____ 1. Which of the following is an important role of the nurse manager?
1.
Give daily bedside care.
2.
Administer medications at least 2 to 3 times weekly.
3.
Coordinate the unit’s activities.
4.
Independently set goals.
____ 2. Effective delegation involves which of the following?
1.
Clear identification of the delegated task
2.
Accurate documentation
3.
The ability to reward positive behavior of a staff member
4.
The assignment of a specific number of in-service education hours
____ 3. You are the nurse manager and know that you must assess a client’s needs before you can delegate a task regarding that patient to a certified nursing assistant. Assessing the client’s needs involves:
1.
determining whether patient goals have been met.
2.
gathering information about the client.
3.
giving care to the client.
4.
planning care and formulating the written nursing care plan.
____ 4. In order to gain the cooperation of staff members, you ask for their input on patient care and share information regarding patient care. These actions are examples of:
1.
empowerment.
2.
delegation.
3.
accountability.
4.
teaching.
____ 5. As the nurse manager, when you hold staff members responsible for their actions and require them to document on flow sheets such tasks as intake, output, and personal care, which of the following terms applies?
1.
Responsibility
2.
Empowerment
3.
Accountability
4.
Delegation
____ 6. Susie, an RN, is employed in her first job. She has been there for 8 months, and yesterday she was informed that she had been chosen as employee of the month. The facility’s recognition of Susie’s work is an example of:
1.
empowerment.
2.
formal positive feedback.
3.
informal positive feedback.
4.
rewards.
____ 7. When a staff member makes a mistake, the nurse manager should:
1.
ignore the mistake and give the person another chance.
2.
punish the person.
3.
call all staff members together to discuss the mistake.
4.
accept the mistake and help the person learn from the mistake.
____ 8. The most common reason for employee error is:
1.
lack of adequate supervision.
2.
lack of adequate staffing.
3.
lack of knowledge.
4.
lack of adequate counseling.
____ 9. The primary reason for employee counseling is:
1.
to inform employees that they need to do something differently or that they have done something well.
2.
to punish employees for errors.
3.
to discipline employees.
4.
to reward employees.
____ 10. Counseling sessions should be private and brief. They should also be:
1.
confrontational.
2.
nonconfrontational.
3.
empowering.
4.
frequent.
____ 11. A positive approach to discipline requires a certain focus from the manager. That focus is:
1.
punitive.
2.
giving criticism in a very sweet manner.
3.
helping the employee to improve performance and behavior.
4.
a written warning to the employee.
____ 12. The emphasis in performance analysis is on:
1.
the present.
2.
the future.
3.
the past.
4.
the employee’s personality.
____ 13. Performance review is based on:
1.
past reviews of the employee.
2.
how the manager views the job.
3.
a review of job standards.
4.
the job description.
____ 14. When a manager uses the contrast effect in performance analysis, this refers to:
1.
rating an employee by comparison with other employees.
2.
the ratings being all higher or lower than the expected average.
3.
allowing past performance ratings to influence current ratings.
4.
rating all areas at average or midpoint.
____ 15. The major components of a performance analysis are:
1.
personality characteristics.
2.
goals or objectives.
3.
behavioral characteristics.
4.
performance standards.
____ 16. A performance plan for improvement should include:
1.
a time frame for achieving each goal.
2.
behavioral characteristics.
3.
personality characteristics.
4.
a job description.
____ 17. Patient assignments are best made by delegating tasks based on:
1.
patient acuity.
2.
patient age.
3.
staff ages.
4.
medical diagnoses.
____ 18. When is it appropriate to give an employee a written warning as part of a disciplinary action?
1.
After previous counseling and employee is aware of the rule being broken
2.
A first occurrence of breaking a rule occurs.
3.
A severe violation of a rule occurs.
4.
Employee is suspected of breaking a rule.
____ 19. The nurse manager incorporates verbal reports and walking rounds for what purpose?
1.
To provide staff members with adequate exercise
2.
To introduce different staff members to promote teamwork
3.
To improve communication and provide opportunities for feedback
4.
To allow staff nurses to take time off from patient care
____ 20. At a staff meeting the nurse manager tells the group of nurses, “I know census was high last month, but you all did an amazing job of taking care of your patients while keeping the quality of care high. I am very proud of you.” What is this manager doing?
1.
Providing verbal report
2.
Coaching
3.
Mentoring
4.
Goal setting
____ 21. What actions can the newly graduated RN take to improve their sense of empowerment? (Select all that apply.)
1.
Take a job that will require a high level of expertise.
2.
Join a nursing organization.
3.
Continue to read and study new topics encountered at work.
4.
Seek a mentor with expertise who works well with the RN.
5.
Handle all situations that arise at work independently.
____ 22. Negative use of power helps: (Select all that apply.)
1.
personal gain.
2.
professional gain.
3.
meet the needs of the group.
4.
group harmony.
5.
promote the ideas of an individual without regard for the group.
____ 23. You add to your patient’s empowerment when you: (Select all that apply.)
1.
do everything for the patient without input from the patient.
2.
believe in your patients.
3.
act as a patient advocate.
4.
perform all procedures without error.
5.
act aloof.
____ 24. The theory of utilitarianism states that an ethical decision is based on the greatest good for the greatest number of people. This theory often leaves out which of the following groups?
1.
Elderly people
2.
Those who are in a minority
3.
Patients who, for the most part, can independently care for themselves
4.
Certain ethnic groups
____ 25. You are a nurse manager on the 11 p.m. to 7 a.m. shift. You periodically make rounds, observing and checking on your staff and residents. You do this on a regular basis throughout your shift because:
1.
your facility requires you to do so.
2.
the policy manual states this as a regulation.
3.
you are responsible for the behavior of those you manage.
4.
state law requires this action.
____ 26. Your orientation as a nurse manager in a long-term care facility was done quickly. You are unsure of some of the regulations relating to your new position. As a responsible nurse manager, what should you do to remedy this situation?
1.
Review your agency regulations and know the Nurse Practice Act.
2.
When a situation comes up, ask the staff what the normal procedure is.
3.
Call the state board of nursing.
4.
Call the state department of health.
____ 27. You are a student practical nurse assigned to a medical-surgical unit. The night before going to the clinical area, you are very tired and fail to look up your patient’s diagnosis as assigned. Which of the following is appropriate?
1.
Ask your friend to quickly give you the information during shift report.
2.
Look up the information while your patient is eating breakfast.
3.
Use break time to get the information you need.
4.
Tell your instructor what happened as soon as you arrive in the clinical area.
____ 28. You are an RN employed in your first job. A resident complains to you about the care and incompetence of a nurse on the previous shift. Which of the following actions is most appropriate?
1.
Discuss the situation with another staff member.
2.
Argue with the resident.
3.
Agree with the resident.
4.
Report the incident to your head nurse or supervisor.
____ 29. Ethical dilemmas are situations that result in a _____ of two or more fundamental values.
1.
conflict
2.
blending
3.
change
4.
discussion
____ 30. Your classmate, who is also a good friend, tells you this morning that she didn’t have time to study for the anatomy and physiology test because her daughter was sick all night. She sits next to you in class and asks you to position your answer sheet so that she can copy your answers. You reply that you are very sorry, but that you do not feel it would be appropriate behavior to do so. You suggest that your friend talk to the instructor to see if she can take the test at a later time. Your actions exhibit:
1.
ethical behavior.
2.
unethical behavior.
3.
abuse of power.
4.
deontology.
____ 31. Another term for ethical behavior is:
1.
mandatory.
2.
lawful.
3.
appropriate.
4.
ideal.
____ 32. David, a student practical nurse, is bathing Mr. Smith. He puts on gloves to brush Mr. Smith’s dentures and keeps the same gloves on throughout the bath. His reasoning is that he will be able to get the bath finished more quickly and allow Mr. Smith to rest. This is an example of:
1.
ethical behavior.
2.
unethical behavior.
3.
abuse of power.
4.
deontology.
____ 33. You make an error while caring for a patient. Which of the following is the appropriate person to whom to report the mistake?
1.
Your classmate
2.
Wait until you go off duty and then report the error to your instructor.
3.
Report the error to your instructor immediately.
4.
Leave your clinical area immediately and go see the director of the nursing program.
____ 34. Personal values are:
1.
customs of society.
2.
personal beliefs about truth, behavior, and thoughts.
3.
society’s behavioral code.
4.
legal standards of an action.
____ 35. When a nurse uses ethical reasoning, the nurse does which of the following?
1.
Clearly identifies the issue based on the perspective of the persons involved
2.
Follows gut reaction and trusts instincts
3.
Ignores personal values
4.
Puts a plan into action but does not need to evaluate the plan
____ 36. The RN is assigned to 30 residents in a LTC facility. She is administering medications and is supposed to administer a heart medication. The apical pulse must be taken before the medication is given. The nurse feels she just doesn’t have time to stop and take the pulse. When she charts, she looks at the record of previous pulse counts and arrives at an average. She charts this pulse with the medication. This is an example of:
1.
ethical behavior.
2.
unethical behavior.
3.
abuse of power.
4.
deontology.
____ 37. The night shift nurse is late in coming into work to relieve the evening shift nurse. The evening shift nurse does not leave until a replacement nurse can be found. This is an example of the theory of:
1.
unethical behavior.
2.
utilitarianism.
3.
negligence.
4.
deontology.
____ 38. Using animals for research studies for human drugs is an example of which theory?
1.
Utilitarianism
2.
Deontology
3.
Permission to treat
4.
Informed consent
____ 39. The Nurse Practice Act is an example of which type of law?
1.
Common
2.
Statutory
3.
Institutional policies and procedures
4.
Criminal
____ 40. The rule that states a nurse must delegate care to another nurse while on a lunch break is an example of:
1.
regulatory law.
2.
statutory law.
3.
institutional policies and procedures.
4.
criminal law.
____ 41. A nurse works in delivery and is attending two women in labor. The patient in bed A asks how dilated the patient in bed B is. The nurse tells her, “She is farther along than you. She is 7 cm dilated and 100 percent effaced.” This is an example of:
1.
standard of care.
2.
informed consent.
3.
permission to treat.
4.
breaking confidentiality.
____ 42. One way to assure that you, as the nurse, have permission to treat a patient is:
1.
ask the patient to sign an informed consent document each time you administer medications.
2.
explain to patients the procedure you are going to do and what to expect.
3.
check admitting documents for permission to treat before entering a patient’s room.
4.
have patient cosign physician orders and medication sheets.
____ 43. Prior to surgery, the nurse should assure that which of the following tasks has been completed?
1.
Informed consent has been signed by the patient.
2.
ID band is attached to the patient.
3.
The patient understands the type of surgery that is being performed.
4.
All of the above are correct.
____ 44. A nurse writes in the nursing notes that a physician is “unreasonable and refuses to prescribe morphine for a patient in pain.” This is an example of:
1.
informed consent.
2.
libel.
3.
slander.
4.
negligence.
____ 45. The purpose of advanced directives is:
1.
to give guidance to the person who has durable power of attorney.
2.
to give caregivers authority to allow a patient to die with dignity.
3.
to allow an individual to instruct caregivers prior to surgery what their wishes are about end-of-life decisions.
4.
All of the above are correct.
____ 46. How can the RN expand practice areas without advancing their career by becoming a registered nurse?
1.
Attain certification in a specific area.
2.
Work in a nursing specialty area.
3.
Work in the same facility for five or more years.
4.
Learn by watching how other nurses perform at work.
____ 47. The nurse sets a goal in a career plan to be working as a charge nurse in one year. When the year has passed and the nurse is not working as a charge nurse, what priority action should the nurse take?
1.
Complain to the nursing supervisor because the nurse’s talents are not being fully utilized.
2.
Quit this job and find another job in a facility where nurses are promoted faster.
3.
Determine which of the nurse’s coworkers is most likely saying bad things about the nurse.
4.
Determine the reasons why the nurse hasn’t been promoted and create an action plan.
____ 48. The new graduate nurse is looking for a mentor and is considering several coworkers. Which experienced nurse would make the best mentor for the new graduate?
1.
The nurse who has a great sense of humor and always invites the new grad to go out after work.
2.
The nurse who says graduate nurses are poorly prepared and attended the same school as the graduate.
3.
The nurse who is always delegating to the graduate tasks like making beds and feeding patients.
4.
The nurse who is very skillful and often calls the graduate over to teach something new.
____ 49. The charge nurse tells the graduate nurse to talk to a dying patient’s family, who are very upset. The graduate says, “What should I say? I’ve never dealt with a situation like this before.” The charge nurse assures the graduate everything will be fine. What type of mentor is this charge nurse?
1.
Avoider
2.
Dumper
3.
Destroyer
4.
Blocker
____ 50. The new graduate accepts a position at a facility and is assigned a preceptor to act as a mentor during the orientation process. After two weeks on orientation the graduate overhears the preceptor telling a coworker, “This new graduate I’m working with is never going to make it as a nurse. She doesn’t know what she is doing.” What type of mentor is this preceptor?
1.
Avoider
2.
Dumper
3.
Destroyer
4.
Blocker
_____________________________________________________________________________
Answer
1. ANS: 3
The nurse manager needs to coordinate the creative ideas of the staff. The manager cannot unilaterally set goals but must add the input of all involved so goals can be achieved.
2. ANS: 1
The delegated task must be clearly identified before work can be assigned.
3. ANS: 2
You are gathering information about the client both subjectively and objectively, which will give you the information you need to make assignments.
4. ANS: 1
You demonstrate empowerment by showing respect for the staff and valuing their input.
5. ANS: 3
Accountability requires that the staff understands your expectations and that they are responsible for their assignments and goals.
6. ANS: 2
Formal recognition programs are important for employee morale and are a way of recognizing valued employees and their contributions.
7. ANS: 4
Mistakes are learning opportunities that should be dealt with positively, not negatively. Managers should help staff members learn from their mistakes.
8. ANS: 3
Most mistakes occur because the employee lacks knowledge about the policies and procedures of the facility. Teaching and providing the correct information will prevent the recurrence of errors.
9. ANS: 1
Counseling sessions are for discussions of either negative or positive behaviors.
10. ANS: 2
Counseling should be done in a nonconfrontational manner in a positive atmosphere.
11. ANS: 3
A positive approach to discipline is a problem-solving approach. A punitive focus emphasizes punishment for mistakes, whereas a positive approach means that the employee is being helped to improve performance.
12. ANS: 2
In performance analysis, the manager and the employee establish realistic targets for performance improvement together. This involves a focus on the future as opposed to a focus on the mistakes of the past.
13. ANS: 4
The performance review should be based on the employee’s job description. The review is designed to help the employee do a better job, so the manager should be aware of the job requirements.
14. ANS: 1
The contrast effect is when the manager rates the employee by comparing that employee with other employees. When managers use the contrast effect, they are not using the established performance standards of the facility.
15. ANS: 2
Goals or objectives are the tasks that both the manager and the employee agree should be completed during the evaluation time. Emphasis on goals focuses attention on individual achievements and motivates the employee. Goals are based on the employee’s strengths and weaknesses.
16. ANS: 1
A reasonable time frame should be established, which the employee should know.
17. ANS: 1
Acuity systems are used in making assignments by allocating patients by category to each staff member.
18. ANS: 3
A repeated occurrence or a severe violation of a rule warrants a written warning.
19. ANS: 3
Improving communication and offering staff nurses the opportunity to provide input and feedback is the goal of verbal reports and walking rounds.
20. ANS: 2
Coaching, demonstrated by the commendation provided by this nurse manager, pumps up the team’s enthusiasm.
21. ANS: 2, 3, 4
Joining a nursing organization will help to empower the new graduate by providing learning and growth opportunities. Learning increases the feeling of empowerment. Having a mentor who is experienced and works well with the RN will empower the new graduate.
22. ANS: 1, 5
Power is used for negative purposes when it is used without regard for the larger group or for personal gain. There is no caring in the use of this power.
23. ANS: 2, 3
The nurse helps others feel worthwhile by believing in them and treating them with dignity and respect. Advocacy is using your power with patients to help them reach their health goals.
24. ANS: 2
Use of the utilitarian approach often neglects those who are in a minority and may have special or serious needs.
25. ANS: 3
A nurse manager has additional legal responsibilities. As a manager, you are responsible not only for your own behavior, but also for the behavior of those whom you supervise.
26. ANS: 1
When you obtain a management position, you must be responsible for informing yourself about laws and agency regulations that apply to your position. It is also a good idea to informally increase your knowledge through nursing journals and newspapers.
27. ANS: 4
It is not ethical behavior for you to get the information you need from others or make do with limited information. Go to the instructor immediately so that the instructor can assist you in getting the correct information you need to provide safe patient care.
28. ANS: 4
Reporting the error to your supervisor is the appropriate action. The supervisor is then responsible for speaking to the resident and finding out what happened. Also, every person in the healthcare system has the absolute right to be protected from being discussed by inappropriate persons.
29. ANS: 1
Ethical dilemmas are situations that result in a conflict of two or more fundamental values. These dilemmas are complex and do not have apparent solutions.
30. ANS: 1
This is an example of ethical behavior. Even though your classmate may not be happy with your response, it is the correct action. It is very likely that when the instructor learns of the problem, the instructor would delay the test for this student. If you had allowed her to see your paper, you share in the act of cheating with your classmate. Cheating is never ethical behavior. Also, students must adjust their lives so they have time for study.
31. ANS: 4
Ethical behavior is the quest for ideal behavior.
32. ANS: 2
This is an example of unethical behavior. David's reasoning is faulty. Through his actions, he is putting his patient at risk for an infection. This should be his first priority in caring for Mr. Smith. His second priority should be to get the bath done well with good technique in a timely manner, so his patient will be comfortable and able to rest.
33. ANS: 3
Reporting to your instructor immediately is responsible and accountable behavior. Nursing requires ideal behavior both as a student practical nurse and as a RN.
34. ANS: 2
Personal values are personal beliefs about truth, thoughts, and behaviors of another person. These values are the underlying principle of ethical behavior.
35. ANS: 1
Using this type of thinking, the nurse does follow personal values and recognizes personal values of all involved. The nurse does not trust “gut reaction” but follows the steps for ethical reasoning.
36. ANS: 2
This is an example of unethical behavior. The RN is required to administer medication with accuracy. She is also lacking in honesty when she charted a blood pressure she did not take. Finally, she is putting the patient
at risk. Perhaps the patient’s blood pressure reading is such that the medication should be withheld and the doctor notified.
37. ANS: 4
Duty is what the theory of deontology represents. It is the nurse’s duty to remain at work until a competent replacement arrives. Leaving before the night nurse arrives is patient abandonment and can result in license suspension.
38. ANS: 1
Utilitarianism is the doctrine that what is useful is good and the determining consideration of right conduct should be the usefulness of its consequences. In other words, determining what is “right” is based on the greatest benefit for the greatest number of people.
39. ANS: 2
Statutory law has two component parts: enacted law and regulatory law. Enacted laws are the written and passed by a law-making body, such as the state and national legislatures. Enacted laws also can be made by city councils and county organizations. Regulatory laws are made by regulatory agencies to regulate or govern according to established rules. For example, regulatory laws for nursing are the rules and regulations of the State Board of Nursing.
40. ANS: 3
Institutional policies and procedures provide guidance to the nurse as to how a situation should be managed and the proper course of action to be taken. Frequently the court will consider institutional policies as common law.
41. ANS: 4
In addition to what a patient may share with you, you have access to the person’s hospital records. The law requires you to treat all such information with strict confidentiality.
42. ANS: 2
Patients admitted to hospitals, nursing homes, and home health services, sign a document that gives personnel permission to treat them. However, every time the nurse provides nursing care to a person, permission must be obtained. The courts have ruled that people are expected to have some understanding of basic care, which means the nurse should briefly explain what he or she is about to do without going into an exhaustive explanation.
43. ANS: 4
The law states that the persons receiving healthcare must give permission to treat based on informed consent. The principle of informed consent states that the person receiving the treatment fully understands the possible outcomes, alternatives to treatment, and all possible consequences.
44. ANS: 2
Defamation of character is the act of sharing information that is malicious and false. When the defamation is written it is called libel. Libelous defamation is most frequently seen on a chart when inappropriate comments are made about a patient or the patient’s family.
45. ANS: 4
The purpose of advance directives is to give the person an opportunity to make decisions regarding healthcare before an illness or a need for treatment that would prohibit making such critical decisions. The major decision
made is in regard to resuscitation. Some people have assigned a durable power of attorney to someone they trust to make healthcare decisions in their stead. Often, people designate on their advance directive a person assigned to sign consent forms and make other decisions about the welfare and treatment of the patient.
46. ANS: 1
An RN can expand his or her practice by becoming certified in a specific area. This certification can lead to a job change or advancement in the same facility. Professional healthcare organizations grant national certification in such areas as hospice care, gerontology, and stoma therapy. Certification also can come from an agency, such as certification in IV therapy.
47. ANS: 4
The nurse needs to figure out why a promotion has not been offered, and then create an action plan to improve the situation.
48. ANS: 4
Mentors should demonstrate a high level of skill and take interest in the graduate’s learning needs. So this individual would be a good choice.
49. ANS: 2
Dumpers throw people into new roles or positions and let them fail, which is exactly what this charge nurse is doing in this situation.
50. ANS: 3
Destroyers tear down the individual by tearing down the nurse’s self-confidence. This preceptor is acting as a destroyer, perhaps because she is threatened by the new nurse’s knowledge.
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