Test Bank For Leading And Managing In Nursing, 6th Edition

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Chapter 01: Leading, Managing, and FollowingChapter 01: Leading, Managing, and FollowingYoder-Wise: Leading and Managing in Nursing, 6th EditionMULTIPLE CHOICE1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She isasked to assess and adapt the unit to better meet the unique needs of the older adult patient. Usingcomplexity principles, what would be the best approach to take in making this change?a. Leverage the hierarchical management position to get unit staff involved in assessment andplanning.b. Engage involved staff at all levels in the decision-making process.c. Focus the assessment on the unit, and omit the hospital and community environment.d. Hire a geriatric specialist to oversee and control the project.ANS: BComplexity theory suggests that systems interact and adapt and that decision making occursthroughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voicecounts, and therefore, all levels of staff would be involved in decision making.REF: Page 8 TOP: AONE competency: Communication and Relationship-Building2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who hascalled in sick five times in the past month. He tells the manager that he very much wants to come towork when scheduled but must often care for his wife, who is undergoing treatment for breast cancer.According to Maslow’s need hierarchy theory, what would be the best approach to satisfying theneeds of this nurse, other staff, and patients?a. Line up agency nurses who can be called in to work on short notice.b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be callingin frequently in the future.d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around hiswife’s treatments.ANS: DPlacing the nurse on unpaid leave may threaten the nurse’s capacity tomeet physiologic needs anddemotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and

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threaten the needs of staff to feel competent. Arranging the schedule around the wife’s needs meetsthe needs of the staff andof patients while satisfying the nurse’s need for affiliation.REF: Page 10 TOP: AONE competency: Communication and Relationship-Building3. A grievance brought by a staff nurse against the unit manager requires mediation. At the firstmediation session,the staff nurse repeatedly calls the unit manager’s actions unfair, and the unitmanager continues to reiterate the reasons for her actions. What would be the best course of action atthis time?a. Send the two disputants away to reach their own resolution.b. Involve another staff nurse in the discussion so as to clarify issues.c. Ask each party to examine her own motives and issues in the conflict.d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.ANS: CUry, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interestsand involvement of participants in the conflict by examining the real issues of all parties.REF: Page 16 TOP: AONE competency: Communication and Relationship-Building4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.It would now be best to:a. Arrange another meeting in a week’s time so as to allow a cooling-off period.b. Turn the dispute over to the director of nursing.c. Insist that participants continue to talk until a resolution has been reached.d. Back the unit manager’s actions and end the dispute.ANS: BAccording to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period isrecommended if resolution fails.REF: Page 16 TOP: AONE competency: Communication and Relationship-Building5. The manager of a surgical area has a vision for the future that requires the addition of RNassistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have alwayspracticed in a primary nursing–delivery system and are very resistant to this idea. The best initialstrategy in this situation would include:a. Exploring the values and feelings of the RN group in relationship to this change.

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b. Leaving the RNs alone for a time so they can think about the change before it is implemented.c. Dropping the idea and trying for the change in a year or so when some of the present RNs haveretired.d. Hiring the assistants and allowing the RNs to see what good additions they are.ANS: AInfluencing others requires emotional intelligence in domains such as empathy, handlingrelationships, deepening self-awareness in self and others, motivating others, and managingemotions. Motivating others recognizes that values are powerful forces that influence acceptance ofchange. Leaving the RNs alone for a period of time before implementation does not provideopportunity to explore different perspectives and values. Avoiding discussion until the team changesmay not promote adoption of the change until there is opportunity to explore perspectives and valuesrelated to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives ofthe RN staff.REF: Page 7 | Page 15TOP: AONE competency: Knowledge of the Health Care Environment6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found thatthere is little turnover among your LPN and nursing assistant (NA) staff members, but they are notvery motivated to go beyond their job descriptions in their work. Which of the following strategiesmight motivate the staff and lead to greater job satisfaction?a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNsand NAs.b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in theinstitution.c. Hire additional staff so that there are more staff available for enhanced care and individualworkloads are lessened.d. Ask the director of nursing to increase job security for night staff by having them sign contractsthat guarantee work.ANS: BHygiene factors such as salary, working conditions, and security are consistent with Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such asrecognition and satisfaction with work promote a satisfying and enriched work environment.

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Transformational leaders use motivator factors liberally to inspire work performance and increase jobsatisfaction.REF: Page 9 | Page 10TOP: AONE competency: Communication and Relationship-Building7. As the nurse manager who wants to increase motivation by providing motivating factors, whichaction would you select?a. Collaborate with the human resource/personnel department to develop on-site daycare services.b. Provide a hierarchical organizational structure.c. Implement a model of shared governance.d. Promote the development of a flexible benefits package.ANS: CComplexity theory suggests that systems interact and adapt and that decision making occursthroughout systems, as opposed to being held in a hierarchy. In complexity theory, every voicecounts, and therefore all levels of staff would be involved in decision making. This principle is thefoundation of shared governance.REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member whobegins to complain loudly about the quality of care his mother is receiving. His behavior is sodisruptive that it is overheard by staff, physicians, and other visitors. The family member rejects anyattempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse isleft feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills inan emotionally intelligent practitioner?a. Reflect to gain insight into how the situation could be handled differently in the future.b. Try to catch up with the angry family member to resolve the concern.c. Discuss the concern with the patient after the family member has left.d. Notify nursing administration of the situation.ANS: AGoleman suggests that emotional intelligence involves insight and being able to step outside of thesituation to envision the context of what is happening as well as being able to manage emotions suchas frustration effectively.REF: Page 7 | Page 8 TOP: AONE competency: Leadership

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9. The chief nursing officer has asked the staff development coordinator to facilitate the developmentof a clinical competency program for the facility. While making rounds on the units, the staffdevelopment coordinator overhears RN staff complaining that they feel it is insulting to be requiredto participate in a competency program. Which behavior by the staff development coordinator ismost appropriate in this situation?a. Disregard staff concerns and continue with development of the program.b. Inform the nurses that this program is a requirement for JCAHO accreditation.c. Schedule a meeting with the chief nurse executive to apprise her of the situation.d. Facilitate a meeting so nurses can articulate their values and concerns about a competencyprogram.ANS: DThe manager role involves guiding others through a set of derived practices that are evidence-basedand known to satisfy preestablished outcomes such as participation in a competency program. Thisinvolves engagement of staff through sharing of concerns and ideas. A close analysis of the IOMreport and the summary of the PPACA suggests that no health reform can unfold without activenursing engagement. Each document emphasizes that nurses must lead, manage, and behave as activecollaborators with other members of the health team and with those being served.REF: Page 3 TOP: AONE competency: Communication and Relationship-Building10. As the manager, you have been asked to implement an evidence-based approach to teach ostomypatients self-management skills postoperatively that is being operationalized throughout yourorganization. Which of the following illustrates effective leadership?a. The training modules are left in the staff room for times when staff are available.b. The current approach is continued because it is also evidence-based and is more familiar to staff.c. You decide to implement the approach at a later date because of feedback from the RNs that thenew approach takes too much time.d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring andteaching others how to implement it.ANS: DFollowership occurs when there is acquiescence to a peer who is leading in a setting where a teamhas gathered to ensure the best clinical decision making and actions are taken to achieve clinical ororganizational outcomes. Followership promotes good clinical decisions and use of clinicalresources.

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REF: Page 4 | Page 5TOP: AONE competency: Communication and Relationship-Building11. You overhear a newly graduated RN telling one of your colleagues that leadership andmanagement belong to the unit manager and not to her. As a nursing colleague, you respond bydemonstrating understanding that the perception of the new graduate:a. Is correct. Leadership is not the role of the staff nurse.b. Would benefit from further understanding of her role as a professional, whose influence may affectthe decision making of patients, colleagues, and other professionals.c. Has been influenced by nurse leaders and managers who leave for other positions.d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.ANS: BCare coordination that involves the intersection of individual, family, and community-based needsrequires that nurses have self-confidence, knowledge of organizations and health systems, and aninner desire to lead and manage. There is often a view that leadership is isolated to those holdingmanagerial positions and that a direct care nurse is subject to following by adhering to the directionof others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead,manage, and follow when practicing at the point-of-care and beyond.REF: Page 3 | Page 4 TOP: AONE competency: Leadership12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviouslyvery upset and after you speak with him regarding his behavior, you determine that he has not sleptfor three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and callshim an“ugly, old man.” You acknowledge her feelings and concerns and then suggest that Mr.Smith’s behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones,“Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches tocontrolling his pain?” This approach demonstrates:a. Lack of empathy and understanding for Miss Jones.b. Concern with placating Mr. Smith.c. Leadership behavior.d. Management behavior.ANS: CThe situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient

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symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance anddecision making in a complex situation where there is no standardized solution reflects leadership.REF: Page 4 TOP: AONE competency: Leadership13. After assessing an older adult patient in long-term care who has been slowly deteriorating forweeks, the nurse manager calls the family and asks them to come in, as the patient is dying. Thenursemanager’s decision and actions are based on:a. An established clinical pathway.b. Confirmatory scientific evidence.c. Unit protocol.d. Experience.ANS: DThe nurse manager is employing knowledge and experience in determining that the patient is dying,because the course of dying is not standardized and cannot be determined by clinical pathways.REF: Page 4 TOP: AONE competency: Knowledge of the Health Care Environment14. Chart audits have revealed significant omissions of data that could have legal and fundingguidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and tofind approaches that will address the gaps in charting and achieve desired goals. This is an exampleof:a. Leadership.b. Management.c. Decision making.d. Vision.ANS: BThe process of guiding others to meet established goals, outcomes, and procedures is management.This can require collaborative decision making to determine how best to reach pre-determined goalsand follow established practices.REF: Page 5 TOP: AONE competency: Knowledge of the Health Care Environment15. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, notyet able to come, call the unit continuously, asking for updates and wanting to express concern. Youspeak with the distant family members and suggest that you are going to refer them to the hospital

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social worker, whose role is to work with people in such situations. What role are you assumingthrough this action?a. Managerb. Leaderc. Followerd. Laissez-faireANS: AAs a manager, you are concerned with managing and coordinating resources to achieve outcomes inaccordance with established clinical processes. Referral to a social worker alleviates demand on stafftime and is consistent with hospital procedures.REF: Page 5 TOP: AONE competency: Communication and Relationship-Building16. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, notyet able to come, call the unit continuously, asking for updates and wanting to express concern. Youspeak with the distant family members and suggest that you are going to refer them to the hospitalsocial worker, whose role is to work with people in such situations. In response to this situation, youapproach the unit manager to apprise her of your concerns that the family dynamics of the patientinvolved may lead to staff-family and patient-family conflicts. You suggest that the physician mayneed to discuss the treatment plan with the family. The unit manager advises that he will arrange thisdiscussion. If, after the meeting with family members, this is identified as a desired approach, yousupport the manager’s decision. Your actions indicate that you are acting in what role?a. Leadershipb. Managementc. Followerd. Evidence-basedANS: CIn the followership role, you bring to the manager your concerns about potential litigation andmaximization of outcomes and accept the direction given by the manager in response to yourconcerns.REF: Page 3 | Page 4TOP: AONE competency: Knowledge of the Health Care Environment

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17. You pull staff together to assess a situation in which the family of a seriously ill patient isanxious and is absorbing a great deal of staff time in consultation, discussion, and questioning oftreatment decisions. Staff members are becoming distanced from the family. After inviting theconcerns of staff, you explain that the organization values patient-centered care and that evidencesupports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas asto strategies that are effectively patient-centered in these situations. In this situation, you are takingon which role?a. Leadershipb. Managementc. Followerd. VisionaryANS: AAs a leader, you provide and communicate vision and direction based on evidence and experience,and you engage others in decision making that moves them toward the vision with a reasonable levelof risk taking.REF: Page 4 | Page 5 TOP: AONE competency: Leadership18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomashas many ideas, and his manner of presenting them irks Joan. After reflection and discussion withothers, Joan recognizes that she also feels threatened by his behavior. She comes to understand thatThomas is trying to establish his own role on the unit, is not trying to challenge her, and needsguidance, coaching, and affirmation. Joan is demonstrating:a. A positive self-concept.b. Deepening self-awareness.c. Leadership.d. Acquiescence.ANS: BAccording to Goleman (1995), stepping outside oneself to envision the situation while assumingownership is a component of emotional intelligence.REF: Page 7 | Page 8 TOP: AONE competency: Professionalism19. As the head of a nursing program, you consistently invite the ideas of your team aboutinnovations in teaching, community partnerships, and curriculum design and invite participation in

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decisions. Many of these ideas have been implemented successfully, and your staff members arekeen to try on other ideas. You are employing _____ leadership.a. Situationalb. Trait-basedc. Contingency-basedd. TransformationalANS: DTransformational leadership involves attending to the needs and motives of followers, which resultsin creativity, improvement, and employee development.REF: Page 10 | Page 11 TOP: AONE competency: Professionalism20. As a leader on a rehab unit, you encourage all staff members to see themselves as having a role indecision making and quality care. You see your role as involving particular responsibilities indecision making but not as a hierarchal role. This view of decision making and leadership isconsistent with:a. Trait theories.b. Complexity theory.c. Situated theory.d. Emotional intelligence.ANS: BComplexity theory involves envisioning each member of the team involved in decision making,management, and leadership, with the leader not seen in a hierarchal relationship to other teammembers.REF: Pages 8-11 TOP: AONE competency: Leadership21. You recently acquired a position as a unit manager. During your time on the unit, you haveformed a strong social network among your staff, have promoted the development of relationshipsbetween your staff and workers in other areas of the organization, and have formed relationships thatgenerate ideas from patient organizations and the local nursing education program. According tocomplexity theory, you are engaging which principle?a. Empowermentb. Systematic thinkingc. Development of networks

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d. Bottom-up interactionsANS: CAccording to complexity theory, social networks evolve around areas of common interest and areable to respond to problems in creative and novel ways.REF: Page 12 TOP: AONE competency: Knowledge of the Health Care Environment22. According to the complexity theory, which of the following should be the focus of measurement?a. Cost per hospital dayb. Bed utilizationc. Infection ratesd. Staff morale and budgetsANS: DAccording to complexity theory and the principle “Think systematically,” you cannot ignoreobjective data or nonmeasurable data, as both inform decisions.REF: Page 13 TOP: AONE competency: Business Skills23. During a staff meeting held to discuss developing a mission statement for the unit, the idea ofplacing patient needs first is:a. Empowering.b. A leadership tag.c. A symbol.d. A management task.ANS: BAccording to complexity theory, leadership tags, which are similar to values, reflect the patient-centered philosophies and values-driven characteristics that define an organization and give itpersonality.REF: Page 12 TOP: AONE competency: Knowledge of the Health Care Environment24. A dispute arises between an RN staff member and an LPN over a patient issue. The tensionbetween the two begins to affect other staff members, who are drawn into the conflict; eventually, theteam becomes polarized toward either the RN or the LPN. This situation might have been preventedthrough:a. Expediency in responding to the initial dispute, once it became apparent that it could not be

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resolved by the two parties themselves.b. Asking other staff members what the real issues were in the dispute between the RN and the LPN.c. Reassigning one of the parties to another unit when it became apparent that the two individualscould not resolve the dispute themselves.d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discussthe initial dispute.ANS: AThe initial step in conflict resolution should have involved an expedient response to the issues andputting a focus on the issues involved in the dispute between the LPN and RN through negotiationinvolving the two parties, before the dispute involved others.REF: Page 16 TOP: AONE competency: Communication and Relationship-Building25. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staffmembers are angry and ask for a meeting to discuss the change. After hearing their concerns relatedto reduction in professional autonomy and care quality, you:a. Acknowledge the loss.b. Explain the reasons for change, emphasizing the need to reduce costs.c. Repeat the information several times, giving detailed budget overviews.d. Adjourn the meeting and provide explanation through e-mail.ANS: AVisioning involves engaging with others to assess the current reality, specify the end point, and thenstrategize to reduce differences. This requires trusting relationships that acknowledge the differencesin values and ideas. When done well, the nurse and the nurses within a unit experience creativetension that inspires working in concert to achieve desired goals.REF: Page 15 TOP: AONE competency: Communication and Relationship-BuildingMULTIPLE RESPONSE1. Sarah wonders about the direction that you have given regarding management of incontinent,confused patients. She brings you evidence that she has found regarding incontinence interventionsand asks you if she and you could talk about the guidance that you have given after you have had anopportunity to read the articles she has given you. This is an example of (select all that apply):a. Assertiveness.b. Followership.

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c. Management.d. Insubordination.ANS: A, BThis is an example of followership in which a staff nurse is demonstrating assertive behavior andpresenting evidence that may influence the decision making of her nurse leader and manager.REF: Page 5 TOP: AONE competency: Knowledge of the Health Care EnvironmentChapter 02: Safe Care: The Core of Leadingand ManagingChapter 02: Safe Care: The Core of Leading and ManagingYoder-Wise: Leading and Managing in Nursing, 6th EditionMULTIPLE CHOICE1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospitalreduced the number of its managers and increased the number of units for which each manager wasresponsible. Within a year, the number of adverse events on the units had doubled. This may beattributable to:a. The overload of staff nurses.b. Resistance to change by staff.c. A change in reporting systems.d. Fewer clinical leaders to remove barriers to care.ANS: DEliminating barriers to the implementation of best practices is the role of managers and leaders.When there are insufficient resources for leadership to encourage a culture in which evidence-basedpractice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.REF: Page 24 TOP: AONE competency: Knowledge of the Health Care Environment2. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of thefollowing interventions might assist to reduce the number of falls on the unit?a. Determining who is responsible for the fallsb. Strengthening unit policies to avoid inappropriate admissionsc. Encouraging involvement of nurses in education related to falls and safety

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d. Ensuring that patients are appropriately restrained if they are at risk for fallsANS: CThe IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidenceand best practices to inform practice and ensure safety.REF: Page 27 | Page 32 TOP: AONE competency: Professionalism3. To increase safety in patient care areas of the Valley Hospital, the executive begins by:a. Asking the community what the safety issues are.b. Consulting with a management expert about staffing schedules.c. Ensuring that the senior nursing officer attends the board meetings.d. Instituting improved practices to reduce needle-stick injuries.ANS: CThe IOM report (2004) highlighted the importance of the attendance of the senior nurse executive atboard meetings to be a key spokesperson on safety and quality issues.REF: Page 25 | Page 26TOP: AONE competency: Knowledge of the Health Care Environment4. During review of back injuries, it is determined that a large number of injuries are occurring inspite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. Inaddressing this concern, the unit manager:a. Meets individually with nurses who are observed to be using the lifts incorrectly to review thecorrect procedure.b. After consultation with the staff about the review, orders new lifts to replace older ones that aremalfunctioning.c. Blames the system for inadequate funding for resources.d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.ANS: AThe IOM report (2004) points to the need to involve nurses in decisions that affect them and theprovision of care.REF: Page 25 | Page 26TOP: AONE competency: Communication and Relationship-Building

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5. The IOM Health Professions Education report highlighted patient safety concerns as:a. A normal risk in professional practice.b. A result of disciplinary silos.c. A reflection of frontline staff.d. Related to systems errors.ANS: BThe IOM Health Professions Education report (2004) highlighted the education of health disciplinesin silos as a major concern in patient safety and endorsed five recommendations.REF: Pages 25-27 TOP: AONE competency: Knowledge of the Health Care Environment6. If you are supporting the steps in the AHRQ document “Five Steps to Safer Health Care,” youwould ensure that:a. Patients are actively encouraged to make decisions related to care.b. Rules and decisions are made through centralized processes.c. You monitor the performance of each staff member closely.d. Preference is given to increasing staff numbers rather than staff credentials.ANS: AThe Agency for Healthcare Research and Quality (AHRQ) outlines “Five Steps to Safer HealthCare,” which suggests that safe, patient-centered care is facilitated by assisting patients to becomeactive partners in their own care.REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment7. After consulting with practice environments about quality and safety concerns in health care, theDean of Health Programs at U.S. University develops:a. A nursing program that emphasizes the development of a strong disciplinary identity.b. Programming that stresses discipline-based research.c. Partnerships with health care to develop software for the reporting of adverse events.d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizescollaborative learning teams.ANS: DHealth Professions Education identified that education related to health disciplines in silos leads tocompromised communication and inability to function as an integrated whole for patient-centeredcare.

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REF: Pages 25-27 TOP: AONE competency: Knowledge of the Health Care Environment8. In designing a quality, safe healthcare environment, the primary emphasis needs to be on:a. Evidence-based practice.b. Informatics.c. Staffing.d. The patient.ANS: DFocusing on the patient moves care from concern about who controls care to a focus on what care isprovided to and with patients, which was an aim identified in the IOM report Crossing the QualityChasm.REF: Page 25 | Page 26TOP: AONE competency: Knowledge of the Health Care Environment9. As a patient care advocate, you regularly coach patients on how to stay safe in health care byeducating them about:a. The need to understand and record all medications being taken.b. Bringing their own linens and other personal items to the hospital.c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.d. Following closely the directions and orders of healthcare providers.ANS: AThe Five Steps to Safer Health Care for patients include keeping a list of medications that patientsare taking.REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety andreducing morbidity and mortality on your unit. Which of the following recommendations would beconsistent with the IOM The Future of Nursing report?a. Careful screening of nursing staff for substance use and abuseb. Increased RN staffing on the unitc. Salary and benefits that reflect nursing accountabilitiesd. Increase in the percentage of baccalaureate-prepared nurses to 80%ANS: DThe Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-

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prepared level. This recommendation reflects research that suggests that improved mortality andmorbidity rates occur with a better educated workforce.REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment11. On the West Surgery unit, you want to institute a new system for checking armbands thatevidence suggests may increase safety in medication administration. The system involvestechnology. Which of the following strategies may assist with rapid adoption of the technology andsystem?a. Employ a centralized decision-making approach.b. Use simulators for initial practice to build confidence.c. Bring in a nurse consultant who is familiar with the technology.d. Use early adopters among the staff as leaders and role models in implementation.ANS: DThe Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient carethrough a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovationand changes quickly through early adopters who share information and energy over time and act asrole models for others.REF: Page 26 | Page 29TOP: AONE competency: Knowledge of the Health Care Environment12. To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of thefollowing in your health facility?a. Evidence-based practice to reduce the prevalence of pressure soresb. Implementation of informatics at the bedsidec. Staff-manager conferences to review reporting of adverse medical eventsd. Patient councils to review food, recreation, and nurse-patient relationsANS: AThe National Quality Forum (NQF) outlines nursing-centered intervention measures related toprevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing carehours per day, and skill mix of staff.REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment

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13. You notice that Sally, a student on your unit, is giving information to an anxious young teen whoseems very uncertain about preparation for an upper GI series. After Sally leaves the room, you askher how she thought her conversation with the patient went and:a. Encourage her to ask the patient if he has questions or concerns about the procedure.b. Advise her to consider providing the patient with more information.c. Suggest that she leave some brochures on the procedure with the patient.d. Suggest that she also provide teaching to the adolescent’s parents.ANS: AThe Five Steps to Safer Health Care for Patients includes the step of asking questions if there aredoubts or concerns. The nurse can encourage patients to take a larger role in care by taking thesesteps and by providing patients with coaching in the steps.REF: Page 27 TOP: AONE competency: Communication and Relationship-Building14. The NQF provides a model for advancement of healthcare quality that could be used inhealthcare organizations. The use of this model by the Centers for Medicare & Medicaid Servicesspecifically affects the interaction between adverse events and:a. Staffing.b. Funding.c. Composition of executive councils.d. Composition of consumer-based councils.ANS: BThe Centers for Medicare & Medicaid Services (CMS) have adopted a policy based on the NQF’s“never events.” The CMS will no longer pay for patient conditions or events that result from poorpractice while patients are under the care of a health professional.REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment15. In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends itssafety practices and policies to emphasize:a. Safety goals specific to Pleasant Valley.b. Decision-making processes.c. Sufficient staffing for safe care.d. Increased numbers of baccalaureate-prepared RNs.ANS: A

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When the TJC, a not-for-profit organization that accredits healthcare organizations, changed its focusfrom processes to outcomes, it emphasized patient safety and issues setting-specific annual patientsafety goals.REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment16. Which of the following would managers and staff review annually in order to ensure compliancewith the Joint Commission (TJC) to improve patient safety?a. Appropriateness of charting terms and abbreviationsb. Nursing hours per patientc. Acuity of patient admissionsd. Wait times for careANS: AThe Joint Commission issues setting-specific patient goals annually, as well as a list of “do-not-use”terms, abbreviations, and symbols and sentinel events.REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment17. In preparation for redesignation as a MagnetTM Hospital, how would you prepare?a. Commit staff resources over a 6-month period to updating procedure manuals.b. Educate staff through meetings and training sessions regarding appropriate answers to questions.c. Prepare a manual that outlines orientation procedures and ensure that all safety issues areaddressed.d. Ensure that there are empirical data to support review of patient outcomes, actions taken, andresults of actions.ANS: DThrough the MagnetTM model, organizations must demonstrate how they provide excellence in fiveareas. Between designation and redesignation as a MagnetTM organization, greater emphasis isplaced on empirical quality results.REF: Page 29 TOP: AONE competency: Knowledge of the Health Care Environment18. Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patientthat she “always” checks patients’ bracelets before giving medication and she is not sure how thenurses on the unit “get away with” not making more errors than they do. The clinical instructor pullsSarah aside and explores with her how her communication might affect the patient and what it

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reflects about her beliefs related to the team. The actions of the clinical instructor reflectcompetencies outlined by:a. QSEN.b. IHI.c. DNV/NIAHO.d. AHRQ.ANS: AThe Quality and Safety Education for Nurses (QSEN) project provides resources related tocompetencies that prelicensure and graduate students need to develop to serve as safe practitioners.These competencies include leading and managing, teamwork and collaboration.REF: Page 29 TOP: AONE competency: Knowledge of the Health Care Environment19. The SBAR approach to patient safety encourages:a. Consistency in assessment and practices.b. Continuing education.c. Multidisciplinary approaches.d. Patient feedback.ANS: AThe use of SBAR (Situation, Background, Assessment, and Recommendation) checklists aredesigned to decrease omission of important information and practices.REF: Page 30 TOP: AONE competency: Knowledge of the Health Care Environment20. As a manager in a new nursing home, where might you consult for guidance and evidence tosupport the development of safe patient practices?a. Hospitalsb. Businessc. Industryd. Outpatient clinicsANS: APractices that were once mostly studied in hospital settings are now scrutinized for implementation inother settings, such as outpatient clinics, rural settings, and nursing homes.REF: Page 30 TOP: AONE competency: Knowledge of the Health Care Environment

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21. As a manager, the development of your decision-making skills related to safe patient care isfacilitated by:a. Regular reflection on decisions.b. A culture of perfectionism.c. Recognition of who should be held responsible for individual errors.d. A culture of trust between the staff and you.ANS: AReflection on how well decisions were enacted enables knowledge of the complexity of situationsand ramifications of the decisions made. Reflection enables elimination of strategies and methodsthat are inappropriate in meeting needs and aids in narrowing choices of best actions to take.REF: Page 30 TOP: AONE competency: Leadership22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanderscontinuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unitmanager, you have initiated a least restraint practice. An appropriate action in this situation would be:a. Setting up a nursing team meeting to review practices.b. Calling the family to inform them of the practice.c. Initiating a multidisciplinary and family meeting to focus on Mary’s needs.d. Restraining Mary to satisfy the family’s wishes.ANS: CCrossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparentdiscussions about quality needs and takes a team approach that involves healthcare professionals, thefamily, Mary’s needs, and evidence associated with safe practice.REF: Pages 24-26 TOP: AONE competency: Knowledge of the Health Care Environment23. A client requires an appendectomy. The surgeon explains the procedure and asks the client tosign the consent. The patient speaks very little English and looks worried. As a nurse, you would:a. Suggest that an interpreter explain the procedure to the client and answer any questions.b. Ask the client if he has any questions.c. Draw a picture to show the incision.d. Not intervene.ANS: A

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The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when thereare doubts and concerns and ensuring understanding before surgery is performed are ways in whichnurses can support patients in having greater influence in their own care. In this situation, asking aninterpreter to help enables access to information for the patient and active assessment of hisunderstanding.REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment24. As the manager on an acute care medical unit, you note that the incidence of medication errorshas increased since the implementation of staffing changes. As part of your strategy to reduce errors,it is important toa. Re-visit reporting standards for medication errors in your organization.b. Ensure that medication errors are consistently reported.c. Provide staff with additional education related to safe practice in medication administration.d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety ofmedication administration.ANS: DKeeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many pastpractices that had a negative impact on nurses, and thus on patients, and recommended the inclusionof nurses in direct care in decision making involving their practice. Future of Nursing: LeadingChange, Advancing Health (2010) also emphasizes the role of nurses as leaders in changes thatimprove health.REF: Page 25 | Page 27 TOP: AONE competency: ProfessionalismMULTIPLE RESPONSE1. Which of the following patients would be at greatest risk in a healthcare visit (select all thatapply)?a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include anherbal supplement.b. George is very shy and withdrawn. He asks the nurse to leave him alone.c. Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager toaccept all suggestions, including those that she does not yet understand.d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tellshis wife that he reallydoesn’t know what the doctor meant by colostomy.

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ANS: A, C, DSafer health care involves the patient as an active consumer who keeps and brings a list of allmedications, including natural remedies, and questions if there are doubts, concerns, or lack ofunderstanding.REF: Page 25 | Page 27TOP: AONE competency: Knowledge of the Health Care EnvironmentChapter 03: Developing the Role of LeaderChapter 03: Developing the Role of LeaderYoder-Wise: Leading and Managing in Nursing, 6th EditionMULTIPLE CHOICE1. As the clinical director of 24 employees, you have been asked to explain to staff members whythey are not getting a raise this year, even though they have been working short-handed for manymonths and patient satisfaction scores have never been higher. Because you believe yourself to be atransformational leader, you will approach this problem by:a. Telling the assistant clinical director and asking her to share the bad news with the other staffmembers.b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, soanyone who has complaints may express them.c. Showing staff members the budget and asking for input about how to cut costs so that raises willbe possible in the future.d. Meeting with a small group of seasoned staff members and asking them how to break the news.ANS: CTransformational leadership involves engaging those being led and inspiring shared vision in movingtoward a goal that all will accept as desirable. This involves enabling and empowering others tobelieve that their input and effort will make a difference in solving problems.REF: Page 38 | Page 39 | Page 48TOP: AONE competency: Communication and Relationship-Building2. After a newly hired director of nursing has reviewed the hospital’s strategic plans, she develops atimeline for achieving those plans. The new leader is:a. Not expecting that novice leaders will have a vision.

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b. Demonstrating mistrust of the abilities of her staff to implement the plans.c. Instituting deadlines against which the performance of staff will be evaluated.d. Translating a global document into realistic plans for nursing.ANS: DFollowers need three things from leaders: direction, trust, and hope. Developing timelines for thestrategic plan involves translating a vision into reality and being able to communicate a visionmeaningfully, which is an example of a leader’s influencing behavior.REF: Page 35 | Page 36TOP: AONE competency: Communication and Relationship-Building3. A nurse executive is hiredto restore a unit’s productivity, which has decreased as the result of lowstaff morale. The nurse executive utilizes which of the following leadership principles?a. The leader declares the intent and goals to enhance productivity and assumes that the unit alsowishes to increase productivity, which allows nurses to feel in control of the environment.b. If staff members increase productivity, then they are given opportunity to engage in learningevents such as workshops and conferences. If the staff members are not satisfied, they will insist on adifferent leader, who will get them what they want.c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as thesolution to the nursing shortage.d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, andthese are things the leader can control.ANS: AStephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. SmartTrust Actions include declarationof the leader’s intent and assumption by the leader that others alsohave positive intentions. Building trust involves signaling goals and intended actions in advance.Actions such as promising external rewards such as additional learning opportunities, workloadrelief, and compensation are consistent with transactional leadership, which leads to low to stablecommitment and limited satisfaction.REF: Page 38 | Page 42TOP: AONE competency: Communication and Relationship-Building4. The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Basedon her observations, which of the following staff members is an obvious leader?

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a. The unit secretary who knows everyone’s businessb. The chief nursing officer who is in charge and is responsible for nursing servicesc. The chief cardiologist who admits the largest number of patients and brings in more revenue thanany other physiciand. The staff nurse who persuades other staff members to practice by making evidence-baseddecisionsANS: DLeaders are those who do the best job of sharing their vision of where the followers want to be andhow to get there. It is the ability to inspire others to bring a vision (such as evidence-based decisionmaking) to reality and is not necessarily tied to status or information flow.REF: Page 35 | Page 40TOP: AONE competency: Communication and Relationship-Building5. After being interviewed for the unit manager position, the staff nurse reflects on the interviewprocess. The staff nurse is aware that leadership begins:a. Within.b. Through a relationship with a mentor.c. With the job description.d. With the chief nursing officer of the organization.ANS: APeople notice differences in workplaces and tend to choose those that evidence a high degree of trustbetween leaders and followers. Stephen M.R. Covey suggests that trust begins with self and thatleaders must focus first on developing character and confidence, which is their credibility. Credibilityenables leaders to trust themselves and gives others someone or something that they can trust.REF: Page 40 TOP: AONE competency: Leadership6. The nurse manager in the Emergency Department needs to implement new staffing patterns. As atransformational leader, the nurse manager should:a. Explain in detail how well the new idea will work.b. Reinforce how this change will respond to the ideas and solutions generated by staff members.c. Reason with staff members that the new idea will save money and allow more free time.d. Imply that raises will be smaller than anticipated if the new idea is not accepted.ANS: B

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Transformational leadership inspires and motivates others through influence and persuasion ratherthan through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leaderlistens to the views of others (such as those of the staff members), empowers others to lead (such asin generating solutions for staffing problems), finds ways to remove barriers, and serves as anadvocate for those who care for patients.REF: Page 38 | Page 39 TOP: AONE competency: Leadership7. To retain supervisory staff members, the director of nursing develops a mentoring program. Thebest person to be a mentor for a new supervisor in a leadership position is someone who has:a. Been in exactlythe same position and can relate to the new supervisor’s problems.b. Had vast leadership opportunities and likes to talk about his or her past experiences.c. Leadership experience and time to spend communicating with the new supervisor about his or herexperiences.d. People who can help the new supervisor get what he or she needs to make the organization growquickly and prosper in the process.ANS: CMentors need to have experience and some success in the leadership area of interest, as well asinterest in the future development of the novice. The mentor can be geographically distant or closeand able to provide advice and feedback.REF: Page 40 | Page 41 TOP: AONE competency: Leadership8. Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcareagencies. Marketing brochures should address the leadership and vision of the healthcare agency.Which of the following workplace environments will attract applicants in the emerging workforce?a. A highly professional environmentb. A nurturing and receptive environmentc. An environment highlighted by lots of meetings, so staff members can have lots of inputd. A totally online environment, so staff members will not have to interface with uncaring colleaguesANS: BA study of student nurses who represent this age group indicates that they want a leader who isreceptive, approachable, a team player, and motivating.REF: Page 43 TOP: AONE competency: Communication and Relationship-Building

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9. A nurse executive who considers herself a Baby Boomer will have the challenge of convincing theemerging workforce of the necessity of committee meetings. One of the primary reasons that theBaby Boom generation appears to have so many meetings in the work environment is that:a. They feel more comfortable in a group.b. They find that the journey to the solution is as important as the solution itself.c. They were deprived of collective action opportunities in the past and now feel that solutions arebetter when many people have input.d. Baby Boomers are aging and need the respite from work that meetings offer, so they canrecuperate from the physical demands of the work environment.ANS: BBaby Boomers mistrust authority and trust in collective action, based on successes with socialmovements in their formative years.REF: Page 43 TOP: AONE competency: Leadership10. The hospital administration is discussing the possibility of closing hospital beds in your unitbecause of a nursing shortage and the increased amount of overtime required to care for patients. Asthe leader on the unit, which of the following examples best demonstrates your transformationalleadership style?a. Your entire staff walks out on strike.b. Your staff sends an ultimatum to the clinic director demanding higher pay.c. A group of your staff members goes to the administration to propose closing of a different unit.d. A group of your staff members goes to the administration to request that they be allowed to workthe overtime hours.ANS: CCommitment to the vision that has been created is seen in the ability of the leader to influence,motivate, and persuade others. The transformational leader can motivate employees byencouragement of novel, innovative thinking. Drenkard (2013) describes true transformationalleadership as occurring when the leader “created an environment that brought leaders and followerstogether to solve problems, create new ways of doing work, and manage change together” (p. 57).REF: Page 38 | Page 39 TOP: AONE competency: Leadership11. John is interested in leadership positions within his nursing organization. Al-though he has beenon the same unit for 10 years, he has attended two workshops during that time and has steadfastly

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refused opportunities to engage in leadership development opportunities or other learning offered aspart of the hospital’s succession planning strategy. He says that he is interested in a leadership roleprimarily because it will give him a more stable work schedule and will enable him to spend moretime with his family. In coaching John, it would be important to:a. Affirm that his years of service and stability on the unit are the most important attributes forassumption of a leadership role.b. Reinforce that his concern with maintaining balance outside work would be a key factor inselecting him for a leadership position.c. Encourage him to consider the financial rewards of the position, as well as the positive effect onhis work schedule.d. Encourage him to seek out new experiences and learning that will complement his existingstrengths derived from experience and his interest in life-work balance.ANS: DAccording to Covey, effective leaders continually engage in learning and self-renewal, as well as inmaintaining a balanced life, radiating positive energy, believing in other people, being concernedwith the common good, and being synergistic.REF: Page 36 | Page 49 TOP: AONE competency: Professionalism12. Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. Shehas been active in learning about leadership through workshops and Internet research and recentlybegan a graduate degree program with a focus on nursing administration. She has excellent clinicalskills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimesaggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you:a. Suggest that she reflect on situations in which she has had a positive influence and consider howher interactions contributed to the situation.b. Suggest that she not consider leadership roles because her interaction skills are more suited to rolesin which she has limited opportunities to work with others.c. Ask staff members on the unit with whom she works to provide her feedback about ways in whichher behavior irritates or turns them away.d. Encourage her to continue her graduate courses, as information about strategies and technicalaspects of the role will compensate for negative interactions.ANS: ALeadership involves radiating positive energy and the ability to inspire and motivate others.

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Management can be taught through formal instruction, but leadership is attained through reflectionon rich personal experience.REF: Page 36 TOP: AONE competency: Leadership13. The Sunny Long-Term Care Facility has experienced numerous difficulties with staffrelationships, despite its success in maintaining financial viability and judicious use of resources.Staff members complain that the primary concerns of the facility include applying policy, savingmoney, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staffmembers. This facility may be:a. Well managed and well led.b. Overly managed and not well led.c. Poorly managed and well led.d. Overly led and overly managed.ANS: BThis organization is concerned primarily with coordination of resources, application of currentpolicy, and economic issues connected to the present. These behaviors are consistent with themanagement role. There is little evidence that the organization displays leadership, which involvestrust, belief, hope, and vision.REF: Page 36 | Page 37 TOP: AONE competency: Leadership14. While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that:a. Most nurses are not expected to assume leadership roles.b. The role of nurse leadership is only at the bedside, ensuring that patient care is performedaccording to established standards.c. Only individuals in formal leadership roles are expected to be leaders.d. The public depends on nurses to assume leadership in moving consumer advocacy concernsforward.ANS: DThe complexity of nursing and the healthcare environment demands that all nurses assume roles ofmanager, leader, and follower, depending on the situation. Nurses are involved in providingleadership in direct patient care, in leading others at a unit or organizational level, in moving the

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profession forward, and in participating in legislative and policy arenas. Consumers depend onnursing leadership to carry the healthcare agenda forward.REF: Pages 35-37 | Page 45 | Page 46TOP: AONE competency: Knowledge of the Health Care Environment15. Which of the following nurses is MOST likely to inspire others to do their best?a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for thenext shift about what has been done incorrectly or omitted.b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families.He continually searches for new knowledge and skills, and his sense of humor and optimism areinfectious.c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and theirfamilies. She has not been to a conference in years because the unit is her entire life.d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairlyin assignments. She is also very conscientious about care and regularly checks up on what everyoneis doing to ensure that it is done correctly.ANS: BTo be inspired, people must have a positive leader who radiates energy, a zest for learning, and aninterest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic.Leaders, not managers, inspire others to work to their highest level.REF: Page 36 | Page 37 TOP: AONE competency: Leadership16. The new head nurse on G Unit has been the subject of a great deal of discussion and complainingduring breaks. She is a competent nurse of tremendous integrity with approximately 30 years’experience. Her predominant method of problem solving and communication is through meetings,which can go over the allotted time. The staff may:a. Be represented by a high number of Baby Boomers.b. Be presenting different generational values and attitudes than the head nurse.c. Be unresponsive to her transactional leadership style.d. Want a leader rather than a manager.ANS: BLeaders who come out of the Baby Boomer generation may be more comfortable with collectiveaction than followers who come out of the Emerging Workforce generation, who are more

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