4. Process standard Answer: 1 Explanation: 1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement. 2. Standards are written statements that define a level of performance. An outcome standard involves the end results of care given. 3. An indicator is a tool to measure the performance of structure, process, and outcome standards. 4. Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 6-1: Describe how total quality management, continuous quality TestBankWorld.org

management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 3) The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen? 1. Continuous quality improvement (CQI) 2. Total quality management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma Answer: 2 Explanation: 1. CQI is the actual process, not the philosophy, used to improve quality and performance. 2. TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. 3. The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy. 4. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 4) The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard Answer: 4 Explanation: 1. An indicator is a tool used to measure the performance of a structure, process, or outcome standard. 2. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care. 3. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care. 4. A process standard is a written statement that defines actual delivery of nursing care to a specific population. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 6-1: Describe how total quality management, continuous quality TestBankWorld.org

management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 5) Which situation would be included in reporting for Joint Commission mandatory national client safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The average wait time in the emergency department has increased by 5 minutes over last year's average. 2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye. Answer: 2, 3, 4, 5 Explanation: 1. Increased wait times are not included as a client safety goal. 2. Improving staff communication is one of The Joint Commission's national client safety goals. 3. Using medications safely is one of The Joint Commission's national client safety goals. 4. Preventing infection is one of The Joint Commission's national client safety goals. 5. Preventing mistakes in surgery is one of The Joint Commission's national client safety goals. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare. 6) Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'm not interested in this program." 2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work." Answer: 2, 3, 4, 5 Explanation: 1. Lack of interest on the part of nurses is not a reason EBP is not used. 2. Lack of time is a barrier to using EBP that is consistent across settings. 3. The need for autonomy over the nurse's own practice can be a barrier to using EBP. 4. Inability to find and assess evidence is a barrier to using EBP. 5. Lack of support from administration is a barrier to using EBP. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. TestBankWorld.org

7) A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation? 1. Non-reportable incident 2. Medical-legal incident 3. Client dissatisfaction with care 4. Medication error Answer: 2 Explanation: 1. Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed. 4. A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 8) Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident does not fall into a risk category. Answer: 3 Explanation: 1. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication. 4. Complications from diagnostic or treatment procedures are a high-risk area in healthcare and are reported as incidents. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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9) After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record? 1. IV heparin restarted. Physician notified. Client's vital signs unchanged. 2. IV heparin restarted at a rate to catch up dosage accidentally deleted. 3. IV heparin turned off by previous shift. Restarted. 4. IV heparin restarted and incident report completed. Answer: 1 Explanation: 1. The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident. 2. The word "accidentally" should not be used to document incidents. 3. The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used. 4. The fact that an incident report was completed should not be documented. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 10) The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation? 1. Appropriately written 2. Inappropriate because it places blame on an individual 3. Inappropriate because it does not include that the client's family was notified 4. Appropriately written because it only documents the facts Answer: 2 Explanation: 1. Documentation in the chart following an incident should be a statement of the facts; no blame should be placed. 2. The documentation is not appropriately written because it implies that someone was to blame for the incident. 3. The documentation must indicate that the physician was notified, not that the client's family was notified. 4. The documentation is not appropriately written; no blame should be placed. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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11) The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client's hand is injured during an arterial blood gas draw. 2. A client's family is dissatisfied with the breakfast just served. 3. A client leaves the hospital against medical advice (AMA). 4. A client claims he is not ready to be discharged. 5. The family does not want a client to be transferred from the intensive care unit (ICU). Answer: 1, 3 Explanation: 1. Any reaction or injury associated with a diagnostic test must be reported as an incident. 2. The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed. 3. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 4. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 5. The physician and healthcare team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 12) Which statement reflects a characteristic common to all methods of quality management? 1. Each method uses all staff members in the organization. 2. None of the methods are designed to place blame on an individual. 3. All methods provide clinical information. 4. Most methods focus on cost containment. Answer: 2 Explanation: 1. All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities. 2. Quality management is not designed for the purpose of placing blame on an individual. 3. Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement. 4. The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality. TestBankWorld.org

13) The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information? 1. Surveyors are driving to clients' homes to collect data on hospital visits. 2. This electronic tool makes it easy to aggregate and display data. 3. "Dashboard" is an acronym for the topics covered in client satisfaction surveys. 4. The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information. Answer: 2 Explanation: 1. The "dashboards" in this scenario are not associated with automobiles. 2. Dashboards are electronic tools that provide ease of access to real-time or retrospective data. 3. Dashboard is not an acronym. 4. Dashboards are not part of the electronic medical record. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 14) In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Investigating a complaint about nursing care from a client's spouse 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime Answer: 1, 3, 4, 5 Explanation: 1. By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint. 2. Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous. 3. The nurse manager is in a position to discuss improvement of client care across disciplines. 4. The nurse manager can help make work more efficient by keeping staff members on task throughout the workday. 5. When staff members are tired from working overtime, they are more likely to make errors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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15) Which part of Six Sigma is vastly different from other quality management programs? 1. Six Sigma has a client focus. 2. Data drive the program. 3. Failure is tolerated. 4. Management is proactive. Answer: 3 Explanation: 1. Most quality improvement programs are client focused. 2. Data drive most quality improvement programs. 3. One of the Six Sigma themes is aiming for perfection but tolerating failure. 4. Proactive management is common in most quality improvement initiatives. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 16) Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The amount of material opened and wasted for surgical procedures will drop by 25% this fiscal year. 2. The number of nurses who hold a bachelor's degree will increase by 10% this year. 3. Wait times in the emergency department will decrease by 15% this year. 4. Employee absences will drop by 10% this year. 5. Fewer than 5% of clients will report inadequate pain control while hospitalized. Answer: 1, 3, 5 Explanation: 1. No waste is an IHI goal. 2. Increasing the educational preparation of nurses is not an IHI goal. 3. No unwanted waiting is an IHI goal. 4. Employee attendance is not an IHI goal. 5. No needless pain or suffering is an IHI goal. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.

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17) The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy? 1. "If I make a mistake and report it, I will not be reprimanded or punished." 2. "When I make a mistake, I should immediately fill out an incident report." 3. "It is left up to each employee to self-monitor so we do not report others' mistakes." 4. "When I make a mistake, I should report it and look for ways to prevent it from recurring." Answer: 4 Explanation: 1. If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken. 2. Incident reports are not the first step after making a mistake. 3. Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment. 4. Mistakes should be reported and reflected upon so that the same mistakes will not be made again. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 18) Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse routinely changes nursing notes after a client is discharged. 2. A physician order is overlooked on a newly admitted client. 3. An unlicensed assistant drops a client. 4. A nurse does not complete an incident report after a medication error. 5. A nurse miscounts narcotics. Answer: 1, 4 Explanation: 1. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis. 2. Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error. 3. Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors. 4. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. 5. Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. TestBankWorld.org

19) Which is the most effective method of creating a blame-free environment? 1. Work to develop a just culture within the organization. 2. Make sure all nurses agree to report every mistake. 3. Set up a self-reporting board so that all employees will know that everyone makes mistakes. 4. Ensure nurse managers keep a list of how often each employee makes a mistake. Answer: 1 Explanation: 1. A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution. 2. Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free. 3. A self-reporting board is a form of punishment and placing blame. 4. The manager should not be keeping lists in a blame-free environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 20) The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. Ensure the client's safety as fully as possible. 4. Say nothing as no one saw the incident. Answer: 3 Explanation: 1. It is not appropriate to discuss errors with others. 2. Reporting the incident to the supervisor is appropriate only after the client's safety is protected. 3. The client's safety is always the priority. 4. Ignoring the mistake if no one saw it is not ethical and may be dangerous. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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21) A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Newly hired radiology technicians 2. People who are visiting clients admitted within the last two days 3. Physicians who have admitting privileges 4. Nurses who have worked at the facility more than five years 5. Vendors who supply disposable medical equipment to the hospital Answer: 1, 4 Explanation: 1. Internal customers include employees and departments within the organization. 2. Visitors are considered external customers. 3. Physicians are considered external customers. 4. Nurses are hospital employees and are therefore considered internal customers. 5. Vendors are not employed by the hospital and are considered external customers. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

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22) The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The hospital CEO 2. A representative from the pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain 5. A representative from social services Answer: 2, 3, 4 Explanation: 1. The CEO is not involved in the process of managing clients' pain and would not be part of this investigation. 2. Because the pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting. 3. Because the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting. 4. The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group. 5. It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

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23) The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The CQI coordinator 2. The hospital CEO 3. The vice-president in charge of finance 4. Members of the CQI team 5. The team leader Answer: 2, 3 Explanation: 1. The CQI coordinator is appointed by a member of the resource group. 2. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. 3. The resource group is made up of senior management such as the CEO and vice-presidents. 4. Team members are not part of the resource group. 5. The team leader is not a part of the resource group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality. 24) Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement? 1. Almost 85% of call lights are answered within 4 minutes. 2. Results of pain medication administration are documented 95% of the time. 3. Nursing overtime hours increased by 25% in the last quarter. 4. In the last 6 months, overall client satisfaction scores have increased by 15%. Answer: 3 Explanation: 1. Lean Six Sigma is focused on improving process flow and eliminating waste. 2. Lean Six Sigma is focused on improving process flow and eliminating waste. 3. Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur. 4. Lean Six Sigma focuses on improving process flow and eliminating waste. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

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25) The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 3. The CQI coordinator has used the process in practice for more than two years. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process. Answer: 1, 2, 4, 5 Explanation: 1. The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation. 2. Quality measures should document that evidence-based practice was given. 3. Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure. 4. The monitor is written in the "positive," meaning that the process is desirable. 5. The process should have minimal or no unintended adverse effects. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare. 26) Which statement reveals the most dangerous result of using measured standards as part of the CQI process? 1. A nurse complains, "Collecting this data takes so much time." 2. A radiology technician says, "CQI is lots of work." 3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors." 4. The laboratory technician says, "Writing these CQI reports is boring." Answer: 3 Explanation: 1. Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given. 2. The work of CQI should be balanced out by the improvements to care and reduction in waste. 3. When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization. 4. Boredom is not the biggest danger of using measured standards. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.

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27) A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices? 2. Can the manager find two or more research studies that support the use of the intervention? 3. Is the intervention one that the manager has seen used in the past? 4. Are the authors of the research articles well-known experts in the field? 5. Is the research study that recommends the intervention rigorous in design and execution? Answer: 2, 5 Explanation: 1. The size of the hospital is not significant in selecting evidence-based practice interventions. 2. Evidence-based practice is most reliable when more than one study has confirmed the results. 3. Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them. 4. While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field. 5. The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Evidence-Based Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 28) Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement? 1. EMR has strong linkage to improving quality. 2. Much more research must be done before the impact of EMR on quality can be determined. 3. EMR does not affect the quality of care provided. 4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated. Answer: 2 Explanation: 1. There is not enough research to prove a strong linkage. 2. There is not enough research on using EMR and the quality of care provided to determine the impact. 3. Not enough research has been done to make this statement. 4. Research does exist, but it is insufficient to measure correlation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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29) A hospital increased its RN-to-client ratio one year ago. What effects is the hospital likely to see as a result of that choice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The cost of providing care has decreased. 2. There has been a decrease in client deaths. 3. The average length-of-stay for clients has increased. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped. Answer: 2, 4, 5 Explanation: 1. Increasing RN-to-client ratio generally increases costs. 2. Increasing RN-to-client ratio has been shown to decrease client mortality. 3. Increasing RN-to-client ratio generally decreases length of stay. 4. Increasing RN-to-client ratio generally increases quality of care. 5. Increasing RN-to-client ratio generally results in few infections. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 30) A risk manager generally uses root-cause analysis to investigate incidents. What are the likely outcomes of this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents. 3. The system or process causing the incident is identified and corrected. 4. Improvements to the system are widespread. 5. Sufficient evidence is acquired so that management is comfortable in making needed changes. Answer: 1, 2 Explanation: 1. Professional disagreements often occur as root-cause analysis is being conducted. 2. Often the root-cause analysis takes up so much time and so many resources that no changes are ever made. 3. Root-cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur. 4. Root-cause analysis generally does not result in widespread system improvement. 5. Root-cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. TestBankWorld.org

31) The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action? 1. Call the nurse from the last shift to participate in a conference call about the complaint. 2. Ask the daughter to explain what happened. 3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred. 4. Ask the daughter what can be done to improve the situation. Answer: 2 Explanation: 1. The manager should collect more information before contacting the nurse from the previous shift. 2. The nurse manager must first assess the situation. 3. The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter's concerns. 4. Until the manager has assessed the issue, intervention cannot be provided. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 6-3: Explain how nurses are involved in reducing risks. 32) The nurse manager on the obstetrical unit is adopting Total Quality Management (TQM). Which characteristics are associated with TQM? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Boundaryless collaboration 2. Involve the total organization 3. Focus on client 4. Identify key processes 5. Use quality tools and statistics for measurement Answer: 2, 3, 4, 5 Explanation: 1. Boundaryless collaboration is one of the six themes of the Six Sigma quality management program. 2. Involving the total organization is a characteristic associated with TQM. 3. Focusing on the client is a characteristic associated with TQM. 4. Identifying key processes is a characteristic associated with TQM. 5. Using quality tools and statistics for measurement is a characteristic associated with TQM. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.

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33) The nurse manager receives a report that a medication was given to the wrong client. This is called a(n) ________ and will be reviewed with the physician and risk management committee member. Answer: reportable incident Explanation: Reportable incidents include any unexpected or unplanned occurrences that affect or could potentially affect a client, family member, or staff. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 7 Understanding Legal and Ethical Issues 1) The nurse completes an admission assessment with the client. The client hands the nurse two documents. The documents state the treatment the client wants withheld if permanently unconscious, in the event of terminal illness, and the primary physician's order for no heroics. The nurse communicates in report that copies of which documents are located in the chart? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Do-Not-Resuscitate order (DNR) 2. Tort 3. Living will 4. Will 5. Durable power of attorney (DPOA) Answer: 1, 3 Explanation: 1. The DNR is a medical order that no resuscitative measures be administered to the client. 2. Tort is divided into unintentional (professional negligence) and intentional (intent to harm is present). 3. A living will is when the competent adult signs a form indicating what healthcare the person does and does not want in the event of terminal illness. 4. A will is a legal declaration by which a person, the testator, names one or more persons to manage his or her estate and provides for the distribution of his or her property at death. 5. The DPOA is for healthcare decisions permitting a competent adult to appoint a surrogate or proxy to make decisions in the event that the individual becomes unable to do so. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 7-3: Examine the sources of law, types of law, and liability in the legal system. 2) The nurse manager has had two incidents happen on the unit in the last month. An LPN administered an intravenous push (IVP) medication to a client and a nurse noticed alcohol on another nurse's breath. The manager is aware that the ________ will take action after being notified of these incidents. Answer: State Board of Nursing Explanation: It is the nurses' duty to educate, examine and report another nurse's behavior to protect the health, safety, and welfare of the public. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Int Conc: Nursing Process: Intervention/Ethics Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters. TestBankWorld.org

3) A 14-year-old client tells the nurse that she is going to have sexual activity with her boyfriend. What should the nurse say to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You need to make an appointment to get birth control." 2. "Tell me more about this decision." 3. "Have you told anyone about this decision?" 4. "Do you have any insurance to pay for this visit?" 5. "I'll have to tell your parents about this." Answer: 2, 3 Explanation: 1. Telling the client to make an appointment and get birth control takes the client's autonomy away and does not address the client's present need. 2. Allowing the client to talk through this decision and giving options is helping to address the client's needs. 3. Enquiring about if the client has talked to anyone helps to address the client's need for information. 4. Knowing whether the client has insurance does not address the client's needs. 5. This answer is incorrect; the nurse would not need to tell the parents because this information is confidential. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Health Teaching and Health Promotion Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters. 4) A client is admitted for back pain and the client's family plans with the nurse what interventions will be initiated for the client. The issue with this plan of care is the lack of ________. Answer: autonomy Explanation: Autonomy is the ability of an individual to determine his or her own course of action. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 7-2: Analyze the ethical principles of autonomy, beneficence, nonmaleficence, and distributive justice.

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5) Restraining clients without consent or sufficient justification may be interpreted as ________. Answer: false imprisonment Explanation: Restraining clients without consent or sufficient justification may be interpreted as false imprisonment. In addition to legal rights, the use of restraints involves ethical issues such as autonomy and beneficence. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters. 6) Which of the following requirements are necessary for informed consent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion Answer: 1, 2, 3 Explanation: 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters.

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7) For malpractice to exist, which of the following elements must be present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Causation 2. Defamation 3. Breach of duty 4. Duty 5. Injury Answer: 1, 3, 4, 5 Explanation: 1. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 2. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Defamation is not an element that must be present. 3. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 4. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 5. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 7-3: Examine the sources of law, types of law, and liability in the legal system.

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8) The nurse acknowledges the job of the State Boards of Nursing is to secure the safety of the public by which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Practice defined by each state 2. Practice protecting the client's privacy 3. National licensure exam 4. Regulation of practice 5. Nationwide continuing education credits Answer: 1, 3, 4 Explanation: 1. In each state nursing practice is regulated and defined by the State Board of Nursing. 2. Nursing practice is meant to protect the public from unsafe practice. 3. Each nursing graduate must apply to the appropriate State Board of Nursing to take the National licensure exam. 4. In each state nursing practice is regulated and defined by the State Board of Nursing. 5. Not all State Boards of Nursing require continuing education (CE) credits but in the future all states may require CE credits to maintain competence of practice. The number of CEs required are dependent on the individual state's requirement. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters. 9) A client has been diagnosed with leukemia and is scheduled to talk with the oncologist. After listening to the oncologist talk about treatment plans the client states, "God will take care of me. I don't want any treatment." The nurse knows the client has exercised the principle of ________. Answer: autonomy Explanation: Autonomy is the ability of an individual to determine his or her own course of action. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 7-2: Analyze the ethical principles of autonomy, beneficence, nonmaleficence, and distributive justice.

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10) The charge nurse observes another nurse access a client's medical record. When asking about this behavior the nurse responds, "As a nurse I have the right to know what type healthcare coverage my clients have." What are the best responses to this nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Are you assigned to this client?" 2. "You are not planning care for this client." 3. "This is a breach of confidentiality." 4. "What is your purpose in accessing the clients' healthcare coverage?" 5. "If you are not giving any type of care to this client, you should not be accessing the client's record." Answer: 4, 5 Explanation: 1. The charge nurse must determine the nurses' purpose for being in the chart. 2. The question does not address whether the nurse is planning care for this client. 3. It is not a certainty that the nurse is breeching confidentiality unless the nurse does not need to know the client's healthcare coverage. 4. The charge nurse must ascertain the nurses' purpose for being in the chart. 5. This is a correct statement by the charge nurse. If the nurse is not giving or preparing care for the client, the nurse should not access the record. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters. 11) Which document serves to inform the nurse and the public of nursing expectations in ethical matters? 1. The International Code of Ethics for Nurses 2. The Code of Ethics of the American Nurses Association 3. The American Association of Critical Care Nurses Ethics Work Group 4. Ethical Foundations for Critical Care Nursing Research Answer: 2 Explanation: 1. The International Code of Ethics for Nurses is a guide for action based on social values and needs. 2. The Code of Ethics of the American Nurses Association makes explicit the professional values and standards of ethical conduct. 3. The American Association of Critical Care Nurses Ethics Work Group is a work group of critical care nurses who develop case studies and scenarios regarding ethical dilemmas. 4. Ethical Foundations for Critical Care Nursing Research design and carry out research studies prominent to the needs of critically ill clients and their families. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, TestBankWorld.org

management, and employment matters. 12) The nurse acknowledges which principles are most directly related to nursing care and play a role in solving ethical dilemmas? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Beneficence 2. Distributive justice 3. Autonomy 4. Negligence 5. Non-maleficence Answer: 1, 2, 3, 5 Explanation: 1. Beneficence means action that is done for the benefit of others. 2. Distributive justice means socially just allocation of goods in a society. 3. Autonomy means the ability of an individual to determine his or her own course of action. 4. Negligence means failure to take proper care in doing something. 5. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 7-2: Analyze the ethical principles of autonomy, beneficence, nonmaleficence, and distributive justice. 13) The RN recognizes that in cases of conflict involving client care decisions which principle overrides beneficence? 1. Negligence 2. Autonomy 3. Non-maleficence 4. Distributive justice Answer: 2 Explanation: 1. Negligence means failure to take proper care in doing something. 2. When an individual does not desire what others determine to be in that person's interest, the principles of beneficence and autonomy conflict. When in conflict situations involving client care decisions, the principle of autonomy overrides the principle of beneficence. 3. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. 4. Distributive justice is giving a person that which he or she deserves and it implies that benefits and burdens are distributed equally and fairly. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 7-2: Analyze the ethical principles of autonomy, beneficence, nonmaleficence, and distributive justice. TestBankWorld.org

14) The nurse discerns that the responsibilities essential in obtaining informed consent include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Determine that the client receives and understands information. 2. Probabilities of success 3. The client exercises freedom of choice without coercion. 4. Get consent signed before discussion of treatment. 5. Sign consent form as a competent adult. Answer: 1, 3, 5 Explanation: 1. Information must be furnished to clients in a manner that is understandable to them. Includes explanation of treatment, expected results, description of anticipated risks and discomforts, potential benefits, disclosure of alternatives, offer to answer questions, and a statement that the client may withdraw consent at any time. 2. No one can assure probability of success; the client must be informed of expected results. 3. One must be an adult in the technical and legal sense in order to consent to treatment. 4. The consent form must be signed after detailed information is given and all questions are answered. 5. Individuals act voluntarily when they exercise freedom of choice without force, fraud, deceit, duress, or any other form of coercion. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters.

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15) Which of the following are examples of statutory laws? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Informed consent 2. Marriage by mutual agreement 3. Disability benefits 4. Licensing laws 5. Elder abuse Answer: 1, 4, 5 Explanation: 1. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 2. Marriage by mutual agreement is a common law marriage. Common law is a type of law that establishes a custom or tradition by which other similar cases are judged. Awareness of this law assists nurses to function within the boundaries of their role and to advocate for nursing practice when necessary. 3. Disability benefits are governed by administrative laws. This allows the legislature to delegate the authority to create rules and regulations governing a specific administration to an administrative agency of experts in the field. 4. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 5. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 7-3: Examine the sources of law, types of law, and liability in the legal system.

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16) Which of the following elements fall under unintentional torts? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vicarious liability 2. Respondent superior 3. Negligence 4. Malpractice 5. Intentional torts Answer: 3, 4 Explanation: 1. Vicarious liability: the law ascribes negligence to certain parties who may not be negligent themselves but whose negligence is assumed because of association with the negligent person; this is not an element that falls under unintentional tort. 2. Respondent superior: this doctrine allows the courts to hold the employer responsible for the actions of the employee when the employee is performing services for the organization; this is not an element that falls under unintentional tort. 3. Negligence is defined as the failure of an individual not to perform an act (omission) or to perform an act (commission) that a reasonable, prudent person would or would not perform in a similar set of circumstances; this is an element that falls under unintentional tort. 4. Malpractice is professional negligence and it is under the premise that all individuals are responsible for the consequences of their actions or inactions and refers to any misconduct or lack of skill in carrying out professional responsibilities; this is an element that falls under unintentional tort. 5. Intentional torts is defined as the intent to harm is present. Assault, battery, false imprisonment, invasion of privacy, inappropriate disclosure of private information, libel, slander, and defamation of character are all examples of intentional torts; this is not an element that falls under unintentional tort. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 7-3: Examine the sources of law, types of law, and liability in the legal system.

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17) For malpractice to exist, which of the following elements must be present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Causation 2. Defamation 3. Breach of duty 4. Duty 5. Injury Answer: 1, 3, 4, 5 Explanation: 1. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 2. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Defamation is not an element that must be present. 3. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 4. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 5. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 7-3: Examine the sources of law, types of law, and liability in the legal system.

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18) Which of the following requirements are necessary for informed consent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion Answer: 2, 3, 4 Explanation: 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 7-4: Explore legal issues in nursing involving licensure, patient care, management, and employment matters.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 8 Understanding Power and Politics 1) Which statement reflects the most important use of power in nursing? 1. The nurse manager uses power when evaluating staff. 2. The nurse can use power to impact and improve client care. 3. The nurse uses power in relationships with unlicensed personnel. 4. The nurse manager can use power to assist newly licensed nurses. Answer: 2 Explanation: 1. Using power to evaluate staff is not its most important use. 2. The most important use of power is to affect the quality of client care. 3. The nurse can use power in relationships with unlicensed personnel, but this is not the most important use of power. 4. Using power to assist newly licensed nurses is not the most important way it is used. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 8-2: Describe how to use power appropriately. 2) There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using? 1. Legitimate power 2. Expert power 3. Referent power 4. Reward power Answer: 4 Explanation: 1. Legitimate power is the authority to make a request of staff. 2. Expert power is based on a manager having unique skills or knowledge. 3. Referent power is based on the employees' respect for a manager. They comply with requests out of respect for the manager. 4. Reward power is based on the inducements a manager can offer a staff. In this case, the manager can offer increased benefits. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership.

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3) The local hospital has recently been acquired by a larger hospital corporation. The nurse manager hangs a poster announcing that the new wage scale and benefits package will be discussed in the next unit meeting to encourage staff to attend. This is an example of which type of power? 1. Referent power 2. Information power 3. Legitimate power 4. Connection power Answer: 2 Explanation: 1. Referent power is based on admiration and respect for an individual. 2. The nurse manager possesses information that employees desire. The only means of getting the information is through the manager, so the manager has information power. 3. Legitimate power stems from the manager's right to make a request based on the authority associated with the job. 4. Connection power is based on an individual's formal and informal links to influential or prestigious persons. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership. 4) One of the nurses often fails to attend educational offerings available to the staff. The nurse manager implies the nurse may receive a negative evaluation, which is a use of which type of power? 1. Coercive power 2. Information power 3. Referent power 4. Reward power Answer: 1 Explanation: 1. Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty. 2. Information power is based on information a manager has and employees want. 3. Referent power is based on the respect the followers have for the manager. 4. Reward power is based on the inducements a manager can give to the employees. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Professional Practice Environment Learning Outcome: 8-1: Differentiate between power and leadership.

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5) Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reward power 2. Information power 3. Legitimate power 4. Expert power 5. Referent power Answer: 2, 4, 5 Explanation: 1. A leader may not have reward power unless the leader is also the manager. Leaders can be formal or informal. 2. A leader may have information power. 3. A leader may not have legitimate power unless the leader is also the manager. Leaders can be formal or informal. 4. A leader may have expert power. 5. A leader may have referent power. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-2: Describe how to use power appropriately. 6) The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ? 1. Administer behavioral warnings in public to alert other staff to the seriousness of the issue. 2. Reduce punishments for noncompliance after the majority of staff members have complied. 3. Wait at least 72 hours prior to responding to infractions so that emotions are better controlled during the meeting. 4. Investigate to get the facts of potential infractions before responding to them. Answer: 4 Explanation: 1. Behavioral warnings and punishments should always be done in private. 2. Punishment for noncompliance should be fairly and consistently applied. 3. Infractions should be addressed promptly once the manager is certain of the facts. 4. The manager should always investigate to get facts and avoid jumping to conclusions. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-2: Describe how to use power appropriately.

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7) As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval? 1. "More than 75% of the nurses on unit 3M want to return to the previous process for passing meds." 2. "The physicians have complained about the new system, and the nurses on 3M have voted to return to the old medication passing routine." 3. "The nurses on 3M do not like the new system. Do other units agree?" 4. "Medication errors have increased 40% on 3M since the new system began. We believe there is a problem." Answer: 4 Explanation: 1. During a transition, there is a time when it is easier to go back to the way things were done prior to the change. This is not a strong argument for abandoning the change. 2. Physician and nurse preference is not a strong argument for abandoning the change. 3. Nurse preference is not a strong reason to abandon the change. 4. When taking action within an organization, it is more powerful to be prepared with data. This statement focuses on why there is a need for action to address a problem. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 8-3: Explain how to use shared visioning as a power tool. 8) A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate? 1. "Being politically active helps you influence events and the decisions of others." 2. "You might want to run for political office someday." 3. "It might help you increase your salary." 4. "It will give you a better understanding of client rights." Answer: 1 Explanation: 1. Nurses can be politically aware and active in an organization or in the community. By being aware of issues and the people who can effect change, the nurse can influence those in the decision-making roles. 2. Running for political office is a way to be politically active, but it is not the reason to be politically aware for most nurses. 3. There is no guarantee that being politically aware and active will have any effect on wages and benefits. 4. A nurse can increase understanding of client rights without being politically aware and active. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future.

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9) The nurse is working on a committee responsible for making policy decisions for the healthcare organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate? 1. "We are going about this all wrong." 2. "We are a good team, but we need to look at this problem from a different viewpoint." 3. "I have to intervene in our work. We are just wasting time." 4. "This is going nowhere. I am resigning." Answer: 2 Explanation: 1. This statement may be correct, but it is not likely to start a calm and focused conversation about the issue. 2. When offering criticism, one should always begin the conversation with a compliment. 3. "Wasting time" is a strong statement and is likely to inflame the situation. 4. The nurse may feel that continuing on the committee is impossible, but this is not the way to convey that information. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future. 10) The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness? 1. Image 2. Age 3. Beliefs 4. Political party Answer: 1 Explanation: 1. A person who portrays an image of success and trust will be politically effective. 2. Age is not the reason people will follow this nurse. 3. Beliefs alone are not enough to make people politically effective. Without other attributes, the nurse would not influence others to follow those beliefs. 4. Affiliation with a particular political party is not enough to make someone politically effective. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 8-4: Explore the relationships among power, politics, and policy.

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11) The nurse leader wishes to develop a culture of shared visioning for the healthcare organization. How should the nurse proceed with this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The leader should be a passive observer in meetings. 2. The leader should encourage a change to a more efficient top-down management system. 3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas. 5. The leader should use coercive primary power. Answer: 3, 4 Explanation: 1. The leader is not a passive participant in visioning. 2. Top-down management is outdated and is not a part of shared visioning. 3. Shared visioning requires that all those involved in the organization have a say in its future. 4. Shared visioning is a strategy that encourages innovation. 5. The leader encouraging shared visioning would not use coercive power. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-3: Explain how to use shared visioning as a power tool. 12) The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective? 1. "I am only showing the student how to take care of patients, so I have no need for power." 2. "I can use power to teach the student how to motivate, communicate, and achieve outcomes." 3. "I do not want to give the student the idea that nurses are all about who has the most power." 4. "I can use power to ensure that other disciplines know that I am the one who really does the work." Answer: 2 Explanation: 1. The nurse preceptor needs power to be effective in the teaching role. 2. Nurses must use power to influence others. 3. Nurses must use power to influence others. Power in this situation does not have a negative connotation. 4. This statement about who really does the work is not an appropriate use of power. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 8-1: Differentiate between power and leadership.

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13) Which statement indicates that a nurse has the skills to be politically involved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse does not take credit for his or her own ideas but attributes them to others. 2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas. Answer: 2, 3, 4, 5 Explanation: 1. Getting credit for one's own ideas indicates political savvy. 2. Being "in the loop" is a sign of political savvy. 3. Knowing how to deal with a difficult colleague is a sign of political savvy. 4. A politically savvy nurse's ideas get a fair hearing. 5. Knowing when and how to present ideas is being politically savvy. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future. 14) Which would be the most effective way for nursing to improve the power of its image? 1. All nurses becoming politically active 2. Dressing, speaking, and acting in a professional manner 3. Motivating others to become nurses 4. Encouraging clients to speak positively about their encounters with nurses Answer: 2 Explanation: 1. Although becoming politically active is important, it is not the most effective way to promote a powerful image. 2. A powerful image would best be created by nurses acting and speaking in a professional manner. 3. Motivating others to become nurses is a result of power, but it is not the most effective way to promote a powerful image. 4. Having clients speak positively about nursing encounters is certainly a good thing, but nurses must improve their own image. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership.

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15) Which strategy could be used by nurses to promote nursing's power image? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maintaining expertise by attending continuing education events 2. Encouraging clients to write letters of praise for a job well done 3. Encouraging all disciplines to work toward organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies Answer: 1, 3, 4, 5 Explanation: 1. Nursing is a knowledge profession, and the nurse must maintain expertise in order to retain power. 2. Nurses must affect this image personally, not through their clients or other disciplines. 3. Today's healthcare environment requires collaboration across disciplines. The nurse who can effectively work with others toward organizational goals is powerful. 4. Working with and knowing people of influence helps to increase the nurse's power. 5. Asking questions serves a twofold purpose: the nurse is increasing his or her personal knowledge base, and the nurse is seen as being an interested and active participant in the work of the organization. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership. 16) Which actions diminish the image of power for nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Wearing a crisp, clean uniform 2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question Answer: 2, 3, 4, 5 Explanation: 1. Appearance can add to or detract from power. 2. The nurse should be professional in all encounters. Using endearing terms is not professional. 3. Power plays are attempts to diminish or demolish the opponent. The use of power plays is inappropriate. 4. The nurse should be assertive, not aggressive. 5. The nurse should not accept orders at face value. The nurse should never implement an intervention without knowing why the intervention is being done, that it is appropriate for the particular client, and what the outcome of the intervention should be. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-1: Differentiate between power and leadership. TestBankWorld.org

17) The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Identify what she really wants. 2. Keep her focus on her unit, not the entire organization. 3. Prioritize her needs in order of importance. 4. Identify her current resources. 5. Determine who stands in the way of what she wants. Answer: 1, 3, 4, 5 Explanation: 1. To increase power, the nurse must first identify what she really wants. 2. Focus should be on the entire organization, not just the specific unit where the nurse currently works. 3. The nurse should prioritize her needs and goals in the order of their importance to her and to the organization. 4. The nurse must be aware of what resources exist and how she can obtain the resources she needs. 5. The nurse should identify who or what stands in the way of her achieving what she wants. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-1: Differentiate between power and leadership. 18) The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power? 1. The best strategy is to overwhelm opposition by exerting a great deal of power. 2. The best strategy is to focus the use of power on the individuals who are slow to make the desired change. 3. The best type of power for these situations is coercion. 4. The best strategy is to undertake all power interactions in a polite manner. Answer: 4 Explanation: 1. One of the rules of using power is to use as little as possible to get the results desired. 2. One of the rules of using power is to focus the power on the problem instead of individual people. 3. Coercion is rarely the best type of power to use. 4. Being polite is an essential part of using power effectively. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-2: Describe how to use power appropriately.

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19) Which strategy is best for the newly licensed nurse who wishes to develop power in the organization? 1. Develop a "can do" attitude and reputation. 2. Develop rapport with other staff members by joining in on complaint sessions. 3. Choose uniforms that do not look better than the ones other nurses wear. 4. Refer to the staff as "they" when discussing the unit. Answer: 1 Explanation: 1. To become powerful in the organization, the newly licensed nurse should develop an image of power. This includes building a "can do" reputation. 2. The nurse who wants to be powerful should not develop a reputation as a complainer. 3. Dressing for success is important. 4. Commitment to the organization is demonstrated by referring to the staff as "we." Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 8-1: Differentiate between power and leadership. 20) How can a nurse best influence policies in an organization? 1. Follow the nursing process. 2. React to problems as they occur. 3. Connect with the outside community. 4. Look to administrators to be the policy makers. Answer: 1 Explanation: 1. Close examination of the political process shows that it closely follows the nursing process. The nurse will assess the situation, create a plan of action, implement that plan, and evaluate and revise the plan. 2. Reacting to problems as they occur shows a lack of planning. 3. Connecting with the outside community may be necessary, but if the nurse is trying to influence the policies of an organization, the bulk of the work will be done within the organization. 4. The nurse cannot remain passive and expect administrators to create all the policies. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future.

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21) A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy? 1. Make visits during the day and tell the supervisor that the clients are not home at night. 2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day. 3. Encourage others to refuse to make routine visits at night so you will not be alone. 4. Take the supervisor to lunch and invite all the staff to join to talk the supervisor into changing the policy. Answer: 2 Explanation: 1. Lying to the supervisor is dishonest. 2. Research material provides rationales behind why a policy might need to be changed. This is the assessment phase and provides hard facts. 3. Encouraging others to violate policy is not ethical. 4. This strategy is unfair and coercive. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future. 22) Which action is most likely to undermine the political power of a nursing department? 1. The nurse executive reports on the accomplishments of the nursing staff at each board meeting. 2. The nurses in the hospital often ask for and do favors for one another. 3. The nurse manager wears a business suit to meetings. 4. The nurse executive does more talking than listening in meetings. Answer: 4 Explanation: 1. Reporting the accomplishments of the nursing staff is a way to support their importance and power. 2. Asking for and doing favors for one another is a form of collaboration. 3. The nurse manager should dress in the same manner as others in the meeting. 4. Talking more than listening can undermine credibility in the politics of the organization. The nurse should develop a reputation for listening and responding thoughtfully in discussions. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future.

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23) Which action would help the nurse work with public officials to influence policies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Contact officials only when necessary to avoid becoming a bother. 2. Avoid social media contact with officials. 3. Address only one issue in each correspondence. 4. Depend on form letters for correspondence. 5. Always make an appointment before visiting an elected official. Answer: 3, 5 Explanation: 1. The nurse should build relationships with officials by keeping in touch. It is not savvy to make contact only when a need exists. 2. Email and Twitter are considered viable contact methods. 3. The nurse should focus the official's attention on one issue. 4. Handwritten letters get more attention than form letters. 5. Making an appointment is the best way to ensure that the official will be in the office, will have time to talk, and will be prepared to address the issue. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future. 24) Which statements reveal that the nurse being described has real power? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "She is so powerful. I have to admit that I'm a little afraid of her." 2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation." 5. "She knows how to use her power to get what she wants." Answer: 2, 3, 4 Explanation: 1. Real power does not come from fear. 2. Respect is one of the principles of principle-centered or real power. 3. Honor is one of the principles of principle-centered or real power. 4. Loyalty is one of the principles of principle-centered or real power. 5. Using power for one's own purposes is not part of principle-centered or real power. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership.

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25) A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable? 1. Nurses are knowledge workers, not power workers. 2. Many nurses view power as oppressive. 3. Having power with others is a part of providing nursing care. 4. Remaining powerful reduces self-esteem. Answer: 2 Explanation: 1. Nurses are knowledge workers, but this is not the reason that many view power as unattractive. 2. The idea of having power "over" someone or "power-grabbing" is oppressive. Many nurses hold this view of power. 3. Having power with others is not perceived as unattractive by nurses, but having power over others is. 4. Power increases self-esteem. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 8-2: Describe how to use power appropriately. 26) A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond? 1. "I don't think what you are saying is correct." 2. "Would you clarify what you just said?" 3. "What evidence supports that statement as accurate?" 4. Say nothing and research the topic before the next meeting. Answer: 3 Explanation: 1. The nurse should do further assessment before confronting the person. 2. Asking for clarification is not the strongest response to this statement. 3. The nurse should not take the statement at face value but should ask for evidence that it is correct. 4. By not saying anything, the nurse allows the rest of the committee to hear and perhaps believe the statement is true. The time to speak up is now. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 8-2: Describe how to use power appropriately.

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27) Why would the strategic planning committee choose shared visioning as a strategy for change? 1. Shared visioning makes change easier. 2. Shared visioning facilitates the more rapid implementation of changes. 3. Shared visioning means responsibility for error is shared. 4. Shared visioning means the leader has less responsibility for getting things done. Answer: 1 Explanation: 1. If leaders and followers share in a vision for the future, it is easier for changes to be made. 2. It is not necessarily true that shared visioning allows changes to be implemented more quickly. 3. Diluting the responsibility for error is not a reason to implement shared visioning. 4. The leader does not have reduced responsibility in shared visioning. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 8-3: Explain how to use shared visioning as a power tool. 28) A nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter? 1. Dear Senator: 2. Dear Bill: 3. Dear Sir: 4. To whom it may concern: Answer: 1 Explanation: 1. The nurse should use a professional manner in the letter. 2. The nurse should not assume familiarity with the senator in this professional matter. 3. The senator's correct title is Senator. 4. The letter should be addressed specifically to the senator. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 8-5: Summarize ways nurses can influence nursing's future.

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29) As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ability to reward others 2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Remain friendly, helpful, and likable Answer: 2, 3, 4, 5 Explanation: 1. Reward power is not a source of personal power. 2. Technical competence and knowledge are part of expert power. Expert power is a personal power. 3. Ability to access data is information power. Information power is a personal power. 4. Formal and informal links with people of influence are the basis of connection power. Connection power is a personal power. 5. Admiration and respect for an individual is based partly on the person's friendliness, helpfulness, and likability. Admiration and respect result in referent power. Referent power is a personal power. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 8-1: Differentiate between power and leadership. 30) Which event would likely improve a nurse's position power within an organization? 1. The nurse is promoted to nurse manager. 2. The nurse is voted "most likable" as part of a Nursing Day celebration. 3. The nurse has just graduated from a master's program in nursing. 4. The nurse's wife has just been elected to the town council. Answer: 1 Explanation: 1. Position power is determined by job description, assigned responsibilities, recognition, advancement, and authority. Being promoted to nurse manager increases position power. 2. Likability is associated with referent power, which is a personal power. 3. Advancing one's education is more likely to increase knowledge power, which is a personal power. 4. Connection power is based on an individual's links to influential people. Connection power is a personal power. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 8-1: Differentiate between power and leadership.

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31) A manager wants the unit to be known as the primary wound care unit for the organization. The manager achieves staff buy-in, and they work together to establish goals and share accomplishments. The nurse acknowledges that this power tool is called ________. Answer: shared visioning Explanation: Shared visioning is an interactive process in which both leaders and followers commit to the organization's (unit's) goals. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Diagnosis/Leadership Learning Outcome: 8-3: Explain how to use shared visioning as a power tool. 32) The nurse manager reviews the policy and procedure for central line (flushes) maintenance. To determine potential changes, the manager considers which of the following areas? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Current policy and procedures 2. Current research 3. Length of stay 4. Infection rates 5. Practice guidelines Answer: 1, 2 Explanation: 1. Current policy and procedures allow the manager to know what is already in place and if they need to be updated. 2. Current research determines that the policy and procedures should be guided by evidencebased research. 3. Length of stay is determined by specialized health problems and quality of practice. 4. Infection rates are determined by quality of practice. 5. Practice guidelines determine the care needed by a client with specialized health problems. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Evidence-Based Practice Learning Outcome: 8-4: Explore the relationships among power, politics, and policy.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 9 Thinking Critically, Making Decisions, Solving Problems 1) The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making Answer: 1 Explanation: 1. Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations. 2. Problem solving implies there is a problem that needs a solution. 3. Brainstorming generates diverse ideas with many superficial solutions. 4. Decision making identifies one effective strategy that is not necessarily innovative. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-1: Summarize ways to use the critical-thinking process. 2) A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent? 1. Group problem solving 2. Critical thinking 3. Groupthink 4. Satisficing Answer: 2 Explanation: 1. Group problem solving implies that a problem exists, which is not the case in this situation. The task force is comparing two models of practice, not solving a problem. 2. Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. 3. Groupthink is a negative phenomenon that occurs in highly cohesive groups that become isolated. There is no evidence that groupthink has occurred in this situation. 4. Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. There is no evidence that satisficing has occurred in this situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Process Learning Outcome: 9-1: Summarize ways to use the critical-thinking process.

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3) The nursing group has been charged with the task of solving a patient care problem on the unit. Which step should this group take first in this process? 1. Investigate what has already been tried to solve the issue. 2. Brainstorm about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability. Answer: 3 Explanation: 1. Once the problem has been identified, the group would then look at solutions that have already been tried. 2. Brainstorming is used to develop solutions after information about the problem is analyzed. 3. Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. 4. Information cannot be sorted into an orderly arrangement until it has been collected. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 9-3: Develop a plan to improve your problem-solving skills. 4) Currently, clients on a unit are bathed in the morning between 8:00 a.m. and 11:00 a.m. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 p.m. and 9:00 p.m. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "I read a research article that reported that clients sleep better if they have been bathed right before bedtime." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too." Answer: 1, 2, 4, 5 Explanation: 1. This is an underlying assumption about why this change is being considered. 2. This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. 3. A research article report is not an assumption but based on evidence. 4. This is an assumption that might well be erroneous. 5. This is an assumption. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 9-1: Summarize ways to use the critical-thinking process.

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5) A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the assistant manager when making a decision. Answer: 1, 4 Explanation: 1. A history of ineffective trial-and-error solutions to problems tends to make the manager rigid. 2. Generally, fear of risk taking is characteristic of a rigid management style. 3. Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. 4. Using old ways of thinking to solve new problems is characteristic of rigid management. 5. Rigid managers typically prefer to make decisions independently. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 9-4: Evaluate stumbling blocks to making decisions and solving problems. 6) The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a two-week gap in the meetings to allow which portion of the creative process to occur? 1. Farsight 2. Verification 3. Preparation 4. Incubation Answer: 4 Explanation: 1. Farsight is not part of this process. 2. Verification is evaluation of the solution's effectiveness. 3. Preparation is planning time. 4. The time lapsed before a decision is made is the "incubation" time. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations.

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7) Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I would like to change the format we use for shift report, but I'm afraid it would upset staff members who have been here a long time." 2. "This is the decision I have made, and there is no room for discussion." 3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself." Answer: 3, 4, 5 Explanation: 1. Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. 2. The leader who does not value input from staff will not promote creativity. 3. The leader who recognizes the staff's efforts and sacrifices is more likely to energize the staff. 4. Optimism is crucial to energizing staff and promoting creativity. 5. Humor is a good method to help energize staff and promote creativity. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-5: Foster innovation in your work and in the work of others. 8) The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential? 1. Obtain funding for a simulation mannequin. 2. Write standardized scripts for volunteers who will portray clients. 3. Add more information to existing care plans as the study unfolds. 4. Assign client care debate topics to teams of three or four students. Answer: 3 Explanation: 1. Simulation mannequins are not essential for problem-based learning. 2. It is not essential to have a person who portrays a client in order to conduct problem-based learning. 3. Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses. 4. Debates are a way to encourage innovation but are not essential for problem-based learning. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 9-5: Foster innovation in your work and in the work of others.

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9) A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability? 1. When disagreements occur on the unit, the manager privately asks the dissenters to be silent about the issue at meetings. 2. Tell staff members that they must present one opinion regarding the solutions they desire. 3. Demonstrate a genuine desire to find our why there is dissention. 4. Develop "tunnel vision" when it comes to problems on the unit. Answer: 3 Explanation: 1. Managers should not assume that only one opinion can be voiced and that others will be silent. 2. Managers should not assume that only one opinion can be voiced. 3. Good managers start out with a commitment to find out why others disagree. 4. Tunnel vision makes it difficult to see things from another perspective and will not encourage staff to avoid preconceived ideas. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-5: Foster innovation in your work and in the work of others. 10) The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use? 1. Political decision-making model 2. Experimentation process 3. Rational decision-making model 4. Trial-and-error method Answer: 3 Explanation: 1. The premise of the political decision-making model is that decisions align with the interests of powerful stakeholders such as hospital boards and regulatory bodies. 2. Experimentation involves the use of a pilot project to test the effectiveness of a solution. 3. The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. 4. The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations.

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11) Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method Answer: 2, 4 Explanation: 1. Experimentation involves testing a theory to produce a prediction. 2. Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 3. Satisficing involves choosing a solution to meet minimum standards of care. 4. Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 5. The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. 12) The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration? 1. Are there different situational effects or contexts to be considered? 2. How has the problem usually been handled? 3. What is the easiest and least expensive alternative? 4. Can the problem be solved using the nursing process? Answer: 1 Explanation: 1. Critical thinking involves choosing the best alternative from among several, depending on the situation in which the problem occurred. This is the context of the problem. 2. Handling the problem the way it is usually handled may be easy but would not involve critical thinking. 3. Choosing the easiest or least expensive alternative may be easy but would not involve critical thinking. 4. The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 9-1: Summarize ways to use the critical-thinking process. TestBankWorld.org

13) Which statements exemplify the attributes of critical thinking essential to nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I am always curious about why we do things the way we do." 2. "I think we need to hurry up and make a decision." 3. "Can you help me understand your perspective a little better?" 4. "I don't think that your concern is necessarily pertinent to this issue." 5. "I don't think I can make that decision until I have more information." Answer: 1, 3, 5 Explanation: 1. Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. 2. A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. 3. The critical thinker considers the possible alternative perspectives. 4. The critical thinker does not discount the concerns of others who have knowledge of the issue. 5. The critical thinker collects and analyzes the facts before considering any decision. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 9-1: Summarize ways to use the critical-thinking process. 14) A nurse working in a rehabilitation center notices that clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home Answer: 2 Explanation: 1. Calling a local beverage distributor is a "classic" way to address this problem and does not engage the creativity of the staff. 2. Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity. 3. Finding out the drink preferences of the clients is part of the standard information gathering stage of providing drinks and does not reflect creativity. 4. Simply encouraging clients to bring a drink from home is not a creative approach to solving this problem. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 9-5: Foster innovation in your work and in the work of others.

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15) A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior? 1. This nurse is too inexperienced to realize the behavior is inappropriate. 2. This nurse is learning to be creative. 3. This nurse believes that new nurses are more knowledgeable than those who have worked several years. 4. This nurse misunderstands the work of the committee. Answer: 2 Explanation: 1. This behavior is not inappropriate. 2. Challenging details is a part of the preparation portion of learning to be creative. 3. There is no indication that this is the belief of this nurse. 4. There is no indication that this nurse does not understand the work of the committee. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 9-1: Summarize ways to use the critical-thinking process. 16) The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity? 1. Watch others implement creative solutions. 2. Work with a group to implement a creative solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible. Answer: 4 Explanation: 1. Watching others implement creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 2. Working with a group to implement a creative solution would be helpful in improving the nurse's creativity, but it is not the best of these choices. 3. Evaluating the effectiveness of creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 4. The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 9-1: Summarize ways to use the critical-thinking process.

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17) Which statement indicates understanding how a nurse could improve personal decisionmaking skills? 1. "We should gather a group together to make important unit decisions to ensure fairness." 2. "I should practice making decisions by developing potential solutions and then choosing one." 3. "We can make a decision and then ask for input from others to make sure it was the right choice." 4. "I know I will never be able to improve my decision-making skills because I am not a strong person." Answer: 2 Explanation: 1. Depending on a group is not likely to help the nurse improve personal decisionmaking skills. 2. Practicing making decisions will increase the nurse's experience, comfort, and overall skill. 3. Including a "we" in this process is not as likely to improve the nurse's personal decisionmaking skills as making an individual decision. Asking for input to make certain the choice was correct indicates lack of certainty. 4. Decision-making skills can be learned regardless of one's perceived personal strength. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 9-3: Develop a plan to improve your problem-solving skills. 18) The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision? 1. Probability 2. Probability analysis 3. Objective probability 4. Subjective probability Answer: 4 Explanation: 1. Probability is the likelihood, expressed as a percentage, that an event will or will not occur. 2. Probability analysis is a method of calculating expected risk; this is the method the nurse used to compare the two options. 3. Objective probability is the likelihood that an event will or will not occur, based on facts and reliable information. 4. Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. TestBankWorld.org

19) Which situation requires an adaptive decision? 1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state. 2. The nurse has made a medication error on an experimental medication. 3. The nursing student makes an error when changing a client dressing. 4. The nurse manager scheduled too many nurses for the client census on the night shift, and all of the nurses scheduled have already been asked to take a low-census unpaid day off this month. Answer: 1 Explanation: 1. Adaptive decisions must be made when the situation is unusual and there is no clear-cut policy for decision making. 2. Making a medication error is not an unusual situation, and a policy exists for handling this issue. 3. A policy exists for handling procedure errors. 4. A policy exists for handling staffing errors. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. 20) Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals. Answer: 1, 3, 4, 5 Explanation: 1. Decisions made by groups are often better than those made by individuals because there is more input into the process. 2. There is no evidence to support that a decision made by an individual results in greater commitment. 3. Decisions made by groups are often better than those made by individuals because there is more input into the process. 4. The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. 5. Routine decisions are often made by individuals, with no group input necessary. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collaboration Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. TestBankWorld.org

21) Which action by the nurse manager is a demonstration of satisficing? 1. The nurse manager works with the staffing schedule until all requested days off are honored. 2. The nurse manager reposts a job opening because no applicants were a good fit for the current unit staff. 3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds. 4. The nurse manager insists on firing a nurse who is chronically late to work. Answer: 3 Explanation: 1. Satisficing would not involve extra effort to honor requested days off. 2. If the nurse manager was satisficing, someone would be hired, even if the fit was not good. 3. This is an example of satisficing. An example of not satisficing would be the nurse manager not agreeing with the budget until funding for the beds was provided. 4. A nurse manager who is satisficing would provide continued counseling, work with the nurse, make excuses, and retain the nurse on staff. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 9-4: Evaluate stumbling blocks to making decisions and solving problems. 22) A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect? 1. Assessment 2. Diagnosis 3. Planning 4. Evaluation Answer: 2 Explanation: 1. Assessment is collecting the evidence. 2. Suspending judgment is equivalent to the diagnosis step. 3. Planning would occur when information is collected and analyzed and a course of action is being determined. 4. Deciding which hypothesis is correct is evaluation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Diagnosis/Leadership Learning Outcome: 9-4: Evaluate stumbling blocks to making decisions and solving problems.

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23) A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes during a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning. Answer: 1, 2, 5 Explanation: 1. Exposure to new ideas and a fresh environment outside the facility increases creativity. 2. Freedom is necessary to support the creative process. 3. Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. 4. Making creativity an assignment is a sure way to stifle it. 5. Being receptive to new ideas encourages creativity. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 9-1: Summarize ways to use the critical-thinking process. 24) Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation, the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions." 4. "I am strongest in making decisions when the problems are very unusual or unclear." 5. "I make good decisions when the situation is novel." Answer: 1, 2, 3 Explanation: 1. Routine decisions are based on policies and rules. 2. Routine decisions are based on procedures. 3. Adaptive decisions are often modifications of well-known problems or solutions. 4. Solving unusual or unclear problems requires innovative decision making. 5. Novel situations require innovative decision-making abilities. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 9-3: Develop a plan to improve your problem-solving skills. TestBankWorld.org

25) At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced? 1. Do not suggest any solution that is prohibitively expensive. 2. Suggest only ideas that the group has not already tried. 3. Do not critique any ideas presented. 4. Limit the session to the first 15 ideas. Answer: 3 Explanation: 1. Although all organizations are governed by a budget, what is "prohibitive" to one committee member may not be so to another. All solutions should be presented. 2. Sometimes an "old" solution is workable. 3. Brainstorming is for idea generation only. Idea critique will follow in another session. 4. The idea of brainstorming is to generate many ideas quickly. It would be better to limit the time than to limit the number of ideas. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. 26) A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation. Answer: 1, 2, 3, 4 Explanation: 1. Many situations resolve themselves with time. 2. Support from the manager is important and may lead to self-solving of the problem. 3. Depending on the problem, the nurses may need information, time off, or problem-solving practice. 4. The manager should intervene if client care begins to suffer. 5. The manager must manage this situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations.

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27) Which statements by a nurse in the emergency department are examples of groupthink? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work." 4. "We need to consider the workload of the intensive care unit nurses." 5. "Does anyone else have any ideas to discuss?" Answer: 1, 2, 3 Explanation: 1. Suppression of dissent and new ideas occurs with groupthink. 2. Stereotyping outsiders is a symptom of groupthink. 3. There is a strong tendency in groupthink to seek concurrence. 4. Considering the opinion of others is not a symptom of groupthink. 5. Leadership controls the discussion and numbers of topics to be discussed in groupthink. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 9-4: Evaluate stumbling blocks to making decisions and solving problems. 28) A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept? 1. Evidence 2. An underlying assumption 3. An alternative perspective 4. An inquiring attitude Answer: 2 Explanation: 1. Scientific evidence shows that milk is not tolerated by all adults. This action is not based in science. 2. The nurse's assumption is that milk is good for adults. 3. The nurse has not considered the alternative perspective that milk is not tolerated by some adults. 4. An inquiring attitude would lead the nurse to investigate research about adult tolerance to milk. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 9-1: Summarize ways to use the critical-thinking process.

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29) A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic. Answer: 2, 3 Explanation: 1. With decisions made under certainty, there is little if any risk. 2. When a decision is made under certainty, the possible alternatives are known. 3. When a decision is made under certainty, the conditions surrounding possible alternatives are clear. 4. If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. 5. Complex and dynamic decisions are those made under uncertainty. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations. 30) A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement? 1. Emergency department nurses do not make professional client handoff reports. 2. Long-term care facility nurses lack the education to make complete assessments prior to client transfers. 3. Housekeepers are getting sloppy about cleaning rooms. 4. Unit clerks have made 10 transcription errors in the last 6 months. Answer: 4 Explanation: 1. This is a judgment statement. 2. This is a judgment statement. 3. "Getting sloppy" is a judgment statement. 4. A good problem statement reflects the facts without judgment as to cause. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations.

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31) A nurse on a mission trip needs a urinary catheter for an infant. The nurse only has a pediatric feeding tube and must think creatively. The nurse knows the creative process includes which stages? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Communication 2. Incubation 3. Verification 4. Innovation 5. Insight Answer: 2, 3, 5 Explanation: 1. Communication is not included in the stages of the creative process. 2. Incubation is included in the stages of the creative process. 3. Verification is included in the stages of the creative process. 4. Innovation is not included in the stages of the creative process. 5. Insight is included in the stages of the creative process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 9-5: Foster innovation in your work and in the work of others. 32) The nurse manager needs to cover vacation shifts and must decide whether to use agency nurses or the PRN nursing pool. The manager must decide between the two choices. Decision making includes which steps? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Seek alternatives. 2. Make a decision. 3. Define the problem. 4. Weigh the criteria. 5. Troubleshoot. Answer: 1, 4, 5 Explanation: 1. Seeking alternative is one of the steps in the decision-making process. 2. Making a decision is not one of the steps in the decision-making process. 3. Defining the problem is not one of the steps in the decision-making process. 4. Weighing the criteria is one of the steps in the decision-making process. 5. Troubleshooting is one of the steps in the decision-making process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Utilization Review Learning Outcome: 9-2: Compare and contrast individual and collective decision-making processes in various situations.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 10 Communicating Effectively 1) The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an email to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse in a telephone conversation. 4. Discuss the complaint with the individual nurse face-to-face. Answer: 4 Explanation: 1. The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy. 2. The purpose of email is to broadcast information to large groups; it has a low level of personal intimacy. 3. A telephone conversation is less intimate than face-to-face communication, and the individual's response cannot be seen. 4. More important or difficult issues should be communicated face-to-face to the nurse involved so that the individual's response can be seen and questions can be answered appropriately. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. 2) A nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Send an email to the nurse manager, requesting a job interview. 2. Send a written letter and résumé in the mail. 3. Call the nurse manager to ask if any jobs are open. 4. Drop into the nurse manager's office to discuss employment options. Answer: 2 Explanation: 1. This approach is too informal. 2. Applying for a job requires a high level of formality. A written cover letter and résumé are expected by most organizations offering employment opportunities. This submission would be done by email only if that is the organization's specific request. 3. This approach is too informal. 4. "Dropping in" to the manager's office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the résumé and cover letter are sent. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. TestBankWorld.org

3) The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication Answer: 3 Explanation: 1. Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). 2. Downward communication involves direction given by management to the staff. 3. Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). 4. Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. 4) The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect? 1. He will focus more on the issue than on personal experience. 2. He will strive to reach consensus within the group. 3. He will strive to avoid conflict within the group. 4. He will prefer to ask questions rather than make statements. Answer: 1 Explanation: 1. Men have been socialized to remain focused on the issue and avoid selfdisclosure about personal experiences. 2. Men can tolerate disagreement within the group. 3. Men may be more apt to tolerate conflict than women are. 4. Women are more apt to ask questions to seek input. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-1: Identify the factors that influence communication.

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5) The nurse manager has instituted a policy of sending information to the staff in emails. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication? 1. Use text messaging instead of email. 2. Require a return email from everyone reading the information. 3. Be certain that emails go only to the intended recipients. 4. Send all emails with a message line that says "Important." Answer: 3 Explanation: 1. Text messaging can make the problem worse because it implies the need to respond quickly. 2. Having everyone send a return email will set the nurse manager up for an onslaught of messages that really are not important. 3. Email communication is fraught with difficulties. The best of these options is to be certain that emails go only to the intended recipients. The use of "reply to all" or distribution lists is convenient, but it can result in sending the email to people that it does not affect. When this happens, people begin to ignore email. 4. Sending the message line "Important" with each email is much like crying wolf, and recipients will soon realize that the term Important is meaningless. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. 6) The nurse manager has determined that two staff nurses need to be hired. Which factor is most critical as the nurse manager prepares to submit the request to administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence Answer: 1 Explanation: 1. The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. 2. Negative inquiry is used after a request has been denied. 3. Compromise occurs after a request has been denied. Persistence and repetition are used after a request has been denied. 4. Persistence and repetition are used after a request has been denied. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved.

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7) What is the most important reason that excellent communication skills are essential for nurses? 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Good communication ensures no problems occur. Answer: 2 Explanation: 1. Although nurses do communicate with all disciplines, the correct reason is broader. 2. Nursing activities occur in relationships, making communication skills essential. 3. Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader. 4. Excellent communication skills do not keep problems from occurring. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 8) The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse? 1. Plan to be more assertive in all communication. 2. Work to manage fear of conflict. 3. First learn to delegate clearly to others. 4. Attend the hospital-based communication training. Answer: 4 Explanation: 1. Although being more assertive in communication could help this nurse, this is not the most complete option. 2. Working to manage fear of conflict is not the most complete option. 3. Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy. 4. Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills.

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9) Which example represents a qualifier that may interfere with the message being communicated? 1. "Please notify me when this task is complete." 2. "Are you satisfied with the care you are receiving?" 3. "I hate to bother you with this, but we have a problem." 4. "How can I help you solve your issues with this physician?" Answer: 3 Explanation: 1. This is a direct command or request and does not contain a qualifier. 2. This is a valid inquiry that does not include a qualifier. 3. Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated. This qualifier ("I hate to bother you") sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender. 4. This is a valid inquiry and does not include a qualifier. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 10) The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication is understood. Answer: 4 Explanation: 1. Thinking about the goals is assessment. 2. Developing an appropriate response is an implementation. 3. Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan. 4. Ensuring all parties understand the communication is the last step as it involves evaluation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills.

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11) A nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say. Answer: 3, 4, 5 Explanation: 1. Thinking ahead in the conversation interferes with the ability to listen and comprehend. 2. Eye contact does not mean the nurse is listening. 3. When many people are talking at one time, it is difficult to listen and comprehend. 4. Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. 5. Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and organization can affect communication.

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12) A problem has arisen on a unit with primarily Generation X nursing staff. Which strategies should the nurse manager employ to get staff input into solving this problem? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input in text message and promise to respond to texts immediately. Answer: 2, 3 Explanation: 1. Generation X members do not like group problem solving and decision making. This is more the style of Baby Boomers. 2. Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. 3. Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. 4. Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. 5. Generation Y is more likely to want immediate feedback from emails or text messages. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved.

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13) An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. "I know it must be frustrating working with a new charge nurse, but how can we make this situation better?" 2. "This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it." 3. "I know the charge nurse is new to the role, but you should get used to it or there will be more changes." 4. "I know the new charge nurse is difficult to work with, but please help make the job easier to do." Answer: 1 Explanation: 1. Acknowledging the person's frustration validates his or her feelings, and asking for input helps make him or her part of the solution. 2. This statement is confrontational and is unlikely to result in a positive response from the employee. 3. Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response. 4. Patronizing remarks are condescending and are not likely to result in a positive employee response. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 14) When the nurse manager orders supplies for the unit, which communication mode is best? 1. Telephone 2. Email 3. In person 4. Voice mail Answer: 2 Explanation: 1. Telephoning an order leaves room for misinterpretation or inaccuracy in recording what was ordered. 2. To avoid misunderstanding what supplies are needed, a written request is the most appropriate choice. It avoids misunderstanding because the items can be checked off a list. 3. A verbal order in person may still result in double orders because there is no written record of what was ordered. 4. Voice mail may result in a mistake because there is no written record of what was ordered. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. TestBankWorld.org

15) An inexperienced speaker is practicing delivering a speech. Which statement indicates a lack of understanding about how easily communication is distorted? 1. "I know I can better connect with my audience with good eye contact." 2. "If I repeat a complicated section in another way, comprehension is improved." 3. "If I know the background of the audience, it can help with tailoring the content." 4. "The topic is not complicated, so I don't have to worry about misunderstanding." Answer: 4 Explanation: 1. Eye contact can assist in keeping the message clear. 2. Repeating the message can assist in keeping the message clear. 3. Tailoring the message can assist in keeping it clear. 4. It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and organization can affect communication. 16) After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff members communicate with physician staff. Which advice from the manager would be most beneficial to the nursing staff? 1. "Don't forget, you are just as good as they are." 2. "Physicians just don't listen as well as nurses." 3. "Let's review the steps of the procedures that we know are the biggest problems." 4. "I'm going to listen to the physicians, but I think most of the problem is with the physicians, not the nurses." Answer: 3 Explanation: 1. This statement sets up an "us against them" mentality. This mindset does not support respect for the physicians and could make communication more difficult. 2. This statement sets up an "us against them" mentality. This mindset does not support communication. 3. The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them. 4. The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved.

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17) The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse? 1. "Make sure that anything you say is clear and concise." 2. "Don't feel as if you are responsible for fixing every problem." 3. "Avoid using phrases such as 'sort of' when talking to females." 4. "Don't personalize everything." Answer: 2 Explanation: 1. Males tend to communicate clearly and concisely, especially in professional relationships. 2. There are many gender differences in communication. Males tend to take responsibility and feel the need to "fix" things. 3. Using phrases such as "sort of" is a more common trait of female conversation than of male conversation. 4. Women tend to personalize, whereas men are more focused on the issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-1: Identify the factors that influence communication. 18) In which situation should the nurse be most concerned that communication was distorted? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a confused client who was transferred in an ambulance. Answer: 4 Explanation: 1. Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired. 2. Just because a person is older does not mean that communication is impaired. 3. Just because the person is from another country does not mean that communication will be distorted. 4. Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-1: Identify the factors that influence communication.

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19) Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112." 3. "Ambulate the clients on the south wing." 4. "Do you think you'll have time to do shampoos today?" 5. "It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon." Answer: 1, 2 Explanation: 1. Saying "Here are your directions" alerts the assistant that an important statement is going to be made. The instructions are clear and concise. 2. This is a clear and concise set of instructions. 3. This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? 4. This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. 5. The nurse should be clear regarding what should be done before instruction is provided. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 20) The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication Answer: 1 Explanation: 1. Intersender conflict occurs when a person receives two conflicting messages from different sources. 2. Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning. 3. Metacommunication is the combination of oral messages with nonverbal messages. 4. Downward communication occurs from manager to staff and is often directive. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and TestBankWorld.org

organization can affect communication. 21) During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication? 1. Metacommunication 2. Intrasender conflict 3. Fogging 4. Intersender conflict Answer: 1 Explanation: 1. Metacommunications are nonverbal messages conveyed by body language and environmental factors. 2. Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. 3. Fogging is a communication technique in which one partially agrees with what was said. 4. Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and organization can affect communication. 22) The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time, and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor? 1. Fogging 2. Negative assertion 3. Negative inquiry 4. Compromise Answer: 3 Explanation: 1. Fogging is a technique used when the person is in partial agreement with what was said. 2. Negative assertion involves some acceptance of blame for what was said. 3. Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught. 4. Compromise implies that an agreement has occurred between the nurse manager and the nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. TestBankWorld.org

23) The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'm sorry, doctor, but I need for you to repeat the dosage on that medication order." 2. "Doctor, what was the dosage on that medication you ordered, and do you want the client up in a chair today?" 3. "How often did you want the furosemide given?" 4. "Uh, can you tell me if you need for this client to be NPO today?" 5. "Doctor, what rate did you want for the IV?" Answer: 3, 5 Explanation: 1. Saying "I'm sorry" discounts the message. 2. The nurse should focus on one point at a time. 3. This is a direct statement. 4. This statement is weak. Avoid "uh" and "um." 5. This is a direct statement, and it starts with a "name" that gets the physician's attention. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 24) A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?" 3. "I think it is unfair to refuse my unit this opportunity based on the past." 4. "Why are you always so opposed to change on my unit?" 5. "If we don't offer alternative staffing patterns, we aren't going to be able to attract new hires." Answer: 1, 2 Explanation: 1. This is an example of using "fogging," or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. 2. Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisor's position, but also requires the supervisor to rethink the issue. 3. Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. 4. This approach is confrontational. 5. Threats, even veiled threats, are confrontational and should not be used. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication TestBankWorld.org

Learning Outcome: 10-5: Develop a plan to improve your communication skills. 25) A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication. Answer: 1, 2 Explanation: 1. Grapevine communication is often rapid and complete. 2. Grapevine communication is often altered as is goes from person to person. 3. The grapevine is very prone to distortion-sometimes significant distortion. 4. Most people do believe or at least attend to the grapevine. 5. Grapevine communication crosses all levels of professionalism. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and organization can affect communication. 26) The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 1. The hospital administrator discussing next year's budget 2. A staff nurse the manager has worked with for 25 years 3. A newly licensed nurse who is hesitant to address the manager 4. A physician discussing prognosis with the client and family Answer: 2 Explanation: 1. The manager will probably pay close attention to the hospital administrator because of the position. 2. When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations. 3. The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs. 4. The nurse manager will likely to listen very closely to this conversation without preconceived beliefs. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-2: Describe how difference in gender, generation, culture, and organization can affect communication. TestBankWorld.org

27) In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step? 1. Check with the assistant to see how the assignment is going during the time breakfast is served. 2. Check the client's breakfast trays before they are returned to dietary. 3. Check with the clients to see if they had breakfast. 4. At the end of the shift, ask the assistant how the clients ate. Answer: 1 Explanation: 1. Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene. 2. Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly. 3. Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken. 4. Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved.

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28) The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 2. "I don't see why another position cannot be funded. We have met our budget each year for the last 3 years." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress." 4. "I can understand what you said about budget being tight, but we still need the position." 5. "Do you not understand how hard my nurses are working?" Answer: 1, 3 Explanation: 1. Negative assertion occurs when the speaker accepts some of the blame for the situation. 2. This is an example of negative inquiry. 3. Negative assertion is accepting some of the blame. 4. This is an example of fogging. 5. This is a confrontational statement and should be avoided. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 10-3: Explain how communication content and medium selection vary according to the situation (context), goals, and relationship of those involved. 29) The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills Answer: 2, 3, 4, 5 Explanation: 1. This topic is diffuse and hard to understand. More precise topics should be used. 2. Understanding roles is essential to collaboration. It must include both roles. 3. Understanding roles is essential to collaboration. It must include both roles. 4. Communication is the key to collaboration. 5. Listening is an essential part of communication. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. TestBankWorld.org

30) The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern? 1. The medium of the message 2. The relationship between the nurse and the receiver of the message 3. The timing of the message 4. What to include in the message Answer: 2 Explanation: 1. The medium of the message is not the first consideration. 2. The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make. 3. Timing is essential, but it is not the first consideration. 4. In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills. 31) The nurse manager works at a rural hospital and is in charge of a medical unit. Another nurse manager is in charge of the adjacent surgical unit. Equipment is shared between the two units. The surgical unit manager frequently confronts and intimidates the manager of the medical unit regarding the use of the equipment. Which strategies could the manager of the medical unit use to generate feelings of personal power? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Body language 2. Power plays 3. Arguing 4. Word choices 5. Listening Answer: 1, 4, 5 Explanation: 1. Body language is a strategy used to generate feeling of personal power. 2. Power play is not a strategy used to generate feeling of personal power. 3. Arguing is not a strategy used to generate feeling of personal power. 4. Word choice is a strategy used to generate feeling of personal power. 5. Listening is a strategy used to generate feeling of personal power. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 10-1: Identify the factors that influence communication.

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32) A nurse often has difficulty explaining and getting a clear message through to the receiver. Which communication skills will help the nurse to improve communication. Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Check timing 2. Expect respect 3. Consider relationship to receiver 4. Find an interpreter 5. Reply appropriately Answer: 1, 3, 5 Explanation: 1. Check timing is a communication skill that will help the nurse to improve communication. 2. Expect respect is not a communication skill that will help the nurse to improve communication. 3. Consider relationship to receiver is a communication skill that will help the nurse to improve communication. 4. Find an interpreter is not a communication skill that will help the nurse to improve communication. 5. Reply appropriately is a communication skill that will help the nurse to improve communication. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 10-5: Develop a plan to improve your communication skills.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 16 Recruiting and Selecting Staff 1) Which step should be taken first when recruiting and selecting nursing staff? 1. Develop a structured interview guide. 2. Become familiar with the position description for the jobs available. 3. Develop a recruitment strategy to attract qualified applicants. 4. Identify potential applicants who would meet the job description. Answer: 2 Explanation: 1. Before an interview guide can be developed, knowledge of the position is necessary. 2. Prior to beginning recruitment efforts, those involved in the hiring process must be familiar with the position descriptions for jobs that are available. 3. Development of a recruitment strategy is effective only after the recruiters understand what is required for the jobs offered. 4. Identifying potential applicants is part of a recruitment strategy or guides it. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 16-2: Describe how to recruit applicants. 2) Which information is an example of what should be included in the position description for the RNs who will staff a newly opened hospital unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Base salary is $22.00 per hour with a 10% shift differential for hours worked after 7:00 p.m. 2. Communicates changes in client condition to appropriate staff 3. Will accrue sick time at a rate of 4 hours per month 4. Reports directly to the nurse manager of the unit 5. Must maintain ACLS certification Answer: 4, 5 Explanation: 1. Salary is not included in this document. 2. Tasks required to carry out the duties involved in the position are included. 3. Benefit package is not a part of the position description. 4. The position description should indicate the person to whom the employee will report. 5. Professional qualifications for the position are included in this statement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-2: Describe how to recruit applicants.

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3) What should a nurse manager consider when including a staff nurse in an interview of an applicant? 1. Restricting the number of questions the nurse can ask 2. Providing the nurse with an orientation program on interviewing techniques 3. Allowing the nurse to provide information but not the ability to ask the applicant questions 4. Allowing the nurse to ask and answer all questions freely Answer: 2 Explanation: 1. Restricting the nurse's ability to ask and answer questions of the applicant defeats the purpose of having a staff member present during the interview. 2. An orientation program provides the nurse with the state and federal guidelines to ensure appropriate questions are asked. 3. Restricting the nurse's ability to ask and answer questions of the applicant defeats the purpose of having a staff member present during the interview. 4. Allowing the nurse to ask questions freely could violate state and federal regulations governing the interview. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 16-4: Explain how to interview prospective candidates. 4) Which question is considered appropriate to ask during an interview? 1. "What is the country of your national origin?" 2. "Do you speak any language in addition to English?" 3. "Will child care be a problem if you are hired?" 4. "Are there any holidays on which you would not work?" Answer: 2 Explanation: 1. Questions about an applicant's place of birth are inappropriate during an interview. 2. The recruiter may inquire about language skills such as reading and writing of a foreign language. 3. Questions about the number and ages of the applicant's children or child care are inappropriate. 4. Asking about holidays the applicant would not work is inappropriate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 16-5: Determine how to make a hiring decision.

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5) A new graduate nurse is preparing for an interview by the nurse recruiter. The applicant should be ready to be asked questions about which topic? 1. General state of health 2. Availability of transportation to work 3. Previous military service 4. Willingness to work all shifts Answer: 4 Explanation: 1. Questions about general medical condition, state of health, or specific diseases are inappropriate. 2. Questions about availability of transportation to work are not appropriate. 3. Questions about previous military service are not appropriate. 4. Questions about the applicant's willingness to work the required work schedule are appropriate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 16-5: Determine how to make a hiring decision. 6) A human resources (HR) manager knows which method of recruitment is most likely to be productive and inexpensive? 1. Internet websites 2. Advertisements in professional journals 3. Employee referrals 4. Job fairs Answer: 3 Explanation: 1. Internet posting can be expensive and is not as effective as another option. 2. Advertising in professional journals can be expensive and is often not as effective as another option. 3. Nurses coming from informal referrals are likely to have more realistic information about the job and the organization; thus, their expectations most closely fit reality. 4. Job fairs can be effective if properly advertised but are usually not as effective as another option. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-2: Describe how to recruit applicants.

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7) A medical unit nurse manager is conducting an interview of a potential employee. Which strategy should the manager use? 1. Document first impressions of the applicant. 2. Review the résumé during the interview. 3. Use closed questions to elicit more information. 4. Use work sample questions to determine knowledge. Answer: 4 Explanation: 1. First impressions may lead to premature judgments and hasty decisions. 2. The résumé should be reviewed alone prior to the initiation of the interview. 3. Closed questions elicit yes or no answers and do not provide much information. 4. Work sample questions are used to determine an applicant's knowledge about work tasks and ability to perform the job. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates. 8) A candidate has arrived for an interview. The interview is conducted with various personnel within the organization. This is an example of an attempt to ensure which result? 1. Interrater reliability 2. Intrarater reliability 3. Validity 4. Construct validity Answer: 1 Explanation: 1. Interrater reliability is agreement between two interviews of the same candidate by several interviewers. 2. Intrarater reliability is agreement between two interviews of the same candidate by the same interviewer. 3. Validity is the ability to predict job performance. 4. Construct validity means the standardized interview questions will accurately predict job performance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 16-4: Explain how to interview prospective candidates.

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9) A nurse manager tells the human resources (HR) director, "I would really like to hire someone of another race to balance out the team." The HR director tells the manager recruiting and hiring based on race is in violation of which statute? 1. The Equal Pay Act of 1963 2. Age Discrimination Act 3. Americans with Disabilities Act 4. Title VII of the Civil Rights Act Answer: 4 Explanation: 1. The Equal Pay Act of 1963 aimed to eliminate wage disparities based on sex. 2. The Age Discrimination Act prohibits discrimination against applicants and employees over the age of 40. 3. The Americans with Disabilities Act prohibits discrimination based on an individual's disability. 4. Title VII of the Civil Rights Act specifically prohibits discrimination in any personnel decisions based on race, color, sex, religion, or national origin. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation Learning Outcome: 16-6: Examine the legal issues involved in hiring. 10) The nurse manager is conducting an interview for a position as a full-time RN in a critical care unit. Which statements by the nurse manager would be most effective in selecting a qualified nurse for this position? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I have 20 years of experience as a critical care nurse and I am an advanced practice nurse in adult medical-surgical nursing." 2. "We do lots of client teaching. Do you like doing client teaching?" 3. "Tell me about your past work experience." 4. "Please tell me about your most rewarding experience as a nurse." 5. "Have you ever cared for a client on a ventilator?" Answer: 3, 4 Explanation: 1. Questions should be focused on the candidate, not the person conducting the interview. 2. This is a leading question, which should be avoided. The obvious "correct" answer is "yes." 3. Information about past work experience is helpful in determining qualifications for the prospective job. 4. Asking about the most rewarding experience as a nurse may reveal much about the nurse's past. 5. Whether or not a candidate has cared for a client on a ventilator does not prove the applicant's ability. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership TestBankWorld.org

Learning Outcome: 16-4: Explain how to interview prospective candidates. 11) A nurse manager would like to add the statement "Provide ongoing education to the client and the client's family" to the position description of RNs. Where would this statement be placed in this document? 1. In the job qualifications 2. In the job responsibilities 3. In the job overview 4. In the job benefits Answer: 2 Explanation: 1. Job qualifications are such things as having a current license to practice nursing. 2. This is a statement of one of the job responsibilities of this nurse. 3. The job overview is a general statement about the job and does not include specifics like those in the question. 4. Job benefits include items such as salary, paid holidays, and insurance coverage. The benefits are not included in the position description. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Health Teaching and Health Promotion Learning Outcome: 16-2: Describe how to recruit applicants. 12) A nurse manager is conducting her first interview. The manager is provided interview guidelines by the human resources (HR) director. Which advice from the HR director is most effective? 1. "Follow these guidelines and do not ask personal questions." 2. "If you are unsure of a question, ask yourself if the question applies to job performance." 3. "You may ask any question as long as it is stated in third person." 4. "You may ask only the questions that are provided." Answer: 2 Explanation: 1. Following guidelines and not asking personal questions is good advice, but is likely what the manager already knew. Better advice is more specific. 2. As long as the question is related to job performance, the question is appropriate. 3. Asking questions in third person may still violate state and federal regulations. 4. While having an interview guide is helpful, additional questions may be pertinent to this applicant. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates.

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13) A new nurse manager has conducted a series of interviews, but did not use an interview guide. Why would the manager's director be dismayed that no interview guide was used? 1. Each organization has standardized interview questions that must be used. 2. The director has selected questions to ask the interviewee. 3. A list of standardized questions allows for reliability in comparing candidates. 4. The director was not included in the interview process. Answer: 3 Explanation: 1. Organizations vary as to how interviews are conducted. Some organizations may have standardized questions for each candidate and some may have specific questions for each position. 2. Organizations vary as to how interviews are conducted. Some organizations may have standardized questions for each candidate and some may have specific questions for each position. 3. The use of structured or standardized interview questions allows for objectivity and consistency when interviewing candidates. This allows the manager to compare the candidates in a consistent manner. 4. There is no indication that the director wanted to be included in the interview process. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates. 14) An OB manager is interviewing a registered nurse for a labor and delivery position. The manager asks the interviewee, "Tell me about the most challenging delivery experience in your nursing career," and learns the candidate has experienced several challenges that required quick action. Which nursing skill will this exchange best assess? 1. Adaptability 2. Negotiation skills 3. Initiative 4. Decision-making skills Answer: 4 Explanation: 1. Adaptability focuses on how an experience has affected the nurse and how the nurse handled the situation. 2. Negotiation skills provide information as to how the nurse was able to compromise in a situation. 3. Initiative provides the interviewer with information as to the nurse's resourcefulness. 4. Decision-making skills provide the interviewer with information about the nurse's thought process in managing a difficult or challenging situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates.

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15) During an interview the candidate informs the manager of a difficult experience between a client and a physician. The nurse had to negotiate between an unhappy client and a difficult physician. Which notation by the manager would describe this situation? 1. The candidate has good initiative. 2. The candidate has good conflict resolution skills. 3. The candidate is a client advocate. 4. The candidate is adaptable. Answer: 2 Explanation: 1. The question does not focus on the candidate's degree of adaptability or initiative. 2. The candidate used good negotiation skills and a conflict was resolved between a client and a physician. 3. One may assume the nurse acted as a client advocate but the question does not provide enough information to choose this answer with certainty. 4. The question does not focus on the candidate's degree of adaptability or initiative. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 16-4: Explain how to interview prospective candidates. 16) The chief nurse officer (CNO) receives a call that the candidate for a nurse opening has arrived, but that the unit manager who was to have interviewed the candidate had to work an unscheduled night shift and is unavailable. Which action by the CNO is appropriate? 1. Inform the candidate the interview will have to be rescheduled. 2. Have the HR department refer the candidate to a nurse on the unit. 3. The CNO should conduct an initial interview and arrange for a second interview with the manager. 4. The CNO should call the manager and conduct an interview via a conference call. Answer: 3 Explanation: 1. The purpose of the interview is to gain information about and supply information to the candidate. Rescheduling will not promote a positive impression of the facility. 2. The interview should be conducted by someone prepared to interview. A nurse on the unit will be busy with clients and does not have time to prepare for or conduct the interview. 3. Interviewing the candidate and informing the candidate of the intention of a second interview with the manager is a professional approach for managing this situation. 4. The manager is likely not prepared to conduct this interview via a conference call and may be sleeping. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates.

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17) An emergency department (ED) manager has an interview scheduled for 8:00 the next morning. The manager's usual hours are 8:00 a.m. to 4:00 p.m. This manager has been working as staff due to an increased volume of clients. What action should the manager take to prepare for this interview? 1. Reschedule the interview to a later time. 2. Arrive to work early in the morning to prepare for the interview. 3. Arrive at the usual time and conduct the interview. 4. Have a human resources representative conduct the interview. Answer: 2 Explanation: 1. As the interview is in the morning, there is insufficient time to reschedule. 2. Arriving to work early will allow the manager to review the résumé and focus on the questions to ask the candidate. Arriving at the usual time may result in an inadequate interview. 3. Arriving at the usual time may result in an inadequate interview. 4. A human resources representative will not be able to assess the candidate as well as the nurse manager. The interview will likely not be useful and may have to be repeated, which is a waste of everyone's time. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates. 18) A medical intensive care unit has a registered nurse position open. The qualifications for the position require a minimum of 1 year of acute-care nursing experience, BLS and ACLS certification, and the ability to administer intravenous cardiac drips. Which fact in an applicant's application would be sufficient reason to decline the applicant's request for an interview? 1. The candidate graduated from nursing school 9 months ago. 2. The candidate does not have ACLS certification. 3. The candidate does not have experience with cardiac drips. 4. The candidate was an LPN for 10 years prior to being an RN. Answer: 1 Explanation: 1. The only criterion that cannot be quickly met through education is length of experience. 2. ACLS certification can be obtained if the candidate is a good match for the position otherwise. 3. The ability to administer cardiac drips can be obtained through education if the candidate is a good match for the position otherwise. 4. The fact that the candidate was previously an LPN is not pertinent to this decision. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 16-3: Delineate how to select candidates.

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19) A chief nurse officer (CNO) of a rural hospital is meeting with department directors and the human resources officer to discuss the hospital's recruitment strategies. A newly promoted director suggests a recruitment fair at a metropolitan city 100 miles away. The CNO rejects this proposal. Which option is likely the CNO's rationale for this decision? 1. The CNO would prefer to focus on the local area initially. 2. A metropolitan area is not a good area in which to recruit for a rural hospital. 3. Metropolitan nurses' skills are too advanced for a rural hospital. 4. The director is new to the role and the CNO does not respect the nurse's opinion. Answer: 1 Explanation: 1. A hospital should focus on their local area initially and then extend to other geographical areas. 2. Rural hospitals do recruit in metropolitan areas but typically focus on the local area as priority. 3. Metropolitan nurses' skills and rural hospital nurses' skills are similar. Their client populations are different but rural hospital nurses have similar nursing skills, especially when stabilizing clients for transfer to tertiary hospitals. 4. There is no indication that the CNO does not respect this director, who may have fresh ideas and new perspective when addressing recruitment. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 16-2: Describe how to recruit applicants.

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20) A chief nurse officer (CNO) is considering a collaborative effort with a school of nursing to offer externships to students. The chief financial officer (CFO) rejects the proposal because it will entail a cost to the organization. Which statement by the CNO would influence the CFO to reconsider this proposal? 1. "Nursing is the foundation of this hospital and we have to get nurses into the organization." 2. "We could hire students as nurse's aides, which would save costs." 3. "An externship will allow the nursing students to work with nurses, learn about the organization, and create a positive impression of our facility." 4. "Offering a nurse externship would allow the organization to create the types of nurses we would like to hire." Answer: 3 Explanation: 1. Stating that nursing is the foundation of the hospital may alienate a CFO who works closely with staff from other departments. 2. Hiring nursing students as nurse's aides would save cost but this position may not allow for the student to experience an RN's role. 3. The best rationale for an externship program is that it allows the students to work with nurses and to learn about the profession and how it is practiced in the organization. Hopefully, this will result in the student having a positive impression of the facility. 4. "Create the types of nurses we would like to hire" is a demeaning statement and would not likely influence a CFO positively. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 16-2: Describe how to recruit applicants.

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21) The human resources (HR) director is planning on attending a career fair and has asked the director of nursing to attend as well. The nursing director replies, "I really don't have time to attend. Do you really need a nurse to go with you?" Which response by the HR director is most appropriate? 1. "Your attendance is necessary to assist me with managing the booth." 2. "Your attendance is necessary to answer specific nursing questions." 3. "I need your assistance in answering questions about our benefit package and nurses' wages." 4. "I would like another person from the organization to assist in representation." Answer: 2 Explanation: 1. If the reason for having two people attend the event is just to manage a booth, anyone could attend. The HR director should be specific about why it is important for a nurse to attend. 2. Specific nursing questions such as nurse-to-client ratios, infection rates, electronic documentation systems, and client safety initiatives are topics with which the HR director has no personal experience. 3. Answering questions regarding benefits and wages are part of the HR director's role. 4. If having two people attend is just an effort to represent the organization, any employee could attend. The HR director must be specific about why a nurse should attend. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning Learning Outcome: 16-2: Describe how to recruit applicants.

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22) The hiring process to fill a nursing position has been slowed because the human resources (HR) department is involved in a recruitment effort for laboratory positions. A staff nurse says, "Why do we have to wait on HR? Why can't we just hire a nurse?" What rationale does the nurse manager provide for waiting until HR can be involved in filling the nursing position? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "HR makes all the final hiring decisions. I just suggest the candidate I would like to have to fill the job." 2. "HR will screen the applicants for us so we don't waste time interviewing people who are not qualified." 3. "HR makes certain that we are not doing anything illegal as we interview for this position." 4. "We can't hire a nurse until HR has done a criminal background check." 5. "HR has to check to be certain that the applicant has a valid license before we can offer the job." Answer: 2, 3, 4, 5 Explanation: 1. The final hiring decision is that of the manager with input from nursing supervisors as needed. 2. HR conducts the initial screening. 3. HR is responsible for assuring legal hiring practices are followed. 4. HR is generally responsible for conducting criminal background checks. 5. HR does confirm licensure. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-5: Determine how to make a hiring decision.

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23) Unrest and employee turnover have resulted in a unit being critically understaffed. The human resources department and nurse manager are attempting to recruit new nurses for the unit. How should the history of this unit be presented? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The facts of the history should be presented while maintaining the confidentiality of those involved. 2. The history should briefly be mentioned as "some minor problems with staffing." 3. The history should not be mentioned. 4. The recruiters should focus on the positive work environment of the rest of the facility. 5. Steps being taken to correct problems on the unit should be outlined and explained. Answer: 1, 5 Explanation: 1. The facts should be presented honestly and as completely as possible without breaching confidentiality. 2. Unrest and employee turnover cannot honestly be categorized as minor problems with staffing. 3. It would not be fair to hire a nurse into this unit without providing some history. 4. Focusing on the rest of the facility is not a fair representation of the work environment a nurse could expect on this unit. 5. Candidates should be made aware of the problems and what is being done to correct them. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation Learning Outcome: 16-2: Describe how to recruit applicants. 24) An emergency department (ED) manager interviews and hires a candidate who reports having several years of ED experience. Soon after hire, the nurse makes a series of errors and harms several clients. When investigating these errors, the nurse manager discovers the nurse falsified his experience and credentials. Is the hospital liable for this nurse's actions? 1. Yes, the hospital could be liable for negligent hiring if credentials were not checked. 2. Yes, the hospital could be liable but only if it did not properly train the nurse. 3. No, the nurse is liable because information about experience was falsified in the interview. 4. Yes, the hospital is liable for all errors committed by nursing staff. Answer: 1 Explanation: 1. The hospital could be liable for negligent hiring if the nurse's credentials and experience were not checked. 2. The hospital is responsible for properly training all newly hired nurses, but in this case the falsified experience and credentials are a more relevant issue. 3. The nurse could also be liable, but the hospital probably will be found at fault as well. 4. Hospitals are not always liable for all errors committed by nursing staff if the staff is not following written policy and procedure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation Learning Outcome: 16-6: Examine the legal issues involved in hiring. TestBankWorld.org

25) A nurse manager is interviewing a candidate who has much experience in other industries. The candidate was recently licensed and is interviewing for a registered nurse charge position. Which consideration is most important for the manager to bear in mind when regarding this candidate? 1. Can the candidate perform the job? 2. Will the candidate perform the job? 3. Will the candidate apply past work experience? 4. How long will the candidate retain this position if hired? Answer: 3 Explanation: 1. Although the candidate has past work experience in other industries, it is unlikely that he or she would be able to handle a charge nurse position as an inexperienced nurse. An inexperienced nurse must learn the work environment before performing in a leadership role. 2. The candidate will probably perform the job to some degree but likely does not have sufficient nursing experience to do the job well. 3. The candidate will apply his or her previous work experience because it brings knowledge to the job. 4. How long a candidate will retain a position is uncertain, no matter what his or her qualifications and past work experience. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 16-5: Determine how to make a hiring decision. 26) A nursing applicant is scheduled for an interview with the nurse manager. Prior to the day of the interview, the human resources (HR) department reports that the applicant's references would not recommend her for hire. How should the nurse manager proceed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have HR call the applicant and cancel the interview. 2. Call the applicant, tell her that the references were poor, and cancel the interview. 3. Conduct the interview without telling the applicant that the references were poor. 4. Conduct the interview and tell the applicant that the references were poor. 5. Conduct the interview and see if the applicant spontaneously explains why the references might be poor. Answer: 3, 5 Explanation: 1. The interview should be conducted. 2. The manager should not reveal that the references were poor. The interview should be conducted. 3. The interview should be conducted. The fact that references were poor should not be revealed. 4. The applicant should not be told the references were poor. 5. The applicant may explain situations that could have resulted in poor references. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics TestBankWorld.org

Learning Outcome: 16-3: Delineate how to select candidates. 27) A nurse manager and a human resources (HR) manager are developing an interview guide for registered nurse positions in critical care units. How should this document be structured? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The questions should be specific to the registered nurse position. 2. Questions should be general enough that they will guide the interview for any critical care unit. 3. Sufficient room should be allowed between the questions so that notes on the interview can be written directly on the guide. 4. Questions should require independent answers and should not be leading. 5. The document should allow space for demographic information such as name, gender, and age. Answer: 1, 3 Explanation: 1. Questions should be specific to the job responsibilities of a registered nurse. 2. The questions should be specific to the unit for which the nurse is being hired. For example, a nurse skilled in adult critical care may not be prepared to work in a neonatal intensive care unit. 3. If notes are taken directly on the guide, it will also serve as a written record of the interview. This written record may be retained or may be destroyed after the position is filled. 4. Leading questions often have very obvious answers and will not give the interviewers a true impression of the applicant. 5. Asking about age and making decisions based on gender is not legal. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-4: Explain how to interview prospective candidates.

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28) A nurse manager lists several preferences for hiring employees. The human resources manager would advise this manager that which practices do not meet the bona fide occupational qualification (BFOQ) regulation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I like to hire all female nurses to work in labor and delivery and postpartum." 2. "I hire only strong young men as transport workers." 3. "I prefer to hire nurses who have served in the military." 4. "I only hire nurses who are bilingual for work in the emergency department." 5. "I prefer to hire women as unit clerks." Answer: 1, 2, 3, 5 Explanation: 1. There is no legal reason to hire only females in labor and delivery and postpartum. 2. There is no reason an older male or a female could not be hired as a transporter. 3. It is not legal to ask questions regarding military service prior to hire. 4. Being bilingual is a qualification necessary for work in some emergency departments. The nurse could not hire based on national origin, just on the basis of speaking more than one language. 5. There is no reason a man could not be successful as a unit clerk. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 16-6: Examine the legal issues involved in hiring. 29) A nurse manager is aware that U.S. citizenship is required by a job position being filled. How should the manager handle this requirement during the job interview? 1. Ask the applicant to provide proof of citizenship before the interview is scheduled. 2. Ask the applicant if he or she is a U.S. citizen. 3. Do not ask unless the applicant mentions citizenship. 4. Ask if the applicant's family is from the United States. Answer: 1 Explanation: 1. It is not appropriate to ask for proof of citizenship before hiring. 2. It is appropriate to ask if the applicant is a U.S. citizen. 3. There is no reason to avoid talking about citizenship. 4. It is not appropriate to ask questions about the applicant's family and their citizenship. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 16-4: Explain how to interview prospective candidates.

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30) During an interview, the manager has a strong impression that the applicant is a good "fit" for the position. How should the manager proceed? 1. Offer the applicant the job. 2. Cancel the remaining interviews for the position. 3. Keep this feeling in mind but do not make a hasty decision. 4. Tell the applicant that he or she is the strongest candidate for the position. Answer: 1 Explanation: 1. The manager should not offer the job until all pre-employment checks have been done by human resources. 2. The manager should continue interviewing the rest of the applicants. 3. Mistakes are often made based upon first impressions. 4. The manager should not tell the applicant that he or she is the strongest candidate. This is confidential information until the job offer is made. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 16-5: Determine how to make a hiring decision. 31) The manager is preparing for an interview and is most interested in collecting information about the potential hire. What fundamental questions does the manager want to know? 1. Will the applicant work overtime? 2. When will the applicant indicate acceptance? 3. Will the applicant perform the job? 4. Will the applicant fit into the culture of the unit/organization? 5. Can the applicant perform the job? Answer: 3, 4, 5 Explanation: 1. Asking about overtime is not a question that should asked at a primary interview. 2. Acceptance letters usually indicate a final date for acceptance. 3. This is basic information that a manager would want to know before hiring an applicant. 4. This is basic information that a manager would want to know before hiring an applicant. 5. This is basic information that a manager would want to know before hiring an applicant. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 16-5: Determine how to make a hiring decision.

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32) ________ has the benefits of increasing ________ and job satisfaction, improving efficiency, increasing the ________ of the staff, and providing a means to manage ________ in the census. Answer: Cross-training, morale, flexibility, fluctuations Explanation: Cross-training has the benefits of increasing morale and job satisfaction, improving efficiency, increasing the flexibility of the staff, and providing a means to manage fluctuations in the census. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 16-3: Delineate how to select candidates.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 17 Staffing and Scheduling 1) A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy? 1. Maximizing the availability of nursing staff 2. Good communication among staff 3. A high RN-skill mix 4. Overlap between shifts Answer: 3 Explanation: 1. Maximizing the availability of nursing allows for more nurses but does not take into account the staffing mix. If the RN number is low, flexibility is lower. 2. Good communication among staff is very important but does not create the greatest flexibility. 3. A high RN-skill mix allows for more flexibility to meet client needs. An RN is educated and licensed to provide care that an assistant or LPN cannot provide. 4. Overlap between shifts may provide more staff, but if the staff members are not RNs, flexibility is not appreciably increased. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. 2) The nurse manager is determining the day's nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per patient per day (NHPPD) figured to the nearest hundredth decimal point is ________. Answer: 7.33 Explanation: Nursing hours per patient per day (NHPPD) is calculated by dividing the total nursing care hours (220) by the total census (30). Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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3) The administration of a healthcare organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association (ANA) requirements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. RNs from across the facility were included on the committee that developed the system. 2. RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility. 3. The nurse's level of educational preparation will be considered in staffing decisions. 4. The number of clients and their acuity will be considered for staffing purposes. 5. When low census occurs the unlicensed assistant category will be first to be furloughed. Answer: 2, 5 Explanation: 1. The ANA requires that staffing systems be developed with input from direct-care RNs. 2. The ANA requirements state that the RN cannot be forced to work on a unit without "having established that he or she is able to provide professional care on such a unit." 3. The ANA requirements state that staffing will "reflect the level of preparation and experience of those providing care." 4. The ANA requirements state that staffing will be "based on the number of clients and clientacuity level." 5. There is no mention of low census furlough in the ANA requirements for staffing systems. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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4) The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Contracting with outside agency nurses 2. A decentralized float pool 3. Using non-licensed personnel as substitutes for nurses 4. Establishing an internal float pool of nurses who are cross-trained 5. Developing a float pool of nurses shared with another hospital in the system Answer: 1, 2, 4, 5 Explanation: 1. Agency nurses can be used as supplements, but their cost can be significant. 2. A decentralized float pool provides personnel who usually work only for one nurse manager or only on one unit. 3. Non-licensed personnel cannot be used as substitutes for nurses. 4. This can be an effective way to provide supplementary staff. 5. This is an innovative idea that creates a system-wide internal float pool. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed. 5) A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit's staffing budget? 1. PRN nurse 2. Internal float nurse 3. Part-time nurse 4. Agency nurse Answer: 4 Explanation: 1. PRN nurses are part of an internal float that provides supplemental staffing at a substantially lower cost than using agency nurses. 2. Internal float nurses are part of an internal pool that provides supplemental staffing at a substantially lower cost than using agency nurses. 3. Part-time nurses may work independently of organized supplement pools but still be assigned throughout the facility. Their salary typically is the same as or only slightly higher than that of regular staff. 4. Agency nurses used for supplemental staffing often earn two to three times the salary of inhouse nurses. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed.

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6) The hospital has elected to use the demand management staffing system instead of the client classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following? 1. Immediate client needs 2. Historical data of expected client outcomes 3. Using hospital-wide data to staff individual units 4. Reduction of nursing care hours Answer: 2 Explanation: 1. Client classification systems focus on immediate client needs. 2. Demand management uses unit-specific historical data to determine client outcomes and nursing hours needed to meet these outcomes. 3. The data used to staff are client outcome data. 4. The goal is appropriate use of nursing care hours, not reduction. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 17-3: Describe the various ways to schedule staff. 7) Which group determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized client? 1. American Nurses Association (ANA) 2. The Joint Commission 3. Nurse managers 4. Hospital administrators Answer: 3 Explanation: 1. The American Nurses Association (ANA) has developed principles for nurse staffing, and the nurse managers follow these guidelines. 2. The Joint Commission does not identify specific levels of nursing care hours for specific client populations. 3. Staffing and scheduling is the responsibility of the nurse manager. 4. Although the hospital administration must ensure that the right number of competent staff is provided to meet client needs, the responsibility of staffing has been delegated to the nurse manager or charge nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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8) The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix? 1. Block staffing 2. Creative scheduling 3. Flexible scheduling 4. Self-staffing Answer: 1 Explanation: 1. Block staffing is scheduling a set staff mix for every shift so that adequate staff is available at all times. This staffing is commonly used in areas such as labor and delivery and the emergency care unit. 2. Staffing for this unit is likely to be rather repetitive and predictable rather than creative. 3. Flexible scheduling combines shifts of differing lengths and presents a challenge to nurse managers. It is not as predictable and set as block scheduling. 4. Self-staffing and scheduling is a staffing model whereby managers and their staff completely manage staffing and schedules. This could potentially be done following a block staffing outline but can follow other staffing schedules as well. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. 9) A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care? 1. A nurse from an outside agency 2. A nurse from a hospital unit that has a low census today 3. A nurse from a decentralized internal float pool 4. A nurse from the centralized internal float pool Answer: 3 Explanation: 1. Nurses from outside agencies may be unfamiliar with the routine in the unit, and their services are substantially more expensive. They may be used as supplemental staff, but continuity of care may be compromised. 2. Nurses from another unit may not have the expertise needed to care for clients on a highly specialized unit. 3. In decentralized pools, a staff member works for one unit manager or on only one unit. Highly specialized units tend to rely on decentralized internal float pool nurses. 4. A nurse from the centralized internal float pool would likely be familiar with facility policy, layout, and culture, but may not be skilled in caring for critically ill clients. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed.

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10) A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift? 1. "First you must determine the nursing care hours needed." 2. "First you must become familiar with the classification system we use." 3. "First consider how to modify the schedule to meet client needs." 4. "First consider the need to supplement the current nursing staff so that arrangements can be made." Answer: 2 Explanation: 1. Nursing care hours can be determined after the nurse manager has become familiar with the current client classification. 2. The individual responsible for staffing should first become familiar with the staffing method used. 3. Modification of the schedule is part of the implementation process. Supplementing staff as needed is part of the implementation process. 4. Supplementing staff as needed is part of the implementation process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning Learning Outcome: 17-1: Determine staffing needs using evidence-based tools. 11) The medical-surgical unit's census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix? 1. Average daily census of the hospital 2. Client care needs 3. Number of staff on vacation 4. Financial productivity of the unit Answer: 2 Explanation: 1. The average daily census of the hospital probably will not have a direct bearing on the staffing mix of this unit. 2. The staffing mix should be based on the needs of the clients currently on the unit. A higher need for assessment, education, or discharge planning requires more RNs. 3. The number of staff on vacation is not an issue, as the clients still need care. 4. The financial productivity of the unit should not be an issue as that is historical data, not current client care need data. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff.

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12) The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct? 1. Staff members would prefer to make out their own schedules. 2. Nursing shortages and salary constraints have affected staffing patterns. 3. Lower client acuity has contributed to the need for more flexibility. 4. Flexible pattern staffing is the easiest method available. Answer: 2 Explanation: 1. The fact that staff members like to make out their own schedule is not pertinent to a flexible pattern. 2. Nursing shortages and wage constraints have necessitated an innovative approach to using the staff available to cover client care needs. A flexible staffing pattern can help fill this need. 3. Client acuity has risen, not lowered. 4. Flexible staffing can be very complex from a management standpoint. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. 13) On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem? 1. The hospital is experiencing a nursing shortage, so staff members are very busy. 2. The client mix on the unit is much more varied. 3. The unit has just adopted combined staffing patterns. 4. There is a 1-hour overlap of staff between shifts. Answer: 3 Explanation: 1. A nursing shortage and a busy staff should not impact the manager's ability to communicate information to staff. 2. The amount of variation in client mix should not adversely affect the manager's ability to provide information to the staff. 3. A combined staffing pattern allows for such variation in shifts that the manager may not come into contact with all of the staff during the manager's work hours. 4. An overlap of staff should make communication easier for the manager. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 17-3: Describe the various ways to schedule staff.

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14) The nursing staff of a medical-surgical unit would like to work four 10-hour shifts each week. For which reason would the unit nurse manager probably deny this request? 1. There is no overlap of staff. 2. There are not enough nurses working during a 24-hour period. 3. This would create discord and confusion with other healthcare departments. 4. This staffing pattern would not be cost-efficient. Answer: 4 Explanation: 1. With 10-hour shifts, there is an overlap of staff. 2. In order to cover 24 hours, three nurses are needed. In order to cover 24 hours with 12-hour shifts, two nurses are needed. 3. There is no evidence that 10-hour shifts for nurses would adversely affect other departments. 4. Since there is substantial overlap when covering 24 hours with 10-hour shifts, this staffing pattern is generally not cost-efficient. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 17-3: Describe the various ways to schedule staff. 15) The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The chief nurse officer (CNO) decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Current licensure to practice within the state 2. Orientation to the facility and the unit 3. Certification as an agency nurse 4. Documentation of malpractice insurance 5. Documentation of ability to work unsupervised in the environment Answer: 1, 2, 4 Explanation: 1. An agency nurse must have a current licensure to practice in the state in which the requesting organization resides. 2. The agency nurse must be oriented to both the facility and the agency. 3. There is not a certification for agency nurses. 4. Either the nurse or the supplying agency must have documentation of malpractice insurance that covers the nurse. 5. The nurse must be supervised by an in-house nurse and cannot work unsupervised. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed.

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16) The unit has open shifts even after staff members have signed up for overtime. The chief nurse officer (CNO) does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable conclusion? 1. It takes a significant amount of time to orient agency nurses. 2. The agency nurses are costly. 3. There is a significant amount of documentation required for agency nurses. 4. The physicians are not comfortable with agency nurses. Answer: 2 Explanation: 1. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost. 2. Agency nurses are a considerable cost to an organization and their use may cause staff resentment since agency nurses may be making two or three times the salary of the in-house nurse. Usually it is more cost-effective to offer an incentive and overtime to the current nursing staff. 3. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost. 4. The physicians may not know that the nurse is from an agency. Their primary interest is that their client's needs are met. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed. 17) A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital's intranet. This is an example of which type of scheduling? 1. External pools 2. Internal pools 3. Open shift management 4. Float pools Answer: 3 Explanation: 1. External pools are nurses employed from outside the organization, such as agency nurses. 2. Internal pools are pools of nurses within the organization from which the unit manager may assign supplemental staff as needed. 3. Open shift management is a technique in which a nurse may self-schedule by monitoring open shifts on the hospital intranet. 4. Float pools are pools of nurses within an organization who work on units in which there is a need. They are typically assigned that day or within 24 hours of their shift. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. TestBankWorld.org

18) The State Board of Health requests the employee file of all agency nurses employed within the past year. At the end of the review, the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction? 1. No current address on file for the nurse 2. Past employment history not documented in file 3. Evaluation of the nurse's performance missing from file 4. No documentation of past certifications in file Answer: 3 Explanation: 1. The agency employing the nurse is required to maintain a file of the nurse's current address, past employment history, and past certifications. 2. The agency employing the nurse is required to maintain a file of the nurse's current address, past employment history, and past certifications. 3. The hiring organization must have a mechanism in place to evaluate agency nurses' performance. 4. The hiring organization is most interested in current certifications, not past certifications. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Resource Utilization Learning Outcome: 17-4: Explain how to supplement staff when needed. 19) The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, and feeding. Which level of supplementary staff would be costeffective? 1. Additional RNs 2. Additional unit clerks 3. Additional licensed practical nurses 4. Additional unlicensed assistive personnel Answer: 4 Explanation: 1. Additional RN staff would not be cost-effective for these tasks. 2. Additional unit clerks are not likely to alleviate this staffing issue. 3. Additional LPN staff would be less expensive than additional RN staff but are not the least expensive choice. 4. Additional unlicensed assistive personnel could provide the care needed if supervised. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff.

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20) A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request? 1. "The Joint Commission manual is kept with the other unit manuals." 2. "For that information you will need to refer to the human resources department's policy on employment manual." 3. "You need to look at the policy and procedure manual for the organization, not the Joint Commission manual." 4. "Before you look any further, refer to the unit's current schedule." Answer: 3 Explanation: 1. While this is likely a true statement, it does not get to the problem with the manager's statement. 2. Human resources policy on employment will refer to general employment guidelines for all employees, not guidelines on staffing ratios. 3. The policy and procedures of the organization will set staffing criteria. The Joint Commission only determines if the organization is following its own policy. 4. The current schedule will list vacancies but not the staffing guidelines for the unit. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 17-3: Describe the various ways to schedule staff. 21) The nurse manager of a postsurgical unit is preparing the next month's schedule. The manager has reviewed the surgery schedule for the corresponding month and notes there are several high-acuity surgeries. Which staffing adjustment would the manager make to best provide the care needed by these postoperative clients? 1. Increase the number of unlicensed assistive personnel (UAP). 2. Increase the number of licensed practical nurses (LPN). 3. Increase the number of nonnursing support personnel. 4. Increase the number of RNs. Answer: 4 Explanation: 1. While UAPs would be needed for some nursing care, these surgeries are high acuity. UAPs are not the most critical employee for their care. 2. LPNs could be helpful in caring for these clients, but since these are high-acuity surgeries, this employee classification is not the most helpful. 3. Nonnursing support personnel are important to client care, but adding this classification of employee is not the most helpful choice. 4. Since these are high-acuity clients, critical thinking and clinical judgment will be important. The employees best prepared to care for these clients are RNs. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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22) A nursing supervisor is setting up a new unit and must make a blanket decision about whether the unit will be staffed on 12-hour shifts or 8-hour shifts. What should this supervisor keep in mind when making this decision? 1. Staffing 8-hour shifts uses slightly more full-time equivalents (FTEs). 2. Staffing 12-hour shifts uses more full-time equivalents (FTEs). 3. Staffing 12-hour shifts uses significantly fewer full-time equivalents (FTEs). 4. There is no difference in the full-time equivalents (FTEs) required. Answer: 4 Explanation: 1. Staffing 8-hour shifts does not use more FTEs. 2. Staffing 12-hour shifts does not use more FTEs. 3. Staffing 12-hour shifts does not use fewer FTEs. 4. There is no difference in FTEs required. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 17-2: Plan workforce full-time equivalents (FTEs). 23) The OB manager is looking at staffing for the night shift. The postpartum unit is busy and the labor-delivery unit has four clients in labor. The manager collects data from the nursing staff regarding the acuity of their clients. These data assist the manager in determining the staff for the next shift. This is an example of which type of system? 1. Demand management 2. Block scheduling 3. Organizational related 4. Client classification Answer: 4 Explanation: 1. Demand management predicts needs over the next few days, not the next shift. 2. In block scheduling, a set number of nurses would work during the shift and client acuity would not be as big a factor. 3. Organizational related refers to the principles for nurse staffing, not a staffing system. 4. Client classification systems focus on the client's acuity as it is currently occurring. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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24) The hospital is caring for more high-acuity clients due to the recent flu endemic. The chief nurse officer (CNO) reviews the census from last year's flu season and instructs the manager to schedule more RNs for the weekend. Which system has the CNO used? 1. Client classification systems management 2. Demand management system 3. The Baylor plan 4. Automated staffing Answer: 2 Explanation: 1. Client classification systems focus on client acuity in which data are collected on the current census. 2. Demand management system focuses on predicting and controlling the demand for nurses and uses historical data. 3. The Baylor plan is a method for weekend staffing. 4. Automated staffing matches client demand to nurse staffing on a more individual level. It does not use historical data. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 17-1: Determine staffing needs using evidence-based tools. 25) An emergency department manager is looking over the next month's schedule and decides to supplement the schedule due to vacations. The manager decides to use decentralized pool staffing to lower costs and provide quality care. Which group of nurses is a part of this manager's decentralized staffing? 1. PRN staff from the external pool of nurses 2. Agency nurses 3. PRN staff from the emergency department nurses 4. PRN staff from the nurses who work on medical-surgical units Answer: 3 Explanation: 1. External pool nurses are generally more expensive to employ. 2. Agency nurses are from the external pool. 3. PRN emergency department nurses are decentralized or from the same department and/or manager. 4. PRN staff composed of nurses who work on medical-surgical units make up centralized internal float pools. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff.

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26) A nurse has agreed to work on the Baylor plan. The nurse should arrange day care for which shifts? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 12-hour shift on Saturday 2. An 8-hour shift on Monday 3. An 8-hour shift on Sunday 4. A Thursday shift once a month 5. Shifts every weekend Answer: 1, 5 Explanation: 1. Twelve-hour weekend shifts are part of the Baylor plan. 2. Weekday shifts are not included in the Baylor plan. 3. In the Baylor plan, weekend shifts are 12 hours. 4. Weekday shifts are not included in the Baylor plan. 5. Under the Baylor plan, the nurse works 12-hour shifts every weekend and is paid for a standard work week. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. 27) Two nurses have agreed to share a schedule in which each will work 4 hours each day for a total of 20 hours a week. In 2 weeks, ________ FTEs will be generated by these nurses. Answer: 80 Explanation: In a 2-week pay period, one FTE equals 80 hours. These two nurses are working 4 hours each per day for 10 days: 4 × 2 × 10 = 80 hours. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 17-2: Plan workforce full-time equivalents (FTEs).

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28) A healthcare facility has adopted automated scheduling across all client care areas. When presenting this decision to nursing staff, the nurse executive should include which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This system will allow nurses to spend more time with those clients who need us the most." 2. "We expect that using this system will help us improve client outcomes." 3. "There will be little financial gain to the institution, but we are committed to improving our scheduling." 4. "Using this Baylor plan will help us improve client outcomes." 5. "This system will allow nurses to choose shifts and clients." Answer: 1, 2 Explanation: 1. Automated systems match nursing time to client need more effectively. This allows the nursing care to match the amount of care needed. 2. Automated scheduling systems do improve client outcomes. 3. Automated scheduling often results in improved financial outcomes. 4. The Baylor plan is not an automated scheduling system. 5. The automated system does not allow nurses to choose shifts or clients. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff. 29) A nursing supervisor requests information technology support for posting all nursing scheduling online. What justification can the supervisor provide for this request? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. If schedules are posted online, they are open for all to see. 2. Posting schedules online will promote fairness in shift assignments. 3. It is easier to change the schedule if it is posted online. 4. If the schedule is posted online, all shifts must be 12-hour shifts. 5. Open shift scheduling is easier to maintain if all schedules are online. Answer: 1, 2, 5 Explanation: 1. Posting schedules improves transparency. 2. If everyone can see the schedule, it is more likely that shift assignments will be fair. Favoritism would be difficult to hide. 3. There is little difference between a written schedule and an online schedule in ease of change. 4. There is no requirement that all shifts must be 12-hour shifts. 5. If schedules are online it is easier for nurses to see open shifts that they might wish to work. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 17-3: Describe the various ways to schedule staff.

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30) An acute care nursing unit has determined that an acuity level III client requires 6 hours of nursing care per shift while a level IV client requires 8 hours. Today the unit has seven level III clients and nine level IV clients. The manager should staff for ________ hours of nursing care for the next shift. Answer: 114 Explanation: To determine nursing care hours, multiply the number of hours per client by the number of clients in that category and add up the results. Category III = 7 clients × 6 hours of care = 42. Category IV = 9 clients × 8 hours of care = 72. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 17-1: Determine staffing needs using evidence-based tools. 31) The manager has appointed a nurse to complete staffing. The nurse knows that the goal of staffing is to provide what? 1. Effective/efficient nursing care 2. Appropriate numbers/mix of nursing staff 3. Client assessment data 4. Opportunities/chances for measuring nursing expertise 5. Matched actual/projected client needs Answer: 1, 2, 5 Explanation: 1. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs. 2. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs. 3. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs. 4. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs. 5. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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32) A full-time equivalent (FTE) equals ________ hours/year. Answer: 2,080 Explanation: Answer is computed as follows: 40 hours per week times 52 weeks equals 2,080 hours. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 17-1: Determine staffing needs using evidence-based tools.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 18 Motivating and Developing Staff 1) The nurse manager is concerned about the apparent lack of staff motivation to improve client care on a unit. How should this manager use motivational theories to help improve this situation? 1. Choose one theory that the manager thinks best suits the situation. 2. Review several theories but use no more than two. 3. Combine theories to develop a plan for this specific unit. 4. Review the motivational theories, but don't depend on any of them to work in "the real world." Answer: 3 Explanation: 1. Limiting motivation to one theory will narrow the manager's influence. Different workers are motivated in different ways. 2. It is important for the manager to be aware of many theories. Using only two theories narrows the managers' ability to be influential. 3. The manager will encounter workers who are motivated in a variety of ways. The manager should learn about as many theories as possible and combine them to suit the specific population of the unit. 4. There is a significant amount of research that supports the use of these theories in "the real world." Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning Learning Outcome: 18-1: Describe the factors that influence job performance. 2) There is substantial unrest among the staff of an intensive care unit that has resulted in negative client outcomes. Which employee factors should the manager assess first? 1. Motivation and ability to be effective in the job 2. The age of employees and their social background 3. Gender and educational preparation of staff 4. Experience base of employees and their attitude toward the job Answer: 1 Explanation: 1. Research has found an employee's ability and motivation to be the two major dimensions that most affect the employee's effectiveness. 2. The age of employees and their social background may influence job performance but are not as significant as other factors. 3. Educational preparation and gender may influence job performance but are not as significant as other factors. 4. The experience base of employees and their attitude toward the job may influence job performance but are not as significant as other factors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 18-1: Describe the factors that influence job performance. TestBankWorld.org

3) A registered nurse is dissatisfied with the wages and health benefits available in his current position and decides to seek other employment. This employee's frustration is most linked to which motivational theory? 1. Reinforcement theory 2. Process theory 3. Content theory 4. Equity theory Answer: 3 Explanation: 1. Reinforcement theory deals with behavioral modification and the individual's response to positive or negative reinforcement. 2. Process theories emphasize how the motivation process works to direct an individual's effort into performance. 3. Content theories explain why an individual behaves in a particular manner, emphasizing the individual's needs or the rewards that satisfy those needs-in this case, wages and health benefits. 4. Equity theory suggests that effort and job satisfaction depend on the degree of equity, or perceived fairness, in the work situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 4) In an attempt to decrease tardiness, a hospital gives employees an extra hour's pay for each wage period that the employee has not been late for work. This incentive program is an example of which theory? 1. Expectancy 2. Shaping 3. Equity 4. Goal-setting Answer: 1 Explanation: 1. Expectancy theory emphasizes the role of rewards to the employee in order to increase a desired behavior. 2. Shaping is a procedure that involves selectively reinforcing behaviors that are successively closer approximations to the desired behavior. 3. Equity theory is concerned with the conditions under which employees perceive their contribution to the job and the rewards obtained as fair and equitable. 4. Goal-setting theory suggests that it is not the reward or outcomes of task performance per se that causes an individual to expend effort, but rather the goal itself. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 18-1: Describe the factors that influence job performance.

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5) The hospital has initiated a new fall risk assessment tool. The nurse manager would like to reward those staff members who use the tool regularly. Which method of reinforcement would be most successful in getting long-term compliance? 1. A coupon for free lunch for staff members each time they use the tool 2. A counseling session with the nurse manager when the assessment tool has not been used 3. A coupon for a free lunch for staff members who, according to a medical record review of nursing documentation, consistently use the tool correctly 4. A pizza party for the staff when there is 100% compliance Answer: 3 Explanation: 1. A reward on each instance of a behavior will change behavior but is not as effective for a lasting behavior change. Behaviors learned under a continuous schedule extinguish very quickly once the reinforcement stops. 2. Positive reinforcement is a better way to change behavior than punishment. 3. When giving reinforcement for desired behaviors, the reward should be seen as positive for the employee and based on continued performance. 4. To be most effective the staff member should have as much control as possible over the reward. This is not possible with a pizza party. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 18-1: Describe the factors that influence job performance. 6) The nursing administration has instituted a "horizontal promotion" system within the nursing department. What benefit is this program to the staff nurse? 1. The most competent nurses will rise to managerial positions. 2. It rewards the nurse's clinical excellence. 3. Over time the nurse will move steadily upward through the levels. 4. The process is practice based rather than research based. Answer: 2 Explanation: 1. In horizontal promotion, the system rewards clinical excellence by moving clinically superb nurses upward on a clinical ladder, but they remain at the bedside. 2. Horizontal promotion is a reward for clinical excellence. 3. This promotion process is based upon the nurse's clinical excellence, not longevity. 4. The process is based on Patricia Benner's novice-to-expert concepts. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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7) A nurse manager is investigating the application of the principles of equity theory to rewarding staff. Which options are rewards that the manager could influence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Job satisfaction 2. Prestige 3. Pay 4. Ability 5. Effort Answer: 1, 2 Explanation: 1. Job satisfaction is a reward that the manager could influence. 2. The prestige associated with a job is a reward the manager could influence. 3. Pay is a reward the manager could influence. 4. Ability is typically seen as a contribution to the job by the employee. 5. Effort is a job contribution by the employee. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 8) The nurse manager has identified physical assessment skills lacking in a new RN. Using goalsetting theory, which statement by the manager would be the most effective in enhancing the RN's assessment skills? 1. "You need to work on your health assessment skills before your next employee evaluation." 2. "Get someone to help you with your health assessment skills by the end of the month." 3. "Read a health assessment book and practice your skills." 4. "Plan to study one body system a week and demonstrate your assessment skills to me every week." Answer: 4 Explanation: 1. Telling the nurse to develop skills without offering a plan will not motivate the nurse. 2. Saying "Get someone to help you" is not managing the process of development. 3. Reading and practicing skills is a good plan, but there is no component of review by the manager to motivate the nurse. 4. A measurable, realistic, and obtainable goal with a component of follow-up will be more motivating to the nurse. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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9) An experienced nurse often answers less experienced nurses' questions about client care and teaches hemodynamics during orientation to the unit. The nurse has also participated in research into hemodynamic monitoring of ICU clients. Which clinical ladder designation does this nurse best exemplify? 1. Clinical colleague 2. Clinical mentor 3. Clinical leader 4. Clinical expert Answer: 4 Explanation: 1. Clinical colleagues are full partners in care, but do not teach or do research. 2. A clinical mentor demonstrates preceptor abilities. 3. A clinical leader demonstrates leadership in practice. 4. The clinical expert combines teaching and research with practice. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collegiality Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 10) A nurse manager has planned orientation activities for a new registered nurse. The new nurse is required to observe shift report and UAP delegation for a week. Then the new nurse is required to take shift report and delegate UAP assignments for a week. What is the rationale for making this orientation assignment? 1. Delegation is not taught at all nursing schools. 2. Shift report differs in all hospitals. 3. Shift report and UAP delegation are minimal tasks and good for novice nurses. 4. The manager should focus on those skills specific to the new nurse's role. Answer: 4 Explanation: 1. Delegation is taught in nursing schools, but must be practiced. 2. The fact that shift report may differ in all hospitals is not relevant to this situation. 3. Shift report and UAP delegation are not minimal assignments. 4. Successful orientation requires that the nurse understand job responsibilities. The manager should focus on those items unique to the employee's specific job. Learning how to delegate staff will take time, and orientation is a good opportunity to allow the employee to learn this role. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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11) The newly licensed nurse is delighted to have been hired at a Magnet hospital and says, "They even assigned me a mentor." What is erroneous about this statement? 1. Magnet hospitals do not hire new graduates. 2. Magnet hospitals do not use mentor programs. 3. Mentors are only assigned to experienced nurses. 4. Preceptors are assigned; mentors choose protégés. Answer: 4 Explanation: 1. Magnet hospitals do hire new graduates. 2. Magnet hospitals do use mentor programs. 3. The mentor-protégé relationship is typically between an experienced nurse and a younger, inexperienced nurse. They are not assigned. 4. The nurse is mistakenly describing a preceptor as a mentor. Preceptors are assigned, whereas mentors choose protégés. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 12) The nurse has expressed job dissatisfaction to the unit manager. The manager assigns another staff member as a coach for this nurse. What is the most important aspect of the coach's job? 1. Get the nurse to explain the cause of the dissatisfaction. 2. Conduct the relationship in a confidential manner. 3. Encourage the nurse to stay in the organization. 4. Help the nurse increase bedside skill competency. Answer: 2 Explanation: 1. This is an important strategy, but is not the most important aspect of the relationship. 2. The relationship and the information divulged must be treated in a confidential manner. 3. While it is important to try to get the nurse to stay if possible, this is not the most important aspect of this relationship. 4. There may be nothing wrong with bedside skills. Even if that is the case, this is not the most important aspect. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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13) The staff development nurse has elected to use coaching as a staff development technique. Which situation is an example of this technique? 1. Pairing a newly licensed nurse with a nurse who has worked on the unit for 5 years 2. Matching a newly hired male nurse with a newly hired female nurse 3. Pairing a nurse with conflict management experience with an employee who has expressed dissatisfaction with the job 4. Matching nurses who have similar educational and cultural backgrounds when selecting participants for an educational offering Answer: 3 Explanation: 1. Pairing a newly licensed nurse with a nurse who has worked on the unit for 5 years more closely describes preceptorship. 2. Matching a new male nurse and a new female nurse does not describe coaching. 3. Coaching is a strategy suggested to address a nurse's job dissatisfaction. 4. Assigning educational offerings on the basis of similar educational and cultural backgrounds does not represent coaching. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 14) The nurse manager tells a newly licensed nurse that having a mentor is a benefit to career development. What should the new nurse expect from a mentor-protégé relationship? 1. The protégé will select the mentor. 2. Once established, this relationship lasts forever. 3. The relationship will develop through stages. 4. Mentors are generally of the opposite gender as the protégé. Answer: 3 Explanation: 1. The mentor typically selects the protégé. 2. These relationships change and often end as the protégé develops. 3. These relationships move through a definable series of stages, just like most relationships. 4. The mentor and protégé are typically the same gender. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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15) The nurse manager is reviewing the current staff to determine who should precept a newly licensed nurse. Which nurse is the most logical choice? 1. A nurse who needs the temporary pay increase that accompanies precepting 2. A nurse who is clinically competent and has the desire to assume the responsibility to train new staff 3. A nurse who has expressed the desire for additional training and unit responsibilities 4. The nurse who needs to work an 8-hour schedule for a few weeks while recovering from a work-related incident Answer: 2 Explanation: 1. The preceptor role may offer a financial incentive, but this is not sufficient reason to choose this nurse. 2. Clinical competence and concern for effective orientation of new nurses are critical attributes for the preceptor. 3. While precepting will be an additional unit responsibility, the focus is on orienting the new nurse, not on increasing a staff nurse's skills. 4. Preceptorship may or may not be based on an 8-hour schedule. Also, a nurse recovering from a work-related incident may not have the focus and energy necessary for precepting. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 16) After the second week of orientation the new nurse witnesses the death of a child in the ED. Which role should this nurse's preceptor focus on at this time? 1. Orientation of the nurse to protocols associated with this death 2. Socialization of the nurse to the staff 3. Counseling the new nurse 4. Serving as a role model Answer: 3 Explanation: 1. The new nurse should be oriented to protocols, but this is not the most important role at this time. 2. The new nurse should be socialized to the staff, but this is not the most important role at this time. 3. In this situation, the most important role is counseling. 4. The preceptor should always act as a role model for the new nurse, but this is not the most important role at this time. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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17) Which findings associated with an employee are likely to be considered when discussing performance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The employee states, "I have to work so that we can have insurance coverage for our disabled child." 2. The employee has been tardy on one occasion when an unexpected snow fell just before shift change. 3. The employee was involved in a motor vehicle crash last fall. 4. The employee found a purse containing $200 in the cafeteria and turned it in to security. 5. The employee made two work errors requiring incident reports in the last year. Answer: 2, 4, 5 Explanation: 1. This statement relates more to motivation rather than to performance. 2. Punctuality is a performance measure. 3. Personal accidents that occur when the employee is not on shift are not considered as part of performance. 4. Honesty and trustworthiness are considered performance measures. 5. Work errors are considered performance measures. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 18-1: Describe the factors that influence job performance. 18) A nurse manager wishes to use a model of job performance to help match employees and tasks to achieve the greatest effectiveness. What should the manager do first? 1. Evaluate each employee's educational and experiential background. 2. Establish the expectations of each task in writing. 3. Consider how much variation from standard is acceptable. 4. Review unit statistics for incidents, errors, and accidents. Answer: 2 Explanation: 1. This evaluation is not the first step of this process. 2. In order to know which employee can do the task, a description of how the task looks when it is done correctly must be established. 3. Variation from standard cannot be assessed until the acceptable standard is established. 4. Using a job performance model focuses on specific individuals, not unit-wide statistics. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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19) Which job behaviors would the nurse executive consider troublesome no matter which unit employed the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse made two medication errors today that resulted in poor client outcomes. 2. A nurse was tardy twice last month due to car trouble. 3. A manager reports that a nurse used a piece of equipment that had been taken out of service for malfunction. 4. A nurse did not report to work for 2 days and did not call in the absence. 5. A physician calls to complain that a nurse was rude. Answer: 1, 3, 4 Explanation: 1. Medication errors are serious no matter where they occur. 2. This might or might not be a problem, depending on the unit. 3. Using malfunctioning equipment is a serious problem, no matter where it occurs. 4. Not calling to report intended absence is a serious problem. 5. This might or might not be a problem, depending on the situation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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20) A unit secretary is chronically late returning from breaks. The rest of the secretary's work is excellent and he is always helpful and supportive of nurses and client families. The nurse manager has discussed the lateness with him, but it has not stopped. Thinking this might be an attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Offer the secretary a free lunch if he can go 1 week without being late. 2. Ignore the behavior. 3. Place a large alarm clock in the break room and set it each time the secretary takes a break. 4. Plan to be away from the secretary's area during his break times. 5. Tell the secretary that one more late return will result in a written critical incident report. Answer: 2, 4 Explanation: 1. This is a reward, not extinction. 2. Extinction occurs when the stimulus to continue the behavior is removed. In this case, the secretary will no longer get the manager's attention. 3. This is not the way an adult should be disciplined. 4. If the manager is not there to see the lateness and "reward" the employee with attention, perhaps the behavior will stop. 5. If the manager is correct and this is an attention-seeking behavior, a written critical incident is reinforcing the behavior. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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21) A staff nurse is not meeting job expectations. The manager has followed some standard strategies such as counseling to try to motivate the nurse, but they have not been successful. When discussing the situation with the supervisor, the manager says, "I think I will try shaping strategies." What can the supervisor expect of the staff nurse's performance? 1. It should gradually move toward the expected behaviors. 2. The behaviors will likely get worse before they get better. 3. The nurse will probably get frustrated and resign. 4. Performance should be at expected levels within a week. Answer: 1 Explanation: 1. Shaping consists of moving the individual toward desired behaviors a little at a time. 2. Shaping should not make behaviors worse. 3. Resignation is not the goal of shaping. 4. It may take weeks to get behaviors to their expected levels. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 22) A newly licensed nurse is considering a job offer at a hospital that offers a residency program. The nurse should expect to be in this program for up to ________ months. Answer: 12 to 18 months Explanation: Residency programs are 12- to 18-month programs designed to acclimate new graduates to the work environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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23) A nurse executive is trying to convince the hospital management team that a clinical ladder system would work well in nursing. Which points should the nurse include in this argument? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clinical ladders keep very good nurses at the bedside. 2. These programs prove to be worth their cost. 3. These programs reveal substandard nurses quickly so they can be terminated. 4. Similar programs have been shown to improve nurse job satisfaction. 5. Quality of client care increases with these programs. Answer: 1, 2, 4, 5 Explanation: 1. Nurses with excellent clinical skills are promoted, but not into management. They stay at the bedside. 2. Evaluation of established programs has shown substantial positive fiscal impact. 3. Terminating nurses is not the focus of the clinical ladder program. 4. Improvement of job satisfaction has been shown to be a result of clinical ladder programs. 5. The programs have been shown to increase quality of client care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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24) A nurse executive says, "I would really like to develop our current nurses so they can take a greater leadership role in the future." Why is this a good management plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Employees with a long history at the facility are easier to control. 2. This method of developing leaders has proved to be cost-effective. 3. The leadership development can be varied according to the needs of the nurse. 4. When leaders are developed from within, management is already aware of their strengths and weaknesses. 5. The specific needs of the organization can be served. Answer: 2, 3, 4, 5 Explanation: 1. Developing leaders from within is not a control strategy. 2. Cost-effectiveness comes from retaining high-performing nurses. 3. Many nurse leaders fail, not because they don't want to be a leader, but because they don't have the tools and skills they need. When a leader is developed from within, these tools and skills can be tailored to the individual. 4. When a nurse has worked at the hospital as a staff nurse, strengths and weaknesses are revealed. 5. Since the leaders are being developed from within, the organization can match strengths and interests to identified needs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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25) During strategic planning, the committee finds a need to develop a succession plan for the facility. What committee findings would draw attention to this need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. More nurses are electing to move into management positions. 2. Many of the facility's senior nursing managers indicate they will likely retire within 5 years. 3. The nursing shortage in the area continues to worsen. 4. Salaries continue to rise, making profitability low. 5. Many of the nurses moved into leadership positions fail. Answer: 2, 3 Explanation: 1. The issue with succession is not having enough nurses in place to effectively fill management positions. 2. In general, nursing is experiencing retirement of many experienced and excellent nurses, both from the bedside and from management. 3. As the nursing shortage worsens or continues, fewer nurses will be available to fill management openings. 4. Succession planning is not focused on salary or profitability. 5. Succession planning is not focused on why some nurses who are moved to leadership positions fail. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-3: Discuss why succession planning is essential to the future. 26) In order to develop a succession-planning program as rapidly as possible, the management team has elected to divide the processes up among team members. Which assignments would be expected? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Identify the most important things that managers do." 2. "Find out how much managers in the local area hospitals are paid." 3. "Decide which current nurses would make good managers." 4. "Analyze management training opportunities." 5. "Research generational change theory." Answer: 1, 3, 4 Explanation: 1. This is identification of core competencies and is the first step in designing a succession plan. 2. Salary determination is not part of the succession plan. 3. Identifying potential recruits is part of a succession plan. 4. Providing opportunities for development and growth is a key part of a succession plan. 5. This is not a part of succession planning. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration TestBankWorld.org

Learning Outcome: 18-3: Discuss why succession planning is essential to the future. 27) A nurse manager often uses negative reinforcers as part of operant conditioning in order to inhibit undesirable behaviors. What often results from this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The employee ducks into a client room each time the manager is seen. 2. The undesirable behavior vanishes permanently. 3. No improvement in the frequency of the undesired behavior is seen. 4. The employee calls in sick more often. 5. The manager must constantly monitor the situation. Answer: 1, 3, 4, 5 Explanation: 1. Avoidance behavior can be a result of use of negative reinforcers. 2. The undesirable behavior may go away temporarily, but it often returns. 3. Often negative reinforcers, or punishment, do not result in a decrease in the undesired behavior. 4. Calling in sick is a way of avoiding the punishment. 5. If the manager stops monitoring the situation and does not consistently employ the negative reinforcer, the behavior resurfaces. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 28) A nurse manager has scheduled several on-the-job instruction sessions. Why would the nurse choose this format? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It is very cost-effective. 2. Travel expenses are minimized. 3. The professional educators used are experts in adult learning. 4. Transfer-of-learning issues are eliminated. 5. The learners are motivated to learn. Answer: 1, 2, 4, 5 Explanation: 1. On-the-job instruction is one of the most cost-effective methods. 2. When training is on-the-job there is no need to leave the facility campus. 3. No professional educators are necessary. 4. Since the nurse is learning while doing the skill or procedure, there is no issue with transfer of learning. 5. Since the nurses are learning something they are actively doing, they are motivated to learn. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff TestBankWorld.org

development methods. 29) A nurse has been asked to teach newly hired nurses how to operate some client care equipment that the unit has just received. The nurse says, "I'd love to do this, but someone else will need to take my clients today." How should the manager respond? 1. "You will need to work the education into your day as you take care of clients." 2. "This will be a good break for you." 3. "You can use the classroom in the hospital basement for your instruction." 4. "I will authorize your additional salary for the next pay period." Answer: 1 Explanation: 1. The teaching assignment should not be seen as a chance to get away from caring for clients. 2. Teaching is not to be seen as a break from the "real" work of the unit. 3. On-the-job training is done on the unit in real time with real clients. 4. On-the-job instruction does not mean extra pay. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 30) A nurse manager is selecting nurses to serve as teachers in on-the-job instruction. What qualifications should these nurses hold? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. At least one nursing degree higher than those being taught 2. Willingness to teach new nurses 3. Ability to explain procedures accurately and clearly 4. Formal instruction in educational methodology 5. Experience as a clinical preceptor Answer: 2, 3 Explanation: 1. On-the-job instruction is not formal education. There is no educational degree requirement. 2. Willingness to take on the role of teacher is essential. 3. Ability to teach is essential. 4. Instruction in methodology can be informal and provided by the manager. 5. The on-the-job instructor may or may not have experience as a clinical preceptor. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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31) Reinforcement theory, commonly known as behavioral modification, views motivation as learning. Which of the following is true according to this theory of behavior? 1. An individual starts off as a blank slate, learning as time goes on. 2. An individual's response/consequence connection is strengthened over time. 3. Reinforcement is learned through a process called operant conditioning. 4. Learning is conditioned by the environment. 5. Behavior becomes associated with a particular consequence. Answer: 2, 3, 5 Explanation: 1. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 2. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 3. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 4. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 5. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods. 32) ________ is a technique used to eliminate negative behavior. By ________ a positive reinforcer, undesired behavior is extinguished. Answer: Extinction, removing Explanation: Extinction is a technique used to eliminate negative behavior. By removing positive reinforcement, undesired behavior is extinguished. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 18-2: Compare and contrast the use and effectiveness of various staff development methods.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 19 Evaluating Staff Performance 1) The nurse manager is completing employee evaluations. Which practices should the manager use when doing these appraisals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Appraising staff nurses every 18 to 24 months 2. Sharing the appraisal with staff nurses verbally and in writing 3. Requiring the staff nurse to sign the appraisal 4. Allowing the nurse to make written comments on the appraisal 5. Advising the nurse of the right to appeal the appraisal Answer: 2, 3, 4, 5 Explanation: 1. A staff nurse should be appraised at least once every 12 months. 2. The appraisal should be shared with the staff nurses both in writing and face-to-face discussion. 3. The nurse should sign the appraisal to indicate that it has been received. 4. The nurse should be allowed to make written comments on the appraisal. 5. The nurse does have the right to appeal the findings of the appraisal and should be advised of this right. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 2) Which statement would be inappropriate for a manager to write on an employee's performance appraisal? 1. "The nurse's attitude positively affects coworkers." 2. "The nurse seeks learning experiences." 3. "The nurse is frequently tardy." 4. "The nurse is shy and quiet." Answer: 4 Explanation: 1. The nurse's attitude is important because of its effect on coworkers, which the manager can see or measure. 2. Seeking learning experiences is something the manager can see or measure. 3. Tardiness is something that can be measured. 4. A performance appraisal must focus on an individual's job performance and not personal characteristics. Shy and quiet are personal characteristics. If the nurse has impaired communication skills because of being too shy and quiet, then that is related to job performance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-2: Explain the components of a successful performance evaluation TestBankWorld.org

process. 3) An ICU nurse manager prefers to use a "results-oriented system" when evaluating employees. Why would the manager prefer this system? 1. It allows for comparison between employees. 2. The employee knows in advance what is expected. 3. It is apparent when an employee stands out against peers. 4. It eliminates the category of "excellence" from the system. Answer: 2 Explanation: 1. Comparative judgments measure employees against peers. 2. A results-oriented system evaluates the employee based upon outcomes and the employee knows what is expected. This appraisal system is quantifiable, objective, and easily measured. 3. Comparative judgments measure employees against peers. 4. Systems have different scales, but "excellence" is almost universally included and is not excluded simply because the system is "results oriented." Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 4) A nurse manager is discussing the hospital's changes to peer evaluation with nursing staff. Which comment by a staff nurse would the manager interpret as evidence of understanding this process? 1. "Our evaluations will be more objective." 2. "This must be a less expensive method of evaluation." 3. "This should be quicker than our existing method." 4. "This would be a good way to get back at the nurses who don't work as hard." Answer: 1 Explanation: 1. A benefit of peer evaluations is that more than one individual writes the evaluation. This increases objectivity. 2. There is no information to indicate that peer evaluation is more economical. 3. Peer evaluation may actually be more time consuming because more people are involved. 4. Revenge or getting back at nurses is not the focus of peer evaluation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment.

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5) An organization has changed its performance appraisal process and is conducting training for managers. What topics should the trainer include in the agenda for this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. What a reasonable job performance should look like 2. How to conduct a disciplinary meeting 3. How to complete the evaluation form 4. How to give the employee feedback on evaluation 5. Use of anecdotal notes Answer: 1, 3, 4, 5 Explanation: 1. The manager must be able to differentiate reasonable job performance from unreasonable job performance. 2. Discipline is not a part of the evaluation process. 3. The evaluation form becomes a part of the employee's permanent file and is legally discoverable. It must be completed accurately and completely. 4. Feedback is important and must be offered and documented. 5. Anecdotal notes or critical incident notes are a vital part of the evaluation process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 19-2: Explain the components of a successful performance evaluation process.

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6) A nurse manager has been terminated for failing to follow institutional policy and procedures. Upon reviewing the manager's files, the supervisor discovers multiple unfinished employee evaluations from the last two years. The supervisor is faced with which concerns? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Finding someone with enough knowledge of the employee's work to complete the evaluation processes 2. How to share evaluation information with employees 3. The legal steps necessary to invalidate the in-process evaluations and begin new evaluations 4. Whether the care provided on the unit has been safe and effective 5. How long it has been since employees have had a valid evaluation Answer: 1, 2, 4, 5 Explanation: 1. The evaluator must have direct knowledge of the employee's work. The supervisor must find people who have that knowledge who are qualified to evaluate the work, whether the current evaluations are finished or new ones are started. 2. Evaluations must be shared with the employee. If these evaluations were not finished, it is likely they were not shared. 3. No legal steps are necessary to invalidate these in-process evaluations. 4. Without a valid evaluation process, the care on the unit has not been assessed. 5. Employees should be evaluated at least once a year. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-2: Explain the components of a successful performance evaluation process.

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7) Adopting which strategy would be helpful in reducing recency error in staff appraisals? 1. Being careful not to overrate employees 2. Evaluating each behavior separately and fairly 3. Carefully defining performance standards 4. Recording critical incidents as they occur Answer: 4 Explanation: 1. Overrating employees is leniency error. Recency error can result in either overrating or underrating an employee. 2. This strategy is not helpful if the manager remembers only behaviors that occurred recently. 3. Carefully defining performance standards is a good idea but is not helpful to the manager who does not remember facts about a particular employee. 4. Recency error is the tendency of a manager to remember only what has occurred with an employee recently. To combat recency error, the manager should keep notes on critical incidents in the employee's work as they occur. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. 8) A nurse manager looks through a file that contains information regarding critical incident reports filed within the past year. For which reasons does the manager review and use this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. To increase leniency 2. To decrease the possibility of lawsuits by the employee being evaluated 3. To increase manager-employee communication 4. To decrease recency error 5. To increase the accuracy of the evaluation Answer: 2, 3, 4, 5 Explanation: 1. The goal of evaluators is to decrease leniency errors. 2. The reason the manager who is doing evaluations must review the critical incident file is to collect information to help the manager do the best evaluation appraisal possible. This helps to decrease the possibility of a lawsuit being filed against the manager for inaccurate evaluation. 3. Reviewing the critical incident file prior to the evaluation will refresh the manager's memory of the employee's overall performance and will increase and improve manager-employee communication. 4. Looking back at the employee's record for the evaluation period will help to decrease recency error. 5. Reviewing the employee's records over the evaluation period will help the manager write a more accurate evaluation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly TestBankWorld.org

identifies performance strengths and weaknesses within a trusting environment. 9) The RN has had recent difficulty finishing and documenting client care during the assigned shift. The nurse has historically had very good appraisals, and the climate of the unit has not changed. Which would be the best approach to correct recent behaviors? 1. Provide education 2. Simplify tasks 3. Clarify expectations 4. Reassign the nurse to another unit. Answer: 3 Explanation: 1. The nurse performed well in the past, so the problem is more likely due to motivation, not skills. 2. If the climate of the unit had changed in such a way that the nurse was not overloaded with work, simplifying tasks might be a valid option. Since this has not occurred, motivation is the most likely cause for this issue. 3. The nurse may lack the motivation to do the job on time. The manager should first clarify the expectation that the nurse will have work completed by the end of the shift. If the problem continues, additional intervention may be necessary. 4. There is no indication that assigning the nurse to another unit would solve this problem. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. 10) A nurse manager and an employee meet to discuss the employee's appraisal. They disagree on the content of the employee evaluation. The disagreement turns into an argument. Which is the best managerial strategy in this situation? 1. Postpone the interview. 2. Agree on arbitration. 3. Seek input from employee peers. 4. Report the employee to the human resources manager. Answer: 1 Explanation: 1. Postponing the interview allows both manager and employee to calm down and reflect on the disagreement. 2. Suggesting arbitration is not the first step for this manager. 3. It is inappropriate to seek input from peers as evaluation is a confidential interaction. 4. Reporting the employee to human resources is not the first step. If problems continue, human resources should be advised. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review.

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11) A nurse manager gives a staff nurse an exceptional appraisal. The other nurses learn of the appraisal and are upset because this nurse has had numerous complaints from peers regarding laziness. The manager informs a colleague that the nurse obtained an exceptional appraisal because the nurse "will always work for me when I need extra help to come in." This is an example of which problem in evaluating? 1. Recency error 2. Leniency error 3. Ambiguity error 4. Halo error Answer: 2 Explanation: 1. Recency error indicates the manager is evaluating the nurse based on recent events. 2. Leniency error indicates the manager is allowing tolerance, which may not provide an accurate account of the nurse's performance. In this case, the manager is lenient with the nurse who is always eager to work extra if needed. 3. Ambiguity is related to the rating scale itself not being specific enough. 4. Halo error occurs when the manager evaluates an employee based on overall impression and is not specific to different functions of the nurse's performance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. 12) The manager overhears a nurse say to a client, "I am having trouble getting your IV started because you are so fat." The manager determines that a critical incident form should be completed. Which entry is appropriate to document on the form? 1. The nurse was rude to the client. 2. The nurse was rude and incompetent when caring for the client. 3. The client is obese, and IV catheter placement was attempted but unsuccessful due to the client's size. 4. Nurse ________ attempted to start an IV on this client and stated, "I'm having trouble getting your IV started because you are so fat." Answer: 4 Explanation: 1. A statement that the nurse was rude is an opinion and should not be used in the critical incident form. 2. Rudeness and incompetence are value statements and should not be used in critical incident forms. 3. The facts of the incident are correct, but this statement makes no mention of why a critical incident form should be completed. 4. The critical incident form must contain the event with accuracy and without judgment. Documentation should include the facts and the sequence of events. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 19-5: Set the stage for a successful performance review that clearly TestBankWorld.org

identifies performance strengths and weaknesses within a trusting environment. 13) An experienced ICU nurse manager is orienting a newly hired nurse manager to the organization. The ICU manager makes occasional notes in a small notebook. The new manager asks why the ICU manager is taking notes. What are the most likely rationales for this behavior? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It saves me time in the long run." 2. "Taking notes helps me to address issues immediately so they do not escalate." 3. "Although this looks time consuming, it is just how I learned to manage." 4. "It helps me to remember what to address in staff meetings." 5. "Having notes helps protect me when evaluations are written." Answer: 1, 2, 4, 5 Explanation: 1. Taking notes does save time for the manager when evaluations are written or if other issues come up on the unit. 2. On a busy unit, the manager must rely on written notes as a reminder of issues that should be discussed with staff. 3. Note taking is quick and this statement does not provide rationale for why notes are taken. 4. Notes will help the manager remember what should be addressed in staff meetings. 5. Having notes about the incidents cited in evaluations helps to protect the manager in case a staff member disputes the situation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment.

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14) During appraisal interviews, the nurse manager defends the choice of rating by emphasizing the negative aspects of the nurse's performance. What is the likely outcome of this strategy? 1. The nurse will clearly see the impact of attitude on performance. 2. The nurse will identify ways that performance can be improved. 3. The nurse will pay less attention to maintaining what is done well. 4. The nurse will ignore the negative statements and focus only on the positive. Answer: 3 Explanation: 1. The nurse will not see the relationship between attitude and performance just because negative statements were made. 2. The nurse is less likely to identify ways that performance can be improved if making only negative statements. 3. Focusing only on the negative aspects of a nurse's performance can result in the nurse discounting the importance of the things the nurse does well. If this is the case, the nurse may pay less attention to those areas in the future and may not do them as well. 4. The nurse is unlikely to simply ignore the negative statements and will probably not focus on ways to improve as well as if positive statements had also been made. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 15) A nurse manager believes that a staff nurse is rude to clients. In the past year, other nurses and staff from other departments have reported that the nurse has treated them rudely. The manager reviews the staff nurse's employee file and finds last year's appraisal as exceptional. What is the manager's best course of action during this year's evaluation? 1. Tell the nurse that complaints about rudeness have been received and that additional complaints will result in termination. 2. Notify nursing administration of the issues and complaints. 3. Tell the nurse that other staff nurses have complained about rudeness and have been instructed to keep a log of incidents. 4. Include documentation of these issues in the evaluation that is discussed with the nurse and provide a plan of action. Answer: 4 Explanation: 1. Unless the nurse has done something outrageous or illegal, there is not enough information to warrant termination. 2. The manager may elect to notify administration, but this is not the best answer to this question. 3. Other staff nurses should not be involved in keeping a log regarding this nurse's behaviors. 4. Documenting the issues, a one-on-one conference with the nurse, and providing a specific plan of action with a specific time frame is the best course of action. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. TestBankWorld.org

16) An emergency department nurse manager is preparing for a night-shift nurse's annual appraisal. The manager is apprehensive because there are issues to address regarding rudeness and unprofessional behavior. How should the manager prepare for conducting this appraisal? 1. Place the evaluation in an envelope with specific details addressing the nurse's behavior and allow the nurse to review it during his or her next shift. 2. The manager should complete the evaluation and ask a peer to review it and provide feedback. 3. The manager should arrange a 20-30-minute meeting with the nurse to discuss the evaluation privately. 4. The manager should allow the human resources manager to conduct the appraisal. Answer: 3 Explanation: 1. Placing the evaluation in an envelope and allowing the nurse to review it during a shift is unprofessional and does not allow for dialogue between the nurse and the manager. 2. Allowing a peer to review the manager's evaluation of another employee is unethical, unprofessional, and illegal. 3. The manager should control the environment in which the appraisal meeting is conducted. The meeting should be private and the manager should allow at least 20-30 minutes for the interview. 4. The human resources manager may give the appraisal but this does not allow for dialogue and questioning between the manager and the staff nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 19-2: Explain the components of a successful performance evaluation process. 17) A nurse manager has discussed behavioral and unprofessional behaviors with a nurse. During the performance appraisal, the manager addressed these issues and the two nurses have developed a specific plan to address the performance areas that can be strengthened. What should the manager's next course of action be? 1. Take notes of the nurse's behavior during the appraisal. 2. Inquire as to the nurse's perception of the appraisal. 3. Schedule a follow-up session to determine if the nurse has made progress in the areas specified. 4. Schedule the next annual appraisal. Answer: 3 Explanation: 1. The manager should have been taking notes all through the discussion. Notes taken now have a smaller impact. 2. The manager should have been checking the nurse's perception of the progress of the meeting throughout the meeting. 3. At this point of the interview, the manager should schedule a follow-up session to determine if the nurse has made progress. 4. The next annual appraisal will be scheduled closer to the time it will be held. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership TestBankWorld.org

Learning Outcome: 19-2: Explain the components of a successful performance evaluation process. 18) A director has performed an annual appraisal of the ICU manager, which reflects several issues in regard to the manager's attitude. At the end of the interview the manager expresses disagreement with the appraisal. The director instructs the manager to sign the appraisal and ends the interview. The manager reports this situation to the human resources director for which reason? 1. The interview was conducted in an unprofessional manner. 2. The appraisal could be interpreted as discriminatory. 3. The appraisal was not a fair evaluation of the manager's work. 4. The director appraised the manager's attitude, which is unprofessional. Answer: 2 Explanation: 1. There is not enough information to determine whether the interview was managed in an unprofessional manner. 2. The appraisal could be discriminatory because the manager should be offered the time to add written comments to the appraisal form. The director failed to allow this time. 3. There is not enough information to determine if the appraisal was a fair evaluation of the manager's work. 4. If there are attitude issues the director should address how they affect the work of the unit in the appraisal. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. 19) A manager has conducted a nurse's evaluation, focusing a large portion of the appraisal on the nurse's personality. The nurse does not agree with the appraisal and contacts the human resources director. What is the soundest basis on which to dispute the appraisal? 1. The appraisal is incomplete. 2. The appraisal is unfair. 3. The appraisal is not valid. 4. The nurse's perception of the appraisal is unjustified. Answer: 3 Explanation: 1. The appraisal is technically not incomplete, but it is insufficient. 2. There is not enough information to judge the fairness of the appraisal. 3. Because the majority of the appraisal focused on the nurse's personality, the appraisal is not valid. The focus of the appraisal should be how the nurse's actions affect the work of the unit. 4. There is not enough information to judge whether the nurse's perception of the appraisal is justified. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. TestBankWorld.org

20) During the review of an organization's appraisal policies, a nurse consultant finds that the facility uses a traditional rating scale based on general performance. What would be the consultant's greatest concern with this choice of appraisal style? 1. It is time consuming for the manager to write the evaluation essay required by this method. 2. Ratings are based on the supervisor's idea of satisfactory performance. 3. The standards used are so specific that they do not allow for individual variation. 4. Since this style involves input from peers, there is room for problems with confidentiality. Answer: 2 Explanation: 1. The length of time it takes to write an evaluation is not the primary concern. 2. One of the problems with this style of appraisal is that the ratings are based on the supervisor's idea of satisfactory performance rather than specific employee behaviors. 3. The standards used in this type of evaluation are broad. 4. There is no input from peers in this style. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 21) A hospital uses a results-oriented evaluation system. During a nurse's hiring process, the manager states, "Once you have been officially hired, I want to meet with you regarding evaluation." What will be the focus of this meeting? 1. The manager will give the nurse a set of work objectives for the next year. 2. The manager will explain how poor evaluations can lead to termination. 3. The nurse and the manager will work together to write work objectives for the nurse. 4. The manager will review the nurse's previous job experiences. Answer: 3 Explanation: 1. The manager should not just give the nurse a set of work objectives. 2. The focus of the meeting will not be on termination. 3. The nurse and the manager should work together to write these work objectives. 4. This review should have been conducted prior to hiring. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment.

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22) An organization has adopted the peer review process of evaluation. The manager shares which information with staff? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Begin to work on a portfolio that shows how you have met your work goals for this year." 2. "All of you will be called on to review each of the other nurses working on the unit." 3. "If you are a member of a peer review committee, you will submit a written evaluation to me." 4. "The evaluation will be based solely on the input of the peer committee." 5. "This change has occurred as a result of our move to self-governance." Answer: 1, 3, 5 Explanation: 1. The portfolio is a part of the peer review system of evaluation. 2. Generally, the peer review process involves two to four nurses reviewing the work of a peer. All nurses may be involved at some point, but not all nurses will review the work of every nurse. 3. The members of the peer review committee submit a written evaluation to the manager. 4. The manager also completes an evaluation. 5. Peer review is often used in self-governance models. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 23) The standard method of appraisal used by the facility rates a nurse's performance as satisfactory, but the nurse manager feels the nurse has room for improvement in many areas. What action should be taken by the manager? 1. Ask another staff nurse's opinion of the situation. 2. Address the situation with the chief nursing officer. 3. Submit the appraisal as computed by the standard form. 4. Focus on developing a plan to improve the areas concerned. Answer: 4 Explanation: 1. It is not ethical to share this dilemma with another staff nurse. 2. An astute nurse manager can address this issue without involving the chief nursing officer. 3. If the nurse manager just submits the appraisal as computed by the standard form, the opportunity to improve the nurse's practice is lost. 4. In this situation, the nurse does not "match" the method of appraisal used by the facility. The nurse manager should "go beyond the form" and strive to help this nurse improve his or her practice. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review.

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24) The staff nurse has challenged the appraisal rating given by a new nurse manager. What should the nurse manager do? 1. Do not change the rating as that will undermine the manager's authority. 2. Change the rating immediately as the staff nurse has more experience than the manager. 3. Investigate the staff nurse's challenge and change the rating if it is justified. 4. Ask another staff nurse to act as a mediator in the challenge. Answer: 3 Explanation: 1. Not changing an error undermines the staff's confidence in the evaluation process. 2. The manager should carefully consider the challenge and should not make an immediate decision. 3. The manager should investigate the challenge and if there is merit should change the appraisal. Staff members respect a manager who admits a mistake and corrects it. 4. It is inappropriate to ask another staff nurse to mediate. If necessary, another manager may be involved. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 19-4: Anticipate and address the challenges of performance review. 25) A nurse manager overhears a conversation in which staff nurses complain about the evaluation process. One nurse says, "It really is just a waste of time. I get the same raise no matter what I'm rated." Which is the best way for the manager to address this concern? 1. Lobby administration to implement raises based on merit. 2. Call the nurse aside and state agreement with the complaint. 3. Report the episode to the chief nursing officer. 4. Emphasize the practice development aspects of evaluation. Answer: 4 Explanation: 1. The process of implementing merit raises is long and would probably not be feasible until the next budget cycle; lobbying for merit raises would not address this concern immediately. 2. Calling the nurse aside and agreeing with the complaint does not address the concern, but rather validates the concern. 3. The nurse manager may wish to report the episode in order to support the need for a merit system, but that action also does not address the immediate concern. 4. All of these options are possible strategies for dealing with this complaint, but the best one is to emphasize the practice development aspects of evaluation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 19-4: Anticipate and address the challenges of performance review.

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26) An organization has elected to use a behavior-oriented, self-evaluation system for nurses. Which statement would be included on the evaluation form? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Becomes BLS (basic life support) instructor within 1 year of employment 2. Maintains confidentiality of information 3. Achieves certification in specialty 4. Demonstrates care, respect, and compassion in all interactions 5. Works well on multidisciplinary teams Answer: 2, 4, 5 Explanation: 1. This is a results-oriented statement. 2. This is a behavior-based statement. 3. This is a results-oriented statement. 4. This is a behavior-based statement. 5. This is a behavior-based statement. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 19-2: Explain the components of a successful performance evaluation process. 27) An organization has begun using critical incidents as part of the evaluation process. The supervisor is meeting with a manager to review the manager's use of critical incidents since training last week. Which finding would concern the supervisor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Each nurse has one critical incident recorded and it is positive. 2. The manager is writing these notes in a handheld electronic device. 3. The manager's notes are all written at the same time on the same day. 4. There is no indication that the critical incidents recorded have been shared with staff. 5. One note states, "This nurse has an abrasive personality." Answer: 3, 4, 5 Explanation: 1. The manager may be taking the advice of starting the process by writing and reviewing a positive critical incident with each nurse. 2. Each manager will develop his or her own style of recording notes that works best for the individual. 3. It is best that the note be recorded at the time of the occurrence. 4. The reason for critical incident recording is to improve practice. If the note is not shared with the employee, this improvement is less likely to occur. 5. Notes should focus specifically on what occurred, not on personal traits. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 19-5: Set the stage for a successful performance review that clearly TestBankWorld.org

identifies performance strengths and weaknesses within a trusting environment. 28) The supervisor is teaching managers about the use of critical incidents as part of the evaluation process. What information should the supervisor share? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Our primary focus for using these notes is to find out who is doing a poor job." 2. "Using these notes will help you identify little problems before they become big problems." 3. "You can expect some negative reactions from staff." 4. "It is okay to tell your staff that you cannot remember all the details of each encounter for evaluation and the notes will help." 5. "Having these notes will help you feel more confident in your evaluation of staff." Answer: 2, 3, 4, 5 Explanation: 1. The focus is on improving accuracy of the performance review. 2. Using notes forces the manager to deal with problems when they begin rather than after they have caused additional issues to arise. 3. When note taking is introduced, people tend to be suspicious and to react negatively. 4. Managers should be encouraged to be honest with staff about the note-taking strategy. 5. Having performance notes written across the evaluation period will help the manager have greater confidence in the evaluation process. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. 29) A nurse manager elects to ignore a nurse's performance problem, hoping it will go away. What does this strategy indicate about the nurse's management ability? 1. The nurse is a lazy manager. 2. The nurse is gullible. 3. The nurse is using a valid strategy. 4. The nurse needs an update on management strategy. Answer: 3 Explanation: 1. This is not necessarily the case. 2. This is not necessarily the case. 3. Ignoring a performance problem may be a valid strategy-for instance, if a new nurse is late for report and a seasoned nurse tells the new nurse not to be late again. 4. This is not necessarily the case. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment. TestBankWorld.org

30) The manager senses that a nurse is very anxious at the beginning of the performance interview. How should the manager proceed? 1. "I have looked back over all of my notes and interactions with you to prepare for our interview." 2. "I sense that you are very tense. Is there a reason you feel this way?" 3. "You are so tense! How about a cup of coffee to relax?" 4. "How are your children? Are you planning anything fun this summer with them?" Answer: 1 Explanation: 1. The manager should calmly start the interview, ignoring the nurse's tension, which will likely pass as the interview continues. 2. Drawing attention to the nurse's feelings in this manner would not serve to ease the tension. 3. The manager should not draw attention to the fact that the nurse is tense. 4. The fact that the interview is going to happen will not be changed by social chitchat and the nurse will still be nervous. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 19-5: Set the stage for a successful performance review that clearly identifies performance strengths and weaknesses within a trusting environment.

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31) The formal evaluation includes what primary components? 1. Concrete example of performance or lack of performance 2. Self-evaluation of performance 3. Behavior-oriented criteria 4. Development plan for performance improvement 5. Amount of skills mastered Answer: 1, 2, 3, 4 Explanation: 1. The formal evaluation includes these primary components: Concrete examples of performance or lack of performance, self-evaluation of performance, behavior-oriented criteria, development plan for performance improvement, and feedback on the level of performance against a rating scale. 2. The formal evaluation includes these primary components: Concrete examples of performance or lack of performance, self-evaluation of performance, behavior-oriented criteria, development plan for performance improvement, and feedback on the level of performance against a rating scale. 3. The formal evaluation includes these primary components: Concrete examples of performance or lack of performance, self-evaluation of performance, behavior-oriented criteria, development plan for performance improvement, and feedback on the level of performance against a rating scale. 4. The formal evaluation includes these primary components: Concrete examples of performance or lack of performance, self-evaluation of performance, behavior-oriented criteria, development plan for performance improvement, and feedback on the level of performance against a rating scale. 5. The formal evaluation includes these primary components: Concrete examples of performance or lack of performance, self-evaluation of performance, behavior-oriented criteria, development plan for performance improvement, and feedback on the level of performance against a rating scale. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-3: Examine a variety of methods for collecting performance data.

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32) A behavior-oriented performance evaluation will include what elements? 1. Developmental goals 2. Values of the organization 3. Examples of behaviors 4. Skills description 5. Position description Answer: 1, 2, 3, 5 Explanation: 1. Behavior-oriented performance evaluation includes the following elements: position description, examples of behaviors, values of the organization, developmental goals, and cluster behaviors. 2. Behavior-oriented performance evaluation includes the following elements: position description, examples of behaviors, values of the organization, developmental goals, and cluster behaviors. 3. Behavior-oriented performance evaluation includes the following elements: position description, examples of behaviors, values of the organization, developmental goals, and cluster behaviors. 4. Behavior-oriented performance evaluation includes the following elements: position description, examples of behaviors, values of the organization, developmental goals, and cluster behaviors. 5. Behavior-oriented performance evaluation includes the following elements: position description, examples of behaviors, values of the organization, developmental goals, and cluster behaviors. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 19-3: Examine a variety of methods for collecting performance data.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 20 Feedback and Coaching, Disciplining, and Terminating Staff 1) The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "What is causing you to be late?" 2. "When you are late it throws the pace of the entire unit off and client care suffers." 3. "Does it not bother you that your lateness makes everyone else's job more difficult?" 4. "You have been late three times this week and that is not acceptable." 5. "What are you going to do to avoid being tardy again?" Answer: 1, 2, 4, 5 Explanation: 1. The manager should investigate why the nurse is being tardy. 2. The impact on client care is always the most important aspect of meeting job expectations. 3. Accusing the nurse of not caring about others in the workplace is not appropriate at this point. 4. The employee must first know that the tardy behavior is unacceptable. 5. The manager should develop a plan for behavior change that the nurse can agree to. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 20-2: Describe the essentials for effective coaching. 2) What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy? 1. To punish the guilty 2. To protect the institution from liability 3. To set an example for other employees 4. To encourage the correct behavior Answer: 4 Explanation: 1. The manager does not confront policy violations as a means of punishment. 2. The primary reason for confrontation is not as a protection from liability. 3. The manager does not confront policy violators to set an example for others. 4. The primary reason a manager confronts policy violation or inappropriate behavior is to encourage correct behavior. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Environment Health Learning Outcome: 20-2: Describe the essentials for effective coaching.

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3) An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first? 1. Plan a private meeting for the disciplining. 2. Wait for one more infraction to occur and discipline immediately afterward. 3. Make certain that the information regarding policy violations is correct. 4. Keep the human resources department informed. Answer: 3 Explanation: 1. Planning a private meeting is not the first step in the process. 2. The manager has decided discipline is required. There is no need to wait for another infraction to occur. 3. The manager must first be certain that the facts about infraction are complete and correct. 4. The human resources department should be informed, but this is not the first step. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 4) Which statement by the nurse manager is the best example of day-to-day coaching? 1. "Can we meet this afternoon for about 30 minutes to discuss your progress?" 2. "I think you need to get different child care that would allow you to be on time." 3. "Over the past 6 months the narcotics count has been off on several days that you have worked." 4. "Let me show you a method I have found to be effective in making client assignments." Answer: 4 Explanation: 1. This is not a good example of coaching because 30 minutes is too long for a coaching session. 2. Giving advice about child care assumes the manager knows the employee's problem. 3. This statement is accusatory and would not set up a good coaching opportunity. 4. Coaching is a mentoring relationship. It is a brief interaction. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 20-2: Describe the essentials for effective coaching.

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5) A certified nurse's aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective? 1. "Do you need a class on hand hygiene?" 2. "Forgetting to perform hand hygiene between clients can spread infection." 3. "Why do you refuse to perform hand hygiene?" 4. "If I hear of any more instances of you not performing hand hygiene, I will write you up." Answer: 2 Explanation: 1. Asking if the CNA needs a class on hand hygiene is demeaning. 2. The employee needs to realize the unwanted behavior has consequences for the client. A better understanding may prevent the behavior in the future. 3. There is no choice except for the CNA to perform hand hygiene. Why it is not being performed is not as important as reinforcing the need. 4. The employee must understand the consequences if the behavior does not change but this should not be communicated in a threatening manner. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 20-4: Explain how to address performance issues with confrontation. 6) Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning? 1. When the termination will occur 2. How to keep the human resources department informed 3. Accurately documenting all stages of the situation 4. Whether the termination will adversely affect unit staffing Answer: 3 Explanation: 1. When the termination will occur is important but is not the most important aspect. 2. Notifying the human resources department and keeping them up to date is very important but is not the most important aspect. 3. Before termination there must be sufficient and accurate documentation to support the termination. This not only protects the employee from wrongful termination, but also protects the manager and the institution. 4. Hopefully, terminating a poor employee will not adversely affect unit staffing, but this is not the most important consideration. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 20-6: Identify the essential components of an equitable termination.

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7) A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse manager wrote notes on the expectations discussed during disciplinary sessions. 2. The terminated employee's last evaluation discusses problems with performance, but no coaching is described. 3. When problems with the employee arose, the manager's average time of intervention was less than 1 day. 4. There are notes in the employee's record from human resources indicating the nurse manager had discussed issues with the HR director. 5. In one note, the manager describes the employee as "petulant, immature, and uncaring." Answer: 2, 5 Explanation: 1. The manager should keep notes on everything discussed regarding discipline. This would benefit the institution. 2. Even though coaching is done in short sessions, it should be documented. 3. Intervention in less than 1 day shows that the manager was aware of and quickly handled problems. 4. The HR director would be party to problems with employees. This does not violate confidentiality. 5. This note could be a problem for the institution as it is the manager's opinion, not a defensible fact. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 20-6: Identify the essential components of an equitable termination. 8) It has been reported to the nurse manager that an employee is repeatedly parking in the client/visitor parking area. What action should the manager take? 1. Confront the employee. 2. Check the parking lot each morning. 3. Discuss the issue at the next employee appraisal. 4. Provide an education session for all staff regarding parking policy. Answer: 1 Explanation: 1. When there is a policy violation, it is necessary to confront the employee. The steps of confrontation are similar to those of coaching. 2. It is not necessary for the manager to use valuable time checking the parking lot. 3. The problem cannot wait until the next employee appraisal. 4. It is not necessary to involve the entire staff in an education session. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline. TestBankWorld.org

9) A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Go to the cafeteria and confront the assistant. 2. Send a message with a nurse going to lunch for the assistant to return to the unit immediately. 3. Call the cafeteria and ask that they send the assistant back to the unit. 4. Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week." 5. Anticipate that the assistant will give an explanation for the lateness. Answer: 4, 5 Explanation: 1. The manager should take a few moments to prepare before this meeting occurs. 2. The manager should not include other staff in this issue. 3. The manager should not get cafeteria workers involved in this confrontation. 4. It is important to stay calm and to relate the facts. This assistant has been late twice already this week and is late again today. 5. The manager should anticipate that the assistant will offer a reason for the lateness. It will be up to the manager to decide if the explanation is reasonable. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 10) A newly hired certified nurse's aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager? 1. Document the tardy behavior in the CNA's record. 2. Show the CNA the break hours in the employee handbook. 3. Warn the CNA tardiness is not tolerated and follow up in 2 weeks. 4. Warn the CNA that the charge nurse will be timing future meal breaks. Answer: 2 Explanation: 1. Since the CNA was misinformed regarding the length of meals, the coaching should be documented, but not as tardiness in the real sense of the word. 2. The first step is to determine whether the employee is aware of the policy. It seems this employee was not. It would be most appropriate to show the employee where the policy is written. 3. Warning the employee is not justified at this time. 4. Threatening the employee is not justified. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-2: Describe the essentials for effective coaching.

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11) A manager has been informed by a reliable RN that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate? 1. The RN should issue the warning. 2. The first warning should be verbal. 3. The assistant should be allowed to discuss the matter. 4. This type of action should be conducted by the human resources department. Answer: 3 Explanation: 1. It is inappropriate for the RN to issue a warning. 2. While many hospitals have a policy of verbal warning or coaching as a first step, the real issue is that the assistant's due process was not followed. 3. The manager should investigate the matter and listen to the assistant's reasons for the RN's complaint. If a written warning is appropriate, it should not be written until after the complaint has been investigated and the assistant has had an opportunity to discuss the issue. 4. It is inappropriate for the human resources department to issue a warning. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 12) A charge nurse on the night shift did not notify the anesthesiologist regarding an emergency case. The manager investigated the matter and learned the charge nurse thought the primary care nurse would call the anesthesiologist. Which response by the manager would be most appropriate? 1. "It is in your job description and your duty." 2. "It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse." 3. "It's not the surgery nurse's responsibility to call anesthesia!" 4. "Why was this considered an emergency case?" Answer: 2 Explanation: 1. While this is probably a true statement, it is not the best response to the situation. 2. The manager should obtain information; ask questions in a calm manner and offer instruction or solutions so the supervisor learns from the experience. 3. The manager should remain calm while coaching. 4. The question regarding the urgency of the case is not applicable to the situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 20-2: Describe the essentials for effective coaching.

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13) The nurse manager identifies a minor problem with the way a staff nurse documents client care. The manager meets with the nurse and discusses the issue, but does not issue a warning. What is the manager's next action? 1. Report the meeting to the human resources department. 2. Enlist the aid of a more experienced nurse to help monitor the documentation. 3. Record the specific behavioral steps discussed for future reference. 4. Tell the nurse that failure to comply with steps discussed will result in a written warning. Answer: 3 Explanation: 1. There is no need to report the meeting to the human resources department. 2. Involving another nurse is not professional. 3. Even when the discussion does not lead to a formal warning, the manager should record the specific behavioral steps discussed with the nurse for future reference. If there is absolutely no record of what was said, the manager may forget and be unable to evaluate the nurse's progress. 4. Telling the nurse that a warning may occur is a threat and could negate the atmosphere of trust established by the meeting. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-2: Describe the essentials for effective coaching. 14) The staff has complained that a nurse receives frequent personal phone calls, which is a violation of policy. In what manner should the manager address this nurse? 1. Meet with the nurse privately and inquire as to the necessity of personal phone calls. 2. Meet with the nurse and give a verbal warning. 3. The manager should inform the nurse that the other nurses are complaining about the phone calls. 4. Tell the complaining nurses to handle the situation with peer pressure. Answer: 1 Explanation: 1. The manager should address the behavior in private and investigate the situation. 2. It may or may not be appropriate to give a warning. 3. It is not necessary to tell the nurse that peers are complaining about the phone calls if it is a violation of policy. 4. It is inappropriate to have nursing staff address the issue. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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15) A nurse who receives frequent phone calls informs the manager the phone calls are related to a health crisis concerning a family member. Other nurses also receive personal calls, but not as many as the first nurse. Which action by the manager is appropriate? 1. Tell the nurse to have family call the manager's office if there is a crisis. 2. Discuss with the nurse how personal phone calls may affect client care and should be limited. 3. Inform the nurse that the phone calls are causing morale issues among the staff. 4. Lift the policy against staff carrying personal cell phones for this nurse while the crisis continues. Answer: 2 Explanation: 1. The manager should not get involved in the personal family issues of this nurse. 2. The manager should discuss how personal phone calls are affecting client care, perhaps by taking this nurse away from duties. The fact that calls should be limited should be stressed. 3. The manager should not bring the morale of other staff into this conversation. 4. If the manager allows one nurse to carry a personal cell phone, the rest of the nurses must be afforded the same right. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 16) A nurse has frequent visitors while working. The manager has discussed with the nurse the negative effect of these visits on client care. What should the manager do next? 1. Ask staff if the visits have decreased. 2. Arrange a follow-up meeting with the nurse. 3. Counsel all nursing staff regarding the limitations of personal visitors. 4. Arrange to be visible on the nursing unit when this nurse is working. Answer: 2 Explanation: 1. Having staff monitor the actions of a nurse is not appropriate. 2. Arranging for a follow-up meeting allows for evaluation and communication regarding the issue. 3. There is no reason to talk to all staff concerning personal visitors. 4. Being visible on the unit when this nurse is working may adversely impact the manager's productivity. It is also a transparent method of "watching" the nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 20-2: Describe the essentials for effective coaching.

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17) A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client's cardiac rhythm after the medication was administered, the surgical nurse states, "I don't know." What actions should be taken by the unit's nurse manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Meet with the ICU nurse to discuss the situation. 2. Meet with the surgical nurse to discuss the situation. 3. Give a written warning to the surgical nurse for not following policy. 4. Give a written warning to the ICU nurse for not following policy. 5. Meet with the nurses together and issue an informal verbal warning to both. Answer: 1, 2 Explanation: 1. The manager should meet with the ICU nurse to determine if policy was followed in delegating medication administration. 2. The manager should meet with the surgical nurse to determine if the nurse was aware of the policy requiring monitoring the cardiac rhythm. 3. Until the manager meets with this nurse, it is unclear if a warning is indicated. 4. Until the manager meets with this nurse, it is unclear if a warning is indicated. 5. Until the manager has more facts, it is unclear whether a warning is necessary and, if so, what kind of warning is required. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 18) An ICU nurse does not follow policy when administering a medication intravenously. Which would be the most appropriate action by the manager to assist the employee? 1. Provide written instructions for administering the medication. 2. Remediate the situation with the ICU staff. 3. Provide a copy of the policy and discuss the rationale for the policy as it relates to client care. 4. Reprimand the ICU nurse for giving the medication. Answer: 3 Explanation: 1. Providing written instructions for the medication is not as constructive as providing and discussing the policy. 2. The ICU staff does not need remediation or reprimand. 3. This strategy helps to educate the nurse and improve practice. Documenting this action also sets the scene for further action if the policy is not followed in the future. 4. Reprimanding is not the first step in this process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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19) An OB nurse has violated a unit policy. The OB manager is discussing the incident with the nurse. During the discussion, the nurse informs the OB manager of the actions of other staff and the physician's attitude leading up to the event. How should the manager address these issues? 1. Tell the nurse that physician's attitude is none of the nurse's business. 2. Inform the nurse of the policy violation. 3. Inquire about the physician's attitude and the staff actions during the incident. 4. Redirect the nurse to focus on the issue. Answer: 4 Explanation: 1. The physician's attitude is not the issue the manager is addressing at this moment. 2. The nurse is already aware of the policy violation because it has been discussed. 3. The physician's attitude and the staff's actions are not the issue the manager is addressing at this moment. 4. The nurse may be attempting to divert the manager's focus from the nurse to others. The focus of this discussion is the nurse's violation of policy. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 20) The nurse was reported for not following unit policy in relaying a client's complaint regarding another staff member. During a meeting, the nurse insists he managed the situation appropriately. How should the manager respond? 1. "Let's schedule another meeting for later in the week after you have had time to reflect on the situation a little more." 2. "Let's explore some alternative solutions to what happened." 3. "I am going to request a meeting for both of us and the human resources director." 4. "As I see it, the problem is your inability to follow the simplest of unit policies and to take direction." Answer: 2 Explanation: 1. There is no reason to let the nurse reflect further on the situation. 2. Exploring alternatives allows the nurse to develop problem-solving skills and assist in the prevention of future problems related to the situation. 3. There is no evidence to suggest that a meeting with HR is indicated. 4. This statement is inflammatory and will likely make it more difficult for the manager to improve the nurse's practice. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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21) An ICU nurse manager has been struggling to correct client care issues on the unit and has asked the unit director for assistance. The director says, "Training and discipline on your unit is your responsibility. I have other things to do." Now, the manager is faced with disciplining a nurse regarding another client care issue. What is the most significant reason this manager is hesitant to administer this discipline? 1. The nurse may quit. 2. The nursing staff is a cohesive group and might retaliate. 3. The manager is not comfortable with confrontation. 4. The manager does not feel supported by the director. Answer: 4 Explanation: 1. The fact that this nurse might quit is an issue with which managers deal every day. 2. The fact that the nurses are a cohesive group is an issue with which managers deal every day. 3. It may be that the manager is not comfortable with confrontation, but another option suggests a more significant problem. 4. The job of managing others is difficult without the full support of superiors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 22) An emergency department (ED) manager is disciplining a nurse with a history of multiple client and staff complaints. The last disciplinary action was a verbal warning. If the institution follows the progressive method of addressing disciplinary issues, the manager would prepare for which action? 1. A written warning 2. A counseling session 3. Another verbal warning 4. Termination Answer: 1 Explanation: 1. A written warning is the next step in progressive discipline. 2. A counseling session is part of the verbal warning process. 3. The progressive discipline method does not have provision for a second verbal warning. 4. Termination does not occur until there has been a verbal warning, a written warning, and a suspension. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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23) A nurse has complained to the human resources (HR) director regarding unfair treatment by the nurse's manager. The nurse describes receiving a written warning, unlike other nursing staff who exhibit similar behaviors but are not reprimanded. Which concerns would the HR director discuss with the hospital chief nursing officer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The unusual management styles within the department 2. Confronting the manager's direct supervisor about allowing this situation to occur 3. The apparent inconsistencies in discipline within the unit 4. The potential for litigation that arises from this complaint 5. The need to terminate this problem employee Answer: 3, 4 Explanation: 1. This is not just an unusual management style. 2. The manager's direct supervisor may be unaware that the incident happened. The supervisor should be apprised of the complaint, but not confronted with an accusation of allowing the behavior. 3. There is apparently an inconsistency in discipline that should be investigated. 4. If this situation goes to court, the hospital could be found liable for the actions of the manager. 5. The HR director should not categorize this employee as a problem until a full investigation of the situation has been conducted. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline. 24) A director must discipline an ICU manager. The director and manager have become friends. When disciplining the manager, what is the best approach by the director? 1. Notify the human resources director that the meeting will occur. 2. Include the chief nurse officer (CNO) in the session. 3. Ask a manager from another department to sit in on the meeting. 4. Discuss the issue, concentrate on the issue, and do not make it personal. Answer: 4 Explanation: 1. The HR director does not need to be included at this stage. 2. The CNO does not need to be included at this stage. 3. Asking another manager, even from a different department, to sit in on the meeting violates confidentiality. 4. The director should focus on the issues and not allow the discussion to become personal. The manager should be treated as any other manager would. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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25) An OB manager discusses a nurse's performance with the chief nurse officer (CNO). The CNO learns the nurse has had multiple client and physician complaints that the manager investigated and for which counseling was provided. The behavior continues even though the nurse has received verbal and written warnings. Which course of action would be most appropriate at this time? 1. Issue a written warning from the CNO. 2. Place the nurse on suspension pending a new investigation into the complaints. 3. Terminate the nurse. 4. Transfer the nurse to another department under another manager. Answer: 3 Explanation: 1. Written warnings have already been issued. There is no evidence that another warning will improve the nurse's performance. 2. The complaints have already been investigated. Suspension is not indicated. 3. Since these complaints have been ongoing, even after investigation, counseling, and warnings, termination is likely the best alternative. 4. Transferring the nurse to another department does not address the core issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-6: Identify the essential components of an equitable termination. 26) The hospital's new management company has assigned a "leadership coach" to groups of current nurse managers. Which statements made by a manager would the coach interpret as indicating the manager does not value this opportunity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Why do I need a coach?" 2. "I've been a manager longer than our coach has been a nurse." 3. "I'm getting burned out with the way we manage." 4. "Another new program to waste our time." 5. "Coaching has helped my nurses improve their practice." Answer: 2, 4 Explanation: 1. This question would allow the coach to list the benefits of coaching. It does not indicate that the nurse doesn't value the experience. 2. A statement like this may well indicate that the manager does not think that the coach has any information that will be of benefit. 3. A manager who is burned out with current methods may be very willing to learn new methods. 4. When people go into a program thinking it is a waste of time, they often do not see its value. 5. If the manager has seen improvement in practice as a result of coaching, the manager is more likely to have a positive attitude toward the program. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 20-2: Describe the essentials for effective coaching. TestBankWorld.org

27) The manager is contemplating terminating a nurse. What should the manager consider regarding the expectations of the job prior to proceeding with termination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Did the nurse receive and sign for a copy of the appropriate job description when hired? 2. Was the nurse apprised of the criteria on which evaluation would be based? 3. Have any changes to policy and procedure been discussed with the nurse and made available in writing? 4. Was the nurse hired using the same documentation as others hired at the same time? 5. Have others hired during the same time period been successful? Answer: 1, 2, 3 Explanation: 1. The manager must have documentation that the nurse knew the expectations of the job. Documentation that the nurse received the job description is required. 2. The nurse must be told in advance of the criteria on which evaluation will be based. 3. Changes to policy and procedures change practice. These changes must be made known to the staff. 4. Just because the documentation is commonly used doesn't make it legal or correct. 5. While the success of others hired at the same time is interesting, it is not essential knowledge for the manager. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 20-6: Identify the essential components of an equitable termination. 28) The manager has disciplined a nurse with a written warning. At the end of the session, the manager asks the nurse to sign the warning and the nurse refuses. What should the manager do? 1. Tell the nurse that signing the form in mandatory. 2. Indicate on the form that the nurse declined to sign. 3. Sign the nurse's name to the form and include the manager's initials. 4. Complete a second warning for the nurse's failure to follow procedure. Answer: 2 Explanation: 1. It is not mandatory for the nurse to sign the form. 2. The written disciplinary form should have an area to indicate that the employee refused to sign. If not, this should be written in by the manager. 3. The manager should not sign the nurse's name to the form. 4. A second warning is not indicated. The nurse has the right to refuse to sign the form. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 20-5: Apply the guidelines for progressive discipline.

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29) The manager has just terminated a nurse. What statement by the manager is appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You may go back to the unit to say good-bye to your coworkers." 2. "We have cleaned out your locker and have your personal belongings ready for you." 3. "I have notified security to escort you as you leave the building." 4. "As of this time, you are no longer an employee of this institution." 5. "Please do not discuss your termination with any other nurses." Answer: 3, 4 Explanation: 1. Directing the nurse back to the unit for good-byes is not a good idea. 2. The hospital should not be involved in cleaning out the employee's locker. 3. The terminated employee should be attended by the manager or by security at all times. 4. It must be very clear that termination has occurred and that the nurse is no longer an employee. 5. Once termination has occurred, the manager has no control over the employee's actions. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 20-6: Identify the essential components of an equitable termination. 30) A nurse is being terminated due to continued violation of hospital policy. What statements by the manager are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Your actions have been degrading to the profession." 2. "You may wish to resign rather than being terminated." 3. "Human resources will answer any questions you may have about benefits." 4. "I'm sorry you could not be happy here." 5. "You are being terminated for the policy violations I have just outlined." Answer: 2, 3, 5 Explanation: 1. The nurse manager should not make statements of opinion during the termination process. 2. In many cases, the nurse will choose to resign rather than being terminated. 3. The terminated employee may have rights to some benefits. The HR department should handle those questions. 4. The manager has no idea if the nurse was happy or not and should not be personally involved in the situation. 5. The manager should outline the violations that led up to the termination and should make it clear that the violations are the reason for the termination. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 20-6: Identify the essential components of an equitable termination. TestBankWorld.org

31) In order for coaching to be effective, the nurse must be what? 1. Able to understand coaching 2. Psychologically able to accept coaching 3. Able to follow up 4. Open to the process 5. Capable of changing performance Answer: 2, 4, 5 Explanation: 1. In order for coaching to be effective the nurse must be psychologically able to accept coaching, open to the process, interested in changing, motivated to improve performance, and capable of changing performance. 2. In order for coaching to be effective the nurse must be psychologically able to accept coaching, open to the process, interested in changing, motivated to improve performance, and capable of changing performance. 3. In order for coaching to be effective the nurse must be psychologically able to accept coaching, open to the process, interested in changing, motivated to improve performance, and capable of changing performance. 4. In order for coaching to be effective the nurse must be psychologically able to accept coaching, open to the process, interested in changing, motivated to improve performance, and capable of changing performance. 5. In order for coaching to be effective the nurse must be psychologically able to accept coaching, open to the process, interested in changing, motivated to improve performance, and capable of changing performance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 20-3: Contrast the differences between coaching and feedback. 32) ________ is the day-to-day process of helping employees evaluate and improve their performance. Answer: Feedback Explanation: Feedback is the day-to-day process of helping employees evaluate and improve their performance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 20-2: Describe the essentials for effective coaching.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 11 Delegating Successfully 1) The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation? 1. Instructing the charge nurse to assume a client team 2. Asking the charge nurse to discipline a nurse on the unit 3. Having the charge nurse lead a nursing quality assurance task force 4. Evaluating all unlicensed personnel assigned to the unit Answer: 3 Explanation: 1. Because assuming a client assignment is included in the charge nurse's job description, this is assignment, not delegation. 2. Disciplining a nurse on the unit is the responsibility of the manager. Discipline should not be delegated. 3. Delegation is the mutual transfer of responsibility and authority that occurs on the basis of competence and trust. The nurse manager can delegate both the responsibility of leading this task force and the authority to make decisions regarding this role. Both must be delegated for the delegation to be successful. 4. The process of evaluation is the responsibility of the manager, and this authority cannot be transferred to a delegate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-1: Explain delegation and distinguish between responsibility, accountability, and authority. 2) Which statement made by the nurse manager is an example of the first step of delegation? 1. "I must choose a person with good time management skills to be the delegate for this task." 2. "I plan to evaluate the outcomes of your work in 6 months." 3. "I am going to delegate the responsibility for creating the vacation schedule." 4. "I have some additional information that will help you in this task." Answer: 3 Explanation: 1. Choosing the person to delegate to can only be accomplished after the task to be delegated is identified and defined. 2. Information regarding the task, such as when it will be evaluated, is given to the delegate as part of the delegation process. This cannot be done until the task is defined and the delegate is chosen. 3. The first step of the process is to identify and define the task that will be delegated. 4. Additional information can only be offered when the delegate has been chosen, and the delegate can be chosen only after the task has been identified. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key TestBankWorld.org

behaviors for successful delegation, and the implications of accepting delegation. 3) The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation? 1. Effective delegation 2. Overdelegation 3. Reverse delegation 4. Underdelegation Answer: 2 Explanation: 1. Effective delegation is the process by which responsibility and authority for performing a task is transferred to another person. It is critical that the task is one that can be delegated. 2. Overdelegation occurs when the delegator loses control over a situation by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager that cannot be delegated because of the confidentiality and controversy associated with it. 3. Reverse delegation occurs when a person with a lower rank (unit secretary) delegates to someone with authority (nurse manager). 4. Underdelegation occurs when full authority and responsibility are not transferred in a situation where delegation would otherwise be appropriate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-1: Explain delegation and distinguish between responsibility, accountability, and authority. 4) The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request? 1. Defining the task 2. Deciding on the delegate 3. Determining the task 4. Reaching agreement Answer: 2 Explanation: 1. The task was defined but is inappropriate. 2. The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications. 3. The task was determined but is inappropriate. 4. The nurse and nurse assistant reached agreement, but the delegation was inappropriate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation. TestBankWorld.org

5) The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy? 1. Overburdening others 2. Decreased personal satisfaction 3. Increased liability 4. Competition and criticism Answer: 4 Explanation: 1. Even the novice nurse manager should realize that delegating is part of the role. 2. Fear of decreased personal satisfaction should be diminished by the increased opportunity to explore new challenges and gain other skills and experiences. 3. The novice nurse manager would not fear increased liability if delegating to competent, more experienced nurses. 4. The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. Fear exists that a successful delegate could threaten the nurse manager's credibility as a leader. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-3: Explain how following the five rights of delegation can reduce nurses' fears about delegation. 6) Which situation is an example of reverse delegation? 1. The nurse manager asks the staff nurse to attend an in-service on a new product. 2. The nursing supervisor asks the nurse manager to attend a meeting with the physicians. 3. The licensed practical nurse asks the nurse manager to administer insulin to a client. 4. The staff nurse asks the licensed practical nurse to record intake and output in his client's charts. Answer: 3 Explanation: 1. It is appropriate for a person with more authority (nurse manager) to delegate a task to someone with a lower rank (staff nurse). 2. It is appropriate for a person with more authority (nursing supervisor) to delegate a task to someone with a lower rank (nurse manager). 3. Reverse delegation occurs when someone with a lower rank (licensed practical nurse) delegates a task to someone with more authority (nurse manager). 4. It is appropriate for a person with more authority (staff nurse) to delegate a task to someone with a lower rank (licensed practical nurse). Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-1: Explain delegation and distinguish between responsibility, accountability, and authority.

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7) Which situation represents an obstacle to delegation? 1. Most of the nursing staff deliver highly skilled care. 2. The entire organization has a team-centered culture. 3. There is a budget shortfall for the current fiscal year. 4. Each employee knows and executes job responsibilities. Answer: 3 Explanation: 1. A staff that includes many competent nurses enables the nurse manager to delegate and still have other nurses to rely on to deliver quality nursing care. 2. Democratic leadership styles facilitate delegation and provide good role models. 3. Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation. 4. Environmental factors such as a norm of crisis management as a result of poor job descriptions and unclear chains of command are unsupportive to delegation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation. 8) The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement? 1. The nursing supervisor does not have time to delegate. 2. The nursing supervisor's job description needs to be redefined. 3. The nursing supervisor feels that he or she can do the job faster. 4. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities. Answer: 4 Explanation: 1. It is the responsibility of the supervisor to develop the staff. Failing to delegate is the time waster. 2. An effective manager's role is to develop staff in which such roles are delegated. 3. The fact that the nurse supervisor could do the job faster does not help to facilitate staff development. 4. Even though it may appear that these statements are straightforward and that the supervisor is just trying to save time, statements such as this often suggest a lack of trust and confidence in the abilities of the staff. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation.

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9) What action is necessary by a delegate accepting delegation? 1. Accept all aspects of the task delegated. 2. Assume the delegator will serve as a mentor. 3. Clarify the time line and expectations. 4. Realize the delegate and delegator share responsibility. Answer: 3 Explanation: 1. The delegate has the option to negotiate for those aspects of a task the individual feels can be accomplished. 2. The delegator may have no intention of mentoring the delegate. 3. It is important for the delegate to make sure the time line and expectations are clearly defined, and he or she may opt to outline the specifications in writing. 4. Accepting delegation means accepting full responsibility for the outcomes and the benefits or liabilities associated with a task. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-2: Describe how effective delegation benefits the delegator, the delegate, the unit, and the organization. 10) The staff nurse job description states that the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept? 1. Work assignment 2. Overdelegation 3. Ineffective delegation 4. Transfer of authority Answer: 1 Explanation: 1. This assignment reflects duties listed in the nurse's job description, so asking the nurse to attend a meeting is work assignment. 2. Overdelegation occurs when the delegator loses control over a situation by giving too much authority to the delegate. 3. Ineffective delegation occurs when authority and responsibility are given but the steps of effective delegation are not followed. 4. Assignments are a bureaucratic function and no transfer of authority occurs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-1: Explain delegation and distinguish between responsibility, accountability, and authority.

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11) Which statements would be important for the charge nurse to make when delegating a responsibility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 2. "I have assigned you to be the unit's representative because I don't have enough time to go." 3. "I think your attendance at the task force meeting will be a good reflection on our unit." 4. "I chose you to attend the meeting because it seems as though you have the lightest assignment." 5. "I would like you to be the unit's representative on the client education task force committee." Answer: 1, 3 Explanation: 1. Key behaviors in delegating tasks are describing the task and providing the delegate with the benefit gained for the task. 2. Delegating should be done for the right reasons and not to dump tasks for purely personal reasons. 3. Key behaviors in delegating tasks are describing the task as well as the benefits to be gained. 4. The delegate should be assigned because the task meets the delegate's abilities. 5. The delegator should make the delegate aware of the reason for and the benefits gained from the delegation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation. 12) In order to delegate, what must be present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 4. Responsibility for task completion on the part of the delegator 5. Authority of the delegate to accomplish the task as assigned Answer: 1, 2, 3, 5 Explanation: 1. The delegator and delegate share accountability to accomplish the task. 2. The delegator and delegate share accountability to accomplish the task. 3. The delegator must have the authority to assign the task. 4. The delegate takes on the responsibility for completion of the task. 5. Effective delegation transfers authority to the delegate to empower the delegate for success. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key TestBankWorld.org

behaviors for successful delegation, and the implications of accepting delegation. 13) Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses? 1. Higher job satisfaction 2. Greater confidence in skills 3. Higher client satisfaction 4. Increased time for other tasks Answer: 3 Explanation: 1. Higher job satisfaction occurs when delegation skills are improved, but this is not the most important outcome. 2. Effective delegation may result in greater confidence in skills, but this is not the most important outcome. 3. When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management. 4. If delegation skills improve, the delegator should have increased time for other endeavors. This is not the most important outcome of increasing delegation skills. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-2: Describe how effective delegation benefits the delegator, the delegate, the unit, and the organization. 14) The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place? 1. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital." 2. "The clients on our unit come and go so frequently that delegation is of little benefit." 3. "I just don't understand why people think delegation is difficult; all you have to do is tell other people what to do." 4. "Now I know that effective delegation means telling my nursing staff when they need to have their regular work done." Answer: 1 Explanation: 1. Delegation can benefit every level of the organization. 2. Delegation can be successfully used in any unit. 3. Delegation does not consist of just telling other people what to do. 4. The "regular work" of the staff is done by assignment, not delegation. Delegation is more than just telling staff when to have work done. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 11-2: Describe how effective delegation benefits the delegator, the delegate, the unit, and the organization. TestBankWorld.org

15) A nurse asks an unlicensed assistant to help with discharging clients because so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation? 1. The delegation is ineffective because the nurse has no responsibility to pack the client's belongings. 2. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed. 3. The delegation is ineffective because the nurse has no authority to ask the unlicensed assistant to help with client discharge. 4. Delegation could have more effective had the nurse gone with the assistant to ensure the assistant did the packing as requested. Answer: 2 Explanation: 1. The nurse has ultimate responsibility to ensure that the client is ready for discharge, which includes packing the client's belongings as necessary. 2. Effective delegation occurs when the delegator gives specific information to the delegate about the requested task. The nurse request in the stem was not specific enough. 3. The nurse has the authority to delegate this task to the unlicensed assistant. 4. There is no need for the nurse to go with the assistant to oversee the packing process. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation.

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16) The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse manager is inexperienced and needs time to adjust. 2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills. 5. The unit is short staffed. Answer: 2, 3, 4 Explanation: 1. There is nothing in this scenario to suggest that the nurse manager is inexperienced. 2. The unit clearly is having problems getting client responsibilities completed in a timely manner, resulting in stress and complaints. Reasons behind this might include distrust, poor communication, and a lack of delegation training. 3. When multiple client complaints are lodged against one unit, there is generally an overall problem with some aspect of the unit. 4. A lack of delegation training may result in chaos and client complaints. 5. There is no indication that the unit is short staffed. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation.

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17) Which statement represents a situation is which delegation is ineffective or inappropriate? 1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. 2. The RN delegates administration of oral medications for a group of clients to the LPN. 3. The LPN directs the unlicensed assistant to report vital sign changes on a postoperative client to the RN. 4. The nurse manager asks the RN to act as chairperson for today's unit council meeting because the charge nurse went home sick. Answer: 1 Explanation: 1. The RN is the only caregiver legally responsible for assessing clients. Thus, the RN cannot delegate this to the LPN, and this is an example of overdelegation. 2. It is within the LPN's scope of practice to administer oral medications. 3. The LPN can delegate tasks to the unlicensed assistant. Reporting vital sign changes to the RN is within the scope of an unlicensed assistant. 4. The nurse manager can delegate to the RN. An RN is a logical substitute for the charge nurse in this situation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation. 18) For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability? 1. The American Nurses Association Bylaws 2. The National Council of State Boards of Nursing 3. The regulations of the state nurse practice acts 4. The rules of the governing specialty organization Answer: 3 Explanation: 1. The ANA Bylaws do not set out legal rules or regulations for delegation. 2. NCSBN does not set the legal rules and regulations of delegation. 3. Nurses in each state are governed by their own state's nurse practice act, and these regulations must be consulted and followed. 4. Specialty organizations do not set the legal rules and regulations of delegation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation.

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19) Which situation indicates that the nurse needs additional training on effective delegation? 1. The charge nurse tells the unlicensed assistant to help prepare rooms for new clients. 2. The office nurse calls in orders for admission on a client following a surgical complication. 3. A rehabilitation nurse asks a physical therapy assistant to assist a client with ambulation around the facility. 4. A home health nurse calls the office and asks another nurse to make the visit to her next client. Answer: 2 Explanation: 1. The charge nurse can delegate the responsibility of preparing rooms to the unlicensed assistant. 2. Unless the office nurse is an advanced practice nurse, the office nurse cannot call in orders not signed off by a physician or nurse practitioner. This opens the organization up to problems with liability. 3. The physical therapy assistant is part of the rehabilitation nurse's team and can legally accept direction from that nurse. 4. A home health nurse might be delayed at a visit and need another nurse to visit the next client. It would be inappropriate for the nurse to ask an unlicensed assistant to make the visit. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation. 20) Which situations would cause concern about liability with regard to delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 3. The nursing assistant asks a nurse to check the status of a client on the team. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment. 5. The charge nurse asks a staff nurse's opinion on the client's surgical incision. Answer: 1, 2, 4 Explanation: 1. The LPN cannot usually work with central lines and cannot legally change the dressing for the RN. 2. Confidential information cannot be shared with individuals not directly involved in the client's care. Under normal circumstances, the nursing supervisor would not need information about a client's history. 3. It is acceptable for a nursing assistant to ask the nurse to check on a client. 4. Requesting that a nurse be given a difficult assignment is leaving the organization open to liability issues. 5. It is common and acceptable for nurses to ask other nurses for consultation on client care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation. TestBankWorld.org

21) A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement? 1. There is no way for the nurse to know how to organize until the assignment is clear. 2. The nurse manager would not make assignments. 3. The nurse manager is not delegating but rather making daily assignments. 4. Assignment occurs after shift report. Answer: 3 Explanation: 1. Organization takes many forms and is different for every nurse. Some nurses may use the time prior to shift report to organize. 2. Depending on the structure of the unit, assignments may be made by the charge nurse or the nurse manager. 3. Assignment is a bureaucratic function that reflects job descriptions and client or organizational needs. Daily work allotment from nurse manager to staff nurse is an assignment, not delegation. 4. Team assignments occur prior to shift report. In some institutions, all nurses working on the unit listen to shift report on all clients. In other institutions, the nurse receives report only on the assigned team. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-1: Explain delegation and distinguish between responsibility, accountability, and authority.

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22) A healthcare organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 3. Delegation is required by state boards of nursing. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity. Answer: 1, 2, 4, 5 Explanation: 1. When delegation is appropriate, work gets done in a timely manner and overtime decreases. 2. Delegation helps get work done efficiently and effectively. Absences tend to decrease in this environment. 3. Delegation is permitted by state boards of nursing, but it is not required. 4. Delegation results in care that is efficient and effective. Efficient and effective care results in increased patient satisfaction. 5. Delegation results in each part of the team working at their designated skill level. Nurses are not doing tasks that could be done by assistants. This results in increased productivity. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-2: Describe how effective delegation benefits the delegator, the delegate, the unit, and the organization.

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23) During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency is increased by effective delegation. 3. If the manager has more time to focus on managerial duties, there is more chance of career advancement. 4. The nurse manager thinks unlicensed assistive personnel (UAPs) provide better bedside care than nurses do. 5. The manager is interested in developing the entire staff to its maximum potential. Answer: 1, 2, 3, 5 Explanation: 1. The manager may be able to delegate some tasks to nurses if the nurses are not overloaded with client care that could be completed by UAPs. 2. If delegation is done effectively, unit efficiency is increased. 3. If the manager can get more done because delegation is effective, there is a greater chance for career advancement. 4. There is no evidence that this is the case. 5. Development is stifled when the staff members are doing the wrong tasks. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-2: Describe how effective delegation benefits the delegator, the delegate, the unit, and the organization. 24) A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task? 1. Do other nurses in the facility delegate similar tasks? 2. How long has the assistant worked at the facility? 3. Does this task involve nursing judgment? 4. How busy is the delegate? Answer: 3 Explanation: 1. Whether or not other nurses delegate similar tasks is not as important as another question. 2. Experience is important, but is not the most important question. 3. The nurse should not delegate tasks that involve nursing assessment or judgment. 4. The nurse should consider if the delegate has sufficient time to complete the task, but this is not the most important consideration. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-3: Explain how following the five rights of delegation can reduce nurses' fears about delegation. TestBankWorld.org

25) The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work? 1. A nurse manager 2. A staff nurse 3. A licensed practical nurse 4. An unlicensed nursing assistant Answer: 4 Explanation: 1. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 2. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 3. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 4. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation. 26) Which situations are examples of the nurse directing rather than delegating? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse manager asks a staff nurse to participate in a standing hospital committee. 2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an IV. 4. A nurse tells an assistant to move a client into the hallway during severe weather. 5. A nurse reminds assistants of standard protocol for evacuation in case of fire. Answer: 2, 3, 4 Explanation: 1. This is delegation. 2. This situation is a crisis, so this is direction. 3. This is a crisis situation, so this is direction. 4. This is a crisis situation, so this is direction. 5. Because this crisis is not occurring, this is delegation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-3: Explain how following the five rights of delegation can reduce nurses' fears about delegation.

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27) A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Begin the instruction with a statement such as "It would be good if you could help me with this project." 2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in an email. 4. Introduce the generalities of the task with a promise that details such as a time line will follow shortly. 5. Discuss the importance of the task to the organization. Answer: 2, 3, 5 Explanation: 1. The manager should use a more direct "I" statement such as, "I need for you to take the lead on this project." 2. Eye contact helps to ensure that the secretary is attending to the information presented. 3. Face-to-face communication will be necessary for explanation and questions. 4. It is important to have all the critical information available so that the delegate can make a logical decision about the task. 5. It is important to let the delegate know the importance of the task. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation.

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28) The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'll be glad to work on this task." 2. "I will need some education on the accreditation process before I can accept this task." 3. "I don't have time to add that to my work." 4. "Please tell me more about what this assignment entails." 5. "I'm not interested in working on this project." Answer: 2, 4 Explanation: 1. The manager should not accept a task until it is clear. 2. The manager should be clear about not having the required skill set but should indicate willingness to take the job if education is provided. 3. The problem is that the manager is not confident of his or her skills, not that time is unavailable. 4. The manager should clarify the task before accepting or refusing it. 5. Working on accreditation would help this nurse manager in career advancement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation. 29) A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern? 1. "You have lots of liability in your position as an RN." 2. "The hospital will support you as long as you follow your job description." 3. "You are at greater liability if you try to do everything yourself." 4. "As long as you follow the five rights of delegation, your liability is minimal." Answer: 4 Explanation: 1. The RN does have liability associated with job responsibilities, but if delegation is done correctly, liability is minimized. This response is not supportive of the RN's need to delegate. 2. Hospital support is never a given when liability situations occur. This is not a response that would be supportive of the nurse's need to delegate. 3. This is not necessarily an accurate statement. 4. The five rights of delegation outline accepted measures to take when delegating tasks. If these rights are followed, the nurse has fulfilled job responsibilities. The delegate is responsible for his or her own care. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-3: Explain how following the five rights of delegation can reduce nurses' fears about delegation. TestBankWorld.org

30) Which situations are examples of ineffective delegation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. 3. The nurse manager asks the staff nurse to collect information about a new type of hospital bed being considered for purchase. 4. The staff nurse asks the UAP to provide simple discharge instructions to a client. 5. The staff nurse often bathes clients because "I like to give bed baths." Answer: 1, 2, 4, 5 Explanation: 1. The purpose of delegating attendance to a staff nurse is so the manager will not need to attend the meeting. When the manager does attend, the staff nurse's position is diminished. This is an example of underdelegation. 2. When someone of lower rank, in this case the unit clerk, delegates a task to someone of higher rank, in this case the nurse manager, a situation of reverse delegation has occurred. This is ineffective delegation. 3. The nurse manager has asked someone of lower rank to complete a task that is within that person's capabilities. This is effective delegation. 4. Provision of education requires nursing knowledge and judgment and cannot be delegated to a UAP. This is an example of over-delegation. 5. Bathing clients can be delegated to staff of lower rank. If the nurse is giving the bath for assessment purposes, this lack of delegation would be appropriate. If the nurse is not delegating baths because "I like to give bed baths," the lack of delegation is inappropriate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 11-5: Assess the factors that contribute to ineffective delegation.

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31) An RN prepares for the day and makes a list of what should be delegated to the LPN. Which tasks should the nurse delegate to the LPN? 1. Assess a surgical incision. 2. Turn and reposition the client with a decubitus ulcer every two hours. 3. Dressing change and assessment of newly debrided wound. 4. Assessment two new admissions. 5. Administer all oral medications to clients on the unit. Answer: 2, 5 Explanation: 1. Assessment is a responsibility for the RN. 2. The LPN is permitted to turn and reposition the patient with an ulcer. 3. Although the LPN is permitted to change dressings, the RN is responsible for assessment. 4. Assessment is a responsibility for the RN. 5. The LPN is permitted to administer oral medications. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation. 32) The RN plans to delegate responsibility of client care to a certified nursing assistant (CNA). 1. Assist a client to shower. 2. Start an IV. 3. Administer oral medications. 4. Take vital signs. 5. Discontinue an IV. Answer: 1, 4 Explanation: 1. The CNA is permitted to help clients with activities of daily living. 2. The CNA is not permitted to start IVs. 3. The CNA is not permitted to administer oral medications. 4. The CNA is permitted to collect vital signs. 5. The CNA is not permitted to discontinue IV's. The tip of the catheter must be assessed by the RN. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 11-4: Evaluate the delegation process, including the steps in delegation, key behaviors for successful delegation, and the implications of accepting delegation.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 12 Building and Managing Teams 1) A newly hired nurse is asked to join a group working on unit protocols. This nurse is verbal and dominates the conversation of the group. The group leader identifies the disruption this nurse causes as being from which phenomenon? 1. Status incongruence 2. Group isolates 3. Emergence 4. Deviation Answer: 1 Explanation: 1. Status incongruence means that the status of the newly hired nurse is not congruent with being a dominant player in the group. Status in the group is determined by conforming to group norms that often include higher status for those who have worked in the group for a longer time. 2. Isolates are generally those who have a higher external status than other group members and who do not fit the group profile. 3. Emergence is not a word used to describe these group dynamics. 4. Deviation is not a word used to describe these group dynamics. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 12-1: Describe how groups and teams function. 2) The nurse manager asks staff members to work as a group in planning the activities for Nurses' Week. The nurse manager should report to the supervisor that which type of group has been formed? 1. Command group 2. Task group 3. Competing group 4. Informal group Answer: 2 Explanation: 1. A command group accomplishes routine tasks in an organization and is designed to meet a specific mission of the organization. This group is a legitimate organizational entity. 2. The purpose of a task group is to deal with specific issues involving a specific need within a given time limit. Because this group is working on "Nurses' Week," the project is time limited. 3. A competing group's members compete with each other for resources to perform their tasks or compete for recognition. 4. An informal group evolves naturally from social interactions and is not defined by an organizational structure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 12-1: Describe how groups and teams function. TestBankWorld.org

3) While providing continuing education about group dynamics and team building, the nurse manager attempts to explain the difference between a group and a team. Which statement by the manager is most effective? 1. A team is bigger than a group. 2. Teams have authority; groups may be informal. 3. A group has similar goals, whereas a team's goals are dissimilar. 4. Groups are formally designated by the organization, while teams are generally informally organized. Answer: 2 Explanation: 1. Size is not the deciding factor between a group and a team. 2. Teams have a designated task and line authority. Groups may be either formal or informal. 3. Teams have similar goals. Groups may have similar goals or may consist of individuals who perform tasks independently of each other. 4. Teams are created by the organization. Groups may be formally created by the organization or may be informal and not recognized by the organization. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 12-1: Describe how groups and teams function. 4) The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is designed to meet organizational goals, is which type of group? 1. Competing group 2. Command group 3. Task force 4. Informal group Answer: 2 Explanation: 1. In a competing group, members compete with each other for resources to perform their tasks or compete for recognition. 2. The purpose of a command group is to accomplish tasks in an organization, and these groups are recognized as legitimate organizational entities. 3. A task force has a focus with a specific time-limited assignment. 4. An informal group evolves from social interactions that have no organizational structure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-1: Describe how groups and teams function.

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5) During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of the group. These behaviors are characteristic of which stage of Homans's group process? 1. Norming 2. Storming 3. Performing 4. Forming Answer: 4 Explanation: 1. Norming occurs in the third stage of Homans's group process and is characterized by the definition of the goals and rules of behavior. 2. Storming occurs when the group members wrestle with roles and relationships and conflict arises. 3. Performing occurs in the fourth stage of Homans's group process; the group members communicate and cooperate. 4. Forming occurs in the initial stage of the group process; the members are cautious in approaching each other as they come together as a group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 12-1: Describe how groups and teams function. 6) The leader of the task force group announces that tentative plans for Nurses' Week activities have been approved by the hospital administration. The task force has also been given a new task of developing criteria for the nursing awards. What must the group accomplish now? 1. Forming 2. Adjourning 3. Rebuilding 4. Re-forming Answer: 4 Explanation: 1. Forming occurs in the initial stage of group development when members are meeting for the first time. 2. Adjourning occurs when the group dissolves its membership after achieving its objectives. 3. In the rebuilding stage, the group membership remains unchanged although new goals have been established. 4. In the re-forming stage, the group must refocus its activities and recycle through the four stages. The leader explains the new direction and provides guidance in the process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 12-1: Describe how groups and teams function.

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7) In a group meeting, one of the members always arrives early and places the chairs in a circle so all members can interact. This person is responsible for confirming that the room is available for the monthly meetings. Which person does this describe? 1. Gatekeeper 2. Procedural technician 3. Coordinator 4. Initiator-contributor Answer: 2 Explanation: 1. The role of the gatekeeper is to encourage all group members to communicate and participate. 2. The role of the procedural technician is to support group activities by arranging the environment and providing necessary tools. 3. The role of the coordinator is to link ideas or suggestions offered by others. 4. The initiator-contributor's role is to redefine problems, offer solutions, clarify objectives, suggest agenda items, and maintain time limits. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-1: Describe how groups and teams function. 8) The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will assume responsibility for developing the mission and goals of the group." 2. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 3. "I realize there will be dissension; however, I prefer that we not take time from our agenda to address it." 4. "The meeting will be called to order at noon and be adjourned in 1 hour." 5. "It is important that each of you is fully engaged in the decision-making process." Answer: 2, 4, 5 Explanation: 1. Because this is a command group, the mission and goals are set by the organization. 2. The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. 3. An effective leader elicits the expression of dissenting opinions. 4. The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. 5. Group cooperation and engagement should be promoted. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. TestBankWorld.org

9) A nurse manager is focused on team-building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the group's context? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "How well has this group been able to relate to similar groups across the organization?" 2. "What are the group's current goals?" 3. "How have the members organized the group?" 4. "What is the general culture of the group?" 5. "How complex is the job the group has been assigned?" Answer: 2, 3, 4 Explanation: 1. Knowing how well members relate to other groups is important but is not a part of the group context. 2. Goals are a part of the group context. 3. Organizational structure is part of the group's context. 4. It is important to assess the culture of the group, which is part of its context. 5. Job complexity is important but is not part of the group context. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collaboration Learning Outcome: 12-3: Describe various methods of team building. 10) Which statement may reveal that the team member making the comment has a hidden agenda? 1. "I don't understand the second of the goals we are discussing." 2. "Are we voting on this outcome or has it already been decided?" 3. "I have to remember to add membership on the team to my resume." 4. "Are there other teams working on similar projects on other units in the hospital?" Answer: 3 Explanation: 1. Clarification of information not understood is not evidence of a hidden agenda. 2. Clarification of the processes of the team is not evidence of a hidden agenda. 3. Concern over adding items to one's resume could indicate that the team member is more interested in personal achievement than in the goals of the team. 4. Understanding the relationship between the team and other units in the organization is not a sign of a hidden agenda. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 12-2: Explain the norms and roles in groups and teams.

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11) A nurse manager has just posted the membership list for a newly formed quality management task force. Which statement, overheard by the manager, indicates the most potential for problems on the team? 1. "I'm glad I didn't get chosen for this task force. I'm so busy with my kids right now." 2. "I was on one of these teams at my last hospital." 3. "This is certainly an interesting choice of people to put together." 4. "She is such a good nurse; I hope she doesn't work herself too hard." Answer: 3 Explanation: 1. It would have been more detrimental to the group to have a member assigned who does not have adequate time to participate. 2. Although it might be good to have an experienced person on the team, this statement does not indicate a potential problem. 3. This statement may reveal that members assigned to the team have problems working together. The manager should be watchful for any personality issues that might arise. 4. Everyone who is assigned to a team is at risk of overworking. This is not the most concerning of the statements. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 12-2: Explain the norms and roles in groups and teams. 12) A task force leader says, "At the beginning of our next meeting, we are going to do some team-building exercises." Which comment by a group member indicates a need for further education about team building? 1. "I don't see anything wrong with the way our team works. Why do we have to go through team building?" 2. "That should help us meet the goals we have written." 3. "I did some team-building work a long time ago. I probably need a refresher." 4. "I hope the men on our task force will cooperate." Answer: 1 Explanation: 1. Team-building exercises were originally used to improve interpersonal workplace relationships and this group member may still think of them in that vein. 2. Team building is a method to improve a group's chances of meeting its goals. 3. Team-building skills can be learned, but they must be reinforced on the job. 4. Research indicates that female students in medicine and nursing are more open-minded about cooperating with other health professionals compared to their male counterparts. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 12-3: Describe various methods of team building.

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13) Hospital administration has elected to use TeamSTEPPS as a method of team building. What should the nurse manager tell staff about this training? 1. "This program was developed by a nurse to use specifically in small hospitals." 2. "Teams of nurses will be sent to national training seminars." 3. "You can expect additional efforts to help us keep on track." 4. "This is a simulation-based training similar to the old disaster drills we used to do." Answer: 3 Explanation: 1. This program was developed by the Department of Defense and the Agency for Healthcare Research and Quality. 2. Training in TeamSTEPPS is done on-site. 3. Sustainability is a part of this framework. 4. TeamSTEPPS is not like the old disaster drills of the past. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 12-3: Describe various methods of team building. 14) The nurse manager has been asked to assemble several groups to work on tasks to improve the unit's performance and client satisfaction scores. This manager would put the fewest people in a group working on which type of task? 1. Additive 2. Disjunctive 3. Divisible 4. Conjunctive Answer: 4 Explanation: 1. In an additive task, the group performance depends on the sum of individual performances, so the more members, the better. 2. In a disjunctive task, the group succeeds if one member succeeds, so more members give a better chance for one person to succeed. 3. A divisible task is one that can be broken down into subtasks with division of labor, so more people provide a greater opportunity for specialization and interdependence in performing the task. 4. In a conjunctive task, the group succeeds only if all of the members succeed, so it makes more sense to have fewer members on the team. However, the members should be highly qualified for the work. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 12-4: Discuss factors that influence team management.

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15) A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses who each have 7 to 8 years of experience 2. Nurses who work on different units throughout the hospital 3. Staff nurses who are interested in learning about the task of the group 4. Staff nurses who work with one another on a daily basis 5. Staff nurses who are all between 35 and 40 years of age Answer: 1, 3, 4, 5 Explanation: 1. This group has similar backgrounds, which will likely mean they have shared values regarding nursing. 2. Working in proximity with the others increases cohesiveness. 3. People who have specific needs that can be satisfied by involvement with the group are more cohesive. 4. Those who must interact to achieve their goals and tasks are likely to be cohesive when working in a group. 5. Similarity in age increases cohesiveness. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 12-4: Discuss factors that influence team management. 16) Which situation best exemplifies the nurse manager as a team leader? 1. The nurse manager posts the unit's positive accomplishments from the past month in the break room. 2. The nurse manager controls the staff meetings so the staff can get back to work quickly. 3. Every year the nurse manager does staff member evaluations to determine pay raises. 4. The nurse manager encourages conjunctive task performance on the unit. Answer: 1 Explanation: 1. Building the team up by praising team accomplishments best exemplifies the nurse manager as team leader. 2. Controlling staff meetings in the interest of time does not exemplify team leadership. 3. The nurse manager routinely does individual performance evaluations. As team leader, the nurse manager would evaluate the performance of the team. 4. Encouraging conjunctive task performance (all or none have success) does not exemplify team leadership but rather tends to foster individualization. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-5: Explain why the nurse manager's leadership skills are essential to team performance.

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17) Which activities are expected from the nurse manager as team leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Offering constructive criticism 2. Settling all employee conflicts 3. Encouraging group discussions 4. Facilitating group processes 5. Fostering team dependence Answer: 1, 3, 4 Explanation: 1. The nurse manager is expected to evaluate the outcomes of the team and to offer constructive criticism about needed improvement. 2. The nurse manager as team leader would not settle all conflicts but should be aware of most and should get involved when necessary. 3. The nurse manager encourages group discussion. 4. The leader's influence on group processes may be the determining factor in whether or not the group is effective. 5. Fostering interdependence is more appropriate for the team leader because it creates cohesiveness among members. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-5: Explain why the nurse manager's leadership skills are essential to team performance. 18) The nurse is acting as team leader for a client care conference. Which opening statement is best for this meeting? 1. "We are all here to discuss the issues with this client's discharge. What issues are we facing?" 2. "The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge." 3. "I don't really have time for this meeting today; is there anything I can do to expedite this meeting?" 4. "I will let you all decide what might be best, as I am not really as familiar with this client as I should be." Answer: 2 Explanation: 1. The team leader should arrive at the meeting prepared to discuss the issues, not to find out what issues exist. 2. The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference. The team leader should know the issues with the client and be able to facilitate the meeting by listing those issues. 3. The leader should be willing to give sufficient time to the team to achieve the stated goals. 4. The team leader should be familiar with the client and the issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership TestBankWorld.org

Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. 19) This is the first meeting of a task force. What should be the leader's primary objective of this meeting? 1. Determining when the task force has to complete the assignment 2. Identifying the expected outcomes in terms of measurable objectives 3. Asking members if they have time to serve on the task force 4. Establishing a standard of total participation Answer: 4 Explanation: 1. The leader should also already have an idea of when the task must be completed. 2. The leader must clarify the objectives in specific measurable outcomes prior to the first meeting. 3. Task force members should be selected on the basis of their knowledge, skills, personal concern for the task, time availability, and organizational credibility. These attributes should have been considered prior to the first meeting. 4. During the first meeting, a standard of total participation should be established. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. 20) Which ground rule statements by the leader will help the group meeting stay on task and on time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We will wait until everyone who is going to attend is here before we call the meeting to order." 2. "We will always meet on the second Wednesday of the month at 1:00 p.m. because this is the time all members have indicated is most convenient." 3. "If you have information to distribute for discussion, please bring a copy for every member." 4. "We will limit verbal participation to designated key members each week." 5. "You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting." Answer: 2, 5 Explanation: 1. The meeting should start promptly when scheduled, even if some members have not arrived. It should start and end on time. 2. The team leader should arrange to meet in a convenient but quiet place to minimize interruptions and distractions. 3. Meeting time should not be used for reading information that could have been distributed earlier. This material should be distributed at least a week to 10 days before the meeting. 4. Everyone, not just "key players," should be encouraged to discuss issues during the meeting. 5. The meeting agenda should be distributed at least 1 week in advance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership TestBankWorld.org

Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. 21) A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The group manager has line authority in relation to the group members individually. 2. The group manager has line authority in relation to the other nurses in the group, but not in relation to the other disciplines in the group. 3. The group manager has no line authority in this group. 4. The group manager has line authority in relation to all members of the group except the physician. 5. The group manager has line authority in relation to all member of the group collectively. Answer: 1, 5 Explanation: 1. The manager of a group has line authority within that group. The authority extends to individual members and to the members collectively. 2. The group manager has line authority in relation to all members of the group. 3. The group manager has line authority in relation to all members of the group. 4. The group manager has line authority in relation to all members of the group. 5. The group manager has line authority in relation to the group members as a group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 12-4: Discuss factors that influence team management. 22) A staff nurse has been appointed to a task force. What can the nurse expect regarding this group? 1. There will be no official leader for the group. 2. The nurse will be working with people from several different departments within the hospital. 3. The assignment will be time limited. 4. The group members will compete for resources for their own units. Answer: 3 Explanation: 1. Task forces may or may not have a leader. 2. Task groups are generally limited to a specific service area. 3. A task group is charged with accomplishing a specific time-limited assignment. 4. Task groups are not competing groups. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 12-1: Describe how groups and teams function.

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23) A nurse manager is using Homans's framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another. 3. Compare the group to a similar group from the last accreditation cycle. 4. Review the group's final report. 5. Ask a team member how the work of the group is proceeding. Answer: 1, 2, 5 Explanation: 1. Activities are an essential component of a group system that should be evaluated. 2. Interaction is an essential component of a group system that should be evaluated. 3. The essential elements of Homans's framework are activities, interaction, and attitudes. Comparing to a previous group would give little information on any of these aspects of group dynamics. 4. If the group has completed its work, team building is no longer a consideration. 5. Team member attitudes are one of the three elements of Homans's framework. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 12-3: Describe various methods of team building.

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24) A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting, the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 3. Other group members will quietly complete the noncompliant member's work. 4. The remainder of the group will ignore the noncompliant member. 5. The group members will extend patience and understanding to the noncompliant member. Answer: 1, 2, 4 Explanation: 1. If rational argument does not work, group members may resort to manipulation of the deviant member. 2. When lack of compliance increases or slows the remainder of the group, attacks are likely to occur. 3. Group members are not likely to do the work assigned to another member. 4. This ignoring behavior is a final step of frustration with the noncompliant member. 5. Patience and understanding will be extended only for a little while before the other group members result to strategies that are neither patient nor understanding. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-1: Describe how groups and teams function. 25) The nurse manager has completed a series of team-building exercises with a command group. Which statement by a group member indicates that cohesiveness is occurring? 1. "I think I understand the work of the group now." 2. "I have gotten to know my group members better during these exercises." 3. "We have so much work to do in this group." 4. "I like the members of the group." Answer: 3 Explanation: 1. Understanding the work is not an indicator of cohesiveness. 2. Just getting to know the group members is not the same as feeling cohesive with them. 3. A "we" statement indicates that the group member feels like a part of a cohesive group. 4. Liking the members of the group does not necessarily indicate cohesiveness. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 12-2: Explain the norms and roles in groups and teams.

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26) A nursing group cannot complete a task assignment because information from another group has not been provided. Because the nursing group cannot complete its task, a group from physical therapy will not be able to complete its task. This is an example of breakdown in which task format? 1. Pooled interdependence 2. Sequential interdependence 3. Reciprocal interdependence 4. Reverse interdependence Answer: 2 Explanation: 1. In polled interdependence, each individual (or individual group) contributes, but no one contribution is dependent on any other. 2. In sequential interdependence, activities must be coordinated with others in a designated order. 3. In reciprocal interdependence, members must coordinate their activities with every other individual in the group. 4. Reverse interdependence is not a type of group interdependence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 12-1: Describe how groups and teams function. 27) In which situation would a "meeting before the meeting" be advisable? 1. The nurse is managing a standing committee on the unit. 2. The nurse is meeting with a social group to establish a plan for weight loss by walking. 3. The nurse has written information to distribute to members before the meeting. 4. The nurse expects the disagreement that started in the last meeting to carry over into this meeting. Answer: 4 Explanation: 1. There is no apparent reason to have a meeting before this meeting. 2. There is no apparent reason to have a meeting before this meeting. 3. This information could be distributed in a number of ways other than by having a meeting before the meeting. 4. If there was dissention in the last meeting that may affect this meeting, a meeting before the meeting may be necessary. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 12-5: Explain why the nurse manager's leadership skills are essential to team performance.

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28) The group leader often arrives several minutes late to meetings with excuses about workload, telephone calls, or traffic. Today's meeting was scheduled to begin 5 minutes ago, and the leader has not arrived. What should the group members do? 1. Call the leader's cell phone to see when arrival is expected. 2. Wait until the leader is 10 minutes late and then cancel the meeting. 3. One of the members should start the meeting. 4. Wait for the leader to arrive. Answer: 3 Explanation: 1. Calling the leader's cell phone reinforces the lateness behavior. 2. Canceling the meeting because the leader is late is a passive-aggressive action. 3. The work of the committee should not be delayed because the leader is late. One of the members should begin the meeting. 4. The work of the committee should not be delayed because the leader is late. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. 29) The work of a task force is completed, and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Plan on the leader presenting the report to administrators. 2. Share the report with the full task force prior to presenting it to administrators. 3. Send the report to administrators by email. 4. Brief key administrators regarding the report prior to the administrative presentation. 5. Print and bind the presentation in a professional manner prior to presenting it to the full task force. Answer: 2, 4 Explanation: 1. It is often desirable for a few task force members with differing expertise to participate in this presentation. 2. The full task force should have an opportunity to review and comment on the report draft before it goes to the administration. 3. The report should be presented to administrators in person. 4. The leader should meet with key administrators to bring particularly important findings or recommendations to light prior to presenting the report to the full administrative panel. 5. The document presented to the full task force should be legible, but it should be a draft. Professional printing and binding should occur after the draft is finalized. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences.

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30) A nurse manager has been appointed leader of a large task force charged with a complex assignment. What strategies should the manager use? 1. Limit full task force meetings to an initial meeting, a middle meeting, and a final meeting. 2. Lead one of the subgroups established at the first full task force meeting. 3. Develop a work plan with interim deadlines. 4. Set deadlines that are at least 1 week earlier than necessary to give subgroups time to be late. Answer: 3 Explanation: 1. Because this is a complex assignment, full task force meetings should be held more often to assure the work is progressing. 2. The leader should avoid becoming too closely aligned with one subgroup. 3. This work plan will be necessary to keep all subgroups on task. 4. Timelines should be realistic and firm. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 12-6: Discuss how to lead groups, task forces, and patient care conferences. 31) Growth and maintenance of a group is facilitated by nurturing roles. Which roles characterize nurturing roles? 1. Follower 2. Encourager 3. Energizer 4. Harmonizer 5. Gatekeeper Answer: 1, 2, 4, 5 Explanation: 1. Nurturing roles include follower, encourager, harmonizer, and gatekeeper. Energizer is a task role. 2. Nurturing roles include follower, encourager, harmonizer, and gatekeeper. Energizer is a task role. 3. Nurturing roles include follower, encourager, harmonizer, and gatekeeper. Energizer is a task role. 4. Nurturing roles include follower, encourager, harmonizer, and gatekeeper. Energizer is a task role. 5. Nurturing roles include follower, encourager, harmonizer, and gatekeeper. Energizer is a task role. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 12-2: Explain the norms and roles in groups and teams.

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32) The manager is preparing to integrate TeamSTEPPS on the unit. TeamSTEPPs involves which phases? 1. Training on site 2. Assessing need 3. Designing implementation 4. Increasing efficiency 5. Implementing and sustaining training Answer: 1, 2, 5 Explanation: 1. TeamSTEPPs phases include assessment of need, training on site, and implementing and sustaining training. 2. TeamSTEPPs phases include assessment of need, training on site, and implementing and sustaining training. 3. TeamSTEPPs phases include assessment of need, training on site, and implementing and sustaining training. 4. TeamSTEPPs phases include assessment of need, training on site, and implementing and sustaining training. 5. TeamSTEPPs phases include assessment of need, training on site, and implementing and sustaining training. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 12-4: Discuss factors that influence team management.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 13 Handling Conflict 1) The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses' concerns in favor of the doctors' concerns. Which strategies would facilitate this outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Accommodating 2. Compromising 3. Smoothing 4. Collaborating 5. Competing Answer: 4, 5 Explanation: 1. Accommodating is an unassertive tactic used when individuals neglect their own concerns in favor of others' concerns. 2. In a compromise, neither party gets what they want. 3. Smoothing is usually only effective for small problems and does not protect the interests of one party against the other. 4. Collaborating focuses on solving the problem and satisfying both parties' concerns. 5. Competing is a victory for one side and a loss for the other. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 13-3: Describe approaches that can be used to manage conflict.

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2) The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept? 1. Intrapersonal conflict 2. Interpersonal conflict 3. Intragroup conflict 4. Intergroup conflict Answer: 1 Explanation: 1. Intrapersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one individual. In this case, the nurse's conflict is between personal plans and the need to help alleviate the low staffing issue. 2. Interpersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs between two or more individuals. 3. Intragroup conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one group. 4. Intergroup conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs between two or more groups. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 3) The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy? 1. Integrative decision making 2. Win-lose strategy 3. Accommodation 4. Consensus Answer: 4 Explanation: 1. Integrative decision making is a strategy that focuses on the process of decision making, not the outcome. 2. Win-lose strategies allow one party to win and the other to lose. 3. Accommodation is an unassertive strategy used when individuals neglect their own concerns in favor of the other party's concerns. 4. Consensus occurs when the problem is fully explored, the needs and goals of both parties are addressed, and a mutual decision is made. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. TestBankWorld.org

4) The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management? 1. "We need to clearly define the nature of the conflict." 2. "I will evaluate the outcomes of our strategies on a monthly basis." 3. "Let's create a timeline for the implementation of our strategies." 4. "Hopefully, each group can understand each other's perceptions of the issue." Answer: 2 Explanation: 1. Defining the nature of the conflict is a part of assessment. Assessment is the first step of conflict management. 2. In any situation, the nurse manager should use the nursing process to intervene. The final step of the nursing process is evaluation, which is reflected in the statement, "I will evaluate the outcomes…." 3. Creating a timeline for the implementation of strategies is an intervention, which is one of the middle steps of conflict management. 4. Understanding each other's perceptions is part of assessment, which is the first step of conflict management. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 5) The staff nurses and nursing administration are attempting to construct a method of scheduling that meets the needs of both the clients and the nursing personnel. Because nurses and nursing administration have experienced conflict about the issue, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify? 1. Negotiation 2. Accommodation 3. Forcing 4. Consensus Answer: 1 Explanation: 1. Negotiation involves a reciprocal "give and take" on issues among the parties. The desired outcome is to achieve agreement even though consensus will never be reached. 2. Accommodation is a cooperative tactic used when the desired outcome is to preserve harmony when one party has a vested interest in an issue that is unimportant to the other party. 3. Forcing is an inappropriate mode of responding to conflict, and even though a solution is found, the conflict remains unresolved. 4. Consensus implies that the solution meets everyone's needs, which is often not the case in negotiation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Professional Practice Evaluation Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. TestBankWorld.org

6) A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict? 1. Competitive 2. Role 3. Perceived 4. Disruptive Answer: 4 Explanation: 1. Competitive conflict occurs when there is a positive outcome for one side and a negative outcome for the opponent. 2. Role conflict occurs when people have related responsibilities that may overlap and are ambiguous. 3. Perceived conflict occurs when two parties misunderstand each other's position and is often the result of a knowledge deficit. It does not necessarily result in irrational behavior. 4. Both parties are engaged in activities to reduce, defeat, or eliminate the opponent, which result in irrational, unproductive behavior. This is disruptive conflict. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 7) The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a "we-they" distinction on the unit. This is an example of which phenomenon? 1. Distancing 2. Suppression 3. Group withdrawal 4. Unification Answer: 1 Explanation: 1. Distancing mechanisms, or differentiation, serve to divide group members into small, distinct groups, which increases the risk for conflict. 2. Suppression occurs when one group defeats the other. Only the dominant side is fully committed to the decision. 3. Withdrawal occurs when one group simply removes itself from the conflict. 4. Unification implies understanding and acceptance among members, which would not occur in a conflict situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 13-2: Describe the conflict process.

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8) A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider? 1. Address the conflict in the break room. 2. Make a timely decision regarding if and when to intervene. 3. Accept full responsibility for developing a solution. 4. Redirect expressions of disagreement between the participants. Answer: 2 Explanation: 1. It is generally best to address conflict management in a neutral and confidential territory. 2. Conflict management begins with a decision regarding if and when to intervene. Failure to intervene can allow the conflict to escalate, whereas premature intervention can cause individuals to lose self-confidence and avoid risk taking. 3. The responsibility for developing a solution to the problem falls on each of the participants, not the mediator. 4. Full expression of positive and negative feelings is conducive to conflict resolution. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 9) A difference in opinion has arisen regarding methods to care for clients who are on mechanical ventilators. The nurse manager asks a group of nurses to meet and review evidence-based practice related to this client care situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving? 1. Negotiation 2. Collaboration 3. Compromise 4. Forcing Answer: 2 Explanation: 1. Negotiation implies differences in opinions. There is no evidence that negotiation will be necessary in the work outlined. 2. Collaboration occurs when all parties use their expertise to problem solve. The group focuses on problem solving as opposed to competition. 3. Compromise means that neither party gets what he or she wants. Rewards are divided between both parties. There is not yet any compromise indicated in this scenario. 4. Forcing provides an immediate end to the conflict but fails to resolve the cause of the conflict. An example of forcing would be the nurse manager making a decision on the client care and telling nurses that is how it is to be done. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice Learning Outcome: 13-3: Describe approaches that can be used to manage conflict.

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10) The nurse manager determines that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision? 1. Allow sufficient time for the problem to resolve spontaneously. 2. Motivate the participants to seek resolution. 3. Give the nurse manager time to identify problem-solving strategies. 4. Relieve the nurse manager of the time commitment necessary to intervene. Answer: 2 Explanation: 1. The problem is unlikely to spontaneously resolve or just go away no matter how much time is allowed. It is the responsibility of the participants to identify problem-solving strategies. 2. The nurse manager may delay intervention to allow the conflict to escalate because increased intensity can motivate participants to seek resolution. The nurses would still actively work to resolve the issue. 3. The nurse manager would facilitate the identification of problem-solving strategies by the participants. The manager does not need to shoulder the responsibility of solving the problem. 4. Preventing the nurse manager from intervening is incorrect because although conflict management does take time, at times it is beneficial to allow the parties to seek resolution. Delay is not designed to relieve the manager from the responsibility of intervening if necessary. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 11) The nurse manager assesses that two staff nurses are engaged in a conflict that is having a negative impact on client care. The manager meets with the nurses involved and identifies the conflict. An attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using? 1. Confrontation 2. Resolution 3. Negotiation 4. Forcing Answer: 1 Explanation: 1. Confrontation is the most effective means of resolving conflict. The conflict is brought out in the open, and deliberate attempts are made to resolve it through knowledge and reason. 2. Resolution is the final stage of conflict management that occurs when a mutually agreed-upon solution is arrived at, and both parties commit themselves to carry out the agreement. 3. Negotiation is a technique in which the conflicting parties give and take on various issues. 4. Forcing is a conflict management technique that forces an immediate end to conflict, but the cause is not resolved. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership TestBankWorld.org

Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 12) A nurse manager states, "I cannot stand all these conflicts in my department. Nothing good can come out of it." Which indicates the best reason the manager's statement is untrue? 1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue. 2. When people are in conflict, they tend to work harder just to avoid the conflicting situation. 3. Groups in conflict spur competition, which is always beneficial to the units from which the groups emerged. 4. When there is conflict in an organization, people are more open to discussion, thus conflict can open the lines of communication. Answer: 1 Explanation: 1. Conflict can be positive because as a conflict arises, individuals may become involved who might not have otherwise. Getting more people involved usually results in more creative solutions. 2. Those in conflict do not necessarily work harder to avoid the situation. 3. The competition spurred by conflict is often negative and not beneficial to those involved. 4. It is more likely that conflict will damage the lines of communication. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 13) A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days, the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a "smoothing" comment? 1. "We are never going to agree because I am from Generation X and you are a Baby Boomer." 2. "I'm tired of this fight, and I'm not going to argue with you anymore." 3. "Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks." 4. "I think everything is fine and that we can get along." Answer: 3 Explanation: 1. A comment on generational differences could actually promote conflict. 2. Being tired of the fight is a statement of withdrawal. 3. Smoothing includes statements or actions such as complementing one's opponent, downplaying differences, and focusing on minor areas of agreement. Agreeing about the length of lunch break is one such minor area. 4. The statement the "we can get along" is a statement of avoidance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Collaboration Learning Outcome: 13-3: Describe approaches that can be used to manage conflict.

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14) The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a "trophy" designed by the administrative staff. This is an example of which type of conflict? 1. A conflict that is disruptive to the work of the hospital 2. A competitive conflict that is positive to the work environment 3. An intragroup conflict that is not appropriate in healthcare 4. A felt conflict that will result in unresolved feelings of frustration Answer: 2 Explanation: 1. There is no indication that the conflict will be disruptive. 2. This is an example of a competitive conflict and is an example of how conflict can be positive in an organization. 3. This is an intergroup conflict, not an intragroup conflict, and there is no indication that anything about the competition is inappropriate. 4. There is no indication that this conflict will result in unresolved feelings of frustration. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collaboration Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 15) Why does conflict help generate change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Conflict assists change to occur more rapidly than it would otherwise. 2. It brings more attention to an issue in need of change. 3. People get involved because conflict breeds curiosity. 4. If there is an existing conflict, a change must occur to stop the conflict. 5. Change is inevitable, and some people refuse to change, which causes conflict. Answer: 2, 3 Explanation: 1. Conflict does not necessarily speed up the change process. It may slow the process. 2. When conflict around a change occurs, more people become aware of the issue, and because of curiosity or interest, more people become involved in the process. 3. When conflict around a change occurs, more people become aware of the issue, and because of curiosity or interest, more people become involved in the process. 4. Conflict does not always occur as a resolution of conflict. In some instances, things stay the same. 5. The question asks about conflict causing change, not change causing conflict. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Collaboration Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative.

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16) A new triage area has been built in the emergency department, causing conflict between the nurse manager and the nurses who think the design is not "user friendly." After repeated complaints, the nurse manager asks maintenance to change the arrangement of the room. What is the most important reason this change occurred? 1. The complaints motivated the nurse manager to make the change to increase unit effectiveness. 2. The room design was uncomfortable for the nurses, which convinced the nurse manager to change the design. 3. The nurse manager was afraid the nurses would refuse to work in the room so the room had to be changed. 4. The nurses would keep complaining so the nurse manager changed the room to stop the griping. Answer: 1 Explanation: 1. As the nurse manager, unit effectiveness is paramount. If the nurses are complaining, it is probably a legitimate problem in need of change. 2. It is true that the room design was uncomfortable for the nurses, but it was the complaints that triggered the change. 3. If the nurses had not complained about the room, the nurse manager would not have known about the situation. 4. It might be correct that the nurses would keep complaining, but it was the fact that they were complaining in the first place that caused action by the nurse manager. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Professional Practice Evaluation Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative.

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17) The medical residents on a particular unit do not answer pages very quickly, and sometimes the residents do not answer them at all. The nursing staff complains to the nursing supervisor. After several weeks, this conflict has spiraled into a heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict? 1. Client care and satisfaction will suffer should the conflict be allowed to continue. 2. The residents cannot be allowed to continue such unprofessional behavior. 3. Residents who do not answer pages do not get the most out of the experience. 4. Physicians do not know what is going on with clients if the residents do not tell them. Answer: 1 Explanation: 1. Client care and satisfaction must take precedence over other reasons for settling the conflict. 2. This is unprofessional behavior on the part of the residents, but this does not answer why it is important to settle the conflict. 3. It is true that residents must fully participate in training in order to get the most out of it, but this does not answer why it is important to settle the conflict. 4. Physicians may be slower in getting client information if residents are not professional, but this is not the best answer to this question. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 18) The nurse and a client are discussing instructions for self-care after discharge. The client's husband says, "I can't take care of her by myself. We need home health like we had before she came to the hospital." This statement reflects which antecedent condition? 1. Task interdependence 2. Resource competition 3. Structural conflict 4. Differences in values and beliefs Answer: 4 Explanation: 1. Task interdependence occurs when one group's success in completing tasks is dependent on another group's work. 2. The statement that the husband wants home health is not a clear example of resource competition. 3. Structural conflict has to do with structured relationships in which one person in the conflict is subordinate to the other. 4. This situation is a potential conflict between the healthcare workers who believe that the husband can take care of the wife and the husband who believes that he cannot. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 13-2: Describe the conflict process.

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19) The nursing staff is continually upset being unable to provide clients with needed supplies because third-party payers will not reimburse for those items. This is an example of which conflict antecedent? 1. Task interdependencies 2. Distancing 3. Role 4. Incompatible goals Answer: 4 Explanation: 1. Task interdependencies occur when one group is dependent upon another group to complete a task. 2. Distancing divides a group's members into small, distinct groups and increases chance for conflict. 3. Roles are defined as other people's expectations regarding behavior and attitudes. 4. The nurses in this situation have the goal to provide the best possible care to clients. The thirdparty payers have the goal of providing care at the least cost. These two sets of goals are often incompatible and result in conflict. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 13-2: Describe the conflict process. 20) Which is the most important factor in whether a conflict will be perceived or felt between two nurses? 1. How well the nurses know and trust each other 2. If the nurses are on the same job level 3. The congruence of the nurse's values and beliefs 4. Whether or not the nurses perform the same roles Answer: 1 Explanation: 1. Perceived versus felt conflict depends on whether or not the involved parties know and trust each other. If past problems have been handled calmly and rationally, and each knows what to expect from the other, it is considered a perceived conflict. 2. Job level is not as important in determining whether a conflict is felt or perceived. 3. Congruence of values and beliefs is not as important as another factor in determining whether a conflict is felt or perceived. 4. Whether or not the nurses perform the same roles will not be useful in determining whether a conflict is perceived or felt. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 13-2: Describe the conflict process.

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21) Which statements would alert a nurse manager that a unit conflict has become disruptive? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I won't stop until I have gotten her fired." 2. "He doesn't fight fairly." 3. "I've almost forgotten what started this; I just focused on beating her." 4. "I am going to win this argument." 5. "He is so wrong; he just has to go." Answer: 1, 2, 3, 5 Explanation: 1. Conflict that is focused on reduction, defeat, or elimination of the opponent is disruptive. 2. Competitive conflict follows a set of rules. When rules are ignored, the conflict becomes disruptive. 3. Focus on defeating the opponent is disruptive. 4. In competitive conflict, the focus is on winning, not on defeating or eliminating the opponent. 5. An urge to eliminate the competitor is reflective of the competition becoming disruptive. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Professional Practice Evaluation Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 22) A nurse and a physician are in conflict over the treatment of a client. Which statements by the nurse reflect the best way to handle interprofessional conflict? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I think it would be better for the client to stay another day." 2. "This client needs an additional day to learn how to care for a complex wound." 3. "It will help this client manage her diabetes more effectively if she is assigned a diabetic educator." 4. "Research has shown that early ambulation helps to reduce the likelihood of pulmonary embolism." 5. "Do you not remember what happened when you sent that other client home too early?" Answer: 2, 3, 4 Explanation: 1. "I" statements of what the nurse wants are not the best way to discuss options in an interprofessional disagreement. 2. Speaking from the vantage point of the client helps to support the nurse's position in this conflict. 3. Explaining what will best help the client helps to support the nurse's position in this conflict. 4. Using facts to support the nurse's point in the conflict is an important strategy. 5. This statement is confrontational and is unlikely to support the nurse's position in this conflict. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. TestBankWorld.org

23) A physician criticizes the care provided by a nurse in an area where others are present. Which actions by the nurse would the manager interpret as a covert conflict behavior resulting from this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse says, "You can't talk to me like that." 2. The nurse avoids the physician in the hallway. 3. The nurse refuses to care for the physician's clients. 4. The nurse is no longer as careful in caring for this physician's clients. 5. The nurse is apathetic about the care of clients. Answer: 2, 4, 5 Explanation: 1. Aggression is an overt conflict behavior. 2. Avoidance is a covert behavior. 3. Refusal is an overt act of conflict. 4. Not being as careful is a covert action. 5. Apathy is a covert conflict behavior. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Professional Practice Evaluation Learning Outcome: 13-2: Describe the conflict process. 24) Two staff nurses are in conflict about the summer vacation schedule. The nurse manager is contemplating assigning both nurses to a task that will require frequent contact with each other, hoping that they will resolve the issue themselves. What should the manager consider before making this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. What is the anxiety level of the nurses in regard to the vacation schedule? 2. Have the nurses ever worked together before on a project? 3. Will the conflict decrease the efficiency of the unit while the nurses are self-solving the issue? 4. How intense is the conflict about vacation scheduling? 5. Are the nurses talking to the rest of the staff about the conflict? Answer: 1, 3, 4 Explanation: 1. If there is high anxiety about the issue, assigning the nurses to a task together is likely not a good idea. 2. Whether the nurses have worked together before is not a critical consideration. 3. If the efficiency of the unit is in jeopardy, the manager should intervene. 4. If the conflict regarding vacation scheduling is intense, the nurse manager should abandon this plan. 5. It is likely that the rest of the staff already knows about the conflict and that the nurses involved have discussed it. This is not a factor in deciding on a plan. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. TestBankWorld.org

25) A nurse manager and a staff nurse are in conflict. The nursing supervisor has decided to use mediation to arrive at a solution. The supervisor should be most concerned about which person's level of comfort when choosing a place for the mediation meeting? 1. The manager 2. The staff nurse 3. The supervisor 4. There should be equal concern for all participants. Answer: 2 Explanation: 1. The manager is in a power position over the staff nurse. The supervisor should not be most concerned about the manager's level of comfort. 2. The staff nurse has the lowest ranking of all involved in this mediation. The most concern should be with the staff nurse's level of comfort. 3. The supervisor's level of comfort is not the most important in this situation. 4. The lowest ranking person should receive the most consideration when planning a place for this meeting. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 26) A serious conflict between a nurse and a nursing assistant erupted into a shouting match in the hallway. The nurse attempted to slap the nursing assistant. What conflict responses are appropriate for the assistant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Accommodating 2. Withdrawal 3. Avoiding 4. Smoothing 5. Negotiation Answer: 2, 3 Explanation: 1. When the conflict becomes violent, accommodation is no longer appropriate. 2. When safety is at risk, withdrawal is a valid response. 3. When safety is at risk, avoiding is a valid response. 4. When the conflict becomes violent, smoothing is no longer appropriate. 5. When tempers are high and the situation is dangerous, negotiation is not possible. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 13-3: Describe approaches that can be used to manage conflict.

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27) Conflict has arisen within the hospital regarding who will staff a proposed high-acuity unit. The nurse executive and other administrators have purposefully not intervened in this conflict. Why is that strategy appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Conflict draws attention to an issue. 2. The administrators do not like conflict management. 3. Conflict can stimulate new ideas about how to manage the high-acuity unit. 4. Conflict about the unit will help to identify the compromises necessary to make it a viable part of the hospital system. 5. Conflicts about staffing may make current staff members reexamine their own performance. Answer: 1, 3, 4, 5 Explanation: 1. There may be a reason that administration would desire that attention be brought to the new unit. Conflict will bring that attention. 2. Whether the administrators like conflict management probably has little to do with their decision. 3. Conflict can stimulate thought and new ideas. 4. Any new program or unit comes at a cost, and the cost-benefit ratio must be explored. Conflict can help others identify the compromises and costs associated with starting this unit. 5. Staff members who wish to be considered for staffing the new unit may improve their own performance and effectiveness. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 13-1: Explain how the various types of conflict can be positive or negative. 28) A nurse manager is trying to manage a conflict between a staff nurse and a medical student. Which statement by the manager would the nursing supervisor interpret as following the rules of basic mediation? 1. "Both parties need to grow up. They are so immature." 2. "The problem is partially the fault of both parties." 3. "I stopped the conversation frequently to have the parties summarize what was being said." 4. "They just went on and on. I had to stop the discussion because I was out of time." Answer: 3 Explanation: 1. The manager should protect the party's self-respect. Characterizing them as immature is not appropriate. 2. The manager should not put the blame for the problem on the parties involved but should make them responsible for finding a solution. 3. Having the parties summarize the discussion helps to ensure active listening. 4. The manager should encourage full discussion and should plan adequate time for this to occur. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. TestBankWorld.org

29) Which statement by the nurse managing a unit conflict indicates that the integrative decisionmaking strategy is being used? 1. "I've heard all I need to hear. I'll have a decision tomorrow." 2. "Once you have signed this informed consent, the issue will go to mediation." 3. "This will all blow over if everyone just tries to get along better." 4. "Both parties should come up with as many alternative solutions as possible before our next meeting." Answer: 4 Explanation: 1. If the manager makes the decision, positional power has been used. This is not integrative decision making. 2. Integrative decision making does not require informed consent. Mediation is a different strategy. 3. Waiting for everyone to "get along" and the problem to "blow over" are characteristic of smoothing or avoiding behaviors. 4. In integrative decision making, both parties conduct an exhaustive search for acceptable alternatives. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 30) In order to come to a solution for an ongoing conflict among several nursing units, the nursing supervisor says, "Your managers will meet to create a voting form representing both sides of this issue. Each of you will vote, and the majority will rule." What kind of a solution is the supervisor seeking? 1. Consensus 2. Win-win 3. Forcing 4. Win-lose Answer: 4 Explanation: 1. Consensus occurs when all parties come together and decide the best solution to the issue. 2. In a win-win solution, no one loses. That is not the case in this situation. 3. The supervisor is not forcing an immediate end to the conflict but is calling for a majority vote. 4. Someone will win in this case, and someone will lose. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 13-3: Describe approaches that can be used to manage conflict.

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31) The nurse manager tries to resolve conflict between two RNs. Which actions should the manager take first? 1. Allow the nurses to work out the problem. 2. Ignore the issue. 3. Use active listening with each nurse. 4. Meet with each nurse separately. 5. Bring the nurses together and ask them to explain the problem. Answer: 3, 4 Explanation: 1. The actions that should be initiated first are meeting with each nurse separately and using active listening. 2. The actions that should be initiated first are meeting with each nurse separately and using active listening. 3. The actions that should be initiated first are meeting with each nurse separately and using active listening. 4. The actions that should be initiated first are meeting with each nurse separately and using active listening. 5. The actions that should be initiated first are meeting with each nurse separately and using active listening. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 13-3: Describe approaches that can be used to manage conflict. 32) Conflict is often a prerequisite to ________ in people and organizations. Answer: change Explanation: Conflict is often a prerequisite to change in people and organizations. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 13-2: Describe the conflict process.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 14 Managing Time 1) Which strategies would decrease the amount of time the nurse manager spends with "drop-in" visitors to the manager's office? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Set office hours to eliminate those visits. 2. Keep the office door closed. 3. Arrange furniture so the desk faces the door. 4. Stand up to greet the visitor and remain standing. 5. Encourage appointments for routine matters. Answer: 4, 5 Explanation: 1. Office hours should be established to decrease drop-in visits, but the intent is not to totally eliminate them. 2. Keeping the door closed is incorrect because a block of time when the door is open for accessibility and availability is needed. 3. If the desk faces the door, eye contact is made with passersby and anyone who is standing in the doorway, which invites interruption. 4. In order to redirect the drop-in visit, the nurse manager should stand up and remain standing throughout the encounter. This gesture is gracious yet obvious enough to encourage a short visit. 5. Encouraging appointments for routine matters is an effective solution. The manager should indicate that in order to have sufficient time to address the question, a block of time will be needed. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters. 2) The nurse manager routinely experiences stress related to deadlines for projects. What should be the nurse's first action to control this stress? 1. Identify the actual stressor and the precipitating factors. 2. Plan activities to minimize time constraints to reduce stress. 3. Set aside a block of time each day for stress reduction. 4. Engage in distraction activities to minimize the stress. Answer: 1 Explanation: 1. The first step of the nursing process is to assess the situation. 2. Before a plan can be made, the stressor must be assessed. 3. Implementation occurs after the stressor has been assessed and a plan developed. 4. Implementation occurs after the stressor has been assessed and a plan developed. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 14-2: Examine goals and determine priorities. TestBankWorld.org

3) The nurse manager has decided to work on personal time-management skills. What should this manager do first? 1. Review patterns of time use. 2. Purchase a new notebook system for time management. 3. Identify essential job activities. 4. Set a goal of prioritizing tasks every morning. Answer: 1 Explanation: 1. The first step is always to assess, so reviewing patterns of time use is correct. 2. Deciding to purchase a new notebook system for time management is implementing a strategy and is not the first step of the process. 3. Identifying essential job activities would come second as a result of reviewing patterns of time use. 4. Setting a goal of prioritizing tasks every morning is a part of planning and is not the first step of the process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others. 4) A nurse manager has identified that a major time waster is the amount of time spent on the telephone each day. Which strategy would help reduce this time? 1. Answer the phone, "Hello, how are you?" 2. Send all calls to voice mail. 3. Use email for potentially troublesome issues. 4. Set a specific block of time to return calls. Answer: 4 Explanation: 1. Answering the phone this way encourages socializing and small talk. 2. There are situations in which issues must be dealt with immediately and face-to-face. 3. Troublesome issues should be addressed face-to-face. 4. The nurse manager should set time aside to handle routine phone calls and to return calls. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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5) A nurse manager's week is filled with handling routine and repetitive issues. Which strategy should the manager employ to make handling these tasks most effective and efficient? 1. Ask those involved to leave voice mail messages about any routine matter. 2. Encourage those involved in routine matters to call between 10:00 a.m. and 12:00 p.m. each day. 3. Keep the office door open to be accessible to those dealing with these routine tasks. 4. Hold a meeting each week especially for dealing with routine and nonurgent matters. Answer: 4 Explanation: 1. Having people leave voice mail messages is not efficient. The manager must then take time to retrieve, listen to, and respond to these messages. Voice mail also does not facilitate the face-to-face discussion often necessary to address routine issues. 2. Having a designated time for handling these issues is probably the second best option. However, spending 2 hours each day may be excessive. Also, the hours between 10:00 a.m. and 12:00 p.m. are often extremely busy, both for the nurses handling routine issues and for the nurse manager. 3. Allowing unlimited access to the nurse manager encourages drop-in visits, which can be time wasters. 4. Having a regularly scheduled meeting encourages those with routine questions to hold their concerns for a specific time. Setting this time aside also allows time for thoughtful discussion of topics as necessary. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-4: Incorporate time management strategies into meeting activities. 6) The nurse manager has planned a meeting that all staff nurses have to attend. Which method would most efficiently notify the staff members of the meeting time? 1. Email 2. Voice mail 3. Memo 4. Telephone call Answer: 1 Explanation: 1. Email minimizes time wasted trying to contact individuals, and the urgency of the message can be coded. 2. Voice mail is time consuming because the caller must place the call. There is also the possibility the person will answer the call, which entails a greater investment of time. 3. There is a risk that the memo will be placed where it is not accessible to all staff members. 4. A telephone call may lead to socializing and small talk, which are time wasters. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 14-1: Critique time-wasters.

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7) The nurse manager is writing annual evaluations for each nurse. In order to promote professional development, it is vital for the nurse manager and nurse to become involved in which activity? 1. Personal organization 2. Priority setting 3. Goal setting 4. Limit setting Answer: 3 Explanation: 1. Personal organization is the result of clearly defined priorities based on welldefined, measurable, and achievable objectives. 2. Goals must first be identified and set before priorities can be set. 3. Goal setting helps to relate current behavior, activities, or operations to the organization's or the individual's long-range goals. 4. Limit setting is trying to keep a person in line and trying to shape behavior. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-2: Examine goals and determine priorities. 8) What are reasons that nurses fail to manage time effectively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses do tasks they enjoy doing before the ones they do not enjoy. 2. Nurses do things that bring the most immediate closure first. 3. Nurses respond on the basis of who wants something. 4. Nurses do uninteresting jobs before interesting jobs. 5. Nurses work on things in the order of their arrival. Answer: 1, 2, 3, 5 Explanation: 1. Nurses are like anyone else in that they tend to do things they enjoy before they do things they do not enjoy. 2. Nurses (and others) often do those things that they can get done most quickly first. They feel satisfaction with having one thing done and out of the way. 3. Nurses tend to prioritize based on who wants something done-for example, if a client wants something that is a priority over the nurse manager needing a report. 4. It is generally more time efficient to tackle uninteresting jobs first and get them completed before starting interesting jobs that may absorb more of the nurse's time. Uninteresting jobs are likely to be completed as quickly as possible. However, it is not human nature to do what is not interesting first. 5. Nurses tend to work on things "as they come up" and often end up working on unplanned tasks before planned tasks. This is related to the unpredictable nature of working with people who are ill. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice TestBankWorld.org

Learning Outcome: 14-5: Summarize methods to respect time for yourself and others. 9) A nurse frequently has to work late and has no time to do required training while at work. She has to do it on her days off. Choose the work-related time waster that commonly puts nurses in this position. 1. Unscheduled tasks delaying those that are scheduled 2. An overwhelming amount of work to do 3. Taking longer-than-scheduled breaks 4. Volunteering for extra responsibilities Answer: 1 Explanation: 1. When working with different disciplines, work days are in a constant state of flux, unscheduled tasks and events occur, and sometimes nurses get behind. 2. Although the amount of work can be daunting at times, it is generally not overwhelming consistently if time is managed effectively. 3. Although taking longer breaks does occur, it is not a common reason for working late. 4. Volunteering does occur, but the nurse who is having difficulty keeping up with work days would generally not volunteer for extra responsibilities. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-1: Critique time-wasters. 10) A novice nurse manager is devising a schedule to meet the needs of the staff, clients, and other disciplines on the unit. Which is the most important method to counteract wasted time in nursing? 1. Delegate routine activities to concentrate on other tasks. 2. Assign a staff member to attend management meetings. 3. Redesign the position so that the nurse manager works when the unit is not busy. 4. Strictly adhere to a rule that the manager will see only staff members who make appointments. Answer: 1 Explanation: 1. One of the most important time wasters in nursing at all levels is failing to delegate tasks that another lower level staff member could do. 2. Staff should not routinely attend management meetings. 3. The manager must be available during the busier times on the unit, especially in emergencies. Setting the manager's work schedule to avoid these busy times is not appropriate. 4. Seeing staff only by appointment does not fulfill the job responsibilities of a nurse manager. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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11) A nursing supervisor has a report due and just cannot seem to find the time to get it completed. One day before it is due, the supervisor turns it in. This situation best exemplifies which time waster? 1. The supervisor waited for the deadline pressure to increase the priority. 2. The report was one of the last tasks on the "to-do" list. 3. The supervisor has no interest in the topic of the report. 4. The report format is unfamiliar to the nursing supervisor. Answer: 1 Explanation: 1. This is a classic example of procrastination, and the manager waited until it absolutely had to be done because of the looming deadline. 2. Being the last task on the "to-do" list is a plausible reason for the wait, but it is not the most likely reason. 3. Lack of interest on the supervisor's part is a plausible reason for the wait, but it is not the most likely reason. 4. The supervisor could be unfamiliar with the report format, but this is not the most likely reason for the delay. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters. 12) A nurse is participating in time-management education. This week's assignment is to compile a list of personal goals. Which of these goals should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will lose 10 pounds by Christmas." 2. "My family will have more fun." 3. "I will read for pleasure for 1 hour every day after work." 4. "I will not be late for work." 5. "We will save $200 monthly for the next 12 months for a car down payment." Answer: 1, 3, 5 Explanation: 1. This is a measurable, time-defined goal. 2. This is not a measurable goal and has no time component. 3. Pleasure reading is a personal goal. This statement is measurable and has a time frame. 4. Not being late for work is a job-related goal. 5. Saving for a car down payment is a personal goal. This statement is measurable and has a time component. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-2: Examine goals and determine priorities.

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13) During a job interview, the nurse manager asks, "What are your short-term goals?" Which statement by the applicant addresses this question? 1. "I want to become a nurse anesthetist within 10 years." 2. "I will be available to come in for extra shifts if needed." 3. "My brother and I want to go to on a mission trip in the next year." 4. "I want to get this job so I can move on to the next part of my life." Answer: 3 Explanation: 1. Becoming a nurse anesthetist in 10 years is a long-term goal. 2. Being available to come in for extra shifts is not measurable and is not a goal. A short-term goal statement would be, "I hope to work at least three extra shifts each month." 3. Going on a mission trip is a short-term goal because it involves a time frame of the next 6 months to a year. 4. Getting a job and moving on with life are not goals. A short-term goal statement would be, "I want to work and save $5,000 in the next year." Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 14-2: Examine goals and determine priorities. 14) The nurse manager must attend to several tasks this afternoon. Which tasks would the manager categorize as urgent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Waiting for pharmacy to call back about a meeting time 2. Planning a staff meeting for next week 3. Assisting a family whose child is in the emergency department 4. Finding replacements for two staff members on the next shift who called in sick 5. Trying to organize the visitor take-out menus Answer: 3, 4 Explanation: 1. Waiting for a phone call is a time waster and would not be an urgent task. 2. Planning a staff meeting for next week in not urgent. 3. Assisting the family of a child in the emergency department is an urgent matter. 4. Finding replacement staff for the next shift is an urgent matter. 5. Organizing take-out menus is busy work. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-2: Examine goals and determine priorities.

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15) Which activities are similar enough that they could be grouped to better manage time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Restocking the medication cart 2. Discussing a diet request with a new client 3. Calling for extra linen from laundry 4. Searching the internet for an unfamiliar client diagnosis 5. Emailing a colleague a question about the schedule Answer: 4, 5 Explanation: 1. Restocking the medication cart takes attention to detail. This task should not be combined with other tasks. 2. The nurse should pay full attention to the client and not combine this with other activities. 3. Calling for extra linen is unlike any other task in this list and would not make a suitable fit for task combination. 4. While the nurse is searching for a client diagnosis on the internet would combine well with emailing a colleague. 5. The nurse could easily email a colleague and search for information about a client diagnosis while logged into the computer. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-4: Incorporate time management strategies into meeting activities. 16) A newly appointed nurse manager has just completed education on time-management skills. Which statement would the instructor evaluate as indicating this nurse understands the basic concepts of time management? 1. "My job as a nurse manager is so dynamic that I probably will not be able to attain true time management." 2. "The key to using time management is to respect my time as well as the time of others." 3. "If I am going to be able to manage time, the hospital will need to invest in a computer-based time-management system." 4. "The most important aspect of time management for me is to manage paperwork flow." Answer: 2 Explanation: 1. Time management is achievable by nurse managers. 2. The most important aspect is the respect of one's own time, which results in others also respecting that time. 3. Time management is achievable without sophisticated computer-based time-management systems. 4. Managing paperwork flow is important, but not the most important aspect of time management. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 14-5: Summarize methods to respect time for yourself and others. TestBankWorld.org

17) A nurse manager is working on several projects and is stressed most of the time. This manager prefers working at the unit desk instead of in the office to be certain nothing on the unit is missed. Which would be the most effective method to decrease this manager's stress? 1. Keep a structured schedule for "work time" on each project in the office. 2. Elicit assistance from employees to help complete the projects. 3. Allow one project to fall behind while finishing up the others. 4. Take a sick day to work on the projects uninterrupted at home. Answer: 1 Explanation: 1. Carving out work time for each project in the office with a clear place to work is the most effective method to decrease this manager's stress. 2. Eliciting help from employees is not the most helpful option provided. 3. Allowing one project to fall behind to work on others will not decrease stress in the long term. 4. Taking a sick day and working on projects at home is not an appropriate management behavior. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others. 18) How can a nurse who is consistently falling behind at work improve to become more organized and disciplined? 1. Use the same system every day to organize client care and required activities such as paperwork. 2. Ask the nurse manager to grant permission for fewer client assignments until more experience with organization is achieved. 3. Ask the unit secretary to do required paperwork to decrease the amount of time required. 4. Practice a shorter client assessment technique to minimize the time required for this activity. Answer: 1 Explanation: 1. Using the same system consistently makes organization a habit. 2. Asking for a lighter load shifts the load onto other nurses and is not appropriate. 3. The unit secretary cannot legally do the nurse's paperwork. Shifting work onto the unit secretary is not appropriate. 4. Skimping on client assessment could cause a decrease in client care quality or legal consequences. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others.

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19) The nurse manager is significantly behind in the required paperwork for the job. How can the manager rectify this situation? 1. Make stacks of work on the corner of the desk so the work can be seen. 2. Use paper for all communication so a record is kept. 3. Discontinue subscriptions to all journals. 4. Set a goal to work on paperwork for a portion of every day. Answer: 4 Explanation: 1. Stacking work around the desk can make work more difficult and overwhelming. It is better to file materials and keep a running "to-do" list of projects. 2. Using email for communication reduces the amount of paper flow through the office, thereby reducing clutter. 3. The nurse manager must keep current on nursing issues, so the journal subscriptions are important and should be maintained. 4. The best of these options is to set a goal to work on paperwork for a portion of every day. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-1: Critique time-wasters. 20) When driving toward a meeting, the nursing supervisor gets a call explaining the meeting is to be delayed for about 30 minutes. Which activity is the best use of this supervisor's waiting time? 1. Listen to music on the radio. 2. Drive to the meeting place and read the minutes from the last meeting. 3. Stop by the closest store and get doughnuts to share with everyone. 4. Use the time to make some personal phone calls. Answer: 2 Explanation: 1. Listening to music is relaxing but could be wasting time that could otherwise be used to prepare for the meeting. 2. Using the time to refresh memories from the last meeting is the most productive use of the time. 3. Getting doughnuts is a nice gesture but is not a productive one. 4. Using the phone to make personal calls is a waste of professional time. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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21) A nursing supervisor warns the nurse manager, "Having access to electronic communication is not always a blessing." How should the manager interpret this warning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Electronic communication wastes more time than it saves. 2. The manager does not have to be physically present in the facility for communication to take place. 3. If not used effectively, electronic communication can prevent the manager from getting rest. 4. Along with a flatter organization and easy access, the nurse manager's job responsibilities have increased. 5. In today's healthcare environment, there is pressure to do more with less. Answer: 2, 3, 4, 5 Explanation: 1. Electronic communication can be a time waster, but if it is used effectively, it save more time than it wastes. 2. The nurse manager is instantly available through cell phone or email, but this is not always a positive. Easy availability allows nurses to avoid making decisions, and the manager is never really "off call." 3. If nurses have instant contact with the manager and are not taught to solve problems, the manager may be called at all hours and on days off. This prevents the manager from getting needed rest. 4. Job enlargement has occurred, which means the nurse manager has greater responsibility and more employees to supervise. One reason this can occur is that there is easier access to the manager during off-duty hours. 5. There is a need to do more with less in healthcare. Electronic communication makes the potential work place much bigger than it was previously. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others.

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22) Which statements indicate that a nurse manager is using time reactively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We were so busy yesterday that I did not get the schedule completed." 2. "I knew that we would be busy over the holiday, so I ordered extra supplies." 3. "We have so many new graduates on our unit that our work is never caught up." 4. "I am putting a summary of a research article on the board each week since I realize many of the nurses do not read journals." 5. "I am really concerned about what the nursing supervisor said about our unit. I can't get it off my mind." Answer: 1, 3, 5 Explanation: 1. Being too busy to get work done is reactive, not proactive. 2. The manager knew the unit would be busy and could control lack of supplies by ordering more. This is a proactive statement. 3. The manager should predict that new graduates require more time to complete tasks and should plan for that problem. 4. The nurse manager knows that nurses need to keep current and also knows that many of the nurses supervised do not read journals. A proactive solution to this problem has been proposed. 5. A proactive approach would be to ask the supervisor for clarification about the remark. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others. 23) The nurse manager has several tasks that need to be accomplished. Which task is the manager likely to do first? 1. A large job that holds little interest to the manager 2. A difficult task that is going to require several days to complete 3. A task that has been assigned by the supervisor instead of a task that the manager thinks will benefit the unit 4. A task that will have little impact on the unit Answer: 3 Explanation: 1. People tend to do small jobs before large jobs and to do interesting things first. 2. People tend to do easier things first, especially if they can be completed quickly. 3. People tend to respond to the demands of others before demands from themselves. 4. People work on the basis of consequences to the group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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24) As part of a new time management initiative, the nurse manager is creating a "to-do" list. How should the manager structure this list? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Focus on the events that are planned for each day. 2. Focus on the activities the manager expects for the day. 3. Block out time for the unexpected. 4. Be certain the list is flexible. 5. Do not create a "to-do" list for more than one day at a time. Answer: 3, 4 Explanation: 1. The focus should be on outcomes, not events. 2. The focus should be on outcomes, not activities. 3. The manager should leave enough uncommitted time to allow for unexpected occurrences to be handled. 4. Flexibility is of paramount importance in healthcare. 5. In some work environments, "to-do" lists may be better focused on what needs to be done each week. Adding a system to keep track of weekly or monthly standing meetings or appointments is also helpful. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-2: Examine goals and determine priorities. 25) For the last several weeks, the nurse manager has felt as if there is not enough time in the day to accomplish all the required tasks. The manager goes home exhausted and does not look forward to going to work in the morning. What strategy may help alleviate some of this stress? 1. Do tasks as quickly as possible. 2. Hurry through work, hoping someone else will catch any mistakes that are made. 3. Do not start any new tasks after lunch. 4. Pick a simple task and complete it just before going home each day. Answer: 4 Explanation: 1. Working faster is not likely to reduce this manager's stress. 2. Hurrying through work often results in mistakes. Hoping that someone else will catch the mistakes is not fair to others and can be dangerous. 3. The nature of nursing is unpredictable. The manager is unlikely to be able to stick to a plan of not starting any new projects after lunch. 4. Completing a task just before the end of the day helps the manager go home with a sense of accomplishment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others.

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26) A nurse manager has felt overwhelmed by work the last few months. After putting in many hours of unpaid overtime, the workload is beginning to stabilize. The nursing supervisor asks the manager to take on a new task that is exciting and stimulating. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Consider how much work will be added to the current workload. 2. Tell the supervisor no. 3. Talk with the supervisor about decreasing another work responsibility if this project is accepted. 4. Accept the assignment and plan to continue to work very hard until it is completed. 5. Accept the assignment, but only if additional salary is offered. Answer: 1, 2, 3 Explanation: 1. The manager must be realistic about how much work can be done. 2. If the project is too much for the manager to take on, the manager should say no. The manager must be aware of the consequences of declining the assignment. 3. If the manager would like to take on the new project, it may be necessary to decrease another job responsibility. The manager should discuss this possibility with the supervisor. 4. The manager should be aware of the consequences of overloading one's self. Accepting the assignment and continuing the current work pace may be dangerous to the manager and to others. 5. Additional salary does not make additional time. If the nurse does not have sufficient time to commit to the project, additional salary will not be helpful. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-5: Summarize methods to respect time for yourself and others.

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27) A staff nurse frequently interrupts the nurse manager with problems that the staff nurse could solve. What should the manager say to correct this behavior? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I am no longer going to interrupt my work for you." 2. "Let me see what I can do about the problem you are having." 3. "Is this a problem you can handle yourself?" 4. "You have the skills to solve this issue." 5. "I trust you to solve this problem." Answer: 3, 4, 5 Explanation: 1. The manager should be available for solving problems outside the staff nurse's scope of accountability. Telling the nurse that interruptions will not be tolerated may result in the nurse not notifying the supervisor of a situation that requires the manager's expertise. 2. The manager should not take responsibility for solving the problem. It is the nurse's responsibility. 3. Refocusing the nurse's ability to handle the problem may make the nurse reassess the need for the manager's intervention. 4. Reminding the nurse that he or she has the skills to solve the issue may give the nurse enough courage to attempt independent problem solving. 5. A statement of trust in the nurse's judgment may give the nurse enough courage to attempt independent problem solving. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 14-1: Critique time-wasters. 28) A nurse manager must place a telephone call to a colleague who always wants to chat socially for several minutes. The manager does not have time for a social call. What is the best time for the manager to make this call? 1. At 9:00 a.m., after physician rounds are complete 2. A few minutes before the colleague usually goes to lunch 3. In the middle of the afternoon 4. First thing in the morning, just after shift report Answer: 2 Explanation: 1. 9:00 a.m. is not the best time to make this call. 2. A call just before lunch is likely to be limited because the person who receives the call wants to leave the office. 3. In the middle of the afternoon, people are often looking for distractions from their work. If the nurse does not have time for a social chat, the middle of the afternoon is not a good time to call. 4. If this call is made first thing in the morning, the colleague is unlikely to have begun a project and may wish to delay starting the workday by chatting. If the colleague does not keep "shift" hours, he or she may not be at work that early. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice TestBankWorld.org

Learning Outcome: 14-1: Critique time-wasters. 29) A colleague frequently forwards funny emails to everyone on her contact list. The nurse manager does not have time to look at the emails and is aggravated when they appear. How should the manager handle this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Set the email filter to divert the messages to a spam folder. 2. Tell the sender that the manager is not allowed to get personal emails at work. 3. Forward the emails back to the sender. 4. Send the colleague an email that reads, "Stop wasting my time with these emails." 5. Delete the messages without opening them. Answer: 1, 2, 4, 5 Explanation: 1. If the email can be filtered so that the recipient only has to look at them if desired, they are not as aggravating. 2. Using a corporate policy to explain reluctance to get these emails will save face for the sender and the recipient. 3. This action takes time and is rude. 4. Unless the colleague is a dear friend, this email is confrontational and may unnecessarily embarrass the colleague. It may also damage a working relationship. 5. There is no rule that says that all messages have to be opened. When the message appears, delete it. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 14-1: Critique time-wasters. 30) The nurse manager holds a regular Wednesday meeting with the charge nurses on the unit. There is no new information to discuss this Wednesday. What should the manager do? 1. Hold the meeting so that the charge nurses do not feel that the meetings are not important. 2. Hold the meeting, but only meet for 10 minutes instead of the usual 60 minutes. 3. Reschedule the meeting for Thursday. 4. Cancel the meeting. Answer: 4 Explanation: 1. There is no reason to hold a meeting that is not necessary. 2. Holding a meeting that lasts only 10 minutes is a waste of the nurses' time. 3. There is no reason to reschedule a meeting if there is no information to discuss. 4. If there is no reason to hold a meeting, it should be canceled. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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31) The manager is working on the budget, and time wasters are preventing completion. The manager knows that common time wasters include which of the following items? 1. Failure to delegate 2. Organization and self-discipline 3. Interruptions 4. Inability to say "no" 5. Meetings Answer: 1, 2, 3, 4 Explanation: 1. Common time wasters include interruptions, in person or by phone calls, text messages, and email alerts; meetings, both scheduled and unscheduled; lack of clear-cut goals, objectives, and priorities; lack of daily and/or weekly plans; lack of personal organization and self-discipline; lack of knowledge about how one spends one's time; failure to delegate or working on routine tasks; ineffective communication; waiting for others and thus not using transition time effectively, and inability to say no. 2. Common time wasters include interruptions, in person or by phone calls, text messages, and email alerts; meetings, both scheduled and unscheduled; lack of clear-cut goals, objectives, and priorities; lack of daily and/or weekly plans; lack of personal organization and self-discipline; lack of knowledge about how one spends one's time; failure to delegate or working on routine tasks; ineffective communication; waiting for others and thus not using transition time effectively, and inability to say no. 3. Common time wasters include interruptions, in person or by phone calls, text messages, and email alerts; meetings, both scheduled and unscheduled; lack of clear-cut goals, objectives, and priorities; lack of daily and/or weekly plans; lack of personal organization and self-discipline; lack of knowledge about how one spends one's time; failure to delegate or working on routine tasks; ineffective communication; waiting for others and thus not using transition time effectively, and inability to say no. 4. Common time wasters include interruptions, in person or by phone calls, text messages, and email alerts; meetings, both scheduled and unscheduled; lack of clear-cut goals, objectives, and priorities; lack of daily and/or weekly plans; lack of personal organization and self-discipline; lack of knowledge about how one spends one's time; failure to delegate or working on routine tasks; ineffective communication; waiting for others and thus not using transition time effectively, and inability to say no. 5. Common time wasters include interruptions, in person or by phone calls, text messages, and email alerts; meetings, both scheduled and unscheduled; lack of clear-cut goals, objectives, and priorities; lack of daily and/or weekly plans; lack of personal organization and self-discipline; lack of knowledge about how one spends one's time; failure to delegate or working on routine tasks; ineffective communication; waiting for others and thus not using transition time effectively, and inability to say no. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 14-1: Critique time-wasters.

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32) Which strategies would decrease the amount of time the nurse manager spends answering texts and email messages and interruptions? 1. Turn the phone's notification feature off. 2. Discourage people from sending unwanted emails. 3. Enable filter to send texts and email messages to a spam folder. 4. Post available office hours on the office door. 5. Check email once a day. Answer: 1, 2, 3, 4 Explanation: 1. Examples of decreasing interruptions (text, email, in-person) include checking email at certain times of the day, setting the email filter to divert personal or unwanted texts to spam folder, discourage people from sending unwanted emails to work, and display office hours available and close door at other times. 2. Examples of decreasing interruptions (text, email, in-person) include checking email at certain times of the day, setting the email filter to divert personal or unwanted texts to spam folder, discourage people from sending unwanted emails to work, and display office hours available and close door at other times. 3. Examples of decreasing interruptions (text, email, in-person) include checking email at certain times of the day, setting the email filter to divert personal or unwanted texts to spam folder, discourage people from sending unwanted emails to work, and display office hours available and close door at other times. 4. Examples of decreasing interruptions (text, email, in-person) include checking email at certain times of the day, setting the email filter to divert personal or unwanted texts to spam folder, discourage people from sending unwanted emails to work, and display office hours available and close door at other times. 5. Examples of decreasing interruptions (text, email, in-person) include checking email at certain times of the day, setting the email filter to divert personal or unwanted texts to spam folder, discourage people from sending unwanted emails to work, and display office hours available and close door at other times. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Intervention/Quality of Practice Learning Outcome: 14-1: Critique time-wasters.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 15 Budgeting and Managing Fiscal Resources 1) The nurse manager tells the staff that this year's budget numbers will not change, even if census drops over the rest of the year. How should the staff interpret this information? 1. The budget is a fixed one. 2. The hospital uses incremental budgets. 3. The hospital uses a variable budget. 4. The hospital starts the budgeting process with a zero-based budget. Answer: 3 Explanation: 1. A fixed budget is one in which budgeted amounts are set regardless of changes that occur during the year, such as patient volume or program activities. 2. An incremental or line-by-line budget lists each expense item or category on a separate expense line. It is not possible to tell from this description if the budget is incremental. 3. A variable budget is developed with the understanding that adjustments to the budget may be made during the year based on changes in revenue, patient census, utilization of supplies, and other expenses. 4. A zero-based budget assumes the base for projecting next year's budget is zero. It is not possible to tell if the budget being described is a zero-based budget. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 15-1: Describe how the budgeting process works. 2) The nurse manager identified that the census was higher than anticipated and the client acuity level was also high; however, fewer nursing hours are paid. This variance is an example of which budgetary variance? 1. Efficiency 2. Nonsalary expenditure 3. Rate 4. Volume Answer: 1 Explanation: 1. Efficiency variance is a reflection of the difference between budgeted and actual nursing care hours provided. 2. Nonsalary expenditure variance is a deviation from the budget as a result of changes in client volume, supply quantities, or prices paid. 3. Rate variance is the difference between budgeted and actual hourly rates paid. 4. Volume variances are the differences in the budget as a result of increases or decreases in patient volume. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 15-1: Describe how the budgeting process works. TestBankWorld.org

3) As a member of the budgeting committee, the nurse manager reviews the salaries for file clerks in the accounting department. These salaries should be included in which budget item? 1. The fixed cost 2. The variable cost 3. The indirect cost 4. The direct cost Answer: 3 Explanation: 1. Fixed costs are costs that will remain the same for the budget period regardless of the activity level of the organization. 2. Variable costs depend on and change in direct proportion to client volume and acuity. 3. Indirect costs are expenditures that are necessary but do not affect client care directly. 4. Direct costs are expenses that directly affect client care such as nursing personnel who provide hands-on client care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 15-3: Describe components of an operational budget. 4) The nurse has received a commendable progress evaluation and will receive a 3% merit raise. The base salary for an RN is $48,000. Based on this information, the new projected base salary for this RN will be $________. Answer: 49,440 Explanation: If a 3% merit raise is projected and the base salary for an RN is $48,000, then the new base becomes $49,440. $48,000 multiplied by 0.03 equals $1,440. Add $1,440 to $48,000 to determine the new base salary. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-7: Describe how staff affects budgetary performance.

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5) The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added the cost of this supplementary staff to the unit's operating budget. A colleague informs the manager it should have been added to which budget? 1. The personnel budget 2. The operating budget 3. The revenue budget 4. The fixed budget Answer: 1 Explanation: 1. The personnel budget projects the salary costs that will be paid and charged to the cost center in the budget period. 2. The operating budget is the organization's statement of expected revenues and expenses for the coming year. 3. The revenue budget represents the patient care income expected for the budget period. 4. Because the salary cost of supplementary staff is an unknown, the costs are variable, not fixed. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 15-2: Differentiate among different approaches to budgeting. 6) A client's spouse is concerned about the cost of hospitalization. The nurse says, "Because your spouse is on Medicare, the hospital will be paid according to the DRG." What does the nurse mean by this statement? 1. Medicare will pay the total cost for the care provided. 2. Medicare will pay an average of the total costs. 3. Medicare will pay based on the usual cost of the treatments provided. 4. Medicare will pay based on a set amount for the specific condition for which the client was hospitalized. Answer: 4 Explanation: 1. Total cost is the amount of the charges for which the client is billed. Medicare reimbursement does not equal this amount. 2. An average for the costs is not a payer amount used by the healthcare industry. 3. Medicare does not pay based upon the usual cost of the procedure. 4. Medicare payment for inpatient services is currently made at a predetermined specific rate for each Medicare recipient based on the patient's diagnosis. Care is classified into diagnosis-related groups (DRGs). Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 15-1: Describe how the budgeting process works.

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7) During an interview with a potential employee, the nurse manager tells the individual that an additional 10% of the hourly rate will be paid for working the 7:00 p.m. to 7:00 a.m. shift. What is another way the manager could have described this difference in pay? 1. "You will receive an additional 10% for overtime." 2. "The night shift differential is 10%." 3. "Your evening premium is 10%." 4. "You will get a 10% cost-of-living raise for working the night shift." Answer: 2 Explanation: 1. Overtime is paid to personnel who work more than 40 hours per week. Historically, overtime is calculated by multiplying the amount of overtime worked by 1.5 times the hourly rate. 2. Most facilities use a set percentage to be paid to personnel who work evenings, nights, weekends, and holidays, which is known as a shift differential. 3. Premiums are fixed dollar amounts added to the base rate of an employee who has earned a certification or has some advanced clinical achievement. 4. Cost-of-living raises are factored into budget projections and are not related to shift work. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 15-7: Describe how staff affects budgetary performance. 8) The nurse manager of a critical care unit creates the operating budget with the knowledge that a minimum of two professional nurses must be paid per shift regardless of the patient census. Which group determines this standard? 1. Hospital administration 2. Nursing administration of the hospital 3. The Joint Commission 4. Nursing personnel of the special care units Answer: 1 Explanation: 1. The hospital makes the final determination of which staffing ratios are considered safe for their units. This determination may be made with the input of nursing administration and nursing personnel, but the final determination becomes an institutional policy. 2. This determination may be made with the input of nursing administration and nursing personnel, but the final determination becomes an institutional policy. 3. The Joint Commission assures that the institution is following its own policies. 4. This determination may be made with the input of nursing administration and nursing personnel, but the final determination becomes an institutional policy. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-7: Describe how staff affects budgetary performance.

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9) A hospital's budget is incremental. Which statement by the nurse manager reflects use of this type of budget? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The finance department sent me the budget worksheet with last year's expenses." 2. "We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?" 3. "I have to justify all our activities as if we have never done them before." 4. "I like this type of budget preparation because it is fairly simple and straightforward." 5. "In order to create next year's budget, I am to start at 80% of what we budgeted last year." Answer: 2, 4 Explanation: 1. Developing an incremental budget may begin with documentation of the previous year's actual expenses. 2. The disadvantage of an incremental budget is that managers quickly learn to spend all that is in their budget for a specific line item. If budgets are based on the previous year's performance, having budgeted money left over means it is likely that the current year's budget will be cut. 3. Justification of all activities and expenditures is a characteristic of a zero-based budget. 4. Incremental or line-item budgeting is fairly simple and straightforward. 5. Starting with a decreased budget is a form of zero-based budget. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 15-1: Describe how the budgeting process works. 10) A nurse educator is asked by the chairperson of the department to submit a list of equipment that could be used to meet the department's goals. The list includes projectors, computers, office supplies, and computer-assisted programs. How would the educator categorize the materials? 1. As an expense 2. As part of revenue 3. As part of the capital budget 4. As part of the operating budget Answer: 3 Explanation: 1. An expense budget is a comprehensive budget that lists salary and nonsalary items that reflect patient care objectives and activity parameters for the nursing unit. 2. A revenue budget is a projection of expected income for a budget period based on volume and mix of patients, rates, and discounts. 3. A capital budget is a component of the budget plan that includes equipment and renovations needed by an organization in order to meet long-term goals. 4. An operating budget is the organization's statement of the expected revenues and expenses for the upcoming year. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-2: Differentiate among different approaches to budgeting. TestBankWorld.org

11) The nurse manager is reviewing the previous month's budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Greater client acuity 2. Extravagant use of resources 3. Understaffing the unit 4. Low client acuity 5. Use of agency nurses to supplement staff Answer: 3, 4 Explanation: 1. Greater client acuity than allowed for in the budget would likely result in an unfavorable efficiency variance. 2. Using more resources than the budget allows would result in an unfavorable efficiency variance. 3. Understaffing the unit would mean fewer nursing salary hours. This would result in a favorable efficiency variance but would not be a good long-term plan for quality of care. 4. If client acuity is lower, fewer staff members are needed. This would result in a favorable efficiency variance. 5. If agency nurses were used to supplement staff, the efficiency variance would be unfavorable. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Resource Utilization Learning Outcome: 15-3: Describe components of an operational budget. 12) The nurse manager is creating the budget for the next fiscal year. Because the client census has been higher in the past year, more supplies were used. Which type of cost does this reflect? 1. Fixed costs 2. Variable costs 3. Direct costs 4. Zero-based costs Answer: 2 Explanation: 1. Fixed costs are costs that remain the same for the budget period regardless of the activity level of the organization, such as insurance premiums. 2. Variable costs depend on and change in direct proportion to client volume and acuity, such as client care supply expenses. 3. Direct costs are expenses that directly affect client care, such as salaries for nurses. 4. Zero-based costs are not a cost classification. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 15-1: Describe how the budgeting process works.

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13) With the current healthcare industry focus on managed care, nurses must be more cost conscious. Which option is an example of a nurse being cost conscious? 1. The nurse reviews the client's itemized bill each day. 2. The nurse's decides to use fewer supplies when changing a dressing. 3. The nurse manager reviews client costs on a daily basis. 4. The nurse manager requests that the materials management director obtain quotes for less expensive items. Answer: 2 Explanation: 1. The nurse and the nurse manager do not have time nor is it their responsibility to review a client's hospital bill. 2. The nurse can use resources wisely to decrease costs to the client and the hospital. 3. The nurse manager does not review client costs on a daily basis. 4. The materials management director does look for less expensive materials to provide client care supplies and hospital supplies, but it is not the responsibility of the nurse manager to direct this person's work. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-7: Describe how staff affects budgetary performance. 14) The unit employs 35 FTEs (full-time equivalents) based on an 8-hour shift. The average benefits for these FTEs are 12 vacation days, 10 holidays, 6 sick days, and 4 personal days. Based on these figures, the FTE required per employee to replace benefit time is ________ FTE. Round to the nearest hundredth FTE. Answer: 0.12 Explanation: To arrive at this figure, add the number of days off, multiply by 8 hours per shift, and divide by 2,080 (number of hours worked yearly by one FTE). 0.12 of an FTE will be added per employee to the salary budget. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance.

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15) A nursing executive is comparing the entire hospital financials for the month and notes that the medical laboratory's revenue is higher than environmental services. What is a possible explanation? 1. The laboratory has increased charges for its services. 2. Environmental services is a non-revenue-producing cost center. 3. The laboratory is a non-revenue-producing cost center. 4. The nursing units affect the laboratory charges. Answer: 3 Explanation: 1. An increase in charges by the laboratory is not significant in this instance. 2. Environmental services does not charge clients for its services; it is a non-revenue-producing cost center. 3. The laboratory does charge clients for its services; it is a revenue-producing cost center. 4. The nursing unit does affect laboratories' revenue, but this is not applicable to the question. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 15-2: Differentiate among different approaches to budgeting. 16) A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is a higher turnover rate of nursing staff on the medical unit. 2. Costs were incurred during a recent remodeling of the medical unit. 3. The client acuity on the critical care unit is higher. 4. The critical care manager is a better manager than the medical unit manager. 5. More staff on the medical unit received premium pay this year. Answer: 1, 3, 5 Explanation: 1. A higher turnover rate will increase personnel costs because of the need for more personnel to train new employees. 2. The costs of remodeling are not included in the personnel budget. 3. Increased client acuity generally makes personnel costs rise. 4. Better management tends to mean a more stable staff, which decreases expenditures. 5. Premium pay increases personnel costs. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/ Resource Utilization Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance.

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17) The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sick days 2. Weekend days 3. Vacation days 4. Holidays 5. Bereavement days Answer: 1, 3, 4, 5 Explanation: 1. Sick days are benefit days. 2. Weekend days are not benefit days. 3. Vacation days are benefit days. 4. Holidays are benefit days. 5. Bereavement days are benefit days. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance. 18) The medical-surgical nursing manager notices the education expenditure for the month is over budget. How should the manager deal with this difference? 1. Complete an expenditure report for the month. 2. Complete a variance report for the month's budget. 3. Forward a non-revenue-producing report to the administration. 4. Forward the expense line budget to the administration. Answer: 2 Explanation: 1. An expenditure report for the month would not explain the variance. 2. A variance report provides a rationale for over expenses for the month that could result from a variety of unexpected expenses. 3. Non-revenue is not relevant to determining why the unit is over budget. 4. Expense line budgeting is not relevant to determining why the unit is over budget. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-3: Describe components of an operational budget.

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19) A nurse recruiter is developing a handout to take to nursing schools in hopes of recruiting graduating seniors. The salary for a newly hired nurse is $18.15 per hour with shift differential of 20 percent for working the 7:00 p.m. to 7:00 a.m. shift. The salary for those who would like to work this shift would be $________ per hour. Answer: 21.78 Explanation: A 20% shift differential for a salary of $18.15 is $3.63 ($18.15 × 0.20). Adding $3.63 to $18.15 arrives at a salary of $21.78. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance. 20) Every month the chief financial officer (CFO) reviews the budget with the hospital's board of directors. The CFO requests a million dollars to purchase a new MRI (magnetic response imaging) unit for the radiology department. Which category best describes this request? 1. Non-revenue expense 2. Capital expense 3. Variable cost 4. Allocation of funds Answer: 2 Explanation: 1. An MRI machine would be revenue producing. 2. A capital expense is an expense that is above a set dollar amount, such as $10,000, and that must be approved by the board of directors. 3. The cost of this machine is not variable. 4. Allocation of funds is not specific to the type of budgetary expenditure. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 15-2: Differentiate among different approaches to budgeting.

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21) A nurse manager is trying to educate the staff regarding efficiency and how it affects the unit's costs. Strategies to increase efficiency could include which of the following? 1. Increasing the number of unlicensed assistants providing direct nursing care 2. Limiting dressing supplies on the nursing unit 3. Labeling the cost of each item in the clean supply closet 4. Eliminating staff education sessions Answer: 3 Explanation: 1. Increasing the number of staff will not affect efficiency. 2. Limiting the amount of supplies will decrease efficiency because of the time factor involved in obtaining needed supplies. 3. When the cost of each item is displayed, staff becomes more aware of costs and may use supplies more wisely. 4. Eliminating staff education will not increase efficiency and may ultimately decrease efficiency. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance. 22) The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The average daily census for the facility over the last year 2. Current community wage ranges for employee classifications 3. Changes in accrediting body or legislative regulations 4. Number of nurses whose employment was terminated for cause over the last year 5. Current staff mix across the hospital Answer: 1, 2, 3, 5 Explanation: 1. Average daily census will be valuable information in developing this year's budget. 2. Wage ranges in the market are critical information for the budget committee. 3. Regulation changes often result in an increase in cost. 4. Information regarding the number of nurses whose employment was terminated for cause will not be helpful to the budgeting committee. 5. Staff mix for all departments is necessary for this committee. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 15-1: Describe how the budgeting process works.

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23) The finance department of the hospital has distributed information for the next budget cycle that includes a projected 0.19 inflation factor in the cost of water. If the hospital spent $285,000 on water last year, the projected cost of water for this year would be $ ________. Answer: 339,150 Explanation: To figure the cost of water for the coming year, take this year's cost and multiply it by the inflation factor plus 1.0. In this instance $225,000 × 1.19 = $339,150. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 15-1: Describe how the budgeting process works. 24) A hospital has used capital funds to purchase a new piece of diagnostic equipment. The hospital's chief financial officer (CFO) says, "The cost of this equipment will be expensed out across all units that use it." How should the nurse manager interpret this statement? 1. The equipment is jointly owned by all units that use it. 2. If clients on the manager's unit require the use of this equipment, a portion of the cost will be charged to the unit. 3. The equipment will be rented to the units for use. 4. The nurse manager will ask physicians to refrain from using the equipment. Answer: 2 Explanation: 1. The equipment is owned by the hospital. 2. The cost of the equipment will be spread out among the budgets of all the units that have clients that require its use. 3. The equipment is not rented to the units for use, but the unit must share in the cost to use the equipment. 4. It is not appropriate for the nurse to attempt to influence care based upon having to pay for equipment. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Resource Utilization Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance.

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25) The newly hired nurse manager is involved in the first budgetary cycle since being hired. The manager lists some capital equipment needs and is surprised when they are not available for staff use two months after the request. What is the reason for this? 1. The equipment was not approved by the manager's supervisor. 2. The budgetary cycle takes up to 1 year to occur. 3. The hospital has experienced a downturn in revenue and is not fulfilling promises. 4. The nurse manager failed to complete the correct request. Answer: 2 Explanation: 1. There is no indication that the request was not approved, just that it has not yet been filled. 2. The budgetary cycle of a large organization typically takes about 1 year to be completed. If the new manager sent in a request for the next budget, it may be 12-18 months before the equipment arrives. 3. There is no indication that the hospital is not fulfilling budgetary promises, just that the request has not yet been filled. 4. There is no indication that the manager made an error, just that the request has not yet been filled. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance. 26) A nurse manager writes the following note: "Over personnel budget by $1,250 in April due to late snowstorm. Nurses unable to get to work. Overtime wages paid." Why is this note important? 1. It will help the manager create the budget for the next year. 2. It is required by the Joint Commission. 3. All variances must be documented and forwarded to the hospital attorney. 4. It ensures that there is no question of diversion of hospital funds. Answer: 1 Explanation: 1. Keeping notes regarding variances is a key way of preparing for the next budget cycle. 2. This is not a Joint Commission requirement. 3. A budgetary variance is not the same as a client care variance. 4. These notes are not kept as evidence disputing diversion of hospital funds. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 15-3: Describe components of an operational budget.

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27) A nurse manager has received the following email from the finance department: "Your unit's budget for travel is $1,500 for the fiscal year. The unit's actual expenditures have been $2,120." The unit is over budget by ________%. Round to the nearest hundredth percent. Answer: 41 Explanation: To figure the percent over budget, subtract the budgeted amount ($1,500) from the actual expenditure ($2,120). Divide the result by the budgeted amount ($1,500) and multiply by 100. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 15-3: Describe components of an operational budget. 28) An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Were any unexpected bonuses awarded? 2. Did agency personnel hours exceed the number predicted in the budget? 3. Were new employees hired at lower wages? 4. Did the number of client days exceed the predicted budgeted amount? 5. Were fewer nursing hours worked than were predicted? Answer: 1, 2 Explanation: 1. An expected bonus that was not budgeted could result in an unfavorable rate variance. 2. Agency personnel hours are higher than hospital employee hours. If the number of hours exceeded the budgeted amount, an unfavorable rate variance would occur. 3. If new employees are hired at work hours at a lower rate than that of other employees, a favorable rate variance would occur. 4. Client day variations result in volume variances, not rate variances. 5. Fewer nursing hours worked would result in an efficiency variance, not a rate variance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice Learning Outcome: 15-3: Describe components of an operational budget.

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29) The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The FTE factor for an LPN hired this month 2. The current wage range for RNs working on the units 3. The names of all unit clerks working in the unit 4. The level of licensure of a nurse working on the unit 5. The fact that two RNs have retired this year Answer: 1, 2, 4, 5 Explanation: 1. The position control sheet includes the names and FTE factors for each individual employed by the unit. 2. Wage ranges are not included in this information. 3. The names of all unit employees are part of the position control sheet. 4. The position control sheet categorizes those working on the unit by position. Therefore, the licensure level of the nurse would be indicated. 5. Resignations are recorded on this sheet. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 15-3: Describe components of an operational budget. 30) A nursing assistant tells a nurse, "I am going to have to call in sick tomorrow because I don't have a babysitter." How should the nurse respond to this information? 1. The assistant's sick time is earned and should be used in any way the assistant wishes. 2. The assistant should use personal time, not sick time, for this situation. 3. The assistant's absence will not be a major problem for the unit as long as only one day is missed. 4. It will be okay for the assistant to miss a day because it will help another assistant get overtime wages. Answer: 2 Explanation: 1. Misuse of sick time has a negative impact on the unit's finances and perhaps on the quality of care provided. 2. Most facilities award personal days that should be used for situations such as this. 3. The nurse does not know how much impact the assistant's absence will have on the unit. 4. It may be helpful for the assistant to get overtime wages, but it is not good for the unit. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance.

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31) The RNs base salary is $52,000, and the nurse is to get a 2% merit raise. Based on this information, the new projected base salary will be 1. $52,500. 2. $53,040. 3. $53,575. 4. $53,560. Answer: 2 Explanation: 1. 2% of $52,000 is $1,040; so the new projected base salary is $53,040. 2. 2% of $52,000 is $1,040; so the new projected base salary is $53,040. 3. 2% of $52,000 is $1,040; so the new projected base salary is $53,040. 4. 2% of $52,000 is $1,040; so the new projected base salary is $53,040. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implement/Quality of Practice Learning Outcome: 15-6: Demonstrate how to monitor and control budgetary performance. 32) The manager is aware that the cost center that she manages is a revenue producing unit. What type of area could the nurse be managing? 1. Radiology 2. Pain care 3. Environmental services 4. Wound care 5. Laboratory Answer: 1, 2, 4, 5 Explanation: 1. Revenue producing areas are places that take in revenue from services provided to the community. Examples include radiology services, pain care, wound care, and laboratory services. 2. Revenue producing areas are places that take in revenue from services provided to the community. Examples include radiology services, pain care, wound care, and laboratory services. 3. Revenue producing areas are places that take in revenue from services provided to the community. Examples include radiology services, pain care, wound care, and laboratory services. Environmental services does not take in revenue from services provided. 4. Revenue producing areas are places that take in revenue from services provided to the community. Examples include radiology services, pain care, wound care, and laboratory services. 5. Revenue producing areas are places that take in revenue from services provided to the community. Examples include radiology services, pain care, wound care, and laboratory services. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Resource Utilization Learning Outcome: 15-5: Explain the nurse manager's role with capital budgeting.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 21 Managing Absenteeism, Reducing Turnover, Retaining Staff 1) The nurse executive and the human resources manager of a hospital meet to discuss the recent increase in nursing turnover. Which statement reflects the best source of information about this increase? 1. "What have the exit interviews shown as reasons for the resignations?" 2. "Were the reports from nurse managers on resignations completed accurately?" 3. "What are the reasons given in the survey mailed out 6 weeks after resignation?" 4. "Has the human resources staff been making telephone calls to employees when they turn in their resignation?" Answer: 3 Explanation: 1. Although an exit interview is usually done, it may not be the most effective method of evaluating the employee's satisfaction. An employee may not be fully truthful if he or she intends to use the previous employer as a reference for a future job. 2. The nurse manager may or may not be aware of the reasons for nurses leaving their positions and may have a bias toward an unhappy employee. 3. A survey mailed weeks after the employee resignation may be the most effective method to measure nursing turnover. Several weeks later an employee may be in a new job, which could allow for a more honest reflection on reasons for leaving the previous position. 4. A telephone call from someone in human resources has the same limitations as the person-toperson exit interview. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. 2) When the unit manager is on vacation, the charge nurse fills in the leadership role. While in this role the charge nurse senses a change in the nursing staff's morale. The staff appears happier, more energetic, and productive. The charge nurse believes this change is a direct effect of which variable? 1. The staff's relationship with the unit manager 2. The environment of the organization 3. Level of compensation 4. The shifts they are working Answer: 1 Explanation: 1. Job satisfaction is affected by various facets, one of them being the relationship with the nurse manager. 2. The overall environment has not changed. 3. The level of compensation has not changed. 4. It is unlikely that the substitute manager has changed the shifts that nurses are working. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership TestBankWorld.org

Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. 3) A nurse is frequently absent on Fridays. The nurse phones and reports as sick, but the manager discovers that the absences are due to child care issues. How should the manager document this on the critical incident form? 1. Voluntary absence on multiple Fridays due to child care issues 2. Absence frequency on Fridays 3. Total time lost includes Fridays 4. Involuntarily absent due to family circumstances Answer: 1 Explanation: 1. Voluntary absenteeism is not coming to work due to a problem that is under the employee's control. Child care problems are under the employee's control. 2. Absence frequency is the total number of distinct absence periods that an employee has been absence and is not tied to a specific day. 3. The fact that Friday is included in the total time lost is not significant. 4. Involuntary absence is due to something outside the employee's control such as illness. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 4) The night nurse on the pediatric unit has resigned. The night staff is pleased, because this nurse constantly complained about workload and alienated most staff members. What consequences may result from the loss of this nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use of agency nurses 2. Opportunity for overtime 3. Increase in enthusiasm 4. A resignation spiral in which more nurses resign 5. Unit performance improves Answer: 1, 2, 3, 5 Explanation: 1. Unfortunately, agency nurses may need to be used if the position goes unfilled. This is a costly problem. 2. There may be an opportunity for overtime work for those who desire it. 3. Without the constant distraction of a complaining nurse, the night staff's enthusiasm for the job may increase. 4. Since the nurse who resigned was not liked and was classified as a "complainer," it is unlikely that this resignation will trigger a resignation spiral. 5. When a nurse who alienates coworkers and complains frequently leaves, the performance of the unit may improve. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization. TestBankWorld.org

5) During a 3-month period, a nurse has missed work on six occasions due to unreliable child care. Another nurse has missed 10 days due to a minor foot surgery. How should the manager categorize the reliability of these nurses? 1. The nurse with the voluntary absence is more reliable. 2. The nurse with involuntary absences is more reliable. 3. It depends on other factors such as job performance when present. 4. Both nurses are unreliable due to excessive absences during this time period. Answer: 2 Explanation: 1. The nurse who had voluntary absence had fewer days absent but could have controlled the absences by obtaining reliable transportation and back-up child care. 2. The nurse with the involuntary absence is more reliable because the absence is less frequent and due to something outside the nurse's control. 3. The nurse who voluntarily misses work on six occasions in a 3-month period is not a reliable employee even if job performance when at work is good. 4. Involuntary absences do not affect reliability in the same manner as voluntary absences. Typically, involuntary absences for surgery are scheduled in advance and the manager can schedule for the absence. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 6) What is the best strategy the nurse manager can use to help retain nursing staff? 1. Relieve staff of the need to serve on committees in the institution. 2. Hire younger employees. 3. Require that the nurse sign a contract for at least 1 year of service. 4. Closely review applicant's previous job history for length of commitment. Answer: 4 Explanation: 1. Nursing must be represented on committees to retain a sense of ownership of the organization. 2. Age of the employee has less to do with commitment than the person's mobility, which may be affected by age and responsibilities. 3. Contracts are easily broken. Making the nurse feel that there is a 1-year commitment may result in a nurse who is unhappy and ineffective in the job. A 1-year commitment does not reduce turnover. 4. A review of a job applicant's history of employment will give the nurse manager an idea of his or her past commitment to the workplace. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization.

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7) A nurse who has been working the evening shift on the hospice unit for 5 years resigns. The nurse says, "I just can't work here anymore. These clients are so sad." What is the best strategy for retaining this nurse? 1. Increasing the nurse's salary 2. Facilitating a transfer to another nursing unit 3. Offering the nurse a position on the day shift 4. Rewrite the nurse's job description Answer: 2 Explanation: 1. Increasing the nurse's salary is unlikely to make a difference if the nurse is truly unable to stay due to client conditions. 2. This nurse is experiencing burnout. The best strategy to retain the nurse in the organization is to transfer the nurse to a new unit with different job responsibilities. This will be a loss to the unit, but a savings for the organization. 3. The nurse has not indicated that the night shift is the problem. 4. Changing the job description will not change the fact that the nurse is experiencing burnout from working with dying clients. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. 8) The hospital is hiring several new nurses for an expanded OB unit. The manager explains to the current staff that due to a shortage of nurses, salary compression is occurring. How should the current nurses interpret this statement? 1. There will be no raises in the near future. 2. The new nurses' starting salaries will be close to what the current nurses are making. 3. All nurses will receive a merit raise for training new staff. 4. Review of salary structure done while hiring these nurses will result in raises for all current nurses. Answer: 2 Explanation: 1. Salary compression is not linked to raises. 2. Salary compression is the effect of higher starting pay of new nurses resulting in lower salaries for long-term employees. This results in the wages of new nurses being just below or even higher than that of current nurses. This is a quick fix to a nursing shortage, but a dangerous strategy, and it may result in dissatisfaction and turnover of more experienced nurses. 3. Salary compression is not linked to merit raises for training staff. 4. Salary compression is not linked to raises for current employees. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses.

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9) A hospital is experiencing a high nursing turnover rate. One manager suggests offering sign-on bonuses to fill positions. Why would the nurse executive veto this suggestion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sign-on bonuses only attract newly licensed nurses. 2. The bonus schedule adversely impacts the current salary schedule. 3. Current nurses can be discouraged by this program. 4. Sign-on bonuses do not recognize achievement and loyalty. 5. Sign-on bonuses do not attract enough nurses to make it worth the time to set them up and advertise them. Answer: 3, 4 Explanation: 1. Sign-on bonuses are attractive to many nurses, both newly licensed and experienced. 2. Sign-on bonuses do not affect the current salary schedule. 3. Nurses currently working at the facility can be discouraged when newly hired nurses are given big amounts of money just for taking the job. 4. Sign-on bonuses are awarded just for taking the job. They do not recognize such attributes as experience, achievement, and loyalty. 5. Sign-on bonuses can attract a significant number of applicants and are a quick fix for shortages. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization.

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10) The human resources (HR) department is considering motivating employees to maintain good attendance by changing some organizational practices. Which items should HR consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Offering a discount on the cost of on-site child care for employees with good attendance records 2. Encouraging managers to involve employees in the decision making on the unit 3. Banning an employee with more than two absences in a pay period from working overtime in the next pay period 4. Working with managers to change the culture of the units on which absences are frequent 5. Entering the names of employees who have no absences in a 3-month period in a drawing for a paid day off Answer: 1, 3, 5 Explanation: 1. On-site child care is a motivating factor in itself. Adding a discount to those with good attendance is an additional motivating factor. 2. Shared decision making is a change to the job itself. 3. This policy would serve as punishment for those seeking overtime wages and is a change in organizational practice. 4. This is an example of changing the absence culture. 5. A reward for having no absences is a change in organizational practice. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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11) A nurse manager has reduced absenteeism by increasing each nurse's job responsibilities. Why is this strategy effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses who feel their job is important realize that others depend upon their presence at work. 2. A nurse who is given additional work responsibilities must work harder to prevent termination. 3. Nurses who have greater responsibilities do not stress over minor responsibilities any longer. 4. A nurse with less responsibility is always less motivated. 5. Having greater responsibilities enriches the job experience. Answer: 1, 5 Explanation: 1. When employees feel they are making a real contribution, they take greater ownership in their work. 2. Preventing termination is not the reason this strategy is effective. 3. Generally, the greater the responsibility, the greater the stress over all aspects of the job. 4. Many nurses are very motivated even though they may not have as much responsibility as others. 5. Greater responsibilities often change the flavor of the job so that the nurse enjoys it more. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 12) Despite the nurse manager's best efforts to retain an experienced nurse, the nurse leaves for a job in a competing hospital. Which option reflects the most important thing the manager must do now? 1. Find a replacement to hire. 2. Have human resources interview the nurse who left. 3. Manage personal feelings of defeat. 4. Decrease the impact of the hospital grapevine. Answer: 4 Explanation: 1. While finding a replacement for the nurse is important, it is not the primary concern. 2. An exit interview is important, but is not the manager's primary concern. 3. The manager may feel defeated by losing this nurse, but this is not the primary concern. 4. This nurse is gone, so the manager's next task is to decrease the impact of the hospital grapevine. This informal, but powerful information superhighway can spread inaccurate and inflammatory information rapidly and could influence other nurses to leave. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses.

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13) Hospital management is brainstorming ways to reduce absenteeism. Which suggestions from this session deserve further investigation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I think we should define excessive absenteeism by total time lost instead of absence frequency." 2. "Let's offer a salary increase for those with good attendance." 3. "Why not include attendance as part of the employee performance appraisal?" 4. "I don't think we are enforcing the absence policies we have now. That is the logical place to start." 5. "We need to start at the top and be certain all of our management employees maintain good attendance." Answer: 2, 3, 4, 5 Explanation: 1. Total time lost is not as sensitive an indicator of excessive absenteeism as absence frequency. For example, an employee might miss 30 days of work due to a scheduled surgery for which the manager could make scheduling adjustments. Another employee could miss a total of 30 days due to oversleeping, car trouble, or just deciding not to come to work. The difference in impact on the unit is obvious. 2. The idea of offering a salary increase should be further investigated. 3. The idea of using attendance as part of the employee performance appraisal may work, especially if the appraisal is tied to merit raises. 4. If absence policies currently in place are not being followed, employees develop the idea that absences are not a serious issue. 5. Employees model what they see in managerial staff. If the management-level employees do not have good attendance, the staff begins to believe that absences are not a problem. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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14) The management staff is investigating ways to decrease absenteeism that will also help to promote greater job satisfaction over the long term. Which suggestions should they consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We could convert a specified number of unused sick days to vacation days." 2. "Is there a way we could convert unused sick time to retirement credit?" 3. "I think we should stop putting a limit on how many sick days an employee can accumulate." 4. "We should think up some penalty for using more than a given number of sick days in a year." 5. "I think we should stay with our policy of taking away holiday time if the employee uses a sick day in the same week." Answer: 1, 2, 3 Explanation: 1. Conversion of unused sick days to vacation days eliminates the feeling that employees are going to "lose sick days," which they consider a benefit. 2. Converting unused sick time to retirement credit helps to eliminate the feeling that employees are going to "lose sick days," which they consider a benefit. 3. When there is a limit on how many sick days can be accumulated, the employee may feel that a benefit has been taken away and may take unneeded sick days to prevent losing that benefit. 4. Penalties may work to discourage the use of sick time, but will not promote job satisfaction. 5. A policy of taking away holiday time based on a sick day being taken is punitive to good employees. It may also encourage an employee to come to work when sick. It is not a good way to promote job satisfaction. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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15) Which employee is eligible for leave under the Family and Medical Leave Act (FMLA)? 1. A female employee who has worked at the community hospital full-time for 5 months and requests 12 weeks of maternity leave 2. A male employee who has worked two 12-hour shifts for a rural hospital on weekends for 12 months and requests a 12-week leave to care for a newly adopted child 3. A female employee who has worked for a large metropolitan hospital full-time for 1 year and requests 3 months' leave to care for her dying mother 4. A male employee who has worked full-time at a small private clinic with 20 employees for the last 8 years and requests 12 weeks of leave to care for a new foster child Answer: 3 Explanation: 1. The employee must have worked for the employer for at least 12 months. 2. The employee must have worked at least 1,250 hours in the last 12 months. 3. This employee has worked 12 months, at least 1,250 hours, and the hospital is large and therefore likely employs over 50 people. 4. The employee must be at a work site with 50 or more employees, or at a site where 50 workers are employed within 75 miles of the work site. A small private clinic with 20 employees does not meet this requirement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 16) The chief nursing officer notes that the nursing department has exceeded budget in salary expenses for the last 3 months and asks the hospital nurse managers why this occurred. Which would be a cause for increased salaries? 1. Low client acuity for the past year 2. The increase in the amount of tuition reimbursement 3. A high turnover rate in nursing staff 4. The cost-of-living raise given Answer: 3 Explanation: 1. Low client acuity does not cause salary cost to increase. 2. Tuition reimbursement is a benefit, not salary. 3. High turnover rate would increase salaries because of overtime wages to cover when nurses leave and additional staff hours for orienting newly hired nurses, as well as the cost of agency nurses. 4. A cost-of-living raise would have been figured into the budget. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization.

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17) A manager is preparing to write a critical incident regarding a nurse who has voluntary absences for several scheduled shifts. What information should the manager determine first? 1. How many hours were missed per pay period? 2. What was the frequency and time period of the absences? 3. What was the reason for these absences? 4. Who did the nurse notify of the impending absences? Answer: 2 Explanation: 1. The number of hours missed per pay period is interesting information, but is not the most critical statistic for this critical incident. 2. The number of absences and the time periods of the absences are critical pieces of information for the critical incident documentation. 3. It is already clear that these absences were excessive and voluntary, so a critical incident form will be completed. The reason why the absences occurred is of secondary importance. 4. It is important to determine if the nurse followed policy when notifying the institution about the absences, but this is not the most critical information. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 18) A nurse manager is completing a critical incident form regarding a nurse who has missed two 12-hour shifts, three 8-hour shifts, was 2-1/2 hours late to one shift, and left 3 hours early from another shift. The manager should document the total time lost as ________ hours. Answer: 53-1/2 Explanation: Total time lost is figured by adding up the number of hours the nurse did not come to work. In this case, 12 + 12 + 8 + 8 + 8 + 2-1/2 + 3 = 53-1/2. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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19) A nurse who is obtaining a bachelor's degree in nursing is formulating a project regarding nurse's job satisfaction. The nurse is aware that research has shown job satisfaction is related to which factors in the working environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Appropriate staffing 2. Involvement in organizational decision making 3. Ability to work overtime 4. Being recognized for a job well done 5. Good relationships among staff Answer: 1, 2, 4, 5 Explanation: 1. Nurse retention may be a result of enhancing the work environment. Appropriate staffing is a positive indicator of a healthy work environment. 2. Involvement in organizational decision making improves the overall work environment for nurses. 3. Being able to work overtime is not universally important. 4. Recognition for doing one's job well is an important component of job satisfaction. 5. Good staff relationships improve the work environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collegiality Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. 20) An ICU manager is discussing a nurse's frequent absences and tardiness, which the nurse explains results from unreliable child care. The nurse states, "None of the other nurses mind if I am late or have to miss a shift. My kids are important to me. I'd do the same for any of them." This is an example of which situation? 1. Enriched job environment 2. Organizational practices 3. Absence culture 4. Generational differences Answer: 3 Explanation: 1. Enrichment of the job environment makes the job challenging and rewarding, which encourages employee attendance and participation. 2. Organizational practices are such things as on-site child care that can influence an employee's motivation to work. 3. Absence culture on this unit is tolerant of absences. 4. While there may be some differences in how generations view punctuality and attendance, it is not clear that is an issue in this situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. TestBankWorld.org

21) A nurse manager has recently been transferred from obstetrics to pediatrics. The manager consistently stays in the office, does not relieve staff for lunches, and rarely assists staff when the unit is busy. Lately, the manager has noticed an increase in staff absences. Which options may contribute to the situation on this unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The manager has a lack of confidence in personal ability to provide care to pediatric clients. 2. The manager is unable to confront staff regarding absences. 3. The manager is not supervising the work of the unit. 4. The staff is consciously taking advantage of the manager. 5. The manager has a lax attitude toward absenteeism. Answer: 1, 2, 3, 5 Explanation: 1. The manager just transferred from a different unit and may be uncomfortable with skills needed to care for pediatric clients. 2. Confronting the staff about absences may be difficult for a new manager. 3. If the manager consistently stays in the office, supervision is minimal. 4. It is difficult to say that the staff is consciously taking advantage of the manager, but this may be occurring on a subconscious level. 5. The manager's own absence culture may be very tolerant. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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22) An organization has not updated its sick day policy in the last 5 years and has experienced an increase in employee days off for illness over the last year. Which change to the sick leave policy might have a positive effect on the organization's absenteeism? 1. Change the policy to award personal use days rather than sick days. 2. Place stricter limits on the number of sick days that can be accrued. 3. Limit the amount of sick time an employee can use each year regardless of the amount accrued. 4. Allow employees to trade sick time for money no matter how many hours are accrued. Answer: 1 Explanation: 1. Personal use days are days that the employee can schedule for any use or can use in time of sickness. When the days are designated as personal use days, the employee does not have to be deceitful when using a day for personal time rather than when sick. 2. When the number of sick days is limited, employees tend to use days to avoid losing the benefit. 3. Limiting the amount of sick time an employee can use would work as a disadvantage to loyal employees who happen to have an extended illness. 4. Allowing employees to trade sick time for money would be an unmanageable strain on the budget. Employees might trade in all sick time and then become ill and not have a sick time bank. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 23) The director of two nursing units is off on medical leave. The morale on these units has decreased over the past year. During the director's absence, the chief nurse officer (CNO) notices a marked increase in the staff's morale. This causes the CNO to be concerned about which factor on these two units? 1. Lack of appropriate staffing when the manager is present 2. Recognition of the nurse's performance may be lacking 3. A lack of authentic leadership 4. The manager may have unrealistic attitudes about staff work levels. Answer: 3 Explanation: 1. Lack of appropriate staffing is not the overriding concern. 2. While this may be a part of the problem, it is not the major concern. 3. Authentic leadership is required for a healthy work environment. Since the morale on these units has increased in the director's absence, the CNO would be concerned about the manager's leadership style. 4. This is not the primary concern. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. TestBankWorld.org

24) A newly hired nurse has incurred two absences within two pay periods. The nurse manager has scheduled a meeting with the nurse. What other action should the manager plan in addressing this issue? 1. Have a person from human resources (HR) present when confronting the nurse. 2. Discuss the absenteeism with the nurse and then forget the issue. 3. Discuss the issue of absenteeism and other nurses who have had similar experiences when first hired. 4. Document the absences, review the attendance policy with the nurse, and provide a copy of the policy. Answer: 4 Explanation: 1. It is not necessary to have HR present at this meeting since this is the nurse's first occurrence with absenteeism. 2. The absenteeism needs to be addressed and monitored in the future to determine the nurse's progress. 3. It is not appropriate to discuss the absence experiences of other nurses. 4. The manager should document the absences so they can be monitored and discussed. The manager should discuss and present the attendance policy to clarify possible misconceptions by the nurse and to be clear about the consequences of future issues relating to absenteeism. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it. 25) A nursing unit is extremely short staffed. The manager calls a nurse who is on Family and Medical leave (FMLA) to ask the nurse to return to work 2 days prior to schedule. When the nurse declines, the manager becomes insistent. What should be the nurse's first action? 1. Contact a lawyer. 2. Agree to return 2 days early. 3. Contact the human resources director. 4. Contact nursing administration. Answer: 3 Explanation: 1. The employee should contact a lawyer only after all attempts to rectify the situation with the organization have been exhausted. 2. The nurse is assured the time off through FMLA and should not return to work early. 3. The nurse's first action should be to contact the human resources (HR) director. 4. If the nurse contacts nursing administration, he or she is likely to be referred to the human resources department. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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26) Which personal characteristics would increase a nurse's potential for voluntary turnover? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse holds an associate's degree in nursing. 2. The nurse walks to work each day. 3. Through task force meetings, the nurse has become friends with several nurses who work in different organizations in town. 4. The nurse has few personal ties to the city of current employment. 5. The nurse has worked at several job fairs in the area as a hospital representative. Answer: 3, 4, 5 Explanation: 1. A nurse who holds a higher degree is likely to be more mobile. 2. If the nurse lives within walking distance to the hospital he or she is less likely to voluntarily resign. 3. Having contacts in other healthcare organizations increases the nurse's likelihood of changing work sites. 4. If the nurse is geographically mobile, leaving for a "change of scenery" is attractive. 5. Attending job fairs, even as a hospital representative, opens up new contacts and possibilities of new jobs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization. 27) A valued longtime nursing employee says to the manager, "I'm so tired of all the politics on this unit. I'm thinking about retiring." What should be the manager's response? 1. "I've just got 3 more years and I can retire. I can't wait." 2. "I know, but I can't do anything to change the situation." 3. "I'd hate to lose you, but have you thought about transferring to a different unit?" 4. "Will you stay if I can get you a raise?" Answer: 3 Explanation: 1. If the manager wishes to retain this employee, a statement about wanting to retire is not prudent. 2. The manager is not offering this nurse any alternative except that the politics will continue. 3. The manager has offered the possibility of a lateral transfer to this employee. It will not keep the employee on the manager's unit, but will keep the employee in the organization. 4. Money might be enough to entice the employee to stay, so it is not the best option offered. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 21-2: Describe how nursing turnover affects the organization.

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28) The nurse manager charged with hiring staff for a new nursing unit explains the unit's rigid structure and scheduling policies to all potential applicants. The manager is most likely to lose the interest of applicants of which generations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Traditionals 2. Baby boomers 3. Generation X 4. Generation Y 5. Nurses in general do not like structure and rigidity in scheduling. Answer: 3, 4 Explanation: 1. Traditionals in general like structure and are more likely to work well with inflexible schedules. 2. Baby boomers in general do fairly well with structure and rigid scheduling. 3. Generation Xers in general do not like structure and are more interested in flexible scheduling. 4. Generation Yers in general do not like structure and are more interested in flexible scheduling. 5. Some nurses thrive in an environment with lots of structure and a predictable, somewhat rigid schedule. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses. 29) An employee has called in to report being unable to come to work due to car trouble. This is the third time this has happened in the last 2 weeks. The manager should question which variable in this employee's attendance? 1. Ability 2. Motivation 3. Need 4. Supervision Answer: 2 Explanation: 1. Ability to attend is generally linked to such obstacles as car trouble, but since this has happened frequently the manager should look to another issue. 2. Since this car trouble is frequent, the manager must look to the employee's motivation to attend. Why has the employee not arranged better or different transportation? 3. Need to attend can be linked to motivation, but motivation is a better descriptor in this situation. The employee might need to attend for the salary, but is not motivated to do so. 4. Supervision has little to do with this scenario. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-1: Explain absenteeism and how to manage it.

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30) A nurse manager strongly believes that nurses should seek advanced educational degrees. The manager encourages this attitude in staff nurses. What are the dangers of this practice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses who achieve an advanced degree are more mobile. 2. Staff nurses may have a higher degree than the manager. 3. Staff members may need time off to attend school. 4. Staff members may resign to attend school full-time. 5. Salaries are higher for nurses with advanced degrees. Answer: 1, 3, 4 Explanation: 1. The nurse with an advanced degree has greater job opportunity and is more mobile. 2. This may be the case, but should not be a problem. 3. Scheduling around several nurses who have school schedules can be difficult. 4. There is a chance that nurses may resign in order to attend school on a full-time basis. 5. While salaries are higher for nurses with advanced degrees, the manager should know well in advance that a staff member is in school and should have opportunity to budget for those salaries. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses.

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31) Under the federal Family and Medical Leave Act (FMLA), employees are eligible to take a leave if they what? 1. Substitute personal time for leave time 2. Worked for the employer for at least 12 months 3. Worked at least 1,250 hours during the previous 12 months 4. Have good attendance at work 5. Are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite Answer: 2, 3, 5 Explanation: 1. Employees are eligible to take a leave if they worked for the employer for at least 12 months, worked at least 1,250 hours in the previous 12 months, and are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite. 2. Employees are eligible to take a leave if they worked for the employer for at least 12 months, worked at least 1,250 hours in the previous 12 months, and are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite. 3. Employees are eligible to take a leave if they worked for the employer for at least 12 months, worked at least 1,250 hours in the previous 12 months, and are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite. 4. Employees are eligible to take a leave if they worked for the employer for at least 12 months, worked at least 1,250 hours in the previous 12 months, and are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite. 5. Employees are eligible to take a leave if they worked for the employer for at least 12 months, worked at least 1,250 hours in the previous 12 months, and are at a worksite with 50 or more employees, or are employed within 75 miles from the worksite. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses.

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32) The American Association of Critical Care Nurses (AACN) established criteria for a healthy work environment. This includes what criteria? 1. Appropriate staffing 2. Skilled communication 3. Improved salaries 4. True collaboration 5. Personal characteristics Answer: 1, 2, 4 Explanation: 1. Criteria for the AACN healthy work environment includes appropriate staffing, meaningful recognition, skilled communication, effective decision making, true collaboration, and authentic leadership. 2. Criteria for the AACN healthy work environment includes appropriate staffing, meaningful recognition, skilled communication, effective decision making, true collaboration, and authentic leadership. 3. Criteria for the AACN healthy work environment includes appropriate staffing, meaningful recognition, skilled communication, effective decision making, true collaboration, and authentic leadership. 4. Criteria for the AACN healthy work environment includes appropriate staffing, meaningful recognition, skilled communication, effective decision making, true collaboration, and authentic leadership. 5. Criteria for the AACN healthy work environment includes appropriate staffing, meaningful recognition, skilled communication, effective decision making, true collaboration, and authentic leadership. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 21-3: Examine what organizations can do to improve retention of nurses.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 22 Dealing with Disruptive Staff Problems 1) A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. This problem is likely the result of which of the following situations? 1. The hospital is in a poorer part of town and offers a great deal of charity care. 2. The hospital pays about $0.25 per hour less than other hospitals as a starting wage for nurses. 3. The hospital has a reputation for allowing bullying behavior to occur. 4. The other hospital in town has a more modern building and campus. Answer: 3 Explanation: 1. Although some staff may be put-off by the area of town and the fact that charity care is provided, this is not the most probable reason for the situation. 2. Twenty-five cents is not enough of a difference in wages to explain this situation. 3. People do not like to be bullied. If the hospital has this reputation, it is unlikely to attract new employees, and older employees are likely to leave. 4. Physical facilities are important but are not likely important enough to be the most probable cause of this situation. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence. 2) The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility? 1. "Bullying behaviors make nurses uncomfortable." 2. "Physicians do not want to admit clients to hospitals with an uncivil atmosphere." 3. "Bullying and incivility are just not proper work practices." 4. "Bullying and incivility are dangerous to client care." Answer: 4 Explanation: 1. This is a reason for not tolerating harassing behaviors, but it is not the most important reason. 2. It is true that incivility may decrease the number of clients admitted to a hospital, but this is not the primary reason for this work. 3. Bullying and incivility are not proper work practices, but this is not the primary reason for excluding them from the workplace. 4. These behaviors can be dangerous to clients. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence. TestBankWorld.org

3) A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nursing assistants 2. Physicians 3. Managers 4. Office personnel 5. Senior nurses Answer: 2, 3, 5 Explanation: 1. Nursing assistants are often bullied but are not the main bullies. 2. Physicians are among those reported as being the worst bullies. 3. Managers are among those reported as being the worst bullies. 4. Office personnel are not among those listed as being the worst bullies. 5. Senior nurses are among those listed as being the worst bullies. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence. 4) A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate? 1. "I have no control over what the nurses do on their time away from work." 2. "This does not meet the standards for bullying because it was not a face-to-face encounter." 3. "You two are acting like a couple of high school kids." 4. "I will follow up on this complaint and take action as needed." Answer: 4 Explanation: 1. The remarks were about the nurse's professionalism, which is a part of the nurse's work. The manager does have input into this situation. 2. Bullying can occur on the internet, by text message, or face-to-face. 3. This is not an appropriate or helpful remark for the manager to make in this situation. 4. The manager must do an assessment of the complaint before acting. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence.

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5) A group of nursing students have just arrived on the unit. Which staff actions would be considered uncivil to these students? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The unit clerk groans when the instructor enters the nursing station with the students. 2. A nurse quietly says, "Please do not assign a student to me today. I have two very sick clients who are going to require my full attention." 3. A nurse whispers, "Not students again today." 4. A nursing assistant asks the students how long they have been in school. 5. A transport worker says, "Just great, more students to get in the way today." Answer: 1, 3, 5 Explanation: 1. Any action that indicates the students are unwelcome is not civil. 2. This nurse has not been uncivil but is stating a fact about the acuity of clients. 3. This whisper is not civil, despite the level at which it is spoken. 4. This is a valid statement and is civil. 5. The intent of this remark is probably not civil. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence. 6) A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I know. It's a shame that all the old ways are changing." 2. "Why would you want to bully a new nurse? They are all so naïve and cute." 3. "The Joint Commission does not tolerate disruptive or abusive behavior." 4. "The American Nurses Association does not approve of bullying behaviors." 5. "New nurses bring new ideas. Why would you bully them?" Answer: 3, 4, 5 Explanation: 1. Agreeing with the nurse only serves to reinforce the behavior. 2. A statement about the new nurse being naïve and cute is a bullying behavior. 3. The Joint Commission recommends a zero tolerance policy regarding disruptive or abusive behavior. 4. The ANA recommends several strategies to combat these behaviors. 5. New ideas are brought by new nurses. Bullying of any segment of the profession is wrong. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors.

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7) A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tell the nurse to go home for the rest of the day. 2. Have the nurse call the physician back and demand an apology. 3. Document the facts of the encounter. 4. Privately tell the physician that the behavior was bullying. 5. Confront the physician during rounds and demand an explanation. Answer: 3, 4, 5 Explanation: 1. There is no reason for the nurse to go home. 2. The manager should not anger both parties more by creating another immediate encounter. 3. The facts of the encounter must be documented. 4. The manager should name the behavior. 5. The manager should speak to the physician in a civil manner. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 8) A nurse manager does not like conflict and would like to allow instances of bullying to "go away on their own." Which rationale by the manager's supervisor is the most important? 1. "The Joint Commission requires that we address instances of bullying." 2. "We don't want to run off good nurses." 3. "If you let bullying go, it just gets worse and more frequent." 4. "A bully makes the work environment unpleasant for everyone." Answer: 3 Explanation: 1. The Joint Commission does have this requirement, but it is not the most important reason to address bullying. 2. Bullying can make nurses leave the organization, but this is not the most important reason to address each situation. 3. Bullying behavior tends to escalate if ignored. 4. It is true that a bully makes the work environment unpleasant, but this is not the most important rationale. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors.

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9) The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager? 1. Call a meeting of all night shift employees. 2. Review the staffing pattern and absentee list for the night shift. 3. Ask employees for their perceptions on missing narcotics. 4. Request that security search employee lockers and personal items. Answer: 2 Explanation: 1. A staff meeting may be warranted at some point, but is not the first action. 2. The first step is to assess the problem. By checking the staffing pattern on the nights in question, the manager can rule out some employees. 3. Asking for staff perceptions about the missing drugs might be warranted, but it is not the first step in assessment. 4. Legal issues should be considered before planning to search employee lockers. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem. 10) Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs? 1. Place the nurse on a different unit and allow the administration of all drugs. 2. Reassign the nurse for a period to a unit where no mood-altering drugs are given. 3. Retain the nurse on the original unit and allow the administration of mood-altering drugs. 4. Return the nurse to the original unit at a less stressful time, such as night shift. Answer: 2 Explanation: 1. In many cases, state law or administrative policy will restrict a recovering nurse in the early posttreatment period from handling controlled substances. 2. Removal of the temptation is a positive step for the recovering nurse. The best action would be to have the nurse temporarily reassigned to a unit where there are no mood-altering drugs. 3. If the nurse must be assigned to the original unit, he or she should not administer moodaltering drugs. However, this plan does require informing the other nurses of the situation, which can also be problematic. 4. Recovering nurses should be discouraged from working evening or night shifts. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem.

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11) What characteristics would cause the manager to classify an employee as marginal? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The employee works only when client census calls for additional staff. 2. The employee's work does not improve with coaching. 3. The employee just made an error for which discipline has already been done twice. 4. The employee has worked at the facility for less than 1 month. 5. The employee does not mix well with the other staff but stays on the margins of the group. Answer: 2, 3 Explanation: 1. An employee who works only on a prn basis is not necessarily a marginal employee. 2. A marginal employee does not take instruction well. 3. An employee whose work does not improve after discipline is a marginal employee. 4. Length of employment has little to do with being classified as marginal. 5. Marginal does not mean staying at the margins of the social group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 12) A night shift charge nurse frequently points out nurses' faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior? 1. Lateral violence 2. Unprofessionalism 3. Lack of civility 4. Bullying Answer: 3 Explanation: 1. Lateral violence is harassment between employees of equal rank. 2. The behavior is unprofessional, but that is a very broad term and does not identify the issue in this particular case. 3. Lack of civility is defined as disrespectful or rude behavior. 4. Bullying is a broad term used to describe many behaviors. It is not specific to this situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence.

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13) The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility? 1. "Your behavior is rude and disrespectful toward your staff." 2. "This behavior is unprofessional." 3. "This behavior is unacceptable." 4. "This behavior warrants a written warning." Answer: 1 Explanation: 1. Lack of civility is rude, disrespectful, and impolite behavior. 2. This behavior is unprofessional, but this term is not the most specific one provided. 3. This behavior is unacceptable, but this term is not the most specific one provided. 4. This behavior likely does warrant a written warning, but this is not the statement that most specifically describes the behavior. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 14) A night shift nurse is assuming a day shift nurse's assignment, which includes two clients with pain that is being controlled with oral hydrocodone (Lortab). At shift assessment, both clients complain of pain. During shift report, the day shift nurse reports that both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take? 1. Repeat the medication. 2. Inform the manager of the situation. 3. Call the physician to obtain an order for IV narcotics. 4. Tell the clients that pain medication will be given at the next ordered time. Answer: 2 Explanation: 1. Repeating the medication without further assessment is dangerous. 2. Although there is no clear indication that the day shift nurse is diverting drugs, the manager must be made aware of the situation so it can be investigated. The nurse and manager must determine if the clients actually received the medication and, if so, what time it was administered. 3. Calling the physician with a request for IV narcotics would be dangerous. 4. The issue in this situation is whether the clients actually received the medication. Telling the clients that they must wait until the next scheduled time for pain medication is not appropriate pain management. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem.

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15) A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which of the following should be the manager's first action? 1. Meet with the coworker in private and discuss the behaviors. 2. Meet with other staff to determine if the coworker has issues at home. 3. Meet with human resources (HR) to determine the best method to terminate the employee's employment. 4. Collect additional information regarding behaviors, absenteeism, or tardiness. Answer: 4 Explanation: 1. The manager will meet with the nurse but should have information to support the investigation of substance abuse. 2. Obtaining information from other staff is unprofessional and violates confidentiality. 3. The manager should meet with HR to determine a course of action but should have documentation to support suspected abuse prior to HR's involvement. 4. The manager should obtain information and documentation to determine if there is a problem. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem. 16) A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization's policies. Which statement by the HR director is appropriate? 1. "We should meet with the nurse and offer access to the employee assistance program." 2. "We should confront the employee and discuss involuntary or voluntary termination of employment." 3. "You need to meet with this nurse and confront these behaviors." 4. "We need to set up a counseling session with a psychologist and this nurse." Answer: 1 Explanation: 1. Most healthcare organizations offer substance abuse programs for employees. 2. Termination of employment is typically the last resort. 3. Meeting with the employee should be to offer help, not to confront. 4. The manager and HR director should offer the employee assistance program (EAP) but not schedule appointments for the employee without consent. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem.

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17) The manager has determined that a nurse is marginal but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse may harm a client. 2. Other nurses on the unit may become disgruntled by having to cover for this nurse. 3. The nurse may never become a good employee. 4. The manager's employment may be terminated. 5. The morale of the unit may decline. Answer: 1, 2, 3, 5 Explanation: 1. Marginal work may result in harm to clients. 2. A marginal employee increases the workload on other, more competent employees. 3. If marginal work is allowed to continue, the nurse may never change. 4. It is unlikely that a manager's employment would be terminated because of one marginal employee. 5. Having a marginal employee who must be constantly coached and watched may negatively affect the morale of other staff and the entire unit. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 18) An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, "That probably happened when the nurse covering for me at noon or for my breaks was in charge." How should the manager interpret this statement? 1. This is a plausible explanation of who was in charge at the time of the error. 2. The coverage nurse is likely incompetent. 3. This nurse was not in charge when the error was made. 4. This nurse is scapegoating the coverage nurse. Answer: 4 Explanation: 1. A statement this broad is likely not a clear explanation. 2. There is no indication that the coverage nurse is incompetent. 3. There is no evidence that this nurse was not in charge when the error was made. 4. By raising the possibility (and being very sure) that the other nurse was in charge, the nurse has created a scapegoat. This is a form of lateral violence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence.

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19) A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Continue to be persistent in your work with these nurses." 2. "You can fire them at any time." 3. "Be fair and consistent with them." 4. "You must continuously assess the rest of your staff as you work with these two nurses." 5. "You must continue to address the issues with these nurses as they arise." Answer: 1, 3, 4, 5 Explanation: 1. Persistence is a key to being perceived as fair and just. 2. Termination practices are governed by strict procedures that must be followed to protect both the manager and the institution. 3. Fairness and consistency are keys to being perceived as just. 4. The manager must be aware of the impact of marginal nurses on the remainder of the staff. 5. The manager cannot ignore any issues that arise with these nurses. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 20) Two staff members have a long-standing dislike of one another. Generally, they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation? 1. Tell the two staff members to go to the manager's office immediately. 2. Send both of the employees off the unit. 3. Immediately call for security. 4. Stand between the employees and tell them to calm down. Answer: 3 Explanation: 1. The manager should not try to intervene when physical violence is occurring. 2. The manager should not send these employees off the unit. Violence may continue or escalate. 3. Security should be notified immediately when physical violence occurs or is imminent. 4. The manager should not risk harm to self by standing between these employees. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors.

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21) A nurse constantly complains about employee policies and procedures and frequently mentions how "they" are "out to get us." The nurse is surprised when referred to by the manager as "disgruntled" during a discussion of this behavior. What information should the manager provide this nurse? 1. "People who are constantly complaining decrease the morale of the rest of the unit." 2. "You have complained so long, it will be impossible to change your behavior." 3. "Being a complainer is a character trait." 4. "Your attitude problem makes everyone else in the unit miserable." Answer: 1 Explanation: 1. Disgruntled, complaining employees adversely affect everyone else's morale. 2. Complaining is a behavior, and it can be changed with time, work, and coaching. 3. Complaining is a learned behavior and can be unlearned. 4. Complaining is not an attitude problem as much as a learned behavior. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Ethics Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 22) A nurse manager has been working with a disgruntled employee for several weeks. Today the employee comes to the manager's office with yet another complaint about a new hospital policy. The manager says, "I am sick of your complaining. Leave me alone so I can get some work done." What should the manager do now? 1. Firmly shut the office door. 2. Tell the employee to go to human resources with complaints about the policy change. 3. Apologize to the employee for being unprofessional and ask what the issue with the policy is. 4. Tell the employee to go back to work. Answer: 3 Explanation: 1. The manager has made a tactical error and should not just shut the door. 2. There is no reason to send the employee to HR. 3. The manager must remain professional at all times. In this case, when the manager was not professional, an apology is in order. 4. The manager has made a tactical error and should not send this employee back to work. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors.

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23) A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first? 1. Tell the employee to go home and change. 2. Check the human resources policies regarding appropriate dress. 3. Ask the employee why the shirt was worn to this event. 4. Bring the employee a scrub shirt from surgery to change into. Answer: 2 Explanation: 1. This is not the first step of this process. 2. Before the manager does anything else, he or she must be certain that policy backs up the planned actions. 3. This is not the first action the manager should take. 4. This is not the first action the manager should take. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 24) A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager, the nurse says, "The nurses who smoke always take longer lunches. No one says anything to them." What is the manager's major consideration before replying to this statement? 1. Policies must be consistently applied to all employees. 2. Because the hospital is smoke free, those nurses who wish to smoke must leave campus for lunch. 3. This nurse complains about everything. 4. The human resources policy is that nurses get 60 minutes for lunch. Answer: 1 Explanation: 1. No matter the situation, policies must be consistently applied. 2. This may be a fact, but it is not relevant to this discussion. 3. The fact that this nurse is a known complainer is not relevant to the issue. 4. The length of the lunch break is not the most important aspect of this discussion. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors.

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25) A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate? 1. Discuss the issues at a staff meeting and elicit methods to improve morale. 2. Use progressive discipline to manage the employee. 3. Monitor the staff's performance to determine the lack of civility. 4. Terminate the employee's employment. Answer: 2 Explanation: 1. Discussing the issue of morale and monitoring staff regarding civility will not address the issues regarding the marginal employee. 2. Using progressive discipline to manage the employee allows for communication regarding poor performance and allows the employee the opportunity to improve his or her performance. 3. Discussing the issue of morale and monitoring staff regarding civility will not address the issues regarding the marginal employee. 4. Terminating employment does not provide the employee with an opportunity to improve his or her performance. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 22-2: Describe strategies to manage staff with problem behaviors. 26) Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Chart review on effectiveness of pain control. 2. Increase in clients with conditions requiring pain medications. 3. Increase in use of doses of as-needed narcotics that results in wastage. 4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others. 5. Narcotic containers that look as if they have been altered. Answer: 1, 3, 4, 5 Explanation: 1. If many clients report their pain is not controlled, diversion may be occurring. 2. An increase in clients requiring pain medications is likely census related. 3. If the nurse has a choice of doses and is trying to divert medications, a smaller dose might be given resulting in a larger wastage that is then diverted. 4. If one shift is giving much more pain medication that the other, it may be because someone is diverting drugs on that shift. It may also mean that inadequate pain control is being given on the other shift because someone is diverting drugs. 5. Altering the container is a method of diversion. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem. TestBankWorld.org

27) A nurse admits to diverting narcotic drugs while working. The manager says, "All nurses who admit diverting narcotics have to be reported to the state board of nursing." How should the nurse interpret this statement? 1. As true, because any nurse who admits diversion must be reported to the state's board of nursing 2. As false, because in some states reporting depends on other factors 3. As beneficial, because the state board of nursing will help the nurse find a substance abuse program 4. As career ending, because the state board of nursing is required to suspend the license of any nurse who admits to diverting drugs Answer: 2 Explanation: 1. This is not universally true. 2. In some states, if the nurse completes a substance abuse program, reporting is not done. 3. This is true in some but not all states. 4. This is not a true statement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem. 28) A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled? 1. A certified letter outlining the accusation and investigation should be sent to the nurse's home. 2. A certified letter outlining the accusation and investigation should be sent to the nurse at work. 3. The nurse should be contacted and asked to make an appointment with the nurse executive without giving cause. 4. The nurse should be approached at work with no prior notice and asked to come to the nurse executive's office. Answer: 4 Explanation: 1. Sending a letter to the nurse's home will give the nurse opportunity to rationalize the abuse, to create a "story," or to develop denial. 2. Sending a letter to the nurse at work will give the nurse opportunity to rationalize the abuse, to create a "story," or to develop denial. 3. If a request to make an appointment with the nurse executive is made, a nurse who is abusing narcotics would likely be suspicious that administration had found out about the abuse. 4. This surprise approach minimizes the amount of time the nurse has to create a story or to rationalize the abuse of narcotics. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem.

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29) A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make? 1. "Health insurances generally pay 100% of treatment charges for medical professionals who are seeking help." 2. "If you go to treatment, the state board will never know you were abusing." 3. "Treatment is your best chance at returning to practice." 4. "We will be able to follow your progress through reports from your treatment team." Answer: 3 Explanation: 1. Unfortunately, this is not a true statement. 2. Just going to treatment is not sufficient; the nurse must successfully complete treatment. In some states, the state board must be notified regardless of the decision to seek treatment. 3. The nurse who successfully completes treatment stands the best chance at successfully reentering practice. 4. Unless the nurse gives consent to release information to the nurse executive, this is not possible. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem. 30) A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse? 1. Administration reports the nurse to the state board of nursing. 2. The nurse is counseled and asked to participate in a treatment center plan. 3. The nurse is allowed to continue supervised practice while a treatment plan is being devised. 4. The nurse's employment is terminated with no report made. Answer: 4 Explanation: 1. If this occurs, the nurse is likely to be offered some kind of assistance back into health and the profession. 2. If the nurse agrees to treatment, help is forthcoming. 3. In this case, the nurse is supervised, and a treatment plan is forthcoming. 4. If the nurse's employment is terminated, employment at another facility may occur and the cycle may continue. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 22-3: Explain how to handle staff with a substance abuse problem.

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31) Lack of civility includes behaviors that are what? 1. Ill-mannered 2. Rude 3. Violent 4. Impolite 5. Disrespectful Answer: 1, 2, 4, 5 Explanation: 1. Behaviors that indicate lack of civility include those that are ill-mannered, rude, impolite, and disrespectful. 2. Behaviors that indicate lack of civility include those that are ill-mannered, rude, impolite, and disrespectful. 3. Behaviors that indicate lack of civility include those that are ill-mannered, rude, impolite, and disrespectful. 4. Behaviors that indicate lack of civility include those that are ill-mannered, rude, impolite, and disrespectful. 5. Behaviors that indicate lack of civility include those that are ill-mannered, rude, impolite, and disrespectful. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence. 32) ________, is the harassment between employees of equal rank. Answer: Horizontal violence Explanation: Horizontal violence is the harassment between employees of equal rank. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 22-1: Identify harassing behaviors, including bullying, incivility, and horizontal violence.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 23 Preparing for Emergencies 1) A nurse manager is working on a task force to develop policy for man-made disasters. There is some discussion in the committee about whether fire should be included in the policy. Which suggestion by a task force member would be most useful? 1. "Fire is a natural occurrence, so we should not address it." 2. "Fires are not generally a real disaster, so we should not include it." 3. "We should only focus on wildfires." 4. "We should only focus on arson fires." Answer: 4 Explanation: 1. Fire is natural, but not all are from a natural source. 2. Fires can be a major disaster. 3. Wildfires are natural disasters. 4. Because arson fires are man-made, they would be included in this plan. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation. 2) Healthcare providers are bracing for a worldwide outbreak of H1N1 influenza. How would this outbreak be classified in planning literature? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A man-made disaster 2. As a pandemic 3. As a health disaster 4. As a natural disaster 5. As an epidemic Answer: 2, 3, 4 Explanation: 1. H1N1 occurs naturally and is therefore a natural disaster. 2. If H1N1 spreads around the world, it is a pandemic. 3. H1N1 that spreads around the world would be a health disaster. 4. H1N1 is naturally occurring and is therefore a natural disaster. 5. If the illness spreads around the world, it is considered a pandemic. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation.

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3) A tornado destroyed 65% of the businesses and homes in a small midwestern city. Aid would be requested based on categorization as a level ________ disaster. Answer: III Explanation: Tornado damage of this magnitude would require statewide or national assistance, which is the definition of a level III disaster. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation. 4) A small creek has flooded, requiring the rescue of one person from a stranded automobile. Electrical service was interrupted for a short period, and traffic will be diverted around flooded roads for several hours. Local law enforcement and fire departments have been well equipped to manage the disaster. The newspaper should report that the town suffered a level ________ disaster. Answer: I Explanation: If the response at the local level is sufficient, the disaster is categorized as level I. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation. 5) Fire departments from a three county area have responded to a wildfire that has threatened several homes and a hospital in a wooded area. The fire is now under control, and the fire chief is completing paperwork on the response. The disaster should be classified at level ________. Answer: II Explanation: A level II disaster is one that requires a regional response-in this case, fire departments from three counties. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation.

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6) The nurse executive of a hospital is surveying hospitals in a four-state area regarding their disaster preparedness. The nurse would expect to hear which response to the question, "What have you done to prepare for a disaster?" 1. "We have conducted a drive to get area healthcare professionals registered so they can be contacted in case of a disaster." 2. "We have a designated place with beds and equipment so that staff can be directed to an alternate care area." 3. "We have not prepared for a disaster." 4. "We conduct practice disaster drills." Answer: 4 Explanation: 1. Only half of the hospitals in the United States have conducted healthcare professional registration. 2. Only about half of hospitals report having plans for an alternative care delivery site with beds and equipment. 3. Most hospitals have at least some level of preparation for a disaster. 4. More than half of U.S. hospitals report conducting practice disaster drills. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation. 7) A nurse is working with a hospital team to create an emergency response plan that will meet Joint Commission requirements. Which sections should be included in this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A method to predict when a disaster will occur through close attention to news and weather reports 2. A method to recognize that a disaster is imminent or occurring with plans to reduce the disaster's impact 3. A plan whereby policies and procedures as well as equipment and personnel are in place to handle disasters 4. Policies and procedures that operationalize actual activities during the disaster 5. Policies and procedures describing what will occur immediately after the disaster Answer: 2, 3, 4, 5 Explanation: 1. It is not possible to predict when a disaster will occur. 2. This section of the plan would address mitigation of the disaster. 3. This section would be titled, "Preparedness." 4. This is the "response" section. 5. This is the "recovery" section. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-2: Determine emergency preparedness for hospitals. TestBankWorld.org

8) A hospital has sustained massive destruction after being struck by a tornado. The disaster plan has been activated. The administrator would expect help from which agency to coordinate the disaster efforts? 1. The Federal Emergency Management Agency (FEMA) 2. The Joint Commission 3. The Office of Homeland Security 4. Congress Answer: 1 Explanation: 1. Congress directed FEMA to coordinate disaster efforts. 2. The Joint Commission does not coordinate disaster efforts, but it does ensure that the hospital has a plan. 3. The Office of Homeland Security would be part of the disaster recovery effort, but it would not be the coordinating service. 4. Congress has designated organizations to coordinate relief efforts, but it would not direct those efforts. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 9) A hospital on the Gulf Coast of the United States would list which situations among its top vulnerabilities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Flooding 2. Hurricane 3. Earthquake 4. Tornado 5. Industrial accident Answer: 1, 2, 4, 5 Explanation: 1. Flooding would be a big concern for a hospital on the Gulf Coast. 2. Hurricane would be a big concern for a hospital on the Gulf Coast. 3. Earthquakes may occur on any fault line, but this is not a primary concern on the Gulf Coast. 4. Tornadoes often accompany hurricanes and would be a big concern on the Gulf Coast. 5. Industrial accidents would be of concern related to the large oil production capacity of the Gulf waters. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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10) The hospital is preparing for a tabletop test of its emergency operations plan. What is the potential for an interruption in services from this drill? 1. There is little potential for interruption because the drill is all done in a meeting. 2. There is some potential for interruption of non-client-care services, such as billing and scheduling. 3. There will be interruption in some services that generally occupy the area where the enormous table is set up for the drill. 4. Normal services will probably be interrupted by the simulated situations and simulated clients. Answer: 1 Explanation: 1. A tabletop drill occurs when key players in the emergency operations plan gather and "walk" through a drill. 2. There is no expected interruption in these services. 3. There is no requirement for an enormous table for this drill. 4. There are no simulated clients or real scenarios in this drill. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 11) The hospital is conducting a drill of its emergency operations plan (EOP). A nurse is acting as triage officer. Which client would be triaged for immediate care? 1. A client with a minor forearm laceration that will require a simple bandage and tetanus immunization 2. A child with a severe, penetrating head wound 3. A man complaining of chest pain that radiates to his jaw 4. A woman with a compound fracture of the femur Answer: 1 Explanation: 1. The least serious people are seen first in a disaster. 2. This child is unlikely to survive and would be triaged as last. 3. This client may be having a myocardial infarction but would not be triaged as high as another client. 4. A compound fracture is complicated, and therefore this client would be triaged later than another client. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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12) A nurse manager is leading an education session regarding disaster triage for emergency department nurses. Which statement should the manager include in this instruction? 1. "Follow your current triage system." 2. "Your triage system will be reversed during a disaster." 3. "Triage is not necessary during disasters." 4. "Your triage system will basically be first-come, first-served." Answer: 2 Explanation: 1. Triage in a disaster is vastly different than "normal" triage. 2. Triage is reversed during a disaster. The least injured clients are seen first. 3. Triage is essential during disasters. 4. Triage follows a designated plan and is not first-come, first-served. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 13) A nurse manager has provided education to emergency department nurses regarding disaster management. Which statement would the manager interpret as indicating understanding of this education? 1. "We should treat as many clients as possible as quickly as possible." 2. "Quick separation of any victim with bleeding wounds from those who are not bleeding is essential." 3. "Our goal is to treat those with serious injuries first." 4. "We should send those with less serious injuries home without treatment." Answer: 1 Explanation: 1. This is the goal of emergency treatment in a disaster. 2. There is no indication to take the time to do this separation. 3. In a disaster, those with minor injuries are treated first. 4. There is no indication that clients would be sent home without treatment. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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14) Which statements would the nurse manager interpret as indicating a nurse understands the critical thinking skills necessary for disaster management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It is just like critical thinking in the emergency department or critical care unit, only done faster." 2. "The nurse's prioritization will be different in a disaster." 3. "Clinical judgment skills will be an essential part of nursing's contribution to disaster management." 4. "Decision making will basically be done by following established protocols." 5. "The nurse's abilities will make the difference in successful management of a disaster." Answer: 2, 3, 5 Explanation: 1. Critical thinking in disasters is different compared to normal healthcare situations. For example, the triage system is reversed. 2. Normal prioritization will not be helpful in a disaster. 3. The nurse's clinical judgment will be essential in making rapid assessments and treatment decisions. 4. Disaster situations cannot be scripted with protocols. Decisions must be made quickly and accurately based upon the situation and may change in a moment-to-moment fashion. 5. Nursing will be a big part of management of a disaster, and good nursing skills will make a difference. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies.

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15) An emergency department has been notified that hundreds of injuries have occurred following the collapse of bleachers at a football game. The emergency department nurses should prepare to make which types of assessments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Physical 2. Self 3. Situational 4. Family 5. Community Answer: 1, 2, 3, 4 Explanation: 1. Physical assessment skills will be necessary as victim's injuries are assessed. 2. The nurse must be able to conduct a self-assessment of abilities to manage a victim and of personal reaction to the disaster. 3. The nurse must make situational assessments at all times during the disaster to ensure a flow of clients, equipment, personnel, and information. The nurse must also assess the safety of the situation. 4. Victim families are also involved in the disaster. The nurse must assess the families' coping abilities. 5. The nurse will not be involved in community assessment at the time of the disaster but may be called on for this skill in the days and weeks to follow. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies. 16) Multiple casualties have arrived at the emergency department following a tornado. Which instruction from the manager to staff is incorrect? 1. "There is no time to worry about using personal protective equipment, just try to be safe." 2. "Be aware that some of these victims may have been exposed to hazardous substances." 3. "Don't let client safety considerations be lost in all of the activity." 4. "Feel free to use isolation techniques if required." Answer: 1 Explanation: 1. This is an essential time to use personal protective equipment. 2. In a tornado, many structures are damaged or destroyed, including those housing hazardous chemicals. The victims may have been exposed to those substances. 3. Client safety must continue to be an important consideration. 4. Some clients may require isolation, and these techniques should be used if necessary. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies.

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17) A disaster planning task force has been asked to focus on communication. Which instruction should this group provide to nursing staff? 1. Limit your communication to physicians and other nurses. 2. Be certain to maintain the client tracking system. 3. All communication with law enforcement will be conducted through the public resource officers. 4. Communication is likely to follow the standard daily pattern. Answer: 2 Explanation: 1. The nurse will be communicating with multiple people in multiple roles during the disaster. 2. A system to track the client's presence in the facility should be a part of the disaster plan. It is essential to maintain this system so that victims can be accounted for by rescuers. 3. The nurse may be communicating directly with law enforcement officers who bring victims to the hospital. All status reports should be given through PR. 4. Communication is very unlikely to be like the daily pattern. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies. 18) As part of the disaster plan, the nurse executive is planning an education session on the core competencies for nurses established by the National Emergency Preparedness Education Coalition. Which topics should be included in the handout being written for this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cost control 2. Managing conflict with other disciplines 3. Communication 4. Handling the media 5. Technical skills Answer: 3, 5 Explanation: 1. Cost control is not one of the core competencies for nurses established by this group. 2. Conflict management is not one of the core competencies for nurses established by this group. 3. Communication is a core competency for nurses established by this group. 4. Handling the media is not one of the core competencies for nurses established by this group. 5. Technical skills are a core competency for nurses established by this group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies.

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19) A hospital's disaster management team is reviewing the disaster plan after reading about a hospital that was hit directly and destroyed by a tornado. What questions should team members ask themselves? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "What are our current capabilities for evacuation?" 2. "Do we have sufficient resources in any other areas to continue operations if this happens to us?" 3. "Are there physical training needs that we have not filled?" 4. "What education should we provide to the staff and community?" 5. "Would we eventually rebuild if the hospital was destroyed?" Answer: 1, 2, 3, 4 Explanation: 1. Evacuation of clients, visitors, and staff should be of primary interest to this team. 2. The team should consider its resources. What would happen if the hospital campus were damaged? Where are other resources available? 3. Training for a disaster is essential. 4. Education about disasters and training for a disaster are two different topics. Training involves physical skills as well as learning. 5. This is a valid question, but it is outside the scope of a disaster plan. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 20) During discussion about the hospital's disaster plan, the administrator says, "I am concerned about our current surge capacity." How should the members of the group interpret this concern? 1. The administrator is worried about the ability of the hospital's electrical system to handle the power fluctuation common during physical disasters. 2. The administrator is concerned that flood waters following a storm surge might overwhelm the hospital infrastructure. 3. The administrator is worried about the hospital's ability to respond to a large influx of clients from a disaster. 4. The administrator is concerned that a disaster would bring about the influx of media and frightened family. Answer: 3 Explanation: 1. In this context, surge capacity is not about electrical power. 2. In this context, surge capacity is not about flood waters. 3. Surge capacity, when discussed in disaster planning, describes the facility's ability to mobilize when suddenly confronted with a vast increase in client demand. 4. In this context, surge capacity is not only about media and family. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization TestBankWorld.org

Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 21) A nurse executive is assigned to a task force working on a surge system for the hospital in case of a disaster. This group should write strategies to cover which procedures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Postincident follow-up 2. Supplies 3. Physical space 4. Management infrastructure 5. Personnel Answer: 2, 3, 4, 5 Explanation: 1. Postincident follow-up is not a part of surge strategy. 2. How to get supplies, how to know how many supplies are on hand, and how to distribute supplies are all part of a surge strategy. 3. Allocation of physical space is a part of surge strategy. 4. Whom to notify, how to communicate with community officials and media, and how to notify staff are all part of surge strategy concerning management infrastructure. 5. How to notify staff of the disaster, how to allocate staff in a disaster, how to allocate and manage volunteers, and how to provide for all these personnel is a part of surge strategy. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 22) A hospital administrator receives a call that shootings resulting in mass casualties have occurred at several different locations within the city. Early information indicates that up to 50 victims may be arriving at the hospital starting within minutes. What action should the administrator take? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Mobilize the hospital incident command system. 2. Notify other administrators and order a rapid needs assessment in all critical areas. 3. Authorize the implementation of the hospital's disaster plan. 4. Call the emergency department and ask the charge nurse if the department has received any clients. 5. Conduct a risk assessment to see if the hospital is vulnerable to attack. Answer: 1, 2, 3 Explanation: 1. This is a disaster situation and incident command is essential. 2. A rapid needs assessment is essential so that quick action can be taken to fill as many of those needs as possible. 3. The administrator must be proactive in initiating the disaster plan. 4. If this is a real disaster, it is unlikely that the charge nurse has time to come to the phone. 5. This risk assessment should have already been done. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care TestBankWorld.org

Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 23) Why is post-disaster follow-up an essential part of disaster planning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. To assure staff members of their personal safety 2. To evaluate the performance of those involved 3. To initiate any improvements needed 4. To evaluate the overall effectiveness of the plan 5. To complete critical incident forms Answer: 2, 3, 4 Explanation: 1. This is not the reason for the follow-up. 2. Evaluating the performance of those involved helps to identify areas of need. 3. Follow-up helps to identify areas where improvement is needed. 4. The plan itself should be evaluated for effectiveness. 5. This is not an appropriate use of critical incident forms. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 23-2: Determine emergency preparedness for hospitals. 24) A level III disaster has occurred and the hospital is receiving clients by ambulance and those who have walked in to the emergency department. The wife of a man who is critically injured screams, "Why doesn't someone do something for my husband? He is dying!" How should the nurse manager respond? 1. "Ma'am, you should not be back here. You will have to leave." 2. "I'm so sorry, but your husband's injuries are very severe. We have to take care of the others first." 3. "Is there someone who can stay with this woman? She is distraught." 4. "He doesn't pass the triage screen for someone we can save." Answer: 2 Explanation: 1. The manager should take measures other than just making the woman leave. 2. This is a kind statement of fact and is a good way to address this wife. 3. This is a true statement, but it does not explain to the wife why her husband is not being cared for. 4. Even though this is a true statement, the wife will probably not understand what a triage screen is. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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25) Hospital administration is aware that staff may be reluctant to be called back to work in a disaster. How can the hospital be proactive in encouraging staff to make the decision to serve? 1. Develop a caring relationship with staff during normal times. 2. Develop a pay scale that offers double pay for all those who work during disasters. 3. Offer additional time off to those who work during a disaster. 4. Focus on the skills advancement opportunities that occur when working in a disaster. Answer: 1 Explanation: 1. If staff members have a caring relationship and feel ownership of the hospital, they are more likely to respond in an emergency. 2. Salary may not be a big enough incentive for those who are reluctant to leave family during a disaster. 3. Time off in the future is not likely to be enough incentive to attract staff into a disaster situation. 4. The opportunity to advance skills is not likely to attract many staff members back to work in a disaster. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies. 26) A hospital has written a well-defined surge call-back system for employees to use in case of a disaster. What are key vulnerabilities of this system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Employees may be unwilling to come back into the disaster. 2. Employees may be personally affected by the disaster. 3. Many employees will request additional pay for shifts worked during disasters. 4. There may be no way to contact employees for call-back. 5. The employee may not physically be able to return to the hospital. Answer: 1, 2, 4, 5 Explanation: 1. There is no assurance that employees will respond by returning to work once a disaster has happened. 2. It is impossible to know if employees will be personally affected by the disaster. For example, if the employee's home is destroyed by a wildfire, that employee would have pressing family needs. 3. This may occur, but it is not a key impediment. 4. If utilities such a telephone and cell phone towers are destroyed, there may be no way to contact the employee to come back to the hospital. 5. There may be physical impediments such as washed out roads, snow-packed roads, or debriscovered roads that prevent employees from returning to the hospital. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies. TestBankWorld.org

27) A hospital administrator on a disaster planning team says, "I am worried about our liability in using volunteers to provide care during a disaster." What should this team consider? 1. In disaster situations, no liability exists. 2. The hospital would have liability for what a volunteer does, but not for anything that happens to the volunteer. 3. The hospital could have liability for the volunteer's performance and for his or her safety. 4. Hospital liability would be limited to any injuries sustained by the volunteer. Answer: 3 Explanation: 1. Liability always exists, and it may be heightened during a disaster. 2. Liability for both the volunteer's safety and actions may exist. 3. Hospital liability could extend to actions taken by the volunteer and for anything that happens to the volunteer. 4. The hospital could be liable for injury to the volunteer or injury caused by the volunteer. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies. 28) A hospital successfully implemented its disaster plan to manage providing care during a massive three-day snow storm. What is the most likely way additional costs for this service will be paid? 1. Medicare will increase reimbursement for any client age 65 or over who was hospitalized during the disaster. 2. The federal government will pay any costs over and above the normal operating expenses for the period. 3. The hospital will absorb the additional costs. 4. State and county governments have reserve funds to reimburse for such expenses. Answer: 3 Explanation: 1. Medicare will not increase reimbursement. 2. There may or may not be federal reimbursement. If reimbursement is made, it will likely not be at the full cost to the hospital. 3. It is likely that the hospital will absorb the additional costs. 4. There are likely no additional funds earmarked to reimburse the hospital for these expenses. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 23-3: Discuss staff requirements to respond to emergencies.

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29) An outbreak of smallpox has followed a national sporting event. Terrorist activity is suspected. How would this event be categorized? 1. As a natural, biologic disaster 2. As a man-made, chemical disaster 3. As a natural, radiological disaster 4. As a man-made, biologic disaster Answer: 4 Explanation: 1. Because terrorism is involved, it is not a natural disaster. 2. Because the substance used was smallpox, it is not a chemical disaster. 3. Because the substance used was smallpox, it is not a radiological disaster, and it is not natural. 4. The dispersion of the biologic agent in this case would be man-made. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Environment Health Learning Outcome: 23-1: Identify examples of disasters that require preparation. 30) A hospital administrator initiated the emergency operations plan (EOP) after being notified that a tornado struck a nearby community. Thirty minutes later law enforcement calls to report that while significant damage was done, there were only minor injuries. What should the administrator do now? 1. Follow the EOP to deactivate the plan. 2. Let the plan continue for another hour to ensure that no victims arrive. 3. Call the emergency department and tell the staff that the plan is discontinued. 4. Notify local media that the EOP was discontinued. Answer: 1 Explanation: 1. There should be specific information in the EOP to deactivate the plan. 2. Instituting this plan is expensive and is an imposition on many employees. It should not be used if not needed. 3. Unless this is the protocol established in the EOP, just calling the emergency department is not sufficient. 4. There is no reason to notify the local media. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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31) How are disasters categorized? 1. Level I-municipal response 2. Level I-local response 3. Level III-statewide response 4. Level III-continental response 5. Level II-regional response Answer: 2, 3, 5 Explanation: 1. Level I (local response), Level II (regional response), and Level III (statewide response). 2. Level I (local response), Level II (regional response), and Level III (statewide response). 3. Level I (local response), Level II (regional response), and Level III (statewide response). 4. Level I (local response), Level II (regional response), and Level III (statewide response). 5. Level I (local response), Level II (regional response), and Level III (statewide response). Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 23-1: Identify examples of disasters that require preparation. 32) A hospital emergency operations plan (EOP) includes what components? 1. Activation response 2. Practice drills 3. Security plan 4. Communication plan 5. Community vulnerability Answer: 1, 3, 4 Explanation: 1. The EOP includes activation response, client care coordination plan, security plan, traffic flow, resources, data management, and communication plan. 2. The EOP includes activation response, client care coordination plan, security plan, traffic flow, resources, data management, and communication plan. 3. The EOP includes activation response, client care coordination plan, security plan, traffic flow, resources, data management, and communication plan. 4. The EOP includes activation response, client care coordination plan, security plan, traffic flow, resources, data management, and communication plan. 5. The EOP includes activation response, client care coordination plan, security plan, traffic flow, resources, data management, and communication plan. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 23-2: Determine emergency preparedness for hospitals.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 24 Preventing Workplace Violence 1) A nurse manager is investigating a report made by a staff nurse. The nurse states that a visitor backed the nurse up against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the human resources (HR) director? 1. Encounter with a disgruntled family member 2. Violence against the nurse 3. Incident with a family member 4. Physical attack against an employee Answer: 2 Explanation: 1. Encounters with disgruntled family members can occur with no threat of violence. 2. This incident is an example of violence against the nurse. 3. Calling this an incident with a family member does not give it its full importance. 4. This is not an actual physical attack; the nurse was not touched. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Diagnosis/Ethics Learning Outcome: 24-1: Summarize components involved in workplace violence. 2) A chief nurse officer (CNO) is contacted by the organization's supervisor on a Saturday night regarding a problem in the hospital's emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report? 1. This is a typical occurrence in the emergency department. 2. Healthcare violence is more likely to occur in emergency departments. 3. Healthcare violence generally occurs on the weekend. 4. Healthcare violence is likely to occur on the night shift. Answer: 2 Explanation: 1. Violence should not be characterized as a typical or expected aspect of the workplace. 2. In healthcare, violence is more likely to occur in psychiatric settings, emergency departments, waiting rooms, and geriatric units. 3. Violence can occur on any day. 4. Violence can occur at any time of day. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 24-1: Summarize components involved in workplace violence.

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3) The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matrix and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff during the past two days. To which of these distractions is the absenteeism most likely related? 1. The staffing dilemma caused by the scheduler 2. The change in the staffing matrix 3. The decline in staff morale due to a hostile environment 4. The miscommunication between management and nursing administration Answer: 3 Explanation: 1. Staffing dilemmas are not uncommon occurrences in healthcare and would not result in an increase in absenteeism. 2. Changes in staffing matrix are not uncommon in healthcare and would not result in an increase in absenteeism. 3. The hostile work environment may cause a decline in morale or staff may be frightened to come to work. 4. Management miscommunication with administration is not uncommon in healthcare and would not result in an increase in absenteeism. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 4) An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate? 1. "The unit has been so busy, I must allow for the nurses to have time to provide client care." 2. "The visitor hours have not been adjusted in years. It was time to change them." 3. "The physicians have requested limited visiting hours." 4. "The visiting hours allowed for added stress and commotion to the nursing staff." Answer: 4 Explanation: 1. It is true that nurses need time to care for clients, but this is probably not the real reason for the change. 2. Visiting hours are not changed simply because they have not been changed in years. 3. There is no indication that the physicians have anything to do with changing these hours. 4. Open visiting hours do allow for added stress and commotion. When visitors are aggressive toward nurses, restricting visiting hours may be essential. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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5) An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days, the client's son has been increasingly verbally abusive to the nursing staff. The unit secretary tells the nurse that the son is at the nurse's station demanding to see the client. Which action by the nurse is most important? 1. Remove the central line tray from the room. 2. Inform the son regarding the client's condition. 3. Ignore the son as he enters the client's room. 4. Limit the son's visitation. Answer: 1 Explanation: 1. Healthcare staff should be aware when and where to store medical instruments that may be used as weapons. 2. The son should be informed of the client's condition, but with the history and the escalation of his behavior, the nurse should take action to protect staff. 3. Ignoring the son may cause the violent behavior to escalate. 4. Limiting visitation may cause the violent behavior to escalate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 6) The hospital operator announced over the paging system, "Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing." A newly hired nurse asks another nurse, "Who is Dr. Strong?" The nurse replies, "This is the announcement that alerts security that there is violent behavior on that unit." Which statement would be an appropriate report to this unit's manager? 1. "Our new nurse does not know what 'Dr. Strong' means." 2. "There was an incident in which a staff person did not know what 'Dr. Strong' meant. Could we have an in-service on this policy?" 3. "The operator paged a 'Dr. Strong,' and we didn't know what to do." 4. "Why do they use 'Dr. Strong' when there is trouble? They should just call for help." Answer: 2 Explanation: 1. This statement does not offer any plan for correction. 2. Because this is a newly hired nurse, one would expect that the 'Dr. Strong' page would have been covered in orientation. Because this nurse did not understand the meaning of the page, it is likely others will not. An in-service is needed. 3. The newly hired nurse did not know what to do, which indicates that others in the same orientation may also be uninformed. The more experienced nurse did know what the page meant. 4. The nurse needs to understand the policy, not make comments on its worth. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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7) A hospital's safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reserving parking spaces closest to the facility for staff 2. Security cameras throughout the facility 3. Curved mirrors in the corridors 4. Using restraints on all confused clients 5. Requiring all personnel to take physical self-defense training Answer: 2, 3 Explanation: 1. Although isolated or unlit parking can be a safety concern, there is no reason that staff should have the parking next to the facility. There are also concerns for visitor and client safety to consider. 2. Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. 3. Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. 4. Just because a client is confused does not indicate a tendency toward violence or a need for restraints. 5. Although all staff should be trained regarding violence, physical self-defense training is not practical for every staff member. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 8) A nurse manager has required that all nursing staff attend an in-service on dealing with verbal threats. A staff nurse wonders why this is necessary since, "Words don't hurt me. I just ignore them." What is the nurse manager's most appropriate response to this statement? 1. "Don't argue with me; I said everyone has to be in-serviced." 2. "Verbal threats often precede physical violence." 3. "I want my staff to be prepared to handle anything." 4. "This is a requirement from our accrediting agency." Answer: 2 Explanation: 1. This response is aggressive and not appropriate. 2. Verbal aggression often precedes physical violence; if the situation can be defused at the verbal stage, physical violence may not occur. 3. Staff members cannot be expected to handle everything, but they should be prepared to handle common incidents. 4. The manager should have a more concrete and personally relevant rationale for this action. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. TestBankWorld.org

9) An emergency department (ED) client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions? 1. Distract the client. 2. De-escalate the situation. 3. Determine the client's real reason for seeking treatment. 4. Assess the client's level of pain. Answer: 2 Explanation: 1. The physician's tactics may distract the client, but this is not the reason for this action. 2. The physician's tactics is an attempt to de-escalate the situation until security arrives. 3. Determining the real reason the client is seeking treatment is not the current priority. 4. Assessing the level of pain is not the current priority. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 24-3: Describe responses to violent incidents. 10) The emergency department (ED) staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate? 1. Arrange an agreement with law enforcement for rapid response on these incidents. 2. Post a sign stating that pain management medications are not given unless the client is admitted to the hospital. 3. Develop a team of staff who would be on call for these types of situations. 4. Organize a training program to educate staff on how to manage these types of situations. Answer: 4 Explanation: 1. It is unlikely that the manager has the authority to institute such an arrangement. The staff also must know what to do until security or law enforcement arrives. 2. It is not possible to eliminate the use of pain medications in the ED. 3. Such a team might help in some situations, but the staff must still know what to do until they arrive. 4. The staff needs to be prepared in case of an emergency such as this one. This preparedness can occur through education. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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11) A newly formed task force is addressing the prevention of violence in the healthcare organization. Which group of employees is most likely to experience violence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Private practice physicians 2. Nurses working in a geriatric unit 3. Nurses working in a pediatric clinic 4. Nurses whose work space includes large waiting rooms 5. Technicians working in the medical laboratory Answer: 2, 4 Explanation: 1. Physicians in private practice can control their practice environment. Physicians are not in the group that experiences the most violence. 2. Geriatric units are among the sites in which violence is most likely to occur. 3. Clinics are among the sites in which violence is least likely to occur. 4. Waiting rooms are among the most common sites of healthcare violence. 5. Medical laboratories are isolated areas and are not among the places where healthcare violence commonly occurs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 12) A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says, "We have lots of threatening behaviors on our unit." What is the most important question for the supervisor to ask? 1. "Why is so much threatening behavior happening on your unit?" 2. "Why haven't you reported that?" 3. "Where do you work?" 4. "When you report threats to your manager, is action taken quickly?" Answer: 4 Explanation: 1. Although the reason for this behavior would be interesting to discuss, another question is more important. 2. This is the second best question to ask. 3. Where the nurse works is not as important as another factor. 4. This is the most important question. If the staff is reporting threats, yet nothing is done, it is very important for the supervisor to act. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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13) A nurse is caring for a client who is aggressive, demanding, and verbally abusive toward staff and visitors. The client says, "I'm getting out of here. I'm going to end it all." What immediate action should the nurse take? 1. Attempt to block the exit door. 2. Call security. 3. Attempt to administer a sedative to the client. 4. Notify the client's family. Answer: 2 Explanation: 1. The nurse should not get between the client and the exit door. 2. This client is a danger to self and perhaps to others. Security should be notified. 3. The nurse should not approach the client. 4. The family should be notified, but this is not the nurse's first action. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 24-3: Describe responses to violent incidents. 14) The nurse has just been notified that a client is to be admitted from the emergency department (ED) with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client's lethargic state. Which action is an appropriate intervention by the nurse? 1. Approach the client with caution when obtaining vital signs and shift assessments. 2. Place the client in a room farthest from the nurse's station so as not to disturb other clients. 3. Place the client in four-point restraints as a protective measure. 4. Post an armed security person at the client's door. Answer: 1 Explanation: 1. Alcohol withdrawal clients may lash out in violence. 2. Placing the client farthest away from the nurse's station may cause added liability to the organization due to the client's lethargic state and potential for harm if not closely monitored. 3. There is no evidence that it is necessary to place this client is restraints. 4. There is no evidence that it is necessary to post an armed guard at the door. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Environment Health Learning Outcome: 24-1: Summarize components involved in workplace violence.

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15) The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. When addressing the client, use powerful body language. 2. Remain calm and speak in a moderate tone. 3. Approach the client with an aggressive "I'm in charge" attitude. 4. Speak in simple terms. 5. Allow the client to speak. Answer: 2, 4, 5 Explanation: 1. Powerful body language may be interpreted as threatening. 2. A calm manner and moderate tone are calming to the client. 3. Aggression or aggressive attitudes can escalate this client's hostility. 4. The nurse should use simple terms when talking to this client. 5. The client should be allowed to speak, and the nurse should respectfully listen. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 24-3: Describe responses to violent incidents. 16) An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name the baby's father. A male visitor who comes to visit the client raises the nurse's concern that he might be violent. Which behavior would raise this concern? 1. The visitor states, "I am the baby's father." 2. The client is very anxious with the visitor present. 3. The visitor moves into the nurse's personal space when asking about the client's status. 4. The visitor sits in a chair in the corner of the client's room, rocking and smiling constantly. Answer: 3 Explanation: 1. Claiming paternity does not indicate potential for violence. 2. The client's anxiety may or may not be related to the visitor's potential for violence. 3. The most concerning behavior is the lack of respect for the nurse's personal space when asking questions. This behavior can indicate that the person can become threatening or violent. 4. Sitting in the corner, rocking, and smiling could be indicators of detachment from reality, but could also be benign behaviors. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Environment Health Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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17) When a nurse enters the room, the client states, "He has a gun," and points toward a male visitor. The nurse does not see a gun. What should the nurse do? 1. Question the visitor regarding the statement. 2. Contact security. 3. Call for another nurse to assist in confronting the visitor. 4. Notify the client's physician. Answer: 2 Explanation: 1. The nurse should not make any attempt to question the visitor or to appear aggressive in any manner. 2. The nurse should contact security immediately and should implement any other strategies outlined in the security plan. 3. The nurse should not confront the visitor or allow any other nonsecurity employee to do so. 4. The client's physician will not be able to offer any assistance during the immediate incident. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 24-3: Describe responses to violent incidents. 18) A nurse hears screaming from a client's room. A male visitor leaves the client's room. Which is the nurse's priority action? 1. Call the police. 2. Notify the client's physician. 3. Follow the visitor. 4. Check on the client. Answer: 4 Explanation: 1. Calling the police is not the priority action. 2. Notifying the client's physician is not the priority action. 3. The nurse should not follow the visitor but should make note of the direction the visitor took when leaving. 4. The priority action for the nurse is to ensure the safety of the client and the other staff. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 24-1: Summarize components involved in workplace violence.

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19) A nurse appears in the nursing station with multiple facial lacerations and says, "A visitor hit me." What is the manager's priority action? 1. Ask the nurse why the visitor became violent. 2. Ask a nurse to accompany the employee to the emergency department. 3. Call security to report the incident. 4. Call administration and inform them of the incident. Answer: 2 Explanation: 1. Asking for information about the incident is not the manager's first priority. 2. The manager's first priority is to arrange treatment for the injured employee. 3. Reporting the incident is important, but it is not the first priority. 4. Administration should be informed of the incident, but this is not the manager's first priority. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 24-3: Describe responses to violent incidents. 20) A manager is following up on an employee's injuries. The manager has contacted human resources to initiate the process of worker's compensation. Which action would be appropriate by the manager? 1. Contact the employee's physician and inform him or her of the injuries. 2. Follow up with human resources regarding scheduling staff to cover the employee's absences. 3. Follow up with the employee to express concern and answer any questions regarding the situation. 4. Follow up with the worker's compensation nurse. Answer: 3 Explanation: 1. It is not appropriate for the manager to contact the employee's physician. 2. Human resources is not responsible for covering staff absences. 3. The manager should contact the injured employee to express concern for his or her well-being and follow up with any questions the manager may have. 4. The manager should not contact the worker's compensation nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 24-3: Describe responses to violent incidents.

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21) During orientation, a newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says, "Well, I guess you should call 911." What is incorrect about this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 3. The nurse should never call 911 from the hospital. 4. The nurse should have been told to follow the reporting policy. 5. The nurse should have been reported as suspicious for asking the question. Answer: 1, 2, 4 Explanation: 1. The person conducting the orientation should be aware of the policy and relay the information accurately and with certainty. 2. Notification of security is essential. 3. There could be instances in which a nurse should call 911 from the hospital. In a small hospital with no full-time security, calling 911 may be the immediate response. 4. The hospital must have a bomb threat reporting policy. This would be a good time to introduce it to the orientation group. 5. There is no reason to report the nurse. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 24-3: Describe responses to violent incidents. 22) A night shift supervisor has been called to the emergency department to assist in managing a violent situation with a visitor. Once the violent person has been contained and security and police have responded, what should be the supervisor's next action? 1. Notify staff on other nursing units. 2. Notify the violent person's physician. 3. Complete an incident report. 4. No action is necessary; the situation has been managed. Answer: 3 Explanation: 1. The violent person is contained and security and police have arrived, so it is not necessary to alert other staff regarding the situation. 2. It is inappropriate to call the violent person's physician. 3. An incident report is a part of the reporting process for violent events. 4. The supervisor does have duties following a violent episode. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 24-3: Describe responses to violent incidents.

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23) A nurse enters a client's room and sees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation? 1. Keep a safe distance from the visitor. 2. Yell for another nurse to assist with the visitor. 3. Leave the room. 4. Threaten the visitor with assault charges. Answer: 1 Explanation: 1. The nurse should recognize threatening behavior and keep a safe distance from the visitor exhibiting the behavior. 2. The nurse should obtain assistance, but yelling may increase the visitor's aggression. 3. The nurse should not leave the client unless it is absolutely necessary to obtain assistance. 4. Threatening the visitor with assault charges may further escalate the situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 24) The emergency department (ED) has seen an increase in violent behavior over the past year. The manager has voiced concerns to the chief nurse officer (CNO) regarding the safety of the ED staff. What should be done as a first step in addressing this issue? 1. The manager should consult with local law enforcement. 2. The CNO should review the management of violent incidents procedure policy. 3. The CNO should discuss the matter with hospital security. 4. The CNO should have the manager discuss the matter with the ED staff. Answer: 2 Explanation: 1. It might be beneficial to discuss the organization's policies and procedures with local law enforcement, but this is not the first step. 2. The first step should be to review and revise policies and procedures so that they are reflective of effectively managing the types of incidents seen in the department. 3. The CNO should certainly discuss the request with hospital security, but this is not the first step. 4. The CNO should not delegate this concern but should personally manage the issue. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations.

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25) An emergency department (ED) has doubled its client visits within the past year. This has led to increased wait times and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the chief nurse officer (CNO) would be most effective? 1. Increase the size of the waiting room and add more beds to the ED unit. 2. Hire more ED nursing staff to manage the increased volume of clients. 3. Hire another ED physician. 4. Hire another registration employee to improve the intake process and reduce the volume in the waiting areas. Answer: 2 Explanation: 1. Simply adding space and beds will not help with the rapidity in which clients are seen and discharged, if there are not enough nurses to staff the additional area. 2. The department has doubled in volume of clients, so it is necessary to increase staff to manage this volume. Increased wait times and overcrowding may lead to violent behavior. 3. Hiring an additional ED physician will not be helpful if there are not enough ED nurses to provide care. 4. Hiring another registration employee may speed up client registration, but it will not decrease wait times. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health Learning Outcome: 24-2: Explain strategies for preventing violence in healthcare organizations. 26) A geriatric client in a long-term-care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 3. The client suddenly becomes alert and oriented. 4. The client raises his fist. 5. The client says, "I know where there is a gun." Answer: 1, 2, 4 Explanation: 1. The client may be about to flee the room or may be blocking the nurse's exit. 2. A blank stare could be related to pathology such as dementia or may signal a violent episode. 3. Alertness and orientation do not signal impending violence. 4. Preparing for battle signals impending violence. 5. It is fairly unlikely that a geriatric client in a long-term-care facility has access to a gun. The nurse must be aware of the statement but should consider the context. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 24-1: Summarize components involved in workplace violence. TestBankWorld.org

27) Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, "I'm sorry you are upset. What can I do for you?" The visitor continues to complain more loudly. What should the other nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Quietly direct other people out of the room. 2. Leave the room and call security. 3. Say, "Who are you?" 4. Move toward the visitor and say, "Keep your voice down." 5. Stay next to the other nurse. Answer: 1, 2 Explanation: 1. Isolating a person who is angry and aggressive is helped by taking away part of the audience. This is also a strategy to protect others. 2. It may be that the visitor is just upset and will calm down quickly with the other nurse's verbal intervention, but that is not assured. 3. This question may further infuriate the visitor because the nurses don't know him or his mother. Also, one nurse should carry the conversation. 4. The nurse should not make a move toward the visitor or demean him. 5. The nurse should move away and out of the room to call security. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Environment Health Learning Outcome: 24-1: Summarize components involved in workplace violence. 28) A highly intoxicated client is brought to the emergency department. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 3. Ask the paramedics to place the client in leather restraints. 4. Enter the room calmly, with a smile. 5. Give the client 20 minutes or so to calm down before the assessment begins. Answer: 1, 2, 4 Explanation: 1. The nurse should remove any potential weapons. 2. A stethoscope hung around the neck is a convenient "handle" for anyone who would like to gain control of the nurse. 3. The nurse should not ask the paramedics to perform this intervention. 4. Being calm and pleasant can help defuse potentially violent situations. 5. The nurse should not wait 20 minutes to see a client who is highly intoxicated. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Environment Health TestBankWorld.org

Learning Outcome: 24-1: Summarize components involved in workplace violence. 29) As part of a presentation on healthcare workplace violence, the speaker says, "Injuries to nurses from violent acts in the workplace are probably underreported." What rationale should the speaker offer for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. 5. Most violence against nurses is initiated by physicians, and nurses are afraid to report them. Answer: 1, 2, 3, 4 Explanation: 1. The definition of workplace violence may not be clear. 2. Reporting policies may not be in place. 3. For many years, violence was tolerated in healthcare. 4. Some believe that being the target of a violent act is the result of poor job performance. 5. Most violence against nurses is from clients. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 24-3: Describe responses to violent incidents. 30) A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. The behavior has never been violent, but today it is becoming more threatening. The nurse just came into the station and said, "My nurse assistant is stupid. I'm not going to put up with that much longer. She needs to be put in her place." How should the manager respond to this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 3. The manager should explain that this is a good nurse who has difficulty tolerating stress. 4. Security should be notified of the behaviors. 5. The manager should warn other staff to stay clear of this nurse for the rest of the shift. Answer: 1, 2, 4 Explanation: 1. The nurse should be removed from the situation. 2. This behavior should be documented. 3. Making excuses for this nurse is not appropriate. The nurse's temper is escalating and may grow out of control. Excuses violate the zero-tolerance policy. 4. As the behaviors are escalating, security should be notified. 5. The nurse should not be allowed to remain on the unit for the rest of the shift. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Environment Health TestBankWorld.org

Learning Outcome: 24-1: Summarize components involved in workplace violence. 31) Incivility includes which of the following behaviors? 1. Laughing 2. Verbal abuse 3. Ignoring a person 4. Sexual harassment 5. Searching the room Answer: 2, 3, 4 Explanation: 1. Incivility is aggressive behavior including ignoring a person, treating in a belittling manner, disparaging remarks purposely within hearing distance, ridiculing a person, speaking sarcastically about a person, direct verbal abuse, sexual harassment, and physical attack. 2. Incivility is aggressive behavior including ignoring a person, treating in a belittling manner, disparaging remarks purposely within hearing distance, ridiculing a person, speaking sarcastically about a person, direct verbal abuse, sexual harassment, and physical attack. 3. Incivility is aggressive behavior including ignoring a person, treating in a belittling manner, disparaging remarks purposely within hearing distance, ridiculing a person, speaking sarcastically about a person, direct verbal abuse, sexual harassment, and physical attack. 4. Incivility is aggressive behavior including ignoring a person, treating in a belittling manner, disparaging remarks purposely within hearing distance, ridiculing a person, speaking sarcastically about a person, direct verbal abuse, sexual harassment, and physical attack. 5. Incivility is aggressive behavior including ignoring a person, treating in a belittling manner, disparaging remarks purposely within hearing distance, ridiculing a person, speaking sarcastically about a person, direct verbal abuse, sexual harassment, and physical attack. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 24-1: Summarize components involved in workplace violence.

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32) Potential violence in healthcare organizations can include what risk factors? 1. Unlimited public access 2. Inadequate security 3. Locked down units 4. Long wait times 5. Over-crowded waiting rooms Answer: 1, 2, 4, 5 Explanation: 1. Risk factors for potential violence in healthcare organizations include working understaffed especially at mealtimes and visiting hours, long wait times, overcrowded waiting rooms, working alone, inadequate security, unlimited public access, and poorly lit corridors, rooms, and parking lots. 2. Risk factors for potential violence in healthcare organizations include working understaffed especially at mealtimes and visiting hours, long wait times, overcrowded waiting rooms, working alone, inadequate security, unlimited public access, and poorly lit corridors, rooms, and parking lots. 3. Risk factors for potential violence in healthcare organizations include working understaffed especially at mealtimes and visiting hours, long wait times, overcrowded waiting rooms, working alone, inadequate security, unlimited public access, and poorly lit corridors, rooms, and parking lots. 4. Risk factors for potential violence in healthcare organizations include working understaffed especially at mealtimes, and visiting hours, long wait times, overcrowded waiting rooms, working alone, inadequate security, unlimited public access, and poorly lit corridors, rooms, and parking lots. 5. Risk factors for potential violence in healthcare organizations include working understaffed especially at mealtimes and visiting hours, long wait times, overcrowded waiting rooms, working alone, inadequate security, unlimited public access, and poorly lit corridors, rooms, and parking lots. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 24-1: Summarize components involved in workplace violence.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 25 Handling Collective Bargaining Issues 1) The nurse manager is educating staff about the collective bargaining process. Who should this nurse say controls collective bargaining in healthcare? 1. The judicial system 2. Individual hospitals 3. Nurses' unions 4. Federal laws Answer: 4 Explanation: 1. The judicial system has ruled on some collective bargaining laws but does not write the law. 2. Individual hospitals are participants in collective bargaining but do not govern it. 3. Nurses' unions are participants in collective bargaining but do not govern it. 4. Laws have been enacted by Congress to guide and control labor relations between employees and employers. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 2) The nurses of a hospital have given notice of their desire to unionize. The nurse executive is meeting with all nurse managers to discuss their role. Which information should the executive provide for these managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We need to stop this if at all possible. I am counting on you to discourage nurses from joining the union." 2. "If the nurses on your unit want to organize, do not interfere." 3. "You cannot say anything about the union, but your actions can speak for you." 4. "We are not going to participate in this." 5. "I will keep you posted as we move through this process." Answer: 2, 5 Explanation: 1. Encouraging or discouraging union membership by a manager is an unfair labor practice. 2. Interference with the right to organize is an unfair labor practice. 3. Any act of domination or indication of preference regarding the union is an unfair labor practice. 4. Refusal to bargain collectively is an unfair labor practice. 5. The managers must be kept apprised of the process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 25-4: Summarize collective bargaining for nurses. TestBankWorld.org

3) Nurses in a hospital are working to establish a union. Which finding will these nurses be interested in seeing? 1. Thirty percent of eligible hospital nurses have signed a card indicating interest. 2. Seventy percent of hospital employees have said they are interested. 3. Fifty percent of staff nurses and management nurses must vote. 4. Thirty percent of all nurses working for the agency must vote. Answer: 1 Explanation: 1. Before an election can be held, the union must demonstrate interest by 30% of eligible hospital nurses signing an authorization card. 2. Interest in establishing a union must be demonstrated by those who will be establishing the union-in this case, nurses. 3. Management nurses are not considered eligible employees when interest in a union is measured. 4. Eligible employees include staff nurses but not managers and supervisors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 4) The nurses in an organization are in the process of selecting a bargaining agent. Which action by the nurse executive is considered a fair labor practice? 1. Promising wage increases if the desired agent is chosen 2. Questioning staff nurses regarding their vote 3. Threatening demotions if the desired agent is not chosen 4. Disallowing collective bargaining organizational meetings at the hospital Answer: 4 Explanation: 1. Administrators are not allowed to promise incentives in return for a favorable selection. 2. Nursing management is not allowed to question nurses regarding their feelings about the union activity. 3. Nursing administrators are not allowed to threaten punishment for undesirable choices. 4. Nursing administrators are not required to allow union activities on hospital property or during working hours. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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5) A housekeeping employee is questioning the employees' agent regarding the role of administering the ratified contract. The agent should explain to the employee that this role belongs to which person? 1. Union president 2. Hospital administrator 3. Designated union representative 4. Bargaining agent Answer: 3 Explanation: 1. The union president is most active during the collective bargaining phase or when negotiating the contract and does not administer the contract. 2. The hospital administrator is responsible for adhering to the negotiated contract but does not administer it. 3. A designated hospital staff nurse may serve as the union representative. It is the duty of this nurse to provide fair and equal representation to all members of the unit. 4. The bargaining agent is most active during the collective bargaining phase or when negotiating the contract but does not administer the contract. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 6) The housekeeping employee asks the employees' agent what role the union representative plays. What answer should the agent provide? 1. "They will set wages for union members." 2. "They are responsible for writing floating policy for administration." 3. "They oversee the retirement funds." 4. "They are responsible for administering the contract." Answer: 4 Explanation: 1. Wages are set in the contract. 2. Policies are negotiated in the contract. 3. Retirement funds are negotiated in the contract. 4. The role of administering the contract falls to an individual designated as the union representative. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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7) Approximately half of an organization's employees decide they are not happy with their current contract, which will expire in 4 months. The union representative informs the group that they can work to change the contract. What is the next step in this process? 1. Giving the union notice of desire to change the contract at least 90 days before it expires 2. Ratification of the current contract 3. Vote for cessation 4. Appointment of a mediator Answer: 1 Explanation: 1. Before changing or terminating a contract, one party must notify the other of its intent to do so 90 days prior to the contract expiration date. 2. Ratification is the process by which employees approve a contract. 3. Cessation is not related to union membership. 4. A mediator is appointed if the two sides of the contract cannot agree on changes. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 8) As a cost-saving initiative, the hospital administration has asked the night staff nurses to refill drug supplies at night while the pharmacist is not present. The nurses file a grievance, and nurse managers become involved. How would this grievance be classified? 1. Violation of agency rules 2. Contract violation 3. Failure of management to meet its responsibilities 4. Violation of federal and state laws Answer: 4 Explanation: 1. The agency could make a new rule that allows this practice. 2. It is unlikely that this scenario would be covered in the contract. 3. This is the second best answer to this question. 4. Nurses cannot act as substitute pharmacists. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Ethics Learning Outcome: 25-4: Summarize collective bargaining for nurses.

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9) A nurse has been hired as a new nurse manager at a hospital that has union representation. Which union-related activities should this manager expect to be included in the role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Actively helping to administer any grievance procedures 2. Participating in issues related to disciplining employees 3. Encouraging union membership 4. Being certain that all disputes within management are public 5. Avoiding collective bargaining Answer: 1, 2 Explanation: 1. The nurse manager should help to administer grievance procedures and should participate in issues about disciplining employees. 2. The nurse manager should help to administer grievance procedures and should participate in issues about disciplining employees. 3. The nurse manager should not encourage or discourage union membership. 4. Disputes within management should be confidential. 5. The nurse manager must participate in the activities of collective bargaining. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Collaboration Learning Outcome: 25-4: Summarize collective bargaining for nurses. 10) A union has won a representative election. What right does that union now hold? 1. The right to represent all employees of the hospital 2. The right to forbid management from unilaterally changing employment conditions for employees outside the bargaining unit 3. The right to jointly negotiate expanded bargaining units with the employer after the election 4. The right to be the bargaining agent for a group of employees Answer: 4 Explanation: 1. The union has the right to represent the group of employees covered by the election. For example, a nurses' union may or may not include healthcare workers in the laboratory or radiology departments. 2. The union cannot effect change for employees outside of the bargaining unit. 3. The union cannot expand to another unit without an election. 4. The union that wins the election then has the right to enter into contract negotiations with the organization on behalf of the employees. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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11) A nurse manager enters the staff break room. The manager overhears the nursing staff discussing wages and paid time off as issues to consider during the bargaining process. Which action by the manager would be appropriate? 1. Leave the break room and not discuss with others what was heard. 2. Inform staff they are not to talk about their bargaining issues during work time or at the work site. 3. Issue a written warning regarding discussion of wages while on the job. 4. Tell nursing administration that a strike is likely. Answer: 2 Explanation: 1. The manager may leave the break room but should address the issue of employees not discussing collective bargaining while at work or on the work site. 2. The manager should address the issue of employees not discussing collective bargaining while at work or on the work site. 3. It is not necessary to issue a written warning for discussion of wages. 4. Simple discussion of wages and benefits does not herald a strike. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-4: Summarize collective bargaining for nurses. 12) A nurse who works in a hospital with a collective bargaining unit requires disciplining. Which actions by the nurse manager are critical? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Coaching the nurse as appropriate 2. Letting the collective bargaining unit handle any disciplinary needs 3. Reviewing policy and procedures with the nurse 4. Discussing expectations that were not met 5. Directing any questions the nurse has to the union representative Answer: 1, 3, 4 Explanation: 1. The manager is responsible for many of the same activities as in any situation. Coaching is included in these responsibilities. 2. The manager is responsible for discipline in the unit just as in any other situation. 3. A review of policy and procedures is part of all disciplinary issues. 4. Discussing unmet expectations is a part of all disciplinary issues. 5. The manager should answer questions that pertain to the actions for which the nurse is being disciplined. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-4: Summarize collective bargaining for nurses.

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13) An ICU nurse manager states, "The hospital has a union, but I wouldn't advise joining," to a newly hired nurse. The human resources (HR) director is informed of this comment. How should the HR director respond? 1. Call the new nurse and explain that joining the union is encouraged by the hospital. 2. Remind the manager that there is to be no interference with an employee's decision to join the union. 3. File a grievance against the manager. 4. Terminate the manager's employment. Answer: 2 Explanation: 1. The hospital should neither encourage nor discourage employees from joining the union. 2. The manager's role is not to interfere with the employee's right to organize. The manager should not dominate, encourage or discourage union membership, terminate employment for filing a charge with the NLRB, or refuse to bargain collectively. The HR director should clarify this role with the manager. 3. There is no reason to file a grievance. 4. Unless this manager makes it a practice to tell employees to avoid the union and has continued to do so after being apprised of the regulations, there is no reason for termination. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 25-4: Summarize collective bargaining for nurses. 14) A grievance has been filed against a hospital where the nursing staff has just established a union. What is the nurse executive's first step? 1. Call the union representative for a meeting to discuss the grievance. 2. Call managers together to discuss the grievance. 3. Notify staff nurses that the grievance has been received. 4. Review the agreement for information about grievances. Answer: 4 Explanation: 1. This may be a wise idea, but it is not the first step. 2. This may be a wise idea, but it is not the first step. 3. This is not the first step. 4. The nurse executive's first step should be to review the agreement with the union. This agreement will describe the steps and progression of a grievance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-3: Explain what is involved in handling grievances.

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15) A grievance has been filed against a hospital. Which statement by the nurse executive reflects common reasons for grievances? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The nurses want more benefits than specified in the contract we just signed." 2. "I think there is a misunderstanding of one of the terms of the contract." 3. "I think this grievance is based on a term in the old contract that is not included in the new contract." 4. "The nurses want higher wages because the other hospital in town just raised their pay scale." 5. "This contract just is not going to work. We need to renegotiate." Answer: 2, 3, 5 Explanation: 1. If the benefits provided are those specified in the contract, there are no grounds for grievance. 2. Misunderstandings are common causes of grievances. 3. Lack of familiarity with the contract is a common reason for a grievance. 4. If the nurses want higher wages, the contract should be renegotiated. A grievance is not indicated. 5. An inadequate agreement is a common reason for a grievance. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care Learning Outcome: 25-3: Explain what is involved in handling grievances. 16) To balance the rights of employees and the public, Congress passed a special set of procedures for settling labor disputes in the healthcare industry. These include a specification that one party must notify the other of intent to change or terminate a contract ________ days before the contract expires. Answer: 90 Explanation: The period for this notification in the healthcare industry is 90 days. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-3: Explain what is involved in handling grievances.

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17) A nurse assistant states, "I don't understand why they would select a nurse to be the union representative." Which response by a coworker is appropriate? 1. "Administration chose a nurse for this role." 2. "Why do you care who is the representative?" 3. "The representative must be an employee of the union or a member of the nursing staff." 4. "The representative must be a nurse if the unionized organization is a hospital or healthcare organization." Answer: 3 Explanation: 1. This person is not chosen by administration. 2. It is important that all staff know who the representative is. 3. The union representative may be an employee of the union or a member of the nursing staff. 4. The union representative may be an employee of the union or a member of the nursing staff. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 25-3: Explain what is involved in handling grievances. 18) A union representative tells the nurses of a hospital that they should review the Kentucky River trilogy as part of their education regarding unionization. What will the nurses learn from this review? 1. A summary of the benefits of collective bargaining in the healthcare industry 2. The history of unionization in the United States 3. What the nurse can expect to pay as a member of the collective bargaining unit 4. Which nurses are considered to have supervisory status Answer: 4 Explanation: 1. This is not the focus of this work. 2. This is not the focus of this work. 3. This is not the focus of this work. 4. These three landmark decisions outline which nurses have supervisory status. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Education Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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19) A nurse is discussing the intent of the nurse's collective bargaining representation to strike. The nurse's spouse is concerned about the length of time the nurse may lose as a result of a strike. Which statement by the nurse is correct? 1. "Nurses can't strike; it's just a term on paper." 2. "The hospital isn't allowed to replace my position because of a strike." 3. "The hospital has a 10-day notice before we go on strike." 4. "Not all staff nurses are included in the strike." Answer: 3 Explanation: 1. Nurses do strike. 2. The hospital has the right and obligation to provide continuity of care. 3. By law, a 10-day notice must be given to allow hospitals the opportunity to prepare for striking nurses' absences. 4. All staff nurses employed by the facility are included in the strike. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 25-3: Explain what is involved in handling grievances. 20) The nursing staff at a hospital is upset regarding nurse-client ratios. One of the nurses says, "Our contract is not being honored. I think we need to tear it up and strike, starting tomorrow." Which response by the union representative is most appropriate? 1. "We can't strike until we have given administration 10 days' notice of our desire to change the contract." 2. "The FMCS (Federal Mediation and Conciliation Service) has to have 30 days' notice of our intent to strike." 3. "I have to let the medical chief of staff know we are going to strike at least 30 days before it happens." 4. "I have to meet with the board of directors and tell them 24 hours in advance." Answer: 2 Explanation: 1. Notice to change the contract must be given 90 days in advance. 2. The FMCS is notified if agreement has not occurred within 30 days of the notification to terminate the contract. 3. The notification of intent to strike goes to the management, not the chief of staff. The notice is 10 days. 4. Notice of intent to strike is given further in advance than 24 hours and must be in writing. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 25-3: Explain what is involved in handling grievances.

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21) The manager tells a potential nurse hire that the organization is a "closed shop" organization. The nurse asks for clarification. Which response by the manager is most accurate? 1. "A 'closed shop' is an organization in which union representation and collective bargaining practices are not discussed." 2. "It is a term used to describe the collective bargaining practices in this state." 3. "It means you are required to join the union if you accept this position." 4. "You are required to sign a statement stating you received information regarding union membership." Answer: 3 Explanation: 1. Closed shop does not refer to where union activities can be discussed. 2. While the term closed shop is used to describe collective bargaining practices in the hospital, it does not necessarily pertain to the whole state. 3. A "closed shop" is a business in which union membership is a precondition of employment. 4. The requirement extends further than just signing a statement that information was received. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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22) A nurse manager is conversing with a colleague at a national meeting. The colleague states, "I've just never understood why a nurse would want to join a union." What responses by the manager would explain the attraction of unionization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It's usually a combination of factors such as low wages and high nurse-to-client ratios." 2. "Low wages cause so much job dissatisfaction that the nurses unionize." 3. "Having to work with supervisors as staff when nurses call in is one reason." 4. "Many nurses have supervisors who think they understand what it's like to work on the unit every day." 5. "Many nurses are frustrated because communication between nurses and administration is so poor." Answer: 1, 4, 5 Explanation: 1. Unionization becomes an attractive option when a combination of factors causes dissatisfaction. Low wages alone are not usually the cause, but low wages associated with other factors such as high client acuity and ratios may cause nurses to seek unionization. 2. Unionization is an attractive option when a combination of factors causes dissatisfaction. Low wages alone are not usually the cause. 3. Supervisors and managers working and assisting as staff would improve nurse/management relations and assist with communication. 4. Supervisors who assume they know what issues are concerning to the staff do not help create trust in the work environment. 5. Ineffective communication is often the reason for job dissatisfaction, which can make unionization an attractive option. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 25-2: Describe the process of unionization.

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23) Which job responsibilities indicate that a nurse has supervisory capacity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse makes clinical judgments about client care. 2. The nurse assigns a nurse assistant to care for a team of clients. 3. The nurse discusses client care with the supervising physician. 4. The nurse hires staff to manage units. 5. The nurse retains responsibility for the actions of nurses assigned to provide client care. Answer: 2, 4, 5 Explanation: 1. Both staff nurses and supervisory nurses make clinical judgments about client care. 2. If the nurse makes assignments to a nurse assistant, the nurse has supervisory capacity. 3. Both staff nurses and supervisors discuss client care with supervising physicians and other physicians. 4. Hiring staff to manage a unit is a type of assignment that indicates supervisory capacity. 5. If the nurse has responsibility for the actions of those to whom client care has been assigned, the nurse has supervisory capacity. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 24) A nurse who has accepted a position as an assistant ICU manager is discussing unionization with the human resources (HR) director. The HR director says the nurse cannot join the union. What rationale should the HR director offer for this statement? 1. The nurse has never been in a union in the past. 2. The nurse must first complete orientation before being eligible to join the union. 3. The nurse must have worked in a hospital environment for at least 5 years. 4. Registered nurses hired as management are not eligible for collective bargaining. Answer: 4 Explanation: 1. Not being in a union in the past is not a valid rationale. 2. Completing orientation is not pertinent in this situation. 3. Length of employment is not pertinent to this situation. 4. Registered nurses employed as staff nurses are eligible for collective bargaining, but nurses who are employed as managers are not. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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25) The National Labor Relations Board (NLRB) has certified a union to be the bargaining agent for a hospital. A nurse working in the hospital has a grievance and says to the nurse manager, "Wait until the union gets involved." Which response by the manager is appropriate? 1. "NLRB certification does not mean a union will develop." 2. "A union will not get involved in this situation." 3. "The NLRB is not concerned with your grievance." 4. "The grievance will be resolved with or without the NLRB." Answer: 1 Explanation: 1. Certification by the NLRB of a union to be the bargaining agent does not automatically mean employees have a contract. 2. The manager has no way of knowing if this grievance will be settled by the time the union is in place. 3. Unions do get involved in grievances. 4. There is no guarantee that this grievance will be resolved. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. 26) One of the areas of supervision defined by the National Labor Relations Board (NLRB) is "independent judgment." Which nurses fall into this category? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse who routinely reviews lab work and makes a clinical judgment of when to notify the physician 2. A nurse who works twice a month as charge nurse on an acute care unit 3. A nurse who makes team assignments as part of the charge nurse role 4. A nurse whose job includes choosing which assistants to place with which clients 5. A nurse who applies assessment findings when altering the plan of care for a client Answer: 2, 3, 4 Explanation: 1. Routine clinical judgment in care of clients is not included in "independent judgment." 2. If the nurse is scheduled as charge nurse regularly, the nurse is considered to be using independent judgment to match staff skills to client needs. 3. If the nurse is matching staff skills to client needs, independent judgment is being used. 4. If the nurse is matching employee skills with client needs, independent judgment is being used. 5. Using assessment findings to alter the plan of care is clinical judgment, not independent judgment in the context of collective bargaining. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 25-1: Discuss the laws that govern collective bargaining. TestBankWorld.org

27) Which statements by a nurse manager would the supervisor interpret as indicating an understanding of why collective bargaining is complicated for nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "There just are not many union options for nurses." 2. "None of the unions available for nurses were developed specifically for nurses." 3. "The determination of who is eligible to join a union is complicated." 4. "In some institutions, nurses have formed their own unions." 5. "No nursing unions have the backing of national organizations like the AFL/CIO." Answer: 3, 4 Explanation: 1. Several organizations offer union options for nurses. 2. National Nurses United and United American Nurses are organizations specifically for nurses. 3. The determination of who is a supervisor is complicated in nursing. 4. Nurses in some institutions have formed their own unions. 5. United American Nurses is an AFL/CIO affiliate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 25-3: Explain what is involved in handling grievances. 28) The nurse executive is addressing a conference on collective bargaining and nurses. Which statement should the executive include in this address? 1. "It is clear that collective bargaining is the way of the future for nursing." 2. "Collective bargaining does not help nurses influence the practice environment." 3. "Your concerns that collective bargaining may separate staff nurses and managerial nurses are well founded." 4. "The future of collective bargaining in nursing will begin to stabilize along with the healthcare environment." Answer: 3 Explanation: 1. The future of collective bargaining in nursing is uncertain and unknown. 2. The primary reason nurses participate in collective bargaining is to influence the practice environment. 3. One of the major concerns regarding collective bargaining in nursing is the fear that this separation will occur. 4. There is no indication that this is going to occur in the near future. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 25-2: Describe the process of unionization.

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29) A nurse is interested in the possibility of collective bargaining in the workplace. What will the nurse find when researching this possibility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Most nurses do not work under collective bargaining agreements. 2. If the nurse is a manager, collective bargaining would be of no interest. 3. The NLRB has addressed collective bargaining in nursing. 4. The nurse works in a state hospital, where collective bargaining is not possible. 5. The cost of the dues or "fees" associated with collective bargaining is more than could be gained from joining. Answer: 1, 3 Explanation: 1. This is a true statement. 2. A nurse manager may not be included in the collective bargaining agreement but certainly would have an interest in the process. 3. The NLRB has addressed many issues that directly affect collective bargaining and nursing. 4. Whether or not collective bargaining is used depends on the state in which the nurse works. 5. The fee schedule is set by the union, and the value of unions differs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Education Learning Outcome: 25-4: Summarize collective bargaining for nurses. 30) A nurse works in a federal hospital that is beginning the collective bargaining process with the nurses. The nurse is disappointed to discover that which concern cannot be addressed in negotiations? 1. Work hours 2. Job responsibilities 3. Wages 4. Conditions of client care Answer: 3 Explanation: 1. Conditions of work, such as work hours, can be negotiated. 2. Job responsibilities can be negotiated. 3. Wages cannot be negotiated in federal institutions. 4. Conditions of client care can be negotiated. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 25-1: Discuss the laws that govern collective bargaining.

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31) ________ result when employees believe that the ________ has violated the contract agreement. Answer: Grievances, organization Explanation: Grievances result when employees believe that the organization has violated the contract agreement. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 25-3: Explain what is involved in handling grievances. 32) Grievances can usually be classified as what? 1. Interference of agency 2. Violations of federal and state law 3. Contract violations 4. Failure of management to meet responsibilities 5. Violation of agency rules Answer: 2, 3, 4, 5 Explanation: 1. Grievances are usually classified as violations of state and federal law, contract violations, violations of agency rules, and failure of management to meet responsibilities. 2. Grievances are usually classified as violations of state and federal law, contract violations, violations of agency rules, and failure of management to meet responsibilities. 3. Grievances are usually classified as violations of state and federal law, contract violations, violations of agency rules, and failure of management to meet responsibilities. 4. Grievances are usually classified as violations of state and federal law, contract violations, violations of agency rules, and failure of management to meet responsibilities. 5. Grievances are usually classified as violations of state and federal law, contract violations, violations of agency rules, and failure of management to meet responsibilities. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 25-3: Explain what is involved in handling grievances.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 26 Managing Stress 1) An ICU nurse manager noticed a competent nurse has become forgetful and has made medication errors in the past few months. This type of behavior is unusual for this nurse. What action should the manager take? 1. Issue a written warning to the nurse. 2. Meet individually with the nurse to discuss the behavior. 3. Ask other staff members if they have noticed the behavior. 4. Report the nurse to the human resources department. Answer: 2 Explanation: 1. It is premature to issue a written warning. 2. Meeting with the nurse will provide information. The nurse may be experiencing unusual stress at home, may be unaware of his or her behavior, or may have a medical condition. The first step should be to address and assess the situation. 3. It is not appropriate for the manager to involve other staff members. 4. It is premature to report the nurse to the human resources department. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 2) A rural hospital has been at capacity for the past 3 months. The chief nursing officer (CNO) has heard numerous complaints from the nursing staff. Most of the complaints are issues related to other nursing departments and are minor. How should the CNO interpret these complaints? 1. The nursing staff members are inefficient in managing the client load. 2. This is a typical reaction among nursing departments. 3. The nursing staff are stressed due to a sustained increased workload. 4. The nurses are ready to unionize. Answer: 3 Explanation: 1. The nursing staff's efficiency is not in question. 2. It is not appropriate to dismiss these issues as "typical" among nursing departments. 3. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to do the tasks assigned because of a lack of preparation/experience and insufficient information regarding the assignment. 4. There is no evidence that this is the case, but improving workplace conditions is a primary reason that nurses seek collective bargaining. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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3) A busy ICU unit has a high noise level. This frustrates the charge nurse in part because it is difficult to focus when entering physician's orders into the electronic medical record. Which would be the most appropriate action by the ICU nurse manager? 1. Decrease the noise level on the unit. 2. Tell the staff members that they need to be quiet when sitting at the nurse's station. 3. Close the doors to the client's rooms. 4. Rearrange the space so that a quieter area is available for order entry. Answer: 4 Explanation: 1. The long-term plan would be to work on lowering the noise level on the unit, but busy ICU units tend to be noisy. 2. Telling the staff to be quiet may create the additional stress of a disgruntled staff. 3. Closing the doors to client rooms is not always possible, and those rooms are generally not the areas where the excessive noise is produced. 4. The most logical of these options is to rearrange the area so that order entry can be done in a quieter environment. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 4) A medical-surgical nurse manager has received a complaint by a client regarding the noise level on the unit. The manager reviews the schedule and harshly reprimands the nursing staff who cared for the client. What is the evaluation of this manager's action? 1. It is appropriate and timely. 2. The action is inappropriate and increases the nursing staff's level of stress. 3. The action is inappropriate and should be reported. 4. It is appropriate and should be a model for future disciplinary actions. Answer: 2 Explanation: 1. A harsh reprimand is seldom a professional approach to discipline. 2. Authoritative or punitive supervisory behavior is closely related to stress levels. 3. More information is required to decide whether the manager should be reported. 4. This action should not serve as a model. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Environment Health Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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5) The nurse manager holds a staff meeting and announces, "I want to aggressively manage the stress on this unit." Why would the manager have this goal? 1. Stress has a negative impact on the functioning of the unit. 2. If the stress level is too low, people become apathetic and bored. 3. Low stress levels will reduce turnover on the unit. 4. Coping mechanisms only work when stress is high. Answer: 2 Explanation: 1. Stress is not always negative. 2. When stress levels are too low, the environment is not stimulating and people become apathetic, bored, and poorly motivated. 3. If the unit's stress level is so low that it is boring, the turnover rate may actually increase. 4. Coping mechanisms work at lower levels of stress. When stress exceeds coping, negative effects occur. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 26-1: Explain why stress is necessary. 6) A staff nurse tells the nurse manager, "I don't know how you do it. You manage the unit, work extra shifts, and have so many people depending on you and yet you seem so calm and in control." What explains this nurse's perception? 1. Nurse managers don't do much direct client care, so their work is predicable. 2. The staff nurse is trying to manipulate the manager. 3. The manager has excellent coping skills and high stress tolerance. 4. Some people do a very good job of hiding their stress. Answer: 3 Explanation: 1. A nurse manager's work is no more predictable than that of a staff nurse. 2. There is no indication that this nurse is not being honest in this assessment. 3. Some people seem to thrive on stress, but close examination reveals that they have developed excellent coping skills to go along with their ability to tolerate high stress levels. 4. Although some people can hide their stress for a time, it usually will begin to show in poorer work performance, attitude, or health issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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7) Which factors increase the stress associated with interpersonal relationships in healthcare? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Longer length of stay for clients 2. Few assistive personnel 3. Job redesign 4. New technology 5. Unrealistic expectations of other disciplines Answer: 3, 4, 5 Explanation: 1. A shorter length of stay for clients is more likely to increase staff stress. 2. Surpervising assistive personnel is very stressful. 3. Trying to do more with less is very stressful. 4. New technology can be very stressful during the learning curve. 5. Unrealistic expectations from anyone can increase the nurse's stress. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress. 8) A staff nurse is late for work for the second time this week. When the manager mentions the tardiness, the nurse says, "I'm so sorry. I've just got so much going on with my impending wedding. I am so stressed." Which responses by the manager would help this nurse cope? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Good stress can be just as bad as negative stress." 2. "We need to get you back in balance." 3. "Your personal issues should not interfere with work." 4. "Weddings are fun, but they can be stressful as well." 5. "If you are late again, I am going to write you up." Answer: 1, 2, 4 Explanation: 1. Good stress can be just as hard on the body as negative stress. 2. A balance should exist between stress and the ability to handle it. 3. The nurse realizes this fact, apologized, and offered an explanation for the tardiness. 4. Acknowledging the nurse's situation may help with coping. 5. A threatening response will not decrease the nurse's stress. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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9) The hospital has elected to initiate a rotating 8-hour shift schedule. Which strategy, taken by the nurse manager, will help staff cope with the stress associated with this staffing pattern? 1. Rotate the shifts several times each month so no one is on one shift very long. 2. Rotate the nurses among all shifts so that they know the concerns of each shift. 3. Be certain that nurses are taking their meal and work breaks during each shift to increase rest. 4. Schedule a "double back" at the end of each rotation to allow new rotations to start uniformly. Answer: 3 Explanation: 1. It takes several weeks to acclimate to a new shift, so rotating several times a month will increase stress. 2. Nurses should rotate only between two shifts. 3. Reducing physiological stress can occur by receiving adequate rest and work breaks. 4. Double-back shifts (in which the nurse works 8 hours, is off 8 hours, and comes back to work for 8 hours) should not be scheduled. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 10) The chief nursing officer (CNO) recognizes a large increase in turnover on a given unit. The nurse manager of the unit says that this is just a coincidence and that the unit is "fine." What action by the CNO is appropriate? 1. Talk to current nursing staff and review the exit interviews of those who have left. 2. Call the unit supervisor and inquire as to why the turnover rate is high. 3. Discuss the matter with other nurse managers. 4. Discuss the matter with the hospital chief administrator. Answer: 1 Explanation: 1. The CNO should investigate the matter to determine what has caused a high turnover in staff. Reviewing exit interview notes of employees who have left and insightful discussion of the matter with current staff will provide the CNO with information regarding the director's management style. Assessment is the first step of the nursing process. 2. If the nurse manager thinks all is well, it is unlikely that issues leading to turnover have been reported to the supervisor. 3. Other nurse managers will not be likely to have information about this unit that will be helpful. 4. The CNO may need to discuss the matter with another administrator at some time, but not until further investigation is conducted. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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11) A newly hired registered nurse is having difficulty focusing and performing nursing tasks. The nurse manager has noted a decrease in the nurse's performance. When meeting with the nurse, the manager learns the nurse has recently gotten married and moved into a new home. The client load in the unit has returned to normal levels from very high levels and the employment of another newly hired nurse was terminated for disruptive behavior. The nurse reports that "everyone has been so nice and they try to help me." Which situations are most likely causing this nurse's stress? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Marriage 2. Purchasing a new home 3. Decreased workload 4. Assistance from other nursing staff 5. The coworker whose employment was terminated Answer: 1, 2, 5 Explanation: 1. Even though getting married is a happy time, the wedding can be very stressful to plan. Adapting to married life can also be stressful. 2. Purchasing a new home is very stressful. 3. Typically, a reduced workload is not stressful. 4. Assistance from other nursing staff should not be stress inducing. 5. Working alongside a noncompliant coworker whose employment is terminated can be very stressful. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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12) A nurse who has just returned from two weeks of time off following minor surgery says, "I'm so glad to be back to work. I'm sick of watching television. I can't believe I missed the stress here." What are possible explanations for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Lack of stress can cause boredom. 2. Stress can be motivational. 3. Apathy can occur if stress is absent. 4. Eustress occurs when stress is decreased too much. 5. A balance between stress and coping is essential. Answer: 1, 2, 3, 5 Explanation: 1. A certain amount of stress is stimulating. Without stress, boredom can occur. 2. A moderate amount of stress can motivate a person to perform. 3. A person who is accustomed to stress may become apathetic if stress is removed. 4. Eustress is positive stress. 5. If there is not enough stress, the person feels "out of balance." Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 26-1: Explain why stress is necessary. 13) A staff nurse on a busy outpatient surgery unit comes to the manager and says, "I don't know what is going on. I just feel unsettled and anxious." How should the manager interpret this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse is trying to establish a problem for which days off will be necessary. 2. The nurse may be suffering from free-floating anxiety. 3. The nurse may be overstressed. 4. The nurse has compassion fatigue. 5. The nurse is about to experience posttraumatic stress disorder. Answer: 2, 3 Explanation: 1. There is no indication that the nurse is trying to make up an illness to get time away from work. 2. Free-floating anxiety is anxiety that seems to have many alternating causes. 3. Stress can cause these feelings of anxiety or fear. 4. Compassion fatigue has much more serious symptoms than anxiety. 5. There is no evidence of posttraumatic stress disorder. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 26-3: Summarize the consequences of stress.

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14) A staff nurse finds a newly licensed, newly hired staff nurse crying in the break room halfway through a shift. The new nurse says, "I am just not getting this. I had no idea nursing would be this hard." The experienced nurse says, "Reality shock is terrible, but you will get through it." What does the nurse mean by reality shock? 1. A period when it becomes clear the new nurse is not able to function as a registered nurse 2. A period of surprise and disequilibrium about the nursing role 3. A period when expectations of the role are unclear 4. A period when managers determine if the new nurse is a good fit for the profession of nursing Answer: 2 Explanation: 1. There is no indication that the new nurse cannot eventually function as a registered nurse. 2. Reality shock is the period of transition from a protected student role to a professional role in which the nurse is responsible and accountable for the care of several clients. 3. Being unclear about the role is role ambiguity. 4. It would be unfair for the manager to determine the nurse's fitness for the profession during reality shock. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress. 15) The unit nurses take turns filling the charge nurse role. Which statement reveals risk for development of role conflict in these nurses? 1. "I think I do a better job as charge nurse than the other nurses." 2. "I like being charge nurse better than being a staff nurse." 3. "Sometimes it is just faster to do things myself." 4. "I have difficulty with understanding the report from the previous shift." Answer: 3 Explanation: 1. Thinking that one does a good job in a role is not an example of role conflict. 2. Liking one role better than the other is not a symptom of role conflict. 3. Inter-role conflict occurs when the differences between being a staff nurse (doing it myself) and a charge nurse (direct someone else to do the task) become stressful. The nurse suffering from this conflict may well "switch over" to the other role in the interest of getting a task done quickly or well. 4. Having difficulty understanding a report is not a symptom of role conflict. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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16) A nurse manager praises a staff nurse by saying, "You are such a perfectionist, and it clearly shows in your work." The supervisor who hears this praise is concerned for which reason? 1. Giving such high praise to a staff nurse may result in the nurse asking for a raise. 2. The manager should not praise a staff nurse so highly in front of other nurses. 3. The manager may be promoting a trait that often leads to constant stress. 4. This type of praise often leads to the nurse behaving in a superior manner when around the other nurses. Answer: 3 Explanation: 1. There is no indication that this staff nurse will ask for a higher salary. 2. It is fine to praise a nurse highly in front of other nurses. 3. Perfectionism is setting unreasonably high standards for oneself, which can result in a state of constant stress. 4. There is nothing to indicate that this is the case with this nurse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 26-3: Summarize the consequences of stress. 17) The nurse manager asks a nurse to become a charge nurse, but then frequently questions the nurse's daily decisions. This situation reflects which problem that will increase the nurse's stress? 1. Reality shock 2. Role ambiguity 3. Role conflict 4. Burnout Answer: 2 Explanation: 1. Reality shock occurs at the transition between nursing student and practicing nurse. 2. This manager has asked the nurse to perform a role but does not trust the nurse to fulfill it. This results in role ambiguity. 3. Role conflict is the result of incompatibility between the individual's perception of the role and its actual requirements. 4. Burnout refers to the perception that an individual has used up all of his or her available energy to perform the job. Burnout may occur if this situation continues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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18) An assistant nurse manager has relieved a staff nurse for lunch. After the nurse leaves, the assistant manager realizes there is a nursing administration meeting at noon. Which stressproducing event does this exemplify? 1. Poor leadership 2. Mismanagement of the unit 3. Role conflict 4. Miscommunication Answer: 3 Explanation: 1. The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. 2. The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. 3. Role conflict occurs when an individual has two competing roles. The assistant manager was caught between the role of being a helper to staff and attending the meeting. 4. There was no miscommunication. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress. 19) A nurse who had advanced to assistant nurse manager was demoted back to staff nurse last month. The manager gives the nurse low-acuity client assignments. The nurse is efficient, unhappy, and bored. The nurse's response is most likely related to which phenomena? 1. Low self-esteem 2. Low morale 3. Mismanagement 4. Underutilization Answer: 4 Explanation: 1. If this situation is not changed, low self-esteem may result. 2. If this situation is not changed, low morale may result. 3. It is difficult to be certain if this is a situation of mismanagement from the information provided in the question. 4. Being underutilized or not having much responsibility may be seen as stressful by a person who is a high achiever or who has high self-esteem. Currently this nurse is likely experiencing being underutilized. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-3: Summarize the consequences of stress.

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20) The manager is watchful of compassion fatigue among the nursing staff of the emergency department. What is the best indicator to the manager that this disorder is occurring? 1. Nurses complain of being too tired to work. 2. Clients complain that nurses are not compassionate. 3. Physicians complain that the nurses are not taking good care of clients. 4. Symptoms much like severe burnout occur in the staff. Answer: 4 Explanation: 1. A nurse could complain about being too tired to work for a variety of reasons. 2. Clients might complain about lack of compassion, but nurses who do not have compassion fatigue may exhibit it as well. 3. Physicians may complain about lack of good care for a number of reasons. 4. Compassion fatigue is secondary traumatic stress experienced by caregivers. It is similar to posttraumatic stress disorder, but the term originated in nursing. It affects individuals who care for others who are experiencing physical and/or emotional pain and has symptoms similar to those of severe burnout. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 26-3: Summarize the consequences of stress. 21) A charge nurse has been trying to please all the nurses, physicians, clients, and staff of the unit. This has caused considerable stress for this nurse. After a few days off, the nurse decides to manage the role differently. What has occurred to the nurse over these days off? 1. Role conflict 2. Role definition 3. Role redefinition 4. Interrelated conflict Answer: 3 Explanation: 1. Role conflict may be what caused the nurse to experience the stress. 2. The role has already been defined upon promotion to charge nurse. 3. Role redefinition involves clarifying roles and attempting to integrate or tie together the various roles individuals play. This nurse had to redefine the role and role expectations. 4. Interrelated conflict does not apply to this situation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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22) A nurse who transferred from the medical-surgical unit completed orientation to the ICU 6 weeks ago, but is stressed and unsure of personal skill competency. The nurse manager learns of this lack of confidence. Which action by the manager would best benefit this nurse and the unit? 1. Reduce the nurse's client assignment. 2. Transfer the nurse back to the medical-surgical unit. 3. Provide written instruction regarding the desired unit specific skills. 4. Provide additional weeks to orientation with a focus on skill development. Answer: 4 Explanation: 1. Reducing the nurse's work load is not addressing the nurse's concerns or requests. 2. Transferring the nurse to the medical-surgical unit may add to the stress and is not a win-win situation for both parties. 3. Written instructions will not address the nurse's concerns or requests. 4. If staff members appear to be under a great deal of stress, the manager must help identify the source and decide how these can be reduced or eliminated. In some cases, additional training or education is necessary. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 23) The nursing unit has experienced high stress and a higher than normal turnover rate. The manager asks a longtime member of the nursing staff to analyze the manager's job performance. What is most likely the reason for this request? 1. The manager is questioning his or her leadership style and its effectiveness. 2. The manager is required to ask for input on his or her personal job evaluation. 3. The manager is attempting to show concern about unit conditions. 4. The manager is inquiring about other leadership styles the nurse has encountered. Answer: 1 Explanation: 1. This nurse manager is in a stressful situation. Assessing whether his or her management or leadership style is helpful or appropriate allows the manager to enhance his or her performance. It is likely that this nurse is questioning his or her effectiveness in the role and is asking for the opinion of an experienced nursing colleague. 2. The evaluation process may require this input, but the rest of this scenario points to another answer. 3. The manager is not likely to be just trying to show concern. 4. The manager has asked the nurse to critique the manager's style, not about other styles. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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24) A nurse supervisor is aware that nurses in the facility have been under a great deal of stress while working through a major change in the ownership of the hospital. Which nurses would the supervisor be most concerned might develop compassion fatigue? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Emergency department nurses 2. Outpatient diagnostic procedure nurses 3. Nurses working in the trauma surgery unit 4. Nurses working in geriatrics 5. Nurses working in obstetrics Answer: 1, 3 Explanation: 1. Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Emergency department nurses fall in this category. 2. Outpatient nurses may be somewhat sheltered from caring for trauma patients, which is a major cause of compassion fatigue. 3. Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Trauma surgery nurses fall into this category. 4. Nurses working in geriatrics are not at as great a risk for compassion fatigue as other nurses. 5. Generally, the risk for compassion fatigue is not as high in nurses working in obstetrics. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Environment Health Learning Outcome: 26-3: Summarize the consequences of stress. 25) During an annual performance review, the staff nurse admits to being very stressed by the demands of the job, marriage, and four teenage children. Which comment by the nurse manager is indicated? 1. "We need to figure out what you can give up in your personal life to help decrease your stress." 2. "You need to be more flexible with the hours you work." 3. "You should not let your personal problems affect your work." 4. "Let's talk about how we can help you develop some resiliency." Answer: 4 Explanation: 1. The nurse manager would look to the nurse's professional life for areas to decrease stress and should only make global statements regarding personal life. 2. Asking the nurse to be more flexible with work hours, when there are the family's demands on time, would only increase stress. 3. It is not reasonable to think that the nurse's personal life can be completely disregarded while the nurse is at work. Even if the nurse is not focusing or thinking about personal issues, the stress is still there. 4. To manage the demands of a job, family, and society effectively and keep stress at levels that enhance performance, the key is to develop resiliency. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. TestBankWorld.org

26) The supervisor of critical care services tells the unit manager, "We must cut costs, so I am asking you to arrange your day so that you provide care to two or three clients and cover for lunch and rest breaks. Also don't forget that your budget estimates are due next week, as are your preliminary schedules for the winter holidays." Two days later, the nurse manager is stressed and exhausted. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Think through the roles being required. 2. Confront the supervisor and ask for clarification of status. 3. Try to improve work organization. 4. Tell the supervisor, "I can't work this hard. Get someone else to be manager." 5. Call in sick for a day to rest. Answer: 1, 2 Explanation: 1. A role conflict is present. Is this nurse to provide care or complete managerial tasks? 2. The supervisor must be confronted and must understand that the two roles being asked of this nurse are in conflict. 3. Often nurses who are overloaded believe they can continue to carry the current load "if only I could get more organized." 4. The real problem here is conflicting role expectations, not the nurse's inability to work hard. 5. Calling in sick is not going to change the expectations when the manager returns to work. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Environment Health Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 27) A nurse manager notes that staff members are struggling with caring for an increased client load while a new management system is being implemented. What managerial action would help reduce this stress? 1. Asking a nursing faculty friend to use the unit for a student clinical 2. Hiring two newly licensed nurses for each shift 3. Asking for nurse input into decisions that directly affect care 4. Instituting a method of shift rotation that increases staff on each shift Answer: 3 Explanation: 1. Helping to manage and supervise students is stressful for many nurses. 2. Helping to orient newly licensed nurses is stressful for many nurses. 3. Involving staff in decision making is one way to identify and reduce stress. 4. Working rotating shifts is very stressful to many nurses. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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28) A nurse manager is considering referring a nurse who is very stressed to the employee assistance program (EAP) offered by the institution. What does this consideration indicate? 1. The manager believes this service would promote the nurse's health and well-being. 2. The manager thinks the nurse is abusing alcohol to cope with the stress. 3. The manager thinks that this referral will help the nurse avoid sanction by the state board of nursing. 4. The manager believes the nurse is abusing controlled medications to cope with stress. Answer: 1 Explanation: 1. EAPs are designed to help the nurse cope with a variety of issues and to support health and well-being. 2. EAPs are used for many issues other than alcohol abuse. 3. There is nothing in this question that indicates sanctions are pending. 4. EAPs are used for many issues other than substance abuse. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 29) A hospital has been acquired by a new management company. As part of this acquisition, several different types of equipment have been introduced into the client care area. How can the manager best plan to reduce the stress of using this equipment? 1. Have all the equipment put into service at one time so learning will be compressed. 2. Teach the nurses with the most seniority to use the equipment and let them teach the other nurses. 3. Be certain that all nurses attend training sessions on the use of all equipment. 4. Post written instructions in the break room on how to use the equipment. Answer: 3 Explanation: 1. Having all the equipment at once would complicate learning and increase stress. 2. The nurses with the most seniority will already be stressed by all the new equipment. Asking them to be responsible for teaching the remainder of the nursing staff is not a good plan. 3. The best way to decrease stress of using this equipment is to be certain training is adequate. 4. There is no assurance that all of the nurses will read these instructions. Many nurses do better when shown how to use equipment and allowed to practice. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 26-4: Examine how individuals and organizations can manage stress.

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30) An experienced nurse manager is serving as mentor to a newly appointed manager. The experienced manager says, "Always try to keep your staff as well informed as possible about what is going on at the administrative level." What rationale should the manager offer for this advice? 1. Nursing involvement at the administrative level is required by accrediting agencies. 2. Involvement of all departments in the agency supports the organizations' management style. 3. Staff members who are kept informed are less likely to be suspicious and spread rumors. 4. Sharing both the positive and negative information from administration helps to reduce the manager's stress. Answer: 3 Explanation: 1. Although nursing involvement is encouraged, this is not the good rationale for this manager's statement. 2. This may be the case, but it is not the primary rationale for this statement. 3. When staff members are informed and find that managerial information is reliable, the amount of suspicion and rumor decreases. 4. The purpose of sharing information is not to reduce the manager's stress. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 26-4: Examine how individuals and organizations can manage stress. 31) ________ is the result of incompatibility between the individual's perception of the role and its actual ________. Answer: Role-conflict, requirements Explanation: Role-conflict is the result of incompatibility between the individual's perception of the role and its actual requirements. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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32) What are the warning signs of too much stress? 1. Physical illness 2. Prolonged anxiety 3. Clarification of roles 4. Abrupt changes in mood 5. Feeling of helplessness Answer: 1, 2, 4, 5 Explanation: 1. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 2. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 3. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 4. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 5. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 26-2: Describe the organizational, interpersonal, and individual factors that cause stress.

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Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 27 Advancing Your Career 1) A student who is about to graduate is discussing the future with a nursing instructor. The instructor asks the student, "What schedule are you interested in working? What organization is near your home?" The student says that salary is the most important thing. Which response by the instructor would be appropriate? 1. "Because you have been in school for so long, the most important thing to you is to get a job that pays well." 2. "I would focus on those organizations that pay premium wages for nurses." 3. "A small difference in salary is less important than working in an organization where you can obtain your future goals." 4. "Money is not important; the job is important." Answer: 3 Explanation: 1. Despite what many students believe, the least important criteria for a first job is the salary. 2. Premium wages are not the most important criteria for choosing a first job. 3. The purpose of the first job is to learn as much as possible, perfect clinical skills, build a network of colleagues, and move toward future goals. 4. Money is important, but it is not the most important determinant of the right job. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 27-1: Describe how to envision your future. 2) The nursing faculty member requires that last-semester nursing students create a résumé. One student submits a résumé that includes education, past employment, and accomplishments. Which additional information will the faculty member recommend the student include in this résumé? 1. Family information 2. Short-term personal goals 3. Transcript 4. Long-term career goals Answer: 4 Explanation: 1. Family information is not part of the résumé. 2. The résumé may include an immediate professional goal, but it does not include personal goals. 3. Transcripts are not part of the résumé. 4. Long-term career goals help a reviewer understand the best position for the candidate. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 27-4: Plan for your next position. TestBankWorld.org

3) A newly licensed nurse has submitted an application, letter of interest, and résumé to the human resources department of a hospital and has an interview scheduled for next week. How should the nurse prepare for this interview? 1. Write down and memorize answers to questions that are typically asked. 2. Go to the organization and try to talk to some staff nurses. 3. Add additional information to the résumé. 4. Review the organization's website. Answer: 4 Explanation: 1. The response to answers should be genuine and honest, not memorized. 2. Arriving on a unit unannounced to talk to staff nurses is not professional. 3. Once the résumé is submitted, it is not necessary to add information. Additional information may be discussed in the interview. 4. Prior to the interview, it is important to learn as much about the organization as possible and to anticipate questions to ask. This is assessment, the first step of the nursing process. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 27-2: Relate the steps needed to obtain your first job. 4) A nurse has an interview with the nurse recruiter at a large metropolitan hospital. During the nurse's education, clinical practice was conducted in smaller facilities. Which topics would be good for the applicant to focus on during the interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Information regarding the position and the organization 2. The nurse's past experiences 3. Salary 4. Benefits 5. The nurse's strengths and weaknesses Answer: 1, 2, 5 Explanation: 1. During the interview, the nurse should obtain information about the position and organization. 2. During the interview, the nurse should describe experiences and education. 3. Once the job has been offered or the interviewer inquires about the applicant's interest in the job, then it is appropriate to discuss salary. 4. Once the job has been offered or the interviewer inquires about the applicant's interest in the job, then it is appropriate to discuss benefits. 5. During the interview, the nurse should identify personal strengths and weaknesses. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 27-2: Relate the steps needed to obtain your first job.

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5) A nurse who has an interview with the human resources (HR) director enters the office, doesn't make eye contact, and is very timid. Toward the end of the interview, the HR director asks the nurse if there are any questions. The nurse states, "No, I think I've learned all I need to know." What impression has this nurse given the HR director? 1. Lack of interest in the position 2. Shyness and the inability to manage people 3. Rudeness 4. Laziness Answer: 1 Explanation: 1. A candidate who has no questions suggests a lack of interest or expertise. The nurse's inability to make eye contact and appearing timid does not facilitate a good impression. 2. Although not making eye contact and appearing timid may indicate shyness, the overwhelming impression is a lack of interest. 3. The applicant has not been rude but does appear disengaged. 4. There is no real reason to think this applicant is lazy, but the HR director may be reluctant to offer a second interview. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 27-2: Relate the steps needed to obtain your first job. 6) During an interview for a night shift ICU position, the manager asks the job candidate, "Will working the night shift interfere with your husband's schedule?" How should the candidate interpret this question? 1. It is a legitimate question. 2. It is an illegal question to ask. 3. It is none of the manager's business. 4. It is something the candidate should consider. Answer: 2 Explanation: 1. It may be a legitimate question and a question the candidate has not thought about, but it is illegal to ask. 2. It is illegal for the interviewer to ask personal questions such as regarding how many children the candidate has or the candidate's marital status. 3. This may be something that the manager would like to know about and might impact the candidate's ability to complete the job, but it is illegal to ask in an interview. 4. This is something the candidate should consider, but the manager should not ask about it during the interview. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Ethics Learning Outcome: 27-2: Relate the steps needed to obtain your first job.

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7) A nurse has interviewed with the nurse manager for a position and is very interested in obtaining it. After the interview, what would be an appropriate action to take? 1. Call the human resources director the following day regarding the selection process. 2. Call a staff nurse on the unit and inquire whether a decision has been made regarding the candidate. 3. Send a post-interview thank-you letter the following day. 4. Call the interviewer every day post-interview until a decision is announced. Answer: 3 Explanation: 1. Calling the human resources director the next day is not appropriate. 2. It is not appropriate to call the staff nurse. 3. Sending a post-interview thank-you letter within 24 hours of the interview to everyone who interviewed is appropriate. The letter should be brief and thank the interview team for the interview and their interest in the candidate, and it should mention the candidate's appreciation for the meeting. 4. Calling the interviewer every day is very unprofessional and may hurt one's chances for the position. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 27-2: Relate the steps needed to obtain your first job. 8) During the interview, a nurse learns that several people are interviewing for the position. Several days post-interview, the nurse is called for a second interview. How should the nurse prepare for this interview? 1. Prepare in the same way as for the first interview. 2. Prepare in a similar way as for the first interview but with more details regarding past experiences. 3. Anticipate questions regarding the position that are situational and provide information regarding competence. 4. Anticipate questions about goals for the future. Answer: 3 Explanation: 1. The purpose of the second interview is different, as is preparation for it. 2. Past experiences are not the focus of the second interview. 3. The second interview usually includes colleagues and managers with whom the nurse will work. Situational questions are often asked. The goal is to show the nurse is a competent, confident professional. 4. Questions about future goals are generally asked during the first interview. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 27-2: Relate the steps needed to obtain your first job.

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9) The nurse has just interviewed with a nurse manager. The manager offers the nurse an opportunity to tour the unit and meet potential coworkers. Why is this a beneficial opportunity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It allows the candidate to learn more about the unit. 2. It allows the candidate to make a final determination about whether the unit is a good work environment. 3. It allows the candidate to make some assessment of coworkers. 4. It allows the candidate to determine nurse-to-client ratios. 5. It allows the candidate a first look at the types of clients served by the unit. Answer: 1, 3 Explanation: 1. This tour allows the candidate to see the unit in action and learn more about how it operates. 2. It is hard to make a logical determination about the unit on one visit, but the nurse will gain information that will be helpful. 3. The nurse is constantly assessing, and a tour allows contact with coworkers for this assessment. 4. One tour is unlikely to provide the candidate with this opportunity. 5. The candidate should be aware of the types of clients served by the unit prior to applying for the position. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 27-2: Relate the steps needed to obtain your first job. 10) A candidate is concerned that some answers she gave during her interview were vague and lengthy. She relates some of the answers to a peer, saying, "I don't know what happened. I was just so nervous." What is an appropriate response by the peer? 1. "Why did you give those answers?" 2. "You should have given short and to-the-point answers." 3. "You gave good answers." 4. "I think your answers were specific." Answer: 2 Explanation: 1. This response is only likely to increase the candidate's concern about the interview. Why the answers were given is not important at this time. The candidate has already admitted to being very nervous. 2. The candidate should be reminded to keep answers short and to the point so as to appear competent and professional. 3. Long, rambling answers are not good answers. 4. The peer should not be untruthful to the candidate. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 27-4: Plan for your next position. TestBankWorld.org

11) A nurse who has worked in the dialysis unit for the past 5 years is considering a career change. The nurse is unsure whether to follow a management or a clinical career path. Which would be a good beginning step for this nurse? 1. Enroll in a graduate nursing program. 2. Investigate careers by talking with nurses in those positions. 3. Investigate the salary options for various careers. 4. Seek advice from the manager of the unit. Answer: 2 Explanation: 1. Prior to enrolling in a graduate program, the nurse should investigate career opportunities and various graduate programs. 2. Networking with nurses working in the fields of potential interest may assist this nurse in determining the correct path. 3. Salary should not be the prime determinant of which path to follow. 4. The nurse is most likely a valuable employee to the manager, so the advice received might not be totally unbiased. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 27-4: Plan for your next position. 12) A nurse with an associate degree in nursing is interested in obtaining more education but is unsure if it is wiser to obtain a baccalaureate degree in nursing or to pursue certification. The answers to which questions would assist the nurse in making a decision? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Am I interested in nursing management? 2. Which goal can be accomplished at the least expense? 3. Do I want to go to graduate school? 4. What are my future options in my current position? 5. Is either option available online? Answer: 1, 3, 4, 5 Explanation: 1. The nurse should determine interests prior to deciding which degree to pursue. 2. The expense it will take to achieve the goal should not be the primary factor determining which one to choose. 3. The nurse should think about future educational goals when deciding upon a degree. 4. The nurse should identify current advancement possibilities when considering further education. 5. Online education is available for many degrees and certifications. This information may make the decision clearer. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Education Learning Outcome: 27-4: Plan for your next position. TestBankWorld.org

13) A nurse who has a baccalaureate degree in nursing is interested in going to graduate school. The nurse is talking to a peer who is in a nurse practitioner program. Which advice would be beneficial for this nurse in choosing a graduate program? 1. Perform an online search and look for the program that requires the least amount of time to obtain the degree. 2. Meet with faculty and students of various graduate programs. 3. Discuss the graduate schools with a physician. 4. Don't start until you are certain you can finish. Answer: 2 Explanation: 1. The time it takes to achieve the degree is not the primary deciding factor. 2. Choosing a graduate program can be time consuming. Gather literature and meet with admissions staff, faculty, students, and colleagues. 3. Physicians will likely not be aware of the particulars about nursing degree programs. 4. No one is certain they can complete a degree program. The point is to start. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 27-4: Plan for your next position. 14) A nurse is unsure in which graduate nursing program to enroll. A colleague recommends the nurse consider a degree program for which it appears there will be growing demand. Which role is expected to continue to be in great demand in the future? 1. Nurse administrators 2. Community health nurse 3. Nursing education 4. School nurse Answer: 3 Explanation: 1. Nursing administration is not one of the two areas expecting the greatest growth. 2. Community health nursing is not one of the two areas expecting the greatest growth. 3. Two areas that are expected to grow in demand are nursing faculty and nurse practitioners. The ranks of nursing faculty are expected to decrease as more faculty members retire. 4. School nursing is not one of the two areas expecting the greatest growth. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 27-4: Plan for your next position.

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15) A nurse has always been interested in the legal nurse field. What would be the best program in which to learn about this field? 1. A seminar in which the nurse can obtain certification as a legal nurse as quickly as possible 2. A seminar that offers a variety of speakers addressing the legal nurse profession 3. An accredited program by a legal nurse association 4. A program in which lawyers speak of the opportunities available for legal nurses Answer: 3 Explanation: 1. The quickest path is not always the best path. 2. Although the nurse would gain knowledge about the field, there is a better way to do it. 3. No matter the subject, the nurse should focus on whether the program is sponsored by a known organization and provides speakers with appropriate credentials. 4. The program should help the nurse meet his or her needs, not just talk about opportunities. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Education Learning Outcome: 27-1: Describe how to envision your future. 16) A baccalaureate nurse has been invited to join Sigma Theta Tau International (STTI). While trying to decide about taking the offer, the nurse asks a member about the organization. Which option reflects the best reason to join a group such as this? 1. It offers the privilege of joining a distinguished group of professionals. 2. It offers the privilege of participating in an organization. 3. It offers the ability to network and learn while serving the organization. 4. It offers the ability to join the American Nurses Association. Answer: 3 Explanation: 1. Although the members of STTI are a distinguished group of professionals and it is a privilege to be asked to join, those are not the major reasons for joining. 2. Although the members of STTI are a distinguished group of professionals and it is a privilege to be asked to join, those are not the major reasons for joining. 3. Membership in professional associations offers many opportunities for networking and learning while serving the organization on committees and task forces. 4. You do not have to be a member of STTI in order to join ANA. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 27-3: Explain how to create your career.

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17) An ICU nurse has been approached by a colleague to join the American Association of Critical Care Nurses. The nurse asks the colleague, "Why would I want to join this organization?" Which would be the best response? 1. "It will further your career." 2. "It looks good on your resume." 3. "It will help you to network and enhance your learning." 4. "You have to join before you can obtain critical care certification." Answer: 3 Explanation: 1. It may further the nurse's career but that is not the best reason. 2. It may look good on a résumé, but that is not the best reason. 3. Specialty organizations exist for nurses who work in many clinical areas and offer divisions, committees, and boards where the nurse's time and talents are welcome. This helps the nurse build a network and is a good way to learn about the issues facing the profession. 4. One does not have to join this organization to obtain critical care certification. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 27-3: Explain how to create your career. 18) A nurse has joined the local Sigma Theta Tau organization. The nurse is hoping to find a mentor within the organization. Which person would be a good candidate? 1. A senior nurse who has the career experience that the nurse is interested in pursuing 2. The president of the organization 3. A senior nurse who has a wide range of career experiences 4. A member of the board of the organization Answer: 1 Explanation: 1. A mentor is a person who has more experience and is willing to help the protégé progress in their career. A mentor should be a senior nurse or someone in a closely aligned profession who can help the protégé with contacts and networking. The most logical selection of these options is the senior nurse who has the career experience the protégé seeks. 2. The president of the organization may not have the career experiences the nurse is interested in pursuing. 3. The senior nurse with a wide range of career experiences would be good as a general mentor but is not the best choice in this situation. 4. A member of the board of the organization may or may not have the kind of career experiences this nurse would need. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 27-3: Explain how to create your career.

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19) A nurse has been in practice for 14 years and has worked in three different departments in the hospital. The nurse is a member of a professional organization and is considering running for an office next year. According to Shirey, this nurse is in which career phase? 1. The promise phase 2. The adolescent phase 3. The momentum phase 4. The harvest phase Answer: 3 Explanation: 1. The promise phase is the first part of the career in which building blocks for a long career are laid. 2. Shirey does not include adolescence as a phase. 3. During the momentum phase, the nurse chooses multiple experiences and becomes more visible in the profession. 4. During the harvest phase, the nurse begins to share experiences and expertise with younger nurses and leaves a legacy for the next generation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 27-3: Explain how to create your career. 20) A nurse is considering graduate school. The nurse is interested in becoming a nurse practitioner. This nurse has worked as a medical-surgical nurse for the past 10 years. Which opportunity would benefit this nurse's career? 1. Taking a position as an assistant nurse manager 2. Applying for a nurse manager position on a renal unit 3. Transferring to the ICU unit 4. Transferring to the oncology unit Answer: 3 Explanation: 1. Being an assistant nurse manager would not provide the skills this nurse needs. 2. Being a nurse manager would not be the best choice to provide the skills this nurse needs. 3. The nurse has decided to obtain a nurse practitioner license. Furthering education by focusing on critical care pathophysiology will assist the nurse when enrolled in graduate school. 4. The oncology unit would provide the opportunity to learn new skills, but not as many as another choice. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 27-4: Plan for your next position.

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21) A nurse says, "At last I feel like I am beginning to harvest some of the benefits of my career. I love sharing what I have learned with the new generation of nurses." Someone hearing this statement would interpret it to mean the nurse has likely practiced for at least ________ years. Answer: 30 Explanation: The harvest phase of a nursing career often comes after the nurse has practiced for 30 years. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Education Learning Outcome: 27-3: Explain how to create your career. 22) A nurse who has worked on a unit for 8 years has just accepted a position as a nurse practitioner at an indigent clinic. How should the nurse handle exiting the current position? 1. Leave by the end of the week. 2. Tell the manager as soon as the decision is made. 3. Advise the human resources department prior to the unit manager. 4. Discuss the matter with colleagues well in advance of telling the manager. Answer: 2 Explanation: 1. Nearly every job has a required notice period, often equivalent to one schedule. Leaving without working out the required notice period is not professional. 2. The nurse should discuss this matter with the manager as soon as the decision is made and should work out the required notice. 3. The nurse should tell the manager before contacting HR. 4. Telling colleagues that one has accepted a new position before telling the manager is not professional. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Communication Learning Outcome: 27-4: Plan for your next position.

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23) A nurse has decided to relocate to another state. Which entry on this nurse's resume will be most useful in searching for a new job? 1. Boy Scout leader for 3 years 2. Member of Sigma Theta Tau International 3. Six years work experience as nurse manager in ICU 4. Graduated with honors from a BSN program Answer: 3 Explanation: 1. Being a Boy Scout leader is a good community service entry on the résumé, but it is not the most valuable in this case. 2. Membership in STTI is a good entry for the résumé, but it is not the most valuable in this case. 3. The work experience is the most important of these potential entries. 4. Educational experiences such as graduating with honors should be included in the résumé, but they are not the most important of these potential entries. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 27-4: Plan for your next position. 24) Several months ago, the nurse accepted a management position in the neurological care unit. The nurse has been very challenged and stressed and is unsure the position change was the correct choice. What should the nurse do now? 1. Give proper notice and go back to the previous position. 2. Discuss the matter with the director of the unit. 3. Discuss the matter with staff nurses on the unit. 4. Take a few days off to think about the situation. Answer: 2 Explanation: 1. Leaving the position without discussing it and thinking about it is not the correct choice. 2. Discussing the matter with the director will allow the nurse to assess progress and obtain feedback and assistance in managing the stress of the job. 3. Discussing the matter with coworkers is not a good idea because the manager must appear confident and sure in the role. 4. The nurse may need to take a few days off to consider options, but this should not be done as a single intervention. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 27-5: Learn to adapt to change.

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25) A newly promoted nurse manager is overwhelmed by the amount of paperwork that must be submitted to the director. The nursing unit is very busy and is short staffed, so the manager also takes a client assignment. This additional work makes the paperwork load even more daunting. Which statement is the most important lesson for this manager to learn? 1. A manager's first priority is client care. 2. A manager's first priority is the nursing staff. 3. The job requires the nurse to adjust, respond to change, and remain flexible. 4. The paperwork is not important. Answer: 3 Explanation: 1. The manager's first priority is providing for quality client care, but the manager does not have to personally provide that care. 2. The manager does make the nursing staff a priority, but this is not the best answer to this question. 3. Every day change is occurring, and in healthcare, the pace is fast. To find satisfaction in a career requires the ability to adjust and respond to change. The most important attribute anyone can bring to this effort is to remain flexible. 4. Paperwork, whether it is documentation of client care or management documents, is always important. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 27-5: Learn to adapt to change.

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26) A nurse knows that both experiences and a plan are important when building a résumé. Which attributes are the most important for the plan part of this endeavor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Flexibility 2. Long term 3. Focused on one career path 4. Includes frequent contact with the nurse's current mentor through the years 5. Designed around a fixed retirement date Answer: 1, 2 Explanation: 1. The nurse's plan must be flexible to account for the speed of change in today's healthcare environment. 2. The plan developed as a young nurse should be long term. The desires of the far distant future must be planned for today. 3. The nurse should be open-minded about the career path but should point the path toward the eventual goal. For example, the nurse may wish to be the nurse executive of the hospital but may eventually end up a nurse executive in a healthcare conglomerate. 4. Mentors often come and go through a nurse's career. The current mentor may change to a different one as years go by. 5. The nurse may find that early retirement is possible and desirable or may choose to work long past the date considered when younger. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 27-4: Plan for your next position.

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27) In an activity log, a nurse records attendance at an education seminar as, "Class on arrhythmia recognition, State College, taught by Sue Smith, RN." What else would be valuable for the nurse to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The exact title of the seminar or event 2. Which colleagues attended with the nurse 3. Who paid for the course and what it cost 4. The date 5. Any certifications achieved Answer: 1, 3, 4, 5 Explanation: 1. The exact title should be included in the activity log. 2. The names of those who attended with the nurse are not necessary. 3. Keeping track of expenses is important for tax purposes. 4. The date of the course is important to include. 5. It is important to keep track of certifications. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 27-4: Plan for your next position. 28) A female nurse has an interview for a new job scheduled next week. What should the nurse plan to wear to this interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Scrubs 2. A neatly pressed lab jacket and white uniform 3. Capri length pants and sandals 4. Dark pants and a gray jacket 5. Simple jewelry Answer: 4, 5 Explanation: 1. It is seldom appropriate to wear scrubs to an interview. 2. It is seldom appropriate to wear a uniform and lab jacket to an interview. 3. Capri length pants and sandals are too casual for an interview. 4. Pants and a neutral-colored jacket are appropriate dress for an interview. 5. Simple jewelry is appropriate for an interview. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 27-2: Relate the steps needed to obtain your first job.

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29) A nurse has two job offers. One will not be available for 6 months, and the other is in an organization that the nurse does not think is a good fit. The client care in the second organization is not what the nurse would feel comfortable providing. What action should the nurse take in regard to the second organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Gracefully decline the job by saying he is moving out of state. 2. Accept the position and plan to resign as soon as the other position opens. 3. Thank the manager for the offer, but decline it. 4. Send a letter to the manager, thanking the organization for the offer. 5. Tell the manager that the client care in the organization was not what was expected. Answer: 3, 4, 5 Explanation: 1. It is better to be honest and just decline the job. 2. It is not right to accept this position. The nurse believes the fit is not right, and it is not fair to the organization to put the nurse through hiring and orientation, only to have the nurse leave. 3. It is best to decline the offer of a job in an organization where there is not a good fit. 4. Even though the organization is not a good fit today, it might be in the future. The nurse should not risk alienating a potential future contact. 5. The nurse should not be blunt or rude in the explanation but should focus on the fit not being correct. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 27-2: Relate the steps needed to obtain your first job.

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30) A nurse manager has a strong belief in the value of certification for staff nurses. Unfortunately, only two staff members are certified. How could the manager encourage the remaining staff to seek certification? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Make it a job requirement. 2. Obtain grant monies to fund purchase of materials for certification. 3. Support those who are seeking certification with study sessions and helpful study hints. 4. Work with administration to obtain a salary adjustment for those who become certified. 5. Role-model the behavior by becoming certified. Answer: 2, 3, 4, 5 Explanation: 1. If certification is made a requirement, then the stimulus to attend is not learning, but survival. 2. The cost of materials may be a barrier for some nurses. 3. Support by management takes down one common barrier to certification. 4. A workplace reward, such as a salary adjustment, is a good incentive to become certified. 5. The manager should also seek certification. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 27-4: Plan for your next position. 31) ________ is a formal ________ that a nurse has acquired ________ knowledge, skills, and experience that meet identified standards. Answer: Certification, recognition, specialized Explanation: Certification is a formal recognition that a nurse has acquired specialized knowledge, skills, and experience that meet identified standards. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 27-3: Explain how to create your career.

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32) The nurse has worked 11 years as an RN and is starting to assume more duties, including cross-training to another unit and representing the unit in various health and job fairs. What stage of the nursing career does this practice portray? 1. Phase I 2. Phase II 3. Phase III 4. Phase IV 5. Phase V Answer: 2 Explanation: 1. Phase II: Momentum (11-29 years). The nurse is continuing to learn and grow, choosing multiple experiences, and becoming visible in the profession are all important for continued success. 2. Phase II: Momentum (11-29 years). The nurse is continuing to learn and grow, choosing multiple experiences, and becoming visible in the profession are all important for continued success. 3. Phase II: Momentum (11-29 years). The nurse is continuing to learn and grow, choosing multiple experiences, and becoming visible in the profession are all important for continued success. 4. Phase II: Momentum (11-29 years). The nurse is continuing to learn and grow, choosing multiple experiences, and becoming visible in the profession are all important for continued success. 5. Phase II: Momentum (11-29 years). The nurse is continuing to learn and grow, choosing multiple experiences, and becoming visible in the profession are all important for continued success. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 27-5: Learn to adapt to change.

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