Leadership Final test bank Study Guide Graded A

Leadership Final test bank Study Guide Graded A+ 1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020? a. Positions that historically required registered nurses will be filled by unlicensed personnel. b. The job growth rate for RNs will surpass job growth in all other occupations. c. The need for hospital nurses will dramatically decrease. d. Hospitals will finally achieve the required RN workforce. ANS: B In 2020 the United States is projected to have only 64% of the registered nursing workforce required to meet the demand for RNs. Unlicensed personnel will not be filling positions for nurses because this group does not have the education needed to provide such care. The need for hospital nurses will dramatically increase, not decrease. Hospitals will not have enough nurses as stated per statistics. DIF: Knowledge REF: Page 28 2. What effect did the movie One Flew Over the Cuckoo's Nest have on health care? a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care. b. The public and the nursing profession were made aware of the right of vulnerable populations. c. Nurses were seen as advocates for individuals who cannot advocate for themselves. d. Funding for nursing traineeships was eliminated. ANS: B One Flew Over the Cuckoo's Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected. The context for the care of patients with mental disability did not change as a One Flew Over the Cuckoo's Nest portrayed nurses as the enforcers of the system. Funding for nursing traineeships was not eliminated. Rather, the Nurse Training Act was established in 1964. DIF: Comprehension REF: Page 30 3. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War? a. Florence Nightingale b. Margaret Hoolihan c. Clara Maas d. Sairy Gamp ANS: C Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever. Florence Nightingale is the founder of professional nursing. Margaret Hoolihan is a character on a TV show, not an actual nurse. Sairy Gamp is a character in a Charles Dickens novel. DIF: Knowledge REF: Page 30 4. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier's head is an artistic representation of nurses who served in which war? a. World War I b. World War II c. Spanish-American War d. Vietnam War ANS: D This statue represents the caring provided by nurses during the Vietnam War. There is no statue that represents nursing during World War I. There is no statue that represents nursing during World War II. There is no statue that represents nursing during the Spanish-American War. DIF: Knowledge REF: Page 31 5. What is the purpose of the Nurse Reinvestment Act of 2002? a. Provides disability insurance to RNs who contract a life-threatening illness while on duty b. Funds public service announcements that promote unlicensed caregivers as an alternative to professional nurses c. Focuses on nurse retention and safety enhancement grants d. Provides pediatric nursing training grants ANS: C This act funded $20 million to provide nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This act does not provide disability insurance to RNs. These funds do not promote unlicensed caregivers as an alternative to professional nurses. This act provides for geriatric training grants, not pediatric training grants. DIF: Knowledge REF: Page 28 6. Potential nursing students are concerned about choosing a profession with job security and ask, "Because more people are choosing nursing, will I have a job in a few years?" The nurse answers, on the basis of the U.S. Bureau of Labor Statistics prediction, that by 2020, a. positions that have historically required RNs will be filled by foreign nurses. b. the total number of RNs will not meet the demand for the workforce number required. c. the need for hospital nurses will dramatically decrease. d. hospitals will finally achieve the required RN workforce. ANS: B According to the U.S. Bureau of Labor Statistics, the nursing profession is predicted to have only 64% of the RN workforce required to meet demands. The number of foreign nurses arriving in the United States is not sufficient to cure the shortage, and a large number of these nurses are unsuccessful on the NCLEX-RN®, resulting in an inability of foreign RNs to practice. More than half of all nurses practice in hospitals, and it has not been indicated that this will change. Even by 2020, it is projected that the United States will achieve only 64% of the needed nursing workforce. DIF: Comprehension REF: Page 28 7. Charles Dickens' character Sairy Gamp: a. portrayed nurses as trained professional individuals who put others before themselves. b. chose nursing because she had no other avenue for employment. c. was a prostitute who took advantage of sick old men. d. characterized nurses as being at the forefront of technology and autonomy. ANS: B Sairy Gamp endured nursing because of the lack of other opportunities. Sairy Gamp did not portray a professional image of nursing, but that of an untrained caregiver who profited from the sick and dying. Sairy Gamp was a nurse who used her position to take advantage of her patients. Dicken's portrayal of a nurse does not suggest that the nurse is at the forefront of technology and autonomy. DIF: Knowledge REF: Page 29 8. What does the Spirit of Nursing statue honor? a. Florence Nightingale's accomplishments in public health b. Edith Cavell's attempt to help the victims of the Tuskegee experiment seek treatment c. Clara Maas, who found the cure for yellow fever during WWII d. All military nurses for their bravery and compassion ANS: D The statue the Spirit of Nursing was created to honor all military nurses. The statue does not seek to honor Florence Nightingale. Nurse Rivers was the nurse who attempted to help the victims of the Tuskegee experiment. The statue does not honor Clara Maas, and Clara Maas did not find the cure for yellow fever. DIF: Knowledge REF: Page 29 9. Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of: a. nurses who can be promiscuous and still help doctors. b. the fact that caring is not as important as the desire to serve one's country. c. the ability of nurses to cope with the dreadfulness of war by using humor. d. the contributions of male military nurses. ANS: C The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting. M*A*S*H's portrayal of promiscuous nurses has no merit because nurses assist physicians. The sitcom addressed both factors as part of the nurse's role in the military. D: No male nurses were portrayed in the sitcom. DIF: Knowledge REF: Page 30 10. With the crisis in health care and the nursing shortage, why is the image of nursing still important? a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship. b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice. c. Nurses must present a unified image if they hope to ever move nursing to a profession. d. The dynamic state of today's health care requires nurses to move from a caring image to one of technologic competence. ANS: A A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient. Nursing has a unique body of knowledge. Nursing is a profession. Unification will enhance the professional goals for nursing. Caring will always be part of the nursing image and nurses have already moved into the technologic realm. DIF: Comprehension REF: Pages 29-30 11. Nurses can combat the nursing shortage by: a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce. b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination. c. working more hours with a higher nurse/patient ratio. d. advocating for funds to pay for nursing education and a safer work environment. ANS: D Advocating for funds to pay for nursing education and a safer work environment is a positive strategy as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise. Unions are not the answer to the nursing shortage. This approach would make access to health care more difficult, and the nursing shortage would only increase because efforts to attract nurses from younger generations would be reduced by the fact that funding for exposure to nursing would most likely decrease. Lowering standards would increase the chance for errors, cause patient care standards to become lower, and harm the image of nursing. As the acuity level of patients increases, the nurse/patient ratio should be lowered. Facts reveal that lower nurse/patient ratios reduce errors and decrease mortality rates. DIF: Application REF: Page 30 12. Today's demographics of the RN population indicate that: a. nurses entering the workforce do so within 2 years of completing high school. b. more white nurses enter and obtain graduate degrees than any other ethnic group. c. the highest level of nursing education for most RNs is an associate degree. d. the majority of nurses practice in hospitals. ANS: D 56% of nurses practice in hospitals. The youngest professionals, those with a BSN, enter at age 26. More African-Americans are entering graduate school. The highest level of nursing education is the baccalaureate degree. DIF: Comprehension REF: Page 34 13. The 2008 Gallop Poll ranked the four most ethical professionals in the following descending order: a. Firemen b. High school teachers c. Physicians d. Nurses e. Pharmacists a. A, B, C, D b. A, D, B, E c. E, D, C, B d. D, E, B, C ANS: D Only in 2001 did firemen rank higher than the other four professions. In the 2008 Gallop Poll nurses ranked first (84%); second, pharmacists (70%); third, high school teachers (65%); and fourth were physicians (64%). DIF: Comprehension REF: Page 33 MULTIPLE RESPONSE 1. According to current data related to the nursing shortage: (Select all that apply.) a. salaries of nurses are competitive with those of other professionals such as teachers. b. only 10.6% of nurses are minorities. c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases. d. over the next decade, more than half of RNs in the United States will retire. e. staff nurses are returning to school to obtain certificates to teach nursing. ANS: B, D Only 10% of nurses are minorities. Nurses are older, with a mean age of 46.8 years. Salaries are not a problem related to the nursing shortage. Most facilities are willing to increase salaries and benefits for nurses. It has not been documented that nurses are afraid of contracting a fatal disease. Nurses take precautions to reduce this risk. There is a shortage of nursing faculty, and graduate education is required rather than certificates to teach nursing. DIF: Knowledge REF: Page 34 2. A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (Select all that apply.) a. More RNs are educated to attain an associate degree than a baccalaureate degree or diploma. b. Because of the push to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings. c. The most popular advanced practice specialty is nurse anesthesia. d. White nurses are more likely to enter graduate school than nurses from other ethnic groups. e. Nursing represents the second largest health care professional group, second only to medical doctors. f. Job satisfaction is high among nurses, despite long hours, high nurse/patient ratios, and lower pay than is often earned by individuals with less education. g. Even with the popularity of nursing as a career, the nation faces a severe deficit of RNs now and even more so in the future. ANS: F, G A recent job satisfaction survey found that 78% of RNs were happy with their jobs. Increasing awareness of nursing as a profession has enhanced enrollment in nursing schools and has promoted interest among high school students Recipients of BSN degrees are younger and represent the largest graduating educational profile. More than half of all nurses practice in acute care hospitals. Nurse practitioners constitute the majority of advanced practice nurses (APRNs). Minority nurses are more likely to enter graduate school than white nurses. Nurses make up the largest group of health care professionals. DIF: Comprehension REF: Pages 28, 34 3. Which actions would result in a greater number of nurses entering and staying in practice, given today's state of nursing? (Select all that apply.) a. Determine why few African-American women enter graduate school. b. Provide incentives for minorities and men to enter nursing. c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. d. Survey nurses to determine why their job satisfaction is lower than that of other health care professions. e. Develop ad campaigns that target younger students. ANS: B, C, E Providing incentives for minorities and men to enter nursing speaks to the core of solutions to the nursing shortage. Obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs speaks to the core of solutions to the nursing shortage. Developing ad campaigns that target younger students speaks to the core of solutions to the nursing shortage. Determining why few African-American women enter graduate school would not result in a greater number of nurses entering and staying in practice. Job satisfaction among nurses is currently high. DIF: Comprehension REF: Pages 28, 33, 34 4. The Nurses of America's media campaign raised awareness of which aspects of nursing? (Select all that apply.) a. Nurses are expert clinicians. b. A higher nurse/patient ratio is needed. c. Nurses are invisible in the news media. d. Nurses are caring. e. Nurses are well paid. ANS: A, C The campaign was designed to convey to the public that nurses are expert clinicians. A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media. Lower nurse/patient ratios are needed. It was not a focus of the campaign to let the public know that nurses are caring. The campaign did not focus on the financial aspects of being a nurse. DIF: Comprehension REF: Page 32 Cherry: Contemporary Nursing, 5th Edition Chapter 06: Nursing Research and Evidence-Based Practice Test Bank MULTIPLE CHOICE 1. Institutional review boards determine whether research studies involving human subjects will: a. be published. b. add to the body of nursing knowledge. c. cause harm. d. receive funding. ANS: C The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. Research publication is not controlled by institutional review boards. Institutional review boards do not review the merit or significance of research to nursing knowledge. Institutional review boards do not award grants or allocate funds. DIF: Knowledge REF: Page 118 2. A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the "lived experience." These characteristics are consistent with the qualitative research method known as: a. grounded theory. b. ethnography. c. phenomenology. d. case study. ANS: C Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Grounded theory is a qualitative research design that is used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection, description, and analysis of data to develop a theory of cultural behavior. Case study is a method of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or other social unit. DIF: Application REF: Page 109 3. The use of research to guide nursing practice is called: a. utilization. b. dissemination. c. generalizability. d. analysis. ANS: A Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. Dissemination is defined as the spreading of information, generally through published reports or by word of mouth. Generalizability is when findings can be generalized from the sample to the entire population. Analysis is the second step or phase of the nursing process. DIF: Comprehension REF: Pages 110-111 4. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is: a. quasi-experimental. b. survey. c. case study. d. ethnography. ANS: B Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Quasi-experimental research design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. Case study designs are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled, broader studies. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection and description and analysis of data for the purpose of developing a theory of cultural behavior. DIF: Analysis REF: Page 108 5. Which organization provides federal funding for research? a. National Institute of Nursing Research b. Robert Wood Johnson Foundation c. W.K. Kellogg Foundation d. Sigma Theta Tau International ANS: A The National Institute of Nursing Research is a federal agency that provides federal funding for health care research. Robert Wood Johnson is a private foundation. W.K. Kellogg Foundation is also a private foundation. Sigma Theta Tau International is a nursing organization. DIF: Knowledge REF: Page 105 6. Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative ANS: C Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. Descriptive statistics consists of numerical data. Inferential statistics consists of numerical data. Quantitative research is a formal, objective, systematic process in which numerical data are used. DIF: Comprehension REF: Page 108 7. A nurse researcher who is seeking funding for a study should identify: a. board members of funding agencies. b. priorities of funding agencies. c. budgets of funding agencies. d. accreditation of funding agencies. ANS: B The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. Identifying the board members of funding agencies would give you information about the agencies, but would not be helpful in the preparation of a study proposal. Learning the budgets of funding agencies would provide descriptive information about the agencies but would not be helpful in the preparation of a study proposal. Identifying the accreditation of funding agencies would give you descriptive information about the agencies but would not be helpful in the preparation of a study proposal. DIF: Application REF: Page 105 8. A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is: a. a survey b. quasi-experimental. c. a needs assessment method. d. a pilot study. ANS: C A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; commonly used to prioritize the needs of an organization or community. A survey is a research design that is used to collect demographic information, social characteristics, behavioral patterns, and other information. Quasi-experimental research is a type of quantitative research that lacks one of the components of an experimental design. A pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study. DIF: Analysis REF: Page 109 9. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a _________ design. a. experimental b. quasi-experimental c. survey d. meta-analysis ANS: B In quasi-experimental studies a control group, randomization, or the manipulation of one or more variables is missing. An experimental design must have a control group. The purpose of a survey design is to collect information, not to compare groups. A meta-analysis is a process whereby multiple research studies are reviewed. DIF: Application REF: Page 109 10. A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation ANS: B Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Case study design is a type of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or social unit. Hypothesis generation is the first step in the basic research process. DIF: Analysis REF: Page 109 11. Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena. ANS: D Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. Qualitative research is time consuming and costly. One-on-one interviewing takes time, and the interviews must be recorded, typed, transcribed, and analyzed. Qualitative studies use small sample sizes that are not randomly selected. The small sample sizes used in qualitative research do not allow results to be generalizable to the whole population. DIF: Analysis REF: Page 108 12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey ANS: C Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. The quasi-experimental method is research involving one study. Secondary analysis is the use of data from a previous study in which new questions are asked. A survey collects data from populations and is a single study. DIF: Analysis REF: Page 109 MULTIPLE RESPONSE 1. The informed consent must include: (Select all that apply.) a. potential risks and benefits to participants in the study. b. medical terminology rather than lay terms to prevent misunderstanding of the study. c. a statement on how the anonymity and confidentiality of participants are protected. d. the cost of the study. e. details on how to contact the investigator. ANS: A, C, E Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment, along with specific information on how to contact the investigator. The informed consent must include specific information on how to contact the investigator. Informed consent is always written in lay terminology so that participants can clearly understand. The actual cost of the study is not included on the informed consent form. DIF: Comprehension REF: Page 118 2. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (Select all that apply.) a. Survey b. Triangulation c. Meta-analysis d. State of the science summary e. Quasi-experimental design ANS: C, D Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic. Survey research design is used to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population. Triangulation is defined as the use of a variety of methods to collect data on the same concept. Quasi-experimental design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. DIF: Analysis REF: Page 109 3. A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which study designs? (Select all that apply.) a. Survey b. Grounded theory c. Phenomenology d. Needs assessment e. Experimental ANS: A, D, E Surveys collect demographics, social characteristics, behavioral patterns, and information bases. Needs assessments are used to determine what is most beneficial to a aggregates. The experimental method establishes cause-and effect relationships while also testing relationships Grounded theory explores and describes a social process such as adjusting to a chronic illness. Phenomenology describes the "lived experience" of abstract experiences. DIF: Analysis REF: Pages 108-109 COMPLETION 1. Development and validation of the body of knowledge and foundation on which practice is based is ____________________. ANS: research Research refines and enhances new and existing knowledge and provides accountability for nursing practice. DIF: Knowledge REF: Page 103 Cherry: Contemporary Nursing, 5th Edition Chapter 16: Nursing Leadership and Management Test Bank MULTIPLE CHOICE 1. In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance ANS: A Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change. Move is incorrect because at this stage, the change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan. Refreeze is incorrect because at this stage the change is being integrated into the organization so that it becomes recognized as the status quo. The change agent must facilitate change by monitoring adherence to the new requirements. Acceptance is incorrect because acceptance and integration represent the final aspect of any change. DIF: Application REF: Page 357 2. In differentiating between a leader and a manager, a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization. ANS: C The terms leadership and management are used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes. Authority is the legitimate right to direct others that is given to a person by the organization through assignment to an authorized position such as a nurse manager. It is the nurse leader who has the ability to guide or influence, as well as to motivate and inspire, others on the team. Managers are assigned responsibility for accomplishing the goals of an organization. DIF: Comprehension REF: Pages 335-336 3. The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions. ANS: B The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation. Identifying the problem is a later step in the nursing and problem-solving processes. Considering the consequences is a later step in the nursing and problem-solving processes. Implementing interventions is a later step in the nursing and problem-solving processes. DIF: Comprehension REF: Page 355, Table 16-1 4. An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent ANS: A The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. Democratic is a leadership style that would not be effective in an emergency situation. Laissez-faire is a leadership style that would not be effective in an emergency situation. "Referent" refers to a type of power that comes from followers' identification with the leader and is not a leadership style. DIF: Application REF: Page 340, Box 16-3 5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? a. Rewards b. Coercion c. Expert d. Legitimate ANS: C Seven primary sources of power are known. Expert power is based on knowledge, skills, and information. Rewards power comes from the ability to reward others for complying; it may include such rewards as money, desired assignments, or recognition. Coercive power is based on fear of punishment or failure to comply. Legitimate power is based on holding an official position within the organization. DIF: Application REF: Pages 336-337 6. Managers who exhibit the authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward ANS: C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished. Informal power is not one of the seven primary sources of power; however, informal leaders may distribute a considerable amount of power among the workers, can influence the attitude of the group, and significantly affect the efficiency and effectiveness associated with workflow, goal setting, and problem solving. Expert power is based on knowledge, skills, and information. Rewards power results from the ability to reward others for complying and may include such rewards as money, desired assignments, or recognition. DIF: Application REF: Page 336; Box 16-3, page 340 7. The illustration below identifies which type of chart? a. Productivity b. Organizational c. Resource d. Staffing ANS: B An organizational chart is a visual picture of an organization that identifies lines of communication and authority. Productivity is the amount of output or work that is produced with a specific quantity of input or resources. Resources include personnel, time, and supplies needed to accomplish the goals of an organization. Staffing is the manpower needed to complete the work. DIF: Comprehension REF: Page 346 8. Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational ANS: A Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. Chaos is an organizational theory that attempts to account for complexity and randomness in organizations. Bureaucracy is part of the organizational theory that provides an understanding of authority within organizations. Organizational theory provides the framework for an understanding of leadership and management, and for an understanding of complex organizations. DIF: Application REF: Pages 337-338 9. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary ANS: A The transactional leader is concerned with the day-to-day operations of the facility. Situational theory has attempted to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables. The transformational leader is committed to organizational goals, has a vision, and is able to empower others with that vision. The contemporary theories attempt to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables. DIF: Application REF: Page 338, Box 16-1 10. According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Bureaucracy b. Closed systems c. Open systems d. Trait ANS: A Weber's concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization. There are two views: open and closed. Closed systems theory views the system as being totally independent of outside influence. Represents the systems theory of the organization. There are two views: open and closed. Open systems theory suggests that the organization is affected not only by internal change but also by external environmental changes that can have a direct or an indirect influence on the organization. Trait theory, which describes intrinsic traits of leaders, is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. DIF: Analysis REF: Page 341 11. A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal. ANS: D To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment. Thanking each employee for doing an excellent job lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. Establishing an "employee recognition award" lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. Waiting until the annual performance review to recognize accomplishments lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. DIF: Application REF: Pages 348-349 12. Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units ANS: D A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future. Determining that all nurses on the unit understand the current organizational philosophy is a form of current evaluation and analysis, and does not look toward the future. Evaluating the communication process between the pharmacy and the nursing departments is a form of current evaluation and analysis, and does not look toward the future. Monitoring data from the quality management initiative related to the last three orientation programs is a form of current evaluation and analysis, and does not look toward the future. DIF: Comprehension REF: Pages 344-345 13. A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication. ANS: D The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision making and change implementation processes, and should clearly communicate goals and work expectations to all staff members. The nurse manager would not gain the respect or trust of other nurses on the unit by excluding one of their peers from an activity. The nurse manager must make a sincere attempt to work with the nurse, whose clinical experience is valuable to the unit. A transfer request would be the last option after all other efforts to develop a working relationship with the staff nurse have been exhausted. The best way to work with this employee and gain the respect of other nurses on the unit is through open and direct communication. DIF: Analysis REF: Page 337 14. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate ANS: D The coordinator of the committee has an official position within the organizational committee. The CNL is not being threatened with punishment. Transformational is not a type of power. Laissez-fair is a type of management style, not a type of power. DIF: Application REF: Page 336 15. A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet their goal of "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic ANS: C Autocratic managers do not seek input from staff. Transactional leaders are involved in day-to-day operations rather than having a vision. The nurses are not looking to the leader as a resource for clinical advice. The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement. DIF: Application REF: Page 359 MULTIPLE RESPONSE 1. Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (Select all that apply.) a. serving on interdisciplinary care teams. b. being competent to work in several areas independently when dictated by patient census. c. attending a meeting to plan advanced training for unlicensed assistive personnel. d. evaluating outcomes of care that are reported to a standing committee. ANS: A, C, D The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. For RNs who are entering the workforce, being competent to work in several areas independently is not a realistic expectation. DIF: Application REF: Page 335 OTHER 1. Place the following five major management functions into correct sequential order. A. Staffing B. Directing C. Planning D. Controlling E. Organizing ANS: C, E, A, B, D Each of the management activities of planning, organizing, staffing, directing, and controlling come into play in the role of resource manager. The nurse must develop skills in the following ordered areas: Planning for the necessary resources (primarily staff and supplies) to manage the unit; planning serves as the basis for all other management functions; thus it comes first in sequential order. Organizing resources to meet identified goals; organizing identifies the numbers and types of staff needed to meet goals, thus must occur prior to staffing. Staffing appropriately as determined by patient needs and the budget plan; staff must be hired and in place prior to directing. Directing. After managers have planned what to do, organized how to do it, and staffed positions to do the work, they must direct personnel and activities to accomplish goals. Controlling is the final management function by which managers, through staffing and directing, ensure that employees accomplish planned goals within the established organizational structure. DIF: Analysis REF: Page 343 Cherry: Contemporary Nursing, 5th Edition Chapter 19: Effective Delegation and Supervision Test Bank MULTIPLE CHOICE 1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. nursing assistive personnel (NAP). d. all levels of staff, because the information is about the past and cannot change. ANS: A Only the RN can perform and sign the admission assessment, although some components such as vital signs may be delegated. The assessment must be completed and signed by the RN; however, some components may be delegated to the LPN/LVN. NAPs are not licensed, and only an RN can perform the initial assessment. The assessment includes present symptoms and treatments, as well as those reported from the past, and the RN must complete the initial patient assessment. DIF: Application REF: Page 416 2. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that: a. the role of the LPN/LVN is the same from state to state. b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN. ANS: C The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN. Each state determines the scope of practice of the LPN/LVN. Specific tasks and roles cannot be delegated except to another RN who has received the training required to perform the task or role. The purpose of The Joint Commission is to increase the safety and quality of care provided to consumers by providing voluntary accreditation that certifies that a hospital meets established standards. DIF: Application REF: Page 413 3. Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma. ANS: A The RN who is delegating must consider the following: (1) the delegatee's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task. Administration of an antiarrhythmic drug requires the skill of an RN to evaluate outcomes, especially when it is administered IV because of its fast rate of distribution. Only an RN can develop the patient's plan of care, although others may assist in updating information. The task of teaching is limited to RNs. DIF: Analysis REF: Pages 413-414, 418 4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Nursing assistive personnel (NAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring. ANS: A The patient's condition is not stable; therefore, the skills of an RN are required. The assessment expertise of an RN is needed because of the unstable nature of the patient's condition. Obtaining a baseline set of vital signs for an unstable patient would be considered high-risk delegation for a NAP. The patient's condition is very dynamic; assessments will have to be completed by the RN on admission and then as indicated by the stability of the patient. DIF: Application REF: Pages 416-417 5. A nurse is delegating to the newly hired nursing assistive personnel (NAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance ANS: D Right circumstance involves the delegation of tasks that do not require independent nursing judgments. Right supervision of delegation involves providing feedback to monitor how the process is working and to suggest improvements to the process. Right communication involves giving clear explanations about tasks and expected outcomes; information is provided about when the delegatee should report to the RN. Right person involves delegating to someone who is qualified and competent, and, because the NAP is a new hire, the RN cannot evaluate the competency level of the delegatee. DIF: Application REF: Page 419 6. A student nurse is concerned about delegation practices and wonders why hospitals employ nursing assistive personnel (NAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing simple, routine patient care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN. ANS: B The NAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice. The NAP and the LPN/LVN cannot supplement staffing when the RN is not available but can assume responsibility for tasks that are simple and routine and do not require adherence to the nursing process. An RN must oversee the care provided by NAPs and LPNs/LVNs in long-term care settings. Only RNs can provide patient teaching. DIF: Comprehension REF: Pages 410-411 7. An RN delegates to NAP the task of performing blood pressure checks for a group of patients on a nursing unit. The NAP accepts the task and is responsible for: a. delegating the task to another NAP if he or she does not have the time or skill to complete the task. b. keeping the RN informed of any abnormal blood pressure readings. c. calling the physician when the patient's vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive. ANS: B After accepting the assignment, the NAP is responsible for completing the task and reporting any patient concerns to the RN. The NAP cannot delegate to any member of the health care team; delegation is the responsibility of the RN. RNs are responsible and accountable for accepting physician orders. Dietary consults are independent nursing orders that only the RN can initiate. DIF: Application REF: Page 411 8. Which task is appropriate for the RN to delegate to the nursing assistive personnel (NAP), provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system. ANS: D Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation. Evaluation requires the expertise of the RN; assessing the gag response may prevent aspiration after surgery and is not within the scope of practice for NAP. Assisting a patient who is ambulating after surgery is not an appropriate task to delegate. An RN will have to assess the patient's tolerance and coordinate care on the basis of this assessment. Changing the tracheotomy cannula is a skill that requires critical thinking and carries a high risk for injury, making the task inappropriate for delegation. DIF: Analysis REF: Pages 417-418 9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit. ANS: C This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence. Supervision is always a required component of delegation. The RN does not know about the training and competencies of the LPN/LVN and has not yet developed a working relationship with this staff member. Initial supervision consists of oversight of a delegated task once a shift; however, this approach should be used when the RN knows the competencies of the LPN/LVN. DIF: Application REF: Page 421 10. An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen, and the RN states, "I will show you this time and you can show me the next time." c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube. d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home. ANS: C Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation. The RN should provide clear directions for assigned tasks, and this assignment falls within typical job duties for nursing assistive personnel (NAP). The RN received appropriate feedback and is providing directions and is demonstrating a skill for which the nursing assistive personnel (NAP) has not shown competency. Routine repetitive dressing changes are within the scope of practice for the LPN/LVN who has demonstrated competency for the skill. DIF: Application REF: Page 416 11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN's license be suspended. d. call the pharmacy and ask for replacement medications for the patients. ANS: B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervenes and identifies concerns with the LPN/LVN. Checking the patient's drug packages to ensure that the correct drugs were given is not proactive intervening for patient safety because an inappropriate medication would have already been given. The RN must intervene immediately to protect the patient but may later discuss with the nurse manager a plan of corrective action for the LPN/LVN. The first step is to stop the violation of the five rights of medication administration; consequently, medications will not have to be replaced. DIF: Analysis REF: Pages 423-424 12. Which statement related to delegation is correct? a. The practice of nursing assistive personnel (NAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and/or NAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for NAP. ANS: D Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice. Most state laws do not define practice for NAP. Nursing practice cannot be delegated; only tasks can be delegated. The RN must determine that tasks have been completed and were performed correctly. DIF: Knowledge REF: Pages 412-413 13. During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and nursing assistive personnel (NAPs) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. NAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies. ANS: D The state's nurse practice act is the deciding factor regarding what can legally be delegated. Although on-site training may increase the competency of the individual, legal rules of delegation remain with the state's nurse practice act. Accountability remains with the RN who delegated the task. NAPs are responsible for accepting tasks for which they are competent to perform, but accountability remains with the RN. DIF: Comprehension REF: Page 415 14. A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: a. query the stat