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NURSING 1234 Leadership Test#1 Chapter 1-13 (GRADE A) Questions and Answers, All Correct Rationales, Download to Score A

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NURSING 1234 Leadership Test#1 Chapter 1-13 Chapter 1 Introducing Nursing Management 1) When planning client care the nurse must be aware that current changes in health care are primarily driven... by: 1. Cost of care. 2. Access to care. 3. Availability of care. 4. Quality of care. Answer: 1 Explanation: 1. Cost is the primary factor driving the changes in health care. Rising costs also affect access to care, availability of care, and quality of care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 2) Which is the United Statesʹ largest and most expensive health care program? 1. Medicaid 2. Medicare 3. Social Security 4. Temporary Assistance for Needy Families (TANF) Answer: 2 Explanation: 2. Medicare is the government’s largest health care financing program. It serves 40 million people who are elderly and have disabilities. Medicaid is a smaller health care program that serves the poor. Social Security and TANF are not health care programs. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 3) The nurse explains to the family of an elderly client that the client cannot stay in the hospital for rehabilitation from a hip replacement because Medicare and personal insurance will not continue to pay for hospital care. Which is the correct way for the nurse to explain diagnostic-related groups (DRGs) to the family? 1. Group of clients with the same diagnosis 2. Fee for service payment plan 3. Group of related diagnoses applying to one client 4. Prospective system of payment for health care Answer: 4 Explanation: 4. DRGs are a prospective system of payment to providers and organizations for a set amount for a specific condition stipulated in advance. Health care providers have responded to this system by reducing hospital stays. All other answers are incorrect definitions for DRG. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 4) How would the nurse working in a school clinic that is part of an integrated health care network explain the focus of care to parents and teachers? 1. Hospital care 2. Primary care 3. Specialty care 4. Home care Answer: 2 Explanation: 2. Primary care is the focus of integrated health care systems. The goal is to keep the clients healthy, and to prevent hospital stays, visits to specialists, and home health care. Hospital care, specialty care, and home care are not the focus of integrated health care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) In order to evaluate the quality of client care in the hospital setting, the nurse manager may ask the nursing staff to: 1. Track the number of supplies used on surgical clients. 2. Document nursing time and tasks spent on direct client care. 3. Administer a client and family satisfaction survey. 4. Assess clients and report acuity to shift supervisors daily. Answer: 3 Explanation: 3. Client satisfaction surveys can be used to evaluate client needs and how the organization is meeting those needs. Tracking supplies, documenting nursing time, and reporting client acuity can be used for budgeting and staffing purposes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Health care organizations have used benchmarking to evaluate and enhance quality care by: 1. Comparing outcome indicators between organizations. 2. Comparing internal hospital units. 3. Establishing unit goals. 4. Maintaining effective unit policies. Answer: 1 Explanation: 1. Benchmarking uses an organizationʹs outcome data and compares it with a similar organization to address strengths and challenges. Evaluating the goals and policies of internal units are not benchmarking. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) It is known that fewer professional nurses on each unit will have which effect? 1. Cost savings passed on to the client 2. Negative outcomes with surgical clients 3. Decreased mortality rates 4. Increased quality of client care Answer: 2 Explanation: 2. Recent research has shown a direct relationship between fewer nurses and negative outcomes with surgical clients and increased mortality rates. There are higher client costs related to surgical complications and longer hospital stays. There is decreased quality of client care with fewer nurses. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) Which action by nurse managers and/or staff will positively impact the nursing shortage? 1. Current nursing faculty members return to work in acute care settings. 2. Shorter hospital stays resulting in decreasing need of nurses in acute care settings. 3. Focus on recruitment of middle school and high school students, men, and minorities to schools of nursing. 4. Increase nursing wages. Answer: 3 Explanation: 3. Aggressive recruiting in diverse populations and younger students is needed in nursing. More, not less, nursing faculty are needed to increase class size. As hospital stays are shorter, nurses are needed in settings outside of the hospital. Studies have shown that nurses are more interested in improved workplace settings than in increased wages. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) The first step in planning course content for in-service education for the nursing staff on cultural diversity is to: 1. Determine how many staff members speak Spanish. 2. Evaluate staff membersʹ knowledge of how religion impacts health care. 3. Plan for a guest speaker with knowledge of racial and ethnic health disparities. 4. Assess local community demographic data. Answer: 4 Explanation: 4. The first step in planning for cultural diversity is to assess the local community to determine what diversity exists in the community. The staff needs to be culturally sensitive to the needs of all members of the community. Until the assessment is done, it is unknown what language, religion, racial, or ethnic groups are represented in the community. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) For a new nurse working in a hospital, which management tasks are required? Select all that apply. 1. Supervise nonprofessional personnel. 2. Evaluate client care. 3. Delegate tasks to nonprofessional personnel. 4. Complete performance evaluations on staff. 5. Communicate with practitioners of other disciplines. 6. Plan unit budget with decreasing resources. Answer: 1, 2, 3, 5 . 11) The nurse is assisting a client move from bed to bathroom and notices a spill on the floor. Which is the nurseʹs first action? 1. Call housekeeping to clean up the spill while the client remains in bed. 2. Call housekeeping to clean up the spill after assisting the client to the bathroom. 3. Clean up the spill while the client moves to the bathroom. 4. Clean up the spill while the nursing assistant assists the client. Answer: 1 Explanation: 1. Calling for housekeeping to clean up the spill before moving the client is correct because the nurse is practicing quality management by addressing a problem before it causes a crisis. Taking care of the client is the first priority, which leaves out cleaning up the spill. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) The nurse manager is planning unit orientation for new employees. Which must be considered? Select all that apply. Employee: 1. Cultural diversity 2. Generational differences 3. Socioeconomic status 4. Shifts assigned 5. Retirements on unit Answer: 1, 2 13) A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career to ensure long-term stability. Which specialty is most likely to grow in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing Answer: 3 Explanation: 3. As Baby Boomers age, geriatric nursing will be needed more than any other. No other areas have such a demand due to better health practices as people age and living longer. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) The nurse manager overhears staff discussing the shortage of nurses. The staff is misinformed if which statement is made? 1. There are more nurses retiring than are entering the profession. 2. The demand for nurses is declining because of fewer hospital admissions. 3. There are insufficient numbers of nursing faculty to teach interested students. 4. The number of women in nursing still outnumbers men and minorities. Answer: 2 Explanation: 2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. It is true that more are retiring than are entering (especially Baby Boomers), there are insufficient nursing faculty numbers, and women outnumber men and minorities in the profession. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application . 15) Place the steps of evidence-based practice in the correct order. 1. Evaluate the evidence. 2. Identify the clinical question. 3. Apply the evidence. 4. Evaluate the outcome. 5. Find the evidence to answer the question. Answer: 2, 5, 1, 3, 4 Explanation: This follows very closely with the nursing process. The nurse must know the question to be answered before beginning the search for the evidence with which to answer it. Nurses always evaluate an action once it is complete. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 16) A nurse practicing evidence-based nursing practice would rely on which to assist in addressing a clinical issue? 1. Intuition 2. Clinical experience 3. Formal knowledge 4. Scientific evidence Answer: 4 Explanation: 4. Evidence-based practice focuses on addressing issues based on a thorough review of the evidence, usually through scientific literature, to obtain the most useful and appropriate solution. The remaining options rely on other types of knowledge. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Which is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the Internet. Answer: 4 Explanation: 4. Ensuring adequate training by itself is not enough. Recognition for those willing is also an insufficient motivator. Asking for opinions will also do little to encourage its use. There must be training, easy access, and recognition for using evidence in nursing practice. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) Which technology will make nursing care at the bedside more efficient? Select all that apply. 1. Robotics 2. Electronic Health Record 3. Handheld Personal Data Assistants 4. Online Charting Answer: 1, 2, 3, 4 19) The nurse is trying to understand why an electronic health record is useful to the nurse in the workplace. Which is an accurate reason for using them? 1. To increase medical errors 2. To increase health care costs 3. To reduce redundancies 4. To decrease efficiency Answer: 3 Explanation: 3. Electronic health records (EHRs) can reduce redundancies by allowing a clientʹs complete record to be kept in one place, to be accessed by those who are treating the client. They reduce errors, decrease costs, and increase efficiency by having a complete record for use when needed. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) For a nurse working in a hospital using a robotics pharmacy system, which describes the advantage for nurses? 1. The nurse will be able to leave out some of the 6 rights since the robot checks the medications. 2. The nurse should get medications quicker since the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant since they have already been checked. 4. The nurse can expect that medication administration will be easier and with less potential for error. Answer: 2 Explanation: 2. Robots should be able to get medications to the floor more quickly. However, since there is still great room for error, the registered nurse will still have to complete the six rights of medication administration to ensure client safety. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Why must nurses be prepared to respond to a disaster? 1. Nurses must be ready to provide care in risky circumstances without the use of technology. 2. Nurses must be ready to provide care regardless of circumstances that may occur during a disaster. 3. Regardless of what occurs, nurses cannot have fear. 4. Nurses must practice so they make no mistakes during practice drills to eliminate mistakes during a disaster. Answer: 2 Explanation: 2. Nurses must be prepared to react during a disaster, but no amount of practice drills will eliminate fear or mistakes. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 22) The most important aspect of training and practicing for disasters is: 1. Allowing each nurse to take the role with which they are comfortable. 2. Ensuring each nurse can take on all roles as they occur. 3. Addressing concerns of each participating nurse at each disaster exercise. 4. Making sure each nurse can react instinctively regardless of situation. Answer: 3 Explanation: 3. It is most important, as nurses have concerns and fears at each practice or simulation, that their fears be addressed to ensure nurses are more comfortable in the role as provider of emergency care. Each nurse needs to take responsibility for all roles, and not just those with which they are comfortable. In addition, it is more important that a nurse react with the clientʹs and their own safety in mind. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 23) The most important nursing diagnosis that must be considered when taking care of clients involved in a disaster is: 1. Caregiver Role Strain, Risk for 2. Nutrition, Less than Body Requirements 3. Pain, Acute 4. Tissue Integrity, Impaired Answer: 4 Explanation: 4. Tissue Integrity, Impaired is the priority nursing diagnosis among these options. Caregiver role strain and pain are considered ʺpsychosocialʺ in nature according to NCLEX standards. While nutrition is important to skin integrity and the ability to repair damage, impaired tissue integrity would take priority as this may lead to hypovolemia and shock, or infection and shock. The well-prepared nurse would be able to prioritize these. Diagnosis Category of Client Need: Psychosocial Integrity Cognitive Level: Application 24) There are procedural changes on the unit as a direct result of client satisfaction surveys. The person most strategically placed to handle how these changes are initiated is the: 1. Hospital administrator. 2. Nurse manager. 3. Client. 4. Chief executive officer. Answer: 2 Explanation: 2. The nurse manager is situated on the front lines but is also responsible to the upper management. The manager can be supportive of the feelings of the staff while at the same time adequately and appropriately representing the needs/wants of the administration. The client, CEO, and hospital administrator would not have enough information about the daily unit activities to be effective in instituting these changes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 25) Which aspects of nursing in todayʹs health care system must an effective nurse manager be aware of? Select all that apply. 1. Consistency 2. Decreasing resources 3. Adequate staffing 4. Increasing retirees 5. Complicated technology Answer: 2, 4, 5 Chapter 2 Designing Organizations 1) Using the classical organizational theory model, the most appropriate method for the nurse to voice concern over unfair client workload assignments would be to: 1. Invite the director of nursing to a unit meeting. 2. Organize a unit meeting to discuss the problem on all shifts. 3. Discuss the problem with the team leader and then the charge nurse/unit supervisor if the problem remains unsolved. 4. Circulate a petition to all staff seeking support for change in assignment policy. Answer: 3 Explanation:3. Classical theory provides a formal chain of command and system for communication. The other options would be inappropriate and not take into consideration the chain of command inherent in classical theory. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) Which is an example of staff authority in classical theory? 1. Nurse/mentor relationship 2. Nurse/team leader relationship 3. Nurse/shift supervisor relationship 4. Nurse/manager relationship Answer: 1 Explanation: 1. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The other relationships have line authority. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The management of a local hospital has decided to close a postsurgical unit in the hospital due to the nursing shortage. Of which organizational theory is this an example? 1. Chaos theory 2. Classical theory 3. Systems theory 4. Contingency theory Answer: 4 Explanation: 4. Contingency theorists believe organizational performance can be enhanced by matching an organizationʹs structure to its environment. The environment is made up of internal and external forces. The nursing shortage is an external force that impacts the environment and performance of the organization. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) Which statement indicates a nursing student is in need of more study time? 1. ʺChaos theorists believe change is inevitable.ʺ 2. ʺClassical theorists believe in organizational hierarchy.ʺ 3. ʺSystems theorists discuss outputs and inputs.ʺ 4. ʺContingency theorists believe the environment forces organizational change.ʺ Answer: 3 Explanation: 3. According to systems theory the ʺinputʺ or employees are imported from the environment. The work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the environment. The student neglected to include ʺthroughputʺ and the remaining choices are correct. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment 5) The nurse manager is determining placement for a client in need of medical and nursing care in an inpatient setting for less than 30 days. Which statement indicates the correct placement? 1. ʺThe client requires a long-term care facility.ʺ 2. ʺThis client requires a managed care organization.ʺ 3. ʺThis client needs an ambulatory care center.ʺ 4. ʺThis client needs a hospital.ʺ Answer: 4 Explanation:4. The American Hospital Association defines an acute care hospital as a facility in which the average length of stay is less than 30 days. The other choices are not appropriate as they are either for different length of stays or related to how the overall care is organized. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 6) During the nurseʹs interview for a new job, the health benefits are described as a group of health care providers in the local town who have agreed to provide treatment and health services for the clinic employees. This is an example of a (an): 1. PPO. 2. HMO. 3. POS. 4. SSI. Answer: 2 Explanation: 2. An HMO is a geographically organized system that provides an agreed -upon package of health maintenance and treatment services. A PPO is a managed care organization that contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security insurance. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) Which indicates a weakness of a functional structure in a long-term care facility? 1. All nursing tasks fall under the nursing department. 2. The dietary department is responsible for nutritional assessment. 3. Physical and occupational therapy coordinate and evaluate activities of daily living. 4. The nursing department is responsible for writing the care plan. Answer: 4 Explanation: 4. Nursing tasks falling under the nursing department, the dietary department being responsible for nutritional assessment, and physical and occupational therapy coordinating and evaluating activities of daily living all reflect a functional structure in which individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a care plan without input from other departments while the other options relay stand- alone tasks with little required input from other departments. Nursing Process: Planning 8) A nurse practitioner collaborating with physicians and as a general business partner to provide needed services is an example of which diversification method? 1. Joint venture 2. Conglomerate diversification 3. Concentric diversification 4. Capitation Answer: 1 Explanation: 1. A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service. Conglomerate diversification is the expansion into areas that differ from the original service. Concentric diversification is expansion of services into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) In planning for discharge of a client needing follow-up for diabetic education, the nurse should contact a: 1. Long-term care facility. 2. Home health agency. 3. Temporary service agency. 4. Public health department. Answer: 2 Explanation: 2. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities are used for rehabilitation and care needed for extended periods of time. Temporary service agencies are used to provide health care agencies with professional and nonprofessional personnel when they are short staffed. The public health department focus is usually community health and not individual primary care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) A nurse manager who encourages the nursing staff members to assist in developing a new creative staffing pattern in response to recent resignations and people going back to school subscribes to what organizational theory? 1. Neoclassical theory 2. Systems theory 3. Chaos theory 4. Classical theory Answer: 3 Explanation: 3. Chaos theory proposes an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which statement indicates a reason why the parallel structure in hospitals is being used less frequently? 1. Parallel structure causes complex relationships. 2. Newer models of organizational structure exist. 3. Parallel structure creates two lines of authority. 4. Parallel structure calls for increased authority of medical staff. Answer: 3 Explanation: 3. Parallel structure exists when there are two lines of authority in an organization. Due to new models of organizational structure, medical staff may have less direct authority and may be included as staff members and adhere to hospital policy. The staff relationships are then less complex. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) Which structure is reflected by the statement ʺnursing practice is best determined by nursesʺ? 1. Heterarchy structure 2. Shared governance 3. Strategic planning 4. Matrix structure Answer: 2 Explanation: 2. Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered. Heterarchy structure is a relational design based on the concept of connections. Planning is an activity that projects the organizationʹs goals and actions into the future. Matrix structure combines functional structure and product structure into one overlapping structure. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) ʺWe want to be the hospital of choice in the Midwestʺ is which type of statement? 1. Mission statement 2. Vision statement 3. Value statement 4. Philosophy statement Answer: 1 Explanation: 1. The mission statement is a broad statement of the organizationʹs reason for existence. A vision statement describes the goal to which the organization aspires. The value statement is the beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the organizationʹs values, vision, and mission. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) What is the best example of a pediatric unitʹs organizational culture? 1. All client rooms are private. 2. Nurse-to-client ratio is 4 to 1. 3. Nurses wear colorful scrubs. 4. Primary nursing model is used for care. Answer: 3 Explanation: 3. Organizational culture is based on norms and traditions such as nurses wearing colorful attire. Organizational climate is based on physical attributes and policy and procedure. Private rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of organizational climate. Nursing Process: Implementation 15) Which are the traditional organizational structures? Select all that apply. 1. Heterarchical 2. Hybrid 3. Matrix 4. Hierarchical 5. Classical 6. Chaos Answer: 1, 2, 3 16) Students are trying to learn organizational structures. Which statement indicates more studying time is needed? 1. ʺSelf-organizing is a part of relationship organizing structures.ʺ 2. ʺShared governance believes all professions should share governance of others.ʺ 3. ʺHeterarchical structures are based on the connectedness between individuals.ʺ 4. ʺThe parallel structure exists only in health care organizations.ʺ Answer: 2 Explanation: 2. Shared governance is a type of structure in which the members of one profession govern that profession. Governance is not shared with other professions. The other options are correct statements and thus not the correct answer. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Which portion of strategic planning is indicated by the statement: ʺThe nursing department will increase client satisfaction scores by 20% by Juneʺ? 1. Mission 2. Objective 3. Goal 4. Value Answer: 2 Explanation: 2. The objective statement is specific to each unit or department within the organization. Objectives specify how each department will meet the goals set for the entire organization. The goal statement applies to the entire organization, as does the mission statement. Nursing Process: Implementation Safe, Effective Learning Environment Cognitive Level: Application 18) Which indicate the purpose of strategic planning? Select all that apply. 1. Identify external strengths. 2. Identify external weaknesses. 3. Recognize potential changes. 4. Evaluate goals, objectives, and activities. 5. Determine the market position of competitors. 6. Determine market position once yearly. Answer: 1, 3, 4, 6 19) Which of the following statements represents an organizationʹs philosophy? 1. ʺWe will increase client satisfaction by 15%.ʺ 2. ʺWe will increase productivity by 10% on the 2nd floor.ʺ 3. ʺWe believe clients are most important.ʺ 4. ʺWe believe in honest communication.ʺ Answer: 3 Explanation: 3. The philosophy is a statement of beliefs held by the organization; values are specific aspects of personal relationships or specific situations; the vision statement is the overall outcome desired by the organization; the mission is the reason the organization exists. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 20) The house supervisor is instructing new nurse managers on positive managerial skills. Teaching has been effective if the house supervisor hears which comment? 1. ʺThere is no way I am leaving my door open for the staff to come in whenever.ʺ 2. ʺI expect my staff to be on time every day to work, without exceptions.ʺ 3. ʺI will help my staff whenever they might need an extra hand with something.ʺ 4. ʺI wonʹt call in my on-call person until I absolutely have no other choice. Answer: 3 Explanation: 3. Offering assistance when needed helps raise morale and foster a positive work environment. This in turn will affect the overall success of the organization. The others do not and would require further instruction. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Which are aspects of a positive organizational environment? Select all that apply. 1. Resonant leaders 2. Environmental dissonance 3. Client advocacy 4. Open communication 5. Staff recognition Answer: 1, 3, 4, 5 22) Which constitutes organizational culture? 1. All nurses know to take turns covering each otherʹs clients to facilitate eating breakfast and lunch on day shift. 2. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 3. The cafeteria opens at 0700 for breakfast, 1100 for lunch, and 1700 for dinner. 4. Every Friday the administrator allows everyone to wear crazy hats while on the units. Answer: 1 Explanation: 1. The unspoken rules of the organization make up the culture. Thus, nurses covering for each other is the appropriate option. The other options are part of the organizational environment. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 23) Why would a health care organization want to become a magnet hospital? Select all that apply. 1. To improve nurse recruitment 2. To foster ability to retain physicians 3. To attain higher client satisfaction 4. To broaden the use of evidence-based practice Answer: 1, 2, 3, 4 24) Organizations must apply for magnet status through which organization? 1. American Nurses Credentialing Center 2. American National Credentials Commission 3. Joint Commission for the Accreditation of Healthcare Organizations 4. Joint Credentialing Association for Healthcare Organizations Answer: 1 Explanation: 1. The American Nurses Credentialing Center awards magnet status after the organization applies for, and is accepted for the award. The American National Credentials Commission and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint Commission for the Accreditation of Healthcare Organizations is the agency that accredits hospitals. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 25) The organization that awards magnet status would look for environments in which: 1. Nurses are involved in decision making. 2. Rewards are given to those with money-saving ideas. 3. Decisions are made and then followed. 4. Nurses do not have to work overtime. Answer: 1 Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses becoming involved in decision making would fall under these attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients; demanding that all decisions are followed does not foster autonomy and independence; overtime is sometimes a necessity to ensure clients have quality care that is documented and completed by the end of the shift. Chapter 3 Delivering Nursing Care 1) Which statement describes functional nursing? 1. One nurse has responsibility for all the needs for three clients. 2. One nurse has responsibility for all the medications on the unit. 3. One nurse and one nursing assistant have responsibility for ten clients. 4. One charge nurse and one respiratory therapist have responsibility for all clients. Answer: 2 Explanation: 2. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. Total patient care is given by one nurse assigned to a few clients. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) Which has affected change in nursing care delivery systems? 1. Increased acute care client days 2. Decreased acuity level of clients 3. Availability of registered nurses 4. Enhanced hospital revenues Answer: 3 Explanation: 3. The availability of nurses has historically affected the method of client care delivery. Nursing shortages have required nurses to be creative in caring for clients. Increased acute care days, decreased acuity, and enhanced hospital revenues are incorrect because client days have decreased, acuity levels have increased, and hospital revenues have been challenged. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 3) The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy with physician visits and new client orders and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for one of the clients. What type of nursing care delivery system is in place in this hospital? 1. Total patient care 2. Functional nursing 3. Team nursing 4. Critical pathways Answer: 3 Explanation: 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. Total patient care is given by one nurse. Functional nursing breaks down the assignments into tasks. Critical pathways are a set of strategies used by health care providers to attain expected outcomes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) As the RN team leader, identify all potential disadvantages of using team nursing to deliver care to the assigned clients. Select all that apply. 1. Delegation/accountability 2. Client/staff communication 3. Cost savings/staffing 4. Continuity of care Answer: 1, 2, 4 5) Which has historically been the most the most successful client care delivery system in intensive care units? 1. Team nursing 2. Total patient care 3. Functional nursing 4. Modular nursing Answer: 2 Explanation: 2. In total patient care, one nurse cares for a client and can give continuous, holistic, and expert nursing care, being totally accountable for the client. Team nursing, functional nursing, and modular nursing have the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Which describes the difference between total patient care and primary nursing? 1. One RN is accountable for the nursing care of one client for the duration of the hospital stay. 2. The fewest number of nurses are assigned to one client during the hospital stay. 3. One RN communicates with the physician and family members of the client. 4. One RN completes all tasks related to the care required by the client. Answer: 1 Explanation: 1. In primary nursing a single nurse is responsible for the client for the entire hospital stay. This is not so in total patient care. The remaining answers accurately describe both total patient care and primary nursing. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) Which is an ideal nursing care delivery system for a new RN graduate? 1. Functional nursing 2. Primary nursing 3. Total nursing care 4. Practice partnerships Answer: 4 Explanation: 4. Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN. Functional nursing, primary nursing, and total nursing care have the RN working more autonomously. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) In order to organize services needed to achieve specific client outcomes, the hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Primary nursing 3. Case management 4. Differentiated practice Answer: 3 Explanation: 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. Functional nursing, primary nursing, and differentiated practice do not focus on specific outcomes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) The RN working on an orthopedic unit has a postoperative client with a hip replacement who is not transferring well from bed to chair and has fallen behind on the mobility training program. Which is the nurseʹs priority action? 1. Page the surgeon. 2. Contact the family to discuss pre-op mobility problems. 3. Instruct physical therapy to increase treatments to QID. 4. Inform the case manager of variance in critical pathway. Answer: 4 Explanation: 4. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. Paging the surgeon or contacting the family is not the first step. Ordering an increase in physical therapy is not within the scope of nursing. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) Hospital X is concerned about the low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Functional nursing 2. Total patient care 3. Patient-centered nursing 4. Team nursing Answer: 3 Explanation: 3. The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control. Functional nursing is cost effective but lacks continuity of care. Total patient care is costly and less efficient for nursing staff. Team nursing is cost efficient but may lack continuity of care, which can cause client dissatisfaction. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which indicates the new graduate nurse understands why it is necessary to structure nursing care? Select all that apply. 1. Coordinate care to a group of clients. 2. Organize responsibilities. 3. Ensure the staff leaves on time. 4. Improve physician efficiency. 5. Cluster care to allow rest periods. 6. Provide skilled care by skilled staff. Answer: 1, 2, 5, 6 12) Which is the most important consideration in choosing a structure for nursing care? 1. Cost 2. Timeliness 3. Client need 4. Efficiency Answer: 3 Explanation: 3. While all four options are important, client need takes precedence over the others because nursing provides a service to the client. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which indicates a teaching about different models of nursing care delivery systems has been unsuccessful? The models that exist are: 1. Total patient care. 2. Integrated care. 3. Hospital care. 4. Patient-centered care. Answer: 3 Explanation: 3. The hospital care delivery system does not exist. There is a 12-bed hospital model in use in Miami. All the others are correct. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which indicates the primary reason for the addition of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decision making is best made by nursing leaders for all units within that particular hospital. 3. Those nurses working in particular service area are best suited to make decisions for the clients in that area. 4. Clinical decision making is best made by the clients who are served by a particular unit. Answer: 1 Explanation: 1. The clinical microsystem method began to allow those who are involved in a particular unit make the decisions for that unit. The other options are not correct as they do not describe decision making by those on the ʺfront linesʺ on a particular unit. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) The newest delivery systems are organized around: Select all that apply. 1. Caring for older clients. 2. Giving care to pediatric clients. 3. Home care clients. 4. Smaller ʺunits within units.ʺ 5. Different populations. Answer: 1, 3, 4, 5 16) Regardless of which delivery system or combination of delivery systems is appropriate, which describes a skill required for effective use? 1. Strict adherence 2. Flexibility 3. Resistance to change 4. Persistence Answer: 2 Explanation: 2. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs, the organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to have the desired effects. Thus, strict adherence, resistance to change, and persistence are not correct. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 4 Leading, Managing, and Following 1) If a nurse is working in a department with several less-experienced nurses, which attribute should this nurse possess if the leadership is to be perceived as effective? 1. Accountability 2. Authority 3. Efficiency 4. Vision Answer: 4 Explanation: 4. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. The other three skills and characteristics are necessary for good nursing management, but are not essential for a nurse leader. A leader may have no formal accountability or authority. A leader is not necessarily a good manager and may not be efficient. Nursing Process: Assessment Safe, Effective Care Management Cognitive Level: Application 2) How are leaders formed according to behavioral theorists? Select all that apply. 1. Education 2. Experience 3. Traits 4. Training Answer: 1, 2, 4 3) The nurse manager of the childbirth center has been instructed to implement a cost savings plan by downsizing nonprofessional staff. Which is the most important task for the manager? 1. Reorganize workload and assign tasks. 2. Inspire staff to commit to the organization goals. 3. Evaluate outcomes and report to the administration. 4. Plan transitional activities. Answer: 2 Explanation: 2. A manager is hired to implement tasks to meet the organizational needs. In order to best change behaviors, the manager must convince the staff of the value of the organizational goal. All other answers are correct, but are not most important. After the staff buys into the goals, the manager can plan activities, implement the plan, and evaluate the outcomes. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A 58-year-old client has been admitted to CCU with a myocardial infarction. The client suddenly goes into cardiac arrest and team members rush into the room. What type of nurse leadership style would be best in this situation? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Bureaucratic Answer: 1 Explanation: 1. The autocratic leader makes all the decisions and has the authority. This would be the most effective type of leadership in a code situation. The other leadership styles would be ineffective in an emergency situation. Nursing Process: Implementation 5) A nursing faculty member is mentoring a graduate student in writing a thesis. Which type of leadership would be best in this situation? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Bureaucratic Answer: 2 Explanation: 2. The democratic leader assumes the individual is motivated by internal drive and wants active participation in getting the task done. The leader/follower participates in achieving the goal. The autocratic leader makes all the decisions. The laissez-faire leader gives no direction. The bureaucratic leader does not trust the follower and makes decisions based on the organizational policies. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) The nurse has scheduled a vacation to attend a resort with the family over the childrenʹs spring break. There is a flu epidemic and over 60% of the staff is unavailable to work. The nurse manager cancels all scheduled vacation and requires all staff to work the week of spring break. Using the managerial grid as a model, what type of management decision was made? 1. Country club 1,9 2. Team 9,9 3. Impoverished 1,1 4. Authority compliance 9,1 Answer: 4 Explanation: 4. Authority compliance has the highest regard for the work at hand and the lowest regard for the human elements. The opposite would be country club, in which the relationships between people are higher than the regard for work. The team style has high regard for both task and people. Impoverished decisions lack concern for the task and the people. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) The nurse manager is planning the holiday schedule for the staff on the oncology unit. The staff is highly experienced and has worked well together for over five years. Using situational leadership theory, which is the most effective leadership style for this management decision? 1. Telling 2. Selling 3. Participating 4. Delegating Answer: 3 Explanation: 3. The nurse manager could ask the staff for input and assistance in making the holiday schedule, keeping the final implementation to himself. The task is relatively low-end and the relationship is high-end supportive. The staff may not react well to a schedule presented with a telling style. A selling style may need to be used if the manager makes and implements an unpopular schedule. Delegating the holiday schedule could be a risky choice. The manager would be leaving responsibility for the decision and the implementation up to the staff. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) If a situation develops on a unit and the nurse manager has a meeting to discuss the necessary outcomes, and then asks for the group to discuss possible ways to achieve the outcome, which type of leadership is this? 1. Quantum 2. Contemporary 3. Contingency 4. Behavioral Answer: 1 Explanation: 1. Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. Quantum leadership is one type of contemporary theory and is not related to contingency or behavioral theory. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) Which statement is most likely made by a transactional leader? 1. ʺIf you work overtime tonight I will authorize double your hourly pay rate.ʺ 2. ʺJanʹs mother is ill. Is anyone able to cover her shift tonight?ʺ 3. ʺHow can we work together to cover Janʹs shifts until her mother is better?ʺ 4. ʺI can work an extra shift tomorrow night. Who can cover tonight?ʺ Answer: 1 Explanation: 1. Transactional leadership is based on the principles of social exchange theory. There is an exchange process between leaders and followers. The other three answers are examples of statements made by a transformational leader. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) What is the focus of transactional leadership? 1. Interpersonal relationships 2. Benefits and rewards 3. Common goals 4. Pursuit of higher values Answer: 2 Explanation: 2. In the transactional exchange process between leaders and followers, the focus is on benefits and rewards. The other three answers are examples of the focus of transformational leadership. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 11) The nurse manager in a long-term care facility wants to develop a unique plan of care for each client. The nurse invites representatives from dietary, physical therapy, social work, and nursing to attend a meeting to plan the care together. This nurse manager is demonstrating what type of leadership? 1. Transactional 2. Charismatic 3. Transformational 4. Relational Answer: 4 Explanation: 4. A relational leader has skills that create interconnections between caregivers and empowers nursing staff and interdisciplinary colleagues. The nurse manager may also be a transactional, charismatic, or transformational leader, but this example describes the interdisciplinary approach to leadership and client care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) What is the most common skill effective nurse leaders share in any leadership theory or leadership model? 1. Political knowledge 2. Communication 3. Critical care experience 4. Informal power Answer: 2 Explanation: 2. Communication skills are the most important for an effective leader. Regardless of the type of leader or the type of unit a nurse manages, communication is the key to effective leadership. An effective leader may also have political knowledge or informal power. Critical care experience is not necessary for effective leadership. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which accurately describes shared governance? 1. Nurses working in groups managing themselves 2. Two nurses sharing the management role 3. Nursing leadership originating from a desire to serve and share 4. Nurses formally organized to make decisions regarding practice standards Answer: 4 Explanation: 4. Shared governance is a formal process. Decision making is done by designated nurse representatives. The other answers are incorrect definitions of shared governance. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) The hospital has developed a plan for an internal float pool of nurses to address the problem of increasing costs of staffing agencies. The float pool will be used when scheduled staff nurses call in sick for their shift. What type of planning has the administrative staff done? 1. Strategic 2. Contingency 3. Organizational 4. Directive Answer: 2 Explanation: 2. Contingency planning is a proactive response to problems that may interfere with getting work done. Strategic planning is prioritizing long-term goals. Organizing and directing are related to planning to get the work done. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) What is the most important role/task of nurse managers? 1. Strategic planning 2. Staff development 3. Fiscal resource management 4. Client care accountability Answer: 4 Explanation: 4. Although the nurse manager has a variety of roles and tasks, the most important role of nursing management is to assure quality client care. The nurse manager is accountable for quality care. The other answers are also tasks and roles of the nurse manager, but are secondary to quality care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 16) Which level of management is responsible for shift-by-shift coordination and promotion of quality client care? 1. Charge nurse 2. First level 3. Middle level 4. Upper level Answer: 1 Explanation: 1. The charge nurse is unique to the health care setting. A staff nurse is in charge shift by shift and accountable to the first-level manager. The first-, middle-, and upper-level managers are accountable for quality care 24 hours a day. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 17) The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, ʺI donʹt care how long I am a nurse, I will never be a manager.ʺ Which ways do nurses manage regardless of their official role? Select all that apply. 1. Delegation responsibilities 2. Coordination of client care 3. Working with the budget 4. Deciding on priorities 5. Being a liaison Answer: 1, 2, 4, 5 18) Which explains why nurses must be leaders to be successful in client care? 1. Nurses must be effective at giving orders. 2. Nurses must direct client care activities to reach outcomes. 3. Only nurses as leaders have physician respect. 4. Only nurses as leaders can function in managed care. Answer: 2 Explanation: 2. Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion. Nurses do not give ʺorders,ʺ and do not have to be leaders to be respected or work in managed care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) Which is a difference between nurses as leaders and nurses as managers? 1. Leaders focus on a specific goal and managers focus on multiple goals. 2. Good leaders are always good managers, but managers are not always good leaders. 3. Leaders have good interpersonal skills while nurses as managers do not. 4. Nurses as leaders are born and nurses as managers is a learned skill. Answer: 1 Explanation: 1. Leaders focus on one specific goal and use interpersonal skills to bring others towards the goal. Managers focus on the many goals of the organization. Good managers are good leaders, but not necessarily the other way around. Both leaders and managers may have good interpersonal skills, but do not have to. Both leaders and managers can learn new skills to become effective as either or both. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which statement indicates further teaching is required? 1. ʺI think managers make it easier to see whatʹs expected.ʺ 2. ʺI know my manager is required to review my performance.ʺ 3. ʺManagers cannot affect motivation; it comes from within.ʺ 4. ʺI know if I have a problem with a client, I can go to him.ʺ Answer: 3 Explanation: 3. Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Which indicates leadership or management positions in an organization with legitimate authority? Select all that apply. 1. Formal leaders 2. Informal leaders 3. Nurse managers 4. Staff nurse Answer: 1, 2, 3, 4 22) Why must leaders have followers? 1. Leaders must have followers to ensure there are enough people to get the work done by the deadline. 2. Leaders must have followers in order to make sure the activities are appropriate to get to the goal. 3. Leaders can only be leaders if they have followers to carry out their orders. 4. Leaders can only be effective in the role if there are followers who perceive the leader to be worth following. Answer: 4 Explanation: 4. Leaders cannot lead if there is no one to follow them. The other options are not true statements about the relationship between leaders and followers. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 23) In what ways can a leader also be a follower? Select all that apply. 1. The charge nurse can lead other staff nurses but also follow the house supervisor. 2. The staff nurse can lead other staff nurses but also follow another staff nurse. 3. The CEO can lead other administrators, but also follow the Board of Directors. 4. Nurses can lead some clients, but follow others. Answer: 1, 2, 3, 4 24) In a leadership training class, which statement indicates learning has been successful? 1. ʺRelationship building is essential to be successful in leadership.ʺ 2. ʺIf I am to be successful in leadership, I should make sure no followers are friends.ʺ 3. ʺLeadership means I do can delegate tasks I do not want to do.ʺ 4. ʺMost people would not be able to tell if I only act interested in them.ʺ Answer: 1 Explanation: 1. Authentic caring in relationships is an important method of improving respect and competence as a leader. Although the leader can show no favoritism, leaders can have friends. Authentic leaders are willing to take risks and are not afraid to do any task. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 5 Initiating and Implementing Change 1) A new chairperson of the nursing department has been appointed and plans to institute new programs for faculty development with a focus on innovative teaching strategies. According to Lewin, which is the first step in initiating this plan? 1. Ask staff to assist in the development of a plan for implementing new teaching strategies. 2. Include the staff in actively participating in the identification of problems related to teaching strategies. 3. Implement interventions to improve the teaching strategies currently used. 4. Reinforce the efforts of faculty as they begin to use new teaching strategies. Answer: 2 Explanation: 2. The first step is to unfreeze the existing equilibrium by asking staff to become a part of the process of change, particularly in the first phase. Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. Implementing interventions is incorrect because interventions cannot be made until the problem has been identified and a plan has been developed. Reinforcing the efforts of faculty is incorrect because reinforcement of new patterns of behavior is the last phase of change. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) The nursing supervisor identified ineffective communication as a problem among the managers. According to Lippittʹs Phases of Change, which is the final stage of the improving this problem? 1. Develop the action and evaluation plan. 2. Determine the role of the change agent. 3. Communicate often to maintain the change. 4. Withdraw from the role of change agent gradually. Answer: 4 Explanation: 4. According to Lippittʹs Phases of Change, the final stage is terminating the helping relationship. Developing the action and evaluation plan is incorrect because an action and evaluation plan are developed with the assistance of the change agent. Determining the role of the change agent is incorrect because the role of the change agent must be determined early in the process of change. Communicating often is incorrect because communication is vital throughout the whole process of change. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The nurse manager is planning to initiate new policies in the department. According to Havelockʹs Model, which behavior is characteristic of the moving stage? 1. Resources are acquired to facilitate change. 2. Solutions are identified to create change. 3. Relationships are formed among all participants. 4. Self-renewal among all participants occurs. Answer: 2 Explanation: 2. Choosing a solution and gaining acceptance occurs during the moving stage of change. Acquiring resources is incorrect because acquiring resources and diagnosing the problem occur during the unfreezing stage. Forming relationships is incorrect because building relationships occurs during the unfreezing stage. Self-renewal is incorrect because self-renewal and stabilization occur during the final or refreezing stage of change. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A new IV pump has just been purchased by the facility. According to Rogers, which is the first step in introducing this new pump to the staff? 1. Introducing the decision-making unit to the innovation 2. Seeking reinforcement that the decision to make an innovation is correct 3. Deciding to adopt or reject the innovation 4. Forming a favorable or unfavorable attitude toward the innovation Answer: 1 Explanation: 1. The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained. Seeking reinforcement is incorrect because seeking reinforcement or confirmation that the decision to make an innovation is appropriate is the final step. Deciding to adopt or reject is incorrect because the decision to adopt or reject an innovation occurs after the knowledge and persuasion steps. Forming a favorable or unfavorable attitude is incorrect because the second step involves persuasion, which occurs when a favorable or unfavorable attitude toward an innovation forms. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) Which step is critical for change to be initiated? 1. Data collection and analysis 2. Minimize anxiety about the change 3. Develop operational indicators of success 4. Make people uncomfortable with status quo Answer: 1 Explanation: 1. Emphasis is placed on the assessment phase of change, particularly data collection and analysis of the issue. Minimizing anxiety is incorrect because once the proposed change is introduced, the change agent will attempt to minimize anxiety. Developing indicators is incorrect because operational indicators of success are developed once the planning phase is near completion. Making people comfortable is incorrect because planting the seeds of discontent about the status quo occurs after the problem has been assessed. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 6) Which strategy is most accurate about creating effective change? 1. Providing information addresses the motivation to change 2. Educating people opposed to change creates new opinions 3. Disseminating information is a prerequisite to change 4. Terminating people opposed to the idea of change if necessary Answer: 3 Explanationl:3. Providing information is a prerequisite to change implementation, but is inadequate unless lack of information is the only obstacle to effecting change. Providing information is incorrect because although providing information is a prerequisite to change, it does not address the motivation to change. Educating people opposed to change is incorrect because some people are vested in their opinions and may remain resistant to change regardless of how well informed they are. Terminating people is incorrect because people who refuse to consider change may be transferred to another department within the organization. Others may gradually open themselves to the idea of change once the plan has been implemented. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. Of which is this an example? 1. Power-coercive strategies 2. Empirical-rational model 3. Lippittʹs Phases of Change 4. Normative-reeducative strategies Answer: 2 Explanation: 2. Introduction of new technology that improves quality assurance would be readily accepted after in-service education and perhaps a trial use. Power- coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence. Lippittʹs Phases of Change is a seven-step process to change that involves participants in every step of the process. Normative-reeducative strategies focus on peopleʹs roles and relationships, perceptual orientations, and attitudes in order to accept change. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) The hospital administration has changed from a traditional nursing system to self-governance. This change was recognized by nursing personnel as a positive change and is an example of which strategy? 1. Power-coercive strategy 2. Empirical-rational model 3. A driving force 4. A normative-reeducative strategy Answer: 4 Explanation: 4. In most cases, the normative-reeducative approach to change will be effective in reducing resistance and stimulating personal and organizational creativity. Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. The empirical-rational model is a change agent strategy based on the assumption that people are rational and follow self-interest if that self-interest is made clear. A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) Which option best reflects a driving force in the process of change? 1. A financial deficit of millions of dollars 2. A staff composed of long-term employees 3. An ineffective nurse manager 4. An administration composed of long-term employees Answer: 1 Explanation: 1. A budget in the red necessitates change by pushing participants in a desired direction. A staff of long-term employees is a restraining force that impedes change by discouraging participants from making specified changes. An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes. An administration of long-term employees is a restraining force that impedes change by discouraging participants from making specified changes. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) When faced with the prospect of change, the nurse states, ʺWe have always done it this way and never had any problems.ʺ A few weeks later, the same nurse remarks, ʺThis new way seems to work better than the old way did.ʺ This statement is characteristic of which type of change response? 1. Laggards 2. Innovators 3. Early adopters 4. Early majority Answer: 4 Explanation: 4. The early majority prefers the status quo, but eventually accepts change. Laggards dislike change and are openly antagonistic. Innovators love change and thrive on it. Early adopters are less radical but still receptive to change. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which statements if made by the nurse manager would demonstrate effective change management? Select all that apply. 1. ʺWe cannot lose sight of the mission and values of our institution as we begin to integrate these changes.ʺ 2. ʺAlthough this task is going to be difficult, we have the full support of our hospital administration.ʺ 3. ʺIf this approach doesnʹt work, at least we can say weʹve tried.ʺ 4. ʺIn order for this plan to work, everyone must agree to be a participant.ʺ 5. ʺLetʹs wait until our administration has completed their reorganization before we implement change.ʺ Answer: 1, 2 12) In making a change in hospital policy, which best describes the nursing administrators first priority? 1. Research the options that will work best for the nursing staff and the hospital. 2. Ensure each nurse is aware of the change and why it is necessary to undertake. 3. Speak positively of the change to ensure the most ʺbuy-inʺ from the nurses. 4. Encourage the other administrators to choose the option easiest for the nurses. Answer: 1 Explanation: 1. Assessment is always the first action for a nurse in any situation. The other three options are all interventions and would come after the research phase was complete. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment 13) Which is the expected outcome when acting as a change agent? 1. Demonstrating management skills 2. Encouraging nurses to stick together 3. Improving client care 4. Guiding nursing practice Answer: 3 Explanation: 3. All nursing responsibilities have the expected outcome of improving client care. The other options are more personally related to the nurseʹs role as a whole. Nursing Process: Evaluation 14) Why are nurses in a prime position to act as change agents? 1. Nurses are always acting in the clientʹs best interest. 2. Nurses are role models for positively reacting to change. 3. Nurses often function as intermediaries between other disciplines. 4. Nurses thrive on transitions and work best in such circumstances. Answer: 3 Explanation: 3. Nurses are client advocates and as such often function as intermediaries between other disciplines and the client. The other three options are difficult to prove about the nursing profession. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) Which are questions or statements a nurse involved in an organizational change might say? Select all that apply. 1. What are the obstacles to implementing this change within the organization? 2. I would like to focus on completing this process so we can move on. 3. Are we including the opinions of all stakeholders in this decision? 4. Have we looked at all available data in order to make an informed decision? 5. I know nursing personnel will work diligently in understanding the need for change. 6. I think it does not really matter when we institute this change, as long as it is over quickly. Answer: 1, 3, 4, 5 16) Which indicates an integral part of implementing a change? 1. Providing information and giving support for those undergoing the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Pulling individuals who are not persuaded into a talk about the benefits of the change 4. Continually rewarding those working toward the change and ignoring those who are not Answer: 1 Explanation: 1. Providing information and giving support on an ongoing basis makes the greatest difference in successful change implementation. Ensuring no disagreement and talking with those in disagreement are incorrect because there may still be those in disagreement when the change occurs, and each individual does not necessarily need ʺa talk.ʺ Rewarding those working toward the change is incorrect because this is not supporting everyone undergoing the change. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Which change strategy is most appropriate when administration needs cooperation from all parties involved in the change? 1. Empirical-rational 2. Power-coercive 3. Empirical-reeducative 4. Normative-reeducative Answer: 4 Explanation: 4. Normative-reeducative requires collaboration and ʺbuy-inʺ from all parties affected by the change. The first two options are not correct as they use expert power or legitimate authority respectively to cause the change to occur. Empirical-reeducative is incorrect as there is no such strategy. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) Which are roles a manager might undertake when a change is necessary? Select all that apply. 1. Discussion leader 2. Support person 3. Fact manager 4. Liaison 5. Disciplinarian 6. Data collector Answer: 1, 2, 3, 4, 5, 6 19) Which is the most important role in which a manager should function during a necessary change? 1. Information giver 2. Power player 3. Process coordinator 4. Energy booster Answer: 3 Explanation3. The manager must oversee and coordinate every stage in the change process. This means this person is the information giver, the power player when necessary, and the energy booster as well. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which statement indicates a need for further training? 1. ʺAs we go through this process, I think I need to be flexible but persistent.ʺ 2. ʺI must not get so bogged down in details that I lose focus on the ultimate goal.ʺ 3. ʺThose who are resistant will probably accept it sooner or later with my support.ʺ 4. ʺI think the implementation will go much better if I stay available the whole time.ʺ Answer: 4 Explanation: 4. Staying available the whole time will make it difficult for the change agent to keep up the energy it will take to make the change more successful. Being flexible but persistent, staying out of the details, and supporting the resisters are correct statements about roles or attitudes about the change process. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Analysis 21) Which statement indicates the nurse manager needs further assistance in learning about the change process? 1. ʺResistance to change is never a positive part of the change process.ʺ 2. ʺI know some people will resist but with support they will come around.ʺ 3. ʺFor those resisting this necessary change, assisting in the process will help.ʺ 4. ʺIf colleagues help each other, the resistance will lessen over time.ʺ Answer: 1 Explanation: 1. Resistance to change usually indicates the change is significant enough that those affected by it realize its significance. If handled well, the resistance can be an important impetus to the change process. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment 22) Which is the most important reason resistance to change must be addressed? 1. Resistance can negatively impact future client care. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance will keep the change from occurring at all. 4. Resistance allows others to take power from managers. Answer: 1 Explanation: 1. Client care is always the most important reason why nurses do what they do. If the change is not for improved client care in some respect, is it worth the effort? Resistance from the late majority is incorrect because the late majority will eventually accept the change. Keeping the change from occurring at all is incorrect because it is the managerʹs responsibility to ensure the resistance does not completely stall the change process. Taking power is incorrect as the nurse manager must not allow resisters to have the power. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 23) Which indicates the priority nursing diagnosis for handling a change made difficult by laggards or rejecters? 1. Knowledge Deficit related to lack of willingness to discuss planned change 2. Noncompliance related to lack of willingness to comply with new policy 3. Social Isolation related to antagonistic behavior when change discussed 4. Risk for Role Performance Alteration related to antagonistic behavior Answer: 2 Explanation: 1. Noncompliance is correct because noncompliance may affect client care outcomes. Knowledge Deficit and Social Isolation are less likely to specifically affect client care. Risk for Role Performance Alteration indicates a ʺrisk for,ʺ which means it is only a potential problem. Diagnosis Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 6 Improving Quality and Managing Risk 1) Which of the following statements is an example of the overall goal of quality management in todayʹs health care activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department lets nonproductive employees go. 4. The nurse wipes up a spilled drink before clients are allowed to enter. Answer: 4 Explanation: 4. The focus of quality management is on ways to prevent problems and to improve quality of care. Identification of failed standards is reactive and not proactive. Assessment of problems within the organization was the focus of quality management in the past. Identification of inefficient employees is reactive as opposed to proactive. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) The nursing manager is comparing data on average length of client hospital stay for a total hip replacement between two hospitals in order to promote quality improvement. This comparison is an example of which process or step? 1. Benchmarking 2. An outcome standard 3. An indicator 4. A process standard Answer: 1 Explanation: 1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement. An outcome standard involves the end results of care given. An indicator is a tool used to measure the performance of structure, process, and outcome standards. Process standards are those connected with the actual delivery of care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which process are these characteristics typically seen? 1. Continuous Quality Improvement (CQI) 2. Total Quality Management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma Answer: 2 Explanation: 2. Total Quality Management (TQM) is a management philosophy emphasizing a commitment to excellence throughout the organization and is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. Continuous Quality Improvement (CQI) is the actual process used to improve quality and performance. Plan, Do, Check, Act (PDCA cycle) is the scientific method that is used to build knowledge, make decisions, and improve quality outcomes within an organization. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. Nursing Process: Implementation 4) The nursing task force is developing measurable goals for each client on the orthopedic unit. Of which is the statement: ʺEach client will have a written assessment and plan of care document within eight hours of admissionʺ an example? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard Answer: 4 Explanation4. A process standard is a written statement that defines actual delivery of nursing care to a specific population. An indicator is a tool used to measure the performance of an outcome standard. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) A nurse from the quality improvement committee is assigned to review a clientʹs chart throughout the hospitalization and determines that discharge teaching has not been initiated. This finding is discussed with the primary nurse who will follow through with the teaching. This process is an example of which review or audit method? 1. Peer review 2. Concurrent audit 3. Utilization review 4. Retrospective audit Answer: 2 Explanation: 2. A concurrent audit is conducted during the clientʹs course of care and examines care being given to achieve a desired outcome and recommends change as needed. A peer review occurs when practicing nurses determine the standards and criteria that indicate quality care and then assess performance against these standards. Utilization reviews are based on the appropriate allocation of resources and are not specifically directed at nursing care. A retrospective audit is conducted after a clientʹs discharge and involves examination of a large number of cases. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) A collaborative team composed of members of the interdisciplinary health care team develops a set of goals and research-based standardized critical pathways. Of which is this an example? 1. Outcomes management 2. Risk management 3. Peer review 4. Six Sigma Answer: 1 Explanation: 1. Outcomes management is a process in which costs and quality are concurrently and retrospectively measured and analyzed in order to improve clinical practice. Risk management is directed at the identification, evaluation, and corrective action against potential risks that could threaten the well-being of the client, staff, or visitors. Peer review occurs when practicing nurses determine the standards and criteria that indicate quality care and then assess performance against these standards. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. 7) The client has been told that chemotherapy must be postponed until the client is hydrated. The client refuses the intravenous hydration and demands to go home. The nurse would report this occurrence as: 1. A reportable incident. 2. A medical-legal incident. 3. Client dissatisfaction with care. 4. Medication error. Answer: 2 Explanation: 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. A reportable incident is any unexpected or unplanned occurrence that could potentially harm a client, family member, or staff. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed. A reportable incident occurs when the nurse unintentionally omits a medication or fluid. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) The client noticed hives and a feeling of shortness of breath immediately following a barium swallow. Although there were no known allergies to food or drugs prior to this incident, the client was diagnosed as having an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident is not a risk Answer: 3 Explanation: 3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure risk. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client. A medical-legal incident occurs when a client or family refuses treatment as ordered. Complications from diagnostic or treatment procedures are a high-risk area in health care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) The nurse finds a client on the previous shift received 100 mg of Demerol intravenously instead of the ordered 50 mg of Demerol. Which statement should be documented in the clientʹs chart? 1. Demerol 100 mg given IV at 0800. Clientʹs vital signs unchanged. 2. Demerol 100 mg given IV instead of the ordered dose of Demerol 50 mg. 3. Demerol 100 mg given accidentally instead of Demerol 50 mg. 4. Demerol 100 mg given IV and client notified. Answer: 1 Explanation: 1. The documentation in the chart should be a statement of the facts as well as the clientʹs physical status after the incident. Demerol given IV instead of the ordered dose is incorrect because this information should be placed on the detailed incident report that documents the error in depth. Demerol given accidentally is incorrect because words such as ʺerrorʺ and ʺaccidentʺ should not be written on the clientʹs chart. Demerol given IV and the client notified is incorrect because documentation in the chart should address notifying the physician, not the client. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment 10) The following documentation was written on a chart: ʺThe client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied.ʺ Which statement best describes this documentation? The documentation is: 1. Appropriately written. 2. Inappropriate because it places blame on an individual. 3. Inappropriate because it does not include that the client was notified. 4. Appropriately written because it only documents the facts. Answer: 2 Explanation: 2. Documentation in the chart following an incident should be a statement of the facts and no blame should be placed. The documentation is not appropriately written because it infers that someone was to blame for the incident. The documentation must indicate that the physician was notified, not that the client was notified. The documentation is not appropriately written if it documents only the facts because more than just facts are documented. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) The nurse is assigned to be a member of the Risk Management Team. Which events would be addressed by this team? Select all that apply. 1. The client has an allergic reaction to the preservative in the barium used in a barium swallow. 2. A clientʹs family is dissatisfied with the meals that are served. 3. The client leaves the hospital against medical advice (AMA). 4. The client claims he is not ready to be discharged. 5. The family does not want the client to be transferred from the intensive care unit (ICU). Answer: 1, 3 12) Which indicates the aspect similar between the different methods of quality management? Each method: 1. Uses all staff in the organization. 2. Does not blame. 3. Provides clinical information 4. Focuses on cost containment. Answer: 2 Explanation: 2. Each system of quality management does not place blame. The focus is on fixing the process that is causing errors or lower quality, not just cost containment. While all staff in the organization will focus on quality, all staff will not be used in quality management. Quality management systems do not provide clinical information, but use the data from clinical information systems to determine a focus for quality improvement. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which best illustrates the methods of Lean Six Sigma for quality management? 1. The emergency department manager looks at the monthʹs patient usage totals before deciding on how to change staffing. 2. The charge nurse of the ICU sets a goal for the day that every patient call light will be answered in less than 1 minute. 3. The floor manager does a small study to find out patient satisfaction ratings for January before deciding about staffing. 4. The team leader encourages the floor staff to turn off lights and water when not in use. Answer: 4 Explanation: 4. Lean Six Sigma focuses on quality management through controlling waste. The other methods are Six Sigma, continuous quality improvement, and total quality management, respectively. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which indicate ways nurse managers can plan to reduce risks for the organization? Select all that apply. 1. Investigating a complaint from a clientʹs wife 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about better ways to do things 4. Keeping staff on task throughout the work day 5. Making sure staff work minimal overtime 6. Enforcing staff discipline for wrongdoing Answer: 1, 3, 4, 5 15) Which is the most effective method by which a nurse manager can help reduce organizational risk? 1. Quickly confront the person or persons who put the organization at risk. 2. Personally discuss the issue with the person affected or who made the complaint. 3. Handle every aspect of the issue on the unit to protect the privacy of all parties. 4. Develop a blame-free environment regardless of mistake made to encourage reporting. Answer: 2 Explanation: 2. The nurse manager should quickly discuss any issue that comes to the attention of either the manager or any other staff person in a personal, caring manner. This can help diffuse the situation before it gets blown out of proportion. Confrontation is never a good idea as it can only escalate the incident, and sometimes handling the issue means involving other people. This may be necessary if the resolution is beyond the responsibility of the manager. Finally, while a blame-free environment does encourage reporting of errors, there are some mistakes that cannot be without repercussions. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 16) The nurse manager is describing reduction of risk of the organization and uses a nursing care plan to illustrate. Which is the priority? 1. Anxiety related to unclear medical prognosis 2. Disabled family coping related to seriously ill family member 3. Family decisional conflict related to varying physician opinions 4. Altered communication related to unwillingness to discuss concerns Answer: 4 Explanation: 4. In reducing risk, it is most important to keep the lines of communication clear and open for discussion of whatever issues or complaints arise. The other three answers are related specifically to the clientʹs condition and not organization risk. Diagnosis Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) The nurse manager is discussing the blame-free environment in place at the organization with new hires. Which statement indicates understanding of the policy? 1. ʺIf I make any mistake, if I report it I will not be reprimanded or punished.ʺ 2. ʺWhen I make a mistake, I should immediately fill out an incident report.ʺ 3. ʺIt is left up to each employee to self-monitor, and we do not report othersʹ mistakes.ʺ 4. ʺWhen I make a mistake, I should report it and look for ways to prevent it from reoccurring.ʺ Answer: 4 Explanation: 4. Reporting mistakes is blame-free to encourage not only the reporting, but process corrections to improve the quality of care. Certain mistakes may be exceptions to this, such as illegal activity or failure to report personal mistakes or the mistakes of others. Incident reports are not the first step after making a mistake. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) Which of the following statements indicate exceptions to the blame-free environment? Select all that apply. 1. A nurse notices a colleague changing nursing notes after a client is discharged. 2. A housekeeper reports a nurse who switches syringes when giving client medications. 3. A nurse manager reports a staff nurse who continually miscounts narcotics. 4. A staff nurse falsely reports a colleague for mislabeling client medications. 5. A nurse reports an unlicensed assistant pull a client up too sharply. Answer: 1, 4 19) Which is the most effective method of creating a blame-free environment? 1. Ensure all employees are knowledgeable about the reasons behind the policy. 2. Make sure all nurses know the reasons behind the policy and agree to comply. 3. Keep the system processes the same so everyone will know them well. 4. Ensure nurse managers keep a list of employees that shows how many mistakes each made. Answer: 1 Explanation: 1. If the reasons behind the policy are well known, everyone is more likely to comply equitably. All employees, not just nursing personnel, must be involved for it to be successful. The entire reason for the blame-free environment is to change processes in the entire organization that foster adverse events. Managers should not keep lists as this does not portray ʺblame -free.ʺ 20) If the nurse is working on a unit with a blame-free environment, which is the initial action when the nurse makes an error? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. If there is a client involved, ensure the clientʹs safety. 4. Make sure no one saw the incident and say nothing. Answer: 3 Explanation: 3. The clientʹs safety is always the priority. It is not appropriate to discuss errors with others or just ignore them if no one saw it. Reporting the incident to the supervisor is appropriate only if no client is directly involved. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 7 Understanding Power and Politics 1) Which indicates why the use of power is important to nursing? 1. The nurse manager can use it to evaluate staff. 2. The nurse can better impact and improve client care. 3. The RN can better supervise unlicensed personnel. 4. Power enables the nurse to ethically treat the agitated patient. Answer: 2 2. The nurseʹs power to impact the quality of client care is the best use of power. Formal power does enable nurse managers to evaluate and supervise. Principle-centered power would allow the nurse to treat the agitated client. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Effective Leadership and Mgmt in Nursing, 7e (Sullivan) -- CVC 12/3/08 -- Page 133 2) There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours paid vacation per month. The manager is using: 1. Legitimate power. 2. Expert power. 3. Referent power. 4. Reward power. Answer: 4 4. Reward power is based on the inducements a manager can offer a staff. In this case the manager can offer increased wages. Legitimate power is the authority to make a request of staff. Expert power is based on a manager having unique skills or knowledge. Referent power is based on the employeesʹ respect for a manager. They comply with requests out of respect for the manager. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The local hospital has recently been acquired by a larger hospital corporation. The nurse manager encourages staff to attend the next unit meeting by hanging a poster announcing the new wage scale and benefits package will be discussed. This is an example of: 1. Referent power. 2. Information power. 3. Legitimate power. 4. Connection power. Answer: 2 2. The nurse manager possesses information that employees desire. The only means of getting the information is through the manager. The others are not applicable in this situation. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) One of the nurses often fails to attend educational offerings available to the staff. The nurse manager who implies the nurse may receive a negative evaluation is using: 1. Coercive power. 2. Information power. 3. Referent power. 4. Reward power. Answer: 1 Explanation: 1. Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty. Information power is based on information a manager has and employees want. Referent power is based on the respect the followers have for the manager. Reward power is based on the inducements a manager can give to the employees. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 5) Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Select all that apply. 1. Reward 2. Punishment 3. Legitimate 4. Expert 5. Referent 6. Information 7. Connection Answer: 4, 5, 6, 7 6) Designing a plan to ensure the staff knows about the managerʹs open-door policy is an example of which method of gaining employee cooperation? 1. Rewards and punishment 2. Interpersonal communication 3. Organizational power 4. Personal self-confidence Answer: 2 2. Communication is the most valuable management skill for motivating and leading an effective nursing staff. Rewards, punishment, power, and confidence are not always effective in gaining cooperation of staff. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) The nursing staff does not like the new system for medication administration. You have been chosen to represent your unit on a committee to evaluate the system. Which statement would be the most effective method to communicate your unitʹs disapproval? 1. ʺOver 75% of the nurses on unit 3M want to return to the previous process for passing meds.ʺ 2. ʺThe physicians have complained and the nurses on 3M have voted to return to the old medication passing routine.ʺ 3. ʺThe nurses on 3M do not like the new system. Do other units agree?ʺ 4. ʺThere has been a 40% increase in medication errors on 3M since the new system began. We believe there is a problem.ʺ Answer: 4 4. When taking action within an organization, it is more powerful to be prepared with data. The statements regarding 75% of the nurses wanting to return to the previous process, physicians complaining, and the nurses not liking the system state the nursesʹ dislikes. The correct statement focuses on why there is a need for action to address a problem. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment 8) Why must nurses stay politically aware and active? 1. To influence events and decisions of others 2. To run for political office 3. To increase wages and benefits 4. To better understand patient rights Answer: 1 Explanation: 1. Nurses can be politically aware and active in an organization or in the community. By being aware of issues and those people who can effect change, the nurse has the capability of influencing those in the decision-making roles. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 9) Place the steps of political action in the correct order. 1. Learn about the players and what they want. 2. Be prepared to answer opponents. 3. Determine what you want. 4. Explain how what you want can help them. 5. Gather supporters and form coalitions. Answer: 3, 1, 5, 2, 4 10) A nurse who is well-known for advocating for clients through honesty and hard work is using which to increase political effectiveness? 1. Image 2. Age 3. Beliefs 4. Political party Answer: 1 Explanation: 1. A person who portrays an image of success and trust will be politically effective. People will follow regardless of the personʹs age, personal beliefs, or political party. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which statement indicates the most important reason nurses must have power? 1. ʺMr. Jones, it is important for you to get out of bed, at least for a few minutes.ʺ 2. ʺMs. Allen, I will have to call your doctor if you donʹt stop acting like that.ʺ 3. ʺMs. Michaels, you need to ensure this is set up to enable it work correctly.ʺ 4. ʺMr. Smith, is there a way we can look up more information about that?ʺ Answer: 1 Explanation: 1. The nurse uses power most appropriately to help with client goal achievement. If the client gets out of bed, it is possible to avoid some complications. The others may be using power, but are more behavior, process, and information related. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) When teaching nursing preceptors about power, which statement indicates learning has been successful? 1. ʺI am only showing the student how to take care of patients so I have no need for power.ʺ 2. ʺI can use power to teach the student how to motivate, communicate, and achieve outcomes.ʺ 3. ʺI do not want to give the student the idea that nurses are all about who has the most power.ʺ 4. ʺI can use power to ensure other disciplines know I am the one who really does the work.ʺ Answer: 2 2. Nurses must use power to influence others. The other three options are not accurate statements about power. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Choose the nursing diagnosis that most closely indicates the need for power in nursing. 1. Powerlessness 2. Knowledge Deficit 3. Social Isolation 4. Fear Answer: 2 2. To communicate or to acquire knowledge is one of the most important reasons nurses need to use their power. Powerlessness, Social Isolation, and Fear are related but are not specific enough. Diagnosis Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which would be a most effective way for nursing to improve the power of its image? 1. Becoming politically active 2. Behaving professionally at all times 3. Motivating others to become nurses 4. Encouraging clients to speak positively Answer: 2 2. Those in the nursing profession must act and speak professionally at all times in all places. This would increase nursingʹs power image. Becoming politically active, motivating others to become nurses (while good for the shortage!), and encouraging others to speak positively would not necessarily promote a power image. Nurses must do it for themselves. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) Choose methods nurses could use to promote nursingʹs power image. Select all that apply. 1. Maintaining expertise by attending continuing education events 2. Encouraging clients to write letters of praise for a job well done 3. Encouraging all disciplines to work towards organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies 6. Addressing others professionally using their appropriate titles Answer: 1, 3, 4, 5 16) Which are considered ways of decreasing the image of power for nurses? Select all that apply. 1. Wearing a crisp, clean uniform 2. Addressing others in endearing terms 3. Using power plays to achieve goals 4. Becoming aggressive in advocating for clients 5. Accepting orders without question Answer: 2, 3, 4, 5 17) Which habits are effective ways to increase your power? Select all that apply. 1. Focus on the unitʹs goals. 2. Make choices about what you want. 3. Develop self-confidence. 4. Pursue power positions. Answer: 2, 3 18) As a new nurse manager, which are effective ways to increase your power levels on the unit? Select all that apply. 1. Do favors for those working on the unit. 2. Be consistent. 3. Defend the staff at all times. 4. Keep your word and follow through. 5. Fix problems immediately. 6. Follow the chain of command. Answer: 2, 4, 6 19) As a new graduate nurse, which is the most important way to increase power in nursing? 1. Do favors for those you work with. 2. Volunteer to work late frequently. 3. Assist others without being asked. 4. Take care of only assigned responsibilities. Answer: 3 3. Assisting others and acting like part of team is the fastest and most important way to gain power in nursing. It is important new nurses do not let themselves get taken advantage of by frequently working late and doing favors for others. In addition, it is also important for new nurses to be aware of others and assist when possible to be a team player. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) How might a nurse best influence policies in an organization? 1. Follow the nursing process. 2. Talk about nursesʹ needs. 3. Connect with the outside community. 4. Make an appointment with the administrator. Answer: 1 Explanation: 1. Given that the political process closely mirrors the nursing process, following it will enable the nurse to obtain information about stakeholders and those who might assist in policy changes. Talking about nursesʹ needs with the outside community and/or the administrator will do little to influence others. In addition, it is important to remember to follow the change of command when attempting to influence policies in the organization. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy? 1. Make visits during the day and tell the supervisor clients are not home when visited at night. 2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during daytime. 3. Encourage others to refuse to make routine visits at night so you will not be alone. 4. Take the supervisor to lunch and invite all the staff to join to talk the supervisor into changing the policy. Answer: 2 2. Research material provides rationales behind why a policy might need to be changed. This is the assessment phase and provides hard facts. Lying to the supervisor is dishonest, avoiding making visits at night is client abandonment, and taking the supervisor to lunch in order to talk her into changing policy is unfair and coercive. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 22) Choose the major restriction undermining political savvy in nursing. 1. Dressing for success 2. Being strong and assertive 3. Talking more than listening 4. Being your own cheerleader Answer: 3 3. Sometimes listening is much more important than talking, especially if gossip is involved. Dressing for success, being assertive, and being your own cheerleader are positive ways to build political savvy. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment 23) Which is the one best method of gaining political savvy? 1. Work with others. 2. Run for office. 3. Develop top-level connections. 4. Organize people with similar backgrounds. Answer: 1 Explanation: 1. Frequently working with others at all levels is the best means of increasing political savvy. Becoming and staying ʺin the loopʺ allows the nurse to be more informed about activities and possible changes. Running for office does not necessarily increase political savvy and the organization of people should include diverse backgrounds. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 8 Thinking Critically, Making Decisions, Solving Problems 1) The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which describes the ability to create an effective, innovative staffing pattern? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making Answer: 1 Explanation: 1. Creativity is a part of the critical thinking process that fosters the development and implementation of new approaches to different situations. Problem solving infers there is a problem that needs a solution. Brainstorming generates diverse ideas with many superficial solutions. Decision making identifies one effective, not necessarily innovative, strategy. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) A nursing task force is created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. This process exemplifies: 1. Group problem solving. 2. Critical thinking. 3. Group decision making. 4. Satisficing. Answer: 2 2. Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. Group problem solving addresses substantial issues and promotes groupthink, which is contrary to critical thinking. Group decision making may create positive decisions but does not necessarily involve critical thinking. Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) Which step should be done first for effective problem solving to occur? 1. Classify information into categories. 2. Brainstorm ideas about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability. Answer: 3 3. Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. Classification of information into categories such as human factors and technical problems occurs after information has been gathered. Brainstorming is used to develop solutions after information about the problem is analyzed. The information cannot be sorted into an orderly arrangement until it has been collected. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A committee chair schedules a meeting to discuss all points of view and the possible solutions. Of which technique is this an example? 1. Premature concurrence thinking 2. Dialectical inquiry 3. Gatekeeping 4. Mind guarding Answer: 2 2. Dialectical inquiry minimizes groupthink by allowing disagreement and reducing the emotional aspects associated with the conflict. Premature concurrence thinking promotes self-censorship of ideas and exerts pressure to conform. Gatekeeping protects the group from controversial information and discourages dissent by diverting doubts about the groupʹs decision. Mind guards use gatekeeping to protect the group from controversial information and discourage dissent by diverting doubts about the groupʹs decision. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 5) The nurse manager meets with new employees to discuss the employeesʹ insights from previous experiences and to discuss possible solutions to issues. Which describes this process? 1. Insight 2. Verification 3. Preparation 4. Incubation Answer: 4 4. Incubation encourages new employees to offer suggestions about solutions to problems based on their past experiences. Insight is the ability of the nurse manager to realize limitations to innovative thinking and to develop strategies to foster creativity. Verification is a climate produced by the nurse manager that recognizes the value of potentially useful ideas. Preparation is a step of creativity that focuses mainly on planning. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Why is it difficult for organizations to foster creative solutions? 1. The initial cost 2. A bureaucratic setting 3. Fear of reprisal 4. Time constraints Answer: 1 Explanation: 1. The greater the creativity sought and the greater the departure from present practice, the greater the investment will be. A bureaucratic setting is incorrect because an effective nurse manager will recognize that creativity does have a priority in the health care setting and will build an environment that fosters it. Fear of reprisal is incorrect because special ground rules can be established that permit innovative managers and staff to function without fear of termination if their ideas fail. Time constraints is incorrect because time constraints can be minimized through a carefully designed planning program. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) In order to deal with the facts of a self-scheduling proposal objectively, the nurse manager verifies the proposal through deliberate investigation. Of which approach is this characteristic? 1. Premature interpretation 2. Risky shift 3. Dialectal inquiry 4. Reflective inquiry Answer: 4 4. Reflective inquiry is a process that enables a person to deal with facts and solutions in an objective, scientific manner. Premature interpretation has the potential to alter oneʹs ability to deal with facts objectively and can introduce biases. Risky shift occurs when a decision is made by a group as opposed to an individual. Dialectal inquiry formalizes conflict within group decision making. Nursing Process: Assessment 8) Which strategy would be most effective in the prevention of groupthink within cohesive groups? 1. Participation at the meetings should be limited to core members of the problem- solving group. 2. A member of administration should be present at every meeting to assume the role of ʺdevilʹs advocate.ʺ 3. Promote open inquiry by assigning the crucial evaluator role to a different member at each session. 4. Encourage several independent work groups to examine the same issue prior to group problem solving. Answer: 4 4. The leader may set up several independent work groups to examine an issue and then reconvene to explore a variety of approaches to problem solving. Limiting participation to core members of the problem-solving group is incorrect because one or more outside experts within the organization who are not core members of the problem-solving group should be invited to each meeting on a rotating basis to constructively challenge the views of the core members. Having an administrator play devilʹs advocate is incorrect because at least one core member of the group should be assigned to every problem-solving meeting to attempt to find fault with any argument that may be considered valid. Assigning the role of crucial evaluator to a different member at each session is incorrect because the role of crucial evaluator should be assigned to each member of the core group. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) A decision-making process using a series of steps to make logical choices that maximizes the achievement of the objective is the: 1. Political decision-making model. 2. Experimentation process. 3. Normative decision-making model. 4. Trial-and-error method. Answer: 3 3. The normative decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. The premise of the political decision-making model is that the power for decision making is held by individuals who assume positions of power or authority. Experimentation involves the use of a pilot project to test the effectiveness of a solution. The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment 10) The nurse manager asks each member of the nursing staff to write ideas and reactions about the decision to require mandatory overtime. This structured method of silently generating ideas in writing is characteristic of: 1. The nominal group technique. 2. The Delphi technique. 3. Statistical aggregation. 4. Brainstorming. Answer: 1 Explanation: 1. The nominal group technique is a structured, precise method of eliciting ideas and insights from members with no direct exchange of ideas among the members. The Delphi technique gathers information from group members using questionnaires. The group members never meet face to face. Statistical aggregation gathers information by tallying responses to a poll relative to a specific problem. Brainstorming is a technique that involves the interaction of group members and the generation of lots of ideas about issues in a short amount of time. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Although the postoperative assessment of the client reveals no abnormalities, the nurse believes the clientʹs condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Select all that apply. 1. Trial and error method 2. Experimentation 3. Intuition 4. Satisficing 5. Past experiences Answer: 3, 5 12) If a nurse is using critical thinking skills in deciding which of several options is the best, which would the nurse take into consideration? 1. Different situational effects 2. How the problem is usually handled 3. The easiest alternative 4. The nursing process Answer: 1 Explanation: 1. Critical thinking involves choosing the best alternative from several, very much dependent upon the situation in which the problem occurred. Handling the problem the way itʹs usually handled or choosing the easiest alternative may be easy but would not involve critical thinking. The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which of the following statements exemplify the attributes of critical thinking essential to nurses? Select all that apply. 1. ʺI am always curious about why we do things like we do.ʺ 2. ʺI think we need to hurry up and make a decision.ʺ 3. ʺCan you help me understand your perspective a little better?ʺ 4. ʺLetʹs go into this conference room where I can hear you better.ʺ 5. ʺI donʹt think that your concern is necessarily pertinent to this issue.ʺ 6. ʺI donʹt think I can make that decision until I have more information.ʺ Answer: 1, 3, 4, 5, 6 14) A nurse working in a rehabilitation center notices clients frequently asking for something to drink while in the facility. Which action indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home Answer: 2 2. Asking others to think about different options opens up the possibilities beyond one individualʹs ideas. This is part of the preparation stage of creativity. The other choices do not encourage thinking of different ways to fix the problem. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) When implementing a creative solution to an issue, what is the most important step in creativity? 1. Make sure many people have input before deciding on the solution. 2. Make the decision before any further problems are incurred. 3. Evaluate the effectiveness of the creative solution. 4. Ensure those who offered the creative solution get recognition. Answer: 3 3. Evaluation must occur to ensure the solution is appropriate and corrects the problem without causing further issues. The other three answers are important in encouraging creativity, but not the most important. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 16) If a nurse wants to become more creative, which method would be most effective? 1. Watch others implement creative solutions. 2. Work with a group to implement a solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible. Answer: 4 4. Practicing being creative, like practicing starting IVs, comes easier the more it is done. The other answers are incorrect as they are not practicing the entire process in a hands- on manner. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 1. ʺWe should gather a group together to make important unit decisions to ensure fairness.ʺ 2. ʺI should practice making decisions by developing potential solutions and then choosing one.ʺ 3. ʺWe can make a decision and then ask for input from others to make sure it was the right choice.ʺ 4. ʺI know I will never be able to improve decision making skill because I am not a strong person.ʺ Answer: 2 2. Practice making decisions will increase the nurseʹs experience, comfort, and overall skill. Including a ʺweʺ is not an appropriate method to improve personal decision -making skills. These skills can be learned regardless of the type of person one is. 18) How can a nurse improve decision-making skills? Select all that apply. 1. Work with a group on a continual basis. 2. Gain experience in the clinical area. 3. Work on improving self-confidence. 4. Maintain a positive attitude. 5. Keep an open mind about options. 6. Maintain an atmosphere of trust. Answer: 2, 3, 4, 5 19) Which indicates a situation in which problem-solving skills are indicated? 1. A nurse manager gets a report indicating the narcotics count has been wrong three times in the past month. 2. The emergency department nurse manager is contemplating how to best schedule her staff to ensure coverage. 3. A nurse administrator needs to hold administrative staff meetings on a day when most are available. 4. A floor nurse needs to organize care activities for a team of clients for the day including two surgeries and a discharge. Answer: 1 Explanation: 1. Reporting the incorrect narcotics count is the only response in which a problem is indicated. The other three answers would involve decision-making and not necessarily problem-solving skills. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which describes the primary difference between group and individual decision making, besides the number of individuals involved? 1. A decision made by a group is always better than a decision made by one person. 2. A decision made by an individual is always better than a decision made by a group. 3. Before a group decision can be made, one individual decides a group decision would be more appropriate. 4. A cause and effect diagram can only be used in individual decision making. Answer: 3 3. Having one individual decide a group decision is appropriate is correct because a person must evaluate the decision to be made and determine it is appropriate for a group to be involved. Neither a group nor an individual decision is better than the other because it depends on the situation. A cause-and-effect diagram can be used in either collaborative or individual decisions. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 9 Communicating Effectively 1) The nurse manager is concerned about a family memberʹs complaint regarding professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an e-mail to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse via the telephone. 4. Discuss the complaint with the individual nurse face to face. Answer: 4 4. The more important or difficult issues should be communicated face to face to the nurse involved so that the individualʹs response can be seen and questions can be answered appropriately. Posting a memo is incorrect because the purpose of a memo is to convey general information to a group, and it has a low level of personal intimacy. Sending an e -mail is incorrect because the purpose of e-mail is to broadcast information to large groups, and it has a low level of personal intimacy. Addressing the complaint over the telephone is incorrect because a telephone conversation is less intimate than face-to-face communication, and the individualʹs response cannot be seen. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) The nurse plans to seek employment in an acute care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Apply to the nurse manager via e-mail. 2. Send a written letter and résumé via the mail. 3. Call the nurse manager to schedule an interview. 4. Visit the nurse manager to discuss employment options. Answer: 2 2. Applying for a job requires a high level of formality. A written cover letter and résumé are expected by most organizations offering employment opportunities. Applying via e -mail is incorrect because it is less formal than a written letter. It is appropriate when the organization specifically requests that résumés be mailed via e-mail. Calling the nurse manager to schedule an interview is incorrect because a telephone call is an intimate form of communication but may be made as an inquiry after the written résumé is sent. Visiting the nurse manager is incorrect because a face-to-face meeting is the highest level of personal intimacy involved in communication. A meeting can occur at the request of the potential employer. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) Monthly focus groups are held with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication Answer: 3 3. Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). Downward communication involves direction giving from management to the staff. Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential for the generation of misinformation. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A nurse is mentoring a male colleague who has just been appointed nurse manager. Which behavior can the nurse expect this male colleague to exhibit? 1. Men focus more on the issue than on personal experience. 2. Men strive to reach consensus within the group. 3. Men strive to avoid conflict within the group. 4. Men prefer to ask questions instead of make statements. Answer: 1 Explanation: 1. Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences. Striving to reach consensus is incorrect because men can tolerate disagreement within the group. Striving to avoid conflict is incorrect because men may be more apt to tolerate conflict than women may. Preferring to ask questions is incorrect because women are more apt to ask questions in order to seek input. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 5) The nurse manager evaluates the nurseʹs performance as below average. Which strategy will facilitate improvement in this concern? 1. Document the behavior on the nurseʹs performance evaluation. 2. Identify all steps needed to correct the problem in a detailed manner. 3. Meet with the nurse at regular intervals to reevaluate performance. 4. Give specific directions to the nurse on ways to improve performance. Answer: 3 3. Follow-up communication determines the outcome of the nurse managerʹs instruction and facilitates feedback to the receiver. Documenting the behavior is incorrect because documentation does not necessarily mean the employee understands the steps needed to improve performance. Identifying all steps is incorrect because clear, concise instructions promote understanding. Giving specific directions to the nurse is incorrect because direction giving is not, in itself, a method of effective communication. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 6) The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to make the request from administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence Answer: 1 Explanation: 1. The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. Negative inquiry is used after a request has been denied. Compromise occurs after a request has been denied. Persistence and repetition are used after a request has been denied. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment 7) The nurse manager approaches the nursing supervisor asking for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request stating this staffing pattern was used previously with poor outcomes. Which response if made by the nurse may positively influence the supervisor? Select all that apply. 1. ʺI agree it was not effective years ago; but other units have now had success with it.ʺ 2. ʺWhat were your specific concerns about the 12-hour shifts before?ʺ 3. ʺI think that it is unfair to refuse my unit the opportunity to try it based on the past.ʺ 4. ʺWhy are you so opposed to this method of staffing on my unit?ʺ 5. ʺIf we donʹt offer alternate staffing patterns, our unit will remain short staffed.ʺ Answer: 1, 2 8) Which statement if made by the nurse manager would be most effective when interacting with a difficult employee? 1. ʺYou should always talk with me when you are dissatisfied.ʺ 2. ʺWhy would you make that kind of statement?ʺ 3. ʺYou always get defensive when I correct you.ʺ 4. ʺI can meet with you for 30 minutes to discuss your concerns.ʺ Answer: 4 4. A common method to interact with a difficult person is to create physical distance and limit the time spent with that person. Telling a difficult person ʺyou shouldʺ is incorrect because the word should may be psychologically offensive to the individual. Asking the employee ʺwhy?ʺ is incorrect because the word why may make the individual feel defensive. Saying ʺyou alwaysʺ and ʺdefensiveʺ is incorrect because the label defensive attached to the behavior may be an inaccurate perception. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 9) The nurse asked the nurse manager to go home early because the census was low. When the request was denied, the nurse stated, ʺI donʹt understand why I canʹt leave early. I will use vacation time and this will help minimize personnel costs for the shift.ʺ This statement is an example of: 1. Fogging. 2. Negative assertion. 3. Negative inquiry. 4. Compromise. Answer: 3 3. Once the rationale for the decision is understood, negative inquiry is an effective technique provided the nurse does not become defensive or distraught. Fogging is a technique used when the nurse is in partial agreement with what was said. Negative assertion involves some acceptance of blame for what was said. Compromise implies that an agreement has occurred between the nurse manager and the nurse. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) During an evaluation conference, the nurse manager observes nonverbal messages, including nodding of the head in agreement and smiling. These behaviors are examples of: 1. Metacommunication. 2. Intrasender conflict. 3. Fogging. 4. Intersender incongruity. Answer: 1 Explanation: 1. Metacommunications are nonverbal messages conveyed by body language and environmental factors. Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. Fogging is a communication technique in which one partially agrees with what was said. Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 11) The staff nurse is unsure of the correct protocol to take when reporting off from work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. Of which distorted communication is this the result? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication Answer: 1 Explanation: 1. Intersender conflict occurs when a person receives two conflicting messages from differing sources. Intrasender conflict occurs when a verbal message differs from the nonverbal message; therefore, the recipient has difficulty interpreting the intended meaning. Metacommunication is the combination of oral messages with nonverbal messages. Downward communication occurs from manager to staff and is often directive. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) Which indicate factors affecting communication clarity? Select all that apply. 1. A nursing supervisor talking with a staff nurse 2. Two female staff nurses talking after work 3. A 63-year-old nurse discussing work with a 25-year-old 4. A staff nurse discussing changing policies with the manager 5. An Asian student attending nursing school in the United States Answer: 1, 3, 4, 5 13) Which example has the greatest potential to influence communication? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a client via ambulance transferred for confusion. Answer: 4 4. Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client communicates. Just because a person is adopted, elderly, or originally from another country does not automatically mean communication will be influenced. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which action will most positively influence communication when planning to affect communication in a department? 1. Ensure the office door is always open when discussing employee concerns. 2. Encourage staff members to discuss personal problems with each other. 3. Discourage shift-to-shift ʺleftoverʺ responsibilities. 4. Discourage charge nurses from being friends with staff. Answer: 3 3. When responsibilities are left undone on one shift for another to complete, negative communication tends to develop in the form of complaints and ʺus against them.ʺ Leaving the office door open when discussing concerns, discussing personal problems with each other, and discouraging friendly relationships will promote a culture of negative communication. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Cognitive Level: Application 15) Which are always metacommunications? Select all that apply. 1. Laughing while listening to a speaker 2. Bouncing the foot while waiting for someone 3. Typing an e-mail while talking to someone 4. Looking away when speaking to someone 5. Yawning during a continuing education class 6. A strong handshake when meeting someone Answer: 1, 2, 3, 6 16) An inexperienced speaker is practicing her speech delivery. Which indicates a lack of understanding how easily communication is distorted? 1. ʺI know I can better connect with my audience with good eye contact.ʺ 2. ʺIf I repeat a complicated section in another way, comprehension is improved.ʺ 3. ʺIf I know the background of the audience, it can help with tailoring the content.ʺ 4. ʺThe topic is not complicated, so I donʹt have to worry about misunderstanding.ʺ Answer: 4 4. It does not matter how uncomplicated the topic is, misunderstandings and distortions can still occur. Eye contact, repeating the message, and tailoring the message can all assist in keeping the message clear. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) If the nurse manager is ordering supplies for the unit, which communication mode is best? 1. Oral 2. E-mail 3. In person 4. Voice mail Answer: 2 2. To avoid misunderstanding of supplies needed, a written request is the most appropriate choice. It avoids misunderstanding since the needs can be checked off a list. The other choices leave room for forgetting items. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) An employee is sabotaging the work of a newly oriented charge nurse and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. ʺI know it must be frustrating working with a new charge nurse, but how can we make this situation better?ʺ 2. ʺThis is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it.ʺ 3. ʺI know the charge nurse is new to the role, but you should get used to it since there will be more changes.ʺ 4. ʺI know the new charge nurse is difficult to work with, but please help make the job easier to do.ʺ Answer: 1 Explanation: 1. Acknowledging the personʹs frustration validates their feelings and asking for his/her input helps makes him/her part of the solution. The other choices are confrontational by making threats or patronizing by adding to the problem. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) Which indicates understanding of how communication with difficult people should be handled? 1. ʺI will ask a person upset about an issue to immediately sit down with me to talk about it.ʺ 2. ʺMost upset people just want their concerns heard and fixed as quickly as possible.ʺ 3. ʺI will try to figure out the underlying issue that is causing the personʹs distress and try to address it.ʺ 4. ʺI will send anyone who seems upset to discuss the issue with a supervisor or manager.ʺ Answer: 3 3. Most people who are upset have an issue causing them to be difficult and the nurse should attempt to find out the exact issue causing the problem. More activity, such as getting a drink, may be more effective than sitting still to defuse the situation. Individuals who are upset sometimes just need someone to listen and may not have an issue to ʺfix.ʺ The Band -Aid quick fix is not always a good idea. Nurses should try to discuss the issue with the person before seeking a supervisor or manager. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Choose the situation in which humor might be an effective method to communicate with an upset or angry person. 1. A mother bringing her daughter to the emergency department is upset about the wait time to be seen. 2. A nurse angrily calls the lab complaining that the clientʹs morning labs have not been drawn. 3. A pharmacist complains about discrepancies on the narcotic record for the third week in a row. 4. The mother of a child with a white count of 3000 cells/mcL is upset when a nurse enters with no mask. Answer: 2 2. While morning labs are certainly important, this situation has the least potential to be a dangerous situation. The others are more serious in nature and humor is certainly inappropriate. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Which indicates the final activity in continuously enhancing communication skills? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication was understood. Answer: 4 4. Ensuring all parties understood the communication is the last step since it involves evaluation. The others are earlier steps. Thinking about the goals is assessment, and both deciding how to say the message and developing the response are implementations. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 22) To show excellent communication skills, which is an important consideration? 1. Crafting messages without qualifiers 2. Sending intimate messages 3. Requiring title use 4. Succeeding through persistence Answer: 1 Explanation: 1. Qualifiers reveal a concern for the consequences of sending the communication message. These also reveal lack of confidence. Intimate messages are not always appropriate and the receiver, goal, and message must be considered first. Requiring the use of titles, such as Nurse Jones or Ms. Smith can be appropriate for respect is some situations but is not necessarily excellent communication. Persistence is not necessarily an aspect of excellent communication. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 23) In order to communicate more effectively, which would be the most important strategy for a staff nurse to implement? 1. Be assertive. 2. Manage conflict. 3. Delegate appropriately. 4. Attend training. Answer: 4 4. All four answers are correct, but attending training includes the other three options. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 24) Excellent communication skills are essential for nurses to develop because: 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Communication ensures no problems occur. Answer: 2 2. While nurses do communicate with all disciplines, and excellent communication skills can get the work done more quickly and effectively, it is the broader option that is correct. Nursing activities occurring among relationships make communication skills essential for the nurse. Excellent communication skills do not keep problems from occurring. Nursing Process: Assessment Chapter 10 Delegating Successfully 1) The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which is appropriate? 1. Instructing the charge nurse to assume a client assignment 2. Assigning the charge nurse to discipline a nurse on the unit 3. Leading a task force of nurses with a focus on quality assurance 4. Evaluating all unlicensed personnel assigned to the unit Answer: 3 3. Delegation is the mutual transfer of responsibility and authority that occurs on the basis of competence and trust. Assuming a client assignment is incorrect because the assignment of tasks included in the employeeʹs job description is known as work allocation. Disciplining a nurse is incorrect because discipline of an employee is the responsibility of the manager and confidentiality must be maintained. Evaluation of the unlicensed personnel is incorrect because the process of evaluation is the responsibility of the manager, and this authority cannot be transferred to a delegate. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) Which statement made by the nurse manager is an example of the first step of delegation? 1. ʺI will designate a person with good time management skills to be the delegate for this task.ʺ 2. ʺThe outcomes of this project will be evaluated by nursing administration in six months.ʺ 3. ʺI am going to delegate the responsibility of creating the vacation schedule.ʺ 4. ʺI will monitor your progress throughout the project and give you feedback.ʺ Answer: 3 3. The first step of the process is to identify and define the task that will be delegated. Designating a person as the delegate is incorrect because the appointment of a delegate occurs after the task has been identified. Evaluation of outcomes is incorrect because a clear definition of the expectations of the delegate occurs midway in the delegation process. Monitoring progress is incorrect because monitoring performance occurs after the delegated tasks have been carried out. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The nurse manager gave the unit secretary complete responsibility for the unitʹs staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of: 1. Effective delegation. 2. Overdelegation. 3. Reverse delegation. 4. Underdelegation. Answer: 2 2. Overdelegation occurs when the delegator loses control over a situation by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager that cannot be delegated because of the confidentiality and controversy associated with it. Effective delegation is the process by which responsibility and authority for performing a task is transferred to another person. It is critical that the task is one that can be delegated. Reverse delegation occurs when a person with a lower rank (unit secretary) delegates to someone with authority (nurse manager). Underdelegation occurs when full authority and responsibility are not transferred. Nursing Process: Implementation 4) The nurse pours the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast. This is an example of: 1. Ineffective delegation. 2. Negligence. 3. Underdelegation. 4. Unnecessary duplication. Answer: 2 2. Delegation of a task to a person who is not competent or qualified is in violation of the nurse practice act and constitutes negligence. Ineffective delegation occurs when the steps of delegation are not properly followed or barriers remain unresolved. Underdelegation occurs when the delegate is unable to complete the task and the delegator must resume responsibility for its completion. Unnecessary duplication occurs when the manager has given related tasks to too many people and there is overlapping of tasks. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) The novice nurse manager is hesitant to delegate tasks to competent, experienced nurses. Which is most likely to explain this hesitancy? Fear of: 1. Overburdening others. 2. Decreased personal satisfaction. 3. Increased liability. 4. Competition and criticism. Answer: 4 4. The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. There is a fear that a successful delegate could threaten the nurse managerʹs credibility as a leader. Fear of overburdening occurs when the delegator belittles the decisional capabilities of others. Fear of decreased personal satisfaction should be diminished by the increased opportunity to explore new challenges and gain other skills and experiences. Fear of liability arises when the delegator experiences fear of being blamed for the delegateʹs mistakes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Which situation is an example of reverse delegation? 1. The nurse manager asks the staff nurse to attend an in-service on a new product. 2. The nursing supervisor asks the nurse manager to attend a meeting with the physicians. 3. The licensed practical nurse asks the nurse manager to administer insulin to her client. 4. The staff nurse asks the licensed practical nurse to record intake and output in her clientʹs charts. Answer: 3 3. Reverse delegation occurs when someone with a lower rank (licensed practical nurse) delegates a task to someone with more authority (nurse manager). The nurse manager asking the staff nurse is incorrect because it is appropriate for a person with more authority (nurse manager) to delegate a task to someone with a lower rank (staff nurse). The nursing supervisor asking the nurse manager is incorrect because it is appropriate for a person with more authority (nursing supervisor) to delegate a task to someone with a lower rank (nurse manager). The staff nurse asking the licensed practical nurse is incorrect because it is appropriate for a person with more authority (staff nurse) to delegate a task to someone with a lower rank (licensed practical nurse). Nursing Process: Implementation 7) Which represent obstacles to delegation? 1. Most of the nursing staff deliver highly skilled care. 2. The entire organization has a team-centered culture. 3. There is a budget shortfall for the current fiscal year. 4. Each employee knows and executes job responsibilities. Answer: 3 3. Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation. Highly skilled staff is incorrect because a staff that is comprised of many competent nurses enables the nurse manager to delegate and still have other nurses to rely on to deliver quality nursing care. The team-centered culture is incorrect because democratic leadership styles facilitate delegation and provide good role models. Knowing job responsibilities is incorrect because environmental factors such as a norm of crisis management as a result of poor job descriptions and unclear chains of command are nonsupportive to delegation. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) The nursing supervisor states, ʺI really donʹt have the time to delegate this assignment to a nurse manager. I can do it faster!ʺ These statements suggest the: 1. Nursing supervisor does not have time to delegate. 2. Nursing supervisorʹs job description needs to be redefined. 3. Process of delegation is too time consuming. 4. Staff is ill-prepared to assume additional responsibilities. Answer: 4 4. These statements suggest a lack of trust and confidence in the abilities of the staff. Not having time is incorrect because it is the responsibility of the supervisor to develop the staff. Failing to delegate is the time waster. The redefinition of the nursing supervisorʹs job description is incorrect because an effective managerʹs role is to develop staff in such roles as a delegate. The process is too time consuming is incorrect because that time invested in developing staff today is later repaid many times over. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) Which concept is necessary for the delegate to understand when accepting delegation? 1. Accept all aspects of the task delegated. 2. Assume the delegator will serve as a mentor. 3. Clarify the time line and expectations. 4. Realize the delegate and delegator share responsibility. Answer: 3 3. It is important for the delegate to make sure the time line and expectations are clearly defined, and he or she may opt to outline the specifications in writing. Accepting all aspects of the task is incorrect because the delegate has the option to negotiate for those aspects of a task the individual feels can be accomplished. Assuming the delegator as mentor is incorrect because the delegate should never assume anything. Sharing responsibility is incorrect because accepting delegations means the delegate accepts full responsibility for the outcomes and the benefits or liabilities associated with a task. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 10) The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of: 1. Work allocation. 2. Overdelegation. 3. Ineffective delegation. 4. Transfer of authority. Answer: 1 Explanation: 1. This bureaucratic assignment reflects the nurseʹs job description so is work allocation. Overdelegation occurs when the delegator loses control over a situation by giving too much authority to the delegate. Ineffective delegation occurs when authority and responsibility are given but the steps of effective delegation are not followed. Transfer of authority assumes the delegate has assumed all of the roles and responsibilities associated with the task. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which statements would be important for the charge nurse to make when delegating a responsibility? Select all that apply. 1. ʺI think it would be important to our organization if you represent the unit on the policy and procedure committee.ʺ 2. ʺI have assigned you to be the unitʹs representative because I donʹt have enough time to go.ʺ 3. ʺI think your attendance at the task force meeting will be a good reflection on our unit.ʺ 4. ʺI chose you to attend the meeting because it seems as though you have the lightest assignment.ʺ 5. ʺI would like you to be the unitʹs representative on the client education task force committee.ʺ Answer: 1, 3 12) In order to delegate, which must be present? Select all that apply. 1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 4. Responsibility for task completion on the part of the delegate 5. Authority of the delegate to accomplish the task as assigned Answer: 1, 2, 3, 4, 5 13) Which indicates the most important reason effective delegation is essential for nurses to practice and master? 1. Higher job satisfaction 2. Greater confidence in skills 3. Higher client satisfaction 4. Increased time for other tasks Answer: 3 3. When effective delegation takes place in an organization, everyone benefits. Personal skills and confidence increase, there is increased time for other tasks and management responsibilities, and higher job satisfaction. All of these lead to higher client satisfaction, which is the ultimate goal of nursing care and nursing management. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) After attending a ʺhow toʺ refresher course on successful delegation, which statement indicates successful learning has taken place? 1. ʺI never knew I could actually benefit myself, the delegate, and the organization by taking a few minutes to thoughtfully delegate tasks to others.ʺ 2. ʺDelegation has no benefit on our unit since our clients are so frequently admitted and discharged.ʺ 3. ʺI just donʹt understand how people think delegation is not a benefit to everyone; all you have to do is tell other people what to do.ʺ 4. ʺI never knew delegation only required me to tell others what to do, and by when to have it completed.ʺ Answer: 1 Explanation: 1. Delegation does save time if done effectively, which benefits all levels of the organization. All units have time to delegate because delegators explain the task specifics, and then can move on to the next priority task. The delegate not only needs to know what to do, and when it needs to be completed, but also needs to know why the delegator needs the delegate to do it. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, ʺCan you help get these clients ready to go home by helping them pack?ʺ Which option best describes the statement with regard to effective delegation? 1. The delegation is ineffective since the nurse has no responsibility to pack the clientʹs belongings. 2. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed. 3. The delegation is ineffective because the nurse has no authority to ask the unlicensed assistant to help with client discharge. 4. Delegation could have more effective had the nurse gone with the assistant to ensure the assistant did the packing as requested. Answer: 2 2. Effective delegation occurs when the delegator gives specific information to the delegate about the requested task. The nurseʹs request was not specific enough. The nurse has ultimate responsibility to ensure the client is ready for discharge, which includes packing their belongings as necessary. The nurse also has authority to ask for the assistance, but does not need to go with the assistant to ensure the task is completed. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 16) The nursing supervisor is assessing the organization by spending time on each unit. The nurse manager seems overwhelmed and stressed trying to address many client complaints. The charge nurse is trying to help everyone at once. In this situation, what might this supervisor conclude based on this assessment? Select all that apply. 1. The nurse manager is inexperienced and needs time to adjust. 2. The unit culture fosters distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills. 5. The unit must have had several call-ins or is short staffed. 6. Delegation may be seen as too time consuming to undertake. Answer: 2, 3, 4, 6 17) Which represents an obstacle that frequently impedes effective delegation of client care from the RN to the LPN? 1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. 2. The LPN asks the RN to specifically describe assignments given for the day just after receiving report. 3. The RN realizes one of the unitʹs unlicensed assistive personnel has called in for the day. 4. The LPN asks the unlicensed assistant to obtain vital signs on the new admission as they are admitted. Answer: 1 Explanation: 1. The RN is the only caregiver legally responsible for assessing clients. Thus, the RN cannot delegate this to the LPN, and this is an example of overdelegation. The LPN asking the RN to describe assignments is appropriate. The RN delegation to the LPN should not be affected by the unlicensed assistantʹs call-in, and the LPN should not delegate to the unlicensed assistant as only RNs should delegate tasks. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) For the nurse to effectively and legally delegate, which must be consulted and followed to reduce the likelihood of liability? 1. The American Nurses Association By-Laws 2. The National Council of State Boards of Nursing Rights 3. The regulations of the state nurse practice acts 4. The rules of the governing specialty organization Answer: 3 3. Nurses in each state are governed by their own stateʹs nurse practice act, and these regulations must be consulted and followed. The ANA, NCSBN, and specialty organizations cannot make rules or regulations differing from those in the nurse practice acts. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) Which situation indicates the nurse needs additional training on effective delegation? 1. A charge nurse tells an unlicensed assistant to transport a client to radiology during an emergency. 2. The office nurse calls in orders for admission on a client following a surgical complication. 3. A rehabilitation nurse asks a physical therapy assistant to assist a client ambulate around the facility. 4. A home health nurse calls the office and asks another nurse to check on the next client to be seen. Answer: 2 2. Unless the office nurse is an advanced practice nurse, the office nurse cannot call in orders not signed off by a physician or nurse practitioner. This opens the organization up to problems with liability. The situations involving the home health and rehabilitation nurse are not cause for concern for liability. The charge nurse telling the unlicensed personnel to transport a client is not delegation, it is an assignment. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which of the following situations cause concerns with liability with regard to delegation? Select all that apply. 1. The nurse asks the LPN to change a central line dressing for her. 2. The nursing supervisor asks the nurse to discuss a clientʹs history with him. 3. The nursing assistant requests a nurse to check on a clientʹs status. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment. Answer: 1, 2, 4 Chapter 11 Building and Managing Teams 1) The nurse manager often gives preferential treatment to one of the staff nurses on the unit. This behavior is an example of: 1. Difficulty managing oneʹs interpersonal relationships. 2. Lack of conflict management skills. 3. Inability to transform a work group into a team. 4. Lack of group planning skills. Answer: 1 Explanation: 1. Playing favorites, ignoring reticent members, and allowing animosity to develop within a group are signs of an inability to manage oneʹs interpersonal relationships. A lack of conflict management skills occurs when the manager is unable to assist coworkers to understand and accept differing work styles and views. The inability to transform a work group into a team happens when the manager does not know how to help group members identify goals, tasks, and practical work plans. A lack of planning and organization skills needed to facilitate group work performance fails to create cohesive groups among the workers. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) The nurse manager asks staff members to work as a group in planning the activities for Nurseʹs Week. Which is the correct name for this group? 1. Command group 2. Task group 3. Competing group 4. Informal group Answer: 2 2. The purpose of a task group is to deal with specific issues involving a specific need and work independently on a project. A command group accomplishes routine tasks in an organization and is designed to meet a specific mission of the organization. A competing groupʹs members compete with each other for resources to perform their tasks or compete for recognition. An informal group evolves naturally from social interactions and is not defined by an organizational structure. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 3) A group is a collection of individuals who have: 1. Common goals. 2. Identical roles. 3. Homogenous needs. 4. Similar ideas. Answer: 1 Explanation: 1. A group is an aggregate of people who interact and mutually influence each other. Identical roles is incorrect because a groupʹs members often have different roles within the group. Homogeneous needs is incorrect because the needs of each individual member may vary. Similar ideas is incorrect because each member of a group may have unique thoughts and opinions. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 4) The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is assigned to meet organizational goals, is known as a(an): 1. Ordinary interacting group. 2. Command group. 3. Task force. 4. Informal group. Answer: 2 2. The purpose of a command group is to accomplish tasks in an organization, and these groups are recognized as legitimate organizational entities. An ordinary interacting group generally has a formal leader and is run with an informal structure. A task force has a focus with a specific time-limited assignment. An informal group evolves from social interactions that have no organizational structure. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 5) During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of this group. These behaviors are characteristic of which stage of Homanʹs group process? 1. Norming 2. Storming 3. Performing 4. Forming Answer: 4 4. During the initial stage of the group process, the members are cautious in approaching each other as they come together as a group. Norming occurs in the third stage of Homanʹs group process and is characterized by the definition of the goals and rules of behavior. Storming occurs when the group members wrestle with roles and relationships and conflict arises. Performing occurs in the fourth stage of Homanʹs group process and the members communicate and cooperate. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) The leader of the task force group announces their tentative plans for Nurseʹs Week activities have been approved by the hospital administration. They have also been given a new task of developing criteria for the nursing awards. Which must the group accomplish now? 1. Forming 2. Adjourning 3. Rebuilding 4. Reforming Answer: 4 4. When a group must refocus its energy on an added assignment, the leader will explain the new direction and provide guidance in the process of reforming. Forming is incorrect because forming occurs in the initial stage of group development when members are meeting for the first time. Adjourning is incorrect because adjourning occurs when the group dissolves its membership after achieving its objectives. Rebuilding is incorrect because the group membership remains unchanged although new goals have been established. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment 7) In a group meeting, one of the members always arrives early and places the chairs in a circle so all members can interact. This person is responsible for confirming that the room is available for the monthly meetings. Which person does this describe? 1. Gatekeeper 2. Procedural technician 3. Coordinator 4. Initiator-contributor Answer: 2 2. The role of the procedural technician is to support group activities by arranging the environment and providing necessary tools. The role of the gatekeeper is to encourage all group members to communicate and participate. The role of the coordinator is to link ideas or suggestions offered by others. The initiator-contributorʹs role is to redefine problems, offer solutions, clarify objectives, suggest agenda items, and maintain time limits. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statement, if made by this leader, is reflective of effective leadership? Select all that apply. 1. ʺI will assume responsibility for developing the mission and goals of the group.ʺ 2. ʺI have created an agenda that identifies the amount of time allotted for each step of the problem-solving process.ʺ 3. ʺI realize there will be dissension; however, I prefer that we not take time from our agenda to address it.ʺ 4. ʺThe meeting will be called to order at noon and be adjourned in one hour.ʺ 5. ʺIt is important that each of you is fully engaged in the decision-making process.ʺ Answer: 2, 4, 5 9) Which of the following are considered formal groups? Select all that apply. 1. Several people work together to facilitate a policy change for discharge procedures. 2. The nurse managers meet once monthly to discuss issues varying from unit to unit. 3. The unit staff meet once monthly after work and discuss problems encountered recently. 4. Once every quarter the nursing supervisors work on projects as assigned by the nursing administrator. Answer: 1, 2, 4 10) If several people in different positions from different areas of the organization meet for the purpose of achieving a goal as requested by the facility administrator, which term correctly describes the group? 1. Team 2. Task group 3. Real group 4. Competing group Answer: 1 Explanation: 1. A team works together to accomplish a goal for the entire organization if requested by the administrator. A task group meets to accomplish a task for a unit or department and a real group (or command) group functions on an ongoing basis as an interdependent body. An example is the administrative board of an organization. Individuals in a competing group function as adversaries of each other as they compete for resources to complete the assigned tasks. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Choose the example portraying a situation in which a group is not a team. 1. A group of people are working toward streamlining the admission process. 2. Seven nurses are working to get their hospital to magnet status, led by their manager. 3. A group of nurse managers are working on their unit budgets for the following fiscal year. 4. Three nurses and two unlicensed assistants are given the task of revising position descriptions. Answer: 3 3. A group cannot be a team if the members are competing for resources such as when completing a budget request. The other group descriptions are considered teams because they are working together to complete a task or responsibility. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) Which statement indicates a nursing student needs further instruction if discussing the characteristics of a task force? 1. ʺIt is considered a formal group.ʺ 2. ʺA task force can be called a team.ʺ 3. ʺA task force may or may not have a leader.ʺ 4. ʺThis group must work toward problems on a specific unit.ʺ Answer: 4 4. A task force or committee works on issues involving several units, not just one. The task force is also a formal group since it has an official purpose, is a team since members work together, and does not necessarily require a leader. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) The nurse manager is planning a meeting for members of her staff and wants to describe the word ʺteamʺ when describing the desired behavior for the staff. Which is appropriate to use in this description? 1. A team is a group of more than three people. 2. A team does not need a leader to coordinate activities. 3. All members of the team contribute their talents. 4. Teams consist of members from the same job level. Answer: 3 3. Members of teams do contribute their talents to assist the team in achieving the goals of the group. A team can be just two people, usually has a leader, and has people from different job levels and work groups. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which statement describes the way in which most groups are formed? 1. Members with common goals come together and start working on the groupʹs tasks. 2. People in the group work toward a common understanding of the purpose and member roles. 3. The informal leaders of the group make sure everyone knows the purpose to avoid conflict. 4. Relationship building is not necessary as the group forms because members already work together. Answer: 2 2. As the members come together, the leader must explain the purpose, tasks required, and behavior expected. The group forms without a concrete understanding of how the goal(s) for the group will be met. Understanding specific tasks involved takes time and at the beginning, some conflict is expected and helpful. This builds the group relationship among members to a cohesive group with a formal structure and function. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) If part of a groupʹs process is team building, which is the correct order of these activities? 1. Learn about each potential memberʹs past experiences with the task at hand. 2. Schedule an overnight retreat with activities meant to bring group cohesiveness. 3. Observe group meetings to determine areas where problems could develop. 4. Send email notification of the establishment and overall group purpose. 5. Determine the groupʹs effectiveness and intervene as necessary. Answer: 4, 1, 3, 2, 5 16) Which situation best exemplifies the nurse manager as a team leader? 1. The nurse manager posts the unitʹs positive accomplishments from the past month in the break room. 2. The nurse manager controls the staff meetings so the staff can get back to work quickly. 3. Every year the nurse manager does staff member evaluations to determine pay raises. 4. The nurse manager encourages conjunctive task performance on the unit. Answer: 1 Explanation: 1. Building the team up by praising team accomplishments best exemplifies the nurse manager as team leader. For the nurse manager, allowing little time for discussion at staff meetings, and encouraging conjunctive task performance (all or none have success) does not exemplify team leadership because these tend to foster individualization instead of team players. Individual performance evaluations do not exemplify team leadership. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Expectations from the nurse manager as team leader include: Select all that apply. 1. Offer constructive criticism. 2. Settle all employee conflicts. 3. Encourage group discussions. 4. Facilitate group processes. 5. Foster team dependence. Answer: 1, 3, 4 18) When acting as the team leader for a patient care conference, which statement is appropriate? 1. ʺWe are all here to discuss the issues with this clientʹs discharge. Can anyone tell me what those issues are?ʺ 2. ʺThe issue with this client is the time limit for Medicare to pay has almost expired, and we arenʹt ready for discharge.ʺ 3. ʺI donʹt really have time for this meeting today; is there anything I can do to expedite this meeting?ʺ 4. ʺI will let you all decide what might be best for this client, as I am not really as familiar with her as I should be.ʺ Answer: 2 2. The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) For an initial meeting of a task force, which is most important for the team leader to accomplish? 1. Determine when the task force has to complete the assignment. 2. Identify the expected outcomes in terms of measurable objectives. 3. Communicate frequently with those initiating the task forceʹs job. 4. Select members based on interest in the particular task. Answer: 2 2. The task force leader must first and most importantly identify and understand the objectives for the group to accomplish. Only then should the team leader determine when the assignment must be completed. Members of the working group should not only be chosen based on their interest, but also their skills, knowledge, and time availability. As the task force work begins, it is then important to frequently report to those initiating the task force. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 20) How should a team member assist a group meeting to stay on task and on time? Select all that apply. 1. Start promptly as soon as everyone arrives. 2. Set a convenient and quiet meeting time and place. 3. Ensure members know what is expected as completed ʺprework.ʺ 4. Allow only the key members to participate in group discussions. 5. Distribute an agenda prior to the meeting to ensure all are prepared. 6. Evaluate each idea as it comes up and then decide to keep or discard. Answer: 2, 3, 5 Chapter 12 Handling Conflict 1) The nurse manager is facilitating a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nursesʹ concerns in favor of the doctors. Which strategies would facilitate this outcome? Select all that apply. 1. Accommodating 2. Compromising 3. Smoothing 4. Collaborating 5. Competing Answer: 4, 5 2) The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. Of which concept is this an example? 1. Intrapersonal conflict 2. Interpersonal conflict 3. Intragroup conflict 4. Intergroup conflict Answer: 1 Explanation: 1. Intrapersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one individual. Interpersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs between two or more individuals. Intragroup conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one group. Intergroup conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs between two or more groups. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of: 1. Integrative decision making. 2. Win-lose strategy. 3. Accommodation. 4. Consensus. Answer: 4 4. Consensus occurs when the problem is fully explored, the needs and goals of both parties are addressed, and a mutual decision is made. Integrative decision making is a strategy that focuses on the process of decision making, not the outcome. Win-lose strategies allow one party to win and the other to lose. Accommodation is an unassertive strategy used when individuals neglect their own concerns in favor of the other partyʹs concerns. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 4) The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement, if made by the nurse manager, best exemplifies the final stage of conflict management? 1. ʺWe need to clearly define the nature of the conflict.ʺ 2. ʺI will evaluate the outcomes of our strategies on a monthly basis.ʺ 3. ʺLetʹs create a time line for the implementation of our strategies.ʺ 4. ʺHopefully, each group can understand each otherʹs perceptions of the issue.ʺ Answer: 2 2. The final stage of the Process Model of Conflict Management is the implementation of the outcome decision. Steps involved in this stage include identification of new expectations, facilitating a smooth transition, and monitoring outcomes. Defining the nature of the conflict is incorrect because the first stage of the Process Model of Conflict Management is assessment of the conflict. A time line for implementation is incorrect because creating a time line occurs early in the Process Model of Conflict Management and is a facilitative technique. Understanding each otherʹs perceptions is incorrect because validation of perceptions is a strategy used to move toward a resolution of the conflict. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) The staff nurses and nursing administration are attempting to construct a method of scheduling meeting the needs of both the clients and the nursing personnel. Because nurses and nursing administration have experienced conflict about the issue, their intent is to arrive at an agreeable solution between both parties. This process best exemplifies: 1. Negotiation. 2. Accommodation. 3. Forcing. 4. Consensus. Answer: 1 Explanation: 1. Negotiation involves a reciprocal ʺgive and takeʺ on issues among the parties. The desired outcome is to achieve agreement even though consensus will never be reached. Accommodation is a cooperative tactic used when the desired outcome is to preserve harmony when one party has a vested interest in an issue that is unimportant to the other party. Forcing is an inappropriate mode of responding to conflict, and although a solution is found, the conflict remains unresolved. Consensus implies that the solution meets everyoneʹs needs, which is often not the case in negotiation. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) A staff nurse has experienced disagreements with one of the residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is characteristic of: 1. Competitive conflict. 2. Role conflict. 3. Perceived conflict. 4. Disruptive conflict. Answer: 4 4. Both parties are engaged in activities to reduce, defeat, or eliminate the opponent, which result in irrational, unproductive behavior. Competitive conflict occurs when there is a positive outcome for one side and a negative outcome for the opponent. The process of conflict resolution follows a specific set of rules. Role conflict occurs when people have related responsibilities that may overlap and are ambiguous. Perceived conflict occurs when two parties misunderstand each otherʹs position and is often the result of a knowledge deficit. It does not necessarily result in irrational behavior. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a ʺwe-theyʺ distinction on the unit. This mechanism is an example of: 1. Distancing. 2. Suppression. 3. Structural conflict. 4. Unification. Answer: 1 Explanation: 1. Distancing mechanisms or differentiation serve to divide group members into small, distinct groups, which increases the risk for conflict. Suppression occurs when one group defeats the other. Only the dominant side is fully committed to the decision. Structural conflict occurs when there is an inequality in relationships such as superior to subordinate. The different ranking among people in a hierarchy has the potential to create conflict. Unification implies greater intimacy among all members, which is counterproductive to conflict. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) Which strategy is most important when mediating between two or more people? 1. Address the conflict in the superiorʹs office. 2. Make a timely decision regarding if and when to intervene. 3. Accept full responsibility for developing a solution. 4. Redirect expressions of disagreement between the participants. Answer: 2 2. Conflict management begins with a decision regarding if and when to intervene. Failure to intervene can allow the conflict to escalate; whereas premature intervention can cause individuals to lose self-confidence and avoid risk taking. Addressing the conflict is incorrect because routine disagreements can be dealt with in a superiorʹs office, but serious confrontations should be addressed in a neutral setting. Accepting full responsibility is incorrect because the responsibility for developing a solution to the problem falls on each of the participants, not the mediator. Redirecting expressions of disagreement is incorrect because full expression of positive and negative feelings is conducive to conflict resolution. Nursing Process: Implementation Safe, Effective Care Management Cognitive Level: Comprehension 9) The nurse manager asks a group of nurses to work together to create a schedule that will meet the staffing needs of the unit. Each nurse volunteers to gather data prior to the next meeting. Of which type of problem solving is this an example? 1. Negotiation 2. Collaboration 3. Compromise 4. Forcing Answer: 2 2. Collaboration occurs when all parties use their expertise to problem solve. The group focuses on problem solving as opposed to competition. Negotiation implies differences in opinions. Although agreement may be achieved, consensus is not necessarily reached. Compromise means that neither party gets what he or she wants. Rewards are divided between both parties. Forcing provides an immediate end to the conflict but fails to resolve the cause of the conflict. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. The nurse manager might make this decision to: 1. Allow sufficient time for the problem to spontaneously resolve. 2. Motivate the participants to seek resolution. 3. Give the nurse manager time to identify problem-solving strategies. 4. Prevent the nurse manager from making a premature intervention. Answer: 2 2. The nurse manager may delay intervention to allow the conflict to escalate because increased intensity can motivate participants to seek resolution. Allowing sufficient time is incorrect because effective problem solving is needed for resolution. Giving the nurse manager time is incorrect because it is the responsibility of the participants to identify problem- solving strategies and not the obligation of the nurse manager. Preventing the nurse manager from intervening is incorrect because although conflict management does take time, at times it is beneficial to allow the parties to seek resolution. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 11) The most effective means of resolving a conflict occurs when the problem is brought to the attention of the involved parties and attempts are made to resolve it through effective problem solving. This strategy is known as: 1. Confrontation. 2. Resolution. 3. Negotiation. 4. Forcing. Answer: 1 Explanation: 1. Confrontation is the most effective means of resolving conflict, in which the conflict is brought out in the open and deliberate attempts are made to resolve it through knowledge and reason. Resolution is the final stage of conflict management that occurs when a mutually agreed -upon solution is arrived at and both parties commit themselves to carry out the agreement. Negotiation is a technique in which the conflicting parties give and take on various issues. Forcing is a conflict management technique that forces an immediate end to conflict but the cause is not resolved. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 12) A nurse manager states, ʺI cannot stand all these conflicts occurring in my department. Nothing good can come out of it.ʺ Which indicates the best reason for the managerʹs statement to be untrue? 1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue. 2. When people are in conflict, they tend to work harder just to avoid the conflicting situation. 3. Groups in conflict spur competition, which is always beneficial to the units from which the groups emerged. 4. When there is conflict in an organization, people are more open to discussion, thus conflict can open the lines of communication. Answer: 1 Explanation: 1. Conflict can be positive because as a conflict arises, individuals may become involved that might not have otherwise. More people usually means more creative solutions. The remaining options are not true statements, because conflict can shut down the lines of communication, can spur negative competition, and those in conflict do not necessarily work harder to avoid the situation. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which of the following indicate purely negative sources of conflict within an organization? Select all that apply. 1. The unit has Generation Xers and Baby Boomers working on the same shifts. 2. Two unit groups are in direct opposition to each other. 3. A nearby hospital is beginning a new service in direct competition with the organization. 4. An environment of ʺdonʹt ask, donʹt tellʺ exists within the organization. 5. A night shift nurse frequently checks e-mail and asks others to check on clients. Answer: 1, 2, 4, 5 14) Which is an example in which the conflict could be positive or negative depending upon the parties involved? 1. Group disagreements 2. Generational differences 3. Physician behaviors with nurses 4. Job levels Answer: 1 Explanation: 1. Group disagreements can be positive or negative depending on the type of conflict. Between-group conflict can be positive for the intragroup members, but negative for the intergroup members. If there is a conflict between generations, physicians and nurses, and between those in different job levels, negative conflict occurs as those in conflict are in a ʺwin-loseʺ conflict. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) Why does conflict help generate change? Select all that apply. 1. Conflict assists change to occur more rapidly than it would otherwise. 2. It brings more attention to an issue in need of change. 3. People get involved because conflict breeds curiosity. 4. If there is an existing conflict, a change must occur to stop the conflict. 5. Change is inevitable, and some people refuse to change, which causes conflict. Answer: 2, 3 16) A new triage area has been built in the emergency department, causing conflict between the nurse manager and the nurses who think the design is not ʺuser friendly.ʺ After repeated complaints the nurse manager asks maintenance to change the arrangement of the room. How did this conflict generate this change? 1. The complaints motivated the nurse manager to make the change to increase unit effectiveness. 2. The room design was uncomfortable for the nurses, which convinced the nurse manager to change the design. 3. The nurse manager was afraid the nurses would refuse to work in the room so the room had to be changed. 4. The nurses would keep complaining so the nurse manager changed the room to stop the griping. Answer: 1 Explanation: 1. As the nurse manager, unit effectiveness is paramount. If the nurses are complaining, it is probably a legitimate problem in need of change. The other options may be true, but they are not as important as unit effectiveness. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) The residents on a particular unit do not answer pages very quickly, and sometimes do not answer them at all. The nursing staff complains to the nursing supervisor. After several weeks, this conflict has spiraled into a heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict? 1. Client care and satisfaction will suffer should it be allowed to continue. 2. The residents cannot be allowed to continue such unprofessional behavior. 3. Residents who do not answer pages do not get the most out of the experience. 4. Physicians do not know what is going on with clients if the residents do not tell them. Answer: 1 Explanation: 1. Client care and satisfaction must take precedence over other reasons for settling the conflict. Residents cannot be allowed to continue, but this does not answer the ʺwhyʺ portion of the stem. The other two options may be true, but the broader answer about client care and satisfaction is the best answer. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 18) The nurse and a client are discussing instructions for continued home care, and the clientʹs husband expresses that he does not feel comfortable and wants home health to continue. Of which conflict component is this an example? 1. Conflict suppression 2. Resource competition 3. Structural conflict 4. Antecedent condition Answer: 4 4. Antecedent conditions include competing for resources, structural conflict, differences in values and beliefs, and differing goals. Thus, antecedent conditions cover several possibilities in the broad situation given in the question. Conflict suppression is not applicable yet, as the process has not advanced that far. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) The organization is working toward gaining magnet status in the near future. For which type of antecedent condition does this put the organization at risk? 1. Differing values and beliefs 2. Structural conflict. 3. Role conflict 4. Incompatible goals Answer: 1 Explanation: 1. Magnet status requires that the organization have a percentage of nurses with baccalaureate degrees on staff. If the majority of nurses do not hold this degree, a conflict starts based on this type of conflict component. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which indicates the most important factor in whether a conflict will be perceived or felt between two nurses? The parties involved: 1. Know and trust each other. 2. Are on the same job level. 3. Have the same values and beliefs. 4. Perform the same roles. Answer: 1 Explanation: 1. Perceived versus felt conflict depends on whether or not the involved parties know and trust each other. If past problems have been handled calmly and rationally, and each knows what to expect from the other, it is considered a perceived conflict. Job level, values and beliefs, and the performing the same roles are not as important is determining which type of conflict is occurring. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Choose problems in the workplace occurring because of bullying behavior. Select all that apply. 1. Increased turnover in the organization 2. Increased client satisfaction on the unit 3. Increased litigation against the organization 4. Decreased sick call-ins on the unit 5. Decreased job satisfaction 6. Decreased nurse recruitments Answer: 1, 3, 5, 6 22) The new nurse comes to see the nurse manager and describes situations in which the nurse feels threatened and intimidated. Which is the most appropriate response by the nurse manager? 1. ʺI think you should just avoid the bully when possible.ʺ 2. ʺThe situation is likely not to improve until you confront the bully yourself.ʺ 3. ʺYou are new and may be misunderstanding whatʹs happening.ʺ 4. ʺI will immediately call the bully into the office and we will discuss it.ʺ Answer: 2 2. The new nurse should confront the person doing the bullying in front of others so that personʹs behavior will be public. Avoiding the bully is okay, but delays dealing with the bullying, which in all likelihood will get worse. The other two options are inappropriate because the nurse being new is not the issue, and pulling the person bullying into the office makes the new nurse into a ʺtattletaleʺ and may escalate the problem. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 23) The nursing supervisor overhears two nurses talking while walking to the parking lot. One seems scared of the other. Which is the nursing supervisorʹs priority action? 1. Do nothing until the next time both nurses are working and then confront them both. 2. Start talking to the one who is scared to ʺcome to the rescue.ʺ 3. Start a conversation with the nurse who is scaring the other nurse. 4. Call the organizationʹs security person on duty to address it. Answer: 3 3. It is the responsibility of the nurse manager to protect the nurse from the bullying nurse. By starting a conversation with the nurse who is scaring the other nurse, the nurse manager allows the scared nurse to get away. The next time the nurse manager works with the scared nurse, the nurse should talk to the nurse manager about ways to stop the behaviors. Doing nothing is incorrect as it seems to condone the behavior, overtly coming to the nurseʹs rescue may make the situation worse, and security is not needed at this point. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 24) In a nursing home, the nurse hears an unlicensed assistant threatening to withhold fresh water if the client does not do as the assistant instructed. What is the nurseʹs priority action? 1. Immediately confront the assistant at the bedside about the behavior. 2. Ask the assistant to immediately follow you to a private place to talk. 3. Tell the nurse manager or nursing supervisor what was witnessed. 4. Encourage the client to report the situation to the administration. Answer: 2 2. As a client advocate, the nurse must confront the assistant immediately, but should do so in private. This allows the assistant to explain the behavior and ʺsave face.ʺ Follow the ʺpraise in public, confront in privateʺ rule. The nurse manager is not necessary at this time, but may be if the behavior continues. The nurse is the client advocate and should address the issue for the client. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 13 Managing Time 1) Which strategy would promote time management for the nurse manager while interacting with a drop-in visitor? 1. Set office hours to eliminate drop-in visits. 2. Keep the office door closed. 3. Hold meetings in the nurse managerʹs office. 4. Stand up to greet the visitor and remain standing. Answer: 4 4. In order to direct the drop-in visit, the nurse manager should stand up and remain standing throughout the encounter. The gesture is gracious yet obvious enough to encourage a short visit. Setting office hours is incorrect because office hours should be established to decrease drop-in visits, but the intent is not to totally eliminate all drop-in visits. Keeping the door closed is incorrect because a block of time when the door is open for accessibility and availability is needed. Holding meetings in the office is incorrect because it is easier to leave someoneʹs office than to remove an individual from one. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 2) Which approach would be most effective to deal with stress due to a time crunch? 1. Identify the actual stressor and the precipitating factors. 2. Plan activities to minimize time constraints to reduce stress. 3. Set aside a block of time each day for stress reduction. 4. Engage in distraction activities to minimize the stress. Answer: 1 Explanation: 1. The first step of the nursing process is to assess the situation. Planning activities is incorrect because before a plan can be made, the stressor must be assessed. Setting aside time is incorrect because implementation occurs after the stressor has been assessed and a plan developed. Engaging in distraction is incorrect because implementation occurs after the stressor has been assessed and a plan developed. Nursing Process: Assessment Category of Client Need: Psychosocial Integrity Cognitive Level: Application 3) The nurse manager believes the task of scheduling cannot be delegated to anyone. This belief is characteristic of: 1. Necessitating. 2. Deficiency fostering. 3. Low skill recognition. 4. A strained interpersonal relationship. Answer: 1 Explanation: 1. Necessitating is the belief that it is imperative a specific person complete a particular task. Deficiency focusing is the habit of focusing on the negatives at the expense of the positives. Low skill recognition is the tendency not to recognize the role oneʹs own ability has played in producing oneʹs successes. Strained interpersonal relationships occur within the nursing profession and between nursing and other professions. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 4) Which strategy would efficiently manage time spent on the telephone? 1. Answer the phone, ʺHello, how are you?ʺ 2. Use voice mail to screen all calls. 3. Use e-mail for potentially troublesome issues. 4. Set a specific block of time to address issues. Answer: 4 4. The nurse manager should set time aside to handle routine phone calls and return calls. Answering the phone with ʺHello, how are youʺ is incorrect because it encourages socializing and small talk. Using voice mail to screen calls is incorrect because there are situations in which issues must be dealt with immediately and face-to-face. Using e-mail is incorrect because troublesome issues should be addressed face-to-face. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Comprehension 5) Which method would be most effective for the manager who must address routine issues? 1. Encourage the use of voice mail to address routine matters. 2. Encourage the person to call to discuss routine issues. 3. Keep the office door open to be accessible to the staff. 4. Hold regularly scheduled meetings to deal with non-urgent matters. Answer: 4 4. Regularly scheduled meetings with those who need to see the nurse manager allow them to hold routine matters for these appointments. Encouraging the use of voice mail is incorrect because voice mail does not facilitate face-to-face discussion needed to address routine issues. Encouraging to the person to call is incorrect because a telephone call may be unstructured and act as a time waster. Keeping the office door open is incorrect because allowing unlimited access to the nurse manager encourages drop-in visits, which can be time wasters. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Comprehension 6) The nurse manager has planned a meeting that all staff nurses have to attend. Which method would most efficiently notify the staff members of the meeting time? 1. E-mail 2. Voice mail 3. Memo 4. Telephone call Answer: 1 Explanation: 1. E-mail minimizes time wasted trying to contact individuals and the urgency of the message can be coded. Voice mail is incorrect because voice mail is time consuming because the caller must place the call. There is also the possibility the person will answer the call, which entails a greater investment of time. Memo is incorrect because there is a risk that the memo will be placed where it is not accessible to all staff members. Telephoning is incorrect because a telephone call may lead to socializing and small talk, which are time wasters. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 7) The nurse manager is writing annual evaluations for each nurse. In order to promote professional development, in which is it vital for the nurse manager and nurse to become involved? 1. Personal organization 2. Priority setting 3. Goal setting 4. Limit setting Answer: 3 3. Goal setting helps to relate current behavior, activities, or operations to the organizationʹs or individualʹs long-range goals. Personal organization is the result of clearly defined priorities based on well-defined, measurable, and achievable objectives. Priority setting involves attempting to prioritize needs. Limit setting is trying to keep a person in line and trying to shape behavior. Nursing Process: Implementation 8) The new graduate took a position on an orthopedic unit and has been unable to accomplish the same amount of work as other new graduates. Which are possible issues with this nurse? Select all that apply. 1. A lack of self-discipline 2. A lack of organization 3. Problems with time management 4. Role confusion Answer: 1, 2, 3 9) A nurse frequently has to work late and has no time to do required training while at work. She has to do them on her days off. Choose the work-related time waster that commonly puts nurses in this position. 1. Unscheduled tasks delaying those scheduled 2. Frequent phone calls from family members 3. Taking longer than scheduled breaks 4. Volunteering for extra responsibilities Answer: 1 Explanation: 1. While working with different disciplines, work days are in a constant state of flux, and sometimes nurses get behind. Frequent phone calls from family members while at work are a time waster, but the stem asked for ʺwork-related,ʺ so this is incorrect. While taking longer breaks does occur, it is not usually a reason for frequently having to work late. Volunteering does occur, but the nurse who is having difficulty keeping up with work days would generally not volunteer for extra responsibilities. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 10) A novice nurse manager is devising a schedule to meet the needs of the staff, clients, and other disciplines on the unit. Which is the most important method to counteract wasted time in nursing? 1. Delegate routine activities to concentrate on other tasks. 2. Allow the staff to attend management meetings. 3. Redesign the position to work when the unit is not busy. 4. Strictly adhere to an ʺappointments onlyʺ rule. Answer: 1 Explanation: 1. One of the most important time wasters in nursing at all levels is failing to delegate tasks that another lower-level staff member could do. Staff should not routinely attend management meetings and the manager must be available during the busier times on the unit, especially in emergencies. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 11) A nursing supervisor has a report due and just cannot seem to find the time to get it done. One day before it is due, the supervisor turns it in. Of which time waster is this an example? 1. The supervisor waited for the deadline pressure to increase the priority. 2. The report was one of the last tasks on the ʺto-doʺ list. 3. The supervisor has no interest in the topic of the report. 4. The report format is unfamiliar to the nursing supervisor. Answer: 1 Explanation: 1. This is a classic example of procrastination, and the manager waited until it absolutely had to be done because of the looming deadline. The others are plausible reasons for the time wasting, but are not specifically described in the question. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 12) Which are examples of personal goals? Select all that apply. 1. ʺWe nurses will each lose 10 pounds by Christmas.ʺ 2. ʺMy family will not lose any items while on vacation.ʺ 3. ʺI will study 1 hour every day after school.ʺ 4. ʺMy colleagues will not catch me being late for work.ʺ 5. ʺWe will save $200 monthly for the next 12 months for a car down payment.ʺ Answer: 1, 2, 3, 5 13) A nursing student discusses short-terms goals with a nurse manager during a job interview. Which indicates the student understands what this means? 1. ʺI want to become a nurse anesthetist within 10 years.ʺ 2. ʺI will be available to come in for extra shifts if needed.ʺ 3. ʺMy brother and I want to go to on a mission trip in the next year.ʺ 4. ʺI want to get this job so I can move on to the next part of my life.ʺ Answer: 3 3. Going on a mission trip is the short-term goal since it involves the next 6 months to a year time frame. The long-term goal would be to become the nurse anesthetist within 10 years. The statements about extra shifts and getting the job are broad and not measurable. Thus they are not goals. Nursing Process: Evaluation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 14) Place the items in the correct rank order from most important to least. 1. Surfing the Internet to find a song 2. Planning a staff meeting 3. Assisting a family whose child is in the ER 4. Calling to find replacement staff for a call-in 5. Trying to organize the visitor take-out menus Trying to organize the visitor take-out menus Answer: 3, 4, 2, 5, 1 15) Group ʺlike activitiesʺ to maximize the limited time to attend to them. 1. Restocking the medication cart 2. Ordering stock medications from the pharmacy 3. Calling for extra linen from laundry 4. Making sure clients have adequate linens 5. E-mailing a colleague a question about the schedule 6. Searching the Internet for an unfamiliar client diagnosis Answer: 1 and 2, 3 and 4, 5, and 6 16) How does conflict resolution come into play with regard to personal organization and self-discipline? 1. The nurse manager spends most of the time working through conflicts with or between staff members. 2. Conflict resolution occurs when the nurse manager effectively prioritizes conflicting needs. 3. As the nurse works toward personal organization and self-discipline, personal conflicts will resolve. 4. Conflict resolution is the only way a nurse can get organized and become disciplined. Answer: 2 2. The nurse manager must frequently resolve conflicts between tasks all seemingly on the same level of importance. Working through conflicts between staff members is incorrect because these conflicts have little to do with time management and self-discipline. Personal conflicts will not resolve with personal organization and self-discipline. Time conflicts will occur regardless of how organized a person may be, and conflict resolution will not prevent time conflicts from occurring. Nursing Process: Assessment Category of Client Need: Psychosocial Integrity Cognitive Level: Application 17) A nurse manager is working on several projects and is stressed most of the time. This manager usually works on the unit instead of her office to make sure she does not miss anything. Which would be the most effective method to decrease stress? 1. Keep a structured schedule for ʺwork timeʺ on each project in the office. 2. Elicit assistance from employees to help complete the projects. 3. Allow one project to fall behind while finishing up the others. 4. Take a sick day to work on the projects uninterrupted at home. Answer: 1 Explanation: 1. Carving out work time for each project in the office with a clear place to work is the most effective method to decrease this managerʹs stress. Eliciting help, allowing a project to fall behind, and taking a sick day will do nothing toward decreasing stress over the long term. They are also not appropriate management behaviors. Nursing Process: Planning 18) How can a nurse who is consistently falling behind improve to become more organized and disciplined? 1. Use the same system every day both at work and home to organize client care and required personal activities such as paperwork. 2. Ask the nurse manager to grant permission for fewer client assignments until more experience with organization is achieved. 3. Ask the unit secretary to do required paperwork to decrease the amount of time required. 4. Practice a shorter client assessment technique to minimize the time required for this activity. Answer: 1 Explanation: 1. Using the same system regardless of location assists in making this organization a habit. The other options do little to correct the underlying issue of a lack of organizational skills and discipline. In addition, secretarial assistance with charting and skimping on assessment cause concern for legal consequences. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 19) A nursing supervisor comes to a managerʹs office to discuss an issue on the unit. The door is closed, and, although the manager can be heard inside talking at length on the phone, the door remains closed without an invitation to enter. What is the supervisorʹs priority action when it appears the manager is wasting her time? 1. Leave but ask unit employees if the nurse manager is all right. 2. Stay and continue knocking on the door until the manager opens it. 3. Leave the area but make sure to catch up with the manager later. 4. Wait until the manager gets off the phone and knock again. Answer: 4 4. While this scenario may indicate wasted time on the part of the supervisor, and quite possibly for the manager, there is no indication the phone call is a personal call. In this instance it might be important to wait and check on the nurse manager to ensure everything is all right. Leaving but asking the employees about the manager is incorrect because rumors get started this way. Continuing to knock on the door is incorrect because it is unprofessional and a rude interruption. Leaving the area is possibly the next best answer but the supervisor may need to check on the manager earlier rather than later. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 20) When driving toward a meeting, the nursing supervisor gets a call explaining the meeting is to be delayed for an hour. Which indicates an activity this supervisor could undertake to keep from wasting this time? 1. Listening to MP3s while waiting for the meeting to start 2. Reading minutes from the last meeting to refresh the memory 3. Driving to the closest store and get donuts to share with everyone 4. Using the phone to make phone calls Answer: 2 2. Using the hour to refresh memories from the last meeting is the most productive use of the time. Listening to music is relaxing but could be wasting time that could otherwise be used to prepare for the meeting. Donuts are nice but no one needs them so this would be a waste of time. Using the phone could possibly be a waste of time since the option does not state whether these calls are business or personal. 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