MCQs Leadership & Management in Nursing

Nursing Management

Effective Leadership and Management in Nursing 7th Edition Sullivan & Decker NCLEX® Review Note: Some questions in this exercise may have more than one correct answer. To answer such questions correctly, you must select all the correct answers. Also, some questions will require you to type your answer in the space provided. CHAPTER: 1 Introducing Nursing Management 1) Integrated health care systems function in a variety of models. Which of the following is a common characteristic of all systems? a) Deliver selective care only b) Deliver a whole continuum of care c) Treat patients only in the hospital d) Provide care only in the primary care setting Reason: The deliverance of a whole continuum of care is a common characteristic of all systems. 2) Quality management and benchmarking are two approaches used to improve the quality of care. The major difference between these two approaches is which of the following? a) Quality management is not useful in b) Benchmarking compares outcomes the outpatient setting. in a variety of settings and disciplines. c) Quality management is used only in d) Benchmarking looks only at outcomes the primary care setting. specific to nursing. Reason: The major difference between quality management and benchmarking is that benchmarking compares outcomes in a variety of settings. 3) Cultural diversity presents an important challenge to nurse managers due to which of the following? a) A nursing shortage exists. b) Staff nurses are not trained to be culturally sensitive. c) 80% of nursing staff comes from d) The increase in cultural diversity is one or more minority groups. seen both in the patient population and the nursing staff. Reason: Cultural diversity presents an important challenge to nurse managers due to the increase in cultural diversity seen both in the patient population and the nursing staff. 4) One of the most important driving forces behind health care policy changes is which of the following? a) New technology b) Outsourcing of services c) Emerging role of nurse practitioners d) Ability to pay for health care

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Reason: One of the most important driving forces behind health care policy changes is the ability to pay for health care. 5) Which of the following is an important emerging challenge to changes in health care? a) Decrease in immigration b) Nursing staff shortages d) Increased surgical procedures c) Bioterrorism Reason: Bioterrorism is an emerging challenge to changes in health care. 6) Advanced technology in health care, such as integrated health records, has allowed the nurse to do which of the following? a) Skip the assessment step of the b) Order medications nursing process c) Take blood samples d) Track patients' vital signs Reason: Advanced technology in health care has allowed the nurse to track patients' vital signs. 7) A staff nurse attends a continuing education class on advanced technology in health care. The nurse manager should interpret this as which of the following? a) Only important for nurse managers b) Not important c) A waste of time d) Essential to nursing care Reason: Information technology will become increasingly integrated into systems of care. 8) The nurse manager is talking with the CNA about her time management. Which of the following is an example of a nurse manager as coach? b) "Your appearance is seldom a) "Your timely response to patients' professional." call lights is exemplary." c) "You must get the vital signs taken d) "You never report AM blood sugar on time or you will be disciplined." levels on time." Reason: Nurse managers must also be coaches, teachers, and facilitators. 9) Which of the following skills is essential for nurses in today's health care environment? a) Communication b) Supervision & Management c) Delegation d) All of above Reason: Management, supervision, delegation, and communication are all skills essential for nurses in today's health care environment. 10) In our culturally diverse society, barriers to health care result from: a) Prejudice. b) Different socioeconomic status. c) Differences in language. d) All of above. Reason: The main factors that constitute barriers to health care are differences in language, different socioeconomic status, and prejudice. Telehealth is using telecommunications technology to provide medical and nursing services from afar.

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CHAPTER: 2 Designing Organizations 1) Which of the following is the correct definition of "chain of command"? b) Relationship without authority. a) The hierarchy of authority and responsibility. c) Activity directed through linear d) The tendency for people to perform authority. as expected. Reason: Chain of command is the hierarchy of authority and responsibility. 2) The Hawthorne effect explains that the relationship between people and productivity is enhanced by which of the following? b) Organizations a) Special attention c) Creativity d) Groups Reason: The Hawthorne effect explains that the relationship between people and productivity is enhanced by special attention. 3) Which of the following theories best depicts current health care delivery systems? a) Open system theory b) Closed system theory c) Chaos theory d) Contingency theory Reason: The contingency theory best depicts the current health care delivery systems. Contingency theorists believe organizational performance can be enhanced by matching an organization's structure to its environment. Closed systems are self-contained and usually can be found only in the physical sciences. An open system, in contrast, interacts both internally and with its environment. 4) Which of the following is true regarding health care systems today? a) They are all managed care b) They are all privately owned. organizations. c) Only HMOs are profitable. d) There are multiple types of organizations. Reason: There are multiple types of health care delivery systems in today's world. 5) Health care systems primarily have functional structures. Which of the following would be an example of this? a) Open communication exists between b) Medicine has authority over nursing. Physical Therapy and Nursing. c) Laboratory services have little d) All nursing tasks fall under nursing authority. service. Reason: In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group.

Nursing Management

6) "Organizations are made up of intertwined links and diversified choices that generate unanticipated consequences." This defines which of the following theories? a) Contingency theory b) Closed system theory c) Open system theory d) Chaos system theory Reason: The chaos theory is characterized by organizations that are made up of intertwined links and diversified choices that generate unanticipated consequences. The contingency theory best depicts the current health care delivery systems. Contingency theorists believe organizational performance can be enhanced by matching an organization's structure to its environment. Closed systems are self-contained, and usually can be found only in the physical sciences. An open system, in contrast, interacts both internally and with its environment. 7) Of the following types of HMOs (Health Maintenance Organizations), which contracts with two or more IPAs (Independent Practice Associations)? a) Staff model b) Point of service model d) Group model c) Network model Reason: A network model of HMOs contracts two or more IPAs. A staff model is when physicians are HMO employees paid a salary. A group model is when the HMO contracts with a multi-specialty group to provide services for a negotiated fee. Point-of-service plans are not part of HMO systems. 8) Which of the following scenarios would be an example of shared governance on a nursing unit? a) Staff nurses delegate activities to b) Procedure manuals are written by a CNAs. committee of nurse managers. d) A unit manager seeks advice from c) Staff nurses and CNAs make their her supervisor. own schedules. Reason: Shared governance is based on the philosophy that nursing practice is best determined by nurses. 9) Which of the following are essential components of strategic planning? a) Values b) Vision & Mission statement c) Reengineering d) A & B Reason: Values and vision and mission statements are all part of strategic planning. 10) While interviewing for a position at City Hospital, the nurse asks about the organizational structure of the institution. She is told that hospital is organized into departments based on specialty (e.g., nursing, dietary, pharmacy, etc.). Based on what you know about organizational structure, select the structure in this example. a) Parallel b) Functional

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c) Service-integrated d) Matrix Reason: In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group, similar groups operating out of the same department, and similar departments reporting to the same manager. 11) Achieving Magnet Hospital designation offers hospitals the following advantages: (Select all that apply.) a) Greater client satisfaction. b) Improved nursing recruitment. c) Greater client workload. d) Nurses who are independent decision makers. Reason: Organizations that achieve magnet recognition demonstrate greater nursing retention and successful nursing recruitment. The empowered, independent problem solving nurses help to create greater client satisfaction and improved nursing care.

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CHAPTER: 3 Delivering Nursing Care 1) A nurse is considering employment at a long-term care facility that has a functional nursing delivery system. Knowing this, the nurse could expect that: a) Each RN would coordinate care for b) One RN would pass meds for all a group of clients. clients on a unit. c) Each RN would deliver total care to d) One RN, one LPN, and one an assigned group of clients. unlicensed assistive personnel would share responsibility for a group of clients. Reason: This is an example of one of the roles in functional nursing; care is provided by assigning roles or functions to appropriate personnel. 2) Which of the following would a nurse suggest are significant benefits to an organization that is considering adoption of a practice partnership model? (Select all that apply.) a) Clients express greater satisfaction. b) It is less expensive to implement than other models. d) Leadership is well accepted. c) Continuity of care is facilitated. Reason: Evidence has shown that practice partnerships are the most cost effective of the nursing care delivery systems. Continuity of care is enhanced when all members of the health care team work together to plan and implement care. 3) Which of the following clients would most likely be selected for case management? a) An adolescent with a gunshot wound b) A young adult with a fractured who is in the ER. pelvis. d) A 41-year-old client admitted for c) An elderly client awaiting a hip outpatient tonsillectomy. replacement Reason: This is a common surgical problem that is high volume for most hospitals so it would be appropriate for case management. 4) Which of the following conditions would be well suited to use of a nursing critical pathway? a) Foreign object in ear b) Fever of unknown origin d) Bacterial infection acquired in a c) Hip replacement surgery foreign country Reason: A critical pathway tracks the client's progress through assessment, interventions, treatments, and outcomes for conditions across a time line. Hip

Nursing Management

replacement surgery would have a specified time line, with specific interventions and treatments to get the client back to optimal functioning.

5) The nurse is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select all that apply.) b) Assigned staff nurse a) Expected length of stay c) Patient outcomes d) Medical diagnosis Reason: Critical pathways are developed when there are usual expected outcomes for client's with a particular medical diagnosis. A critical pathway is developed with an expected length of stay that is appropriate for the medical diagnosis and treatment plan. A critical pathway can be developed for any medical diagnosis that has a usual set of outcomes and length of stay. 6) A staff nurse is working with a patient who is on a critical pathway for education in preparation for home care. Which one of the following responsibilities would the nurse address first? a) Taking vital signs b) Answering the client's questions c) Evaluating client teaching d) Reviewing the information with the client and family Reason: Assessment is the first phase of the nursing process and history is part of client assessment that precedes all others. The nurse should review pertinent information with the client and family and establish goals for care. 7) What are the key elements essential to implementation of case management? (Select all that apply.) a) Collaborative practice teams b) Established critical pathways c) Quality management system d) All of above Reason: Established critical pathways, collaborative practice teams, qualified nurse case managers, and quality management systems are the key elements of case management. 8) The staff nurse is caring for the client with total accountability and is in continual communication with the client, the family, the physicians, and other members of the health care team. This type of nursing delivery system is known as: b) Qualified nurse case managers a) Total patient care c) Established critical pathways d) Quality management system Reason: Total patient care is the original model of nursing care delivery, in which one RN is responsible for all aspects of one or more patients' care. 9) A high-volume maternity unit uses differentiated practice as its staffing model. As a new graduate employed on this unit, the nurse can expect that:

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a) Evidence-based practice guides risk b) Client teaching is the responsibility management principles. of the team leader. d) Seniority is the main determination c) The initial level of practice of client assignments. responsibility will be limited. Reason: The scope of nursing practice and responsibility are defined for each level of practice. A new graduate will have limited experience so the level of practice will be limited. 10) When would a critical pathway need to be revised? a) When it becomes too long. b) When the variances show a new trend. c) When a member of the team retires. d) When the client leaves the hospital. Reason: The length of the critical pathway is determined by the medical or surgical condition, interventions, and the length of stay.

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CHAPTER: 4 Leading, Managing, Following 1) Which of the following is the major difference between managers and leaders? a) Leaders usually have legitimate b) Leaders do not make good power. managers. d) Managers always have legitimate power. c) Managers seldom are leaders. Reason: Managers will always have legitimate power; leaders do not have to have it. 2) A staff nurse describes the unit manager as "a born leader." The nurse ascribes to which theory of leadership? b) Behavioral theories a) Trait theories c) Formal leadership theories d) Democratic leadership theories Reason: Inborn characteristics are consistent with the trait theory of leadership. The behavioral theory believes people learn new behaviors through direct experience, or by observing other people performing the behaviors, which results in positive and negative outcomes. Leadership is formal when practiced by a nurse with legitimate authority conferred by the organization and described in a job description. A democratic leadership style assumes individuals are motivated by internal forces; the leader uses participation and majority rule to get work done. 3) The unit manager of a 32-bed medical-surgical unit allows the staff nurses to do self-governance for scheduling, client care assignments, and committee work. The manager would be considered which type of leader? a) Autocratic b) Democratic c) Bureaucratic d) Laissez-faire Reason: The laissez-faire type of manager exerts very little control. Bureaucratic leadership is a leadership style that assumes individuals are motivated by external forces; the leader trusts neither followers nor self to make decisions, and therefore relies on organizational policies and rules. Autocratic leadership is a leadership style that assumes individuals are motivated by external forces; therefore, the leader makes all the decisions and directs the followers' behavior. Democratic leadership is a leadership style that assumes individuals are motivated by internal forces; the leader uses participation and majority rule to get work done. 4) A multiple-car accident has occurred with multiple trauma clients being sent to an Emergency Department. The unit manager is preparing the staff for the

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arrival of the trauma victims. Which type of leadership would be most effective in this situation? a) Democratic b) Bureaucratic c) Laissez-faire d) Autocratic Reason: Different situations call for different types of managing style. An emergency is best handled with one person in control, delegating activities. Laissez-faire leaders exert little control; therefore this would not be appropriate in an emergency. A democratic leader seeks consensus and there is insufficient time in an emergency for this type of leadership. A leader who depends on bureaucratic rules and policies will be ineffective in an emergency situation. 5) The manager of a medical-surgical unit is very task-motivated. Using Fiedler's Contingency Theory, under what circumstances would the manager be most effective? a) Only during highly stressful b) When there is little to no stress. situations. d) When the situation is loosely c) Under highly structured situations. structured. Reason: Task-motivated managers function best under highly structured situations where priorities are generally clear. In less structured or stressful situations, the order of task performance is less clear; the manager may feel frustrated under those circumstances. 6) Which of the following types of leadership behaviors would be most useful when managing a staff of newly trained CNAs (Certified Nursing Assisstants)? a) Achievement-oriented b) Supportive c) Participative d) Directive Reason: Directive leadership involves telling employees what is expected, giving specific guidance, ensuring adherence to rules and procedures, and scheduling and coordinating work efforts. Participative leadership is a leadership style that involves consultation with subordinates in decision making. Supportive leadership style focuses on the needs of employees. Achievement-oriented leadership is a leadership style that includes goal setting and maintaining high levels of performance in order to motivate employees. 7) Which of the following leaders would be considered a transformational leader? a) The supervisor of a unit who b) The unit secretary who encourages requests staff to work overtime. staff to use the proper forms. c) A unit manager who reminds a CNA d) The Advanced Practice Nurse who (Certified Nursing Assistant) to encourages a staff nurse to pursue work on time management skills. additional education for career advancement. Reason: Transformational leaders focus on effecting change through a commitment to the organization's vision and seek to elevate followers. A focus on tasks like using proper forms, time management, or making requests is not representative behavior of transformational leaders.

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8) The complexities of the current health care delivery systems require a variety of leadership styles. Which of the following is one that has emerged in response to these changes? b) Servant a) Quantum c) Autocratic d) Democratic Reason: The quantum theory of leadership addresses complexity in organizations. Autocratic leadership seeks to minimize complexity, while democratic leadership looks to build consensus. Servant leadership is based on the premise that in serving, one may be called to lead. 9) Which of the following are managerial functions, according to Mintzberg? (EXCEPT) a) Leading and linking at the people b) Communicating and controlling at level the information level d) Doing at the action level c) Deciding pay structures Reason: Mintzberg believed that managing involves: communicating and controlling at the information level; leading and linking at the people level; and doing at the action level. Pay structure is a decision outside the range of managerial functions. 10) A ___________ manager supervises a number of first-level managers, usually within related specialties. a) self-directed b) first-level d) self-motivated c) middle-level Reason: A middle-level manager supervises a number of first-level managers, usually within related specialties.

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CHAPTER: 5 Initiating and Implementing Change 1) A new manager is implementing an initiative with the desired outcome to have the unit run more "smoothly". What quality is the manager demonstrating? a) Being unrealistic b) Being a change agent c) Being democratic d) Being authoritarian Reason: The nurse serves as a change agent when she acts to bring about change and ensure the effectiveness of the unit atmosphere. 2) A supervisor is restricting the flow of communication between staff. This has resulted in the staff having two very opposite directions. The supervisor's actions are known as which type of force? a) Opposing force b) Driving force d) Restrictive force c) Restraining force Reason: Restraining forces impede change because they push participants in opposite directions. 3) When trying to facilitate change in the staff, it is necessary to build trust and recognize the need for change. This type of action is known as which of the following, according to Lewin's Force-Field Model? a) Moving the system to a new level b) Unfreeze of the system c) Refreeze of the system d) Institutionalization Reason: Unfreezing the existing equilibrium is the stage that motivates the participants and builds trust/recognition. Refreezing reinforces the new patterns of behavior. 4) Lippitt's phases of change are important factors in the change process. The phase that involves key people in data collection is known as: a) Assess the motivation. b) Choose a change agent. d) Maintain the change. c) Diagnose the problem. Reason: There are seven steps in Lippitt's phases of change. The first is the diagnosis of the problem, and it involves the key people in data collection and problem solving. The second step is assessing the motivation. Choosing a change agent is the fifth step. Maintaining the change is the sixth step.

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5) After discussing alternatives to dressing change procedures to minimize discomfort, the nursing staff accepted a new procedure. This is an example of which stage of Havelock's model of change? b) Self-renewal a) Moving c) Refreezing d) Unfreezing Reason: In the moving stage of the Havelock's model, choosing the solution is the first step. Unfreezing is the planning stage. Refreezing stage brings stabilization and self-renewal.

6) In determining a way to make shift change more effective for the nurse and the client, a hospital implemented a course of action. After a week of implementation, the decision was deemed inappropriate. What step of Roger's diffusion of innovations is this? b) Implementation a) Confirmation c) Knowledge d) Persuasion Reason: The stage of confirmation seeks reinforcement of the action taken. In the implementation stage, the innovation is put to use, and reinvention or alterations may occur. In persuasion stage, a favorable (or unfavorable) attitude toward the innovation forms. In the knowledge stage, the decision-making unit is introduced to the innovation and begins to understand it. 7) When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action? a) Collection of data b) Planning c) Analyzing data d) Identification Reason: Planning is the time to make people uncomfortable with the norm. 8) The changes brought forth by the state boards of nursing are an example of which type of change agent? a) Resistance b) Empirical–rational c) Normative–reeducative d) Power–coercive Reason: Power–coercive strategies are based on the application of power by a legitimate authority. In the empirical–rational model of change strategies, the power ingredient is knowledge. The assumption is that people are rational, and will follow their rational self-interest if that self-interest is made clear to them. Normative–reeducative strategies of change rest on the assumption that people act in accordance with social norms and values. Resistance is opposing the change. 9) Even though this is not easy, facilitating ____________ is a mandatory skill for all nurse managers and is crucial in the success of the manager. a) resistance b) change c) planning d) collection of data

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Reason: Successful change agents demonstrate certain characteristics that can be cultivated and mastered with practice. Making change is a mandatory skill for managers. 10) Change is a mandatory skill for managers. Successful change agents display certain characteristics. Some of these characteristics are: (Select all that apply.) a) Energy. b) Confidence. c) Realistic thinking. d) Trustworthiness. Reason: Energy, confidence, realistic thinking, and trustworthiness are among the characteristics that successful change agents demonstrate.

CHAPTER: 6 Managing and Improving Quality 1) A client is admitted to a medical-surgical unit after six hours in the emergency room. He requests that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy? a) Continuous quality improvement b) Total quality management c) Six sigma d) Quality management Reason: Total Quality Management is customer-focused. 2) A family member slips on the wet floor and hits her head. You understand that completion of an incident report is necessary for which hospital process? b) Outcome management a) Risk management c) Quality management d) Peer review Reason: Risk management deals with all incidents of error in the hospital. 3) A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician, and correcting the rate what should be the next step in the client's care? a) Notify family b) Discipline the previous nurse d) Obtain legal consult c) Complete an incident report Reason: Completion of an incident report is necessary after notification of the physician. And legal consult may not be necessary. 4) A client experiences an air emboli, resulting in a stroke, during an IV start. This can be classified as which type of risk? a) Patient dissatisfaction b) Medical-legal incident c) Medication error d) Diagnostic procedure Reason: Any incident occurring during a procedure is known as a diagnostic procedure risk.

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5) A client complains every morning that the night shift nursing staff do not answer his call light promptly to assist his elimination needs. His concerns are not shared with the Nurse Manager, and he falls while trying to walk to the bathroom. This fall could be attributed to which of the following? b) Lack of staff a) Breakdown in communication c) Lack of concern d) Breakdown in management Reason: Communication with the staff allows a better understanding of safety concerns. 6) In order to best reduce the potential for risk, the development of which type of atmosphere is needed? a) Nurse-focused b) Physician-focused c) Family-focused d) Patient-focused Reason: The patients will believe that their best interest is at heart. 7) What is the focus of a continuous quality improvement program? a) Family b) Client c) Nurse d) Physician Reason: Continuous quality improvement is client-focused. 8) Monitoring the number of times a medication is given utilizing the "five rights" is an example of which portion of the Six Sigma program? a) Measure b) Management c) Quantitative d) Goal Reason: The goal of Six Sigma is monitoring. 9) A client experiences a major incident. The time frame for reporting the incident would be: b) 36 hours. a) 24 hours. c) 48 hours. d) 72 hours. Reason: The incident report needs to be submitted within 24 hours of the incident, which is one of the steps in reporting. 10) A client discharges AMA (against medical advice). This is an example of the _________ type of risk category? a) nurse-focused b) physician-focused d) Patient-focused c) medical-legal incident Reason: Any refusal is considered a medical-legal incident.

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CHAPTER: 7 Understanding Power and Politics 1) A staff nurse develops an innovative documentation system for post-op patients. The nurse manager grants the nurse paid leave to develop one for medical patients. What type of power is the nurse manager using? a) Legitimate power b) Reward power c) Expert power d) Information power Reason: Reward power is based on inducements in exchange for contributions towards the manager's objectives. Legitimate power stems from the manager's right to make a request because of the authority associated with job and rank in an organizational hierarchy. Expert power is based on possession of unique skills, knowledge, and competence. Information power is based on access to valued data. 2) The hospital administration plans to introduce a new system of patient transport within the hospital. The nurse managers, when communicating with the staff about the change, should use which source of power to make certain the transition goes smoothly? a) Connection power b) Expert power d) Reward power c) Information power Reason: The nurse managers have access to the information, planning, and rationale for the change. It is important to communicate information in a positive way that reinforces the benefits to the staff and patients. Connection power refers to the manager using relationships to achieve results. Reward power suggests that the manager can offer some inducement for the staff to accept the change. The manager is not an expert on transportation issues in the hospital. 3) A staff nurse wants to become instrumental in changing a policy regarding scheduling. Which of the following might be helpful in this situation? a) Talking to the Director of Nursing b) Compiling data that would support the policy change c) Demonstrating positional power d) Using image power

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Reason: Using facts and figures to demonstrate the effectiveness of a policy change is an effective tool. Image refers to presentation of oneself in a given situation. The staff nurse does not have positional power sufficient to effect change. It would be inappropriate for the staff nurse to communicate with the Director of Nursing without prior communication with the unit manager. 4) A staff nurse tells other staff nurses that the manager is ineffective in order to move into the manager position. Which of the following would describe the nurse's actions?

a) Using punishment power b) Using a power play c) Using personal power d) Using information power Reason: A power play is an attempt to diminish an opponent. Punishment, or coercive, power is based on the penalties a manager might impose on an individual or a group. Personal power refers to one's credibility, reputation, expertise, experience, control of resources or information, and ability to build trust. Information power is based on access to valued data. 5) Which of the following are effective ways to apply power and politics in nursing? (EXCEPT) b) Networking with other professionals a) Picketing the employer c) Writing letters to legislators d) Joining professional organizations Reason: Networking with other professionals, campaigns, and joining professional organizations are some of the effective ways to apply power and politics in nursing. 6) Politics is defined as the art of influencing the allocation of scarce resources. An example of a scarce resource allocated by the manager of a patient care unit is: a) Rises for the staff. b) Patient supplies in the utility room. d) Paper for the printer. c) Staffing that minimizes overtime. Reason: Scarce resources include money, time, personnel, and materials. Staffing is a budget issue and resource over which the manager has control. The manager would expect the staff to use resources wisely but would not have direct control over them. Raises are granted by the institution, not the manager. 7) A nurse who is planning to run for the local school board will find which of the following sources of power important? b) Reward a) Connection c) Charisma d) Expert Reason: Connection and information are two main sources of power important in political action. The nurse will want to use relationships to build coalitions and get information. The nurse does not have to be charismatic to use power effectively. The nurse is not an expert on education and as a candidate does not have rewards to grant. 8) A nurse manager needs to resolve a conflict between the staff nurses and the physical therapy department. What type of power might the manager utilize? (EXCEPT)

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a) Connection and referent power b) Reward and punishment power c) Legitimate power d) Information power Reason: Referent power is based on admiration and respect for an individual. Connection power is based on an individual's formal and informal links to influential or prestigious persons within and outside an area or organization. Information power is based on access to valued data. Reward power is based on the inducements the manager can offer group members in exchange for cooperation and contributions that advance the manager's objectives. Punishment, or coercive, power is based on the penalties a manager might impose on an individual or a group. Legitimate power stems from the manager's right to make a request because of the authority associated with job and rank in an organizational hierarchy. This manager may need to use several types of power to resolve an important issue that crosses departmental lines.

9) Politics is a means for influencing events and the decision of others. The nurse manager who consistently reminds the staff that "there is no I in team" and periodically brings treats for the staff is using: a) Image enhancement b) Political skills. c) Reward power. d) Expert power. Reason: Politics involves interpersonal endeavors, collective activities, analysis and planning, and image. The manager is skillfully building the team morale. Occasional treats are not rewards, nor is the manager using expert knowledge with the staff. 10) By using ___________ in the workplace, nurses increase their professional influence. a) political skills b) reward power c) expert power d) power and politics Reason: By using power and politics, nurses increase their professional influence. Politically savvy nurses effectively use power and politics.

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CHAPTER: 8 Thinking Critically, Making Decisions, Solving Problems 1) After examining her client's abdomen and noting assessment of significant findings, even though the client says it doesn't hurt, the nurse says to a colleague, "I think something is going on here; I am going to investigate further." This nurse is using: a) Deductive reasoning. b) Intuition. c) Trial and error. d) Modified scientific method. Reason: Intuition is the "gut feeling" one has without the conscious use of reasoning. 2) How does decision making differ from problem solving? b) Problem solving always involves a) Decision making always involves selecting one of several alternatives. selecting from a set of alternatives. c) Problem solving never involves d) Decision making always involves decision making. solving a problem. Reason: Decision making always involves selecting one of several alternatives; problem solving always involves diagnosing a problem. Both problem solving and decision making can involve aspects of the other. 3) A nurse manager has two out of six staff nurses call in sick for one shift. Because of reduced availability of staff, the manager decides to manage the unit with the three remaining nurses, which keeps the unit at minimal staffing standards What type of decision-making strategy would this be? b) Routine a) Satisfycing c) Adaptive d) Rationalizing Reason: Satisficing is a decision-making strategy whereby the person chooses an alternative that is not ideal but good enough given the circumstances.

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4) A nurse manager asks the staff to submit written suggestions for a change in policy. The group would then vote on the different suggestions. What type of decision-making technique did the nurse manager use? a) Statistical aggregation b) Nominal group technique c) Brainstorming d) Delphi Reason: The nominal group technique primarily uses a written method for exchange of ideas. In the Delphi technique, ideas are collected through a carefully designed sequence of questionnaires interspersed with summaries of information and opinions derived from previous questionnaires. In statistical aggregation, individuals are polled regarding a specific problem, and their responses are tallied. Brainstorming is a decision-making method in which group members meet and generate diverse ideas about the nature, cause, definition, and/or solution to a problem.

5) A new nurse manager is attempting to solve a management issue by using one solution after another until she solves the problem. This would be known as what type of method? a) Decision making b) Trial and error c) Experimentation d) Analysis Reason: Trial and error is usually used by people with little management experience. Experimentation is a type of problem solving in which a theory is tested to enhance knowledge, understanding, or prediction. 6) Scientific methods for problem solving are useful when time is not an issue. For problems requiring immediate action, nurses can use an organized method that involves seven specific steps. What is this method? a) Nominal group technique b) Delphi method d) Brainstorming c) Problem-solving process Reason: The problem-solving method is an organized seven-step process useful for problems that require immediate action. 7) Which of the following can cause negative effects on decision making among groups? a) Rationalization b) Groupthink c) Risky shift d) Dialectical inquiry Reason: Groupthink is a negative phenomenon occurring in highly cohesive, isolated groups in which group members come to think alike, which interferes with critical thinking. Dialectical inquiry is a technique used to minimize groupthink through the use of a formal debate format. Risky shift is a phenomenon seen in groups in which riskier, more controversial decisions are made. 8) A client who is in pain refuses to be repositioned. In making a decision about what to do, what should the nurse consider first?

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b) Who actually gets to make the decision? c) What are the alternatives? d) When a decision is needed. Reason: Decision making requires the nurse to select the best action to meet a desired goal. When a decision is needed comes after determining why a decision is needed. Who actually makes the decision is important, but not the first thing to consider. What the alternatives are comes after determining why a decision is needed, who makes the decision, and when a decision is needed. a) Why a decision is needed.

9) A __________ is often helpful to use when a problem is not easily identified. a) trial and errors b) delphi method c) political decision making model d) affinity map Reason: A tool often helpful to use when a problem is not easily identified is an affinity map.

10) Which of the following are characteristics of reflective inquiry as described by Schmieding? (EXCEPT) b) Ideas about the problem are a) Judgments on a particular topic are validated or refuted based on systematically gathered from empirical evidence through a serial participants. rather than a linear process. c) Objective data are tested against d) Past experiences and knowledge are one's thoughts and feelings. used to evaluate the situation. Reason: The four characteristics of reflective inquiry are: objective data are tested against one's thoughts and feelings; past experiences and knowledge are used to evaluate the situation; ideas about the problem are validated or refuted based on empirical evidence through a serial rather than a linear process; the facts and ideas generated are verified through deliberate investigation.

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CHAPTER: 9 Communicating Effectively 1) A nurse manager who tells the staff to "come to me with any problem" but then keeps the office door closed is using what type of communication? b) Diagonal communication a) Intrasender conflict c) Metacommunication d) Upward communication Reason: When a verbal message is incongruent with the nonverbal message, it results in intrasender conflict. Metacommunications are behaviors that include head or facial agreement or disagreement. Upward communication occurs from staff to management or from lower management to middle or upper management. Diagonal communication involves individuals or departments at different hierarchical levels. 2) The nurse manager can use several strategies to improve communication when giving directions. Asking the subordinate to repeat the instructions would be which of the following strategies? b) Follow-up communication a) Verifying through feedback c) Getting positive attention d) Knowing the context of the instruction Reason: Making sure the receiver has understood the request is verifying through feedback. 3) A nurse manager finds herself in opposition to her immediate superior. The nurse manager knows that an important strategy to use in a confrontation is using: b) Absolutes. a) "I" language. c) "Why" questions. d) Negative assertion.

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Reason: Using "I" language and a low voice is important when a confrontation occurs. Negative assertion, absolutes, and "why" questions do not promote professional communication during conflict. 4) Which of the following factors may affect successful communication? a) Cultural background b) Organizational structure c) Method of communication & Gender d) All of above Reason: The factors that may affect successful communication are gender, method of communication, cultural background, and organizational structure. 5) Nurse Managers often need to attend to the complaints of their clients. In communicating with the client who has a complaint, what principle is important to keep in mind? a) Supervisors should always be b) The client's physician is often the involved. cause of the problem. c) Avoid discussion of complaints. d) Clients and families should be treated with respect; communication should be open and honest. Reason: The clients and their families are the principal customers of the organization. They should be treated with respect; keep communication open and honest. 6) The staff on a medical-surgical unit is in conflict with the occupational therapy department. What type of communication will be used to discuss the problems? a) Downward communication b) Lateral communication c) Distorted communication d) Upward communication Reason: Lateral communication occurs between individuals or departments of the same hierarchical level. Upward communication occurs from staff to management or from lower management to middle or upper management. Downward communication is communication, generally directive, given from an authority figure or manager to staff. 7) Knowing the different modes of communication used by men and women is important for the nurse manager. Which of the following is a difference in communication in unpleasant situations? b) Men tend to use tag questions. a) Men tend to talk more and women withdraw. c) Women disagree more. d) Women talk longer and faster, men disclose more. Reason: Men tend to talk more, while women withdraw in unpleasant situations. Women tend to use tag questions and disclose more. Men tend to talk longer and disagree more. 8) Which of the following are important techniques when giving directions to subordinates? (EXCEPT)

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a) Know the context of the b) Use lateral communication. instructions. c) Verify feedback. d) Get positive attention. Reason: All of the following are important techniques when giving directions to subordinates: Know the context of the instruction; get positive attention; give clear, concise instructions; verify feedback; and give follow-up communication. 9) A nurse needs to know how to increase her power base. Which of the following are ways nurses can generate power as described by Umiker? a) Using body language, standing when b) By listening for feelings talking c) With words, avoiding cliche's d) Through delivery, making one point at a time e) A & D f) All of above Reason: Umiker describes four ways to generate power: Use words, through delivery, by listening, and through body language. 10) Nonverbal message in communication, including body language and environmental factors, are called ___________. a) lateral communication b) upward communication d) downward communication c) metacommunications Reason: The messages conveyed through body language and environmental factors are called metacommunications. CHAPTER: 10 Delegating Successfully 1) The staff nurse delegates AM care for two patients to the UAP (Unlicensed Assistive Person). What principle of delegation is the nurse following? a) Delegation requires a situation with b) Delegation can only exist with a clearly defined superiors. subordinate. c) Delegation is a tool only used by d) You can delegate only those tasks nurses. for which you are responsible. Reason: You can delegate only those tasks for which you are responsible. 2) Which of the following is an important principle of delegation? b) Responsibility is not transferred a) When delegating, you must transfer with delegation. authority. c) No transfer of authority exists when d) Delegation is the same as work delegating. allocation. Reason: Along with responsibility, one must transfer authority when delegating. 3) A staff nurse has delegated the ambulating of a new post-op patient to a new staff nurse. Which of the following situations exhibits the final stage in the process of delegation?

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b) Having the new nurse tell the physician the task has been completed. c) Telling the unit manager the task has d) Documenting that the task has been been completed. completed. Reason: Monitoring performance and providing feedback is the final stage of effective delegation. a) Supervising the performance of the new nurse.

4) The staff nurse in a long-term care facility wants to delegate the passing of 9 AM medications. The additional staff consists of two UAPs (Unlicensed Assistive Persons). What type of barrier to delegation exists? a) Trust versus control b) Approval versus affiliation c) Poor communication d) Lack of resources Reason: Lack of resources exists when there is no one to whom you can delegate. 5) A staff nurse delegates a task to a UAP (Unlicensed Assistive Person) and then does half of the task herself, telling the UAP that she is too slow. This violates which of the following principles of delegation? a) In work allocation, no transfer of b) Transferring authority empowers authority exists. the delegate to complete the task. c) Poor communication is a barrier to d) To delegate effectively, the delegation. individual should be matched to the task. Reason: Transferring authority empowers the delegate to complete the task. Retaining authority cripples the delegate's abilities to accomplish the task. 6) When considering delegation of responsibility, the registered nurse should consider which "rights" of delegation? a) Right circumstance b) Right task & Right person c) Right supervision d) All of above Reason: The five rights of delegation include the right task, the right circumstances, the right person, the right direction/communication, and the right supervision/evaluation. 7) A staff nurse wants to clarify her responsibilities regarding delegation. Which of the following documents can the nurse refer to, to assist in her decision making? a) The job description b) Standards d) The ANA (American Nurse c) The policy manual Association) standards of care Reason: The state nurse practice act defines the scope of nursing practice. 8) Which of the following is a specific benefit to an organization when delegation is carried out effectively? a) The client feels more of their needs b) The organization benefits by are met. achieving its goals more efficiently.

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c) Managers devote more time to tasks d) Delegates gain new skills facilitating that cannot be delegated. upward mobility. Reason: The organization benefits by achieving its goals more efficiently. 9) __________ is the first step in the delegation process. a) Decide on delegate b) Defining the task c) Determine the task d) Reach agreement Reason: Defining the task is the first step in the delegation process. 10) As a staff nurse you are asked to complete a task you feel you are not qualified to do. What is the best response? a) Ask for other tasks for which you b) Thank the delegator for the offer feel prepared. and clearly explain why you must decline. c) Inform the supervisor that you are d) Try to do the task anyway. being mistreated. Reason: Thank the delegator for the offer and clearly explain why you must decline, this is professional communication, keeps the nurse within the scope of practice, and promotes professional relationships.

CHAPTER: 11 Building and Managing Teams 1) A group of nurses selected by their colleagues plan an orientation program for new staff. What type of group is this? a) Command group b) Formal group c) Informal group d) Task group Reason: A task group is composed of several persons who work together and are charged with accomplishing specific time-limited assignments. Informal groups evolve naturally from social interactions. Groups are informal in the sense that they are not defined by an organizational structure. Real (command) groups accomplish tasks in organizations, and are recognized as a legitimate organizational entity. Formal groups are clusters of individuals designated temporarily or permanently by an organization to perform specified organizational tasks. 2) According to Homans' framework, three essential elements of group systems exist. Which of the following exhibits attitudes? a) An LPN enrolls in an IV b) Staff nurses perform their jobs certification class. satisfactorily.

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c) Two nurses share their d) An individual nurse feels that the understanding of the role of the nurse manager is ineffective. CNA. Reason: A nurse feeling that the nurse manager is ineffective exhibits attitudes. 3) A committee of nurses tries to determine who should be charged with the different workloads of the committee. In what stage of group development is this committee? a) Norming b) Performing c) Forming d) Storming Reason: In the storming stage, the members wrestle with roles and relationships. In the forming stage, individuals assemble into a well-defined cluster. In the norming stage, the group defines its goals and rules of behavior. In the performing stage, members agree on basic purposes and activities, and carry out the work. 4) Behaviors such as not calling in sick on Fridays, accommodating requests for trading shifts, and returning from breaks in a timely manner are examples of what group characteristic? b) Group communication a) Norms c) Status d) Roles Reason: Norms are the informal rules of behavior shared and enforced by group members. Norms emerge whenever humans interact. Groups develop norms that members believe must be adhered to for fruitful, stable group functioning. Nursing groups often establish norms related to how members deal with absences that affect the workload of colleagues. Roles are a set of expected behaviors that fit together into a unified whole and are characteristic of persons in a given context. Status is the social ranking of individuals relative to others in a group, based on the position they occupy. 5) Productivity is influenced by groups. Which of the following aspects of group behaviors would positively affect productivity? a) Leadership b) Resources d) Individual relationships c) Cohesiveness and collaboration Reason: Work-group dynamics that are cohesive and collaborative positively affect productivity. 6) Influencing group processes on a unit toward the attainment of organizational objectives is the direct responsibility of which team member? b) All the group members a) The nurse manager c) An interested group member d) The informal group leader Reason: Influencing group processes towards the attainment of organizational objectives is the direct responsibility of the nurse manager. 7) A team of nurses needs to move the patients and equipment to a new unit while remodeling is done. Each nurse has an assigned task within the group. This is an example of what type of group task?

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b) Informal task a) Divisible task c) Disjunctive task d) Conjunctive task Reason: With a divisible task, more people provide a greater opportunity for interdependency in performing tasks. For a disjunctive task (the group succeeds if one member succeeds), the greater the number of people, the higher the probability that one group member will solve the problem. With a conjunctive task (the group succeeds only if all members succeed), more people increase the likelihood that one person can slow up the group's performance (e.g., a jury trial). 8) A nurse manager wants to call a meeting with the staff. What is the first and most important step in the meeting process? a) Determine which members will b) Determine the place and time. contribute. d) Determine the members. c) Thoroughly prepare for the meeting. Reason: Preparation is the first key to a successful meeting. 9) Which of the following characteristics of a group contributes to cohesiveness? b) Members who work far away from a) Members who are motivated by the each other same goals c) Members whose needs can be d) Members who share similar values satisfied by involvement in the group Reason: Groups are more likely to become cohesive when members share similar values and beliefs, are motivated by the same goals, must interact to achieve the goals, work in proximity to each other, and have specific needs that can be satisfied by involvement in the group.

10) The nurse manager has had a lot of turnover on her unit recently, and decides that team building is needed. An effective technique would be to: a) Allow the team to progress through b) Identify those individuals who are the normal group developmental not team players and recognize their process until cohesiveness occurs. poor attitude in a team meeting. d) Pull the staff aside individually to c) Clarify team goals, roles, identify who is undermining the responsibilities, and boundaries. team. Reason: An effective technique for building a strong group would be clarifying goals, roles, responsibilities, and boundaries within the group.

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CHAPTER: 12 Handling Conflict 1) The staff of a medical-surgical unit is in a disagreement about holiday scheduling. The nurse manager knows that this is what type of conflict? b) Intergroup conflict a) Intragroup conflict c) Interpersonal conflict d) Intrapersonal conflict Reason: Intragroup conflict occurs within one group. Intergroup conflict occurs between two or more groups. Interpersonal conflict occurs between two or more people. Intrapersonal conflict occurs within one individual. 2) In dealing with conflict, the nurse manager knows that feelings or perceptions about the situation will have an effect. According to Filey, what is this effect known as? a) Conflict suppression b) Resolution aftermath

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c) Antecedent conditions d) Manifest behavior Reason: Feelings or perceptions about the situation initiate behavior, known as manifest behavior. Antecedent conditions are preexisting conditions. Resolution aftermath is the aftermath of the conflict. Conflict suppression is the next step, in which conflict is suppressed but not resolved. 3) The babysitter calls the staff nurse to let him know that she will not be able to take care of his children on the day the nurse is scheduled to work. The nurse is presenting important material at a committee meeting that day. What type of conflict is the staff nurse experiencing? a) Intergroup conflict b) Perceived conflict d) Structural conflict c) Role conflict Reason: Role conflict exists when one has responsibilities that are overlapping. Intergroup conflict occurs between two or more groups. Structured relationships (superior to subordinate, peer to peer) provoke conflict because of poor communication, competition for resources, opposing interests, or a lack of shared perceptions or attitudes. Perceived conflict refers to each party's perception of the other's position. 4) In dealing with a conflict on a unit, the nurse manager decides to ask one of the staff nurses, who is not moving towards resolution, to transfer to another unit. What tactic has the manager implemented? a) Avoidance b) Withdrawal d) Competition c) Suppression Reason: The stage of conflict in which one of the conflicting parties is eliminated through transfer or termination is called suppression technique.

5) A nurse manager is interested in solving a serious conflict that exists among the nursing staff. He uses a strategy that involves allowing the group to explore a number of solutions and come to a consensus on a solution. What strategy for conflict resolution has the manager used? b) Win-win a) Integrative decision-making c) Competing d) Confrontation Reason: Allowing the group to explore a number of solutions and come to a consensus on a solution is an integrative decision-making method. 6) The nurse manager has two employees with a longstanding conflict that is affecting the group's productivity and cohesiveness. She decides to meet with the employees in private and bring the conflict out into the open, and to attempt to resolve it through knowledge and reason. Which conflict management strategies did she employ? b) Suppression a) Confrontation

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c) Collaboration d) Intervention Reason: Confrontation is the most effective means of resolving conflict. The conflict is brought out in the open and attempts are made to resolve it through knowledge and reason. 7) A group of physicians come into conflict with the nursing staff of a unit over when AM vital signs are recorded. What type of technique might be used that respects the professionalism of both parties? a) Accommodating b) Collaboration c) Avoiding d) Competing Reason: Collaboration implies mutual attention to the problem, as the talents of all parties are used. 8) Which of the following is one of the positive benefits of conflict within an organization? a) Conflict leads to value and belief b) Conflict leads to intergroup compromise. competition. d) Conflict always leads to a win-win c) Conflict helps people recognize resolution. differences, and motivates people towards improved performance. Reason: Conflict helps people recognize legitimate differences within the organization, and serves as a powerful motivator to improve performance. 9) The final stages of the conflict process are _______________. a) Antecedent conditions b) Perceived and felt conflict d) Conflict behavior c) suppression and resolution Reason: The final stages of the conflict process are suppression and resolution.

10) A resident on night call refuses to answer pages from the staff nurse on the night shift and complains that she calls too often with minor problems. The nurse feels offended and reacts with frequent, middle-of-the night phone calls to "get back" at him. The behavior displayed by the resident and the nurse is an example of what kind of conflict? a) Perceived conflict b) Disruptive conflict c) Competitive conflict d) Felt conflict Reason: In disruptive conflict, the parties involved are engaged in activities to reduce, defeat, or eliminate the opponent. Filey (1975) defines competitive conflict as a victory for one side at a loss for the other side. Felt conflict refers to the feelings of opposition within the relationship of two or more parties. Perceived conflict refers to each party's perception of the other's position.

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CHAPTER: 13 Managing Time 1) A Nurse Manager has left the facility, and one of the remaining managers is given that assignment in addition to her current load. She is told that the open position will not be filled. This is an example of which of the following? b) Proactive Management a) Job enlargement c) Time log d) Prioritizing Reason: Job enlargement occurs when positions are combined, and managers have more employees to supervise. 2) A Staff Nurse submits a six week notice of resignation. The Nurse Manager prepares a request to immediately post the position and begin interviews. This action is best described as which of the following? a) Delegation b) A time waster

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c) Reactive management d) Proactive management Reason: Proactive Management attempts to resolve problems over which you have control. This manager is attempting to prevent short staffing. Reactive Management wastes time on problems over which you have no control. Nothing is delegated or considered a time waster in this example. 3) A Manager has a budget request deadline today at 3:00. He stops his work to answer the phone, check e-mails as they arrive, and speak with staff who stop by his office. As a result, he misses the deadline. What best describes the cause of missing his deadline? a) Goal setting b) Organization d) Assertiveness c) Time wasters Reason: This manager has allowed time wasters to interfere with his organization, goal setting, and assertiveness. 4) A Manager decides that setting goals will assist her in better utilizing her time. Which of the following are true regarding goal setting in the Manager role? b) Writing goals will increase the stress a) Goals need to be measurable, level of the Manager. realistic, and achievable to be effective. c) Goals should be vague, so they are d) Setting goals is a time waster in the more likely to be met. Manager role. Reason: Goals decrease stress by providing direction and saving time. They need to be measurable, realistic, and achievable in order to be effective. 5) If a task is delegated to someone, they need to be granted the ___________ to complete the task. b) Planning a) Authority c) Organizing d) Controlling Reason: A task can not be successfully completed if an individual does not have the authority to complete it. 6) A Manager has been given a deadline to complete an assignment by the end of the day. It will take every minute left of the afternoon to complete. Which interventions illustrate assertiveness to minimize interruptions in order to meet the deadline? (Select all that apply.) a) Allowing voice mail to answer all b) Delegating a discharge planning incoming calls or Turning off e-mail issue for a patient to one of the staff notification nurses c) Placing a "Do Not Disturb for the d) All of above Afternoon" sign on the office door Reason: All of the interventions listed are appropriate ways to minimize interruptions. 7) A Nurse Manager completes an interruption log and identifies two staff members who take inordinate amount of time with drop-in issues that are not

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urgent. What are some methods to address this behavior in attempt to better manage time? (Select all that apply.) a) Designate time scheduled drop-in b) Turn desk chair so that it is not time slots. facing the hall. c) Discuss with staff using e-mail for d) When the staff members drop in, the non-urgent issues to facilitate better manager should stand and remain use of time. standing during the conversation. e) A, B & C f) All of above Reason: All of the interventions listed are appropriate ways to minimize interruptions. 8) A manager identifies that he is spending more time than desired on completing paperwork that is repetitive. Which of the following would be appropriate ways to address this issue? (EXCEPT) a) Combining data reports to reduce b) Delegating staff evaluations to the duplication staff nurse on the unit with the most experience c) Assigning the preliminary draft of d) Saying no to inappropriate the schedule to a subcommittee of paperwork assignments staff nurses Reason: All interventions listed are acceptable, except the delegation to someone outside of their scope. 9) Which of the following would be considered an urgent and important issue? b) Developing an educational program a) Replacing two staff who were for the new heparin protocol, to be injured while caring for a violent implemented in two months patient c) Preparing educational packets on d) Implementing and evaluating the self administration of insulin for staff's response to a tornado drill patients Reason: Urgent and important.

10) A Manager is prioritizing the following issues. Of the following issues, which should be considered urgent and important? The manager of physical therapy calls and A staff nurse reports a pattern of complains about inappropriate behaviors of malfunctioning IV pumps on the unit one of the staff nurses with one of his during her current shift, resulting in therapists overdosing of medications. One of the staff nurses, who would have A small group of staff nurses request a been an extra nurse for the next shift, calls meeting to discuss initiating a scheduling in sick. committee. Reason: Patient safety issues should be considered urgent and important. The other issues are important, but not urgent.

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CHAPTER: 14 Budgeting and Managing Fiscal Resources 1) A nurse manager is preparing the budget for the year. The budgeted amounts have been set without regard to changes that may occur during the year. What type of budget is the manager preparing? b) Zero-based budget a) Fixed budget c) Variable budget d) Operating budget Reason: Budgets are considered fixed budgets when the budgeted amounts have been set without regard to changes that may occur during the year. The zero-based budget approach assumes the base for projecting next year's budget is zero. Variable budgets are developed with the understanding that adjustments to the

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budget may be made during the year. The operating budget, also known as the annual budget, is the organization's statement of expected revenues and expenses for the coming year. 2) The nurse manager needs to buy six new hospital beds for the unit. What type of budget will be used for this expenditure? a) Operating budget b) Capital budget c) Salary budget d) Revenue budget Reason: The capital budget identifies physical renovations, new construction, and new equipment. The revenue budget represents the patient care income expected for the budget period. The operating budget, also known as the annual budget, is the organization's statement of expected revenues and expenses for the coming year. The salary budget, also known as the personnel budget, projects the salary costs that will be paid and charged to the cost center in the budget period. 3) The nurse manager compares the actual results of the budget with the projected results of the budget. What budgeting process is this? a) Variable budgeting b) Controlling c) Revenue sharing d) Incremental budgeting Reason: Controlling is the process of comparing actual results with the results projected in the budget. Incremental budgeting utilizes separate categories for different expense items Variable budgeting may require adjustments to the budget based upon changes in revenues, Revenue sharing refers to sharing the profits and/or losses with different identified groups. 4) When planning a budget, the nurse manager knows that costs depend on and change in direct proportion to patient volume and activity. What type of costs are these? b) Indirect costs a) Variable costs c) Fixed costs d) Direct costs Reason: Variable costs depend on and change in direct proportion to patient volume and activity. Fixed costs are expenses that remain the same for the budget period, regardless of the activity level of the organization. Direct costs are expenses that directly affect patient care. Indirect costs are necessary expenditures that do not affect patient care directly. 5) An expensive variable in salary budgets is overtime pay. Which of the following is a viable option to reduce overtime? a) Limiting overtime for highly paid b) Reducing the number of beds workers d) Refusing to pay overtime c) Using per diem workers Reason: Using per diem workers can keep overtime budgets in check. 6) A typical budget takes time to prepare. What timetable should the nurse manager plan on for the budgeting process?

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a) 9-12 months b) 3-6 months c) 1-2 months d) Over two years Reason: The budgeting process takes 3-6 months. 7) A nurse manager is considering the variances of the budget. Fewer monies were spent than expected. What type of variance is this? b) Favorable variance a) Unfavorable variance c) Dependent variance d) Independent variance Reason: If less money was spent than expected, the variance is favorable 8) A nurse manager is working on the personnel budget for the year. The manager anticipates she will need to replace 832 benefit hours for the year. How many FTEs (Full Time Equivalents) will she need to budget for replacement? b) 17.0 FTEs a) 0.40 FTEs c) 0.05 FTEs d) 1.0 FTEs Reason: 832 (Number of benefit hours) divided by 2,080 = 0.4 FTEs. 9) Which of the following are considered to be part of the operating expenses within health care organizations? (EXCEPT) a) Maintenance costs b) Rental fees d) Supplies c) Renovation costs Reason: Supplies, rental fees, maintenance costs, and equipment service contracts are all part of the operating budget. 10) __________ is the difference between the amounts that were budgeted for specific revenue or cost and the actual revenue or cost that resulted during the course of activities. a) Budget b) Variable d) Premiums c) Variance Reason: Variance is the difference between the amounts that were budgeted for specific revenue or cost and the actual revenue or cost that resulted during the course of activities.

CHAPTER: 15 Recruiting and Selecting Staff 1) Matching a job with an experienced RN first requires a selection process. What is the first step in this process? b) Selection techniques a) Job analysis c) Methods of recruiting d) Assurance of legal requirements Reason: The purpose of the selection process is to match people to jobs. The job analysis is done first to determine the job description.

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2) Who can best describe the job to an applicant? a) Previous employee b) Human resource manager d) Chief operating officer c) Nursing manager Reason: The first line nursing managers are the most knowledgeable about job requirements and can best describe the job to applicants. 3) What is the main purpose of recruitment activities? a) Assess an applicant's motivation b) Generate a pool of qualified applicants c) Assess an applicant's skills d) Assess an applicant's ability Reason: Recruitment allows for a pool of qualified individuals. 4) One reason to give an applicant a comprehensive medical exam is: b) It is needed after a strenuous a) It is needed to protect the hospital interview. from legal actions. c) It is required by law. d) It is necessary to screen against disabilities that may affect the hiring. Reason: A comprehensive medical examination is given to protect the hospital from legal actions. 5) The regulatory body that requires that immunizations be given, particularly for hepatitis B, is: a) American Nurses Association b) Occupational Safety and Health (ANA). Administration (OSHA). c) Joint Commission on Accreditation d) State board of nursing. of Healthcare Organizations (JCAHO). Reason: OSHA requires that the hepatitis immune series be offered to health care workers who are not immune to hepatitis. 6) Which of the following are NOT outcomes of a job analysis? (EXCEPT) a) Job specification b) Job evaluation d) Job performance c) Job description Reason: The outcome of a job analysis is a job description.

7) What is a common method used to collect work activity information from an applicant? a) Self-report logs b) Work sample questions c) Motion studies d) Interviewing Reason: Work sample questions are used to collect work activity information. 8) There are several elements in recruiting strategies. Which of the following is one of those elements? a) Not selling b) How to sell

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c) When to sell d) What to sell Reason: Four elements in any recruiting strategy are where to look, how to look, when to look, and how to sell. 9) The most important factor that nursing graduates look for when seeking their first job is: a) Location. b) Money. d) Vacation. c) Orientation. Reason: Nursing graduates report that the most critical factor they consider in seeking their first nursing position is the orientation program. 10) One of the critical elements in interviewing is: a) Time of the interview. b) Involvement of others. c) Location of the interview. d) Developing an interview guide. Reason: A critical element in interviewing is the development of an interview guide to allow for a systematic approach.

CHAPTER: 16 Staffing and Scheduling 1) The ANA recommends that nursing in the health care organization change its focus. This requires a shift from a technical model to which of the following? b) Industrial a) Professional c) Random d) Organized Reason: Focus should be on the level of nurse competence required to provide quality care, which is the professional model.

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2) Many patient classification systems have some type of shortcoming. Among these are: a) The client's condition changes b) The staffing needs are predicted on a before the next shift. short term basis. c) The potential admissions cannot be d) The staffing mix changes because of accounted for. illness. e) C & D f) All of above Reason: Patient classification systems cannot easily account for changes in a client's condition, changes in staffing due to illness, or the unexpected influx of new admissions. Also, most classification systems only look at the short term staffing needs, rather than utilizing demand management which takes into account client outcomes helping to predict staffing needs over a period of time. 3) There are several things factored into the calculation of the amount of FTEs. Which of following are NOT considered when calculating the FTEs? (EXCEPT) b) Ancillary staff a) Hours of care c) Procedures to be done d) Types of patient Reason: One technique for determining the number of FTEs involves the hours of work for the staff for two weeks, average daily census, and hours of care. 4) The nurse manager determines the staffing needs on a particular unit, and allows only a certain number of nurses during that shift. This is known as which type of staffing? a) Flexible b) Mixed d) Creative c) Block Reason: Block staffing involves scheduling a certain number of people per day consistently. 5) What are the advantages of using internal pools of nurses for staffing purposes? b) Centralization a) Familiarity with the hospital & Lower cost c) Staffing mix d) Staff satisfaction Reason: Internal float pools of nurses can provide supplemental staffing at a substantially lower cost than using agency nurses while also being familiar with the hospital and staff. 6) When utilizing an internal float pool, which of the following pools is most efficient? b) Flexible a) Centralized c) Mixed d) Decentralized Reason: Centralization is most efficient because it allows for a pool of nurses to be used anywhere in the hospital. In decentralized pools, a staff member usually works for only one nurse manager or on only one unit.

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7) During a staffing crisis, managers may need to use nurse extenders. These individuals are better known as: a) Float RNs. b) Unlicensed assistive personnel. c) LPNs. d) Agency nurses. Reason: Persons in the role of nonprofessionals, unlicensed assistive personnel (UAPs) are used to free up some of the nurses' time, allowing for more client care time. 8) ___________ is the agency that reviews whether an organization meets its own criteria for staffing. a) American Nurses Association b) Joint Commission on Accreditation (ANA) of Healthcare Organizations (JCAHO). c) Patient Classification Systems d) Nursing Care Hours (NCHs) (PCSs) Reason: The Joint Commission specifies only that the right number of competent staff be provided to meet client's needs. 9) Working on a schedule within the unit, involving only those who are working within that unit, is called: a) Flexible staffing. b) Self-staffing. c) Internal pools. d) Management scheduling Reason: Self-staffing is the model used when staff completely manage staffing and scheduling themselves. 10) One way to determine staffing needs is to classify clients according to nursing care required. Another name for this is a(n) __________. a) self-scheduling b) supplementing staff system c) patient classification system (PCSs) d) acuity system Reason: An acuity system is when one familiarizes oneself with the current patient classification system.

CHAPTER: 17 Motivating and Developing Staff 1) Which of the following indicators is viewed as important by the nurse manager in relationship to a performance model? a) Patient outcomes b) Rapport with staff d) Flexibility c) Daily job performance

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Reason: The performance model deals with job performance. 2) What is an attribute observed among nurses who strive to find the best way to do their job? a) Punctual b) Strict c) Honest d) Motivated Reason: Motivation is the factor that initiates and directs behavior. 3) The characteristic that influences staff to act in a certain way is: b) Appreciation. a) Instinct. c) Control. d) Esteem. Reason: Instinct theory characterizes instincts as inherited or innate tendencies that predispose individuals to behave certain ways. 4) According to Maslow's theory, what level needs to be met first? a) Self-actualization needs b) Esteem needs c) Safety needs d) Physiological needs Reason: The lowest level of the hierarchy is satisfying needs such as hunger and thirst. 5) Which level in Maslow's hierarchy is rarely met? a) Esteem b) Safety d) Belongingness c) Self-actualization Reason: Self-actualization is developing one's whole potential. 6) The type of theory that discusses how motivation works to direct a person's efforts is: a) Reinforcement. b) Operant. c) Conditioning. d) Process. Reason: Process theory emphasizes how the motivation process works to direct an individual's effort into performance. Reinforcement theory, also known as behavior modification, views motivation as learning. According to this theory, behavior is learned through a process called operant conditioning, in which a behavior becomes associated with a particular consequence. In operant conditioning, the response--consequence connection is strengthened over time -- that is, it is learned.

7) What theory views motivation as learning? b) Process a) Reinforcement c) Operant d) Conditioning Reason: Process theory emphasizes how the motivation process works to direct an individual's effort into performance. Reinforcement theory, also known as behavior modification, views motivation as learning. According to this theory, behavior is learned through a process called operant conditioning, in which a

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behavior becomes associated with a particular consequence. In operant conditioning, the response--consequence connection is strengthened over time -- that is, it is learned. 8) A technique used to eliminate negative behavior by ignoring the behavior is known as __________. a) Punishment b) Extinction c) Shaping d) Equity Reason: Extinction is the process of ignoring behavior until it disappears. 9) The thought that effort will lead to a specific performance level in an individual is known as: a) Rewards. b) Expectancy. c) Valence. d) Instrumentality. Reason: Expectancy is the perceived probability that effort will lead to a specific performance level. Instrumentality is the belief that a given performance level or behavior will lead to some outcome (reward or punishment). Valence is the perceived value (attractiveness or unattractiveness) of an outcome. 10) The theory that emphasizes the long-range plan, not rewards, is known as: a) Equity theory. b) Development. d) Extinction. c) Goal setting. Reason: Goal-setting theory suggests that it is not the rewards or outcomes of task performance, but rather the goal that allows a person to expend effort. Equity theory suggests that effort and job satisfaction depend on the degree of equity, or perceived fairness, in the work situation. Extinction is a technique used to eliminate negative behavior, in which a positive reinforcer is removed and the undesired behavior is extinguished.

CHAPTER: 18 Evaluating Staff Performance 1) The primary reason to conduct a performance appraisal is: b) Punishment. a) Constructive feedback. c) Identification. d) Coaching.

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Reason: A good appraisal system ensures that staff knows what they are to do and how well they are doing it. 2) There are many ways to ensure that your appraisal system is nondiscriminatory. Which of the following is one way to ensure this? b) No appeal process a) Giving the appraisal once per year c) Withholding information from the d) Allowing no input from the employee employee Reason: There are several steps to ensure that your appraisal system is nondiscriminatory. One is by giving the appraisal once per year to ensure ongoing evaluation. 3) Most evaluations are based on absolute judgment. This is: a) A standard set up by an outside b) The manager and staff's perceived source. notion. d) The manager's own opinion. c) Internal standards. Reason: The internal standard reflects what the manager perceives as reasonable and acceptable performance for the employee. 4) Which of the following is the time period used in the traditional rating scale? b) Six months a) Twelve months c) Three months d) One month Reason: In the traditional rating scale, the employee is rated over a 12-month period. 5) After her evaluation, a staff nurse exclaims: "I'm not sure if my manager knows much about my performance, really. He only had three specific examples to give me, two good performance examples and one to work on and they all happened in the last month. I don't feel like he can see the whole picture." What kind of performance appraisal rating does this statement exemplify? b) Leniency error a) Recency error c) Halo error d) Absolute judgment Reason: Halo error is the process of assigning a rating on the basis of an overall impression. Leniency error is the tendency of a manager to overrate staff performance. Recency error is the tendency of a manager to rate an employee based on recent events, rather than the entire evaluation period. Absolute judgment is an evaluation method based on reasonable and acceptable standards set by the organization. 6) The problem of overrating staff performance is called ___________ . a) Recency error b) Absolute judgment c) Halo error d) Leinency error Reason: Leniency error is the tendency of a manager to overrate staff performance. 7) Assigning a rating on the basis of an overall impression is known as: a) Recency error. b) Leniency error. c) Absolute judgment. d) Halo error.

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Reason: Halo error is the process of assigning a rating on the basis of an overall impression. Leniency error is the tendency of a manager to overrate staff performance. Recency error is the tendency of a manager to rate an employee based on recent events, rather than the entire evaluation period. Absolute judgment is an evaluation method based on reasonable and acceptable standards set by the organization. 8) The process by which registered nurses assess and judge the performance of peers against some predetermined standard is called: a) Group evaluation. b) Peer review. c) Forced distribution evaluation. d) Essay evaluation. Reason: Peer review is conducted by professional peers. Essay evaluations represent an evaluation method in which an employee's performance is described through a detailed, written narrative. In a forced distribution evaluation, employees are rated in a fixed method, similar to grading on a curve. Group evaluation is when a group of managers compare individual and group performance to organizational standards. 9) Which of the following is an important facet of note taking? a) Not specific and behavior-oriented b) Forces the manager to deal with the problem c) Records only undesirable events d) Failure to give performance feedback Reason: Note taking forces the manager to deal with the problem, no matter how small. 10) The time period to give as notice for an appraisal is: a) One day. b) None. c) One week. d) Two days. Reason: It is preferable to give two days' notice for a performance appraisal.

CHAPTER: 19 Coaching, Disciplining, and Terminating Staff

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1) The process of helping an employee to improve performance is called: b) Disciplining. a) Coaching. c) Mentoring. d) Peer reviewing. Reason: Coaching helps the employee improve performance, and is an important tool for effective nurse managers to use to promote professional growth. Mentoring means guiding, supporting, and nurturing a less experienced employee. Peer reviewing is a process by which other employees assess and judge the performance of professional peers. Disciplining means taking constructive actions that document consequences when a policy, procedure, standard, or regulation has been violated. 2) The length of a coaching session should be no longer than: a) 15 minutes. b) 60 minutes. d) 30 minutes. c) 10 minutes. Reason: Coaching sessions should last no more than 5-10 minutes. 3) One of the steps in coaching is often overlooked and taken for granted. What is this step? a) Stating the target b) Jumping to conclusions c) Asking for suggestions d) Tying the problem to clients' care Reason: Nurses need to understand the consequences of their actions that are related to the clients' care. 4) If there is a policy violation, one of the first things to do is: a) Terminate the employee. b) Confront the employee. c) Discipline the employee d) Determine whether the employee is immediately. aware of the policy. Reason: The first key behavior is to determine whether the employee is aware of the policy. 5) In order to minimize or avoid negative outcomes as a result of the violation and disciplinary action, the employee should offer which of the following? a) Excuses b) Discipline d) Rules c) Suggestions Reason: In order to minimize or avoid negative outcomes as a result of the violation and disciplinary action, the manager should ask the employee for suggestions regarding alternate behaviors or actions that could have prevented the problem. 6) What is the primary function of discipline? a) To punish b) To evaluate d) To ridicule c) To teach Reason: The primary function of discipline is not to punish the staff nurse for the violation, but to teach new skills. 7) Which of the following is NOT the preferable alternative to firing an employee? (EXCEPT)

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b) Training a) Voluntary resignation c) Confrontation d) Coaching Reason: The preferable alternative to firing is voluntary resignation. 8) When a policy violation occurs, what are necessary steps for the nurse manager? (EXCEPT) a) Describing the staff nurse's behavior b) Terminating the staff immediately that violated the policy c) Confrontation d) Determining the employee's awareness of the policy Reason: When a policy has been violated, the necessary steps for the nurse managers are confrontation, a communication technique used to address specific issues; determining whether the employee is aware of the policy; and focusing on the employee's behavior that violated the policy. Terminating the employee is not always a necessary outcome of the policy violation. 9) Penalties should be __________ . a) Determining the employee's b) Describing the staff nurse's behavior awareness of the policy that violated the policy d) Confrontation c) Progressive Reason: If a rule is violated, penalties should be progressive. For minor violations (e.g., smoking in an unauthorized area), if the frequency or severity of the violation continues, progress discipline may progress from an oral warning, to a written warning placed in the staff's personnel folder, to a suspension for a specific amount of time from work, and ultimately to termination. For major rule violations (e.g., theft of property), initial disciplinary consequences should be more severe (e.g., immediate suspension). 10) If a staff member does not respond to discipline, the manager must __________ employment. b) Confrontation a) Terminate c) Describing the staff nurse's behavior d) Determining the employee's that violated the policy awareness of the policy Reason: Some employees do not respond to techniques to enhance performance, and nurse managers will face the day when they must terminate, or fire, an employee.

CHAPTER: 20 Reducing Turnover, Retaining Staff

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1) Which of the following is one of the sources used to determine the reason for voluntary turnover? a) Following up phone calls b) Employee questioning c) Benchmarking d) Exit interviewing Reason: Two sources for determining voluntary turnover are asking the supervisor and exit interviewing. 2) One of the most useful tools to determine reasons for turnover is: a) Questioning. b) Surveys. c) Employee forums. d) Telephone calls. Reason: Although all these tools may be useful to determine reasons for turnover, surveys allow for the most truthful responses. 3) Dysfunctional turnover is: a) Never losing an employee. b) Constant loss of employees. d) Replacing poor employees. c) Losing highly skilled employees who are difficult to replace. Reason: Nurses who are leaving and who are of high quality, difficult to replace, represent dysfunctional turnover. 4) One of the perceptions of turnover is: a) Poor management. b) Rejection of the job. c) Loss of poor performers. d) Poor job atmosphere. Reason: Steers and Stone suggest that turnover can be interpreted by coworkers as a rejection of the job. 5) Which of the following is voluntary turnover? b) Termination a) Desire to leave c) Forced resignation d) Floating Reason: Voluntary turnover is a direct function of a nurse's perceptions of both the ease and the desirability of leaving an organization. Termination and forced resignation are not a voluntary process. Floating is the reassignment to a unit other than the one on which the nurse normally works. 6) Which of the following is one important factor in sustaining employee satisfaction? a) Employee organization b) Employee performance c) Employee rating d) Employee satisfaction Reason: A number of studies have shown that the higher the employee's satisfaction level or level of organizational commitment, the lower the probability of the individual's quitting.

7) When is the manager's first opportunity to reduce turnover? a) After tenure b) After one month of employment

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d) After three months of employment c) When the decision to hire a new employee is made Reason: The manager's first opportunity to reduce turnover is when the decision to hire is made. An individual's length of stay at past employers is an indication of how long the person can be expected to stay on a new job. 8) Which of the following is NOT referred to as a withdrawal behavior? (EXCEPT) b) Strategies a) Turnover c) Stress d) Punctuality Reason: Turnover allows the employee to leave the workplace. 9) An environment that rewards good __________ is the goal in a work environment. b) Turnover a) Performance c) Strategies d) Stress Reason: Rewarding good performance is the goal in every work environment. 10) Which of the following is the term for higher starting pay of new nurses, or rewarding those with fewer years of experience? b) Salary expectations a) Salary compression c) Salary range d) Salary inflation Reason: Salary compression is compressing the salary of long-term employees.

CHAPTER: 21

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Managing Absenteeism and Other Staff Problems 1) Which of the following is an example of voluntary absenteeism? a) Staying home for a sick child b) Staying home for a funeral d) Staying home for sickness c) Staying home to run errands or finish housework Reason: Voluntary absenteeism is under the employee's control. Sickness or death in the family are events that are not under the employee's control. 2) Which of the following is an example of total time lost? a) Number of days off that an b) Number of scheduled days missed employee asks for c) Number of days missed d) Number of days perceived to be absent Reason: Total time lost is the number of scheduled days an employee misses. 3) Which of the following is used as an indirect estimate of voluntary absenteeism? a) Involuntary absenteeism b) Voluntary absenteeism c) Total time lost d) Absence frequency Reason: Absence frequency is the total number of distinct absence periods, regardless of duration. Voluntary absenteeism is absenteeism that is under the employee's control. Involuntary absenteeism is not under the employee's control. Total time lost is the number of scheduled days that the employee misses. 4) A nurse is chronically late for work. When questioned about her attendance, she states that she has unreliable transportation. This is known as which type of barrier? b) Voluntary a) Attendance c) Motivation d) Involuntary Reason: Attendance barriers can be personal illness, family responsibility, or transportation issues. 5) Which of the following may be considered an absenteeism management strategy? a) Constant meetings regarding b) Lessening advancement absenteeism opportunities d) Ignoring the situation c) Reducing job stress Reason: Decreasing job stress will lessen the need for sick days by fostering a successful work environment. Constant meetings regarding absenteeism, lessening advancement opportunities, and ignoring the situation may add to the job stress. 6) When looking at the issue surrounding absenteeism, an innovative approach would be: a) Rewarding those who do not use b) Substituting personal days. days. c) Termination. d) Disciplinary actions.

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Reason: Substituting personal days for sick days allows for proper planning by the nurse manager. 7) A nurse has a seriously ill parent and must take care of the parent at home. Which of the following would NOT be a suitable solution to this problem? (EXCEPT) a) Resignation b) FMLA c) Termination d) LOA Reason: FMLA provides up to 13 months of leave while securing an employees's job status. Termination, resignation, and LOA are not good solutions, because they do not secure job status. 8) Employees are eligible to take a leave of absence if they have worked: (EXCEPT) a) At least 1,250 hours during the b) At least 12 months. previous 12 months. d) At a work site with 50 employees/75 c) At least six months. miles rule. Reason: Employees are eligible to take a leave of absence if they have worked for the employer for at least 12 months, if they worked at least 1,250 hours during the previous 12 months, and are 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. 9) A nurse who is determined to have a substance abuse problem most likely will exhibit which of the following as a first sign that there is a problem? a) Avoidance b) Bargaining d) Regression c) Denial Reason: Denial is the primary symptom. 10) Constant reports of inadequate pain control in clients indicate which of the following? a) Improper administration of drugs b) Potential substance abuse by the employee c) Poorly written orders d) Improper scheduling by MDs Reason: Constant inadequate pain control may indicate that other substances are being given in place of narcotics.

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CHAPTER: 22 Preventing Workplace Violence 1) Nurse Managers work with staff to educate them about ways to diffuse potentially violent situations. Which of the following diagnoses can staff expect to be more frequently associated with violence? b) Anxiety a) Alcohol or drug withdrawal c) Depression d) Confusion Reason: Violence is associated with conditions that alter a person's inhibitions. Gilmore (2006) reports that working with the public includes inherent risks and stressors. In addition, individuals with head trauma, mental illnesses, and those withdrawing from substances are more likely to respond with violence. 2) Threatening behaviors can be observed before a person becomes violent. These behaviors may include: (EXCEPT) b) Tense shoulders and clenched fists. a) Wandering. c) Blank stare d) Positioned with one foot in back and an arm pulled back. Reason: Individuals exhibit changes in their demeanor and behaviors before an episode of violence takes place. DelBel (2003) suggests that relaxed body language, keeping a physical space of at least an arm's length distance, and silence to provide a calming effect are among the strategies that may positively influence an agitated person's response. 3) Factors that may contribute to workplace violence in a health care setting include: a) Lack of armed security. b) Continuous loud noises and/or poorly monitored entrances. c) Poor staff interactions. d) Tense shoulders and clenched fits Reason: Violence prevention includes self-awareness and awareness of the surroundings. Nursing staff can maintain a safe environment if they identify potential problems and report them to supervisors who will unsafe environments. 4) Verbal interventions with an agitated patient may be calming. These interventions include: a) Holding and reassuring the patient. b) Encouraging other staff to distract the patient. d) Standing close to the patient while c) Remaining calm and keeping an talking. arm's distance. Reason: Agitated individuals benefit from minimal verbal and physical stimulation. They respond to their environment based on how nurses interact with them. If an individual feels threatened or cornered, the response will generally be self

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protective and reactive. If an individual feels that the nurse is listening and not posing a threat, but rather is communicating in a calm, therapeutic manner, the agitated individual is less likely to verbally or physically strike out.

5) A visitor who is loud and active arrives on the unit where you are in charge. You notice that the visitor has a gun. You immediately: a) Ask the visitor to leave. b) Talk quietly to calm the visitor. c) Ask the visitor for the gun. d) Notify security with the details of the situation. Reason: Your responsibility as the professional is to protect patients and yourself. You are in a position to enlist support from other staff to close doors and provide protection to those for whom you care. Health care facilities employee trained security guards or police to disarm a violent individual. Professionals who give accurate, brief information to trained security guards so that they know what to expect when they arrive on the scene can be assured that a well thought out plan with minimal risk could be implemented. 6) After a violent incident, staff needs to discuss what occurred. Several actions need to be taken following the incident: b) Reassure the violent patient that a) Debrief the staff and complete hurting staff when ill is not cause for incident reports and Verify that all concern. staffs are safe d) Standing close to the patient while c) . Avoid any interactions. talking.

Reason: Violence is a reality in organizations. Professionals who are trained to assess the situation, develop and implement a planned intervention, and process the situation following the intervention are more likely to be harmed or to have others be harmed. Processing violent situations and interventions permits learning to take place and helps professionals know how to handle future incidents. 7) Staffs are sometimes injured when a patient or visitor becomes agitated. If a staff member reports an injury, the following actions should take place: (EXCEPT) a) Notify security. b) Complete incident report. d) Make certain that staff has been c) Notify the nursing supervisor. examined. Reason: Staff need to handle the incident and be certain to enlist support from others, follow appropriate protocols, and document the incident relative to patient care as well as from a legal perspective. If staff or patients are injured, documentation of the incident and what was observed is critical if there is an investigation. 8) Construction is occurring in the Emergency Department, with equipment and sharp items being used by the contractors. As the charge nurse, you are

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concerned that agitated patients might use the equipment as weapons and you meet with staff to: (EXCEPT) a) Notify the nursing supervisor. b) Notify security. c) Have them check patients to verify d) Ask construction workers to be safety. responsible. Reason: Construction in health care settings is common for new and renovated areas. With the increased incidence of violence in organizations, the equipment, materials, and supplies that construction workers bring to a facility can pose a risk to patients, staff, and visitors. 9) Staffs refuse to report unsafe conditions, with unattended entrances throughout the health care facility noted. Unidentified individuals are wandering the unit at night, and you: a) Establish expectations. b) Demand that they leave immediately. d) Observe their behaviors. c) Ask them to leave. Reason: Professional nurses need to be aware of their surroundings for their safety and the safety of patients and visitors. As patient advocates, nurses have the power to control the environment and assure that it is free from people who could pose a threat or be menacing. 10) From a unit perspective, disruptive and violent patient behavior may be distracting to patients and staff. As the nurse manager, you are concerned about: (EXCEPT) a) Patient and staff safety. b) Team tension. d) Stress levels. c) Fear of disappointment. Reason: Stressors on a unit create additional tension, which does not enhance relationship based care with patients. In addition, if staff is distracted by agitated patients, they are less likely to be able to focus on priorities, such as uninterrupted medication administration, documentation of patient care, and ensuring positive multi-professional team interactions.

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CHAPTER: 23 Handling Collective-Bargaining Issues 1) Which of the following is likely to facilitate union activity? a) Managers communicating b) Managers listening to concerns of effectively with employees employees d) Belief that supervisors are not c) Belief that low wages cause job understanding of unionizing dissatisfaction Reason: According to a study by Bilchik (2000), hospital administrators make their organizations more likely to unionize if they make three erroneous assumptions: that low wages cause the most job dissatisfaction, that supervisors understand how front-line employees think about unionizing, and that supervisors are ineffective in communicating with employees. 2) Choosing a person/unit to bargain on the group's behalf is known as: a) Labor negotiations. b) Bargaining. c) Establishing a union. d) Representation election. Reason: Representation election is the process of choosing someone to bargain on behalf of the group. 3) On a voting ballot, the persons who are to be elected during a vote are called: a) Representatives. b) Employees. d) Management authorities. c) Bargaining agents. Reason: The bargaining agent is the one who is to be elected during a vote. 4) Which of the following describes the ability to enter into a contract with an employer? b) Certification to represent a) Certification to contract c) Bargaining agreement d) Contract agreement Reason: Certification to contract is the process by which a union, certified by the NLRB as a bargaining agent, can enter into a contract with an employer that has been voted on by the union membership. 5) Which of the following describes the concept of ratification? a) Contract administration b) Contract passage c) Contract denial d) Contract reorganization

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Reason: Ratification is obtained by a simple majority of members who vote and pass the contract. 6) Which of the following best describes decertification? a) Encourage union affiliation b) Change union affiliation c) Reward union affiliation d) Empower union affiliation Reason: Decertification is the process of removal or changing of union affiliation.

7) The ANA is a registered labor organization, but it does not engage in direct __________ . a) Empower union affiliation b) Reward union affiliation c) Encourage union affiliation d) collective bargaining Reason: The American Nurses Association is a registered labor organization, but it does not engage in direct collective bargaining. The actual certification of units, negotiation of contracts, and administration of contracts is conducted by the state nurses associations (SNAs). 8) The main concern with collective bargaining is that it will: b) Reform health care. a) Create tension among nurses. c) Secure economic security. d) Unite the nurses. Reason: The concern is that the very processes of collective bargaining will separate rather than unite nurses, notably staff nurses and those in management. 9) A nurse does not agree with the statements made by a physician about performance. The nurse talks to the nurse manager. This is which step in the grievance process? b) Second a) First c) Third d) Fourth Reason: The first step in the process is to talk to the nurse manager. Step two involves a written appeal to the director of nursing or designee. Step three involves a meeting with the following: employee, agent, grievance chairperson, nursing administrator, and director of human resources. The final step of the grievance process is arbitration, which is invoked when none of the proposed solutions can be agreed to by individuals involved. 10) The nurse and nurse manager did not resolve the situation related to the physician's report about the nurse's performance. What is the length of time allowed for the nurse to submit an appeal? b) 15 days a) 10 days c) 20 days d) 30 days Reason: If informal discussion does not resolve the problem, a written appeal may be submitted within 10 days, according to the health care facility policy.

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CHAPTER: 24 Managing Stress 1) Which of the following behaviors would be an early warning sign that you are not handling job stress in a healthy way? a) Focusing on patient outcomes b) Needing to spend more time with staff c) Juggling work, studies, and family d) Awakening in the morning, not feeling rested Reason: Equilibrium between stress and the ability to cope must exist for an individual. Research by Selye (1978) reported evidence that the human body experiences wear and tear in response to stress, with negative consequences when the amount and intensity of the stress exceed the amount to which an individual can accommodate. 2) Your nurse manager talks with you once per week to determine how you are adjusting to your role as a new nurse. She asks if you feel that you are able to provide good care to your patients, whether you are becoming familiar with the electronic health record, and whether your preceptor is encouraging your independence. This manager is demonstrating: a) An intrusive style. b) An effort to understand if you are coping with the demands. c) An attempt to intimidate. d) An authoritarian style. Reason: Effective professionals benefit from self-awareness, as well as feedback from mentors and preceptors who have experience and insight about professional growth and adjustment to stress. 3) Horizontal violence may be observed among staff interactions and causes stress among staff. To minimize stress associated with such interactions, nurses can: (Select all that apply.) a) Encourage venting to as a way to b) Take control of the situation by express feelings. being assertive. c) Ignore staff who are volatile. d) Avoid interactions with angry staff. Reason: Relationships in an organization can be the source of stress if they are not respectful and professional. Nurses need to exert their professional power and

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get support from managers to promote a healthy work environment that is free from violence, bullying, and/or harassment. 4) Selye's stress theory explains that a person stressed for long periods of time will: b) Become fatigued and become a) Face exhaustion and be more stronger. susceptible to illnesses. c) Become more assertive. d) Safety needs. Reason: Individuals who have frequent, intense, hostile experiences will have a physical response to these stressors. As result, an individual is more likely to become physically and/or psychologically depleted, sometimes causing health problems. 5) A high-volume, noisy emergency room in an urban area with a high incidence of assault victims will affect staff in the following ways: (EXCEPT) a) Feelings of extreme overload. b) Fear of failure. c) A pessimistic sense about the world. d) Inability to separate intense work situations from personal situations. Reason: Constant noises and intense emotional situations create tension, stress, and negative reactions. Managers who work with staff to assess the environment, label situations, and debrief with staff can assist staff to be more aware of how stressors influence their behaviors. 6) As a new nurse on a pediatric unit, you must work nights and you have minimal time to spend with your children. Your colleague observes that you speak abruptly with parents and you become easily annoyed when the patients cry or when they are demanding. You realize you are becoming increasingly more distressed and that you have no time with your children and, as a result you: (Select all that apply.) a) Express negative comments to b) Ask the nurse manager to have a colleagues about patients and schedule with an equal number of parents who annoy you. day and night shifts so that you can be with your children. c) Call off sick as frequently as you d) Minimize your communication with can without violating policies so that patients and parents so you do not you have more time with your offend them. children. Reason: Minimize your communication with patients and parents so you do not offend them. 7) A charge nurse role has negatively affected your relationship with your friends and made you feel tense and isolated. You decide that you will delegate more time consuming tasks to staff who are not your friends, who then complain to your nurse manager about your perceived unfairness. You decide to: b) Not express your angry feelings. a) Talk with your friends individually to let them know that you will be

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assigning patients to all staff in an equitable manner. c) Talk about staff who are annoying d) Ignore your feelings of uncertainty, you with staff on other units. hoping they will diminish. Reason: Being aware of how a professional reacts to managerial styles, interpersonal relationships and to fairness influences a team's functioning and ultimately affects patient care. 8) You believe that you are working harder than other nurses and that you take care of patients that are more complex. You are angry that other staff nurses have less complex and lower acuity patients, but you __________ . a) Avoid discussing the situation b) Know that you need to discuss the because you do not want to be inequity with the nurse manager perceived as a complainer. because you are resenting the work and becoming more dissatisfied with your job. d) None of the above c) A & B Reason: Professionals communicate their views in a respectful and direct manner. In discussing the situation with the manager, professionals may gain insights about their reactions to stress and how they can cope with the intense demands of the health care environment. 9) As a staff nurse you know you are experiencing burnout because: (EXCEPT) b) Staff is questioning your clinical a) You are spending more time talking judgment. to staff on other units. c) You sleep longer hours, sometimes d) You are drinking alcohol more coming in late to work. frequently so that you can relax. Reason: Professionals display behaviors that are on a continuum from healthy to maladaptive. When behaviors indicate a change from professional standards, quality patient care, or suggest that a professional is using substances to cope or relax, these are indications that a professional is unable to cope with the frequency or intensity of stressors. Managers need to intervene and provide awareness with objective information about changes in the professional's behavior. 10) Effective strategies to become more resilient include: (EXCEPT) a) Exercising and avoiding high-fat b) Managing time effectively. foods. c) Becoming more self-aware. d) Deciding that your career is not your highest priority. Reason: Based on the results of Sherman's study (2004), nurses who are more aware of how to avoid burnout can effectively take care of themselves.

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CHAPTER: 25 Advancing Your Career 1) The health care organization where you plan to work has a nurse residency program. You identify that as a new nurse you would benefit most from: a) Avoiding challenging patient b) Relying on your clinical preceptor, assignments so that you can similar to your relationship with minimize the risk of making a your nurse faculty. mistake. d) Waiting to engage in evidencec) Establishing professional goals based practice projects. based on your clinical knowledge. Reason: Your goals and your interests will influence your decision as you take your first job. New graduates take into consideration learning opportunities, competency development, and clinical precepting, knowing that realistic goals will include prioritizing learning needs as a novice nurse. 2) What characteristics will you emphasize in a job interview that will positively influence the meeting? b) Avoiding challenging patient a) Patient diagnoses that are of assignments so that you can greatest interest. minimize the risk of making a mistake. c) Number of times you inserted a d) Your grades on your scholarly nasogastric tube. papers in nursing school. Reason: Within the practice setting, interviewers recognize that new graduates mature from novice to advanced beginner. Successes and recognition in nursing school provides evidence of motivation and interest in achieving, which are typically predictors of professional growth and success. 3) Characteristics that an interviewer will be most interested in when selecting a new staff will be: (EXCEPT)

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a) Your confidence in your clinical b) How many hours of overtime you skills. will work. c) Your ability to work as a team d) Your clinical competence. member. Reason: Clinical knowledge and interpersonal relationships are central to providing professional nursing care. Interviewers consider several factors when they talk to candidates for positions and they know that professional nursing requires knowledge and competencies on multiply levels. 4) Strategies to advance your career and opportunities available in your first job can coexist. Identify factors that will help you prioritize these opportunities to fulfill your goals. (Select all that apply.) b) Determine where can you make the a) Self-actualization OR Assess your highest salary. values and your lifestyle. c) Your ability to work as a team d) Ask friends what they believe will member. make you most professionally satisfied. Reason: Professional nurses who identify how they plan to accomplish goals and determine the meaning of their career find that they are more successful. They determine how they will become more knowledgeable clinically, apply evidence-based practice, and participate in decision making within the organization. 5) Successful professional nurses benefit from working with mentors. What mutually rewarding outcomes are realized in mentoring relationships? (EXCEPT) a) Instilling a sense of accomplishing a b) Assuming each others' meaningful effort characteristics c) Fostering an interdependent d) Promoting self-esteem relationship Reason: Professional nurses who seek mentoring relationships work with their mentors to gain objective feedback, guidance, and confidence. A mentoring relationship is critical when making job decisions, establishing goals, discussing professional judgment, considering ethical issues, and in determining challenges for growth. 6) You have been working at your job for 10 months and you decide that you can no longer tolerate the tension and stress between staff nurses and the laissez faire nurse manager who is not a leader. You decide to: a) Submit a resignation and leave b) Complain to staff about the nurse within 30 days. manager. d) Inform the chief nursing officer that c) Seek another position within the you are leaving and explain your health care organization and apply dissatisfaction with the lack of for a transfer. leadership.

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Reason: Professional decisions require thought and careful evaluation. Successful professionals select jobs where they find that their values and the values of the culture or unit are not the same. Careful consideration must be given to how and why a position was accepted/selected. Seeking advice from a mentor or counselor will provide insight and encourage a professional to consider different viewpoints. 7) Your values do not coincide with your colleagues. When you report for your shift on nights, staff is not responding to patient requests for pain medication. You are interested in being promoted and as your goal you are the nurse responsible for collecting data about patient quality of care, you: a) Explain to the nurse manager that b) Issue a memo to staff to assess quality problems are because of staff patients and document their apathy. response to the pain medication. c) Explain to staff that improving d) Schedule meetings to engage with quality is one of your annual goals staff to monitor pain management. and you expect them to follow through. Reason: Professionals use facts to persuade others to share their goals, particularly related to quality patient care. By enlisting support from staff, reviewing patient satisfaction data, and reviewing quality reports about pain management, you will be more likely to get support and change behaviors. 8) Within the fast paced, changing healthcare environment, job satisfaction will influence your success. What other characteristic is an asset? a) Being friendly b) Humility c) Ability to anticipate consequences d) Flexibility Reason: Shaffer (2006) supports the notion that nurses benefit from the courage to change. The ability to assess the environment and your reactions to changes will contribute to professional growth. 9) As part of Magnet Recognition, you are asked to present your evidence-based practice poster at a national conference. The health care facility supports your participation. Where would information about your participation in the conference need to be communicated? (Select all that apply.) a) In a communication to all staff b) At a conference within the health nurses to inspire them. care facility. c) In an email to a friend. d) In a presentation with select individuals. Reason: Presenting to internal and external audiences fosters growth, serves as role modeling, and promotes exemplar goals.

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