Test Bank Of Effective Leadership and Management in Nursing 8th Edition By Sullivan

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Effective Leadership and Management in Nursing 8th Edition By Sullivan

Sullivan, Effective Leadership and Management, 8/e
Chapter 6

Question 1

Type: MCSA

Which situation is an example of the overall goal of quality management in today’s health care activities?

  1. The nurse manager realizes a policy was ineffective in reducing incidents.
  2. The administrator walks around making a list of potential problems.
  3. The human resources department fires nonproductive employees.
  4. The nurse wipes up a spilled drink before clients are allowed to enter a room.

Correct Answer: 4

Rationale 1: The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive.

Rationale 2: The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past.

Rationale 3: The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive.

Rationale 4: The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 2

Type: MCSA

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?

  1. Benchmarking
  2. Outcome standard
  3. Indicator
  4. Process standard

Correct Answer: 1

Rationale 1: Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement.

Rationale 2: Standards are written statements that define a level of performance. An outcome standard involves the end results of care given.

Rationale 3: An indicator is a tool to measure the performance of structure, process, and outcome standards.

Rationale 4: Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 3

Type: MCSA

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?

  1. Continuous quality improvement (CQI)
  2. Total quality management (TQM)
  3. Plan, Do, Check, Act (PDCA cycle)
  4. Six Sigma

Correct Answer: 2

Rationale 1: CQI is the actual process, not the philosophy, used to improve quality and performance.

Rationale 2: TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement.

Rationale 3: The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy.

Rationale 4: Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 4

Type: MCSA

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement “Each client will have a written assessment and plan of care document within eight hours of admission” is an example of which component of quality management?

  1. Indicator
  2. Structure standard
  3. Benchmark
  4. Process standard

Correct Answer: 4

Rationale 1: An indicator is a tool used to measure the performance of a structure, process, or outcome standard.

Rationale 2: A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care.

Rationale 3: Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care.

Rationale 4: A process standard is a written statement that defines actual delivery of nursing care to a specific population.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 5

Type: MCMA

Which situation would be included in reporting for Joint Commission mandatory national patient safety goals?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The average wait time in the emergency department has increased by 5 minutes over last year’s average.
  2. A client is left waiting in the hallway because the transport person did not make contact with the client’s nurse.
  3. A nurse gives a medication by the wrong route.
  4. A client developed sepsis after insertion of a urinary catheter.
  5. Surgery is done on a client’s right eye instead of the left eye.

Correct Answer: 2,3,4,5

Rationale 1: Increased wait times are not included as a patient safety goal.

Rationale 2: Improving staff communication is one of the Joint Commission’s national patient safety goals.

Rationale 3: Using medications safely is one of the Joint Commission’s national patient safety goals.

Rationale 4: Preventing infection is one of the Joint Commission’s national patient safety goals.

Rationale 5: Preventing mistakes in surgery is one of the Joint Commission’s national patient safety goals.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

 

Question 6

Type: MCMA

Efforts to increase nurses’ use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “I’m not interested in this program.”
  2. “I don’t have time to finish everything I already have to do each shift.”
  3. “I don’t want to practice nursing just like everyone else.”
  4. “The library at our hospital doesn’t have many journals.”
  5. “If administration wanted us to use EBP, they would get us some more nurses to share the work.”

Correct Answer: 2,3,4,5

Rationale 1: Lack of interest on the part of nurses is not a reason EBP is not used.

Rationale 2: Lack of time is a barrier to using EBP that is consistent across settings.

Rationale 3: The need for autonomy over the nurse’s own practice can be a barrier to using EBP.

Rationale 4: Inability to find and assess evidence is a barrier to using EBP.

Rationale 5: Lack of support from administration is a barrier to using EBP.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

 

Question 7

Type: MCSA

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation?

  1. As a nonreportable incident
  2. As a medical-legal incident
  3. As client dissatisfaction with care
  4. As a medication error

Correct Answer: 2

Rationale 1: Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident.

Rationale 2: A medical-legal incident occurs when a client or family refuses treatment as ordered.

Rationale 3: When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed.

Rationale 4: A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 8

Type: MCSA

Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?

  1. Medication error
  2. Medical-legal incident
  3. Procedure complication
  4. This incident does not fall into a risk category.

Correct Answer: 3

Rationale 1: A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client.

Rationale 2: A medical-legal incident occurs when a client or family refuses treatment as ordered.

Rationale 3: Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication.

Rationale 4: Complications from diagnostic or treatment procedures are a high-risk area in health care and are reported as incidents.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 9

Type: MCSA

After shift change the nurse discovers that a client’s IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client’s medical record?

  1. IV heparin restarted. Physician notified. Client’s vital signs unchanged.
  2. IV heparin restarted at a rate to catch up dosage accidentally deleted.
  3. IV heparin turned off by previous shift. Restarted.
  4. IV heparin restarted and incident report completed.

Correct Answer: 1

Rationale 1: The documentation in the chart should be a statement of the facts as well as the client’s physical status after the incident.

Rationale 2: The words accidentally should not be used to document incidents.

Rationale 3: The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used.

Rationale 4: The fact that an incident report was completed should not be documented.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 10

Type: MCSA

The following documentation was entered in the client’s medical record: “The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied.” Which statement best describes this documentation?

  1. Appropriately written
  2. Inappropriate because it places blame on an individual
  3. Inappropriate because it does not include that the client’s family was notified
  4. Appropriately written because it only documents the facts

Correct Answer: 2

Rationale 1: Documentation in the chart following an incident should be a statement of the facts; no blame should be placed.

Rationale 2: The documentation is not appropriately written because it implies that someone was to blame for the incident.

Rationale 3: The documentation must indicate that the physician was notified, not that the client’s family was notified.

Rationale 4: The documentation is not appropriately written; no blame should be placed.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 11

Type: MCMA

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. A client’s hand is injured during an arterial blood gas draw.
  2. A client’s family is dissatisfied with the breakfast just served.
  3. A client leaves the hospital against medical advice (AMA).
  4. A client claims he is not ready to be discharged.
  5. The family does not want a client to be transferred from the intensive care unit (ICU).

Correct Answer: 1,3

Rationale 1: Any reaction or injury associated with a diagnostic test must be reported as an incident.

Rationale 2: The nurse manager can address the client’s expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed.

Rationale 3: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client’s medical condition.

Rationale 4: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client’s medical condition.

Rationale 5: The physician and health care team are responsible for deciding if the client should be transferred from the ICU, based on the client’s medical condition.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 12

Type: MCSA

Which statement reflects a characteristic common to all methods of quality management?

  1. Each method uses all staff members in the organization.
  2. None of the methods are designed to place blame on an individual.
  3. All methods provide clinical information.
  4. Most methods focus on cost containment.

Correct Answer: 2

Rationale 1: All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities.

Rationale 2: Quality management is not designed for the purpose of placing blame on an individual.

Rationale 3: Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement.

Rationale 4: The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 13

Type: MCSA

The director of quality improvement reports that the hospital will soon be using “dashboards” as part of the quality management process. How should the staff interpret this information?

  1. Surveyors are driving to clients’ homes to collect data on hospital visits.
  2. This electronic tool makes it easy to aggregate and display data.
  3. “Dashboard” is an acronym for the topics covered in client satisfaction surveys.
  4. The “dashboard” is a screen on the electronic medical record that can be accessed for quality improvement information.

Correct Answer: 2

Rationale 1: The “dashboards” in this scenario are not associated with automobiles.

Rationale 2: Dashboards are electronic tools that provide ease of access to real-time or retrospective data.

Rationale 3: Dashboard is not an acronym.

Rationale 4: Dashboards are not part of the electronic medical record.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

 

Question 14

Type: MCMA

In which ways can nurse managers reduce risks for the organization?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Investigating a complaint about nursing care from a client’s spouse
  2. Encouraging nurses to cut corners when possible
  3. Talking to physicians about ways to improve client care
  4. Keeping staff members on task throughout the workday
  5. Making sure staff members work minimal overtime

Correct Answer: 1,3,4,5

Rationale 1: By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint.

Rationale 2: Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous.

Rationale 3: The nurse manager is in a position to discuss improvement of client care across disciplines.

Rationale 4: The nurse manager can help make work more efficient by keeping staff members on task throughout the workday.

Rationale 5: When staff members are tired from working overtime, they are more likely to make errors.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 15

Type: MCSA

Which part of Six Sigma is vastly different from other quality management programs?

  1. Six Sigma has a client focus.
  2. Data drive the program.
  3. Failure is tolerated.
  4. Management is proactive.

Correct Answer: 3

Rationale 1: Most quality improvement programs are client focused.

Rationale 2: Data drive most quality improvement programs.

Rationale 3: One of the Six Sigma themes is aiming for perfection but tolerating failure.

Rationale 4: Proactive management is common in most quality improvement initiatives.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 16

Type: MCMA

Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year.
  2. The number of nurses who hold a bachelor’s degree will increase by 10 percent this year.
  3. Wait times in the emergency department will decrease by 15 percent this year.
  4. Employee absences will drop by 10 percent this year.
  5. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.

Correct Answer: 1,3,5

Rationale 1: No waste is an IHI goal.

Rationale 2: Increasing the educational preparation of nurses is not an IHI goal.

Rationale 3: No unwanted waiting is an IHI goal.

Rationale 4: Employee attendance is not an IHI goal.

Rationale 5: No needless pain or suffering is an IHI goal.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

 

Question 17

Type: MCSA

The nurse manager orienting newly hired nurses has explained the organization’s blame-free environment. Which remark by one of the nurses indicates understanding of the policy?

  1. “If I make a mistake and report it, I will not be reprimanded or punished.”
  2. “When I make a mistake, I should immediately fill out an incident report.”
  3. “It is left up to each employee to self-monitor so we do not report others’ mistakes.”
  4. “When I make a mistake, I should report it and look for ways to prevent it from recurring.”

Correct Answer: 4

Rationale 1: If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken.

Rationale 2: Incident reports are not the first step after making a mistake.

Rationale 3: Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment.

Rationale 4: Mistakes should be reported and reflected upon so that the same mistakes will not be made again.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-5: Discuss how to create a blame-free environment.

 

Question 18

Type: MCMA

Which situation represents an exception to the blame-free environment?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. A nurse routinely changes nursing notes after a client is discharged.
  2. A physician order is overlooked on a newly admitted client.
  3. An unlicensed assistant drops a client.
  4. A nurse does not complete an incident report after a medication error.
  5. A nurse miscounts narcotics.

Correct Answer: 1,4

Rationale 1: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis.

Rationale 2: Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error.

Rationale 3: Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors.

Rationale 4: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors.

Rationale 5: Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-5: Discuss how to create a blame-free environment.

 

Question 19

Type: MCSA

Which is the most effective method of creating a blame-free environment?

  1. Work to develop a just culture within the organization.
  2. Make sure all nurses agree to report every mistake.
  3. Set up a self-reporting board so that all employees will know that everyone makes mistakes.
  4. Ensure nurse managers keep a list of how often each employee makes a mistake.

Correct Answer: 1

Rationale 1: A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution.

Rationale 2: Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free.

Rationale 3: A self-reporting board is a form of punishment and placing blame.

Rationale 4: The manager should not be keeping lists in a blame-free environment.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5: Discuss how to create a blame-free environment.

 

Question 20

Type: MCSA

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?

  1. Discuss it with the other nurses on duty.
  2. Immediately report the incident to the supervisor.
  3. Ensure the client’s safety as fully as possible.
  4. Say nothing as no one saw the incident.

Correct Answer: 3

Rationale 1: It is not appropriate to discuss errors with others.

Rationale 2: Reporting the incident to the supervisor is appropriate only after the client’s safety is protected.

Rationale 3: The client’s safety is always the priority.

Rationale 4: Ignoring the mistake if no one saw it is not ethical and may be dangerous.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5: Discuss how to create a blame-free environment.

 

Question 21

Type: MCMA

A nurse manager is orienting newly hired staff nurses to the organization’s total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization’s internal customers. Which group would the nurses interview?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Newly hired radiology technicians
  2. People who are visiting clients admitted within the last 2 days
  3. Physicians who have admitting privileges
  4. Nurses who have worked at the facility over 5 years
  5. Vendors who supply disposable medical equipment to the hospital

Correct Answer: 1,4

Rationale 1: Internal customers include employees and departments within the organization.

Rationale 2: Visitors are considered external customers.

Rationale 3: Physicians are considered external customers.

Rationale 4: Nurses are hospital employees and are therefore considered internal customers.

Rationale 5: Vendors are not employed by the hospital and are considered external customers.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 22

Type: MCMA

The procedures for managing client pain are being investigated as part of the hospital’s total quality management program. Whom should the manager plan to invite to this meeting?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The hospital CEO
  2. A representative from pharmacy
  3. A representative from the medical staff
  4. A staff nurse who works with clients in pain
  5. A representative from social services

Correct Answer: 2,3,4

Rationale 1: The CEO is not involved in the process of managing clients’ pain and would not be part of this investigation.

Rationale 2: As pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting.

Rationale 3: As the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting.

Rationale 4: The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group.

Rationale 5: It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 23

Type: MCMA

The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The CQI coordinator
  2. The hospital CEO
  3. The vice president in charge of finance
  4. Members of the CQI team
  5. The team leader

Correct Answer: 2,3

Rationale 1: The CQI coordinator is appointed by a member of the resource group.

Rationale 2: The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI.

Rationale 3: The resource group is made up of senior management such as the CEO and vice presidents.

Rationale 4: Team members are not part of the resource group.

Rationale 5: The team leader is not a part of the resource group.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 24

Type: MCSA

Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?

  1. Eighty-five percent of call lights are answered within 4 minutes.
  2. Results of pain medication administration are documented 95 percent of the time.
  3. Nursing overtime hours increased by 25 percent in the last quarter.
  4. In the last 6 months, overall client satisfaction scores have increased by 15 percent.

Correct Answer: 3

Rationale 1: Lean Six Sigma is focused on improving process flow and eliminating waste.

Rationale 2: Lean Six Sigma is focused on improving process flow and eliminating waste.

Rationale 3: Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur.

Rationale 4: Lean Six Sigma focuses on reducing waste.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

 

Question 25

Type: MCMA

The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The CQI coordinator has read two research studies that show the process improves client outcomes.
  2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay.
  3. The CQI coordinator has used the process in practice for over 2 years.
  4. The process being measured produces a desirable outcome.
  5. There are very few unexpected bad effects from the process.

Correct Answer: 1,2,4,5

Rationale 1: The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation.

Rationale 2: Quality measures should document that evidence-based practice was given.

Rationale 3: Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure.

Rationale 4: The monitor is written in the “positive,” meaning that the process is desirable.

Rationale 5: The process should have minimal or no unintended adverse effects.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

 

Question 26

Type: MCSA

Which statement reveals the most dangerous result of using measured standards as part of the CQI process?

  1. A nurse complains, “Collecting this data takes so much time.”
  2. A radiology technician says, “CQI is lots of work.”
  3. A nurse manager says, “I’m not going to change this process, because I’d have to change the CQI monitors.”
  4. The laboratory technician says, “Writing these CQI reports is boring.”

Correct Answer: 3

Rationale 1: Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given.

Rationale 2: The work of CQI should be balanced out by the improvements to care and reduction in waste.

Rationale 3: When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization.

Rationale 4: Boredom is not the biggest danger of using measured standards.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

 

Question 27

Type: MCMA

A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices?
  2. Can the manager find two or more research studies that support the use of the intervention?
  3. Is the intervention one that the manager has seen used in the past?
  4. Are the authors of the research articles well-known experts in the field?
  5. Is the research study that recommends the intervention rigorous in design and execution?

Correct Answer: 2,5

Rationale 1: The size of the hospital is not significant in selecting evidence-based practice interventions.

Rationale 2: Evidence-based practice is most reliable when more than one study has confirmed the results.

Rationale 3: Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them.

Rationale 4: While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field.

Rationale 5: The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

 

Question 28

Type: MCSA

Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?

  1. EMR has strong linkage to improving quality.
  2. Much more research must be done before the impact of EMR on quality can be determined.
  3. EMR does not affect the quality of care provided.
  4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated.

Correct Answer: 2

Rationale 1: There is not enough research to prove a strong linkage.

Rationale 2: There is not enough research on using EMR and the quality of care provided to determine the impact.

Rationale 3: Not enough research has been done to make this statement.

Rationale 4: Research does exist, but it is insufficient to measure correlation.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

 

Question 29

Type: MCMA

A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The cost of providing care has decreased.
  2. There has been a decrease in client deaths.
  3. The average length-of-stay for clients has increased.
  4. The overall quality of care has increased.
  5. The nosocomial infection rate has dropped.

Correct Answer: 2,4,5

Rationale 1: Increasing RN-to-client ratio generally increases costs.

Rationale 2: Increasing RN-to-client ratio has been shown to decrease client mortality.

Rationale 3: Increasing RN-to-client ratio generally decreases length of stay.

Rationale 4: Increasing RN-to-client ratio generally increases quality of care.

Rationale 5: Increasing RN-to-client ratio generally results in few infections.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

Question 30

Type: MCMA

A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. There is disagreement over the cause of the incident.
  2. There are insufficient resources to make needed changes to prevent similar incidents.
  3. The system or process causing the incident is identified and corrected.
  4. Improvements to the system are widespread.
  5. Sufficient evidence is acquired so that management is comfortable in making needed changes.

Correct Answer: 1,2

Rationale 1: Professional disagreements often occur as root cause analysis is being conducted.

Rationale 2: Often the root cause analysis takes up so much time and so many resources that no changes are ever made.

Rationale 3: Root cause analysis generally looks for the “sharp end” or the person who made the error, rather than looking for the system or process that allowed the error to occur.

Rationale 4: Root cause analysis generally does not result in widespread system improvement.

Rationale 5: Root cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5: Discuss how to create a blame-free environment.

 

Question 31

Type: MCSA

The daughter of a hospitalized client comes to the nurse manager’s office with a complaint about the care provided on the previous shift. What is the manager’s first action?

  1. Call the nurse from the last shift to participate in a conference call about the complaint.
  2. Ask the daughter to explain what happened.
  3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred.
  4. Ask the daughter what can be done to improve the situation.

Correct Answer: 2

Rationale 1: The manager should collect more information before contacting the nurse from the previous shift.

Rationale 2: The nurse manager must first assess the situation.

Rationale 3: The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter’s concerns.

Rationale 4: Until the manager has assessed the issue, intervention cannot be provided.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

 

 

Sullivan, Effective Leadership and Management, 8/e
Chapter 7

Question 1

Type: MCSA

Which statement reflects the most important use of power in nursing?

  1. The nurse manager uses power when evaluating staff.
  2. The nurse can use power to impact and improve client care.
  3. The nurse uses power in relationships with unlicensed personnel.
  4. The nurse manager can use power to assist newly licensed nurses.

Correct Answer: 2

Rationale 1: Using power to evaluate staff is not its most important use.

Rationale 2: The most important use of power is to impact the quality of client care.

Rationale 3: The nurse can use power in relationships with unlicensed personnel, but this is not the most important use of power.

Rationale 4: Using power to assist newly licensed nurses is not the most important way it is used.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-2: Describe how power is used.

 

Question 2

Type: MCSA

There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using?

  1. Legitimate power
  2. Expert power
  3. Referent power
  4. Reward power

Correct Answer: 4

Rationale 1: Legitimate power is the authority to make a request of staff.

Rationale 2: Expert power is based on a manager having unique skills or knowledge.

Rationale 3: Referent power is based on the employees’ respect for a manager. They comply with requests out of respect for the manager.

Rationale 4: Reward power is based on the inducements a manager can offer a staff. In this case the manager can offer increased benefits.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-1: Define power.

 

Question 3

Type: MCSA

The local hospital has recently been acquired by a larger hospital corporation. The nurse manager encourages staff to attend the next unit meeting by hanging a poster announcing that the new wage scale and benefits package will be discussed. This is an example of which type of power?

  1. Referent power
  2. Information power
  3. Legitimate power
  4. Connection power

Correct Answer: 2

Rationale 1: Referent power is based on admiration and respect for an individual.

Rationale 2: The nurse manager possesses information that employees desire. The only means of getting the information is through the manager, so the manager has information power.

Rationale 3: Legitimate power stems from the manager’s right to make a request based on the authority associated with the job.

Rationale 4: Connection power is based on an individual’s formal and informal links to influential or prestigious persons.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-1: Define power.

 

Question 4

Type: MCSA

One of the nurses often fails to attend educational offerings available to the staff. The nurse manager who implies the nurse may receive a negative evaluation is using which type of power?

  1. Coercive power
  2. Information power
  3. Referent power
  4. Reward power

Correct Answer: 1

Rationale 1: Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty.

Rationale 2: Information power is based on information a manager has and employees want.

Rationale 3: Referent power is based on the respect the followers have for the manager.

Rationale 4: Reward power is based on the inducements a manager can give to the employees.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-1: Define power.

 

Question 5

Type: MCMA

Leaders and managers often exercise power differently. Select the powers most frequently used by leaders.

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Reward power
  2. Information power
  3. Legitimate power
  4. Expert power
  5. Referent power

Correct Answer: 2,4,5

Rationale 1: A leader may not have reward power unless the leader is also the manager. Leaders can be formal or informal.

Rationale 2: A leader may have information power.

Rationale 3: A leader may not have legitimate power unless the leader is also the manager. Leaders can be formal or informal.

Rationale 4: A leader may have expert power.

Rationale 5: A leader may have referent power.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-2: Describe how power is used.

 

Question 6

Type: MCSA

The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ?

  1. Administer behavioral warnings in public to alert other staff to the seriousness of the issue.
  2. Reduce punishments for noncompliance after the majority of staff members have complied.
  3. Wait at least 72 hours prior to responding to infractions so as to better control emotions during the meeting.
  4. Investigate to get the facts of potential infractions before responding to them.

Correct Answer: 4

Rationale 1: Behavioral warnings and punishments should always be done in private.

Rationale 2: Punishment for noncompliance should be fair and consistently applied.

Rationale 3: Infractions should be promptly addressed after the manager is certain of the facts.

Rationale 4: The manager should always investigate to get facts to avoid jumping to conclusions.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-2: Describe how power is used.

 

Question 7

Type: MCSA

As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit’s dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit’s disapproval?

  1. “Over 75 percent of the nurses on unit 3M want to return to the previous process for passing meds.”
  2. “The physicians have complained about the new system and the nurses on 3M have voted to return to the old medication passing routine.”
  3. “The nurses on 3M do not like the new system. Do other units agree?”
  4. “There has been a 40 percent increase in medication errors on 3M since the new system began. We believe there is a problem.”

Correct Answer: 4

Rationale 1: During a transition, there is a time when it is easier to go back to the way things were done prior to the change. This is not a strong argument for abandoning the change.

Rationale 2: Physician and nurse preference is not a strong argument for abandoning the change.

Rationale 3: Nurse preference is not a strong reason to abandon the change.

Rationale 4: When taking action within an organization, it is more powerful to be prepared with data. This statement focuses on why there is a need for action to address a problem.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-4: Explain how to use shared visioning as a power tool.

 

Question 8

Type: MCSA

A staff nurse says, “I have so much to do. Why should I spend time being politically aware and active?” Which response by the nurse manager would be most appropriate?

  1. “Being politically active helps you influence events and the decisions of others.”
  2. “You might want to run for political office someday.”
  3. “It might help you increase your salary.”
  4. “It will give you a better understanding of client rights.”

Correct Answer: 1

Rationale 1: Nurses can be politically aware and active in an organization or in the community. By being aware of issues and those people who can effect change, the nurse can influence those in the decision-making roles.

Rationale 2: Running for political office is a way to be politically active but is not the reason to be politically aware for most nurses.

Rationale 3: There is no guarantee that being politically aware and active will have any effect on wages and benefits.

Rationale 4: A nurse can increase understanding of client rights without being politically aware and active.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 9

Type: MCSA

The nurse is working on a committee charged with the responsibility for making policy decisions for the health care organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate?

  1. “We are going about this all wrong.”
  2. “We are a good team, but we need to look at this problem from a different viewpoint.”
  3. “I have to intervene in our work. We are just wasting time.”
  4. “This is going nowhere. I am resigning.”

Correct Answer: 2

Rationale 1: This statement may be correct, but it is not likely to start a calm and focused conversation about the issue.

Rationale 2: When offering criticism, one should always begin the conversation with a compliment.

Rationale 3: “Wasting time” is a strong statement and is likely to inflame the situation.

Rationale 4: The nurse may feel that continuing on the committee is impossible, but this is not the way to convey that information.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 10

Type: MCSA

The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness?

  1. Image
  2. Age
  3. Beliefs
  4. Political party

Correct Answer: 1

Rationale 1: A person who portrays an image of success and trust will be politically effective.

Rationale 2: Age is not the reason people will follow this nurse.

Rationale 3: Beliefs alone are not enough to make people politically effective. Without other attributes, the nurse would not influence others to follow those beliefs.

Rationale 4: Affiliation with a particular political party is not enough to make someone politically effective.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 11

Type: MCMA

The nurse leader wishes to develop a culture of shared visioning for the health care organization. How should the nurse proceed with this plan?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The leader should be a passive observer in meetings.
  2. The leader should encourage a change to a more efficient top-down management system.
  3. The leader should survey employees regarding what is important to them for the organization’s future.
  4. The leader should encourage innovative ideas.
  5. The leader should use coercive primary power.

Correct Answer: 3,4

Rationale 1: The leader is not a passive participant in visioning.

Rationale 2: Top-down management is outdated and is not a part of shared visioning.

Rationale 3: Shared visioning requires that all those involved in the organization have a say in its future.

Rationale 4: Shared visioning is a strategy that encourages innovation.

Rationale 5: The leader encouraging shared visioning would not use coercive power.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-4: Explain how to use shared visioning as a power tool.

 

Question 12

Type: MCSA

The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective?

  1. “I am only showing the student how to take care of patients, so I have no need for power.”
  2. “I can use power to teach the student how to motivate, communicate, and achieve outcomes.”
  3. “I do not want to give the student the idea that nurses are all about who has the most power.”
  4. “I can use power to ensure that other disciplines know I am the one who really does the work.”

Correct Answer: 2

Rationale 1: The nurse preceptor needs power to be effective in the teaching role.

Rationale 2: Nurses must use power to influence others.

Rationale 3: Nurses must use power to influence others. Power in this situation does not have a negative connotation.

Rationale 4: This statement about who really does the work is not an appropriate use of power.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-1: Define power.

 

Question 13

Type: MCMA

Which statement indicates that a nurse has the skills to be politically involved?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The nurse does not take credit for his or her own ideas but attributes them to others.
  2. The nurse knows a lot about what is going on in the organization.
  3. People often say that the nurse has a way of dealing with difficult people and situations.
  4. Staff members seek out this nurse’s ideas on how unit problems should be solved.
  5. The nurse has a “sixth sense” about when to present new ideas.

Correct Answer: 2,3,4,5

Rationale 1: Getting credit for one’s own ideas indicates political savvy.

Rationale 2: Being “in the loop” is a sign of political savvy.

Rationale 3: Knowing how to deal with a difficult colleague is a sign of political savvy.

Rationale 4: A politically savvy nurse’s ideas get a fair hearing.

Rationale 5: Knowing when and how to present ideas is being politically savvy.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 14

Type: MCSA

Which would be the most effective way for nursing to improve the power of its image?

  1. All nurses becoming politically active
  2. Dressing, speaking, and acting in a professional manner
  3. Motivating others to become nurses
  4. Encouraging clients to speak positively about their encounters with nurses

Correct Answer: 2

Rationale 1: While becoming politically active is important, it is not the most effective way to promote a powerful image.

Rationale 2: A powerful image would best be created by nurses acting and speaking in a professional manner.

Rationale 3: Motivating others to become nurses is a result of power but is not the most effective way to promote a powerful image.

Rationale 4: Having clients speak positively about nursing encounters is certainly a good thing, but nurses must improve their own image.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 15

Type: MCMA

Which strategy could be used by nurses to promote nursing’s power image?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Maintaining expertise by attending continuing education events
  2. Encouraging clients to write letters of praise for a job well done
  3. Encouraging all disciplines to work towards organizational goals
  4. Attending local events with influential people
  5. Asking questions about reasons behind processes and policies

Correct Answer: 1,3,4,5

Rationale 1: Nursing is a knowledge profession, and the nurse must maintain expertise in order to retain power.

Rationale 2: Nurses must effect this image personally, not through their clients or other disciplines.

Rationale 3: Today’s health care environment requires collaboration across disciplines. The nurse who can effectively work with others toward organizational goals is powerful.

Rationale 4: Working with and knowing people of influence helps to increase the nurse’s power.

Rationale 5: Asking questions serves a twofold purpose: the nurse is increasing his or her personal knowledge base, and the nurse is seen as being an interested and active participant in the work of the organization.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 16

Type: MCMA

Which actions diminish the image of power for nurses?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Wearing a crisp, clean uniform
  2. Addressing colleagues in endearing terms
  3. Using power plays to achieve goals
  4. Aggressively advocating for clients
  5. Accepting orders without question

Correct Answer: 2,3,4,5

Rationale 1: Appearance can add to or detract from power.

Rationale 2: The nurse should be professional in all encounters. Using endearing terms is not professional.

Rationale 3: Power plays are attempts to diminish or demolish the opponent. The use of power plays is inappropriate.

Rationale 4: The nurse should be assertive, not aggressive.

Rationale 5: The nurse should not accept orders at face value. The nurse should never implement an intervention without knowing why the intervention is being done, that it is appropriate for the particular client, and what the outcome of the intervention should be.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 17

Type: MCMA

The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Identify what she really wants
  2. Keep her focus on her unit, not the entire organization
  3. Prioritize her needs in order of importance
  4. Identify her current resources
  5. Determine who stands in the way of what she wants

Correct Answer: 1,3,4,5

Rationale 1: To increase power, the nurse must first identify what she really wants.

Rationale 2: Focus should be on the entire organization, not just the specific unit where the nurse currently works.

Rationale 3: The nurse should prioritize her needs and goals in the order of their importance to her and to the organization.

Rationale 4: The nurse must be aware of what resources exist and how she can obtain the resources she needs.

Rationale 5: The nurse should identify who or what stands in the way of her achieving what she wants.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 18

Type: MCSA

The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power?

  1. The best strategy is to overwhelm opposition by exerting a great deal of power.
  2. The best strategy is to focus the use of power on the persons who are slow to make the desired change.
  3. The best type of power for these situations is coercion.
  4. The best strategy is to undertake all power interactions in a polite manner.

Correct Answer: 4

Rationale 1: One of the rules of using power is to use as little as possible to get the results desired.

Rationale 2: One of the rules of using power is to focus the power on the problem instead of individual people.

Rationale 3: Coercion is rarely the best type of power to use.

Rationale 4: Being polite is an essential part of using power effectively.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-2: Describe how power is used.

 

Question 19

Type: MCSA

Which strategy is best for the newly licensed nurse who wishes to develop power in the organization?

  1. Develop a “can do” attitude and reputation.
  2. Develop rapport with other staff members by joining in on complaint sessions.
  3. Choose uniforms that do not look better than the ones other nurses wear.
  4. Refer to the staff as “they” when discussing the unit.

Correct Answer: 1

Rationale 1: To become powerful in the organization, the newly licensed nurse should develop an image of power. This includes building a “can do” reputation.

Rationale 2: The nurse who wants to be powerful should not develop a reputation as a complainer.

Rationale 3: Dressing for success is important.

Rationale 4: Commitment to the organization is demonstrated by referring to the staff as “we.”

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 20

Type: MCSA

How can a nurse best influence policies in an organization?

  1. Follow the nursing process.
  2. React to problems as they occur.
  3. Connect with the outside community.
  4. Look to administrators to be the policy makers.

Correct Answer: 1

Rationale 1: Close examination of the political process shows that it closely follows the nursing process. The nurse will assess the situation, create a plan of action, implement that plan, and evaluate and revise the plan.

Rationale 2: Reacting to problems as they occur shows lack of planning.

Rationale 3: Connecting with the outside community may be necessary, but if the nurse is trying to influence the policies of an organization, the bulk of work will be done within the organization.

Rationale 4: The nurse cannot remain passive and expect administrators to create all the policies.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-5: Discuss how politics influence policy.

 

Question 21

Type: MCSA

A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy?

  1. Make visits during the day and tell the supervisor that the clients are not home at night.
  2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day.
  3. Encourage others to refuse to make routine visits at night so you will not be alone.
  4. Take the supervisor to lunch and invite all the staff to join to talk the supervisor into changing the policy.

Correct Answer: 2

Rationale 1: Lying to the supervisor is dishonest.

Rationale 2: Research material provides rationales behind why a policy might need to be changed. This is the assessment phase and provides hard facts.

Rationale 3: Encouraging others to violate policy is not ethical.

Rationale 4: This strategy is unfair and coercive.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-5: Discuss how politics influence policy.

 

Question 22

Type: MCSA

Which action is most likely to undermine the political power of a nursing department?

  1. The nurse executive reports on the accomplishments of the nursing staff at each board meeting.
  2. The nurses in the hospital often ask for and do favors for one another.
  3. The nurse manager wears a business suit to meetings.
  4. The nurse executive does more talking than listening in meetings.

Correct Answer: 4

Rationale 1: Reporting the accomplishments of the nursing staff is a way to support their importance and power.

Rationale 2: Asking for and doing favors for one another is a form of collaboration.

Rationale 3: The nurse manager should dress in the same manner as others in the meeting.

Rationale 4: Talking more than listening can undermine credibility in the politics of the organization. The nurse should develop a reputation for listening and responding thoughtfully in discussions.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 23

Type: MCMA

Which action would help the nurse work with public officials to influence policies?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Contact officials only when necessary to avoid becoming a bother.
  2. Avoid social media contact with officials.
  3. Address only one issue in each correspondence.
  4. Depend on form letters for correspondence.
  5. Always make an appointment before visiting an elected official.

Correct Answer: 3,5

Rationale 1: The nurse should build relationships with officials by keeping in touch. It is not savvy to make contact only when a need exists.

Rationale 2: Email and Twitter are considered viable contact methods.

Rationale 3: The nurse should focus the official’s attention on one issue.

Rationale 4: Handwritten letters get more attention than form letters.

Rationale 5: Making an appointment is the best way to ensure that the official will be in the office, will have time to talk, and will be prepared to address the issue.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 24

Type: MCMA

Which statements reveal that the nurse being described has real power?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “She is so powerful. I have to admit I’m a little afraid of her.”
  2. “I have such respect for her and the work she does.”
  3. “It is an honor to work with her.”
  4. “She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation.”
  5. “She knows how to use her power to get what she wants.”

Correct Answer: 2,3,4

Rationale 1: Real power does not come from fear.

Rationale 2: Respect is one of the principles of principle-centered or real power.

Rationale 3: Honor is one of the principles of principle-centered or real power.

Rationale 4: Loyalty is one of the principles of principle-centered or real power.

Rationale 5: Using power for one’s own purposes is not part of principle-centered or real power.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-1: Define power.

 

Question 25

Type: MCSA

A nurse is overheard saying, “I just don’t want to be involved in this power struggle. I don’t want power; I just want to do my job.” What is a common reason nurses may feel power is not desirable?

  1. Nurses are knowledge workers, not power workers.
  2. Many nurses view power as oppressive.
  3. Having power with others is a part of providing nursing care.
  4. Being powerful reduces self-esteem.

Correct Answer: 2

Rationale 1: Nurses are knowledge workers, but this is not the reason many view power as unattractive.

Rationale 2: The idea of having power “over” someone or “power-grabbing” is oppressive. Many nurses hold this view of power.

Rationale 3: Having power with others is not perceived as unattractive by nurses, but having power over others is.

Rationale 4: Power increases self-esteem.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-2: Describe how power is used.

 

Question 26

Type: MCSA

A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond?

  1. “I don’t think what you are saying is correct.”
  2. “Would you clarify what you just said?”
  3. “What evidence supports that statement as accurate?”
  4. Say nothing and research the topic before the next meeting.

Correct Answer: 3

Rationale 1: The nurse should do further assessment before confronting the person.

Rationale 2: Asking for clarification is not the strongest response to this statement.

Rationale 3: The nurse should not take the statement at face value, but should ask for evidence that it is correct.

Rationale 4: By not saying anything, the nurse allows the rest of the committee to hear and perhaps believe the statement is true. The time to speak up is now.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-3: Discuss how image is a source of power.

 

Question 27

Type: MCSA

Why would the strategic planning committee choose shared visioning as a strategy for change?

  1. Shared visioning makes change easier.
  2. Shared visioning facilitates the more rapid implementation of changes.
  3. Shared visioning means responsibility for error is shared.
  4. Shared visioning means the leader has less responsibility for getting things done.

Correct Answer: 1

Rationale 1: If leaders and followers share in a vision for the future, it is easier for changes to be made.

Rationale 2: It is not necessarily true that shared visioning allows changes to be implemented more quickly.

Rationale 3: Diluting the responsibility for error is not a reason to implement shared visioning.

Rationale 4: The leader does not have reduced responsibility in shared visioning.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-4: Explain how to use shared visioning as a power tool.

 

Question 28

Type: MCSA

The nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter?

  1. Dear Senator:
  2. Dear Bill:
  3. Dear Sir:
  4. To whom it may concern:

Correct Answer: 1

Rationale 1: The nurse should use a professional manner in the letter.

Rationale 2: The nurse should not assume familiarity with the senator in this professional matter.

Rationale 3: The senator’s correct title is Senator.

Rationale 4: The letter should be addressed specifically to the senator.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6: Describe how nurses can use politics to influence policies.

 

Question 29

Type: MCMA

As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Ability to reward others
  2. Technical competence and knowledge
  3. Ability to access data
  4. Relationships with people who are influential in the organization
  5. Being friendly, helpful, and likable

Correct Answer: 2,3,4,5

Rationale 1: Reward power is not a source of personal power.

Rationale 2: Technical competence and knowledge are part of expert power. Expert power is a personal power.

Rationale 3: Ability to access data is information power. Information power is a personal power.

Rationale 4: Formal and informal links with people of influence are the basis of connection power. Connection power is a personal power.

Rationale 5: Admiration and respect for an individual is based partly on the person’s friendliness, helpfulness, and likability. Admiration and respect result in referent power. Referent power is a personal power.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-1: Define power.

 

Question 30

Type: MCSA

Which event would likely improve a nurse’s position power within an organization?

  1. The nurse is promoted to nurse manager.
  2. The nurse is voted “most likable” as part of a Nursing Day celebration.
  3. The nurse has just graduated from a master’s program in nursing.
  4. The nurse’s wife has just been elected to the town council.

Correct Answer: 1

Rationale 1: Position power is determined by job description, assigned responsibilities, recognition, advancement, and authority. Being promoted to nurse manager increases position power.

Rationale 2: Likability is associated with referent power, which is a personal power.

Rationale 3: Advancing one’s education is more likely to increase knowledge power, which is a personal power.

Rationale 4: Connection power is based on an individual’s links to influential people. Connection power is a personal power.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-1: Define power.