NUR 1234 Leadership Midterm Review – Miami Dade College | NUR1234 Leadership Midterm Review

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NUR 1234 Leadership Midterm Review – Miami Dade College 1. Nurse Q has 12 patients she is responsible for on the orthopedic floor this evening. She “gets a feeling” that she need to chec... k on Mr. Zed in room 437 even though he was fine and sitting up in bed one hour ago when she made rounds. She discovered him on the floor after trying to reach the bathroom and calls for help. What type of thinking was Nurse Q responding to? a. clinical thinking c. reflective thinking b. critical thinking d. intuitive thinking ANS: D When nurses and health care professionals; respond to an innate sense that helps them act in certain situations (Gardner, 2003), also referred to as “gut feelings,” this is called intuitive thinking. Reflective thinking is watching or observing ourselves as we perform tasks or make a decision about a specific issue (Pesut & Herman, 1999). Critical thinking is thinking about your thinking while you are thinking as a means of improving your thinking skills (Paul, 1992), and clinical thinking is what nurses and health care professionals do when in a clinical situation but is not a specified type of thinking or decision making. 2. What does the acronym PERT stand for? a. a type of PDA c. a type of conditioner b. a decision tree d. a tool used for timing of decisions ANS: D The program evaluation and review technique (PERT) is a tool used in decision making for assessing the timing of decisions. It includes a flowchart of the sequence of actions needed to accomplish a project as well as descriptions of those actions and the timing involved. 3A. What does the acronym P-F-A stand for? a. Purpose-Format-Assessment c. Project-Financial-Analysis b. Purpose-Focus-Approach d. Program-Functional-Analysis ANS: B The acronym P-F-A stands for purpose-focus-approach and is a type of strategy that can be used to organize an Internet search. 3B. Your manager has asked to do some research on evidence-based best practices for pediatric nursing specific to leukemia that may be incorporated into guidelines for your pediatric oncology unit. Using the P-F-A Internet search technique, which of the following is not one of the questions/search guidelines you might use pertaining to the focus aspect of this Internet search? a. narrow and technical with research orientation b. are you preparing information to give to patients or families? c. lay-oriented or professionally orientated? d. broad and general (basic information for yourself)? ANS: B Questions that can be used to help with the focus of a P-F-A (purpose-focus-approach) Internet research search include: 1) broad and general (basic information), 2) lay-oriented (to give information to a patient) or professionally orientated (for colleagues), and 3) narrow and technical with a research orientation (Nicoll, 2003). Questions that pertain to the purpose aspects of a P-F-A search are as follows: 1) Are you preparing information to give to patients or families? 2) Is it for personal interest? 3) Do you want to obtain information to share with coworkers or a client? 4) Are you verifying information given to you by someone else? 4. Define team – two or more people working independently towards a common goal. a. teamwork – functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care 5. When a nurse asks the client a question, the nurse is considered the – sender? Information seeker? 6. E-mail etiquette has specific guidelines and preference especially in the workplace. Which of the Following are correct tips for communicating via e-mail? Select all that apply. a. be brief and reply sparingly as appropriate b. reply immediately to an angry message c. use good judgment as e-mail may not be private d. use clear subject lines e. do not forward e-mail messages from others without their permission f. use capital letters generously for emphasis ANS: A, C, D, E E-mail communication has recommended guidelines and expectations as with any other form of communication. Some tips for e-mail communication are: no capital letters, be brief, use clear subject lines, cool off before responding to an angry message, forward e-mail messages from others only with their permission, use good judgment because e-mail may not be private. 7. The Tuckman and Jensen (1977) Conceptual Model of team process development includes five stages. However, not all teams go through them in order. During which stage do team members start to work together cooperatively within the group? a. adjourning c. performing b. forming d. norming ANS: D The Tuckman and Jensen’s (1977) five-stage model of group process provides guidelines for potential behavior of team members in collaborative groups. During the norming stage, which is the third stage of team process, team members begin to show effective cooperation and collaboration. The forming stage occurs when the group first forms and focuses on relationship building. The next stage (storming) includes interpersonal interaction and reaction. The fourth stage, performing, is where the group matures and has stable relationships, and the bulk of the appointed tasks are done. The final stage is adjourning where termination and closure occur. 8. Synergy has been defined as a characteristic of great teams and teamwork. Which of the following statements is not correct about synergy and the application of synergy in health care? a. “The bonus that is achieved when things work together harmoniously.” b. The whole is greater than its parts. c. The Synergy Model of Professional Caring and Ethics was developed by the American Association of Critical Care Nurses. d. The synergy model matches the characteristics of the nurse, clinical unit or system with the patient’s ability to achieve identified outcomes. ANS: D Synergy occurs when “...things work together harmoniously” as noted by Mark Twain, and when the whole is greater than its parts (Steven Covey, 1989). The Synergy Model of Professional Caring and Ethics was developed by the American Association of Critical Care Nurses in which the characteristics of the patient (not the nurse), clinical unit, or system are matched with the nurse’s competencies (not the patient’s ability to achieve identified outcomes) (Hardin & Kaplan, 2005). 9. Three types of supervision identified are: a. unsupervised, supervised, and periodic inspection b. unsupervised, initial direction, and assessment c. continuous supervision, periodic inspection, and initial assessment d. initial direction and periodic supervision, unsupervised, and continuous supervision ANS: D Hansten and Washburn’s (2004) three levels of supervision include: 1) unsupervised, 2) initial direction and periodic supervision, and 3) continuous supervision. These levels are based upon the type of task delegated, education, competency, experience, and working relationship of all of the people involved. 10. It has been stated that the only purpose of _____ is to get the job done in the most efficient manner using the appropriate resources. a. assignment c. supervision b. teamwork d. delegation ANS: C While delegation is not a means of intimidating or isolating the new or experienced nurse, it is a way of providing a means by which patient care can be distributed efficiently, utilizing the most appropriate resources (staff) to enhance desired outcomes. 11. When making patient assignments, it is important to consider: a. staff education levels, skill sets, cultural traditions, and willingness to be a team player b. staff education levels, scope of practice, experience, and patient acuity c. staff skill sets, education levels, timeliness, and patient acuity d. patient acuity, staff experience, staff education, and ethnicity ANS: B An assignment is a distribution of work that each staff member is to accomplish during a given time frame according to the scope of practice. An NAP should not be assigned to irrigate a colostomy or do a dressing change of a stage II decubitus ulcer even if the NAP is very experienced. Willingness to be a team player and skill level are important, but should not be the sole factors when making assignments. 12. An interdisciplinary team is assigned to work on patient safety concerns for the pediatric unit on a large urban not-for-profit hospital. Two of the team members are complaining that one nurse is taking charge and assigning duties to everybody randomly without consulting any of the other nurses on the team. One nurse pushes back and says, “You can’t tell me what to do. You are not my manager!” Which stage of group process is the team in? a. norming c. informing b. forming d. storming ANS: D The first stage of the team process as described by Tuckman and Jensen (1977) is the forming stage, where the team is created and meets for the first time. The second stage of team development is the storming stage, where opposing opinions or interpersonal agendas or issues can surface, increasing the potential for conflict or uneasiness (as noted in the above scenario). This is a natural part of team formation and should be expected whenever people from a variety of disciplines, specialties, and experiences work together. The third stage is the norming stage, where a feeling of group cohesion occurs. The fourth stage is performing, where the team comes together to achieve group goals, and the final stage is adjourning, where termination and consolidation occur. 13. When the nurse considers the effectiveness of the delegation, the nurse should evaluate all except: a. was the task performed properly c. were there any problems b. was the outcome optimal d. the availability of resources ANS: D In considering the effectiveness of delegation, the nurse addresses whether the delegation was successful: was the task performed correctly, was the desired outcome achieved, what went well, and were there any problems or concerns. The availability of resources is not included in this evaluation process, the nurse is directly evaluating the delegation process to the NAP and the care the patient received. 14. Which of the following is not part of the five steps in the NCSBN decision-making tree used for delegation? a. assessment, planning, and communication b. intervention and supervision c. surveillance and supervision d. evaluation and feedback ANS: B The NCSBN delegation decision-making tree consists of: assessment and planning, communication, surveillance and supervision, and evaluation and feedback. While intervention and supervision are important decision-making factors, they are not as vital as these other components as they relate to the delegation of NAP. 15. Define the type of care that cardiac patients requires. 16. The act of being responsible for the actions or inactions of yourself and others in nursing is called: a. accountability c. assignment b. authority d. delegation - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 24B. Reed and Pettigrew (2006) identified some additional time wasters that may contribute to a lack of outcome achievement by nurses during their shifts. Which of the following is not one of these identified time wasters? a. complaining c. enthusiasm b. perfectionism d. disorganization ANS: C A number of time wasters that can inhibit nurses from accomplishing their planned outcomes have been identified. Reed and Pettigrew (2006) added three time wasters to an already lengthy list. These are: complaining, perfectionism, and disorganization. 25A. PDSA is: a. a national quality improvement campaign b. process, demonstrate, supervise, and analyze c. an acronym for an EBP model d. part of the 100,000 Lives Campaign ANS: C The acronym PDSA refers to the process used by the Model for Improvement, which is an EBP (evidence-based practice) model. PDSA stands for: Plan-Do-Study-Act process. 25B. The PDSA cycle begins with: a. three questions c. five agendas b. four stages d. two concepts ANS: A The PDSA cycle is a process improvement tool that begins with three questions. These three questions are: 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? and 3) What changes can we make that will result in improvement? 25C. The question what changes can we make that will result in improvement? Is an integral part of: a. TQM c. FOCUS b. PI d. PDSA ANS: D The question What changes can we make that will result in improvement? is one of three that are utilized at the beginning of each application of the PDSA methodology for improvement. 25D. To increase the ability to predict the effect that one or more changes would have if they were implemented is a goal of: a. FOCUS c. PDSA b. QA d. Risk management ANS: C The PDSA methodology for improvement is used to analyze the potential effect of a specified change or changes if they were implemented. It involves: who will do what, when they will do it, and where they will do it in relation to the proposed change(s). 26A. The University of Colorado Hospital Model categorizes information according to several sources of evidence that are linked to a research core. Which source of evidence does not necessarily belong? a. patient preference c. cost-effective analysis b. clinical expertise d. comparison analysis data ANS: D The University of Colorado Hospital Model has nine sources of evidence (information) linked to a central core of valid and current research. These nine sources are: 1) patient preference, 2) clinical expertise, 3) cost-effective analysis, 4) infection control (not comparison analysis data), 5) benchmarking data, 6) pathophysiology, 7) retrospective or concurrent chart review, 8) quality improvement and risk data, and 9) international, national, and local standards. 26B. “The ______ model provides a way for the nurse to organize information needed not only to care for the patient, but also to evaluate the care provided.” This is a definition of which model? a. Model for Improvement c. Mayo Clinic b. University of Colorado Hospital d. Samaritan Hospital Quality Practice ANS: B The University of Colorado Hospital Model provides a framework that nurses can use to organize data/information needed to care for patients as well as to evaluate the care rendered. The Model for Improvement utilizes a PDSA format. 27A. The acronym FOCUS is a type of process improvement methodology. What does FOCUS stand for? a. Focus, Organize, Understand, Substantiate b. Focus, Opportunity, Continuous, Utilize, Substantiate c. Focus, Organize, Clarify, Understand, Solution d. Focus, Opportunity, Continuous (process), Understand, Solution ANS: C The FOCUS methodology uses a stepwise process to move through the improvement process. The five steps involved are identified with the use of the FOCUS acronym: 1) F = focus on an improvement area, 2) O = organize a team that knows the work process, 3) C = clarify the current process, 4) U = understand the degree of change needed, and 5) S = solution: select a solution for improvement. 27B. The _______ methodology describes in a stepwise process how to move through the improvement process. a. PDSA c. Pareto Chart b. FOCUS d. Control Chart ANS: B The FOCUS methodology describes in a stepwise process how to move through the improvement process. The steps are: F (focus on an opportunity for improvement), O (organize a team that knows the process), C (clarify what is happening in the current process), U (understand the degree of change needed), and S (select a solution for improvement). 28. A systematic process of organization-wide participation and partnership in planning and implementing improvement methods to understand and meet customer needs is called: a. QI c. QM b. QA d. TM ANS: A QI (quality improvement) is a system-wide process of organization-wide participation and partnership in planning and implementing improvement methods to understand and meet customer needs and expectations. It is proactive in its approach. 29. Discuss productive work- Yielding favorable, or affective results 30. The external customer are: Clients, family, and communities, 31. The National Patient Safety Goals established by the Joint Commission focus on: a. regulatory standards c. employee safety b. preparation for accreditation d. patient safety ANS: D The Joint Commission has developed standards to guide critical activities performed by health care organizations. Each year the Joint Commission publishes new goals that organizations must have in place to promote specific improvements in care related to patient safety. 32. A sentinel event is: a. a major change in a patient’s status b. an unexpected incident involving a death or serious physical or psychological injury to a patient c. a way to identify processes for improvement based on an analysis of care over a long period of time d. an occurrence involving a sentinel or someone who is watching ANS: B A sentinel event is an unexpected occurrence involving a death or serious physical or psychological injury to a patient. The results of the analysis of the sentinel event generally lead to process improvement, but tend to be based upon the events surrounding the individual occurrence. 33. A _____ is a method used by performance improvement teams to share their work with others, and can be placed in a high-traffic area and used when an improvement process is complete or “in process” to communicate information. a. clinical value compass c. balanced scorecard b. dashboard d. storyboard ANS: D A storyboard is a performance improvement tool that can be used to communicate information when an improvement process has been completed or when it is still “in process.” Storyboards can be placed in high-traffic areas as a means of sharing the performance improvement progress with others. Clinical value compasses, dashboards, and balanced scorecards are measurement tools utilized in performance improvement, but are not necessarily used alone as a means of communicating the progress of a performance improvement initiative. 34. Philosophies: a. are a way of looking at the world through rose-colored glasses b. are a rational investigation of truths, reality, and human behavior c. are an investigation into behaviors and truths, but not necessarily of reality d. stem from a person’s beliefs and opinions, and principles of bioethics ANS: B The rational investigation of truths and principles of knowledge, reality, and human conduct (behaviors) is called philosophy. Personal philosophies can be a result of a person’s beliefs and values, but bioethics is a type of philosophy that concerns itself with health care, and is not applicable to all philosophies. 35. An example of teleology is: a. do unto others as you would have them do unto you b. murder is always wrong c. the achievement of a good outcome justifies using less than desirable means to attain it d. a person’s character must be developed so that he will be predisposed to behave virtuously ANS: C Teleology is an ethical theory that purports that a person must take those actions which lead to good outcomes, and the outcome of the act determines whether it is good or of no value. According to teleology, one can use a less than desirable action (means) to attain a good outcome. An example of deontology would be “Do unto others as you would have them do unto you.” The statement “Murder is always wrong” is an example of relativism, by which there are no universal ethics and ethical standards are relative to person, place, time, and culture. Living and behaving virtuously relates to the concept of ethics. 36. Beneficence, non-maleficence, fidelity, justice, autonomy, veracity, and respect for others are all examples of: a. philosophies pertaining to nursing b. ethical dilemmas c. philosophies related to organizational law d. ethical principles and rules ANS: D The ethical principles of beneficence, fidelity, nonmaleficence, justice, autonomy, veracity, and respect for others are considered to be ethical principles and rules. They all concern behaviors and beliefs that influence how individuals make decisions when faced with ethical dilemmas, such as those encountered by nurses in their practice settings. 37. A nurse manager at a home health care agency who ensures that all contracts have been completed and payments are timely is displaying the principle of: a. veracity c. autonomy b. respect for others d. fidelity ANS: D The principle of fidelity concerns the obligation of keeping one’s promise or word. The nurse manager in this example is keeping her word by making sure that all contracts have been completed and that payments are made in a timely manner; hence, the nurse manager is keeping her promise to do so. The ethical principle of autonomy relates to a person’s right to self-determination and respect for individual liberty. An example of veracity would be to refuse to participate in any type of fraudulent activity. When a nurse chooses to avoid making paternalistic decisions for others, she is displaying the ethical principle of respect for others. 38. When moving to a different country, it is important to consider the possibility and potential implications of: a. ambivalence c. tradition in ethnic groups b. improved lifestyle d. culture shock ANS: D Culture shock can occur when an individual immigrates to a different country with a different culture. This may occur when the values and beliefs upheld by the new culture are radically different from the individual’s native culture. 39. Identification of a person according to genetic traits and physical characteristics is called: a. culture c. race b. acculturation d. cultural ethnicity ANS: C Race describes a geographical or global population that is distinguished by its physical characteristics such as skin color, facial features, or genetic traits. Cultural ethnicity identifies an individual based upon racial, tribal, linguistic, religious, national, or cultural groups. Acculturation concerns the loss of cultural identity into the new or more dominant cultural group. 40. Within each broad category of race are numerous cultural groups. Why is this important for nurses to recognize? a. for demographic data collection b. different cultural groups have different views of health-related illness practices for care c. to prevent racism from occurring on the unit among the patients d. to provide the best care possible according to their heritage and traditions ANS: A Located within each broad category of race are numerous subcultures, such as different Native American tribes that tend to be broadly categorized as “Native American.” Another broad category is the term “Hispanic,” which encompasses subcultures such as Caribbean, Cuban, Guatemalan, Puerto Rican, Mexican, and Central / South American peoples. 41. According to DeRosa and Kochura’s (2006) article entitled “Implement Culturally Competent Health Care in Your Workplace,” cultures have different patterns of verbal and nonverbal communication. Which of the following communication behaviors is not one of the noted communication differences? a. conversational style c. eye contact b. personal behavior d. subject matter ANS: B DeRosa and Kochura (2006, October) noted four potential differences in communication among different cultures. These differences include: 1) conversational style (e.g., silence may be taken as a sign of respect or acknowledgement), 2) personal space (not personal behavior), 3) eye contact (in some cultures, direct eye contact may be viewed as a sign of disrespect), and 4) subject matter (some subjects are considered taboo in certain cultures). 42. When working with staff from different cultures, it is important to realize that there may be different perceptions of a variety of areas that are inherent in the health care regime. Which of the following is not one of these potential areas of differing perception? a. staff responsibilities c. locus of control b. the health care practitioner d. time orientation ANS: B Working with staff from different cultures brings with it differing perceptions of the health care regime and its inherent elements. Some potential areas of difference that may impact nursing health care service delivery include: staff responsibilities, the role of the nurse (not health care practitioner), locus of control, time orientation, educational differences, and language differences. 43. An individual with an impaired ability to integrate meaning and purpose in his life through his own connectedness with others, self, music, nature, or a higher power has: a. spiritual distress c. depression b. philosophical distress d. schizoid personality disorder ANS: A Spiritual distress is a recognized nursing diagnosis that consists of an impaired ability to integrate meaning and purpose in life through an individual’s connectedness with self, others, art, music, literature, nature, or a higher power. In order to relieve this distress, it is expected that individuals will reconnect with those items or elements that they consider to be important (e.g., meditation, prayer, religious services or rituals, communing with nature or animals, sharing of self, or caring for others) in order to return to meaning and purpose in life. Depression consists of a variety of symptoms that interfere with the ability to work, eat, sleep, and function in activities that once brought pleasure. Schizoid personality disorder consists of a pattern of indifference to social relationships and a limited range of emotional expression and experience. 44. According to the survey of diversity in nursing by the American Association of Colleges of Nursing (AACN, 2006), what percentage of RNs who graduated from an undergraduate program were men? a. 3.9% c. 12% b. 6.2% d. 23.2% ANS: B The American Association of Colleges of Nursing’s survey of diversity in nursing noted that in 2011 6.2% of the registered nurses who graduated from undergraduate nursing programs were men. The initial preparation for male RNs was an associate’s degree. This number of male nurses has steadily increased. 45. Which language is spoken by most people worldwide? Mandarin 46. Nurse administering intradermal tuberculin skin test, client comments it is different from other shots, nurse explains that because the medication does into the dermal tissue the angle for intradermal injections is: 5-15 degrees 47. In teaching a mother to administer eardrops to her 4 month old infant, most important concept to include is: pull the pinna downward and backward 48. The physician asks the nurse to take a telephone order for acetaminophen (Tylenol) 500mg by mouth q4h PRN temp elevation >100 degrees F. What should be the nurse’s response? a. According to ATI about telephone orders: if possible, have second nurse listen to order, ensure prescription is complete and correct by reading back order to provider (clients name, med, dose, time, frequency and route), remind prescription must be signed within specified amount of time, write it in clients med record 49. Reflection/reflective thinking – watching or observing ourselves as we perform a task or make decision about a particular situation to help future tasks and decision a. Debriefing - highly effective type of reflective thinking used in clinical settings to encourage the reflective self to evaluate a situation, problem, or event. 50. Advantages of using groups a. offer innovative alternatives and decisions and afford some protection from mistakes because it uses combined knowledge of all of its members b. more ideas can be generated c. allows for more communication d. more choices e. increases likelihood of higher-quality outcomes f. Nominal group – nonverbal, face to face g. Delphi – not face to face h. Consensus – a general agreement, the judgment arrive at by most of those concerned, not 100% agree but all people can live with and fully support decision regardless if they agree 51. Little-Stoetzel and Fane (2012) identified a decision-making process which is comprised of five specific steps. Which of the following are some of these steps? Select all that apply. a. identify the need for a decision b. determine the goal or outcome c. identify alternative repercussions of said actions and make choices based on these possible problems that may arise d. decide which action to implement e. test the action or decision f. evaluate the decision ANS: A, B, D, F The five steps in the decision-making process as noted by Little-Stoetzel and Fane (2012) are: 1) identify the need for a decision, 2) determine the goal or outcome, 3) identify alternative actions along with the benefits and consequences of each action, 4) decide which action to implement, and finally 5) evaluate the decision. Testing the action or decision and relying solely upon the possible alternative repercussions of the action—without weighing the benefits—are not part of Little-Stoetzel and Fane’s five-step decision-making process. 52. Vroom and Yetton (1973) identified nine questions that may help managers to decide when a group decision is called for. Which of the following are some of these questions? Select all that apply. a. Does the individual have all the information needed? b. How does this decision impact relationships with internal and external stakeholders? c. Will the course of action chosen make a difference to the organization? d. Will the decision promote conflict among the group or individuals? e. Is it absolutely critical that the individual group accept the decision before it’s implementation? f. How will the decision influence future choices made by the organization? ANS: A, C, D, E Some of the nine questions that are useful for nurses when deciding whether to use an individual or group process for decision making are 1) Does the individual have all the information needed? 2) Will the course of action chosen make a difference to the organization? 3) Will the decision promote conflict among the group or individuals? 4) Is it absolutely critical that the individual group accept the decision before its implementation? The questions, How does this decision impact relationships with internal and external stakeholders? and How will the decision influence future choices made by the organization? are a good considerations in certain circumstances, but they are not part of Vroom and Yetton’s recommended line of questioning. 53. What mnemonic can be used by nurses to assist in the evaluation of information found on the Internet? a. PERT c. FINDIT b. ELAPSED d. PLEASED ANS: D When evaluating information found on the Internet, one mnemonic that can be helpful is to ask oneself, am I PLEASED with the site? This acronym stands for: P = Purpose (what is the author’s purpose in developing the site?), L = Links (evaluate the links at the site), E = Editorial (site content), A = Author (who is the author of this site?), S = Site navigation (is the site easy to navigate?), E = Ethical disclosure (is there contact information for the developer and author?), and D = Date site last updated (is the content and information on the site current?). 54. DeLaune and Ladner (2011) have identified some limitations or obstacles to effective decision making that nurses may encounter in various health care settings. Which of the following is not one of these obstacles or limitations? a. choosing decisions that are too narrow or too precise. b. failing to obtain all the necessary information c. failing to intervene and evaluate the solution or decision appropriately d. jumping to conclusions without examining the situation completely ANS: A A number of different obstacles can intervene in effective decision-making, causing errors in judgment or inaccurate choices. DeLaune and Ladner (2011) defined five criteria that can negatively impact decision-making or problem-solving processes. These five criteria are: 1) choosing decisions that are too broad, too complicated, or lack definition (not choosing decisions that are too narrow or too precise), 2) failing to obtain all the necessary information, 3) failing to intervene and evaluate the solution or decision appropriately, and 5) jumping to conclusions without examining the situation completely. 55. Which of the following are types of technology used to support evidence- based information needs of nurses? REVIEW 56. Myers-Briggs Personality Dichotomies Theory: Subjective Objective deductive Intuition/Sensing Perception/Judging Inductive Feeling/Thinking Introversion/Extraversion 57. Todd Bishops steps to develop an assertive statement: 1. Attention getter 2. State your concern 3. State problem as you see it 4. State a solution 5. Obtain an agreement 58. Overcoming communication barriers a. understand the receiver b. communicate assertively c. use two-way communication d. unite with a common vocabulary e. elicit verbal and no-verbal feedback f. enhance listening skills g. be culturally sensitive h. be sensitive to gender differences i. engage in meta communication 59. Which of the following are part of the five rights of delegation? Select all that apply. a. right task c. right evaluation b. right circumstance d. right route ANS: A, B, C The five rights of delegation have to do with the identification and provision of the: 1) correct (right) task, 2) in the correct (right) circumstance, 3) to the correct (right) person, 4) with the correct (right) direction/communication, and 5) under the correct (right) supervision and evaluation. The right route refers to medication administration. 60. A number of factors have been identified in the tendency for new nurse graduates to under delegate. Which of the following are some of these factors? Select all that apply. a. fear of resentment from older personnel b. need for approval c. lack of understanding of clinical principles d. confusion regarding their scope of duties ANS: A, B, D New nurse graduates, as with other newly graduated health care personnel, have a tendency to under delegate. This can be caused by a fear of resentment on the part of more experienced nurses, or by the need for approval or validation by completing all of their assigned duties without assistance. They may also be unsure of the scope of their duties or what they are allowed to do (such as ask for help). As new graduates, however, they should have a firm understanding of basic clinical principles and be willing to ask for assistance for clarification in areas in which they are unsure. 61. Some of the reasons for over delegation are listed below. What are they? Select all that apply. a. seek approval from others c. unorganized b. depend too much on others d. tendency to immerse oneself in trivia ANS: B, C, D A number of different factors can influence a nurse’s choice to overdelegate. Some of these include: depend too much on others, may be uncomfortable performing tasks that are unfamiliar to them, unorganized, tendency to immerse oneself in trivia, and avoiding responsibility. Seeking approval from others is one of the characteristics of underdelegation, particularly by new graduate nurses. 62. A number of characteristics have been identified as behavioral styles of organizations in the United States. Characteristics of these behavioral styles include which of the following? Select all that apply. a. a firm handshake is important b. use direct eye contact in work situations c. be on time to interview appointments d. in areas where daily dress is more casual, casual dress is okay in business situations and in clinical work settings ANS: A, B, C It is important to consider the organizational behavior style for any new work environment you may encounter, particularly when working with organizations from the United States. Some considerations regarding greetings, titles, punctuality, body language, and dress include: a firm handshake is important, use direct eye contact in work situations, be on time to interview appointments as punctuality is highly respected, especially in nursing, in areas where daily dress is more casual, business situations and in clinical work settings require professional dress (not casual dress), and it is important to keep one-arm’s-length distance away from the speaker in conversations. 63. A number of obstacles to delegation have been identified. Which of the following are some of these known obstacles? Select all that apply. a. tendency to delegate all tasks to assistive personnel b. fear of being disliked c. inability to communicate effectively d. lack of administrative support for delegation to LVN and NAP ANS: B, C, D A number of factors have been identified as being potential obstacles to delegation. These noted obstacles include: fear of being disliked, inability to communicate effectively, lack of administrative support for delegation to a LVN and NAP, inability to give up control in any situation, fear of making a mistake, and tendency to isolate oneself, and choosing to complete all tasks alone (instead of tendency to delegate all tasks to assistive personnel). 64. There are four principles inherent in the concept of whole-systems shared governance. Which of these principles are noted below? Select all that apply. a. partnership c. accountability b. collaboration d. ownership ANS: A, C, D The principles of whole-systems shared governance are: partnership (implies horizontal linkages between nursing and other staff roles), accountability (individuals are accountable for their actions), ownership (individuals own the work they perform), and equity (staff roles are based upon relationships, not titles). 65. Maloney (2012) noted some key aspects of time management. The key aspects include which of the following? Select all that apply. a. analysis of how time is currently used b. assessment of time distractions c. requires self-examination of what pursuits are really important d. time must be calculated to fit a diverse staff ANS: A, B, C Maloney (2012) identified some key characteristics of time management. Some of these characteristics are: 1) analysis of how time is currently used, 2) assessment examination of what pursuits are really important. 66. The study by Hendrich, Chow, Skierczynski, and Lu (2008) found that nurses spend 6% of their time: a. coordinating care c. assessing patients b. delegating tasks. d. being nonproductive ANS: D In the study by Hendrich, Chow, Skiercznski, and Lu conducted in 2008, it was found that nurses waste 6% of their time on nonproductive personal time. Assessment and vital signs take up 5% of nurses’ time. Patient care activities utilize 14% of nurses’ time. Care coordination takes up another 14%. 67. Which of the following are areas that should be considered when making shift staffing assignments? Select all that apply. a. patient needs c. agency organizational systems b. end-of-shift outcome achievement d. staffing ANS: A, C, D When making shift assignments, it is important for nurses to consider these three items: patient needs, agency organizational systems, and staffing. While the end-of-shift outcome achievement is important, this is assessed at the end of the shift, not at the beginning while assignments are being assigned. 68. The Model for Improvement begins with three questions. Which are these three questions? Select all that apply. a. What are we trying to accomplish? b. What change is needed for improvement? c. What change can we make that will result in improvement? d. How will we know that a change is an improvement? ANS: A, C, D The three primary questions that the Model for Improvement begins with are: 1) What are we trying to accomplish? 2) What change can we make that will result in improvement? and 3) How will we know that a change is an improvement? These three questions begin the PDSA cycle for improvement advocated by this model. 69. Patient Bill of Rights – provides a means of addressing problems with their care and encourages them to participate in staying healthy and getting well – replaced with Patient Care partnership a. What to expect during hospital stay, right to high quality hospital care, clean and safe environment, involvement in their care, protection of privacy, help when leaving the hospital, help with billing claims 70. Lawrence Kohlberg (1971) identified a multiphase process of moral development. These phases of moral development include which of the following? Select all that apply. a. cognitive c. conventional b. preconventional d. postconventional ANS: B, C, D Lawrence Kohlberg (1971) noted three phases or levels of moral development that humans progress through. These three phases/levels are: 1) preconventional (morals are about rules imposed by some authority), 2) conventional (people begin to internalize their own view of themselves in regards to something meaningful), and 3) postconventional (independent thinker). 71. Research conducted by the Ethics Center identified several ways health care organizations can have an ethical workplace or culture. These include which of the following? Select all that apply. a. formal programs can help an organization strengthen its culture b. an ethical culture makes a difference in achieving positive outcomes c. informal programs with employee involvement are more beneficial in developing a positive culture d. the most critical factor in promoting an ethical culture is leadership ANS: A, B, D There were three key findings noted in research performed by the Ethics Resource Center (Harned, 2005) concerning ethical workplaces. These key findings are: 1) an ethical culture makes a difference in achieving positive outcomes, 2) the most critical factor in promoting an ethical culture is leadership, particularly involvement of senior leadership, and 3) formal (not informal) programs can help an organization strengthen its culture. 72. Which of the following are questions that can be asked when assessing organizational culture? Select all that apply. a. Are risk and change encountered? b. What is the informal chain of command? c. What is the colloquial chain of command? d. What are the rules about how things should be done? ANS: A, B, D When assessing or beginning to work in a new organization, it is important to know and understand what the current organizational culture is and how it relates to your own sense of self and cultural values. Some questions that can be used when assessing an organization’s culture include: 1) Are risk and change encountered? 2) What is the informal chain of command? 3) What is the formal chain of command (not colloquial chain of command) ? 4) What are the rules about how things should be done? and 5) Are the organization’s values consistent with your values? 73. A number of techniques have been identified to assist nurses who work with staff from a different culture who speak English as a second language. Which of the following are some of these techniques? a. if you feel you cannot achieve effective communication, give up b. acknowledge that your coworker’s value system and perception of what “good” is may be different from your own c. appreciate the knowledge you can gain from working alongside a skilled nurse from another culture d. provide your coworker with written resources that can help reinforce your verbal communication ANS: B, C, D Some techniques that can assist in enhancing communication with staff who are from another culture and speak English as a second language are: 1) if you feel you cannot achieve effective communication with your coworker, request to work with another person so you won’t be held accountable for the actions of someone with whom you cannot communicate (not give up), 2) acknowledge that your coworker’s value system and perception of what “good” is may be different from your own, 3) appreciate the knowledge you can gain from working alongside a skilled nurse from another culture, 4) provide your coworker with written resources that can help reinforce your verbal communication, and 5) clarify your coworker’s level of understanding of verbal and written communication. 74. Math 75. Math 76. Who has the legal authority for nursing practice/action according to each state? a. The Joint Commission b. State Boards of Nursing c. Nurse Practice Act d. National Council Licensure Examination (NCLEX) ANS: C The legal authority for nursing practice lies with the state’s Nurse Practice Act. While individual State Boards of Nursing operate under this act, they themselves are not the legal authority. The Joint Commission provides guidelines and standards for safe nursing practice according to evidence-based practice guidelines, and the Joint Commission does have the capacity to accredit health care facilities, but the Joint Commission is not the legal authority for nurse practice. NCLEX is not the legal authority for nursing actions, but does play a significant role in the decision-making process regarding who is qualified for licensure. 77. When making patient assignments, it is important to consider: a. staff education levels, skill sets, cultural traditions, and willingness to be a team player b. staff education levels, scope of practice, experience, and patient acuity c. staff skill sets, education levels, timeliness, and patient acuity d. patient acuity, staff experience, staff education, and ethnicity ANS: B An assignment is a distribution of work that each staff member is to accomplish during a given time frame according to the scope of practice. An NAP should not be assigned to irrigate a colostomy or do a dressing change of a stage II decubitus ulcer even if the NAP is very experienced. Willingness to be a team player and skill level are important, but should not be the sole factors when making assignments. 78. Which of the following does not necessarily belong as a component of culturally competent care? a. cultural awareness c. cultural organizations b. cultural knowledge d. cultural desire ANS: C Culturally competent care is an integration of knowledge, attitudes, and skills that enhance cross- cultural communication and effective interactions. This type of care is a process that combines the elements of cultural awareness, cultural knowledge, cultural skills, cultural encounters (not cultural organizations), and cultural desire. 79. A _____ is a method used by performance improvement teams to share their work with others, and can be placed in a high-traffic area and used when an improvement process is complete or “in process” to communicate information. a. clinical value compass c. balanced scorecard b. dashboard d. storyboard ANS: D A storyboard is a performance improvement tool that can be used to communicate information when an improvement process has been completed or when it is still “in process.” Storyboards can be placed in high-traffic areas as a means of sharing the performance improvement progress with others. Clinical value compasses, dashboards, and balanced scorecards are measurement tools utilized in performance improvement, but are not necessarily used alone as a means of communicating the progress of a performance improvement initiative. 80. Which patient will the nurse see first? 81. Which non-pharmacological interventions should a nurse include in the care for a client who has moderate rheumatoid arthritis? Thermotherapy/cold compress, exercise, electrotherapy, spa, message, splints, and orthosis. 82. Quality improvement efforts use data to determine relationships and outcomes. Which of the following types of charts are used in quality improvement efforts? Select all that apply. a. time series charts c. histamine charts b. Pareto charts d. fishbone charts ANS: A, B, D A number of different types of charts are used in quality improvement initiatives to examine data. Some of these include: time series charts, Pareto charts, histograms (not histamine charts), and fishbone charts. 83. There are four principles inherent in the concept of whole-systems shared governance. Which of these principles are noted below? Select all that apply. a. partnership c. accountability b. c- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- ANS: A QI (quality improvement) is a system-wide process of organization-wide participation and partnership in planning and implementing improvement methods to understand and meet customer needs and expectations. It is proactive in its approach. 99B. Quality improvement efforts use data to determine relationships and outcomes. Which of the following types of charts are used in quality improvement efforts? Select all that apply. a. time series charts c. histamine charts b. Pareto charts d. fishbone charts ANS: A, B, D A number of different types of charts are used in quality improvement initiatives to examine data. Some of these include: time series charts, Pareto charts, histograms (not histamine charts), and fishbone charts. 100. Same as 95. [Show More]

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