Test Bank for Leadership and Nursing Care Management 6th Edition Huber

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Chapter 11: Workplace Diversity Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. Which of these statements are true about culture? a. Culture remains consistent. ... b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion. ANS: C Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. “I don’t blame you. I don’t like lime Jell-O either.” b. “Tell me about your cultural beliefs to best help you.” c. “Why don’t you want to Neat tRhe lIimeGJelBl-O.?C” M d. “It is important for you to eUat sSo thNat yTou willOheal.” ANS: B The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that “we don’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Cultural diversity refers to the: a. variety of cultural or ethnic groups within a society. b. belief that one’s own culture is similar to another’s culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language. ANS: A Cultural diversity is defined by the Oxford Dictionary (“Cultural diversity,” 2016) as “The existence of a variety of cultural or ethnic groups within a society.” DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics ANS: D The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation’s racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non-Hispanic White population, fueled by both immigration and births. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese ANS: C Results from the 2010 census show that racial and ethnic minorities accounted for 91.7% of the nation’s growth since 200N0. MRosIt ofGthatBi.ncCreasMe, from 2000 to 2010 (56%), was due to Hispanics. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality ANS: A According to the World Health Organization (2016), “Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.” DIF: Cognitive Level: Remember (Knowledge) 7. Recognizing one’s own prejudices and learning about other people’s differences is the first step toward: a. cultural diversity. b. multicultural competence. c. social change. d. valuing. ANS: B To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? a. Avoiding the client as much as possible but providing care b. Identifying her biases but providing care c. Requesting another patient assignment d. Taking sick days while the patient is hospitalized ANS: B The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because oNf tUheRiSdeIaNthGatT“Bw.e CdoOnM’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Which of the following supports successful workplace diversity? a. Being a “devil’s advocate” b. Holding tight to one’s cultural values c. Respect for differences d. Withholding judgment of others ANS: C To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) 10. According to the National Healthcare Quality and Disparities Report, which group has worse access to health care in America, compared with Whites? a. Hispanics b. Asians c. Blacks d. American Indians ANS: A According to the 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2015), “Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location.” This study found that Blacks had worse access to health care than Whites for about half of measures of access, Hispanics had worse access to care than Whites for two-thirds of access measures, and Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction is known as: a. bias. b. diversity. c. culture d. stereotyping. ANS: B NURSINGTB.COM Culture refers to the variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. What is the most modifiable factor in the provision of equitable health care? a. Availability of services b. Socioeconomic status c. Care that is responsive to cultural needs d. Education level ANS: C Health inequities are directly related to the existence of historical and current discrimination and social injustice, and one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. When nurses portray an attitude that their cultural group is superior to another, it is known as practicing the concept of cultural: a. diversity. b. egocentrism. c. ethnocentrism. d. prejudice. ANS: C Ethnocentrism is characterized or based on an attitude that one’s own cultural group is superior to another. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A White nurse from the United States is assigned to care for a Vietnamese woman who speaks little English, had a baby 2 months ago, and is 1 day postoperative after fibroid removal. The nurse knows that traditional Vietnamese women will avoid drinking or eating “sour” foods such as lime Jell-O or other citrus types of liquids after surgery. She confirms her patient’s values and beliefs. The nurse is exhibiting characteristics of: a. cultural competence. b. ethnic sensitivity. c. stereotyping. d. nonjudgmental behavior. ANS: A NURSINGTB.COM To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 15. This generational cohort currently dominates the U.S. workforce. They have grown up with little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation. ANS: A The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce. They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation. ANS: B Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. A patient from the Philippines has been admitted to the ICU after a motor vehicle accident. The patient has a very large group of family and friends wanting to visit, hold vigils, and provide meals to the visitors and staff. This is an example of: a. inflexible attitude b. ambiguity c. ethnocentrism d. collectivism ANS: D Collectivism is a tightly knit NsocRietalIfraGmewBo.rkCwhMere people are integrated into cohesive and strong in-groups, often extended families, to look after them in exchange for unquestioning loyalty. Nurses from collectivist cultures tend to look to the team before taking action. The most collectivist culture on Hofstede’s scale is Guatemala at 6, China is 20, and the Philippines is 32. It’s not unusual with patients from collectivist cultures to have large groups of relatives and friends visit at the same time, which can create challenges for nursing staff to accommodate, especially in crowded shared rooms. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Eliminating can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided. a. diversity b. cultural incompetence c. health disparities d. miscommunication ANS: C Principles of eliminating racial and health disparities include providing insurance coverage and access to high-quality care, promoting a diverse health care workforce, delivering patient-centered care, maintaining accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improvement of quality of care. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Members of a generation who are linked through shared life experiences in their formative years are known as: a. baby boomers. b. generational markers. c. generation gaps. d. cohorts. ANS: D Generational groups are categorized into cohorts. These cohorts are members of a generation who are linked through shared life experiences in their formative years. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. A 17-year-old male has presented to the emergency department with appendicitis. He speaks English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctNorUpRroScIeeNdsGwTiBth.ouCt OobMtaining consent, he may face: a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims. ANS: D The National Center for Cultural Competence (n.d.a) noted that health professionals who lack cultural and linguistic competency can be found liable under tort principles in several areas such as treatment in the absence of informed consent. In addition, providers may be presumed negligent if an individual is unable to follow guidelines because they conflict with his or her beliefs and the provider neglected to identify and try to accommodate the beliefs. Additionally, if a provider proceeds with treatment or an intervention based on miscommunication due to poor quality language assistance, he or she and his or her organization may face increased civil liability exposure. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Culturally competent organizations benefit from meeting the diverse health care needs of the population it serves. What are the social benefits to the organization? (Select all that apply.) a. Increases mutual respect. b. Increases community participation. c. Meets regulatory guidelines. d. Assists patient and families in their care. e. Increases cost savings. ANS: A, B, D Becoming culturally competent has social, health, and business benefits for health care organizations, according to a report from the Equity of Care initiative and the American Hospital Association’s Health Research & Educational Trust and Hospitals in Pursuit of Excellence. Becoming a Culturally Competent Health Care Organization (Health Research & Educational Trust, 2013) outlined 16 benefits of organizations’ ability to meet the health care needs of patients with diverse backgrounds, grouped into three broad categories of social, health, and business benefits. Social benefits include increases mutual respect and understanding between patient and organization, increases trust, promotes inclusion of all community members, increases community participation and involvement in health issues, assists patients and families in their care, and promotes patient and families responsibilities for health. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. When communicating health information with diverse populations, miscommunication and misunderstanding can lead to: (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost. ANS: B, C, D, E NURSINGTB.COM The literature illustrates the vital role communication plays in avoiding cases of malpractice due to diagnostic and treatment errors. When communicating with culturally and linguistically diverse populations, the opportunity for miscommunication and misunderstanding increases, which subsequently increases the likelihood of errors. These errors, in turn, can cost millions of dollars in liability or malpractice claims. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. There are three major issues in cross-cultural communication. They are: (Select all that apply.) a. ambiguity. b. ethnocentrism. c. inflexible attitude. d. collectivism. e. negotiation. ANS: A, B, C Research shows that there are three major issues in cross-cultural communication: ambiguity, inflexible attitude, and ethnocentrism. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. In order to make a positive contribution to care of patients, it is critical that nurses recognize which of the following aspects of culture? (Select all that apply.) a. Culture of the clinician b. Culture of the patient and family c. Spiritual beliefs of the clinician d. Culture of co-workers e. Spiritual beliefs of the patient ANS: A, B, D In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with a multiplicity of cultures. They include the clinician’s own culture, the culture of the patient and patient’s family, the culture of co-workers, and the health care institution’s culture. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines.NURSINGTB.COM c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills. ANS: A, B, C Millennials have astonishing multitasking skills. They are problem solvers who grew up in a flourishing economy. Most enjoy the liberty of working on their own in a style that favors their work ethic. Millennials have learned that their presence is in demand. To thrive, they need clear definitions of outcomes, resources to do what needs to be done, and a deadline (Hendricks & Cope, 2013). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. The nurse manager of a nursing unit is a White, female working with a high percentage of Middle Eastern nursing staff. Which of these statements are true about the communication and leadership style of a low-context culture? (Select all that apply.) a. Rules are clear and tend to be followed. b. Low-context cultures require extensive, detailed explanations. c. Verbal communication is less explicit. d. Decisions are made in face-to-face conversations. e. Decisions are focused around tasks. ANS: A, B, E From a global perspective, the cultural context of the Western world is low context. In places such as North America and Western Europe, the explicit verbal or written message carries the meaning. Low-context cultures require extensive detailed explanations, information, and contracts because they are making up for the context that may be missing in a given situation. Decisions are focused around tasks and activities that need to be accomplished. Rules are very clear and tend to be followed precisely. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 15: Group Management for Effective Outcomes Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Active listening typically involves a. active participation and respect for the speaker. b. asking lots of questions. c. judging what is being said. d. agreeing with the speaker. ANS: A Active listening is allowing the speaker to express herself and the listener to listen with respect and without judgment. The other options are not an attribute of an active listening. DIF: Cognitive Level: Analysis REF: page 191 2. When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Strictly adhere to agenda. b. Establish goals and objectives. c. Make the meeting seem friendly. d. Provide snacks. ANS: B Establishing goals and objectives is important in keeping the meeting focused. The other options are not a guide to maNnaUgRinSg IgrNouGpTmBe.etCinOgsM. DIF: Cognitive Level: Application REF: page 192 3. When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Allow group to set agenda. b. Separate the group according to interests. c. Facilitate problem-solving. d. Coerce all members to interact. ANS: C Facilitating problem solving involves all members in an active way. The other options are not a guide to managing group meetings. DIF: Cognitive Level: Application REF: page 192 4. As a team leader, the charge nurse would incorporate which of the following into the meetings for greatest team input? a. Promote involvement of all members. b. Carefully use terms for problem solving. c. Coerce all members to participate. d. Use language with which the UAPs are unfamiliar. ANS: A Involving all members assists in the implementation of changes. The other options are not a guide for leading teams. DIF: Cognitive Level: Analysis REF: page 192 5. Attributes of effective teams include a. friendly interaction. b. respectful, consensus-building discussions. c. embarrassing and personal criticism. d. resentment toward other members. ANS: B Effective teams promote a respectful atmosphere for consensus building. The other options are not examples of an attribute of an effective team. DIF: Cognitive Level: Application REF: page 192 6. Attributes of ineffective teams include which of the following? a. Respectfully listening b. Consensus decision-making c. Leadership is owned by a few who make most of the decisions. d. Open discussion of disagreements ANS: C Ineffective teams have intimidating leaders who do not allow respectful, open consensus-driven decision-making. The other options are examples of an attribute of an effective team. N R I G B.C M DIF: Cognitive Level: Application REF: page 192 7. The challenges facing nurses today include which of the following? a. Stressed nurse managers b. Increased patient acuity c. Increased overtime d. Increased patient length of stay ANS: B Nurses must face increased patient acuity and workload. The other options are not sources for challenge. DIF: Cognitive Level: Application REF: page 161 8. Which of the following are included in the guidelines for valuable, effective acknowledgement of each member’s contribution to the team? a. Acknowledgments should be made privately to avoid embarrassing the person. b. Acknowledgments are best put into the minutes to be read at a later date. c. Acknowledgments are best made in public and recognized as sincere. d. Acknowledgments are not necessary; everyone recognizes what has been done. ANS: C Acknowledgments are most appreciated when sincere and made publicly for all to appreciate. The other options are not a good way to acknowledge a team member. DIF: Cognitive Level: Application REF: page 194 9. What does it mean to create a legend in the organization? a. A legend is to deify a person for his or her extraordinary actions. b. A legend separates one member from another. c. A legend creates an impossible example to duplicate. d. A legend is a means of recognizing and rewarding a job well done. ANS: D A legend is a means of rewarding an employee. The other options are not a reason for creating a legend. DIF: Cognitive Level: Analysis REF: page 194 10. Unique attributes of nurse managers when supervising staff include which of the following? a. Evaluate each worker as a team member b. Provide guidance and role modeling c. Stimulate workers to carry a heavy patient load d. Encourage staff to learn a second language so they can become interpreters ANS: B Orienting, teaching, and guiding are ways of promoting best performance. The other options will not improve performance. DIF: Cognitive Level: Application REF: pages 195-196 11. When leading a team, a highNperRformIingGleaBde.r Cis seMen as which type of leader? a. A problem-solver U S N T O b. Someone who identifies individual personnel problems c. Someone who identifies the causes of problems d. A problem identifier ANS: A High performers are defined as problem solvers. The people in the other options are not high performers. DIF: Cognitive Level: Application REF: page 196 12. When leading a team, a middle performing leader is seen as having which abilities? a. Loyalty to institution b. Acts as role model c. Always positive with fellow nurses d. Safe in all aspects of work ANS: A Middle performers are typically loyal to the institution and committed to improvement performance. The people in the other options are not middle performers and have performance needs for improvement. DIF: Cognitive Level: Application REF: page 196 13. When leading a team, a low performing leader is seen as having which abilities? a. A problem solver b. Identifies cause when identifying problem c. Communicates well with staff d. Solves problems once identified ANS: B Low performers seek blame for problems. The other options are not characteristics of a low performer. DIF: Cognitive Level: Application REF: page 196 14. Which of the following techniques should the manager use when talking with the low-performing employee? a. Reassure him that this conversation is not reflected in his evaluation. b. Compare her performance to that of the high-performer. c. Describe the observations and be sure he knows the consequences. d. Allow no explanations for her actions since she is so good at citing blame. ANS: C Accurate descriptions and consequences must be included in the conversation. The other options do not present a way of conversing with the low performer. DIF: Cognitive Level: Application REF: page 196 15. Guidelines for performance ratings should meet what criteria? a. Patient satisfaction comments b. Quantity of care c. Mastery of skills d. Behavioral expectations ANS: D NURSINGTB.COM Behavioral expectations are the primary evaluation component. The other options do not include evaluation components. DIF: Cognitive Level: Application REF: page 196 16. Peer reviews are frequently included in the overall employee performance appraisal. What values are attributed to the peer review? a. The nurse has the ability to evaluate based on personal knowledge of the employee's performance. b. Friendships can interfere with peer appraisals. c. Selection of peers for appraisals can be biased. d. Frequency of shared work may influence evaluation by peer. ANS: A When asked to submit peer evaluations, they should be selected on the basis of time actually shared in the work day/week. The other options are not an attribute of the peer evaluation method of appraisal. DIF: Cognitive Level: Analysis REF: page 197 17. Team players show many positive characteristics. Which of the following characteristics should be expected of a good team player when asked to participate in a continuing education class for the unit? a. “Sure, but my schedule is full right now.” b. “I did this last time. Let’s give someone else a chance.” c. “Sure, I will need to make some changes to my schedule.” d. “Sure. How about next month?” ANS: C Good team players adapt to the needs of the team to accomplish their goal. The other options are not characteristics of team players. DIF: Cognitive Level: Analysis REF: page 194 18. Which statement would one expect to hear at a team meeting in which members work cohesively? a. “Who has ideas about this?” b. “I think we have a solution.” c. “We are running out of time to discuss this today.” d. “We only want to hear positive ideas.” ANS: A Asking for solutions to problems is a productive characteristic of team building. The other options are destructive to team building. DIF: Cognitive Level: Analysis REF: pages 194-195 19. When organizing a group meNetinRg, wIhatGis aBn.imCpoMrtant consideration? a. Arranging the time of the meeting to be most convenient to leaders b. Seating according to seniority c. Starting and ending on time d. Addressing only the high performers ANS: C An organized meeting must have a specific start and end time and they must be adhered to. The other options are not productive for team meetings. DIF: Cognitive Level: Analysis REF: page 191 MULTIPLE RESPONSE 1. Teams are groups who must work cooperatively to achieve a goal. Which of the following would be considered part of a team on a typical nursing unit? (Select all that apply.) a. Staff nurse b. UAP c. Case manager d. Pharmacist e. Unit secretary f. Admission clerk ANS: A, B, C, D, E Options A, B, C, D, and E are employees who make up a group or team caring for the same patient in one way or another. The admission clerk is usually not involved in the care of the patient. DIF: Cognitive Level: Analysis REF: page 195 2. Which of the following are some of the qualities found in a team player? (Select all that apply.) a. Competence b. Dependability c. Enthusiasm d. Being on time e. Being friendly ANS: A, B, C A good team player would possess the qualities in options A, B, and C. Options D and E are not necessarily qualities found only in team players. DIF: Cognitive Level: Application REF: page 194 3. Smoothly functioning teams should possess which characteristics? (Select all that apply.) a. Everyone is on time for meetings. b. There is mutual trust. c. There is a sense of identity with the team. d. Everyone has the same objectives. e. The team works well together. ANS: A, B, C, E NURSINGTB.COM Well-functioning teams should possess the qualities in options A, B, C, and E. Having the same objectives is not a characteristic of well-functioning teams. DIF: Cognitive Level: Application REF: pages 191-192 4. Which of the following should be used to evaluate the staff’s performance when deciding high, middle, or low? (Select all that apply.) a. Never late b. Teamwork c. Communication d. Knowledge and competence e. Responsive to constructive criticism. ANS: B, C, D Options B, C, and D are areas for evaluation of work performance. Options A and E are not areas for evaluation. DIF: Cognitive Level: Analysis REF: page 197 Chapter 10: Power and Conflict Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to this request because of her great admiration for the vice president of nursing. This is an example of dimension of power. a. dependence b. relational c. subversive d. tactical ANS: B Relational dimension of power is a property of a social relationship. Many classic definitions indicate that power has to do with relationships between two or more actors in which the behavior of one is affected by the other. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A staff nurse frequently is providing positive comments to get the manager in a good mood before asking about additional vacation time. This influence tactic is known as: a. consultation. b. ingratiation. c. inspiration appeals. d. rational persuasion. ANS: B NURSINGTB.COM Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. ANS: D French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. ANS: A French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Subunit power is derived from: a. being independent within the organization. b. providing resources on which the organization most depends. c. supplying multiple cross-trainable functions within the organization. d. voicing unique opinions and values within the organization. ANS: B Subunit power is derived fromN pRroviIdingGresBo.urCcesMon which the organization most depends. Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A nursing manager is leading a recruitment and retention committee. She manages in a laissez-faire style. Her co-leader is a staff nurse who is very detail oriented. The nurse manager usually leads the meetings. During the meeting, the staff nurse frequently needs to interject information that has not been presented. She also creates the agenda and communicates information with other team members. This scenario depicts which type of conflict? a. Competitive b. Disruptive c. Organizational d. Task ANS: D Task conflict is an awareness of differences in viewpoints and opinions pertaining to a group task. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A hospital nurse manager is involved in conflict management between two staff members. The process of collaborating occurs when: a. one person seeks to satisfy his/her own interests. b. both sides strive to meet the interests of both parties. c. a person chooses to withdraw from conflict. d. one party seeks to appease the other. ANS: B Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Nurses derive much of their power from being: a. authority figures in emergent situations. b. central to the delivery of health care services. c. organized through public associations. d. the care coordinator of the health care team. ANS: B Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of moNst hRealIth cGare oBr.gaCnizaMtions, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. A well-known talk show host presents information to a congressional committee to garner support for cancer research. This type of power refers to power. a. coercive b. expert c. legitimate d. referent ANS: D Referent power is based on admiration for a person who has desirable resources or personal traits. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important. a. Assertiveness b. Ingratiation c. Rationality d. Upward appeal ANS: B Ingratiation means trying to make the other person feel important—giving praise or sympathizing. Ingratiation is attempting to advance oneself by trying to make another person feel important. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Subunit or power refers to relationships across departments. a. vertical b. organizational c. horizontal d. exertional ANS: C Subunit or horizontal power pertains to relationships across departments. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. A disagreement or differenceNs beRtweIen tGhe mBe.mCberMs of two or more groups over authority, territory, and resources is calleUd S NcoTnflict. O a. intragroup b. intergroup c. interpersonal d. intrapersonal ANS: B Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. is a personal quality that is admired in the person with referent power. a. Problem solving b. Authority c. Knowledge d. Coercive power ANS: A Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict. ANS: C Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization’s assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Nurses must use which of theNseUtRoSfaIciNliGtatTeBch.aCngOeMin health care organizations? (Select all that apply.) a. Actualization b. Authorization c. Influence d. Ratification e. Power ANS: C, E As the largest health care profession, nursing must use power and influence as a legitimate tool to facilitate change in health care organizations and the health care system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What are the consequences or outcomes of nurse empowerment? (Select all that apply.) a. Increased compensation and benefits b. Decreased burnout c. Decreased job strain d. Increased job satisfaction and work effectiveness e. Increased trust in the workplace ANS: B, C, D Rao (2012) summarized the consequences or outcomes of nurse empowerment as (1) the potential for improved nurse and patient outcomes, (2) decreased burnout, (3) decreased job strain, (4) increased trust in the workplace, and (5) increased job satisfaction and work effectiveness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine have assessed progress made on recommendations for the future of nursing. What are the recommendations for nurses? (Select all that apply.) a. Remove barriers to practice and care. b. Maintain current leadership roles. c. Promote diversity. d. Transform education. e. Improve data. ANS: A, D, E In 2014 the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division) to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing (IOM, 2010) and identify areas that should be emphasized over the next 5 years. This report outlines specific areas to accelerate implementation of the IOM recommendations for nurses: (1) removing barriers to practice and care, (2) transforming education, (3) collaborating and leading, (4) promoting diversity, and (5) improving data. NURSINGTB.COM DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following are the formal dimensions of power? (Select all that apply.) a. Social aspect b. Relational aspect c. Dependence aspect d. Independent aspect e. Sanctioning aspect ANS: B, C, E The three formal dimensions of power are the relational, dependence, and sanctioning aspects of power. The relational aspect of power suggests that power is a property of a social relationship. The dependency aspect of power suggests that power resides implicitly in the other’s dependency. The sanctioning aspect of power is the active component of the power relationship, referring to the direct manipulations of the other’s outcomes. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Empowerment for nurses may consist of three components. Which three of the following components may help nurses become empowered to use their power for better patient care? (Select all that apply.) a. A state in which a nurse has assumed control over his or her own practice b. A social relationship between two or more people c. A workplace that promotes opportunities for growth d. A nurse’s sense of meaning as expressed in values and work role e. Interdependence of personnel ANS: A, C, D Nurse empowerment was defined as a state in which an individual nurse has assumed control over his or her practice, enabling him or her to successfully fulfill professional nursing responsibilities within an organization. Organizational antecedents to nurse empowerment include the “opportunities for mobility and growth and access to resources, support, and information provided within the nurse’s work environment.” The organizational and individual antecedents lead to psychological empowerment, including a nurse’s sense of meaning as expressed in values and work role. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What are the two major content dimensions of power? (Select all that apply.) a. Influence b. Integrity c. Authority d. Dominance e. Control ANS: A, C NURSINGTB.COM Authority and influence are two major content dimensions of power. Influence, dominance, and control may occur in separate dimensions. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.) a. Connection power is based on the perception that the influencer has access to powerful people or groups. b. Legitimate power is based on fear. c. Expert power results from expertise, special skill, or knowledge. d. Information power refers to skill in making rational appeals. e. Referent power is based on admiration for a person. ANS: A, C, E Connection power is based on another’s perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following statements describe structural determinants of power within an organization? (Select all that apply.) a. Power is derived from independence. b. Power is derived from providing resources. c. Power is derived from certainty. d. Power is derived from being irreplaceable. e. Power is derived from the ability to affect the decision process. ANS: B, D, E The following are structural determinants of power within organizations: Power is derived from dependence; power is derived from providing resources; power is derived from coping with uncertainty; power is derived from being irreplaceable; power is derived from the ability to affect the decision process; and power is derived if there is a shared consensus within the organizational subunit. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Organizational change is associated with both direct and indirect costs for which leaders must be prepared. Which of the following are examples of indirect costs associated with conflict? (Select all that apply.) a. Loss of team morale b. Disrupted communication c. Disability or stress claimNs URSINGTB.COM d. Decreased management productivity related to time spent resolving conflict e. Loss of motivation for achieving team goals ANS: A, B, E Dysfunctional outcomes of conflict include development of discontent, reduced group effectiveness, disrupted communication, reduced group cohesiveness, and infighting among group members, which then overrides the focus on group goals. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The main effects of conflict are individual effects, interpersonal relationships, and organizational effects. What are some of the positive effects of conflict within an organization? (Select all that apply.) a. Absenteeism b. Team cohesiveness c. Disrupted communication d. Stimulation of creativity and innovation e. Improved quality of decisions ANS: B, D, E Positive outcomes of conflict include stronger relationships and team cohesiveness, stimulation of creativity and innovation, and improved quality of decisions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Negotiation is a form of conflict resolution. Which of the following terms are associated with negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining ANS: A, B, D Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). According to Knickle and colleagues (2012), the resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which of the following are faNcUtoRrsSthIaNt iGnfTluBen.cCe OthMe way conflict is handled within an organization? (Select all that apply.) a. Behavioral predispositions of individuals b. Bureaucratic hierarchy c. Social pressure in the environment d. Rules and procedures e. Position power ANS: A, C, D A structural model of conflict exists that examines four factors that seem to influence the way conflict is handled in organizations: behavioral predispositions of individuals, social pressure in the environment, the organization’s incentive structure, and rules and procedures. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: Group Management for Effective Outcomes Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Active listening typically involves a. active participation and respect for the speaker. b. asking lots of questions. c. judging what is being said. d. agreeing with the speaker. ANS: A Active listening is allowing the speaker to express herself and the listener to listen with respect and without judgment. The other options are not an attribute of an active listening. DIF: Cognitive Level: Analysis REF: page 191 2. When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Strictly adhere to agenda. b. Establish goals and objectives. c. Make the meeting seem friendly. d. Provide snacks. ANS: B Establishing goals and objectives is important in keeping the meeting focused. The other options are not a guide to maNnaUgRinSg IgrNouGpTmBe.etCinOgsM. DIF: Cognitive Level: Application REF: page 192 3. When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Allow group to set agenda. b. Separate the group according to interests. c. Facilitate problem-solving. d. Coerce all members to interact. ANS: C Facilitating problem solving involves all members in an active way. The other options are not a guide to managing group meetings. DIF: Cognitive Level: Application REF: page 192 4. As a team leader, the charge nurse would incorporate which of the following into the meetings for greatest team input? a. Promote involvement of all members. b. Carefully use terms for problem solving. c. Coerce all members to participate. d. Use language with which the UAPs are unfamiliar. ANS: A Involving all members assists in the implementation of changes. The other options are not a guide for leading teams. DIF: Cognitive Level: Analysis REF: page 192 5. Attributes of effective teams include a. friendly interaction. b. respectful, consensus-building discussions. c. embarrassing and personal criticism. d. resentment toward other members. ANS: B Effective teams promote a respectful atmosphere for consensus building. The other options are not examples of an attribute of an effective team. DIF: Cognitive Level: Application REF: page 192 6. Attributes of ineffective teams include which of the following? a. Respectfully listening b. Consensus decision-making c. Leadership is owned by a few who make most of the decisions. d. Open discussion of disagreements ANS: C Ineffective teams have intimidating leaders who do not allow respectful, open consensus-driven decision-making. The other options are examples of an attribute of an effective team. N R I G B.C M DIF: Cognitive Level: Application REF: page 192 7. The challenges facing nurses today include which of the following? a. Stressed nurse managers b. Increased patient acuity c. Increased overtime d. Increased patient length of stay ANS: B Nurses must face increased patient acuity and workload. The other options are not sources for challenge. DIF: Cognitive Level: Application REF: page 161 8. Which of the following are included in the guidelines for valuable, effective acknowledgement of each member’s contribution to the team? a. Acknowledgments should be made privately to avoid embarrassing the person. b. Acknowledgments are best put into the minutes to be read at a later date. c. Acknowledgments are best made in public and recognized as sincere. d. Acknowledgments are not necessary; everyone recognizes what has been done. ANS: C Acknowledgments are most appreciated when sincere and made publicly for all to appreciate. The other options are not a good way to acknowledge a team member. DIF: Cognitive Level: Application REF: page 194 9. What does it mean to create a legend in the organization? a. A legend is to deify a person for his or her extraordinary actions. b. A legend separates one member from another. c. A legend creates an impossible example to duplicate. d. A legend is a means of recognizing and rewarding a job well done. ANS: D A legend is a means of rewarding an employee. The other options are not a reason for creating a legend. DIF: Cognitive Level: Analysis REF: page 194 10. Unique attributes of nurse managers when supervising staff include which of the following? a. Evaluate each worker as a team member b. Provide guidance and role modeling c. Stimulate workers to carry a heavy patient load d. Encourage staff to learn a second language so they can become interpreters ANS: B Orienting, teaching, and guiding are ways of promoting best performance. The other options will not improve performance. DIF: Cognitive Level: Application REF: pages 195-196 11. When leading a team, a highNperRformIingGleaBde.r Cis seMen as which type of leader? a. A problem-solver U S N T O b. Someone who identifies individual personnel problems c. Someone who identifies the causes of problems d. A problem identifier ANS: A High performers are defined as problem solvers. The people in the other options are not high performers. DIF: Cognitive Level: Application REF: page 196 12. When leading a team, a middle performing leader is seen as having which abilities? a. Loyalty to institution b. Acts as role model c. Always positive with fellow nurses d. Safe in all aspects of work ANS: A Middle performers are typically loyal to the institution and committed to improvement performance. The people in the other options are not middle performers and have performance needs for improvement. DIF: Cognitive Level: Application REF: page 196 13. When leading a team, a low performing leader is seen as having which abilities? a. A problem solver b. Identifies cause when identifying problem c. Communicates well with staff d. Solves problems once identified ANS: B Low performers seek blame for problems. The other options are not characteristics of a low performer. DIF: Cognitive Level: Application REF: page 196 14. Which of the following techniques should the manager use when talking with the low-performing employee? a. Reassure him that this conversation is not reflected in his evaluation. b. Compare her performance to that of the high-performer. c. Describe the observations and be sure he knows the consequences. d. Allow no explanations for her actions since she is so good at citing blame. ANS: C Accurate descriptions and consequences must be included in the conversation. The other options do not present a way of conversing with the low performer. DIF: Cognitive Level: Application REF: page 196 15. Guidelines for performance ratings should meet what criteria? a. Patient satisfaction comments b. Quantity of care c. Mastery of skills d. Behavioral expectations ANS: D NURSINGTB.COM Behavioral expectations are the primary evaluation component. The other options do not include evaluation components. DIF: Cognitive Level: Application REF: page 196 16. Peer reviews are frequently included in the overall employee performance appraisal. What values are attributed to the peer review? a. The nurse has the ability to evaluate based on personal knowledge of the employee's performance. b. Friendships can interfere with peer appraisals. c. Selection of peers for appraisals can be biased. d. Frequency of shared work may influence evaluation by peer. ANS: A When asked to submit peer evaluations, they should be selected on the basis of time actually shared in the work day/week. The other options are not an attribute of the peer evaluation method of appraisal. DIF: Cognitive Level: Analysis REF: page 197 17. Team players show many positive characteristics. Which of the following characteristics should be expected of a good team player when asked to participate in a continuing education class for the unit? a. “Sure, but my schedule is full right now.” b. “I did this last time. Let’s give someone else a chance.” c. “Sure, I will need to make some changes to my schedule.” d. “Sure. How about next month?” ANS: C Good team players adapt to the needs of the team to accomplish their goal. The other options are not characteristics of team players. DIF: Cognitive Level: Analysis REF: page 194 18. Which statement would one expect to hear at a team meeting in which members work cohesively? a. “Who has ideas about this?” b. “I think we have a solution.” c. “We are running out of time to discuss this today.” d. “We only want to hear positive ideas.” ANS: A Asking for solutions to problems is a productive characteristic of team building. The other options are destructive to team building. DIF: Cognitive Level: Analysis REF: pages 194-195 19. When organizing a group meNetinRg, wIhatGis aBn.imCpoMrtant consideration? a. Arranging the time of the meeting to be most convenient to leaders b. Seating according to seniority c. Starting and ending on time d. Addressing only the high performers ANS: C An organized meeting must have a specific start and end time and they must be adhered to. The other options are not productive for team meetings. DIF: Cognitive Level: Analysis REF: page 191 MULTIPLE RESPONSE 1. Teams are groups who must work cooperatively to achieve a goal. Which of the following would be considered part of a team on a typical nursing unit? (Select all that apply.) a. Staff nurse b. UAP c. Case manager d. Pharmacist e. Unit secretary f. Admission clerk ANS: A, B, C, D, E Options A, B, C, D, and E are employees who make up a group or team caring for the same patient in one way or another. The admission clerk is usually not involved in the care of the patient. DIF: Cognitive Level: Analysis REF: page 195 2. Which of the following are some of the qualities found in a team player? (Select all that apply.) a. Competence b. Dependability c. Enthusiasm d. Being on time e. Being friendly ANS: A, B, C A good team player would possess the qualities in options A, B, and C. Options D and E are not necessarily qualities found only in team players. DIF: Cognitive Level: Application REF: page 194 3. Smoothly functioning teams should possess which characteristics? (Select all that apply.) a. Everyone is on time for meetings. b. There is mutual trust. c. There is a sense of identity with the team. d. Everyone has the same objectives. e. The team works well together. ANS: A, B, C, E NURSINGTB.COM Well-functioning teams should possess the qualities in options A, B, C, and E. Having the same objectives is not a characteristic of well-functioning teams. DIF: Cognitive Level: Application REF: pages 191-192 4. Which of the following should be used to evaluate the staff’s performance when deciding high, middle, or low? (Select all that apply.) a. Never late b. Teamwork c. Communication d. Knowledge and competence e. Responsive to constructive criticism. ANS: B, C, D Options B, C, and D are areas for evaluation of work performance. Options A and E are not areas for evaluation. DIF: Cognitive Level: Analysis REF: page 197 Chapter 09: Personnel Policies and Programs in the Workplace Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following is a risk factor for hospital workplace violence? a. Unlimited security coverage b. Public availability 24 hours a day c. Insecure medication access d. Semiprivate rooms ANS: B Unlimited public access, mixed with other risk factor, makes the hospital an unsafe workplace. The other option are not risk factors for violence. DIF: Cognitive Level: Analysis REF: pages 106-107 2. Family members who have access to hospitals may present risks to the staff when which of the following is most likely present? a. Family members are not doing well. b. Family members are in the intensive care unit. c. Family members are under the influence of drugs or alcohol. d. Family members are unable to visit regularly. ANS: C People under the influence of drugs or alcohol are more likely to be volatile and unpredictable. The other optiNonUsRarSeIinNcoGrTreBct.bCecOauMse these people are not as likely to present a problem. DIF: Cognitive Level: Application REF: page 111 3. Workplace violence can be initiated by an employee in the workplace as well as by patients or family members. Which of the following would be cause for concern when observed in an employee? a. Divorce b. Personality changes c. Death in the family d. Miscarriage ANS: B A change in personality may indicate substance abuse or mental health problems. The other options are not risk factors for employee violence. DIF: Cognitive Level: Analysis REF: page 111 4. In the workplace, violence may escalate as a result of many factors. Which of the following should the nurse be alert for in the escalation to violence? a. Crying b. Isolation c. Asking for help d. Pacing and using profanity ANS: D Pacing and use of profanity may be signs of escalation of anger to violence. The other options do not represent a sign of escalation to violence. DIF: Cognitive Level: Analysis REF: page 107 5. Universal strategies to use in the presence of escalation of a potential violent situation include which of the following? a. Demand that the potentially person back off. b. Remain close to the patient to protect her. c. Remain calm with a caring attitude. d. Speak loudly with authority. ANS: C Sometimes not reacting to the situation can calm the person down. Always present a caring attitude, not a threatening one. The other options are incorrect because they may cause the situation to escalate. DIF: Cognitive Level: Analysis REF: page 107 6. There are three steps to conflict management: determining the basis, analyzing the source, and conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? a. Food served b. Medication effects c. Ethical dilemmas d. Smoking withdrawal ANS: C NURSINGTB.COM Treatment decisions that cause ethical dilemmas are likely sources of conflict between patient, family, and health care providers. The other options represent annoyance but usually does not lead to violence. DIF: Cognitive Level: Analysis REF: pages 106-107 7. When determining the basis for conflict, interpersonal sources as the basis would include which of the following? a. Personality differences b. Shift preferences c. Staffing inconsistency d. Assignments ANS: A Personality differences are a source for interpersonal conflict. The other options are incorrect because they are an intrapersonal source of conflict. DIF: Cognitive Level: Application REF: page 107 8. When analyzing the sources for conflict, the nurse manager may identify which of the following as one of the most likely sources? a. Different attitudes b. Different facts or perception of the event c. Different incomes d. Different ages ANS: B The differences in the facts or perception of the facts of the event may be a source of the conflict. The other options are not usually the source of conflict. DIF: Cognitive Level: Analysis REF: page 108 9. Horizontal conflict in the workplace is observed with which of the following situations? a. Discussion with the manager before escalation occurs b. Refusing to work on day off c. Sharing views on patient care d. Withholding information that will undermine the ability to perform his job ANS: D Withholding of information that can affect one’s ability to perform professionally is a form of horizontal violence. The other options are not seen as part of horizontal conflict. DIF: Cognitive Level: Application REF: page 109 10. The AACN has addressed the issue of horizontal violence in the workplace and made recommendations for actions by the nurse manager. Which of the following are recommendations for action by the AACN against workplace horizontal violence? a. Develop a culture that does not tolerate violence. b. Report all incidences to uNppeRr mIanagGemBen.t.C M c. Separate the two people by not assigning them to work on the same shifts. d. Ask the two people to sit down and work it out. ANS: A If the workplace is intolerant of horizontal violence, staff will not participate in that form of conflict. The other options are not actions that should be taken by the manager. DIF: Cognitive Level: Application REF: page 109 11. What is a recommendation from the Occupational Health and Safety Administration for prevention of violence in the workplace? a. Assign different shifts. b. Provide training and education. c. Point out the issues to the people involved. d. Arrange for the people involved to meet and discuss the issues. ANS: B Providing training and education is one of the major recommendations by all organizations for intervening to prevent workplace violence. The other options are not recommendations of the organization. DIF: Cognitive Level: Analysis REF: page 110 12. What methods can administration use for the prevention of workplace violence? a. Separate staff entrance b. Staff ID badges c. Separate parking for staff d. Visual presence of security at all times ANS: B ID badges must be worn by all staff and temporary contract employees. The other options are not a form of administrative control. DIF: Cognitive Level: Application REF: page 110 13. Human resources is required to provide education on violence prevention and management, which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? a. Location of all monitoring equipment b. Schedule of security officers rounds c. Early recognition and response plan d. Identification of people most at risk for causing harm ANS: C The plan for employee early recognition and response to violent behavior is included in the orientation of new employees and annual skills day. The other options are not beneficial to the overall prevention plan. DIF: Cognitive Level: Application REF: page 111 14. Employees who are dependeNnt oRn drIugsGor aBlc.ohCol Mwill exhibit signs that should not be ignored by the nurse manager and colleagues. Which of the following signs would alert the nurse manager that the employee may have a dependency problem? a. Changes in behavior or appearance b. Requesting time off to be with a family member c. Scheduled overtime d. Dieting ANS: A Changes in behavior or appearance should alert the manager that something has changed in this employee and some type of intervention should occur. The other options are not a sign requiring follow-up for substance abuse. DIF: Cognitive Level: Application REF: page 111 15. A nurse is working the night shift with another RN who keeps disappearing without explanation. The nurse is caught napping in a patient’s room. What is the best action by the discovery nurse to take? a. Confront the nurse and ask what is wrong. b. Report the behavior to the vice president of nursing. c. Ask to not be scheduled on the same nights again. d. Report the behavior to the nurse manager. ANS: D The nurse must report this behavior to the nurse manager for further investigation. The other options do not address the legal issues of this behavior. DIF: Cognitive Level: Analysis REF: page 113 16. The nurse manager works regularly with a nurse who has recently gone through a custody battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems “giddy” and is acting inappropriately. The nurse manager understands that she must take which of the following actions? a. Counsel the nurse on these observations. b. Report this behavior to human resources and the state board of nursing. c. Give her the evening off. d. Work closely with her to prevent unsafe care to the patients. ANS: B The nurse manager can talk with the nurse and find out what is going on, but if substance abuse is suspected, it must be reported. The other options do not address mandatory reporting of these actions. DIF: Cognitive Level: Application REF: page 113 17. After reporting a nurse with a substance abuse problem to the State Board of Nursing (SBON), the next step that will most likely occur is a. surrender of license if complaint is found to be valid. b. counseling and then the nurse can return to work. c. the nurse is fired. N R I G B.C M d. the nurse is prevented fromUeveSr wNorkiTng as aOnurse again. ANS: A If the complaint is found valid by the SBON, the nurse will have to surrender her license and will be monitored by the SBON. The other options are not the process for dealing with these issues. DIF: Cognitive Level: Application REF: page 114 18. Most organizations provide assistance to employees with problems that can affect their work performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? a. Faith-based initiatives b. Free confidential employee assistance programs (EAPs) c. Fee-for-service private counseling d. The nurse manager fills this role in most institutions. ANS: B EAPs assist employees in many areas of their lives. Options A and C are not services offered by the institution. Option D is not a responsibility of the nurse manager. DIF: Cognitive Level: Application REF: page 114 19. The nurse working the night shift has concerns about the safety of the unit. What would cause security concerns for this nurse? a. A visitor is sleeping in the recliner in the room with their family member. b. A parent stays overnight with their teenage child. c. No unit secretary is assigned for the night shift. d. She is working with only one other employee. ANS: D Nurses working short staffed are at greater risk for violence from visitors or strangers in the hospital because they can easily be isolated from the other employee. The other options are not a cause for concern as long as sufficient staff is working. DIF: Cognitive Level: Application REF: page 110 20. A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What action is best for the nurse to take to protect herself? a. Call security and notify them of the threat. b. Ask security to escort you to your car. c. Explain to the visitor that you carry a gun. d. Assume that this was a joke. ANS: A Call security immediately whenever you feel threatened even if it has not been verbally stated. Option B is an incident that needs to be reported. Options C and D do not show good judgment. DIF: Cognitive Level: Analysis REF: page 110 21. A male nurse is working with female nurses on a unit. One of the female nurses is overheard talking about how cute the mNale RnursIe isG. ThBe.nuCrseMoverhearing this comment should be expected to do which of the following? a. Notify the nurse manager. b. Tell the male nurse that the female nurse was making inappropriate comments. c. Nothing, this is not harassment. d. Warn the nurse that the conversation was overheard. ANS: C Option C alone does not constitute harassment. The other options are incorrect because they are not appropriate. DIF: Cognitive Level: Application REF: pages 109-110 22. A student nurse is working with a preceptor who appears abrupt and disinterested in precepting students. What action by the student is most appropriate? a. Notify the instructor. b. Talk with the nurse to see what is wrong. c. Identify this as lateral violence. d. Nothing, he was having a bad day. ANS: A The instructor can approach the nurse and determine the next course of action. The other options are incorrect because the problem needs to be dealt with by the instructor, not by the student. DIF: Cognitive Level: Application REF: pages 107-108 23. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because it is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because it would be the responsibility of the charge nurse. DIF: Cognitive Level: Analysis REF: pages 107-108 24. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A Establishing objectives should be seen in the planning step following identification of the problem. Option B is the orgNanizRingIstepG. OBpt.ioCn CMis the directing step. Option D is the controlling step. DIF: Cognitive Level: Application REF: page 7 25. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit ANS: D Decision making is a result of the other steps. The other options are different steps in the management process. DIF: Cognitive Level: Application REF: page 7 26. First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds ANS: B Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other options are not specific to first-level managers. DIF: Cognitive Level: Application REF: page 7 27. Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not an exclusive responsibility of the middle-level manager. DIF: Cognitive Level: Application REF: page 7 28. Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B NURSINGTB.COM Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels. DIF: Cognitive Level: Application REF: page 7 29. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff. ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other activities may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills. DIF: Cognitive Level: Application REF: page 9 30. Which activity should be considered the highest priority by the RN? a. Assessment of a stable patient ready for discharge b. Administration of daily medications c. Administration of STAT medications d. Discharge teaching for a patient with heart failure ANS: C The STAT medications order is a priority because STAT means immediately. The other options do not take priority over a STAT order. DIF: Cognitive Level: Analysis REF: page 9 31. Which patient should be considered the highest priority by the nurse manager? a. A patient who attempts suicide b. A patient who attempts to escape from the hospital c. A patient who refuses to eat d. A patient who refuses her medications ANS: A The priority for the nurse manager is the attempted suicide of a patient. The options are not a priority. DIF: Cognitive Level: Analysis REF: page 7 32. Which patient should be considered the highest priority by the charge nurse? a. A patient who is complaining that no one answers his call light b. A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure c. A confused patient who is attempting to get out of bed d. A patient who is asking for help to the bathroom ANS: B NURSINGTB.COM This patient should be helped to decide against leaving the hospital until he is more stable. The other options are not a priority. DIF: Cognitive Level: Analysis REF: page 7 33. Which patient should be considered the highest priority by the new RN? a. A patient who is requesting his pain medication b. A patient who is reported by the UAP to be choking c. A patient who is requiring suctioning per tracheostomy d. A patient who is requiring discharge instructions who is waiting at the desk with her family ANS: B A patient who is reported by the UAP to be choking is the most unstable and should be seen first. A patient who is requiring suctioning per tracheostomy is not a priority. The patient needs to be suctioned but nothing given here indicates that this patient is more at risk than the patient who is choking, which must be assessed first. The other patients are not a priority. DIF: Cognitive Level: Analysis REF: page 169 34. Which of the following patients should the charge nurse admit to a room with a patient who is confused and incontinent of stool? a. A postoperative patient b. A patient with diabetes c. A patient who is going to surgery later today d. A patient from the cardiac catheterization lab who is going home in the morning ANS: D A patient from the cardiac cauterization lab who is going home in the morning is at the least risk for acquiring an infection from the exposure. The other patients are at high risk for acquiring an infection from the exposure. DIF: Cognitive Level: Application REF: page 169 35. The nurse manager receives a telephone call from an RN saying she will be late because of traffic due to an accident. The charge nurse needs to make arrangements for the care of that nurse’s team of patients until her arrival. What is the best action to take to ensure the management of those patients until the RN arrives? a. Distribute the patients evenly to each of the other nurses. b. The charge nurse will take the assignment until the RN’s arrival. c. Ask the nurse manager to assume care temporarily. d. Ask the night nurse to stay until the RN’s arrival. ANS: A The best action is to evenly distribute the patients so that no single nurse is overwhelmed and the charge nurse can continue to function in her role. The other actions would not provide for the best care to patients. DIF: Cognitive Level: Application REF: page 169 36. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed infNluenRza Iis coGmpBla.inCing Mof shortness of breath with an oxygen saturation of 88%. Which action by the RN is best? a. Increase the oxygen concentration. b. Ask respiratory therapy to administer an albuterol treatment. c. Notify the health care provider. d. Determine if anxiety could be causing the shortness of breath. ANS: B The respiratory therapist should administer a bronchodilator as the first action to assess the patient’s response before determining the next action. Increasing the oxygen concentration should be delayed until assessing any change after the bronchodilator administration. Notifying the health care provider should be delayed until assessing any change after the bronchodilator administration. Determining if anxiety could be causing the shortness of breath is probably not responsible for the change in condition. DIF: Cognitive Level: Analysis REF: page 169 37. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? a. Increase the oxygen concentration and recheck the saturation after 10 minutes. b. Obtain a 12-lead ECG. c. Notify the health care provider. d. Call the patient’s wife to have her sit with him to calm him. ANS: A Increasing the oxygen concentration will provide more oxygen to the tissues, but the saturation should be rechecked to determine effect. Obtaining a 12-lead ECG is appropriate as the next action but not before increasing the oxygen concentration. Notifying the health care provider is an appropriate step after answers A and B are instituted. Calling the patient’s wife is not a priority. DIF: Cognitive Level: Analysis REF: page 169 38. A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? a. Obtain a 12-lead ECG. b. Notify the health care provider. c. Call the patient’s wife to have her sit with him to calm him. d. Ask the UAP to obtain a blood glucose level. ANS: A Because this patient was admitted with an MI, evolution of the MI should be ruled out as the source of the shortness of breath. Notifying the health care provider should be taken after obtaining all the information necessary. The other options do not address the possible underlying problem. DIF: Cognitive Level: Analysis REF: page 169 N R I G B.C M 39. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? a. Call the patient’s wife to have her sit with him to calm him. b. Ask the UAP to obtain a blood glucose level. c. Call the Rapid Response Team. d. Ask the charge nurse to check on the other patients. ANS: C The Rapid Response Team (RRT) should be called to assess the patient’s condition. The other options do not address the cause of the change in condition. DIF: Cognitive Level: Analysis REF: page 169 40. Arrange in order of priority the nurse’s actions when a patient admitted with an elevated ST-segment myocardial infarction on droplet precautions and oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. 1. Call the rapid response team (RRT). 2. Obtain a chest radiograph. 3. Obtain a 12-lead ECG. 4. Initiate a bronchodilator nebulizer treatment. 5. Increase the oxygen concentration 2 L. 6. Repeat the oxygen saturation in 10 minutes. a. 5, 3, 2, 4, 6, 1 b. 1, 4, 2, 5, 6, 3 c. 4, 5, 6, 3, 1, 2 d. 5, 4, 3, 6, 2, 1 ANS: C The first step should be to try a bronchodilator first, then increase the oxygen concentration, repeat the oxygen saturation for changes, then obtain a 12-lead ECG to rule out evolving myocardial infarction, call the RRT for their consult, and then obtain a chest radiograph to see if that explains the change in condition. The other options do not present the steps in the correct order. DIF: Cognitive Level: Analysis REF: page 169 41. What step in the employment process may have been omitted when the staff appears to be nervous and overly cautious around a new nurse manager? a. Involvement of human resources in the interview process b. Involvement of the upper-level manager in the interview process c. Involvement of the staff in the interview process d. Involvement of the middle-level manager in the interview process ANS: B The upper-level manager may have been omitted from the process. Human resources must be involved in the employment process. Staff members would not intimidate the new employee. The middle-level manager is key in the process. DIF: Cognitive Level: Analysis REF: page 9 NURSINGTB.COM MULTIPLE RESPONSE 1. In an escalating situation, the nurse should observe certain rules to protect herself from violence. Which of the following are good rules to keep in mind if one is ever in a violent situation? (Select all that apply.) a. Remove yourself from the situation. b. Speak loudly with authority. c. Call for help. d. Do not allow the person to stand between you and the door. e. Stand in a corner against a wall. ANS: A, C, D Protecting yourself by removal from the situation is one of the best actions that can be taken. Protecting yourself by calling for help is one of the best actions that can be taken. Not allowing the person to come between you and safety is a good rule of thumb. Options B and E do not provide protection. DIF: Cognitive Level: Application REF: page 107 2. What are some tools available for the nurse manager to use for conflict resolution? (Select all that apply.) a. Prevention b. Negotiation c. Cooperation d. Resentment e. Rejection ANS: A, B, C Options A, B, and C are an approach to resolving conflict. The other options are not appropriate ways to resolve conflict. DIF: Cognitive Level: Analysis REF: page 108 3. What methods can the nurse manager use to address horizontal violence in the workplace? (Select all that apply.) a. Provide training to staff. b. Pick a side so that the assaults do not include you. c. Name the problem “horizontal violence.” d. Observe and analyze the culture of the workplace. e. Have the victim file a grievance. ANS: A, C, D Providing training for conflict resolution, calling it by name, and observing what is being said for yourself and then analyzing the culture for ways to prevent this behavior are methods the manager can use to address the issue. Options B and E are incorrect because they are not methods for conflict resolution that a nurse manager should use. DIF: Cognitive Level: Application REF: page 109 4. In what ways is the environment controlled by the hospital safety committee to prevent workplace violence? (Select Nall tRhat IappGly.)B.C M a. Emergency alarms b. Cameras and videos c. Assigned patrol for each unit d. Security provided for visitors in parking lots, etc. e. Respond only when called ANS: A, B, D Environmental controls include accessible alarms, monitoring systems, and access to security in areas of vulnerability. The other options are incorrect because they are not methods to prevent violence. DIF: Cognitive Level: Application REF: page 110 5. Personal and financial issues, as well as drugs or alcohol, can impair employees and can precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) a. Recent divorce b. Troubled adolescent c. Tremors of the hands d. House foreclosure e. Religious counseling ANS: B, C, D Options B, C, and D are symptom of someone under the influence of drugs and/or alcohol. Options A and E are not necessarily associated with drugs or alcohol impairment. DIF: Cognitive Level: Application REF: page 111 6. The role of the charge nurse is a relatively new role in nursing. What responsibilities would the nurse expect to see from the charge nurse? (Select all that apply.) a. Making daily patient care assignments b. Troubleshooting problems occurring during shift c. Providing coverage for breaks d. Taking turns floating to another unit e. Assisting staff as needed ANS: A, B, E Options A, B, and E are responsibilities of the charge nurse. Options C and D do not apply to the charge nurse. DIF: Cognitive Level: Application REF: page 9 NURSINGTB.COM Chapter 09: Personnel Policies and Programs in the Workplace Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following is a risk factor for hospital workplace violence? a. Unlimited security coverage b. Public availability 24 hours a day c. Insecure medication access d. Semiprivate rooms ANS: B Unlimited public access, mixed with other risk factor, makes the hospital an unsafe workplace. The other option are not risk factors for violence. DIF: Cognitive Level: Analysis REF: pages 106-107 2. Family members who have access to hospitals may present risks to the staff when which of the following is most likely present? a. Family members are not doing well. b. Family members are in the intensive care unit. c. Family members are under the influence of drugs or alcohol. d. Family members are unable to visit regularly. ANS: C People under the influence of drugs or alcohol are more likely to be volatile and unpredictable. The other optiNonUsRarSeIinNcoGrTreBct.bCecOauMse these people are not as likely to present a problem. DIF: Cognitive Level: Application REF: page 111 3. Workplace violence can be initiated by an employee in the workplace as well as by patients or family members. Which of the following would be cause for concern when observed in an employee? a. Divorce b. Personality changes c. Death in the family d. Miscarriage ANS: B A change in personality may indicate substance abuse or mental health problems. The other options are not risk factors for employee violence. DIF: Cognitive Level: Analysis REF: page 111 4. In the workplace, violence may escalate as a result of many factors. Which of the following should the nurse be alert for in the escalation to violence? a. Crying b. Isolation c. Asking for help d. Pacing and using profanity ANS: D Pacing and use of profanity may be signs of escalation of anger to violence. The other options do not represent a sign of escalation to violence. DIF: Cognitive Level: Analysis REF: page 107 5. Universal strategies to use in the presence of escalation of a potential violent situation include which of the following? a. Demand that the potentially person back off. b. Remain close to the patient to protect her. c. Remain calm with a caring attitude. d. Speak loudly with authority. ANS: C Sometimes not reacting to the situation can calm the person down. Always present a caring attitude, not a threatening one. The other options are incorrect because they may cause the situation to escalate. DIF: Cognitive Level: Analysis REF: page 107 6. There are three steps to conflict management: determining the basis, analyzing the source, and conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? a. Food served b. Medication effects c. Ethical dilemmas d. Smoking withdrawal ANS: C NURSINGTB.COM Treatment decisions that cause ethical dilemmas are likely sources of conflict between patient, family, and health care providers. The other options represent annoyance but usually does not lead to violence. DIF: Cognitive Level: Analysis REF: pages 106-107 7. When determining the basis for conflict, interpersonal sources as the basis would include which of the following? a. Personality differences b. Shift preferences c. Staffing inconsistency d. Assignments ANS: A Personality differences are a source for interpersonal conflict. The other options are incorrect because they are an intrapersonal source of conflict. DIF: Cognitive Level: Application REF: page 107 8. When analyzing the sources for conflict, the nurse manager may identify which of the following as one of the most likely sources? a. Different attitudes b. Different facts or perception of the event c. Different incomes d. Different ages ANS: B The differences in the facts or perception of the facts of the event may be a source of the conflict. The other options are not usually the source of conflict. DIF: Cognitive Level: Analysis REF: page 108 9. Horizontal conflict in the workplace is observed with which of the following situations? a. Discussion with the manager before escalation occurs b. Refusing to work on day off c. Sharing views on patient care d. Withholding information that will undermine the ability to perform his job ANS: D Withholding of information that can affect one’s ability to perform professionally is a form of horizontal violence. The other options are not seen as part of horizontal conflict. DIF: Cognitive Level: Application REF: page 109 10. The AACN has addressed the issue of horizontal violence in the workplace and made recommendations for actions by the nurse manager. Which of the following are recommendations for action by the AACN against workplace horizontal violence? a. Develop a culture that does not tolerate violence. b. Report all incidences to uNppeRr mIanagGemBen.t.C M c. Separate the two people by not assigning them to work on the same shifts. d. Ask the two people to sit down and work it out. ANS: A If the workplace is intolerant of horizontal violence, staff will not participate in that form of conflict. The other options are not actions that should be taken by the manager. DIF: Cognitive Level: Application REF: page 109 11. What is a recommendation from the Occupational Health and Safety Administration for prevention of violence in the workplace? a. Assign different shifts. b. Provide training and education. c. Point out the issues to the people involved. d. Arrange for the people involved to meet and discuss the issues. ANS: B Providing training and education is one of the major recommendations by all organizations for intervening to prevent workplace violence. The other options are not recommendations of the organization. DIF: Cognitive Level: Analysis REF: page 110 12. What methods can administration use for the prevention of workplace violence? a. Separate staff entrance b. Staff ID badges c. Separate parking for staff d. Visual presence of security at all times ANS: B ID badges must be worn by all staff and temporary contract employees. The other options are not a form of administrative control. DIF: Cognitive Level: Application REF: page 110 13. Human resources is required to provide education on violence prevention and management, which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? a. Location of all monitoring equipment b. Schedule of security officers rounds c. Early recognition and response plan d. Identification of people most at risk for causing harm ANS: C The plan for employee early recognition and response to violent behavior is included in the orientation of new employees and annual skills day. The other options are not beneficial to the overall prevention plan. DIF: Cognitive Level: Application REF: page 111 14. Employees who are dependeNnt oRn drIugsGor aBlc.ohCol Mwill exhibit signs that should not be ignored by the nurse manager and colleagues. Which of the following signs would alert the nurse manager that the employee may have a dependency problem? a. Changes in behavior or appearance b. Requesting time off to be with a family member c. Scheduled overtime d. Dieting ANS: A Changes in behavior or appearance should alert the manager that something has changed in this employee and some type of intervention should occur. The other options are not a sign requiring follow-up for substance abuse. DIF: Cognitive Level: Application REF: page 111 15. A nurse is working the night shift with another RN who keeps disappearing without explanation. The nurse is caught napping in a patient’s room. What is the best action by the discovery nurse to take? a. Confront the nurse and ask what is wrong. b. Report the behavior to the vice president of nursing. c. Ask to not be scheduled on the same nights again. d. Report the behavior to the nurse manager. ANS: D The nurse must report this behavior to the nurse manager for further investigation. The other options do not address the legal issues of this behavior. DIF: Cognitive Level: Analysis REF: page 113 16. The nurse manager works regularly with a nurse who has recently gone through a custody battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems “giddy” and is acting inappropriately. The nurse manager understands that she must take which of the following actions? a. Counsel the nurse on these observations. b. Report this behavior to human resources and the state board of nursing. c. Give her the evening off. d. Work closely with her to prevent unsafe care to the patients. ANS: B The nurse manager can talk with the nurse and find out what is going on, but if substance abuse is suspected, it must be reported. The other options do not address mandatory reporting of these actions. DIF: Cognitive Level: Application REF: page 113 17. After reporting a nurse with a substance abuse problem to the State Board of Nursing (SBON), the next step that will most likely occur is a. surrender of license if complaint is found to be valid. b. counseling and then the nurse can return to work. c. the nurse is fired. N R I G B.C M d. the nurse is prevented fromUeveSr wNorkiTng as aOnurse again. ANS: A If the complaint is found valid by the SBON, the nurse will have to surrender her license and will be monitored by the SBON. The other options are not the process for dealing with these issues. DIF: Cognitive Level: Application REF: page 114 18. Most organizations provide assistance to employees with problems that can affect their work performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? a. Faith-based initiatives b. Free confidential employee assistance programs (EAPs) c. Fee-for-service private counseling d. The nurse manager fills this role in most institutions. ANS: B EAPs assist employees in many areas of their lives. Options A and C are not services offered by the institution. Option D is not a responsibility of the nurse manager. DIF: Cognitive Level: Application REF: page 114 19. The nurse working the night shift has concerns about the safety of the unit. What would cause security concerns for this nurse? a. A visitor is sleeping in the recliner in the room with their family member. b. A parent stays overnight with their teenage child. c. No unit secretary is assigned for the night shift. d. She is working with only one other employee. ANS: D Nurses working short staffed are at greater risk for violence from visitors or strangers in the hospital because they can easily be isolated from the other employee. The other options are not a cause for concern as long as sufficient staff is working. DIF: Cognitive Level: Application REF: page 110 20. A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What action is best for the nurse to take to protect herself? a. Call security and notify them of the threat. b. Ask security to escort you to your car. c. Explain to the visitor that you carry a gun. d. Assume that this was a joke. ANS: A Call security immediately whenever you feel threatened even if it has not been verbally stated. Option B is an incident that needs to be reported. Options C and D do not show good judgment. DIF: Cognitive Level: Analysis REF: page 110 21. A male nurse is working with female nurses on a unit. One of the female nurses is overheard talking about how cute the mNale RnursIe isG. ThBe.nuCrseMoverhearing this comment should be expected to do which of the following? a. Notify the nurse manager. b. Tell the male nurse that the female nurse was making inappropriate comments. c. Nothing, this is not harassment. d. Warn the nurse that the conversation was overheard. ANS: C Option C alone does not constitute harassment. The other options are incorrect because they are not appropriate. DIF: Cognitive Level: Application REF: pages 109-110 22. A student nurse is working with a preceptor who appears abrupt and disinterested in precepting students. What action by the student is most appropriate? a. Notify the instructor. b. Talk with the nurse to see what is wrong. c. Identify this as lateral violence. d. Nothing, he was having a bad day. ANS: A The instructor can approach the nurse and determine the next course of action. The other options are incorrect because the problem needs to be dealt with by the instructor, not by the student. DIF: Cognitive Level: Application REF: pages 107-108 23. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because it is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because it would be the responsibility of the charge nurse. DIF: Cognitive Level: Analysis REF: pages 107-108 24. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A Establishing objectives should be seen in the planning step following identification of the problem. Option B is the orgNanizRingIstepG. OBpt.ioCn CMis the directing step. Option D is the controlling step. DIF: Cognitive Level: Application REF: page 7 25. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit ANS: D Decision making is a result of the other steps. The other options are different steps in the management process. DIF: Cognitive Level: Application REF: page 7 26. First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds ANS: B Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other options are not specific to first-level managers. DIF: Cognitive Level: Application REF: page 7 27. Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not an exclusive responsibility of the middle-level manager. DIF: Cognitive Level: Application REF: page 7 28. Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B NURSINGTB.COM Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels. DIF: Cognitive Level: Application REF: page 7 29. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff. ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other activities may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills. DIF: Cognitive Level: Application REF: page 9 30. Which activity should be considered the highest priority by the RN? a. Assessment of a stable patient ready for discharge b. Administration of daily medications c. Administration of STAT medications d. Discharge teaching for a patient with heart failure ANS: C The STAT medications order is a priority because STAT means immediately. The other options do not take priority over a STAT order. DIF: Cognitive Level: Analysis REF: page 9 31. Which patient should be considered the highest priority by the nurse manager? a. A patient who attempts suicide b. A patient who attempts to escape from the hospital c. A patient who refuses to eat d. A patient who refuses her medications ANS: A The priority for the nurse manager is the attempted suicide of a patient. The options are not a priority. DIF: Cognitive Level: Analysis REF: page 7 32. Which patient should be considered the highest priority by the charge nurse? a. A patient who is complaining that no one answers his call light b. A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure c. A confused patient who is attempting to get out of bed d. A patient who is asking for help to the bathroom ANS: B NURSINGTB.COM This patient should be helped to decide against leaving the hospital until he is more stable. The other options are not a priority. DIF: Cognitive Level: Analysis REF: page 7 33. Which patient should be considered the highest priority by the new RN? a. A patient who is requesting his pain medication b. A patient who is reported by the UAP to be choking c. A patient who is requiring suctioning per tracheostomy d. A patient who is requiring discharge instructions who is waiting at the desk with her family ANS: B A patient who is reported by the UAP to be choking is the most unstable and should be seen first. A patient who is requiring suctioning per tracheostomy is not a priority. The patient needs to be suctioned but nothing given here indicates that this patient is more at risk than the patient who is choking, which must be assessed first. The other patients are not a priority. DIF: Cognitive Level: Analysis REF: page 169 34. Which of the following patients should the charge nurse admit to a room with a patient who is confused and incontinent of stool? a. A postoperative patient b. A patient with diabetes c. A patient who is going to surgery later today d. A patient from the cardiac catheterization lab who is going home in the morning ANS: D A patient from the cardiac cauterization lab who is going home in the morning is at the least risk for acquiring an infection from the exposure. The other patients are at high risk for acquiring an infection from the exposure. DIF: Cognitive Level: Application REF: page 169 35. The nurse manager receives a telephone call from an RN saying she will be late because of traffic due to an accident. The charge nurse needs to make arrangements for the care of that nurse’s team of patients until her arrival. What is the best action to take to ensure the management of those patients until the RN arrives? a. Distribute the patients evenly to each of the other nurses. b. The charge nurse will take the assignment until the RN’s arrival. c. Ask the nurse manager to assume care temporarily. d. Ask the night nurse to stay until the RN’s arrival. ANS: A The best action is to evenly distribute the patients so that no single nurse is overwhelmed and the charge nurse can continue to function in her role. The other actions would not provide for the best care to patients. DIF: Cognitive Level: Application REF: page 169 36. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed infNluenRza Iis coGmpBla.inCing Mof shortness of breath with an oxygen saturation of 88%. Which action by the RN is best? a. Increase the oxygen concentration. b. Ask respiratory therapy to administer an albuterol treatment. c. Notify the health care provider. d. Determine if anxiety could be causing the shortness of breath. ANS: B The respiratory therapist should administer a bronchodilator as the first action to assess the patient’s response before determining the next action. Increasing the oxygen concentration should be delayed until assessing any change after the bronchodilator administration. Notifying the health care provider should be delayed until assessing any change after the bronchodilator administration. Determining if anxiety could be causing the shortness of breath is probably not responsible for the change in condition. DIF: Cognitive Level: Analysis REF: page 169 37. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? a. Increase the oxygen concentration and recheck the saturation after 10 minutes. b. Obtain a 12-lead ECG. c. Notify the health care provider. d. Call the patient’s wife to have her sit with him to calm him. ANS: A Increasing the oxygen concentration will provide more oxygen to the tissues, but the saturation should be rechecked to determine effect. Obtaining a 12-lead ECG is appropriate as the next action but not before increasing the oxygen concentration. Notifying the health care provider is an appropriate step after answers A and B are instituted. Calling the patient’s wife is not a priority. DIF: Cognitive Level: Analysis REF: page 169 38. A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? a. Obtain a 12-lead ECG. b. Notify the health care provider. c. Call the patient’s wife to have her sit with him to calm him. d. Ask the UAP to obtain a blood glucose level. ANS: A Because this patient was admitted with an MI, evolution of the MI should be ruled out as the source of the shortness of breath. Notifying the health care provider should be taken after obtaining all the information necessary. The other options do not address the possible underlying problem. DIF: Cognitive Level: Analysis REF: page 169 N R I G B.C M 39. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? a. Call the patient’s wife to have her sit with him to calm him. b. Ask the UAP to obtain a blood glucose level. c. Call the Rapid Response Team. d. Ask the charge nurse to check on the other patients. ANS: C The Rapid Response Team (RRT) should be called to assess the patient’s condition. The other options do not address the cause of the change in condition. DIF: Cognitive Level: Analysis REF: page 169 40. Arrange in order of priority the nurse’s actions when a patient admitted with an elevated ST-segment myocardial infarction on droplet precautions and oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. 1. Call the rapid response team (RRT). 2. Obtain a chest radiograph. 3. Obtain a 12-lead ECG. 4. Initiate a bronchodilator nebulizer treatment. 5. Increase the oxygen concentration 2 L. 6. Repeat the oxygen saturation in 10 minutes. a. 5, 3, 2, 4, 6, 1 b. 1, 4, 2, 5, 6, 3 c. 4, 5, 6, 3, 1, 2 d. 5, 4, 3, 6, 2, 1 ANS: C The first step should be to try a bronchodilator first, then increase the oxygen concentration, repeat the oxygen saturation for changes, then obtain a 12-lead ECG to rule out evolving myocardial infarction, call the RRT for their consult, and then obtain a chest radiograph to see if that explains the change in condition. The other options do not present the steps in the correct order. DIF: Cognitive Level: Analysis REF: page 169 41. What step in the employment process may have been omitted when the staff appears to be nervous and overly cautious around a new nurse manager? a. Involvement of human resources in the interview process b. Involvement of the upper-level manager in the interview process c. Involvement of the staff in the interview process d. Involvement of the middle-level manager in the interview process ANS: B The upper-level manager may have been omitted from the process. Human resources must be involved in the employment process. Staff members would not intimidate the new employee. The middle-level manager is key in the process. DIF: Cognitive Level: Analysis REF: page 9 NURSINGTB.COM MULTIPLE RESPONSE 1. In an escalating situation, the nurse should observe certain rules to protect herself from violence. Which of the following are good rules to keep in mind if one is ever in a violent situation? (Select all that apply.) a. Remove yourself from the situation. b. Speak loudly with authority. c. Call for help. d. Do not allow the person to stand between you and the door. e. Stand in a corner against a wall. ANS: A, C, D Protecting yourself by removal from the situation is one of the best actions that can be taken. Protecting yourself by calling for help is one of the best actions that can be taken. Not allowing the person to come between you and safety is a good rule of thumb. Options B and E do not provide protection. DIF: Cognitive Level: Application REF: page 107 2. What are some tools available for the nurse manager to use for conflict resolution? (Select all that apply.) a. Prevention b. Negotiation c. Cooperation d. Resentment e. Rejection ANS: A, B, C Options A, B, and C are an approach to resolving conflict. The other options are not appropriate ways to resolve conflict. DIF: Cognitive Level: Analysis REF: page 108 3. What methods can the nurse manager use to address horizontal violence in the workplace? (Select all that apply.) a. Provide training to staff. b. Pick a side so that the assaults do not include you. c. Name the problem “horizontal violence.” d. Observe and analyze the culture of the workplace. e. Have the victim file a grievance. ANS: A, C, D Providing training for conflict resolution, calling it by name, and observing what is being said for yourself and then analyzing the culture for ways to prevent this behavior are methods the manager can use to address the issue. Options B and E are incorrect because they are not methods for conflict resolution that a nurse manager should use. DIF: Cognitive Level: Application REF: page 109 4. In what ways is the environment controlled by the hospital safety committee to prevent workplace violence? (Select Nall tRhat IappGly.)B.C M a. Emergency alarms b. Cameras and videos c. Assigned patrol for each unit d. Security provided for visitors in parking lots, etc. e. Respond only when called ANS: A, B, D Environmental controls include accessible alarms, monitoring systems, and access to security in areas of vulnerability. The other options are incorrect because they are not methods to prevent violence. DIF: Cognitive Level: Application REF: page 110 5. Personal and financial issues, as well as drugs or alcohol, can impair employees and can precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) a. Recent divorce b. Troubled adolescent c. Tremors of the hands d. House foreclosure e. Religious counseling ANS: B, C, D Options B, C, and D are symptom of someone under the influence of drugs and/or alcohol. Options A and E are not necessarily associated with drugs or alcohol impairment. DIF: Cognitive Level: Application REF: page 111 6. The role of the charge nurse is a relatively new role in nursing. What responsibilities would the nurse expect to see from the charge nurse? (Select all that apply.) a. Making daily patient care assignments b. Troubleshooting problems occurring during shift c. Providing coverage for breaks d. Taking turns floating to another unit e. Assisting staff as needed ANS: A, B, E Options A, B, and E are responsibilities of the charge nurse. Options C and D do not apply to the charge nurse. DIF: Cognitive Level: Application REF: page 9 NURSINGTB.COM Chapter 08: Communication in the Work Environment Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively. Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. “Ambulate the patient the length of the hallway and get me if there are any problems.” b. “Have you ambulated this type of post-op patient before?” c. “Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication.” d. “This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable.” ANS: A Delegation requires thorough communication including specific instructions regarding task (“ambulate the length of the hallway”) and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions. DIF: Cognitive Level: Application REF: page 93 2. A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? a. “Dr. Smith, your patient, MUr. JSoneNs is TcomplaOining of a headache.” b. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache.” c. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” d. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” ANS: A This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching. DIF: Cognitive Level: Application REF: pages 95-97 3. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. “Can you step over here out of the hearing of the patients and family members?” b. ‘I’m sorry, you should have ordered restraints for the patient.” c. “We will accept all liability.” d. “My nurses are all new on the night shift. They didn’t know how to handle him.” ANS: A It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician. DIF: Cognitive Level: Application REF: page 99 4. To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. “I don’t need to review the new orders for accuracy.” b. “The orders will go directly to the appropriate departments.” c. “The risk for transcription errors is less.” d. “I am still responsible for communicating the changes to the appropriate care givers.” ANS: A Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions. DIF: Cognitive Level: Analysis REF: page 93 5. The end of shift report is vital for the coordination of patient care. Which of these statements would require an intervention if overheard by the charge nurse during report? a. “Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medicatioNn.” R I G B.C M b. “Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early.” c. “Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today.” d. “Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day.” ANS: D It illustrates the nurse making an inappropriate judgment regarding this patient’s anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention. DIF: Cognitive Level: Analysis REF: pages 95-96 6. Which of the following is an essential part of the shift report? a. Patient’s ECG rhythm b. Patient’s marital status c. Patient’s occupation d. Patient’s insurance status ANS: A The patient’s ECG rhythm is an essential part of the shift report. The other options may not always be appropriate to the shift report. DIF: Cognitive Level: Application REF: pages 95-96 7. Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing. ANS: A This question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question. DIF: Cognitive Level: Application REF: page 93 8. A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step. ANS: D If unfamiliar with the approvNed aRctioIns iGn a Bse.xuCal hMarassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case. DIF: Cognitive Level: Application REF: page 99 9. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician. ANS: B Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors. DIF: Cognitive Level: Application REF: page 93 10. Which of the following patients should be seen by the nurse first based on the information provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes. c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed. ANS: A This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment. DIF: Cognitive Level: Analysis REF: pages 95-96 11. Which response by the patient following discharge teaching would require further teaching? a. “I should weigh myself daily since I started on Lasix (furosemide) for my heart failure.” b. “I need to check my blood glucose after eating.” c. “I should take my Lanoxin (digoxin) with my morning medications.” d. “I need my blood checked frequently now that I am on Coumadin (warfarin).” ANS: B Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching. DIF: Cognitive Level: Analysis REF: page 98 12. Which exchange between the RN and the UAP requires intervention by the charge nurse? a. “Take the patient’s blood pressure every 15 minutes and inform me of the results.” b. “Check the patient’s blood glucose before breakfast and lunch and inform me of the results.” c. “Ambulate the patient in 2210 as far as he can walk.” d. “Shave the patient in 221N0.UHRisSbIeaNrGd Tis Blo.ngC.”OM ANS: C Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention. DIF: Cognitive Level: Application REF: page 95 13. Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day ANS: D This patient is unstable and requires urgent assessment. The other assessments can be delayed. DIF: Cognitive Level: Analysis REF: pages 95-98 14. A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most appropriate? a. “You can’t leave until all the baths are completed.” b. “Write down what needs to be completed.” c. “Tell me what responsibilities still need to be completed.” d. “Be sure to call by 5 AM if you are still sick tomorrow.” ANS: C Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care. Options B is not the most effective means of communication and does not allow for questions and feedback. DIF: Cognitive Level: Analysis REF: page 95 | pages 97-98 15. The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language. ANS: A The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives. DIF: Cognitive Level: Application REF: page 91 16. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient howNwRhat ItheyGsayBi.s CbeinMg interpreted. d. Complain to the physician. ANS: C Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication. DIF: Cognitive Level: Application REF: page 91 MULTIPLE RESPONSE 1. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication ANS: A, B, D, F In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation. DIF: Cognitive Level: Application REF: page 90 2. It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data ANS: A, C, D, F Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances. DIF: Cognitive Level: Application REF: page 96 3. SBAR is a convenient tool to use when notifying physicians of a change in patient condition. In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with casNe mURanSagIeNr GTB.COM c. Transferring patient d. Change of shift report e. Rapid response team (RRT) ANS: C, D, E Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR. DIF: Cognitive Level: Analysis REF: page 96 4. In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments ANS: B, C, D, E Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 5. Formal communication in health care is used to properly inform staff of (Select all that apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee. ANS: A, C Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication. DIF: Cognitive Level: Application REF: page 100 6. Informal (“grapevine”) communication in health care is used to properly inform staff of (Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. N R I G B.C M d. girl Scout cookie order pickU-upS. N T O e. termination of an employee. ANS: B, D, E Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment. Options A and C are examples of formal communication. DIF: Cognitive Level: Application REF: page 100 7. Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task. ANS: A, B, C Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated. DIF: Cognitive Level: Application REF: page 90 8. The end of shift report is the appropriate time to communicate (Select all that apply.) a. the frequency of which the call light was used. b. patient’s relationship to a staff member. c. new patient orders. d. impending procedures. e. evaluation of medication response. ANS: C, D, E Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 9. Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b. Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient’s family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered. ANS: A, C, F Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds. N R I G B.C M DIF: Cognitive Level: Application REF: page 95 | pages 97-98 Chapter 08: Communication in the Work Environment Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively. Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. “Ambulate the patient the length of the hallway and get me if there are any problems.” b. “Have you ambulated this type of post-op patient before?” c. “Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication.” d. “This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable.” ANS: A Delegation requires thorough communication including specific instructions regarding task (“ambulate the length of the hallway”) and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions. DIF: Cognitive Level: Application REF: page 93 2. A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? a. “Dr. Smith, your patient, MUr. JSoneNs is TcomplaOining of a headache.” b. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache.” c. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” d. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” ANS: A This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching. DIF: Cognitive Level: Application REF: pages 95-97 3. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. “Can you step over here out of the hearing of the patients and family members?” b. ‘I’m sorry, you should have ordered restraints for the patient.” c. “We will accept all liability.” d. “My nurses are all new on the night shift. They didn’t know how to handle him.” ANS: A It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician. DIF: Cognitive Level: Application REF: page 99 4. To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. “I don’t need to review the new orders for accuracy.” b. “The orders will go directly to the appropriate departments.” c. “The risk for transcription errors is less.” d. “I am still responsible for communicating the changes to the appropriate care givers.” ANS: A Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions. DIF: Cognitive Level: Analysis REF: page 93 5. The end of shift report is vital for the coordination of patient care. Which of these statements would require an intervention if overheard by the charge nurse during report? a. “Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medicatioNn.” R I G B.C M b. “Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early.” c. “Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today.” d. “Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day.” ANS: D It illustrates the nurse making an inappropriate judgment regarding this patient’s anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention. DIF: Cognitive Level: Analysis REF: pages 95-96 6. Which of the following is an essential part of the shift report? a. Patient’s ECG rhythm b. Patient’s marital status c. Patient’s occupation d. Patient’s insurance status ANS: A The patient’s ECG rhythm is an essential part of the shift report. The other options may not always be appropriate to the shift report. DIF: Cognitive Level: Application REF: pages 95-96 7. Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing. ANS: A This question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question. DIF: Cognitive Level: Application REF: page 93 8. A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step. ANS: D If unfamiliar with the approvNed aRctioIns iGn a Bse.xuCal hMarassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case. DIF: Cognitive Level: Application REF: page 99 9. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician. ANS: B Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors. DIF: Cognitive Level: Application REF: page 93 10. Which of the following patients should be seen by the nurse first based on the information provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes. c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed. ANS: A This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment. DIF: Cognitive Level: Analysis REF: pages 95-96 11. Which response by the patient following discharge teaching would require further teaching? a. “I should weigh myself daily since I started on Lasix (furosemide) for my heart failure.” b. “I need to check my blood glucose after eating.” c. “I should take my Lanoxin (digoxin) with my morning medications.” d. “I need my blood checked frequently now that I am on Coumadin (warfarin).” ANS: B Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching. DIF: Cognitive Level: Analysis REF: page 98 12. Which exchange between the RN and the UAP requires intervention by the charge nurse? a. “Take the patient’s blood pressure every 15 minutes and inform me of the results.” b. “Check the patient’s blood glucose before breakfast and lunch and inform me of the results.” c. “Ambulate the patient in 2210 as far as he can walk.” d. “Shave the patient in 221N0.UHRisSbIeaNrGd Tis Blo.ngC.”OM ANS: C Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention. DIF: Cognitive Level: Application REF: page 95 13. Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day ANS: D This patient is unstable and requires urgent assessment. The other assessments can be delayed. DIF: Cognitive Level: Analysis REF: pages 95-98 14. A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most appropriate? a. “You can’t leave until all the baths are completed.” b. “Write down what needs to be completed.” c. “Tell me what responsibilities still need to be completed.” d. “Be sure to call by 5 AM if you are still sick tomorrow.” ANS: C Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care. Options B is not the most effective means of communication and does not allow for questions and feedback. DIF: Cognitive Level: Analysis REF: page 95 | pages 97-98 15. The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language. ANS: A The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives. DIF: Cognitive Level: Application REF: page 91 16. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient howNwRhat ItheyGsayBi.s CbeinMg interpreted. d. Complain to the physician. ANS: C Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication. DIF: Cognitive Level: Application REF: page 91 MULTIPLE RESPONSE 1. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication ANS: A, B, D, F In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation. DIF: Cognitive Level: Application REF: page 90 2. It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data ANS: A, C, D, F Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances. DIF: Cognitive Level: Application REF: page 96 3. SBAR is a convenient tool to use when notifying physicians of a change in patient condition. In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with casNe mURanSagIeNr GTB.COM c. Transferring patient d. Change of shift report e. Rapid response team (RRT) ANS: C, D, E Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR. DIF: Cognitive Level: Analysis REF: page 96 4. In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments ANS: B, C, D, E Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 5. Formal communication in health care is used to properly inform staff of (Select all that apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee. ANS: A, C Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication. DIF: Cognitive Level: Application REF: page 100 6. Informal (“grapevine”) communication in health care is used to properly inform staff of (Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. N R I G B.C M d. girl Scout cookie order pickU-upS. N T O e. termination of an employee. ANS: B, D, E Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment. Options A and C are examples of formal communication. DIF: Cognitive Level: Application REF: page 100 7. Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task. ANS: A, B, C Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated. DIF: Cognitive Level: Application REF: page 90 8. The end of shift report is the appropriate time to communicate (Select all that apply.) a. the frequency of which the call light was used. b. patient’s relationship to a staff member. c. new patient orders. d. impending procedures. e. evaluation of medication response. ANS: C, D, E Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 9. Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b. Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient’s family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered. ANS: A, C, F Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds. N R I G B.C M DIF: Cognitive Level: Application REF: page 95 | pages 97-98 Chapter 08: Communication in the Work Environment Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively. Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. “Ambulate the patient the length of the hallway and get me if there are any problems.” b. “Have you ambulated this type of post-op patient before?” c. “Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication.” d. “This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable.” ANS: A Delegation requires thorough communication including specific instructions regarding task (“ambulate the length of the hallway”) and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions. DIF: Cognitive Level: Application REF: page 93 2. A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? a. “Dr. Smith, your patient, MUr. JSoneNs is TcomplaOining of a headache.” b. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache.” c. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” d. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” ANS: A This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching. DIF: Cognitive Level: Application REF: pages 95-97 3. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. “Can you step over here out of the hearing of the patients and family members?” b. ‘I’m sorry, you should have ordered restraints for the patient.” c. “We will accept all liability.” d. “My nurses are all new on the night shift. They didn’t know how to handle him.” ANS: A It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician. DIF: Cognitive Level: Application REF: page 99 4. To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. “I don’t need to review the new orders for accuracy.” b. “The orders will go directly to the appropriate departments.” c. “The risk for transcription errors is less.” d. “I am still responsible for communicating the changes to the appropriate care givers.” ANS: A Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions. DIF: Cognitive Level: Analysis REF: page 93 5. The end of shift report is vital for the coordination of patient care. Which of these statements would require an intervention if overheard by the charge nurse during report? a. “Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medicatioNn.” R I G B.C M b. “Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early.” c. “Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today.” d. “Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day.” ANS: D It illustrates the nurse making an inappropriate judgment regarding this patient’s anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention. DIF: Cognitive Level: Analysis REF: pages 95-96 6. Which of the following is an essential part of the shift report? a. Patient’s ECG rhythm b. Patient’s marital status c. Patient’s occupation d. Patient’s insurance status ANS: A The patient’s ECG rhythm is an essential part of the shift report. The other options may not always be appropriate to the shift report. DIF: Cognitive Level: Application REF: pages 95-96 7. Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing. ANS: A This question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question. DIF: Cognitive Level: Application REF: page 93 8. A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step. ANS: D If unfamiliar with the approvNed aRctioIns iGn a Bse.xuCal hMarassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case. DIF: Cognitive Level: Application REF: page 99 9. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician. ANS: B Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors. DIF: Cognitive Level: Application REF: page 93 10. Which of the following patients should be seen by the nurse first based on the information provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes. c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed. ANS: A This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment. DIF: Cognitive Level: Analysis REF: pages 95-96 11. Which response by the patient following discharge teaching would require further teaching? a. “I should weigh myself daily since I started on Lasix (furosemide) for my heart failure.” b. “I need to check my blood glucose after eating.” c. “I should take my Lanoxin (digoxin) with my morning medications.” d. “I need my blood checked frequently now that I am on Coumadin (warfarin).” ANS: B Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching. DIF: Cognitive Level: Analysis REF: page 98 12. Which exchange between the RN and the UAP requires intervention by the charge nurse? a. “Take the patient’s blood pressure every 15 minutes and inform me of the results.” b. “Check the patient’s blood glucose before breakfast and lunch and inform me of the results.” c. “Ambulate the patient in 2210 as far as he can walk.” d. “Shave the patient in 221N0.UHRisSbIeaNrGd Tis Blo.ngC.”OM ANS: C Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention. DIF: Cognitive Level: Application REF: page 95 13. Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day ANS: D This patient is unstable and requires urgent assessment. The other assessments can be delayed. DIF: Cognitive Level: Analysis REF: pages 95-98 14. A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most appropriate? a. “You can’t leave until all the baths are completed.” b. “Write down what needs to be completed.” c. “Tell me what responsibilities still need to be completed.” d. “Be sure to call by 5 AM if you are still sick tomorrow.” ANS: C Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care. Options B is not the most effective means of communication and does not allow for questions and feedback. DIF: Cognitive Level: Analysis REF: page 95 | pages 97-98 15. The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language. ANS: A The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives. DIF: Cognitive Level: Application REF: page 91 16. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient howNwRhat ItheyGsayBi.s CbeinMg interpreted. d. Complain to the physician. ANS: C Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication. DIF: Cognitive Level: Application REF: page 91 MULTIPLE RESPONSE 1. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication ANS: A, B, D, F In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation. DIF: Cognitive Level: Application REF: page 90 2. It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data ANS: A, C, D, F Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances. DIF: Cognitive Level: Application REF: page 96 3. SBAR is a convenient tool to use when notifying physicians of a change in patient condition. In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with casNe mURanSagIeNr GTB.COM c. Transferring patient d. Change of shift report e. Rapid response team (RRT) ANS: C, D, E Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR. DIF: Cognitive Level: Analysis REF: page 96 4. In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments ANS: B, C, D, E Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 5. Formal communication in health care is used to properly inform staff of (Select all that apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee. ANS: A, C Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication. DIF: Cognitive Level: Application REF: page 100 6. Informal (“grapevine”) communication in health care is used to properly inform staff of (Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. N R I G B.C M d. girl Scout cookie order pickU-upS. N T O e. termination of an employee. ANS: B, D, E Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment. Options A and C are examples of formal communication. DIF: Cognitive Level: Application REF: page 100 7. Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task. ANS: A, B, C Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated. DIF: Cognitive Level: Application REF: page 90 8. The end of shift report is the appropriate time to communicate (Select all that apply.) a. the frequency of which the call light was used. b. patient’s relationship to a staff member. c. new patient orders. d. impending procedures. e. evaluation of medication response. ANS: C, D, E Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 9. Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b. Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient’s family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered. ANS: A, C, F Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds. N R I G B.C M DIF: Cognitive Level: Application REF: page 95 | pages 97-98 Chapter 13: Delegation of Nursing Tasks Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following delegations by the RN would require an immediate intervention by the charge RN? a. A UAP checks a diabetic patient’s blood glucose level. b. An LPN assesses a patient after a fall. c. The charge nurse makes changes to the assignments after staff is “pulled” to another area. d. An RN assists with administering medication to another nurse’s patients during a code. ANS: B It is not within the scope of practice of the LPN to assess an unstable patient and thus it would require an immediate intervention. Only RNs can assess an unstable patient. The other actions are appropriate delegation and therefore do not require intervention. DIF: Cognitive Level: Analysis REF: page 163 2. Which of the following delegations by the RN would require an immediate intervention by the charge RN? a. An LPN administers IVP Lasix (furosemide) to a patient in heart failure. b. An RN administers IVP Lasix (furosemide) to a patient in heart failure. c. An LPN obtains a blood glucose level on a diabetic patient. d. An RN obtains a blood gluUcoseSlevNel oTn a diabOetic patient. ANS: A It is not within the scope of practice for LPNs to administer IV medication and therefore would require an intervention. The other options are appropriate delegation and therefore do not require intervention. DIF: Cognitive Level: Analysis REF: pages 165-167 3. Which of the following delegations require an immediate intervention by the charge RN? a. A UAP ambulates a patient 24 hours after a cardiac catheterization. b. A UAP ambulates a patient 24 hours after a bronchoscopy. c. A UAP ambulates a patient 24 hours after a pneumonectomy. d. A UAP ambulates a patient 24 hours after an echocardiogram. ANS: C Ambulation for the first time after major surgery requires an assessment by an RN and thus this would require an intervention. The other options are appropriate delegation and therefore do not require intervention. DIF: Cognitive Level: Analysis REF: pages 161-162 4. Which of the following delegations by the RN would require an immediate intervention by the charge RN? a. A UAP removes the wrist restraints on a patient and provides ROM exercises when giving a bath. b. An LPN assists a patient back to bed from the bathroom. c. A UAP replaces the monitor electrodes on a patient after he has taken a shower. d. An LPN assesses LOC on a stable patient 3 days after surgery. ANS: C Replacement of electrodes requires an assessment and is not within the scope of practice of the UAP and would require an intervention. The other delegations are appropriate delegation and therefore do not require intervention. DIF: Cognitive Level: Analysis REF: pages 165-167 5. A UAP is asked to take a patient’s temperature every 4 hours and report that temperature to the RN. Which best demonstrates the correct interpretation of right communication? a. The UAP takes the temperature for the patient every 4 hours. b. The UAP charts the temperature for the patient every 4 hours. c. The UAP reports that the patient has been afebrile all day. d. The UAP reports the temperature for the patient every 4 hours. ANS: D The UAP has correctly interpreted the delegation and has appropriately acted. The other options are incorrect because they demonstrate an incorrect interpretation of the delegation. DIF: Cognitive Level: Analysis REF: page 165 6. A patient turns his call light on and states, “I’m having trouble breathing.” Which team members should be delegatedNtUo RreSspIoNndGtTo Bth.isCcOallMlight? b. LPN c. Senior student nurse d. UAP ANS: A Correct delegation is the RN because this patient requires an assessment to determine the cause of his difficulty breathing and the appropriate action for the nurse to take. The other team members are not within the staff member’s scope of practice to assess unstable patients. DIF: Cognitive Level: Application REF: pages 162-163 7. A patient turns his call light on and requests someone to help him ambulate. The senior student nurse has been caring for this patient for 2 days but has only helped him to a chair in the past. Which instructions should be given to the student prior to ambulation of the patient? a. “The patient has been ambulated before but still requires some assistance.” b. “The patient has been ambulated before but is only able to walk with supervision and a walker.” c. “The patient is only able to walk with a walker for the length of the hallway.” d. “The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).” ANS: D Proper delegation includes specifics about the task and the possible adverse effects and what to do about them should they occur. This answer provides all of the components for good delegation. The other options do not include specifics regarding adverse effects of the task or what should be done if they occur. DIF: Cognitive Level: Application REF: page 163 8. The charge nurse in the ICU receives a call from the ED. They have three patients who require a bed. Which patient should be transferred first? a. A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention b. A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion c. A patient in sickle cell crisis with a PCA pump to manage his pain d. A patient in DKA for new-onset diabetes mellitus ANS: B This patient is the least stable and will require the most assessment due to titration of the nitroglycerin drip. The other options are incorrect because although the patient requires assessments once on the unit, he or she is currently stable and can wait until a bed is available. DIF: Cognitive Level: Analysis REF: page 166 9. The nurse and UAP are working together with four patients. Which patient should the nurse assign the UAP? a. A patient waiting for discharge instructions before going home b. A patient who received morphine 20 minutes ago and now has the call light on c. A patient with diabetes whUo neSedsNherTblood gOlucose checked d. A patient returning from a bronchoscopy ANS: C It is within the UAP’s scope of practice to check blood glucose levels on a diabetic patient. Options A and B are incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed. Option D is incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed. DIF: Cognitive Level: Application REF: page 166 10. When incorporating the five rights of delegation, the right person is being used in which of the following situations? a. The LPN initiates TPN to a patient as ordered. b. The charge nurse designates a UAP to “float” to another unit. c. The staff nurse trades weekends with another staff nurse. d. The UAP assists a patient to the bathroom after an echocardiogram. ANS: D It is within the UAP’s scope of practice to assist patients to the bathroom as long as the patient is stable in performing that action. Option A is incorrect because this is an inappropriate delegation. It is not within the LPN’s scope of practice to manage IV therapy. Option B is incorrect because this is not a delegation of a task and is merely a function of the position of the charge nurse. Option C is incorrect because it is not delegation. DIF: Cognitive Level: Analysis REF: page 163 11. When incorporating the five rights of delegation, the right supervision is used in which of the following situations? a. The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. b. The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL. c. The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL. d. The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL. ANS: A The UAP reports a low blood glucose level. The RN must check the patient’s response to that glucose level and may need to repeat the measurement if the patient’s assessment does not correlate with the low level, and thus the RN is supervising the performance of the UAP in that task. Options B and C would be an inappropriate action without first assessing the patient’s response and therefore accuracy of the glucose level obtained. Option D would put the patient at risk for severe hypoglycemia if the blood glucose level is accurate. The RN should assess the patient and the accuracy of the reported glucose level. If the glucose level is as stated, the appropriate action by the RN would be to hold the insulin until the blood glucose is at an appropriate level. DIF: Cognitive Level: Analysis REF: page 163 12. When incorporating the five NrigUhRtsSoIf dNeGleTgaBti.onC, OthMe right communication is used when a patient’s blood pressure is low in which of the following situations? a. The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low. b. The RN tells a UAP to recheck the patient’s blood pressure and report back to her before giving the patient a bath. c. The UAP gives a bath to a patient with a low blood pressure. d. The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure. ANS: B Rechecking the blood pressure is the appropriate communication to ensure the safety of the patient. Option A might ensure the safety of the patient for the moment but should be followed up and the blood pressure measurement repeated. Option C could put the patient at risk because of the blood pressure. The RN has not communicated appropriately. Option D is completely inappropriate and places the patient at risk. DIF: Cognitive Level: Analysis REF: page 165 13. When incorporating the five rights of delegation, the right task is used in which situation? a. The UAP reinforces use of the incentive spirometer to a patient. b. The UAP teaches the patient to use the incentive spirometer. c. The UAP listens to breath sounds to encourage the patient to use the incentive spirometer. d. The UAP is not allowed to work with the patient regarding use of the incentive spirometer. ANS: A Although the UAP is not allowed to teach the patient about the use of the incentive spirometer, it is within his or her scope of practice to reinforce that teaching. Only the RN can teach the patient how to use the incentive spirometer. The UAP may not teach patients. UAPs may not assess. Only the RN has that responsibility. The UAP may reinforce use of the incentive spirometer. DIF: Cognitive Level: Analysis REF: page 163 14. When incorporating the five rights of delegation, the right circumstance is used in which of the following situations? a. The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip. b. The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema. c. The RN asks the UAP to draw blood on a newly admitted patient with pneumonia. d. The RN asks a new UAP to draw blood on a patient known to be a “hard stick.” ANS: C It is within the UAP’s scope of practice to draw blood (if allowed in the institution) from patients without IV issues. The prothrombin time blood sample should not be obtained from the arm in which the heparin is running and the UAP is not qualified to know that. The site for blood draws in this patient would need to be carefully chosen by only an RN to protect the patient from injury. Option D is inappropriate delegation; the RN should draw this patient’s blood. N R I G B.C M DIF: Cognitive Level: Analysis REF: page 163 15. After receiving the shift report, which of the following requires a priority action by the nurse? a. Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain. b. Make assignments for the team. c. Talk to a patient who has changed his mind about having a procedure today. d. Round on all the patients on their team. ANS: A Patient safety is a priority. The other options are not a priority for patient safety. DIF: Cognitive Level: Application REF: page 162 16. Which of the following patients should the nurse see first after the shift report? a. A patient with a change in heart rhythm who is complaining of lightheadedness b. A patient with a newly placed pacemaker who is complaining of shoulder pain c. A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg d. A patient in first-degree heart block ANS: A The patient has complained of lightheadedness and his cardiac monitor shows an increase in heart rate. A change in heart rhythm requires a nursing assessment. Options B and C are incorrect because the complaint is predictable and is not a priority. Option D is incorrect because the patient is stable and is not a priority. DIF: Cognitive Level: Application REF: page 169 17. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the LPN? a. Vital signs on a patient about to arrive from the cardiac catheterization lab b. Regulation of a patient’s heparin drip based on the heparin nomogram c. Regulation of a patient’s nitroglycerin drip based on the level of pain d. Administration of all oral medications for the team ANS: D It is within the LPN’s scope of practice to administer oral medications. The other options are incorrect because the patient requires the RN’s assessment skills. DIF: Cognitive Level: Application REF: pages 165-167 18. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the UAP? a. Vital signs on all patients admitted on the previous shift b. Vital signs on a patient being transferred from the ED c. Vital signs on a patient being transferred from the ICU d. Vital signs on a newly admitted stable patient ANS: A NURSINGTB.COM It is within the scope of practice for the UAP to take vital signs on stable, predictable patients. The other options are incorrect because only the RN can make this initial assessment. DIF: Cognitive Level: Application REF: pages 165-167 19. The nurse is working on a medical unit with an LPN and a UAP as the team members. Which tasks should the RN complete? a. Assignments of new admissions to staff b. Regulation of heparin drip based on the heparin nomogram c. Vital signs on patients admitted on previous shift d. Dressing change for a patient 4 days post I&D of a pacemaker wound ANS: B Only the RN is allowed to titrate IV medications because assessment is required. Assignments of new admissions to staff should be performed by the charge nurse. Vital signs on patients admitted on previous shift can be appropriately delegated to the UAP. Dressing change for a patient 4 days post I&D of a pacemaker wound can be appropriately delegated to the LPN. DIF: Cognitive Level: Application REF: pages 165-167 20. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN complete? a. Vital signs on a patient admitted from the ED b. Turning a patient who had a CVA 4 days ago c. Feeding a patient requiring assistance d. Recording the I&O on a patient on strict fluid restrictions ANS: A This patient requires an initial assessment, for which only the RN can be responsible. The other tasks can be delegated. DIF: Cognitive Level: Application REF: pages 165-167 21. An agency nurse is assigned to the thoracic surgery postoperative nursing unit. Which of the following would be the best action by the charge nurse? a. Call the agency to determine her level of experience. b. Assign the nurse to patients ready for discharge. c. Assign her to pass medications only. d. Ask the nurse about her level of experience. ANS: D Assignments are made based on the nurse’s knowledge and skills and the agency nurse should be asked about her experience and background. The other actions are unnecessary. Asking the RN will provide the information necessary to determine the assignment. DIF: Cognitive Level: Analysis REF: pages 163-165 22. Which action by a UAP requires an immediate intervention by the nurse? a. Application of a skin barrier/protection ointment b. Releasing wrist restraints on a patient to allow ROM c. Assisting a patient to the bedside commode d. Obtaining a urine cultureNfrUomRSaIpaNtiGenTtB.COM ANS: A These products are medications and even topical medications are not allowed under the UAP’s scope of practice, and thus this requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention. DIF: Cognitive Level: Analysis REF: pages 165-167 23. Which action by a UAP requires an immediate intervention by the nurse? a. Encouraging a patient to use the incentive spirometer b. Encouraging a patient to ambulate 2 days after surgery c. Checking the pH of the gastric aspirate of a patient receiving tube feedings d. Informing the RN that a patient requests a pain medication ANS: C Checking the pH of the gastric aspirate of a patient receiving tube feedings requires an assessment and is not within the scope of practice of the UAP and thus requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention. DIF: Cognitive Level: Analysis REF: pages 165-167 24. Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit? a. A patient being transferred to an ECF for rehabilitation following a hip replacement b. A patient following a hip replacement with a history of an acute MI 4 weeks ago c. A patient with an external fixator d. A patient to be started on a PCA pump requiring instructions ANS: B With the RN’s knowledge and background for caring for cardiac patients, it is most appropriate to assign her to this patient because of the potential for cardiac issues to arise postoperatively. The other assignments are not appropriate given this nurse’s background and knowledge. DIF: Cognitive Level: Analysis REF: pages 163-165 25. Which actions by the UAP would require immediate follow-up by the nurse? a. Informing the nurse she was taking a break b. Taking her lunch break on her home floor after being pulled to another floor c. Asking the patient to let her know the next time he has a bowel movement d. Asking another UAP to obtain a urine sample for her ANS: D It is not within the scope of practice for the UAP to delegate any tasks and would require an intervention. The other actions are appropriate action by the UAP and do not require intervention. DIF: Cognitive Level: Application REF: pages 165-167 26. A nurse must delegate some responsibilities of the care of patients on a particularly busy and chaotic day to the LPN and UNAPRteaIm mGemBbe.rsC. WMhich of the following can be appropriately delegated to the LPN? a. Assisting with a central line insertion b. Giving bath supplies to patients who are capable of bathing themselves c. Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia d. Transporting a patient in a wheelchair for discharge ANS: A The LPN has been trained to assist the health care provider with complicated procedures. The assignments in options B and D can be delegated to the UAP. Option C is incorrect because this patient is unstable and requires an RN’s assessment. DIF: Cognitive Level: Application REF: pages 167-169 27. Which statement made by the clinical instructor would represent feedback to a student nurse? a. “Explain to me the actions of this medication before you give it.” b. “Can you explain to me why Mr. W. did not receive a bath this morning?” c. “Stop the urinary catheter insertion now. You have contaminated the catheter.” d. “You need to use your critical thinking skills when caring for patients.” ANS: D Although this may not be the most appropriate feedback, it does give the student feedback on his clinical performance. The other statements are confrontational but do not provide feedback. DIF: Cognitive Level: Analysis REF: page 165 28. A nurse assesses a patient reported to have normal vital signs throughout the night and finds the patient in acute respiratory distress. What is the nurse’s next best action? a. Delegate vital signs to the UAP. b. Ask another nurse to call the health care provider. c. Call a code. d. Start another peripheral IV line. ANS: B The nurse should stay with the patient and obtain vital signs, further assessing the patient for changes. The other actions are not appropriate. DIF: Cognitive Level: Analysis REF: pages 166-167 29. Which order should be considered to have the highest priority when delivering care to a patient? a. Albuterol treatment for a patient complaining of shortness of breath b. IV diuretic for a patient in heart failure c. Sliding-scale short-acting insulin d. Antihypertensive for a patient admitted with negative cardiac enzymes ANS: A The patient’s respiratory status has changed, so ABCs should be used to determine the highest priority medication administration. The other orders are incorrect because the patient is not at risk for loss of airway. N R I G B.C M DIF: Cognitive Level: Analysis REF: page 169 30. Which delegation should a UAP consider to have the highest priority? a. Obtaining a routine blood glucose level from a patient with diabetes b. Giving a bath to a patient scheduled for a colonoscopy c. Feeding a patient who needs assistance doing so. d. Helping an older adult patient to the bathroom ANS: D Older adult patients frequently need to get to the bathroom quickly, and if no assistance is provided, they may fall in an attempt to make it there by themselves. The other delegations do not take priority over the older adult patient needing to use the bathroom. DIF: Cognitive Level: Analysis REF: page 169 Chapter 20: Prevention of Workplace Violence Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. What percentage of assaults in the workplace are committed against health care workers? a. 50% b. 20% c. 15% d. 40% ANS: A Although health care workers incur less than 20% of all workplace injuries, health care workers nevertheless suffer 50% of all assaults in the workplace. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as: a. de-escalation. b. chemical restraint. c. stress management. d. emergency assistance proNgraRms.I G B.C M ANS: A U S N T O De-escalation is a long-standing mental health nursing tool. De-escalation is defined as “a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect” (Cowin et al., 2003, p. 65). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation ANS: C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 4. A nurse executive is a member of a collaborative committee assigned to revise the violence prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a: a. detailed description of last year’s injuries. b. list of preferred work injury health care providers. c. method for evaluating the effectiveness of the program. d. way to determine whether an employee is at fault. ANS: C According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program. DIF: Cognitive Level: Apply N(AUpRplSicaItiNonG) TB.COM TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 5. Staff nurses may be able to avoid bullying behavior through: a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training. ANS: D On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying (Stagg et al., 2013). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. Employee assistance programs: a. allow employers to place staff into anger management programs designed to help control potentially violent behavior. b. encourage employees to provide assistance to co-workers experiencing workplace violence. c. provide services to help employees cope with stressors that occur at home or work. d. train employees to deescalate violent situations. ANS: C Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 7. An important role of the human resources department in limiting workplace violence is: a. allowing the local police force to control violence within the facility. b. delegating the control of workplace violence to individual unit managers. c. developing comprehensive violence prevention policies and procedures. d. empowering each nurse to assess each situation and react accordingly. ANS: C Human resource management policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 8. One of the several legal issues surrounding workplace violence is: a. an employer may be subject to liability claims. b. maintaining mandatory seNcurRity IratioGs. B.C M c. Department of Labor laws UrequSirinNg emTployerOs to report each incidence of workplace violence. d. the patient’s right to unrestricted visitation. ANS: A To date, 29 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof (HWB, 2016; Mao, 2013). Basic provisions of the model HWB legislation, developed and introduced by Yamada in 2000, include a clear definition of an “abusive work environment,” a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented (Mao, 2013). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. The most prevalent source of violence against nurses is from: a. a current or former employee. b. customers, clients, or patients. c. criminals with no other connection to the workplace but who simply intend to commit a crime. d. someone who is not employed at the workplace but has a personal relationship with an employee. ANS: B Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 10. Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is: a. hazard prevention. b. environmental designs. c. behavior modification. d. administrative control. ANS: C Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness (OSHA, 2015b). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 11. A common-sense look at the workplace to find existing or potential hazards for workplace violence is: a. worksite analysis. b. risk management. c. administrative rounds. d. hazard prevention and coNntUroRl.SINGTB.COM ANS: A Worksite analysis is a common-sense look at the workplace to find existing or potential hazards for workplace violence. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 12. Employee assistance programs can be especially useful when mitigating which source of violence? a. Patients b. Current or former workers c. Criminals with no connection to the employer d. Someone who has a personal relationship with an employee ANS: D The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 13. An integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called management. a. risk b. threat c. total quality d. human resources ANS: A Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 14. County Hospital has purchased a computerized reporting system for reporting incidents, including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is management. a. risk b. threat c. total quality d. human resources ANS: C NURSINGTB.COM In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a TAT or similar task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 15. Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by: a. the FBI. b. threat assessment team. c. human resources. d. senior leadership. ANS: B A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 16. The agency that oversees the safety and health of health care workers is: a. The Joint Commission (TJC). b. the Department of Public Health (DPH). c. OSHA. d. CMS. ANS: C OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: PhysiologNicUal RInSteIgrNityG: TReBd.ucCtioOnMof Risk Potential 17. Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called violence. a. horizontal b. co-worker c. threatening d. nurse-to-nurse ANS: A A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker’s performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload (Hamblin et al., 2015). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 18. What is the primary component of a violence prevention program? a. Regulatory guidelines b. Employee commitment c. Financial commitment d. Management commitment ANS: D Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 19. may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator ANS: A Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace (ASIS/SHRM 2011, p. 10). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: PhysiologNical RInteIgrityG: ReBd.ucCtionMof Risk Potential MULTIPLE RESPONSE U S N T O 1. Administrative controls that may affect workplace violence include: (Select all that apply.) a. adequate staffing levels. b. controlled access. c. development of systems to alert security personnel to threats of violence. d. conflict resolution. e. architectural modifications. ANS: A, B, C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. The main components in a violence prevention program are: (Select all that apply.) a. a written plan. b. worksite analysis. c. criminal control. d. security staff training. e. record keeping and evaluation of the program. ANS: A, B, E The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Examples of environmental designs that can improve worker safety include: (Select all that apply.) a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby. ANS: A, D, E NURSINGTB.COM NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by . ANS: threat assessment teams A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT reviews troubling or threatening behavior of patients or workers. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential NURSINGTB.COM Chapter 20: Prevention of Workplace Violence Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. What percentage of assaults in the workplace are committed against health care workers? a. 50% b. 20% c. 15% d. 40% ANS: A Although health care workers incur less than 20% of all workplace injuries, health care workers nevertheless suffer 50% of all assaults in the workplace. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as: a. de-escalation. b. chemical restraint. c. stress management. d. emergency assistance proNgraRms.I G B.C M ANS: A U S N T O De-escalation is a long-standing mental health nursing tool. De-escalation is defined as “a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect” (Cowin et al., 2003, p. 65). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation ANS: C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 4. A nurse executive is a member of a collaborative committee assigned to revise the violence prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a: a. detailed description of last year’s injuries. b. list of preferred work injury health care providers. c. method for evaluating the effectiveness of the program. d. way to determine whether an employee is at fault. ANS: C According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program. DIF: Cognitive Level: Apply N(AUpRplSicaItiNonG) TB.COM TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 5. Staff nurses may be able to avoid bullying behavior through: a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training. ANS: D On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying (Stagg et al., 2013). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. Employee assistance programs: a. allow employers to place staff into anger management programs designed to help control potentially violent behavior. b. encourage employees to provide assistance to co-workers experiencing workplace violence. c. provide services to help employees cope with stressors that occur at home or work. d. train employees to deescalate violent situations. ANS: C Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 7. An important role of the human resources department in limiting workplace violence is: a. allowing the local police force to control violence within the facility. b. delegating the control of workplace violence to individual unit managers. c. developing comprehensive violence prevention policies and procedures. d. empowering each nurse to assess each situation and react accordingly. ANS: C Human resource management policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 8. One of the several legal issues surrounding workplace violence is: a. an employer may be subject to liability claims. b. maintaining mandatory seNcurRity IratioGs. B.C M c. Department of Labor laws UrequSirinNg emTployerOs to report each incidence of workplace violence. d. the patient’s right to unrestricted visitation. ANS: A To date, 29 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof (HWB, 2016; Mao, 2013). Basic provisions of the model HWB legislation, developed and introduced by Yamada in 2000, include a clear definition of an “abusive work environment,” a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented (Mao, 2013). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. The most prevalent source of violence against nurses is from: a. a current or former employee. b. customers, clients, or patients. c. criminals with no other connection to the workplace but who simply intend to commit a crime. d. someone who is not employed at the workplace but has a personal relationship with an employee. ANS: B Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 10. Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is: a. hazard prevention. b. environmental designs. c. behavior modification. d. administrative control. ANS: C Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness (OSHA, 2015b). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 11. A common-sense look at the workplace to find existing or potential hazards for workplace violence is: a. worksite analysis. b. risk management. c. administrative rounds. d. hazard prevention and coNntUroRl.SINGTB.COM ANS: A Worksite analysis is a common-sense look at the workplace to find existing or potential hazards for workplace violence. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 12. Employee assistance programs can be especially useful when mitigating which source of violence? a. Patients b. Current or former workers c. Criminals with no connection to the employer d. Someone who has a personal relationship with an employee ANS: D The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 13. An integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called management. a. risk b. threat c. total quality d. human resources ANS: A Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 14. County Hospital has purchased a computerized reporting system for reporting incidents, including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is management. a. risk b. threat c. total quality d. human resources ANS: C NURSINGTB.COM In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a TAT or similar task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 15. Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by: a. the FBI. b. threat assessment team. c. human resources. d. senior leadership. ANS: B A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 16. The agency that oversees the safety and health of health care workers is: a. The Joint Commission (TJC). b. the Department of Public Health (DPH). c. OSHA. d. CMS. ANS: C OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: PhysiologNicUal RInSteIgrNityG: TReBd.ucCtioOnMof Risk Potential 17. Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called violence. a. horizontal b. co-worker c. threatening d. nurse-to-nurse ANS: A A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker’s performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload (Hamblin et al., 2015). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 18. What is the primary component of a violence prevention program? a. Regulatory guidelines b. Employee commitment c. Financial commitment d. Management commitment ANS: D Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 19. may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator ANS: A Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace (ASIS/SHRM 2011, p. 10). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: PhysiologNical RInteIgrityG: ReBd.ucCtionMof Risk Potential MULTIPLE RESPONSE U S N T O 1. Administrative controls that may affect workplace violence include: (Select all that apply.) a. adequate staffing levels. b. controlled access. c. development of systems to alert security personnel to threats of violence. d. conflict resolution. e. architectural modifications. ANS: A, B, C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. The main components in a violence prevention program are: (Select all that apply.) a. a written plan. b. worksite analysis. c. criminal control. d. security staff training. e. record keeping and evaluation of the program. ANS: A, B, E The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Examples of environmental designs that can improve worker safety include: (Select all that apply.) a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby. ANS: A, D, E NURSINGTB.COM NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by . ANS: threat assessment teams A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT reviews troubling or threatening behavior of patients or workers. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential NURSINGTB.COM Chapter 10: Power and Conflict Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to this request because of her great admiration for the vice president of nursing. This is an example of dimension of power. a. dependence b. relational c. subversive d. tactical ANS: B Relational dimension of power is a property of a social relationship. Many classic definitions indicate that power has to do with relationships between two or more actors in which the behavior of one is affected by the other. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A staff nurse frequently is providing positive comments to get the manager in a good mood before asking about additional vacation time. This influence tactic is known as: a. consultation. b. ingratiation. c. inspiration appeals. d. rational persuasion. ANS: B NURSINGTB.COM Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. ANS: D French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. ANS: A French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Subunit power is derived from: a. being independent within the organization. b. providing resources on which the organization most depends. c. supplying multiple cross-trainable functions within the organization. d. voicing unique opinions and values within the organization. ANS: B Subunit power is derived fromN pRroviIdingGresBo.urCcesMon which the organization most depends. Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A nursing manager is leading a recruitment and retention committee. She manages in a laissez-faire style. Her co-leader is a staff nurse who is very detail oriented. The nurse manager usually leads the meetings. During the meeting, the staff nurse frequently needs to interject information that has not been presented. She also creates the agenda and communicates information with other team members. This scenario depicts which type of conflict? a. Competitive b. Disruptive c. Organizational d. Task ANS: D Task conflict is an awareness of differences in viewpoints and opinions pertaining to a group task. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A hospital nurse manager is involved in conflict management between two staff members. The process of collaborating occurs when: a. one person seeks to satisfy his/her own interests. b. both sides strive to meet the interests of both parties. c. a person chooses to withdraw from conflict. d. one party seeks to appease the other. ANS: B Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Nurses derive much of their power from being: a. authority figures in emergent situations. b. central to the delivery of health care services. c. organized through public associations. d. the care coordinator of the health care team. ANS: B Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of moNst hRealIth cGare oBr.gaCnizaMtions, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. A well-known talk show host presents information to a congressional committee to garner support for cancer research. This type of power refers to power. a. coercive b. expert c. legitimate d. referent ANS: D Referent power is based on admiration for a person who has desirable resources or personal traits. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important. a. Assertiveness b. Ingratiation c. Rationality d. Upward appeal ANS: B Ingratiation means trying to make the other person feel important—giving praise or sympathizing. Ingratiation is attempting to advance oneself by trying to make another person feel important. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Subunit or power refers to relationships across departments. a. vertical b. organizational c. horizontal d. exertional ANS: C Subunit or horizontal power pertains to relationships across departments. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. A disagreement or differenceNs beRtweIen tGhe mBe.mCberMs of two or more groups over authority, territory, and resources is calleUd S NcoTnflict. O a. intragroup b. intergroup c. interpersonal d. intrapersonal ANS: B Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. is a personal quality that is admired in the person with referent power. a. Problem solving b. Authority c. Knowledge d. Coercive power ANS: A Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict. ANS: C Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization’s assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Nurses must use which of theNseUtRoSfaIciNliGtatTeBch.aCngOeMin health care organizations? (Select all that apply.) a. Actualization b. Authorization c. Influence d. Ratification e. Power ANS: C, E As the largest health care profession, nursing must use power and influence as a legitimate tool to facilitate change in health care organizations and the health care system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What are the consequences or outcomes of nurse empowerment? (Select all that apply.) a. Increased compensation and benefits b. Decreased burnout c. Decreased job strain d. Increased job satisfaction and work effectiveness e. Increased trust in the workplace ANS: B, C, D Rao (2012) summarized the consequences or outcomes of nurse empowerment as (1) the potential for improved nurse and patient outcomes, (2) decreased burnout, (3) decreased job strain, (4) increased trust in the workplace, and (5) increased job satisfaction and work effectiveness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine have assessed progress made on recommendations for the future of nursing. What are the recommendations for nurses? (Select all that apply.) a. Remove barriers to practice and care. b. Maintain current leadership roles. c. Promote diversity. d. Transform education. e. Improve data. ANS: A, D, E In 2014 the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division) to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing (IOM, 2010) and identify areas that should be emphasized over the next 5 years. This report outlines specific areas to accelerate implementation of the IOM recommendations for nurses: (1) removing barriers to practice and care, (2) transforming education, (3) collaborating and leading, (4) promoting diversity, and (5) improving data. NURSINGTB.COM DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following are the formal dimensions of power? (Select all that apply.) a. Social aspect b. Relational aspect c. Dependence aspect d. Independent aspect e. Sanctioning aspect ANS: B, C, E The three formal dimensions of power are the relational, dependence, and sanctioning aspects of power. The relational aspect of power suggests that power is a property of a social relationship. The dependency aspect of power suggests that power resides implicitly in the other’s dependency. The sanctioning aspect of power is the active component of the power relationship, referring to the direct manipulations of the other’s outcomes. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Empowerment for nurses may consist of three components. Which three of the following components may help nurses become empowered to use their power for better patient care? (Select all that apply.) a. A state in which a nurse has assumed control over his or her own practice b. A social relationship between two or more people c. A workplace that promotes opportunities for growth d. A nurse’s sense of meaning as expressed in values and work role e. Interdependence of personnel ANS: A, C, D Nurse empowerment was defined as a state in which an individual nurse has assumed control over his or her practice, enabling him or her to successfully fulfill professional nursing responsibilities within an organization. Organizational antecedents to nurse empowerment include the “opportunities for mobility and growth and access to resources, support, and information provided within the nurse’s work environment.” The organizational and individual antecedents lead to psychological empowerment, including a nurse’s sense of meaning as expressed in values and work role. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What are the two major content dimensions of power? (Select all that apply.) a. Influence b. Integrity c. Authority d. Dominance e. Control ANS: A, C NURSINGTB.COM Authority and influence are two major content dimensions of power. Influence, dominance, and control may occur in separate dimensions. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.) a. Connection power is based on the perception that the influencer has access to powerful people or groups. b. Legitimate power is based on fear. c. Expert power results from expertise, special skill, or knowledge. d. Information power refers to skill in making rational appeals. e. Referent power is based on admiration for a person. ANS: A, C, E Connection power is based on another’s perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following statements describe structural determinants of power within an organization? (Select all that apply.) a. Power is derived from independence. b. Power is derived from providing resources. c. Power is derived from certainty. d. Power is derived from being irreplaceable. e. Power is derived from the ability to affect the decision process. ANS: B, D, E The following are structural determinants of power within organizations: Power is derived from dependence; power is derived from providing resources; power is derived from coping with uncertainty; power is derived from being irreplaceable; power is derived from the ability to affect the decision process; and power is derived if there is a shared consensus within the organizational subunit. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Organizational change is associated with both direct and indirect costs for which leaders must be prepared. Which of the following are examples of indirect costs associated with conflict? (Select all that apply.) a. Loss of team morale b. Disrupted communication c. Disability or stress claimNs URSINGTB.COM d. Decreased management productivity related to time spent resolving conflict e. Loss of motivation for achieving team goals ANS: A, B, E Dysfunctional outcomes of conflict include development of discontent, reduced group effectiveness, disrupted communication, reduced group cohesiveness, and infighting among group members, which then overrides the focus on group goals. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The main effects of conflict are individual effects, interpersonal relationships, and organizational effects. What are some of the positive effects of conflict within an organization? (Select all that apply.) a. Absenteeism b. Team cohesiveness c. Disrupted communication d. Stimulation of creativity and innovation e. Improved quality of decisions ANS: B, D, E Positive outcomes of conflict include stronger relationships and team cohesiveness, stimulation of creativity and innovation, and improved quality of decisions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Negotiation is a form of conflict resolution. Which of the following terms are associated with negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining ANS: A, B, D Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). According to Knickle and colleagues (2012), the resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which of the following are faNcUtoRrsSthIaNt iGnfTluBen.cCe OthMe way conflict is handled within an organization? (Select all that apply.) a. Behavioral predispositions of individuals b. Bureaucratic hierarchy c. Social pressure in the environment d. Rules and procedures e. Position power ANS: A, C, D A structural model of conflict exists that examines four factors that seem to influence the way conflict is handled in organizations: behavioral predispositions of individuals, social pressure in the environment, the organization’s incentive structure, and rules and procedures. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 11: Workplace Diversity Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion. ANS: C Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. “I don’t blame you. I don’t like lime Jell-O either.” b. “Tell me about your cultural beliefs to best help you.” c. “Why don’t you want to Neat tRhe lIimeGJelBl-O.?C” M d. “It is important for you to eUat sSo thNat yTou willOheal.” ANS: B The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that “we don’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Cultural diversity refers to the: a. variety of cultural or ethnic groups within a society. b. belief that one’s own culture is similar to another’s culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language. ANS: A Cultural diversity is defined by the Oxford Dictionary (“Cultural diversity,” 2016) as “The existence of a variety of cultural or ethnic groups within a society.” DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics ANS: D The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation’s racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non-Hispanic White population, fueled by both immigration and births. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese ANS: C Results from the 2010 census show that racial and ethnic minorities accounted for 91.7% of the nation’s growth since 200N0. MRosIt ofGthatBi.ncCreasMe, from 2000 to 2010 (56%), was due to Hispanics. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality ANS: A According to the World Health Organization (2016), “Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.” DIF: Cognitive Level: Remember (Knowledge) 7. Recognizing one’s own prejudices and learning about other people’s differences is the first step toward: a. cultural diversity. b. multicultural competence. c. social change. d. valuing. ANS: B To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? a. Avoiding the client as much as possible but providing care b. Identifying her biases but providing care c. Requesting another patient assignment d. Taking sick days while the patient is hospitalized ANS: B The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because oNf tUheRiSdeIaNthGatT“Bw.e CdoOnM’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Which of the following supports successful workplace diversity? a. Being a “devil’s advocate” b. Holding tight to one’s cultural values c. Respect for differences d. Withholding judgment of others ANS: C To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) 10. According to the National Healthcare Quality and Disparities Report, which group has worse access to health care in America, compared with Whites? a. Hispanics b. Asians c. Blacks d. American Indians ANS: A According to the 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2015), “Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location.” This study found that Blacks had worse access to health care than Whites for about half of measures of access, Hispanics had worse access to care than Whites for two-thirds of access measures, and Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction is known as: a. bias. b. diversity. c. culture d. stereotyping. ANS: B NURSINGTB.COM Culture refers to the variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. What is the most modifiable factor in the provision of equitable health care? a. Availability of services b. Socioeconomic status c. Care that is responsive to cultural needs d. Education level ANS: C Health inequities are directly related to the existence of historical and current discrimination and social injustice, and one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. When nurses portray an attitude that their cultural group is superior to another, it is known as practicing the concept of cultural: a. diversity. b. egocentrism. c. ethnocentrism. d. prejudice. ANS: C Ethnocentrism is characterized or based on an attitude that one’s own cultural group is superior to another. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A White nurse from the United States is assigned to care for a Vietnamese woman who speaks little English, had a baby 2 months ago, and is 1 day postoperative after fibroid removal. The nurse knows that traditional Vietnamese women will avoid drinking or eating “sour” foods such as lime Jell-O or other citrus types of liquids after surgery. She confirms her patient’s values and beliefs. The nurse is exhibiting characteristics of: a. cultural competence. b. ethnic sensitivity. c. stereotyping. d. nonjudgmental behavior. ANS: A NURSINGTB.COM To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 15. This generational cohort currently dominates the U.S. workforce. They have grown up with little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation. ANS: A The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce. They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation. ANS: B Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. A patient from the Philippines has been admitted to the ICU after a motor vehicle accident. The patient has a very large group of family and friends wanting to visit, hold vigils, and provide meals to the visitors and staff. This is an example of: a. inflexible attitude b. ambiguity c. ethnocentrism d. collectivism ANS: D Collectivism is a tightly knit NsocRietalIfraGmewBo.rkCwhMere people are integrated into cohesive and strong in-groups, often extended families, to look after them in exchange for unquestioning loyalty. Nurses from collectivist cultures tend to look to the team before taking action. The most collectivist culture on Hofstede’s scale is Guatemala at 6, China is 20, and the Philippines is 32. It’s not unusual with patients from collectivist cultures to have large groups of relatives and friends visit at the same time, which can create challenges for nursing staff to accommodate, especially in crowded shared rooms. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Eliminating can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided. a. diversity b. cultural incompetence c. health disparities d. miscommunication ANS: C Principles of eliminating racial and health disparities include providing insurance coverage and access to high-quality care, promoting a diverse health care workforce, delivering patient-centered care, maintaining accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improvement of quality of care. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Members of a generation who are linked through shared life experiences in their formative years are known as: a. baby boomers. b. generational markers. c. generation gaps. d. cohorts. ANS: D Generational groups are categorized into cohorts. These cohorts are members of a generation who are linked through shared life experiences in their formative years. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. A 17-year-old male has presented to the emergency department with appendicitis. He speaks English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctNorUpRroScIeeNdsGwTiBth.ouCt OobMtaining consent, he may face: a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims. ANS: D The National Center for Cultural Competence (n.d.a) noted that health professionals who lack cultural and linguistic competency can be found liable under tort principles in several areas such as treatment in the absence of informed consent. In addition, providers may be presumed negligent if an individual is unable to follow guidelines because they conflict with his or her beliefs and the provider neglected to identify and try to accommodate the beliefs. Additionally, if a provider proceeds with treatment or an intervention based on miscommunication due to poor quality language assistance, he or she and his or her organization may face increased civil liability exposure. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Culturally competent organizations benefit from meeting the diverse health care needs of the population it serves. What are the social benefits to the organization? (Select all that apply.) a. Increases mutual respect. b. Increases community participation. c. Meets regulatory guidelines. d. Assists patient and families in their care. e. Increases cost savings. ANS: A, B, D Becoming culturally competent has social, health, and business benefits for health care organizations, according to a report from the Equity of Care initiative and the American Hospital Association’s Health Research & Educational Trust and Hospitals in Pursuit of Excellence. Becoming a Culturally Competent Health Care Organization (Health Research & Educational Trust, 2013) outlined 16 benefits of organizations’ ability to meet the health care needs of patients with diverse backgrounds, grouped into three broad categories of social, health, and business benefits. Social benefits include increases mutual respect and understanding between patient and organization, increases trust, promotes inclusion of all community members, increases community participation and involvement in health issues, assists patients and families in their care, and promotes patient and families responsibilities for health. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. When communicating health information with diverse populations, miscommunication and misunderstanding can lead to: (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost. ANS: B, C, D, E NURSINGTB.COM The literature illustrates the vital role communication plays in avoiding cases of malpractice due to diagnostic and treatment errors. When communicating with culturally and linguistically diverse populations, the opportunity for miscommunication and misunderstanding increases, which subsequently increases the likelihood of errors. These errors, in turn, can cost millions of dollars in liability or malpractice claims. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. There are three major issues in cross-cultural communication. They are: (Select all that apply.) a. ambiguity. b. ethnocentrism. c. inflexible attitude. d. collectivism. e. negotiation. ANS: A, B, C Research shows that there are three major issues in cross-cultural communication: ambiguity, inflexible attitude, and ethnocentrism. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. In order to make a positive contribution to care of patients, it is critical that nurses recognize which of the following aspects of culture? (Select all that apply.) a. Culture of the clinician b. Culture of the patient and family c. Spiritual beliefs of the clinician d. Culture of co-workers e. Spiritual beliefs of the patient ANS: A, B, D In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with a multiplicity of cultures. They include the clinician’s own culture, the culture of the patient and patient’s family, the culture of co-workers, and the health care institution’s culture. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines.NURSINGTB.COM c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills. ANS: A, B, C Millennials have astonishing multitasking skills. They are problem solvers who grew up in a flourishing economy. Most enjoy the liberty of working on their own in a style that favors their work ethic. Millennials have learned that their presence is in demand. To thrive, they need clear definitions of outcomes, resources to do what needs to be done, and a deadline (Hendricks & Cope, 2013). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. The nurse manager of a nursing unit is a White, female working with a high percentage of Middle Eastern nursing staff. Which of these statements are true about the communication and leadership style of a low-context culture? (Select all that apply.) a. Rules are clear and tend to be followed. b. Low-context cultures require extensive, detailed explanations. c. Verbal communication is less explicit. d. Decisions are made in face-to-face conversations. e. Decisions are focused around tasks. ANS: A, B, E From a global perspective, the cultural context of the Western world is low context. In places such as North America and Western Europe, the explicit verbal or written message carries the meaning. Low-context cultures require extensive detailed explanations, information, and contracts because they are making up for the context that may be missing in a given situation. Decisions are focused around tasks and activities that need to be accomplished. Rules are very clear and tend to be followed precisely. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 07: Communication Leadership Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. The process in which information, perception, and understanding are transmitted from person to person is: a. articulation. b. communication. c. evaluation. d. pronunciation. ANS: B Communication is the process in which information, perception, and understanding are transmitted from person to person. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication ANS: C NURSINGTB.COM Non-verbal communication is unspoken. It is composed of affective or expressive behaviors. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model. ANS: A The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion. ANS: C Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity. ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and ENffecRtiveICarGe EnBv.iroCnmMent: Management of Care U S N T O 6. A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, “You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns.” This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention. ANS: A If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse’s non-verbal behavior may suggest that she is not interested in interacting with the family. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making. c. taking a top-down approach to leadership. d. making unilateral decisions for the team. ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings. ANS: A Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and ENffecRtiveICarGe EnBv.iroCnmMent: Management of Care U S N T O 9. communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing ANS: B Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA). ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient’s privacy in health care transactions. This is an example of breach of confidentiality. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction. ANS: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Organizational tones are baseNd mRostIly oGn: B.C M a. unspoken cultural norms. U b. commitment to success. c. communication behavior. d. leadership styles. ANS: A S N T O The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS. ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency. ANS: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many yearsU. ThSey dNiscoTvered tOhat poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing) ANS: B To address the “communication arm” of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy ANS: A, C, D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness ANS: B, C, D NURSINGTB.COM NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A client’s wife is concerned about her husband’s declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed “no breathing machine” for long-standing care, but she is unsure of his wishes if he were to need a “breathing machine” for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client’s physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client’s concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action ANS: B, C Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient’s diagnosis e. Discharge summary given to patient’s spouse ANS: B, C Fax transmissions sent to the incorrect physician’s office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and ENffecRtiveICarGe EnBv.iroCnmMent: Management of Care U S N T O 5. Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious ANS: B, C, D, E Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients’ health care decisions and preferences. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture ANS: A, C, D Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety. ANS: B, D, E Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaNviorRs suIch Gas dBev.elCopiMng rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy (Sears, 2010). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task. ANS: B, C, E At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing ANS: A, D, E Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that thereUareSfouNr timTes youOshould never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 08: Team Building and Working With Effective Groups Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. Any collection of interconnected individuals working together for the same purpose is known as a(n): a. club. b. group. c. meeting. d. organization. ANS: B Any collection of interconnected individuals working together for the same purpose is known as a group. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A type of group that is stable, meets periodically, has an identified purpose, and is part of the organizational structure is called a: a. club. b. committee. c. group. d. meeting. ANS: B NURSINGTB.COM A committee is a type of group that is stable, meets periodically, has an identified purpose, and is part of the organizational structure. An example of a committee is a policy and procedure committee. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Team building is the process of a group. a. forming b. identifying c. organizing d. unifying ANS: D Team building is the process of deliberately creating and unifying a group into a functioning work unit so that specific goals are accomplished. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a: a. committee. b. group. c. team. d. unit. ANS: C A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent (Katzenbach & Smith, 1993; Manion et al., 1996). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A collection of individuals who are led by a strong, clearly focused leader and who come together to share information and ideas and possibly make decisions is known as a: a. committee. b. pseudoteam. c. team. d. work group. ANS: D A collection of individuals who are led by a strong, clearly focused leader and who come together to share informationNandRideIas aGnd Bpo.sCsiblyMto make decisions is known as a work group. In a work group, there is little or no collective accountability. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. In nursing, the reason groups form is: a. monetary rewards. b. mandatory obligations. c. physical needs. d. professional socialization. ANS: D In nursing, the formation of groups occurs primarily for one of two reasons: (1) to provide a personal or professional socialization and exchange forum, or (2) to provide a mechanism for interdependent work accomplishment. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Group problem solving is known to be more effective over individual problem solving because of a larger knowledge and information base, increased acceptance of solutions, more approaches to a problem, lower economic costs, and the ability for: a. group development. b. individual expression. c. hierarchical bonding. d. organizational team building. ANS: B Individual expression is one of the major advantages of group problem solving (Veninga, 1982). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Some of the major disadvantages to group decision making are negativity, individual focus, and: a. autonomous conclusion. b. disruptive conflicts. c. group synergy. d. inaccurate data interpretation. ANS: B Ronco (2005) identified the six potential negative impacts groups can have on an organization, including negativity, passivity, individual focus, groupthink, vocal minority, and the ethical dark side. Veninga (1982) also suggested a seventh: disruptive conflicts. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and ENffecRtiveICarGe EnBv.iroCnmMent: Management of Care U S N T O 9. A group of tenured nursing faculty at a major university votes on whether a faculty member should receive tenured status. This type of decision making is referred to as: a. autocratic decision procedure. b. consultative decision procedure. c. delegated decision procedure. d. joint decision making. ANS: D Joint decision making occurs when the entire group makes the decision by two-thirds vote, a simple majority, consensus, or some other process. In this process, the group members have as much power as the leader. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Group as well as individual accountability exists within a: a. work group. b. true team. c. pseudoteam. d. committee. ANS: B A true team occurs when there is a collective entity in which leadership rotates and is shared by various members of the team. There is group as well as individual accountability. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The hospital’s regulatory department is experiencing The Joint Commission survey. The surveyors want to review hospital policies for infection control before they leave for the evening. The regulatory team leader states that she can stay past her regular hours to wait for them and acknowledges that there will be a need for a policy change before the surveyors return the following day. All of the department managers stay to assist the regulatory team leader with the required documentation. This is an example of a: a. work group. b. committee. c. true team. d. group. ANS: C A true team is a group where there are collective work products. There is group as well as individual accountability. If one member is having a problem, it is not only that person’s problem but that of the whole team to resolve. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 12. A temporary group of individNuUalRs fSoIrmNeGd TtoBc.arCryOoMut a specific mission or project is known as a: a. club. b. group. c. meeting. d. task force. ANS: D A task force is a temporary group of individuals formed to carry out a specific mission or project. Task forces may solve a problem that requires a multidisciplinary approach. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The stage of group development where control issues arise and disputes or disagreements begin to emerge is the stage. a. orientation b. adaptation c. emergence d. working ANS: C Emergence is the third stage of group development and occurs as control issues arise. Disputes, disagreements, confrontations, alliances, and power struggles mark this stage of determining control over the group in order to emerge with a more consolidated identity. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The nurse manager within a small department has requested that the staff decide department coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision? a. Autocratic decision procedure b. Consultative decision procedure c. Joint decision making d. Delegated decision procedure ANS: D A delegated decision procedure occurs when the leader allows participants to make the final decision. An autocratic decision procedure occurs when the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the decision. Joint decision making occurs when the entire group decides by vote or consensus. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The critical care unit of a hosNpUitaRl SutIiliNzeGs TteBam.ChuOdMdles at change of shift. This is an opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) meeting. a. information-sharing b. opinion-seeking c. problem-solving d. strategy ANS: A An information-sharing meeting occurs when a group is gathered to disseminate information. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. A multidisciplinary committee meets monthly to discuss medication safety issues within the acute care areas. The quality director consistently arrives late for meetings and spends her time in the meeting answering e-mails on her smart phone. What type of disruptive behavior does this exhibit? a. Compulsive talker b. Interrupter c. Squasher d. Unreliable ANS: D Unreliable members are not committed to the work of the group and frequently arrive late, leave early, spend time checking e-mail or texting, and simply want to show up for the purpose of appearance. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Why is an interdisciplinary, team-based approach essential in health care? (Select all that apply.) a. Reimbursement protocols and government regulations require them. b. Diverse team’s enhanced ability to adapt to continuous or sudden change. c. A collective pool of thinking styles allows for greater exchange of information, ideas, and problem solving. d. Rapid information dissemination is most efficient with multidisciplinary teams. e. Engaging teams in this process allows for diverse points of view, creativity, and innovation. ANS: B, C, E Health care leaders recognize that an interdisciplinary, team-based approach is essential for high-quality, patient-centered, coordinated, and effective health care. Teamwork allows for greater exchange of information, ideas, and problem solving to address the complex issues of health care. Engaging teams in this process allows for diverse points of view, creativity, innovation, and an enhancedNabUilRitSy ItoNaGdaTptBt.o CcoOntMinuous or sudden change. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What are some of the positive aspects of utilizing teams in a professional setting such as health care? (Select all that apply.) a. Teams have the potential to perform at higher levels than individuals on their own. b. Teams are a way to keep decision making at the management level. c. Teams may contribute to constraints within the budget. d. Teams can motivate individual members and provide encouragement, constructive criticism, and praise. e. Teams can make individuals feel more connected to the larger organization. ANS: A, D, E Groups have the potential for being a driving force for change in an organization. Ronco (2005) identified the potential positive impact groups can have on an organization: 1. Synergy: Groups have the potential to perform at higher levels than an individual would on his or her own. 2. Positive individual impacts: Groups have the potential to improve every member of the group or at least help each one reach his or her highest potential. 3. Motivation: Groups have the potential to motivate their individual members and provide encouragement, constructive criticism, and praise. 4. Diverse thinking: Groups have the potential to engage in diverse thinking, thereby identifying problems that might otherwise go unnoticed or ignored and exploring solutions. 5. Linkage to the larger organization: Groups have the potential to make individuals feel more connected to the larger organization. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. When teams are assigned, but not designed, dysfunction can occur. What are some characteristics of a dysfunctional team? (Select all that apply.) a. Confusion over the purpose of the team b. Lacks real authority c. Effective interpersonal communication patterns d. Team needs placed above individual needs e. Lack of evaluation criteria ANS: A, B, E Perils and pitfalls can occur when teams are assigned—not designed—including confusion about the team’s work, the team lacks real authority, structural team building is not done, dysfunctional behavior occurs and team members don’t know how to constructively deal with it, and team-based outcome measures and coaching are lacking. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Group interactions are compoNsUedRoSf IwNhiGchToBf .thCe OfoMllowing elements? (Select all that apply.) a. The unique way the group interrelates and begins to work together b. The values and norms of each individual c. The process of problem solving d. The communication that occurs among group members e. The roles played by each member ANS: A, C, D, E Group interactions are composed of the unique way the group interrelates and begins to work together, the standards that regulate the group’s behavior, the process of problem solving and decision making, the communication patterns that occur among group members, and the roles played by each member. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A nursing professional practice council is being formulated within an organization. Nurses from the three acute settings will meet monthly to discuss safety, policy, and practice needs within the organization. What are some of the reasons for this group formation? (Select all that apply.) a. To provide professional socialization b. To provide an exchange forum c. To provide a mechanism for independent work accomplishment d. To allow members to test a theory e. To create a sense of status and esteem ANS: A, B, E In nursing, formation of groups occurs primarily to provide a personal or professional socialization and exchange forum, or to provide a mechanism for interdependent work accomplishment. Groups are established within organizations to create a sense of status and esteem, they allow an individual to test and establish reality, and they function as a mechanism for getting a job done. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 6. Work group disruption has been shown to be linked to negative outcomes. What are some factors that can contribute to work group disruptions? (Select all that apply.) a. Budget constraints b. Multidisciplinary attendance c. Reorganization d. Absenteeism e. Turnover ANS: C, D, E Work groups can be disrupted by factors such as downsizing, reorganization, absenteeism, and turnover. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: AssessNmenRt I G B.C M MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. What are some of the advantages to group work related to problem solving? (Select all that apply.) a. There is greater sharing of knowledge and information. b. Individuals are less likely to accept a solution. c. Complex problems are more manageable in a group. d. Groups discourage individual expression. e. Group decision making is cost-effective. ANS: A, C, E The major advantages of group problem solving over individual problem solving are greater sharing of knowledge and information, increased acceptance of solutions, complex problems are more manageable, groups allow for individual expression, and group functioning is less expensive. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Team dynamics can become dysfunctional over time. What are some factors that can contribute to team dysfunction? (Select all that apply.) a. Taking accountability b. Absence of trust c. Negotiating expectations d. Fear of conflict e. Lack of commitment ANS: B, D, E Dysfunctional team behaviors can occur related to an absence of trust, fear of conflict, lack of commitment, avoiding accountability, and inattention to results. Articulating and negotiating expectations for healthy interpersonal behavior benefits team development. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Effective groups will have a variety of roles. Which of the following are examples of group-building roles? (Select all that apply.) a. Encourager b. Listener c. Summarizer d. Compromiser e. Recorder ANS: A, B, C Group-building roles include initiator, encourager, opinion giver, clarifier, listener, and summarizer. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and ENffecRtiveICarGe EnBv.iroCnmMent: Management of Care U S N T O 10. In planning for an effective committee meeting, what are some of the roles of the leader? (Select all that apply.) a. Allowing the group to set the agenda during the meeting b. Speaking for every member to ensure all opinions are heard c. Identifying the purpose of the meeting d. Ensuring that the meeting starts and ends on time e. Keeping the meeting directed toward accomplishing objectives ANS: C, D, E An effective meeting checklist for leaders includes preparing an agenda and related materials, listen carefully and summarize discussion and assignments at the end of the meeting, ensure balanced dialogue by all members, identifying the purpose of the meeting, ensuring that the meeting starts and ends on time, and keeping the meeting directed toward established goals. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 09: Delegation in Nursing Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. The process for a nurse to direct another person to perform nursing tasks and activities is: a. authorization. b. delegation. c. empowerment. d. supervision. ANS: B In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as “the process for a nurse to direct another person to perform nursing tasks and activities.” DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: a. authorization. b. delegation. c. observation. d. supervision. ANS: D NURSINGTB.COM Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Individuals who are trained to help the registered nurse (RN) in the provision of patient-client care activities as delegated by and under the supervision of the RN are known as: a. certified assistive personnel. b. health care assistive personnel. c. medical assistive personnel. d. unlicensed assistive personnel. ANS: D The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. When considering whether to delegate a task, the nurse needs to assess the patient and: a. how many nurses are available to supervise. b. how complex the delegated action is. c. the severity level of the patient population. d. the expiration date of the license. ANS: B When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the: a. amount of time that the task will take. b. degree of comfort the delegatee has with the task. c. level of patient interaction. d. method of measuring outcomes. ANS: C The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions. NURSINGTB.COM DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: a. interaction. b. outcome. c. supervision. d. time. ANS: C The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up, intervention, and: a. corrective action of the event. b. documentation of the event. c. evaluation of the process. d. summation of the occurrence. ANS: A The nurse is also responsible for corrective action in case of an error. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The nurse has asked a nurse’s aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating: a. assessment of the patient. b. evaluation of an intervention. c. nursing judgment. d. teaching to a delegate. ANS: A The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and ENffUecRtiSveICNarGe TEnBv.iroCnOmMent: Management of Care 9. If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching, who is ultimately responsible? a. Chief executive officer b. Institution where the LPN/LVN works c. Risk manager d. UAP ANS: B Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations (Lanfranchi, 2013). The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard is: a. accountability. b. authority. c. supervision. d. delegation. ANS: A The National Council of State Boards of Nursing (NCSBN, 2016) defined accountability as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN ANS: C The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient. DIF: Cognitive Level: Apply N(AUpRplSicaItiNonG) TB.COM TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Physiological Adaptation 12. The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time ANS: A The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated? a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation ANS: D The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. Who is ultimately accountable for the appropriateness and supervision of the delegated task? a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO ANS: A Accountability in delegation means being obligated to answer for one’s actions, including the act of supervision. The nurseNis uRltimIateGly aBcc.ouCntaMble for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. Delegating requires clear and skillful to avoid liability. a. negotiation b. communication c. corrective action d. planning ANS: B Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support? a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d. Institute for Healthcare Improvement (IHI) ANS: C Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.) a. Nurse apprentices b. Personal care attendants NURSINGTB.COM c. Family members at bedside d. Physicians e. Nursing assistants ANS: A, B, E Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.) a. Potential for harm b. Complexity of the task c. Amount of problem solving required d. Predictability of the outcome e. Level of patient interaction ANS: A, B, C, E In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager. ANS: A, B, D With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. With regard to delegation, wNhaUt oRrSgaInNizaGtiTonBa.l pCrOinMciples are considered? (Select all that apply.) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education ANS: A, B, E At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012). DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The legal and ethical standards to consider when questioning if delegation is appropriate include: (Select all that apply.) a. accountability b. good faith c. cost efficiency d. reasonable e. prudent ANS: B, D, E Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making (Wilkinson, 2016). When considering a questionable situation, the standards of “reasonable,” “prudent,” and “good faith” form the foundations for legal and ethical decision making. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Which principles are important to consider when an RN delegates tasks to UAP? (Select all that apply.) a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient. ANS: B, D, E When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). In making a decision to delegate a nursing task, the following five factors should be assessed: 1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient. NURSINGTB.COM 2. Complexity of the task: The more complex the activity, the less desirable it is to delegate. 3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated. 4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity. 5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A unit manager is utilizing her staff as a resource for educational presentations. An RN in her unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision? (Select all that apply.) a. State nurse practice act b. Organization’s policies and procedures c. The Joint Commission (TJC) d. American Nurses Association (ANA) e. Board of Registered Nursing ANS: A, B, D, E Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state’s board of nursing regulate nursing practice. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.) a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task ANS: B, C, D, E The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Leadership style may be a significant barrier to effective delegation. Which of the following describes the “invincible” style? (Select all that apply.) a. Prefers to do everything tNhemRselIves Gso aBs .noCt toMtransfer control. b. Wants to be everyone’s friend. c. Comes across as a pushover. d. Often stays late to complete documentation. e. Micromanages the UAP. ANS: A, D Many nurses fall into the “invincible” nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The “pal” is the nurse who wants to be everyone’s friend. These nurses do not want to be viewed as pushy or demanding. This type of delegator may come across as a pushover to the UAP. The “watchdog” nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The process of delegation may be undermined in the health care setting as one member of the team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.) a. Lack of ability to direct b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources ANS: B, C, D, E The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 08: Communication in the Work Environment Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively. Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. “Ambulate the patient the length of the hallway and get me if there are any problems.” b. “Have you ambulated this type of post-op patient before?” c. “Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication.” d. “This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable.” ANS: A Delegation requires thorough communication including specific instructions regarding task (“ambulate the length of the hallway”) and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions. DIF: Cognitive Level: Application REF: page 93 2. A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? a. “Dr. Smith, your patient, MUr. JSoneNs is TcomplaOining of a headache.” b. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache.” c. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” d. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” ANS: A This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching. DIF: Cognitive Level: Application REF: pages 95-97 3. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. “Can you step over here out of the hearing of the patients and family members?” b. ‘I’m sorry, you should have ordered restraints for the patient.” c. “We will accept all liability.” d. “My nurses are all new on the night shift. They didn’t know how to handle him.” ANS: A It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician. DIF: Cognitive Level: Application REF: page 99 4. To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. “I don’t need to review the new orders for accuracy.” b. “The orders will go directly to the appropriate departments.” c. “The risk for transcription errors is less.” d. “I am still responsible for communicating the changes to the appropriate care givers.” ANS: A Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions. DIF: Cognitive Level: Analysis REF: page 93 5. The end of shift report is vital for the coordination of patient care. Which of these statements would require an intervention if overheard by the charge nurse during report? a. “Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medicatioNn.” R I G B.C M b. “Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early.” c. “Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today.” d. “Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day.” ANS: D It illustrates the nurse making an inappropriate judgment regarding this patient’s anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention. DIF: Cognitive Level: Analysis REF: pages 95-96 6. Which of the following is an essential part of the shift report? a. Patient’s ECG rhythm b. Patient’s marital status c. Patient’s occupation d. Patient’s insurance status ANS: A The patient’s ECG rhythm is an essential part of the shift report. The other options may not always be appropriate to the shift report. DIF: Cognitive Level: Application REF: pages 95-96 7. Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing. ANS: A This question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question. DIF: Cognitive Level: Application REF: page 93 8. A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step. ANS: D If unfamiliar with the approvNed aRctioIns iGn a Bse.xuCal hMarassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case. DIF: Cognitive Level: Application REF: page 99 9. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician. ANS: B Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors. DIF: Cognitive Level: Application REF: page 93 10. Which of the following patients should be seen by the nurse first based on the information provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes. c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed. ANS: A This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment. DIF: Cognitive Level: Analysis REF: pages 95-96 11. Which response by the patient following discharge teaching would require further teaching? a. “I should weigh myself daily since I started on Lasix (furosemide) for my heart failure.” b. “I need to check my blood glucose after eating.” c. “I should take my Lanoxin (digoxin) with my morning medications.” d. “I need my blood checked frequently now that I am on Coumadin (warfarin).” ANS: B Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching. DIF: Cognitive Level: Analysis REF: page 98 12. Which exchange between the RN and the UAP requires intervention by the charge nurse? a. “Take the patient’s blood pressure every 15 minutes and inform me of the results.” b. “Check the patient’s blood glucose before breakfast and lunch and inform me of the results.” c. “Ambulate the patient in 2210 as far as he can walk.” d. “Shave the patient in 221N0.UHRisSbIeaNrGd Tis Blo.ngC.”OM ANS: C Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention. DIF: Cognitive Level: Application REF: page 95 13. Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day ANS: D This patient is unstable and requires urgent assessment. The other assessments can be delayed. DIF: Cognitive Level: Analysis REF: pages 95-98 14. A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most appropriate? a. “You can’t leave until all the baths are completed.” b. “Write down what needs to be completed.” c. “Tell me what responsibilities still need to be completed.” d. “Be sure to call by 5 AM if you are still sick tomorrow.” ANS: C Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care. Options B is not the most effective means of communication and does not allow for questions and feedback. DIF: Cognitive Level: Analysis REF: page 95 | pages 97-98 15. The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language. ANS: A The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives. DIF: Cognitive Level: Application REF: page 91 16. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient howNwRhat ItheyGsayBi.s CbeinMg interpreted. d. Complain to the physician. ANS: C Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication. DIF: Cognitive Level: Application REF: page 91 MULTIPLE RESPONSE 1. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication ANS: A, B, D, F In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation. DIF: Cognitive Level: Application REF: page 90 2. It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data ANS: A, C, D, F Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances. DIF: Cognitive Level: Application REF: page 96 3. SBAR is a convenient tool to use when notifying physicians of a change in patient condition. In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with casNe mURanSagIeNr GTB.COM c. Transferring patient d. Change of shift report e. Rapid response team (RRT) ANS: C, D, E Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR. DIF: Cognitive Level: Analysis REF: page 96 4. In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments ANS: B, C, D, E Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 5. Formal communication in health care is used to properly inform staff of (Select all that apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee. ANS: A, C Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication. DIF: Cognitive Level: Application REF: page 100 6. Informal (“grapevine”) communication in health care is used to properly inform staff of (Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. N R I G B.C M d. girl Scout cookie order pickU-upS. N T O e. termination of an employee. ANS: B, D, E Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment. Options A and C are examples of formal communication. DIF: Cognitive Level: Application REF: page 100 7. Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task. ANS: A, B, C Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated. DIF: Cognitive Level: Application REF: page 90 8. The end of shift report is the appropriate time to communicate (Select all that apply.) a. the frequency of which the call light was used. b. patient’s relationship to a staff member. c. new patient orders. d. impending procedures. e. evaluation of medication response. ANS: C, D, E Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient. DIF: Cognitive Level: Application REF: page 95 | pages 97-98 9. Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b. Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient’s family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered. ANS: A, C, F Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds. N R I G B.C M DIF: Cognitive Level: Application REF: page 95 | pages 97-98 [Show More]

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