Test Bank For Nursing Today: Transition And Trends 11th Edition By Joann Zerwekh, Ashley, Exams of Nursing

Download Test Bank For Nursing Today: Transition And Trends 11th Edition By Joann Zerwekh, Ashley and more Exams Nursing in PDF only on Docsity! Test Bank For Nursing Today: Transition And Trends 11th Edition By Joann Zerwekh, Ashley Garneau 1. What is the most consistent concern of the nurse as manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals - ANSWER ANS: B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates in not a role of the nurse manager, but instead it is directing or supervising them to achieve patient care needs. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing definition MSC: NCLEX®: Safe and effective care environment—management of care 2. What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans. - ANSWER ANS: C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Safe and effective care environment—management of care 3. What do the responsibilities of the nurse manager include? a. Planning and organizing how nursing care can most effectively be delivered on the nursing unit b. Establishing the nursing care standards to be implemented on the unit c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures - ANSWER ANS: A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option. PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210 PTS: 1 DIF: Cognitive Level: Application REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Nursing management MSC: NCLEX®: Not applicable 7. A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. c. Set the objective. b. Identify and evaluate options. d. Implement the options. - ANSWER ANS: C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome. PTS: 1 DIF: Cognitive Level: Application REF: p. 226 OBJ: Use the decision-making process in clinical situations. TOP: Nursing management MSC: NCLEX®: Not applicable 8. Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? The process a. "increases the time spent discussing alternatives." b. "eliminates opposition to decisions by administrators." c. "allows additional time for the planning process." d. "promotes acceptance of the decision by the group." - ANSWER ANS: D When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by administration, but when the group makes a decision, it may be easier to deal with administrative opposition. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Identify characteristics of effective work groups. TOP: Nursing management MSC: NCLEX®: Not applicable 9. A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power c. Use of expert power b. Use of coercive power d. Use of legitimate power - ANSWER ANS: C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from fear of consequences. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational c. Reward b. Legitimate d. Expert - ANSWER ANS: D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 11. The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Authoritarian c. Laissez-faire b. Democratic d. Eclectic - ANSWER ANS: A The authoritarian style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style. reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 15. A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients. b. Discuss concerns with fellow nurses. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better. - ANSWER ANS: C The nurse needs to shift into the moving phase, which incorporates taking the lead by being responsible and willing to implement change by sorting out what must be done and by facilitating an appropriate and effective approach. Whenever one is not happy with a situation or procedure, it is important that providing suggestions for change be incorporated into the process. Discussing concerns with fellow nurses does not actively involve the change process. For change to be effective, it must have "buy-in" from other staff and not merely inform the staff or change nurse of how there is a better way to administer the medications on the unit. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable 16. A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing. - ANSWER ANS: C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable 17. If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed. - ANSWER ANS: D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable 18. What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing work force? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes - ANSWER ANS: A Members of generations X and Y are more independent and place higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places high value on loyalty, discipline, teamwork, and respect for authority. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 218 OBJ: Identify distinguishing generational characteristics of today's workforce. TOP: Generations X and Y MSC: NCLEX®: Not applicable 19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? The nurse manager has a duty to implement and mandate interventions to reduce infection rates for her unit. Providing a mandatory handwashing in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the handwashing in-service program. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Safe and effective care environment 23. Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning - ANSWER ANS: B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez- faire management style. Emphasizing effective group functioning is common for a democratic management style. PTS: 1 DIF: Cognitive Level: Application REF: p. 211 OBJ: Differentiate the concepts of power and authority. TOP: Management versus leadership MSC: NCLEX®: Not applicable 24. The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. c. Evaluate possible solutions. b. Identify the problem. d. Choose a solution. - ANSWER ANS: B The most critical step in the problem solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem has been identified. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Management problem solving MSC: NCLEX®: Not applicable 25. Which action by the nurse indicates placement in the unfreezing phase of Lewin's Change Theory? a. The nurse reconsiders what has caused themself to be resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent. - ANSWER ANS: A Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life. PTS: 1 DIF: Cognitive Level: Application REF: p. 230 OBJ: Discuss the change process. TOP: The challenge of change MSC: NCLEX®: Not applicable 1. Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants in how to divide up patient care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive e. Assume control of the guidelines for how hourly rounding will work on the unit - ANSWER ANS: A, B, C, E Managers plan, direct, organize. and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable 2. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all that apply.) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies which may interfere with the work of the organization - ANSWER ANS: A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Management versus leadership. TOP: Differentiate between management and leadership MSC: NCLEX®: Not applicable 3. Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents Give the medication. b. Withhold the medication and chart why it was not given. c. Call the physician and question the order in light of the patient's history. d. Ask if the patient is allergic to aspirin. - ANSWER ANS: C The nurse should call the physician and question the medication order for aspirin based on the patient's history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient's allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding. 3. The nurse enters a patient's room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the situation. - ANSWER 3. The nurse enters a patient's room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the situation. 4. What is a correct statement regarding a nurse who acts beyond the scope of practice? a. Demonstrates what a good nurse he or she can be b. Provides enriched services to patients who would not otherwise receive them c. May make other nurses angry because of the increased expectations created d. May be disciplined by the board of nursing - ANSWER ANS: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse's ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice. 5. Which error in judgment would be the most serious for the nurse defendant in a legal case? Do nothing because the nurse cannot prove the child was abused. c. Report the situation to the appropriate authorities. d. Ignore what the child said because little children often lie. - ANSWER ANS: C States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult. 8. What would be the most effective way for a nurse to validate "informed consent?" a. Check the chart for a completed and signed consent form. b. Determine from the physician what was discussed with the patient. c. Ask the family whether the patient understands the procedure. d. Ask the patient what he or she understand regarding the procedure. - ANSWER ANS: D Asking the patient (not the family unless the patient is a minor child) what he or she understands regarding the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained. 9. What action might be taken on a nurse who commits an infraction of the Nurse Practice Act? a. The nurse is subject to discipline by a court of law. b. The nurse is subject to discipline by the state board of nursing. c. The nurse is subject to discipline by the local chapter of the state nurses association. d. The nurse is subject to discipline by the National League for Nursing. - ANSWER ANS: B The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. Some states control who may use the titles registered nurse (RN) and licensed practical nurse (LPN) or licensed vocational nurse (LVN). The Nurse Practice Act is regulated and enforced by the state board of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infarctions to the Nurse Practice Act. Only if the infarction is of a criminal nature will the state board of nursing refer the case to the local court of law. 10. The nurse understands "scope of nursing practice" when making which of the following statements? a. "The scope of nursing practice includes acts that permit some overlap between nursing and medicine." b. "The scope of nursing practice includes activities that are legally permissible for a nurse to perform in a particular state." c. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement, an incident report, or a written legal policy. 13. Which definition, given by the nurse indicates understanding of malpractice? a. "Malpractice is a criminal act committed against society." b. "Malpractice means doing something a reasonable person or nurse would not do." c. "Malpractice is an intentional professional act of negligence." d. "Malpractice is a professional act or failure to act that leads to injury of a patient." - ANSWER ANS: D Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another. PTS: 1 DIF: Cognitive Level: Application REF: p. 454 14. A nurse tells a patient, "If you don't stop getting out of that chair, I'm going to put some restraints on you." What may this nurse be accused of? a. False imprisonment c. Invasion of privacy b. Defamation d. Malpractice - ANSWER ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Use of restraints may also be interpreted as false imprisonment. False imprisonment means making someone wrongfully believe that they cannot leave a place. It is often associated with assault and battery claims. Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Malpractice is the improper performance of professional duties, a failure to meet the standards of care that results in harm to another person. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. Invasion of privacy applies to several behaviors, such as photographing a procedure and showing it without the patient's consent, going through a patient's belongings without consent, or talking about a patient's private life publicly. 15. During a malpractice suit, how can the standard of "what the wise and prudent nurse would do" best be established? a. From the testimony of an expert nurse b. By consulting with nursing faculty regarding standards of care c. Conferring with a lawyer regarding malpractice parameters d. By consulting the standards of The Joint Commissions - ANSWER ANS: A The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse—usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The Joint Commission standards may reflect on hospital policies and procedures, not the nurse's practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse Claims involving medication errors are augmented when the nurse fails to record the medication administration properly, fails to recognize side effects or contraindications, or fails to know a patient's allergies. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart 18. In a legal suit, what element is necessary to prove a tort has been committed? a. Intent c. Injury b. Assault d. Malpractice - ANSWER ANS: C There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. The nurse, as a defendant, does not have a "burden of proof." 19. What action must occur to prove a breach of duty? a. Liability testimony of physician b. Testimony from state board of nurses c. Expert testimony d. Testimony of coworkers - ANSWER ANS: C The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty. The state board of nursing provides the statues and laws that govern nursing practice. 20. What is a significant action a nurse can take to prevent being named in malpractice suits? a. Refuse to care for suit-prone patients. b. Carry professional liability insurance. c. Maintain updated professional knowledge and skills. d. Check with a nursing supervisor before undertaking care. - ANSWER ANS: C When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly. 21. A nurse places a heating pad on the lower leg of a patient with peripheral vascular disease. When the heating pad is removed, it is apparent that the patient has sustained partial-thickness burns to the area covered by the pad, and the nurse is sued for malpractice. Which statement is true? a. All elements are present to find the nurse liable for damages. "Nurse practice acts describe how and when to renew a nursing license." d. "Nurse practice acts provide a list of job openings." - ANSWER ANS: C Nurse practice acts are great resources that provide information to nurses, including how and when to renew a nursing license. The nurse practice acts do not describe how to prepare for the NCLEX exam or provide a list of job openings. 24. A nurse wants to avoid malpractice claims. What action can be taken to greatly reduce the risk of a lawsuit? a. Reduce work status to part time. b. Implement fall precautions on an older adult patient. c. Leave clutter on the floor in patient rooms. d. Leave the patient's bed in the highest position. - ANSWER ANS: B To protect themself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn't be named in a lawsuit. 25. A nurse has just administered a medication when suddenly realizing that more medication was given than was ordered. Which action should the nurse take? a. Call the patient's physician and report the error. b. Say nothing about the medication error and continue to monitor the patient. c. Document the dose that was supposed to be given in the medical record. d. Document the amount given in the medical record but keep the error quiet. - ANSWER ANS: A The nurse should call the physician and report the error after assessing the patient's condition. The nurse should never falsify a document in the medical record or keep the error to them self. 26. Which of the following would be considered a criminal action? a. A nurse who steals narcotics from the hospital b. A nurse who gets into a verbal disagreement with a visitor c. A nurse who restrains a patient who is considered a threat to himself d. A nurse who refuses to allow a visitor onto the unit who appears intoxicated - ANSWER ANS: A An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining a patient who has the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of a criminal action. 27. Which of the following can result in a civil action against the nurse? a. Failure to monitor b. Enforcing strict compliance with contact precautions against the family's wishes 1. Which actions take place in organizations to monitor quality improvement? (Select all that apply.) a. Evaluation of what nurses are doing for patients b. Development of policies and procedures c. Employee evaluations d. Intermittent monitoring e. Continuing education - ANSWER ANS: A, B, C, E There are many actions that take place in organizations to monitor quality improvement. These include evaluation of what nurses are doing for patients, development of policies and procedures, employee evaluations, ongoing monitoring, and continuing education. 2. A nurse is completing an incident report. The nurse demonstrates an adequate understanding of the report when refraining from putting which of the following on the form. (Select all that apply.) a. Conclusions about the incident b. The name of the patient c. Blame of others d. Judgment e. The nurse's opinion about what happened - ANSWER ANS: A, C, D, E The nurse should avoid putting conclusions, blame, judgment, and opinions on the incident report. The nurse should only relay facts. It would be appropriate for the nurse to list the patient's name. 3. The nurse has an adequate understanding of risk management when stating which of the following? (Select all that apply.) a. "Risk management becomes involved when incidents occur." b. "Risk management becomes involved when untoward events occur." c. "Risk management becomes involved to discipline the nurse." d. "Risk managers gather evidence surrounding the event." e. "Risk managers will interview those involved in an event." - ANSWER ANS: A, B, D, E Risk management becomes involved when incidents and untoward events occur. Risk managers gather evidence surrounding the event and interview those involved. Risk management does not become involved to discipline the nurse. Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs? a. "Health care expenditures are exceeding the cost of the gross domestic product (GDP) in excess of 14%." b. "Older adult patients consume more of the health care product than they can afford to finance." c. "The cost of prescription drugs is soaring so rapidly that the majority of people cannot afford them." d. "Because of the limited payment of Medicare, institutions are not being reimbursed at the same level of expenditures." - ANSWER ANS: A Health care expenditures consume more than 16% of the GDP—the amount of money being spent exceeds the amount of money recompensed. The older adult population contributes to this situation a. Projection of costs in the operating budget b. The amount of money allocated to meet expected costs c. Figures on which a zero-based budget were determined d. Planning needs for unit staffing based on patient acuity - ANSWER ANS: A The operating or budget costs are guidelines by which the nurse manager determines whether the unit has operated within allowable expenses. This is often called an expense or operating budget. The other options are not considered critical information that the nurse manager would need to consider when evaluating the report. The operating budget also includes all of the items necessary for care on the unit. These are called line items in a budget and include such things as supplies, telephones, small equipment (e.g., wheelchairs, nurse pagers, fax machines), postage, and copying costs. Some of these are variable costs—that is, costs that change with the volume of patients cared for in a year. Zero-based budgeting is the efficient allocation of resources because it is based on needs and benefits where all expenditures have to be approved. Which statement by the nurse shows understanding of the Rand Health Insurance Experiment? a. "When consumers were required to pay 25% co-payment, there was a considerable decline in the use of health care services." b. "There was an increase in the use of health care services when consumers were required to make a co-payment." c. "If the health care cost is being paid by insurance companies, the consumer is not concerned about the cost." d. "The implementation of the Oregon Health Policy for reimbursement of the cost of health care services led to the Rand Health Insurance Experiment." - ANSWER ANS: A Participants in the Rand study either received free care or paid co- payments of 25%, 50%, or 95%. Economic theory would predict that as price increases, the purchase of goods or services would decline. That is exactly what happened. With a co-payment of 25%, there was a decline in utilization of health care of 19% compared with a free plan. There were even greater declines in utilization of health care services at the higher rates of co-payments. What is the nurse's fiscal responsibility to the patient? a. To provide the best health care that the patient can afford b. To provide the best health care that the insurance company will allow c. To use the most cost-efficient resources to provide maximum health care to the patient d. To use the most efficient method of providing nursing care to patients whose resources are limited - ANSWER ANS: C The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. In clinical practice, fiscal responsibility does not relate to insurance or how the patient is paying for service. The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. Providing the best health care is about quality improvement. What is the most important way that a nurse can be fiscally responsible to the employing institution? a. By providing quality, safe nursing care b. By considering patient needs and prioritizing appropriately c. By accurately documenting the patient's condition d. By maintaining accurate charges for supplies used in patient care - ANSWER ANS: A Quality nursing care includes using fiscal resources wisely, but most important is the provision of quality nursing care—preventing falls, controlling the spread of infection, providing care to prevent complications, for example. All of these situations increase the length of stay for a patient and ultimately the costs of the institution. The other options are ways to be fiscally responsible but not the most important. Which statement is true about patient classification systems? a. The systems measure all the needs of patients. b. The systems provide an absolute formula for unit staffing. c. The systems should not be used to make patient care assignments because acuity systems are more accurate. d. The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget. - ANSWER ANS: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients. The case manager is educating the nurse about health care costs. The case manager knows that the education has been effective when the nurse states: a. "Health care costs are increasing because demand is decreasing." b. "Health care costs are steadily decreasing." c. "The aging population is requiring more health care services, causing the costs to increase." d. "The aging population is requiring less health care services, causing the costs to decrease." - ANSWER ANS: C The case manager would know that the teaching was effective if the nurse states: "Health care costs are continuing to increase because the aging population requires more health care services." The other statements are false regarding health care costs. The nurse has an adequate understanding of productive time when stating: a. "Productive time is the amount of time the nurse is available to give care to patients." b. "Productive time is the amount of time the nurse is attending a continuing education activity." c. "Productive time is counted when the nurse is not directly giving bedside care, such as going to lunch and taking a break." d. "Productive time is counted when the physician is at the patient's bedside." - ANSWER ANS: A The nurse has an adequate understanding of productive time when stating that "productive time is the amount of time the nurse is available to give care to patients." One work day (8 hours) is usually considered to be 7.5 productive hours. Nonproductive time reflects the amount of time that is not available for direct care, such as vacations, days off, holidays, continuing education, committee work, breaks, and lunch. Which of the following statements indicates the nurse's understanding of fiscal responsibility? a. "Fiscal responsibility should be a concern for all nurses." b. "Fiscal responsibility is only a concern for the department manager." c. "Fiscal responsibility is only a concern for the hospital administrators." d. "Fiscal responsibility is not a concern for the nursing staff." - ANSWER ANS: A The nurse has an adequate understanding of fiscal responsibility when stating: "Fiscal responsibility should be a concern for all nurses." Fiscal responsibility affects everyone in the health care system. The nurse, as well as the entire hospital staff and administration, needs to have an understanding of the costs of care. Which statement by the nurse is accurate regarding the current health care American's receive? a. "The distribution of services is efficient across the population." b. "The distribution of care is even across the population." c. "Access to care related to income is improving." d. "Many Americans receive care that causes harm." - ANSWER ANS: D The nurse with an adequate understanding of current health care would state that many Americans receive care that causes harm. The distribution of services is inefficient and uneven across the population, and access to care related to income is worsening. It is important for the nurse to understand strategies that promote a fiscally responsible clinical practice. From the following listing, select those strategies that would achieve a fiscally responsible clinical practice. (Select all that apply.) a. Completes charge slips or scans bar code of nursing supplies used when changing a surgical dressing b. Participates in the annual hospital fund-raising activity c. Visits the Centers for Medicare & Medicaid Services to understand what services are provided during an inpatient visit d. Immediately reports any development of a patient medical complication to the health care provider e. Volunteers to participate in a hospital program initiative to reduce central line associated bloodstream infection (CLABSI) f. Completes a patient's discharge plan on the morning of discharge - ANSWER ANS: A, C, D, E The following is a listing of strategies to promote a fiscally responsible clinical practice: • Provides quality nursing care that prevents complications and documents condition accurately • Makes conscious decisions about the allocation of professional nursing time • Understands Medicare and Medicaid insurance coverage • Engages in evidence-based practice and follows best practice guidelines • Shares information with patients and families about the costs of care and alternatives • Assigns assistive personnel (nurse aides, certified medical assistants) appropriately to help with care • Works with the members of other health care professions to promote fiscal responsibility for clinical practice • Begins discharge planning on admission; otherwise, if not available or prepared until the day of discharge, there may be confounding factors (lack of transportation) that require the patient to stay an additional hospital day • Completes charge slips for patient supplies if required (ANSWER A) • Avoids burnout by taking scheduled breaks, meal times, and vacations • Engages in safe clinical practice that will avoid personal injuries The participation in a fund-raising activity does not directly impact the clinical practice. It does build a sense of camaraderie among staff. Which action by the nurse demonstrates fiscal responsibility to the patient? (Select all that apply.) a. Discharging a patient home with prescriptions and no health insurance to cover the cost b. Assessing the patient's resources and determining their ability to pay for prescriptions c. Setting the patient up for Meals on Wheels d. Giving the patient information on free support groups e. Calling local churches to see what services they can offer the patient - ANSWER ANS: B, C, D, E The nurse demonstrates financial responsibility to the patient by assessing the patient's resources and determining the ability to pay for prescriptions, setting the patient up for Meals on Wheels, giving the patient information on free support groups, and calling local churches to see what services they can offer the patient. newborn, so they are meeting their nursing role; however, the conflict is based on an ethical issue about feeding and bonding. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 2. Of the following common areas of conflict between nurses and their patients and families, which does the nurse interpret as the most easily resolved? a. Issues of concern about quality of care b. Issues surrounding treatment decisions c. Issues of family involvement d. Issues about quality of parental care - ANSWER ANS: A Families typically are concerned with how well their loved one is being attended to. Conflict often arises out of concerns related to quality of care. Whereas this is something that the nurse can directly address, issues of treatment decisions, family involvement, and quality of parental care often require more discussion and intervention. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 3. What is the best strategy for resolving the conflict in a situation in which two staff nurses request the same vacation weeks? a. Accommodation c. Competition b. Collaboration d. Avoidance - ANSWER ANS: B Collaboration is the strategy that involves confrontation and problem solving. Needs, feelings, and desires of both parties are considered to create a win-win outcome. Avoidance is a lose-lose strategy for conflict resolution, which is unassertive and uncooperative. Competition is a win-lose situation in which the use of force or the use of power occurs. Accommodation is the lose-win situation in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 4. On the unit in which you work, one nurse's aide is usually pleasant and helpful; the other is often abrasive and angry. What is the most important basic guideline to be observed by a nurse who must resolve a conflict between the two nurse's aides? a. Deal with issues, not personalities. b. Require the aides to reach a compromise. c. Weigh the consequences of each possible solution. d. Encourage ventilation of anger and use humor to minimize the conflict. - ANSWER ANS: A Dealing with the issues and not the personalities is one of seven important key behaviors in managing conflict. Whereas issues tend to be more concrete, personalities involve emotional issues. Although weighing the consequences is one of the seven key behaviors, it does not apply to this situation which involves the behaviors of the nurse's aides. Asking parties to compromise may not always be the best approach in resolving the conflict. Although encouraging ventilation of anger and using humor are successful approaches, it is important to always deal with the issue at hand and not the personality of the person. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ: Discuss techniques to use in dealing with difficult people. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 5. One of your peers, a staff nurse, is a "potshot artist." This nurse often makes you the butt of innuendo or teasing digs. You are fed up and decide to take action the next time it happens. What strategy should be considered as an effective way of dealing with a "sniper?" a. Clam up and allow the individual to fully ventilate her concern. b. Confront and tell the individual he or she is wrong. c. Coldly withdraw from the individual. d. Obtain group confirmation or denial of criticism raised by the individual. - ANSWER ANS: D When confronting the sniper, it is important to involve the rest of the staff to get a group consensus of denial or confirmation. Remember to always expose the sniper's attack by saying, "That sounded like a put- down to me." Clams tend to withdraw from the individual. Confronting the individual and telling them they are wrong is how a Sherman tank would approach the situation because they have a strong need to be right. PTS: 1 DIF: Cognitive Level: Application REF: p. 294 OBJ: Discuss techniques to use in dealing with difficult people. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 9. During a staff meeting, an upset nursing assistant tells the group that the other nursing assistants are given easier patient assignments and are always given their choice of days off. What approach by the nurse manager would be effective to resolve this conflict? a. Attempt to persuade the upset nursing assistant to calm down. b. Tell the group that this type of conversation needs to be handled privately. c. Consider transferring the upset nursing assistant to another unit. d. Acknowledge the feelings of the upset nursing assistant and make a plan to meet with her. - ANSWER ANS: D Acknowledging the nursing assistant's feelings is the first step in conflict resolution. This process requires dealing with issues, not personalities, by communicating openly, listening actively to the complaints, sorting out the issues, identifying key themes of the discussion, and weighing the consequences and options to resolve the conflict. Transferring the upset person avoids dealing with the conflict. PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 10. Considering the following terms used to label different styles of handling anger—the Sherman tank, the sniper, the constant complainer, and the clam. Which of the following comments would you expect a Sherman tank to make? a. "That sure sounded like a put-down to me." b. "How dare you accuse me of not putting away the linen!" c. "So, you think you know everything, eh?" d. "Why do we always have to rotate shifts?" - ANSWER ANS: B Sherman tanks attack individuals and have a strong need to prove to themselves and to others that their view of a situation is right. Their comments are abusive and abrupt and can be intimidating. Snipers take "potshots" at others and are not as openly aggressive as Sherman tanks. Constant complainers do just that—they complain but offer no solution. Clams also behave like their name—they clam up and refuse to respond when you need an ANSWER or want to talk. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 292 OBJ: Discuss solutions and alternatives in dealing with anger. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 11. Which action by the nurse has a potential for creating role conflict? a. Arguing that the nurse on the next shift is responsible for weighing a patient b. Failing to discuss differences with a coworker the nurse is angry with c. Placing the nurse's personal achievement over that of coworkers d. Trying to change another nurse's personality - ANSWER ANS: A Arguing with another nurse about whose responsibility it is to weigh a patient is an example of a role conflict. Failing to discuss differences is a communication conflict. Placing personal achievements about those of others is goal conflict. Trying to change another nurse's personality is personality conflict. PTS: 1 DIF: Cognitive Level: Application REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Not applicable 12. Which of the following scenarios shows an ethical conflict? a. A nurse who consistently speaks poorly of another nurse for always being "grumpy" b. A nurse who has a hard time respecting 'no codes' on young patients c. A nurse who refuses to run a systems check on the glucometers because "it's night shift's duty" d. A nurse who forgets to alert family members to a change in visiting hours - ANSWER ANS: B A nurse who has a hard time respecting "no codes" on young patients is experiencing an ethical conflict. A nurse who speaks poorly of another nurse has a personality conflict. A nurse who refuses to run controls on a glucometer has a role conflict. A nurse who forgets to alert family members to a change in visiting hours has a communication conflict. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 13. A nurse is aware that an area of conflict between nurses and patient's families is quality of parental care. Which action would not help the nurse reduce conflict? a. Become frustrated with the parents for lack of participation in care b. Model positive parenting techniques c. Encourage parents to meet other parents d. Give out information about parenting classes - ANSWER ANS: A To reduce conflict that nurse can model positive parenting techniques, encourage parents to meet other parents and give out information about parenting classes. The nurse should avoid becoming frustrated with parents because this will likely cause conflict. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict longer occurs in the workplace," "sexual harassment is only caused by men," and "nothing can be done to prove sexual harassment" are false. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions. TOP: Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment 18. A female nurse is experiencing sexual harassment in the workplace by a male nurse. Which action should this nurse take to stop the sexual harassment? a. Ignore the comments made by the male nurse. b. Laugh about the comments. c. Tell the male nurse to stop. d. Begin to sexually harass the male nurse. - ANSWER ANS: C The nurse should take the most direct route and tell the male nurse to stop. Ignoring the comments, laughing at them, or sexually harassing the male nurse will not stop the harassment. PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions. TOP: Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment 1. What action(s) by the staff nurse is an effective way to deal with a sexual harassment issue in the workplace? (Select all that apply.) a. Tell the person to stop. b. Tell your best friend about the incident. c. File a formal grievance. d. Explain the situation to your spouse. e. Play along with the person and document the activities. f. Threaten the person with a sexual harassment lawsuit. - ANSWER ANS: A, B, C, D There are two ways to deal with sexual harassment workplace conflict, informally and formally through a grievance procedure. Start with the most direct measure. Ask the person to STOP! Tell the harasser in clear terms that the behavior makes you uncomfortable and that you want it to stop immediately. In addition, put your statement in writing to the person, keeping a copy for yourself. It is also important to tell other people (e.g., family members, friends, your personal physician, your minister) that this is happening and how you are dealing with it. PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 2. Which of the following are common factors of conflict encountered in nursing? (Select all that apply.) a. Ambiguous boundaries around work responsibilities b. Unclear communication to family members about visiting hours c. Nursing assistant placing personal achievement above everything d. Chief of medicine demanding that the nurse/patient ratio be increased e. Consideration of 26-week termination of pregnancy by a physician because of mother's health f. Vacation schedules posted with new staff members having to work at least one day during all holidays - ANSWER ANS: A, B, C, D, E, F All of these areas are potential factors that can precipitate conflict in a nursing situation—roles, communication, goals, personalities, and conflicting ethics and values. PTS: 1 DIF: Cognitive Level: Application REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 3. What is important for the nurse manager to understand about resolving conflict in the workplace? (Select all that apply.) a. Realize that most new graduates use competition as a form of conflict response. b. Effective role socialization reduces negative conflict behaviors among nursing staff. c. Use of collaboration to solve conflict issues is an important strategy to encourage. d. Thinking like a nurse promotes role socialization and reduces conflict. e. Nurse managers need to create working environments that facilitate professional practice. f. High self-esteem fosters entitlement-type behavior that promotes conflict. - ANSWER ANS: B, C, D, E New graduates use compromise and avoidance as primary means of conflict resolution based on current research. High self-esteem is often found in empowering workplace environments where successful positive conflict resolution occurs. Effective role socialization, positive professional practice environments, using collaboration, and thinking like a nurse are noted in effective conflict resolution situations. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 4. What are some positive results that can come from conflict? (Select all that apply.)