Nursing Leadership Exam Questions, Exams of Nursing

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Leadership Exam 3

1. The nursing leadership team within a medical center plans to initiate a change in their approach to improving patient satisfaction. Nurse Leaders recognize that communication about the new change will have a higher likelihood of being accurately interpreted if they use which one of the following strategies: - Use a variety of communication methods to convey a consistent message about the change.
   • Send a carefully worded letter to all nursing staff explaining the change.
   • Schedule staff meetings to announce the change. - Share the message with their nursing supervisors first and then ask each of them to discuss the change during their shifts with staff.
2. The RN team leader, near the end of her shift, notices that a newly hired UAP has not calculated the intake and output for several clients. Which of the following actions should the RN take first?
   • Notify the nurse manager.
   • Complete an incident report.
   • Delegate this task to the LVN on the team. - Ask the UAP if assistance is needed to complete the intake and output records.
3. A nurse manager calls dietary services to request a late tray for a patient and speaks with a dietary technician. This is an example of what kind of communication?
   • Vertical - Diagonal - Downward
   • Lateral
4. Two RNs on the unit are complaining that their patient assignment is too heavy. Each feels the other RN has a lighter workload. Each complains to the RN Charge nurse. The charge nurse asks them to please calm down and focus on their current patients' needs right now so that everyone can get through the difficult shift. Which of the following conflict resolution strategies is the charge nurse demonstrating?
   • Negotiating
   • Cooperating - Smoothing - Avoiding
5. Progressive discipline is a strategy used by mangers to deal with problem employees. Which of the following is the usual order of steps in a progressive discipline process?
   • Suspension, Verbal Warning, Written Warning, Dismissal
   • Verbal Warning, Suspension, Written Warning, Dismissal
   • Written Warning, Verbal Warning, Suspension, Dismissal - Verbal Warning, Written Warning, Suspension, Dismissal

6. In the Emergency Department (ED), staff share a staff break room area. One of the male emergency technicians posts a calendar with suggestive female pictures on it. A female RN is offended by the pictures on the calendar. What is the best course of action for the offended RN to take first:
   • Take down the calendar
   • Report the emergency technician to Human Resources for sexual harassment.
   • Tell the manager about the situation - Tell the emergency technician that she finds the pictures offensive and ask him to remove it.
7. An unlicensed assistive personnel (UAP) "suffers in silence" instead of speaking up about an unfair assignment to the charge RN. This is an example of which of the following communication styles?
   • Aggressive
   • Indirectly aggressive - Passive
   • Assertive
8. A UAP and a Unit Secretary have helped the nurse manager plan the holiday party for the past two years. They learn that other staff members are not happy with the party themes, locations and activities they planned for the last two holiday parties. As it is not that important for them to do, the two decide to let other interested staff members take over doing the holiday party planning this year. This UAP and the Unit Secretary are using which of the following conflict resolution strategies? - Accommodating
   • Competing - Smoothing
   • Collaborating
9. A quiet, passive nurse who hates conflict is not likely to use which one of the following conflict resolution strategies:
   • Avoiding
   • Compromising - Competing
   • Smoothing
10. A RN is caring for a 17 year-old client who is experiencing a relapse of leukemia and is very vocal in refusing treatment. The client's mother insists that her daughter receive continued IV chemotherapy as ordered. Which nursing action is most appropriate at this time?
    • Tell the daughter that she is sorry, but her mother has the legal right to give consent for her treatment.
    • Give the IV Chemotherapy to the daughter as ordered by the physician.
    • Administer a sedative first to calm the daughter; then start the chemotherapy. - Notify the charge nurse of the situation to get Bioethics Committee help in exploring options

11. Which intervention for a patient with a sudden pulmonary embolism could be delegated to the LPN/LVN on your patient care team?
    • Evaluate the patient's reports of chest pain
    • Monitor blood gas values for changes in oxygenation - Check/document vital signs, oxygen saturation (pulse oximetry), and the color of sputum
    • Assess for symptoms of respiratory failure
12. Which one of the following statements about assertive communication is correct?
    • It is most effective when the communicator uses "you" statements, rather than "I" statements, to prevent defensive responses.
    • It is a communication style that women of all cultures can use and always receive respect. - It allows expression in direct, honest, and nonthreatening ways that do not infringe upon the rights of others.
    • It is a culturally sensitive, empathetic communication style that people can use to always get what they want.
13. Which one of the following statements about conflict is true? - Inter-personal conflict can occur when there are value differences and unclear expectations between two or more people.
    • Teams members who are in the performing phase of team development are trying to establish ground rules for all members to follow during team meetings.
    • Intra-personal conflict can occur when there are differences in preferences and poor communications between groups of individuals.
    • Organizations that experience low levels of conflict are consistently viewed as highly creative and forward thinking organizations.
14. A nurse manager who consistently uses assertive communication knows that this communication style: - Is a style of communication that never offends people.
    • Makes you respect yourself and allows you to get what you want.
    • Although it is unfeminine, is a necessary communication skill for female managers. - Involves rights and responsibilities for all parties involved in the communication.
15. A registered nurse is planning the client assignments for the day. Which of the following is the most appropriate assignment for the certified nursing assistant?
    • A client requiring colostomy irrigation.
    • A client receiving continuous tube feedings. - A client requiring frequent re-orientation and assistance with ambulation.
    • A client having difficulty swallowing food and fluids.

16. A RN is planning care for four clients and is assigning tasks to a licensed practical nurse (LPN) and a certified nursing assistant (CNA). Which of the following is the most appropriate assignment for the LPN? - Administer an enteral feeding to a client who has a gastrostomy tube.
    • Complete an admission assessment for a client who has cellulitis of her right leg. - Measure I & O for a client with an indwelling urinary catheter.
    • Develop a plan of care for a client who has multiple pressure ulcers.
17. A RN in the telemetry unit is caring for a client who has a tracheostomy and is receiving frequent endotrachial suctioning. The client also has an indwelling catheter to gravity drainage and a central venous catheter, and is on anticoagulant therapy for thrombophlebitis of the left leg. Which one of the following specimens collections can the RN delegate to an unlicensed assistive personnel (UAP) to collect?
    • Blood culture - Stool sample for occult blood
    • Sputum culture
    • Arterial blood gas (ABG)
18. Which of the following organizations mandates the use of selected core measures to monitor patient outcome data for accreditation?
    • Centers for Disease Control
    • Institute of Medicine - The Joint Commission
    • Agency for Health Care Research and Quality
19. A nursing staff member comes into the nurse manager's office and complains about another staff member who does not complete his/her work. The nurse manager should tell the staff member to first:
    • Finish the work
    • Document the incident and give it to the manager
    • Come back to the manager's office with the other person - Talk to the other person
20. Instances for which a staff member needs to report an occurrence directly to a manager include which of the following: (select all that apply) - An RN is diverting drugs
    • A nurse sees a gun in another staff member's locker at work
    • A patient complains about the poor care received on the prior shift - A patient reports that a male LVN made a sexual advance toward her

21. A new graduate RN is speaking to the nurse manager about a schedule request. The nurse manager puts his arm around the new grad RN and whispers in her ear, "Let's talk about this over dinner at my place tonight, ok?" Which of the following is the appropriate response by the nurse? - "Stop. When you touch me and talk this way, I feel uncomfortable."
    • "Let's talk about something else."
    • "Uhhh No, that's not what I am here to discuss right now with you."
    • "No--Although that is an interesting offer, not tonight."
22. Which of the following is an example of a sentinel event? (Select all that apply)
    • A visitor slips on a wet floor area in the main lobby and has a bruised hip, but no other injuries - A patient develops third degree burns to 50% of his body during surgery due to an electrical fire.
    • A patient has a major allergic reaction to an antibiotic that he has never taken before. - A mental health patient hangs himself in a restroom on the mental health unit.
23. Which assignment should not be given to a licensed practical nurse? - Teaching a new diabetic patient how to manage low blood sugar symptoms
    • Inserting a Foley catheter
    • Discontinuing a nasogastric tube
    • Obtaining a sputum specimen from a patient with a tracheostomy
24. An RN witnessed a maintenance worker in a paralyzed and unconscious pediatric patient's room inappropriately touching the patient's genital area. What step of the disciplinary process is most likely to be taken by the organization against this worker?
    • Stern verbal reprimand
    • Final Written Warning
    • Suspension without pay - Termination
25. A nurse assigns a nursing assistant (NA) to provide care for a client who is at risk for falls. After delegating the most important aspects of the client's care, what question should the nurse ask the nursing assistant to ensure the client's safety?
    • "Did you write down my instructions?" - "Can you tell me the priority activities for this client's care?" - "Did you understand all my instructions?"
    • "Will you be able to care for this client carefully?"
26. When delegating tasks to staff, which action by the charge nurse best demonstrates appropriate delegation principles?
    • Give detailed instructions of how to perform all activities assigned
    • Obtain staff members' voluntary acceptance of assigned tasks
    • Work with the staff to improve their efficiency and competence. - Communicate the work assignment in a clear and concise manner

27. The hospital has been experiencing low census and staff are concerned about being laid off, even though everyone has been told they will be able to keep their jobs. The evening charge nurse reported to the nursing director, however, that his staff was discussing various rumors about mass layoffs. What is the best approach for nursing director to take?
    • Find out who started the rumor and correct the information.
    • Write a prepared message for all charge nurses to share during report. - Schedule meetings for all staff to discuss the issues and to tell them the rumor is not true.
    • Ignore the rumor because it will soon pass.
28. Which one of the following statements about conflict resolutions strategies is correct?
    • Smoothing is a win-win solution to maintain an ongoing and peaceful work environment.
    • In accommodation, each party gives up something to get something in return. - Compromising is a lose-lose solution that increases feelings of loss by individuals if they feel they have given up more than others in a negotiation. - Avoiding may be appropriate for minor conflicts when an issue is likely to work itself out over time.
29. Which statement about conflict is not true?
    • Conflict is neither good nor bad. It just depends on how it is managed.
    • Bullying occurs when an individual or group engages in repeated intimidating behavior that undermines another's self-confidence, creating stress.
    • Common causes of conflict include poor communication, unclear role expectations, and scarce resources and value differences. - In conflict resolution, getting to agreement is more important than trying to understand the needs of those involved in the conflict.
30. Which behavior is a priority to minimize an RN's risk for a malpractice claim?
    • Maintain positive nurse-patient relationships. - Function within the state's nursing practice act when delegating care activities to other nursing team members.
    • Maintain sufficient professional liability insurance to cover you if you are sued.
    • Ask for assistance from other RNs when engaged in high risk procedures.
31. Which of the following is true of a formal employee grievance process?
    • A formal grievance filed by an employee usually goes directly to a third-party mediator for resolution.
    • A grievance can only be filed if an employee has been clearly mistreated by management. - Usually an employee grievance follows a progressive lodging of complaints up the formal organizational chain of command.
    • A union contract usually does not spell out how an employee should file a grievance.

32. Which task cannot be delegated to an unlicensed assistive personnel (UAP):
    • Re-taping an NG tube to the patient's nose. - Assessing the quality of the drainage from the NG tube.
    • Documenting the amount of fluid draining from the NG tube.
    • Reorienting the confused patient with an NG tube.
33. An RN on a medical-surgical unit is making assignments at the beginning of the pm shift. Which of the following tasks would be appropriate for the RN to delegate to the LPN/LVN? - Obtain q 2 hour vital signs and pulse oximetry for a client who had an uncomplicated bronchoscopy this morning.
    • Develop and provide instructions to a client and his wife about home wound care management in anticipation of discharge tomorrow morning.
    • Establish a plan of nursing care for a newly admitted client with pneumonia.
    • Reassess/monitor a client who experienced flank pain and chills following transfusion of a unit of packed red blood cells four hours ago.
34. A new graduate RN approaches a more experienced RN and says, "I am having difficulty speaking up to some of physicians." Which one of the following initial responses by the experienced RN is best?
    • "I have some ideas to help you be more assertive with physicians." - "What factors are causing difficulty when speaking with some physicians?"
    • "Many other new graduates are finding ISBAR helpful when talking with physicians."
    • "Once you get to know many of our physicians, you will find that they are very nice people."
35. Your nurse manager has assigned you and several other unit RNs to meet and recommend to you a process for evaluating a new piece of equipment. Your group members have met several times already, but are getting nowhere on the assignment because people have differing opinions and won't listen to each other. Based on current behaviors of group members, what phase of the team communications process is your team going through right now?
    • Performing phase
    • Forming phase
    • Norming phase - Storming phase
36. A nurse manager is preparing to talk to her staff about quality improvement at a staff meeting. Which statement below is a correct statement to share with her staff about quality improvement?
    • Bar coding, smart pumps and medication reconciliation have not yet proven helpful in reducing medical errors. - Outcome audits are used to measure how care was delivered to patients. - Examples of nurse sensitive indicators that can be monitored include fall rates, incidence of urinary tract infections, and hospital acquired pressure ulcers.

• A root cause analysis is mainly conducted to determine who was at fault for a serious injury to a patient.

37. A nurse manager would like nursing staff members on the unit to become more involved in using evidence-based practice (EBP) in the care of patients. The nurse manager invites several nurses from a nearby Magnet Hospital to the next staff meeting to share how they are using EBP to decrease patient injuries related to falls. According to Lewin's Change Theory, the nurse manager is trying to stimulate what phase of the planned change process:

• Refreezing Phase
• Movement Phase - Unfreezing Phase
• Maintaining Phase

38. Periodically during the day the RN checks with his/her team members to determine whether they are having any difficulty completing their assigned tasks. This primarily describes which managerial role of the RN?

• Team member competency assessment - Effective delegation
• Patient safety evaluation - Quality control monitoring

39. During the change of shift, the oncoming charge RN notes a discrepancy in the number of morphine vials listed and the number present in the narcotic drawer. What should the charge RN do first?

• Notify the Director of Human Resources
• Notify the Pharmacy Director - Notify the Nursing Supervisor/Manager

40. A Nursing Supervisor is responsible for conducting performance appraisals on all of his unit's night shift employees. Which of the following would not be an appropriate action for the Nursing Supervisor when preparing and giving a performance appraisal to an employee?

• Conduct the appraisal in a private setting and allow adequate time for the employee to be relieved of other duties during the appraisal meeting. - Use mostly peer input when writing the employee's performance appraisal.
• Document observed employee behaviors over the entire time period covered by the performance appraisal.
• Compare the employee's performance against standards set forth in the employee's job description and other written job expectations.

41. Which statement below about the quality improvement process below is correct?

• Concurrent audits are conducted after the patient has been discharged. - Quality improvement includes measuring performance against a set of predetermined standards.
• A process indicator provides important information about the environment where care is provided, the supplies and equipment that are available for care.

• A quality gap is the difference between the highest performing health care organizations and the lowest performing organizations in the nation.

42. An RN asks a float unlicensed assistive personnel (UAP) to weigh the client with the bed scale. Which action should the RN take first?

• Check the California Nursing Practice Act to see if this activity can be delegated.
• Document in the client's medical record that he was weighed using a bed scale.
• Assist the unlicensed assistive personnel to weigh the client on the bed scale. - Talk to the UAP to determine if the UAP knows how to do the procedure correctly.

43. A staff RN is asked to participate with a team of other nurses on a continuous quality improvement (CQI) project to reduce the number of medication administration errors on her unit. Which step below should the CQI project team initiate first?

• Offer an in-service on medication administration to all the nurses.
• Have all the nurses take a medication administration examination.
• Develop a disciplinary policy for nurses who make medication errors. - Review events leading up to each medication administration error under review.

44. A registered nurse (RN) is planning the assignments for the day and is leading a team composed of a licensed practical nurse (LPN) and a nursing assistant (NA). The RN should assign which client to the LPN?

• Client with dementia. - A client who is one day post-mastectomy.
• A client who requires some assistance with ambulation.
• A client who requires some assistance with bathing.

45. Which of the following states that employees should not be discriminated based on physical or mental status.

• Age Discrimination Act - Americans with Disabilities Act
• Civil Rights Act
• Equal Pay Act

46. A member of the team reports that they have been given too much to do and are not going to be able to complete the work on time. What action will the RN take to effectively manage this situation?

• Assign the work to another team member
• Take on the responsibility of the tasks
• Have the team member perform only the necessary tasks - Examine the workload and assist the individual in reprioritizing

47. Which method best provides a structured orderly approach to communicating accurate, relevant information in emergent patient situations as well as routine handoffs?

• GRRRR listening model - SBAR tool
• Hospital Information System

• Wireless, local area networking

48. Which organization is actively engaged in clarifying the delegation parameters for RNs?

• American Hospital Association (AHA)
• The Federal Government
• National League for Nursing (NLN) - State Boards of Nursing Licensure

49. What is the first step the manager takes when a subordinate is having difficulty carrying out a delegated task?

• Take over the task so the employee will not become demoralized
• Reassign the employee a different, less complex task. - Be available to the employee as a role model and resource for the task
• Assign another more experienced employee to do the task

50. A RN smells alcohol on the breath of a float LVN who is working with patients on her team. There have been no staff or patient complaints about this person's behavior or appearance. Which action should the RN take first?

• Confront the LVN about her drinking and send her home.
• Document the details of the situation and leave the information for the nurse manager to handle in the morning.
• Send the LVN to the Emergency Department or Employee Health for an alcohol screening test. - Inform the nursing supervisor about the situation and ask him/her to observe the nurse's behavior.