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NUR 4827 Leadership and management in Healthcare
Midterm Exam
Question 1
At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.  What is the best next action?
  Arrange another meeting in a week’s time so as to allow a cooling-off period
  Insist that participants continue to talk until a resolution has been reached
  Turn the dispute over tot he direcxtor of nursing
  Back the unit manager’s actions and end the dispute
Question 2
After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying.  What is the nurse manager’s decision based on?
   Unit protocol
  An established clinical pathway.
  Confirmatory scientific evidence.
Question 3
A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action?
Question 4
As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership.
Question 5
You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle?
  Development of networks
   Bottom-up interactions
  Systematic thinking
Question 6
As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report?
  Careful screening of nursing staff for substance use and abuse
  Increase in the percentage of baccalaureate-prepared nurses to 80%
   Salary and benefits that reflect nursing accountabilities
  Increased RN staffing on the unit
Question 7
In preparation for re-designation as a Magnet Hospital, how would you prepare?
  Commit staff resources over a 6-month period to updating procedure manuals.
  Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed.
  Educate staff through meetings and training sessions regarding appropriate answers to questions.
  Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.
Question 8
The SBAR approach to patient safety encourages which of the following?
  Continuing education.
  Patient feedback.
  Consistency in assessment and practices.
   Multidisciplinary approaches.
Question 9
As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to do which of the following?
  Re-visit reporting standards for medication errors in your organization.
  Provide staff with additional education related to safe practice in medication administration.
  Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
   Ensure that medication errors are consistently reported.
Question 10
A nurse executive is hired to restore a unit’s productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles?
  If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want.
  Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.
  Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage.
  The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment.
Question 11
After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:
  Through a relationship with a mentor.
  With the chief nursing officer of the organization.
   With the job description.
Question 12
The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager shoulddo which of the following?
  Explain in detail how well the new idea will work.
  Reason with staff members that the new idea will save money and allow more free time.
  Imply that raises will be smaller than anticipated if the new idea is not accepted.
  Reinforce how this change will respond to the ideas and solutions generated by staff members.
Question 13
Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce?
  An environment highlighted by lots of meetings, so staff members can have lots of input
  A nurturing and receptive environment
   A totally online environment, so staff members will not have to interface with uncaring colleagues
  A highly professional environment
Question 14
The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be:
  Well managed and well led.
  Overly led and overly managed.
  Poorly managed and well led.
  Overly managed and not well led.
Question 15
The adage “leaders are born and not made” reflects which of the following ideas around leadership?
  Leadership is a natural skill that cannot be refined or developed.
  Succession planning and formal education related to leadership are ineffective.
  Mentorship is important in developing innate skills of leaders.
  Management can be taught; leadership depends on abilities.
Question 16
A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:
  Negative organizational culture.
  Quantum leadership.
   Realities of current health care.
  Bureaucratic organization.
Question 17
As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to do which of the following?
  Succession planning.
  A manager’s role.
  Budget development.
  Encouragement of staff utilization of technology.
Question 18
To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and:
  Supersede the need for staff members to file incident reports.
  Compensate for previous injuries.
  Eliminate these risks before anyone else is harmed.
   Discipline staff members who have been involved in previous incident reports.
Question 19
The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. What is the best way for the nurse manager  to resolve the problem?
  Identify the problem.
   Obtain support from the 7-3 shift.
  Use institutional research.
  Use creativity.
Question 20
A clinic nurse has observed another nurse deviating from agency policy in performing wound care. What is the best approach for the clinic nurse to take?
  Assess the risk to the client and the agency before proceeding.
   Stay out of it.
  Fill out a notification form (incident report).
  Inform the nursing supervisor.
Question 21
John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. What is the reason for this?
  The policy was too lengthy and inundated readers with too much detail.
  The policy made decisions for other departments in the company.
   Testing should not be done in the lab.
  The staff did not believe that the new policy would be effective.
Question 22
Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
  Post a tentative schedule, and request feedback.
  Ask for requests for vacation time in advance, and post the times.
  Post the completed vacation schedule.
  Post a blank schedule, and ask staff members to fill in their times by a given date.
Question 23
A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his “acupuncture doctor” for treatment of his migraine headache. What is the best response to this patient?
  “Do you think acupuncture relieves your pain satisfactorily?”
  “Have you tried nonprescription pain medication or been given a prescription drug for your headaches?”
  “How long have you been using acupuncture treatment?”
   “What have you told your heart specialist about your migraines and treatment?”
Question 24
Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following?
   Genetic predisposition
  Shared vision
  love for people
Question 25
During managers’ meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say which of the following?
  “I wonder if we should consider changing our policy on performance appraisals? What do you think?”
   “Forget about change in this policy. It is fine as it is.”
  “Sean, your approach to appraisal is completely off track and does not reflect available evidence.”
  “The system that has been developed needs to be implemented. We have already spent enough time in discussion.”
Question 26
The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is which of the following?
   Task clarity
  A designated leader
Question 27
A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:
  If there are no agreements, each member will make up rules about how to handle disagreements and relationships.
   A way to eliminate nonproductive team members must be available.
  People are naturally difficult and will not work well together without such agreements.
  People will naturally ask for agreements about how to be together.
Question 28
The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?
  Speed up your internal processes so that you can process more data.
  Realize that the first words of the sender are the most important.
  Cultivate a desire to learn about the other person.
   Be prepared to make an effective judgment of the communication sender.
Question 29
You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to which of the following?
  Generational differences in communication.
  Therapeutic communication with patients.
  Increased emphasis on sender-receiver dyads.
  Effective communication in the workplace.
Question 30
Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:
  Is establishing career ladders for nurses.
  Has implemented a graduate nurse orientation program.
  Facilitates active staff participation in decision making related to quality nursing care.
   Espouses commitment to excellence in patient care.
Question 31
As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Why does your supervisor cautions you to also consider other sources of data for decisions?
  The return rate on patient questionnaires is frequently low.
  Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.
   Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness.
  Patients are rarely reliable sources about their own hospital experiences.
Question 32
Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?
   Line graphs
Question 33
The outcome statement “Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding” is:
  Physician-sensitive and nonmeasurable.
  Patient care–centered and nonmeasurable.
  Precise, measurable, and physician-sensitive.
  Measurable and nursing-sensitive.
Question 34
Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. What is this known as?
  Quality assurance
   Statistical analysis
  Sentinel data
Question 35
At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. What are these are known as?
  Medically sensitive events.
  Never events.
   Sentinel events.
  Nurse-sensitive events.
Question 36
The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice?
  Conducting a randomized control trial to determine effectiveness of handwashing techniques
  Developing standards for practice
  Using research-based information to develop practice guidelines
  Applying best research evidence to care of patients
Question 37
Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol?
  Using only pre-processed evidence
  Eliminating qualitative research studies
  Limiting the search to randomized clinical trials
  Matching the appraisal tool to the type of evidence
Question 38
Tara, the unit manager, is telling her colleague about her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is which of the following?
  Characterized by lack of knowledge about how to use evidence to guide practice.
  A priority of all healthcare practitioners to improve patient care.
   Less important than knowledge-generating research, which is required to advance the nursing profession.
  So difficult that it is useless to begin the query in the first place.
Question 39
The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO):
  Are intended to increase awareness of issues in incontinence management.
  Reflect practice that is fiscally directed and sound.
  Articulate practice recommendations developed from synthesis and review of evidence.
   Reflect a compilation of information from a variety and range of sources related to incontinence.
Question 40
Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to:
  Search large databases such as CINAHL to amass further evidence.
  Solicit input regarding integration with practice.
  Clarify the clinical practice question.
  Consider whether patients’ families see this as necessary for the well-being of family members.
Question 41
A nurse manager must be familiar with the agency’s policies regarding termination. Termination procedures include which of the following?
  Having a friend present during the termination meeting
  Having adequate written documentation to support the action
   Following specific procedures from other organizations
  Having an attorney present at the termination meeting
Question 42
All of the following are grounds for immediate dismissal except:
  Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.
  Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.
  Selling narcotics obtained from the unit supply of narcotics.
  Failing to pursue further medical help for a patient; patient dies.
Question 43
When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is:
  Asked to attend a union grievance meeting.
  Transferred to another unit.
  Suspended indefinitely.
  Terminated after the first infraction.
Question 44
Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding of which of the following?
  Violence is signaled by a variety of behaviors.
   Her perception is accurate.
  Yelling is more likely associated with aggression.
  She is mostly accurate in her thinking.
Question 45
Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression?
Question 46
Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply):
Question 47
With regard to nursing practice, nurse managers are held responsible for (select all that apply):
  Ensuring that physicians are properly licensed to provide care on patient care units.
  Referring all errors in nursing judgment to state discipline boards.
  Practicing within legal guidelines established under state law and nurse practice acts.
  Ensuring that nursing staff under their supervision are currently licensed to practice.
Question 48
Examples of sentinel events include which of the following:  (select all that apply)
  Administration of morphine overdose.
  Forceps left in an abdominal cavity.
  Patient fall, with injury.
  Death of patient related to postpartum hemorrhage
  Short staffing.
Question 49
A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding (select all that apply):
  Feasibility of the program with respect to unit design.
  Compatibility of this intervention with the values of staff on the unit.
  Usefulness of prompted voiding with the particular population of patients on the unit.
  Advantages of prompted voiding over incontinence products and catheterizations.
Question 50
Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah’s peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
  “It is a nurse’s professional responsibility to maintain quality control.”
  “Patient care is the number one concern. Meeting standards is mandatory and necessary.”
  “It is not considered being disloyal when one nurse reports another for poor care.”
  “All instances of clinical incompetence are to be reported.”

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