2020 Exam 2

Question 1

A patient suffered a brain injury from a motor vehicle accident and has no brain activity. The patient has a living will which states no heroic measures. The family requests that no additional heroic measures be instituted for their son. The nurse respects this decision in keeping with which principle?

a. Accountability
b. Autonomy
c. Nonmaleficence
d. Veracity

Answer 1

b. Autonomy

Patients and families must be treated in a way that respects their autonomy and their ability to express their wishes and make informed choices about their treatment. Accountability is inherent in the nurse’s ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. Veracity means telling the truth as a moral and ethical requirement.

Question 2

A male patient suffered a brain injury from a motor vehicle accident and has no brain activity. The spouse has come up to see the patient every day for the past 2 months. She asks the nurse, “Do you think when he moves his hands he is responding to my voice?” The nurse feels bad because she believes the movements are involuntary, and the prognosis is grim for this patient. She states, “He can hear you, and it appears he did respond to your voice.” The nurse is violating which principle of ethics?

a. Autonomy
b. Veracity
c. Utilitarianism
d. Deontology

Answer 2

b. Veracity

Veracity is the principle of telling the truth in a given situation. Autonomy is the principle of respect for the individual person; this concept states that humans have incalculable worth or moral dignity. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Giving the spouse false reassurance is not a good consequence. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in themselves and never as means to the ends of others.

Question 3

The nurse is faced with an ethical issue. When assessing the ethical issue, which action should the nurse perform first?

a. Ask, “What is the issue?”
b. Identify all possible alternatives.
c. Select the best option from a list of alternatives.
d. Justify the choice of action or inaction.

Answer 3

a. Ask, “What is the issue?”

The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort that is required to understand an issue fully before moving forward in the assessment procedure. Identifying alternatives is the second step in the situation assessment procedure. A set of alternatives cannot be established until an assessment has been completed. Selecting the best option is actually the third step in the situation assessment procedure. Options cannot be selected until an assessment has been done to define the issue. Justifying the action or inaction is the final step in the situational assessment procedure. No justification can be made until the assessment and action phases have been completed.

Question 4

A nursing student is conducting a survey of fellow nursing students. Which ethical concept is the student following when calculating the risk-to-benefit ratio and concluding that no harmful effects were associated with a survey?

a. Beneficence
b. Human dignity
c. Justice
d. Human rights

Answer 4

a. Beneficence

Beneficence is a term that is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. Human dignity is the inherent worth and uniqueness of a person. Justice involves upholding moral and legal principles. Human rights are the basic rights of each individual.

Question 5

A nurse on the unit makes an error in the calculation of the dose of medication for a critically ill patient. The patient suffered no ill consequences from the administration. The nurse decides not to report the error or file an incident report. The nurse is violating which principle of ethics?

a. Fidelity
b. Individuality
c. Justice
d. Values clarification

Answer 5

a. Fidelity

Fidelity is the principle that requires us to act in ways that are loyal. In the role of a nurse, such action includes keeping your promises, doing what is expected of you, performing your duties, and being trustworthy. Individuality is something that distinguishes one person or thing from others. Injustice is when a person is denied a right or entitlement. Values clarification is a tool that allows the nurse to examine personal values in terms of ethical situations.

Question 6

An unconscious patient is treated in the emergency department for head trauma. The patient is unconscious and on life support for 2 weeks prior to making a full recovery. The initial actions of the medical team are based on which ethical principle?

a. Utilitarianism
b. Deontology
c. Autonomy
d. Veracity

Answer 6

b. Deontology

Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Autonomy is the principle of respect for the individual person. People are free to form their own judgments and perform whatever actions they choose. Veracity is defined as telling the truth in personal communication as a moral and ethical requirement.

Question 7

A drug-addicted nurse switches a patient’s morphine injection with normal saline so that the nurse can use the morphine. The nurse is violating which principles of ethics? (Select all that apply.)

a. Autonomy
b. Utilitarianism
c. Beneficence
d. Dilemmas
e. Veracity

Answer 7

ANS: A, B, C, E

a. Autonomy
b. Utilitarianism
c. Beneficence
e. Veracity

Beneficence is providing benefit to others by promoting their welfare. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the patient’s pain medication and substituting saline, the nurse did harm, not good, for the patient. Autonomy is the principle of respect for the individual person; the nurse does not respect someone upon whom the nurse is inflicting harm. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the patient’s pain medication was taken away, the consequences were all bad. Dilemmas are not included as a principle of ethics. Veracity involves truth-telling.

Question 8

Four patients in labor all request epidural analgesia to manage their pain at the same time. Which ethical principle is most compromised when only one nurse anesthetist is on call?

a. Justice
b. Fidelity
c. Beneficence
d. Nonmaleficence

Answer 8

a. Justice

Justice refers to fairness and is used frequently in discussion regarding access to health care resources. Here the just distribution of resources, in this case pain management, cannot be justly apportioned. Nonmaleficence refers to avoidance of harm; beneficence refers to taking positive actions to help others. Fidelity refers to the agreement to keep promises. Each of these principles is partially expressed in the question; however, justice is most comprised because not all laboring patients have equal access to pain management owing to lack of personnel resources.

Question 9

The patient reports to the nurse of being afraid to speak up regarding a desire to end care for fear of upsetting spouse and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patient’s cause?

a. Advocacy
b. Responsibility
c. Confidentiality
d. Accountability

Answer 9

a. Advocacy

Nurses advocate for patients when they support the patient’s cause. A nurse’s ability to adequately advocate for a patient is based on the unique relationship that develops and the opportunity to better understand the patient’s point of view. Responsibility refers to respecting one’s professional obligations and following through on promises. Confidentiality deals with privacy issues, and accountability refers to answering for one’s actions.

Question 10

The patient’s son requests to view documentation in the medical record. What is the nurse’s best response to this request?

a. “I’ll be happy to get that for you.”
b. “You are not allowed to look at it.”
c. “You will need your mother’s permission.”
d. “I cannot let you see the chart without a doctor’s order.”

Answer 10

c. “You will need your mother’s permission.”

The mother’s permission is needed. The nurse understands that sharing health information is governed by HIPAA legislation, which defines rights and privileges of patients for protection of privacy. Private health information cannot be shared without the patient’s specific permission. The nurse cannot obtain the records without permission. The son can look at it after approval from the patient. While talking to the physician or getting an order is appropriate, the patient

Question 11

When professionals work together to solve ethical dilemmas, nurses must examine their own values. What is the best rationale for this step?

a. So fact is separated from opinion
b. So different perspectives are respected
c. So judgmental attitudes can be provoked
d. So the group identifies the one correct solution

Answer 11

b. So different perspectives are respected

Values are personal beliefs that influence behavior. To negotiate differences of value, it is important to be clear about your own values: what you value, why, and how you respect your own values even as you try to respect those of others whose values differ from yours. Ethical dilemmas are a problem in that no one right solution exists. It is not to separate fact from opinion. Judgmental attitudes are not to be used, much less provoked.

Question 12

A nurse is experiencing an ethical dilemma with a patient. Which information indicates the nurse has a correct understanding of the primary cause of ethical dilemmas?

a. Unequal power
b. Presence of conflicting values
c. Judgmental perceptions of patients
d. Poor communication with the patient

Answer 12

b. Presence of conflicting values

Ethical dilemmas almost always occur in the presence of conflicting values. While unequal power, judgmental perceptions, and poor communication can contribute to the dilemma, these are not causes of a dilemma. Without clarification of values, t

Question 13

The nurse questions a health care provider’s decision to not tell the patient about a cancer diagnosis. Which ethical principle is the nurse trying to uphold for the patient?

a. Consequentialism
b. Autonomy
c. Fidelity
d. Justice

Answer 13

b. Autonomy

The nurse is upholding autonomy. Autonomy refers to the freedom to make decisions free of external control. Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care. Consequentialism is focused on the outcome and is a philosophical approach. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.

Question 14

The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment?

a. Scrutinize personal values.
b. Call for an ethical committee consult.
c. Decline the assignment on religious grounds.
d. Convince the family to challenge the directive.

Answer 14

a. Scrutinize personal values.

Clarifying values—your own, your patients’, your co-workers’—is an important and effective part of ethical discourse. Calling for a consult, declining the assignment, and convincing the family to challenge the patient’s directive are not ideal resolutions because they do not address the reason for the nurse’s discomfort, which is the conflict between the nurse’s values and those of the patient. The nurse should value the patient’s decisions over the nurse’s personal values.

Question 15

The nurse values autonomy above all other principles. Which patient assignment will the nurse find most difficult to accept?

a. Older-adult patient who requires dialysis
b. Teenager in labor who requests epidural anesthesia
c. Middle-aged father of three with an advance directive declining life support
d. Family elder who is making the decisions for a young-adult female member

Answer 15

d. Family elder who is making the decisions for a young-adult female member

Autonomy refers to freedom from external control. A person who values autonomy highly may find it difficult to accept situations where the patient is not the primary decision maker regarding his or her care. A teenager requesting an epidural, a father with an advance directive, and an elderly patient requiring dialysis all describe a patient or family who can make their own decisions and choices regarding care.

Question 16

A nurse must make an ethical decision concerning vulnerable patient populations. Which philosophy of health care ethics would be particularly useful for this nurse?

a. Teleology
b. Deontology
c. Utilitarianism
d. Feminist ethics

Answer 16

d. Feminist ethics

Feminist ethics particularly focuses on the nature of relationships, especially those where there is a power imbalance or a point of view that is ignored or invisible. Deontology refers to making decisions or “right-making characteristics,” bioethics focuses on consensus building, while utilitarianism and teleology speak to the greatest good for the greatest number.

Question 17

A nurse agrees with regulations for mandatory immunizations of children. The nurse believes that immunizations prevent diseases as well as prevent spread of the disease to others. Which ethical framework is the nurse using?

a. Deontology
b. Ethics of care
c. Utilitarianism
d. Feminist ethics

Answer 17

c. Utilitarianism

Utilitarianism is a system of ethics that believes that value is determined by usefulness. This system of ethics focuses on the outcome of the greatest good for the greatest number of people. Deontology would not look to consequences of actions but on the “right-making characteristic” such as fidelity and justice. The ethics of care emphasizes the role of feelings. Relationships, which are an important component of feminist ethics, are not addressed in this case.

Question 18

The nurse has become aware of missing narcotics in the patient care area. Which ethical principle obligates the nurse to report the missing medications?

a. Advocacy
b. Responsibility
c. Confidentiality
d. Accountability

Answer 18

b. Responsibility

Responsibility refers to one’s willingness to respect and adhere to one’s professional obligations. It is the nurse’s responsibility to report missing narcotics. Accountability refers to the ability to answer for one’s actions. Advocacy refers to the support of a particular cause. The concept of confidentiality is very important in health care and involves protecting patients’ personal health information.

Question 19

A young woman who is pregnant with a fetus exposed to multiple teratogens consents to have her fetus undergo serial PUBS (percutaneous umbilical blood sampling) to examine how exposure affects the fetus over time. Although these tests will not improve the fetus’s outcomes and will expose it to some risks, the information gathered may help infants in the future. Which ethical principle is at greatest risk?

a. Fidelity
b. Autonomy
c. Beneficence
d. Nonmaleficence

Answer 19

d. Nonmaleficence

Nonmaleficence is the ethical principle that focuses on avoidance of harm or hurt. Repeated PUBS may expose the mother and fetus to some risks. Fidelity refers to the agreement to keep promises (obtain serial PUBS). Autonomy refers to freedom from external control (mother consented), and beneficence refers to taking positive actions to help others

Question 20

A nurse is discussing quality of life issues with another colleague. Which topic will the nurse acknowledge for increased attention paid to quality of life concerns?

a. Health care disparities
b. Aging of the population
c. Abilities of disabled persons
d. Health care financial reform

Answer 20

c. Abilities of disabled persons

The population of disabled persons in the United States and elsewhere has reshaped the discussion about quality of life (QOL). Health care disparities, an aging population, and health care reform are components impacted by personal definitions of quality but are not the underlying reason why QOL discussions have arisen.

Question 21

Which action by the nurse indicates a safe and efficient use of social networks?

a. Promotes support for a local health charity
b. Posts a picture of a patient’s infected foot
c. Vents about a patient problem at work
d. Friends a patient

Answer 21

a. Promotes support for a local health charity

Social networks can be a supportive source of information about patient care or professional nursing activities. Even if you post an image of a patient without any obvious identifiers, the nature of shared media reposting can result in the image surfacing in a place where just the context of the image provides clues for friends or family to identify the patient. The ANA and NCSBN states, “Effective nurse-patient relationships are built on trust. Patients need to be confident that
their most personal information and their basic dignity will be protected by the nurse.” Becoming friends in online chat rooms, Facebook, or other public sites can interfere with your ability to maintain a therapeutic relationship.

Question 22

The nurse is caring for a dying patient. Which intervention is considered futile?

a. Giving pain medication for pain
b. Providing oral care every 5 hours
c. Administering the influenza vaccine
d. Supporting lower extremities with pillows

Answer 22

c. Administering the influenza vaccine

Administering the influenza vaccine is futile. A vaccine is administered to prevent or lessen the likelihood of contracting an infectious disease at some time in the future. The term futile refers to something that is hopeless or serves no useful purpose. In health care discussions the term refers to interventions unlikely to produce benefit for a patient. Care delivered to a patient at the end of life that is focused on pain management, oral hygiene, and comfort measures is not futile.

Question 23

During a severe respiratory epidemic, the local health care organizations decide to give health care workers priority access to ventilators over other members of the community who also need that resource. Which philosophy would give the strongest support for this decision?

a. Deontology
b. Utilitarianism
c. Ethics of care
d. Feminist ethics

Answer 23

b. Utilitarianism

Utilitarianism focuses on the greatest good for the most people; the organizations decide to ensure that as many health care workers as possible will survive to care for other members of the community. Deontology defines actions as right or wrong based on their “right-making characteristics” such as fidelity to promises, truthfulness, and justice. Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible. The ethics of care and feminist ethics are closely related, but ethics of care emphasizes the role of feelings.

Question 24

A nurse is teaching a patient and family about quality of life. Which information should the nurse include in the teaching session about quality of life?

a. It is deeply social.
b. It is hard to define.
c. It is an observed measurement for most people.
d. It is consistent and stable over the course of one’s lifetime.

Answer 24

b. It is hard to define.

Quality of life remains deeply individual (not social) and difficult to predict. Quality of life is not just a measurable entity but a shared responsibility. Quality of life measures may take into account the age of the patient, the patient’s ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality.

Question 25

The nurse is caring for a patient supported with a ventilator who has been unresponsive since arrival via ambulance 8 days ago. The patient has not been identified, and no family members have been found. The nurse is concerned about the plan of care regarding maintenance or withdrawal of life support measures. Place the steps the nurse will use to resolve this ethical dilemma in the correct order. 1. The nurse identifies possible solutions or actions to resolve the dilemma. 2. The nurse reviews the medical record, including entries by all health care disciplines, to gather information relevant to this patient’s situation. 3. Health care providers use negotiation to redefine the patient’s plan of care. 4. The nurse evaluates the plan and revises it with input from other health care providers as necessary. 5. The nurse examines the issue to clarify opinions, values, and facts. 6. The nurse states the problem. a. 6, 1, 2, 5, 4, 3 b. 5, 6, 2, 3, 4, 1 c. 1, 2, 5, 4, 3, 6 d. 2, 5, 6, 1, 3, 4

Answer 25

ANS: d. 2, 5, 6, 1, 3, 4 Step 1. Gather as much information as possible that is relevant to the case. Step 2. Examine and determine your values about the issues. Step 3. Verbalize the problem. Step 4. Consider possible courses of action. Step 5. Negotiate the outcome. Step 6. Evaluate the action.

Question 26

A nurse is a member of the ethics committee. Which purposes will the nurse fulfill in this committee? (Select all that apply.) a. Education b. Case consultation c. Purchasing power d. Direct patient care e. Policy recommendation

Answer 26

ANS: A, B, E a. Education b. Case consultation e. Policy recommendation An ethics committee devoted to the teaching and processing of ethical issues and dilemmas exists in most health care facilities. It is generally multidisciplinary and it serves several purposes: education, policy recommendation, and case consultation. It does not have purchasing power or provide direct patient care.

Question 27

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee’s good qualities and that they give positive direction for professional growth. This belief is an example of: a. Justice. b. Fidelity. c. Beneficence. d. Nonmaleficence.

Answer 27

d. Nonmaleficence. Nonmaleficence refers to “doing no harm.” For a nurse manager following this principle, performance evaluation should emphasize an employee’s good qualities and give positive direction for growth. Destroying the employee’s self-esteem and self-worth would be considered doing harm under this principle.

Question 28

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. The ethical principle that you are most directly reinforcing is: a. Justice. b. Fidelity. c. Paternalism. d. Respect for others.

Answer 28

c. Paternalism. The principle of paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. Paternalism becomes undesirable when the entire decision is taken away from the employee.

Question 29

A patient refuses a simple procedure that you believe is in the patient’s best interest. The two ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice. b. Veracity and fidelity. c. Autonomy and beneficence. d. Paternalism and respect for others.

Answer 29

c. Autonomy and beneficence. Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence to doing good (performing a procedure that will benefit the patient).

Question 30

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers: a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

Answer 30

a. Make reasonable accommodations for persons who are disabled. The purposes of the ADA are to eliminate discrimination against persons with disabilities and to provide consistent, enforceable standards to address discrimination in the workplace.

Question 31

A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse: a. Had previously reported the complaint, in writing, to hospital administration. b. Had threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

Answer 31

a. Had previously reported the complaint, in writing, to hospital administration. An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law.

Question 32

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook: a. Under the doctrine of apparent agency. b. Under the doctrine of respondeat agency. c. Based on the employee’s or the employer’s expectations. d. Based on the theory that the handbook creates an explicit contract.

Answer 32

c. Based on the employee’s or the employer’s expectations. The handbook is an implied contract and frames the employment contract.

Question 33

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: a. Compensate for previous injuries. b. Eliminate these risks before anyone else is harmed. c. Supersede the need for staff members to file incident reports. d. Discipline staff members who have been involved in previous incident reports.

Answer 33

b. Eliminate these risks before anyone else is harmed. Risk management involves taking proactive steps to identify and eliminate risks and liability.

Question 34

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is: a. Employing additional staff to assist with orientation processes. b. Cross-educating staff members to other areas of the institution. c. Transferring patients to units where the staffing pattern is optimal. d. Orienting staff members to all patient care areas as part of their general orientation to the institution.

Answer 34

b. Cross-educating staff members to other areas of the institution. Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

Question 35

A colleague asks you to give her your password access so that she can view her partner’s healthcare record. This request violates the patient’s right to: a. Privacy. b. Confidentiality. c. Undue authorization of treatment. d. Protection against slander.

Answer 35

a. Privacy. Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient’s solitude. Privacy standards limit how personal health information may be used or shared and mandate safeguards for the protection of health information. Institutions can reduce potential liability in this area by allowing access to patient data, either written or oral, only to those with a “need to know.” Persons with a need to know include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and patient advocates. Others wishing to access patient data must first ask the patient for permission to review a record.

Question 36

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. Two nursing practice acts. b. Two nursing practice acts in most states. c. At least one nursing practice act. d. One nursing practice act and a medical act.

Answer 36

c. At least one nursing practice act. In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards.

Question 37

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions may not apply in this situation? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

Answer 37

a. Injury By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

Question 38

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for: a. Professional negligence. b. Assault. c. Avoidance. d. Murder.

Answer 38

a. Professional negligence. Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child’s condition.

Question 39

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son’s deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

Answer 39

b. Under the doctrine of respondeat superior. Known as vicarious liability, the doctrine of respondeat superior makes employers accountable for the negligence of their employees, using the rationale that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.

Question 40

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. Is limited to the temporary agency. b. Is restricted to the RN. c. Could include the RN, the agency, and your institution. d. May depend on the patient’s belief regarding the employment relationship.

Answer 40

d. May depend on the patient’s belief regarding the employment relationship. Apparent agency may apply here because your liability and that of your institution could be established if it can be shown that the patient believes that the RN was an employee of yours and of your institution.

Question 41

You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. The teen is underage and should be referred to the family general practitioner. c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. d. Treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

Answer 41

c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.

Question 42

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

Answer 42

a. Beneficence Beneficence refers to doing what’s good for the patient; in this situation, doing what’s good means providing care to the patient with the best likelihood of recovery.

Question 43

Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

Answer 43

b. Autonomy Autonomy refers to the right to choose freely, which is inherent in informed consent.

Question 44

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

Answer 44

c. Fidelity Fidelity refers to promise keeping or upholding one’s promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner.

Question 45

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with: a. Privacy. b. Confidentiality. c. Veracity. d. Informed consent.

Answer 45

a. Privacy. Privacy protection includes protection against unwarranted intrusion into the patient’s affairs.

Question 46

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

Answer 46

d. Supervising the practice of the physician. Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.

Question 47

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

Answer 47

b. Pennsylvania Under the law, the state in which the patient resides and not the state where the nurse holds his or her license determines the state nurse practice act that is considered.

Question 48

A member of a patient’s family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. Compromised agency. b. Moral distress. c. Moral sensitivity. d. Moral dilemma.

Answer 48

b. Moral distress. Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers.

Question 49

While walking past a patient’s room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. Discuss that statute law provides for patient autonomy and refusal of treatment. c. Remind the nurse to provide clearer explanations to aid in the patient’s comprehension of the treatment and compliance. d. Acknowledge the nurse’s role in ensuring that she does not fail in her duty of care for the patient.

Answer 49

b. Discuss that statute law provides for patient autonomy and refusal of treatment. Statute law states that the patient must be given sufficient information, in terms he or she can reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine of informed consent is the right of the patient to informed refusal. Patients must clearly understand the possible consequences of their refusal.

Question 50

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won’t sign because he doesn’t understand the nature of the surgery. You advise that (select all that apply): a. Consent must not be coerced. b. The patient has a right to choose not to consent. c. The patient must sign the consent because the doctor wants him to sign. d. Witnessing a consent is related only to the voluntary nature of the signature.

Answer 50

ANS: A, B, D a. Consent must not be coerced. b. The patient has a right to choose not to consent. d. Witnessing a consent is related only to the voluntary nature of the signature. Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing a consent means attesting to the voluntary nature of the patient’s signature.

Question 51

With regard to nursing practice, nurse managers are held responsible for (select all that apply): a. Practicing within legal guidelines established under state law and nurse practice acts. b. Ensuring that nursing staff under their supervision are currently licensed to practice. c. Referring all errors in nursing judgment to state discipline boards. d. Ensuring that physicians are properly licensed to provide care on patient care units.

Answer 51

ANS: A, B a. Practicing within legal guidelines established under state law and nurse practice acts. b. Ensuring that nursing staff under their supervision are currently licensed to practice. Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid licensure.

Question 52

According to Leininger, “cultural imposition” is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: a. Abortion. b. Wound management. c. Blood transfusion. d. Advance directives.

Answer 52

b. Wound management. Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses.

Question 53

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. Task force formed to commemorate a New Year’s celebration in the Western tradition. b. Project to provide Christmas gifts to the children in a daycare program. c. Celebration of National Nurses Week with the focus on cultural care. d. Task force to develop a poster for the unit depicting religions of the world.

Answer 53

c. Celebration of National Nurses Week with the focus on cultural care. Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses Week, with a focus on nursing interests, reflects the culture of nursing.

Question 54

One of the staff nurses on your unit makes the comment, “All this time I thought Mary was black. She says she is Jamaican.” The best response would be to say: a. “Who cares what she is?” b. “What did you think when you learned she was Jamaican?” c. “Why did you assume she was black?” d. “We have never had a Jamaican on this unit.”

Answer 54

b. “What did you think when you learned she was Jamaican?” The response of the nurse manager invites cultural awareness, which involves self-examination and in-depth exploration of one’s own biases, prejudices, and assumptions.

Question 55

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, “Why is it that when John and I work together in giving patients care, he jokes about my being “a little fat Mexican”? The nurse manager’s best response is, “Do you think he: a. Is sensitive to your culture?” b. Wants to learn more about you?” c. Has been hurt and wants to hurt others?” d. Is stereotyping you without thinking?”

Answer 55

d. Is stereotyping you without thinking?” Prejudices “enable us to make sense of the situations in which we find ourselves, yet they also constrain understanding and limit the capacity to come to new or different ways of understanding. It is this contradiction that makes prejudice paradoxical.” (Spence, 2004, p. 163). Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights.

Question 56

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient’s eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. Acculturation. b. Ethnocentricity. c. Cultural diversity. d. Cultural sensitivity.

Answer 56

d. Cultural sensitivity. Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people.

Question 57

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. The best response to this patient would be: a. “How long have you been using acupuncture treatment?” b. “Do you think acupuncture relieves your pain satisfactorily?” c. “What have you told your heart specialist about your migraines and treatment?” d. “Have you tried nonprescription pain medication or been given a prescription drug for your headaches?”

Answer 57

a. “How long have you been using acupuncture treatment?” Acknowledging the patient’s use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patient’s cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurse’s experience of health care in Western cultures.

Question 58

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill. b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia. c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.

Answer 58

c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. The cultural and religious backgrounds of nurses influence their perceptions of dignity-conserving care. For example, foreign-born Catholic nurses stated the dying experience should not be altered by analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Approaches to working with differences in the diverse cultural and religious backgrounds of patients, families, and nurses alike include taking time to have conversational chats with patients in end-of-life and with colleagues that will facilitate learning about each other and provide care that fits with the patient’s cultural beliefs about dying.

Question 59

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? a. Behavior b. Love for people c. Shared vision d. Genetic predisposition

Answer 59

a. Behavior Culture is determined by behaviors and beliefs and develops slowly.

Question 60

The nurse manager for a unit’s culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time. b. Maintains a strong work ethic. c. Changes easily. d. Develops quickly.

Answer 60

a. Develops over time. Culture is a patterned behavioral response that evolves slowly as times change. The culture may or may not maintain a strong work ethic.

Question 61

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. Diabetes. b. Cardiovascular disease. c. Cancer. d. Asthma.

Answer 61

a. Diabetes. Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics.

Question 62

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: a. Dominant versus nondominant behaviors. b. The need to recognize diversity within groups. c. The impact of cross-culturalism. d. How language separates subgroups.

Answer 62

b. The need to recognize diversity within groups. When working with various cultural groups and diversity, it is important to recognize that diversity also exists within groups. Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable.

Question 63

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate’s lack of eye contact reflects the candidate’s: a. Lack of confidence. b. Professional behavior. c. Cultural sensitivity. d. Ethnicity.

Answer 63

d. Ethnicity. Ethnicity refers to groups of people who are classified according to common racial, tribal, religious, linguistic, or cultural backgrounds.

Question 64

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her “book learning” is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. Cultural awareness. b. Cultural sensitivity. c. Acculturation. d. Cultural marginality.

Answer 64

c. Acculturation. In accepting the practices of the dominant group on the unit, Mary is demonstrating acculturation.

Question 65

At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. Ethnicity. b. Work environment. c. Work culture. d. Marginalization.

Answer 65

c. Work culture. Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty.

Question 66

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a “family” and that staff members take pride in saying that they are from Unit 4. d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.

Answer 66

a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals now define themselves as members of the dominant culture and is evidenced by when individuals say they are from where they live and practice. When individuals grow up within a culture and take on the characteristics of that culture, it is referred to as socialization. Assisting the staff to recognize differences in the relationships between physicians and nurses on the unit and those in their country of origin is assisting adaptation or acculturation and is promoting positive patient outcomes.

Question 67

During managers’ meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. “I wonder if we should consider changing our policy on performance appraisals? What do you think?” b. “Sean, your approach to appraisal is completely off track and does not reflect available evidence.” c. “The system that has been developed needs to be implemented. We have already spent enough time in discussion.” d. “Forget about change in this policy. It is fine as it is.”

Answer 67

a. “I wonder if we should consider changing our policy on performance appraisals? What do you think?” Males and females in the workplace are likely to have different management styles, and although not all males are authoritative or females more participatory, women are likely to use more participatory and inclusive methods.

Question 68

As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation

Answer 68

c. Multiculturalism Multiculturalism refers to maintaining several different cultures, such as the uniqueness of different work units. Cross-culturalism means mediating between/among cultures, and transculturalism denotes bridging significant differences in cultural practices.

Question 69

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients’ feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia’s culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. Bias. b. Cultural awareness. c. Cultural diversity. d. Ethnocentricity.

Answer 69

b. Cultural awareness. Cultural awareness involves self-examination and in-depth exploration of one’s own cultural and professional background, including biases, prejudices, and assumptions, including assumptions about thinking modes and decision making.

Question 70

Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. Stereotyping. b. Cultural diversity. c. Ethnocentricity. d. Transcultural care.

Answer 70

d. Transcultural care. Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status.

Question 71

Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: a. Eye contact. b. Personal space. c. Harassment. d. Expressions of feeling.

Answer 71

b. Personal space. Body movements, eye contact, gestures, verbal tone, and physical closeness when communicating are all part of a person’s culture. For the nurse manager, understanding these cultural behaviors is critical in accomplishing effective communication within the diverse workforce population.

Question 72

A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. Having cultural sensitivity. b. Experiencing cultural diversity. c. Experiencing cultural marginality. d. Experiencing acculturation.

Answer 72

c. Experiencing cultural marginality. The new graduate is caught between two cultures at this point—work and education—and expresses feelings of belonging to neither.

Question 73

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: a. Lack of understanding of the seriousness of the patient’s illness. b. Lack of communication between family members. c. The social organization of friendships and family networks in East Indian culture. d. Lack of caring about the hospital environment by the friends and family.

Answer 73

c. The social organization of friendships and family networks in East Indian culture. The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision of care for patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures.

Question 74

Sarah, one of your RNs, tells you that she can’t understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah’s response is based on her: a. Cultural marginality. b. Circle of familiarity. c. Cultural understanding. d. Acculturation.

Answer 74

b. Circle of familiarity. The “circle of familiarity” refers to constrained interpretation based on one’s values, attitudes, and beliefs.

Question 75

Sarah, one of your RNs, tells you that she can’t understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? a. “Explain to Jim that there is no smoking in the hospital.” b. “Inform Jim that fires are not allowed in the hospital.” c. “Insist that he give you his tobacco because it is unhealthy for him.” d. “Ask him what he means by a smudge and what meaning it has for him.”

Answer 75

d. “Ask him what he means by a smudge and what meaning it has for him.” By talking with Jim, Sarah is able to step outside her “circle of familiarity” and find and enhance her understanding of personally held prejudices. Prejudice enables Sarah to find meaning in situations, but it also limits understanding. Paradox describes this tension. We have the responsibility to acknowledge the “possibility of tension” as a potential for new and different understandings derived from our communication and interpretation. Possibility, therefore, presumes a condition for openness with a person from another culture (Spence, 2004).

Question 76

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)? a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others

Answer 76

ANS: B, C, D b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences.

Question 77

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because: a. Nurses freely chose to defer to physicians and administrators with more education. b. Women lacked legal, social, and political power because of legal and cultural barriers. c. The first nursing licensure laws prohibited nurses from making most decisions. d. Nurses astutely recognized the risks of grabbing too much power too soon.

Answer 77

b. Women lacked legal, social, and political power because of legal and cultural barriers. Nursing mirrored the lack of legal, social, and political power that was prevalent in the early decades of the profession.

Question 78

Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations: a. Refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. Do not understand how their failure to exercise power can limit the power of the whole profession. c. Purposefully choose to exercise their power in the workplace through indirect means. d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.

Answer 78

b. Do not understand how their failure to exercise power can limit the power of the whole profession. Becoming an active, productive, collegial member of groups and teams within the workplace and in professional associations and community groups ensures that the nursing voice is heard on healthcare issues and problems and is an appropriate exercise of power.

Question 79

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse’s district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness

Answer 79

d. Political astuteness Political involvement is a professional responsibility and nurses’ perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation’s political leadership. This nurse exemplifies several of the skills associated with political astuteness.

Question 80

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information

Answer 80

c. Referent, expert, and information Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, and he has information that he is willing to share, which gives him the power of information. The employee sees him as credible and seeks his advice, which gives him referent power.

Question 81

A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate. b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only. c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing. d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.

Answer 81

a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate. Empowerment is the process of exercising one’s own power to facilitate the participation of others in decision making and taking action so they are free to exercise power It means releasing authority and enabling others to have accountability, for participation and decisions.

Question 82

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry

Answer 82

a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise A powerful and positive approach is communicated through confident behaviors such as greeting others, smiling, and showing respect for the opinions of others through listening. Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to be firm and confident.

Question 83

Two nurses approach their manager about a conflict regarding the next month’s schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. Taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. Separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. Calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.

Answer 83

b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. Negotiation involves the presentation of an opening position with each party, then moving on until they achieve a mutually agreeable result or until one or both move away from a failed negotiation. Negotiation occurs when one party has something that the other party values, such as a desired schedule.

Question 84

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conferences for nurse managers and executives and volunteering to help with professional organizations’ informal luncheons and receptions

Answer 84

c. Making a long overdue return call to a former colleague who is now a chief nurse executive Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one’s place of employment.

Question 85

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. Using power. b. Empowering others. c. Understanding power. d. Moving past apathy.

Answer 85

a. Using power. Influence involves the use of power to effect certain outcomes—in this situation, to arrange days off for a valued employee.

Question 86

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because: a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families.

Answer 86

d. They are closest to the front line of health care and see how it affects clients and families. Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses’ perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation’s political leadership.

Question 87

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses. b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community. c. Morale on her unit can be improved by engaging in shared decision making. d. Identify the informal leaders on her unit and how they affect care decisions.

Answer 87

d. Identify the informal leaders on her unit and how they affect care decisions. Developing organizational savvy includes identifying the real decision makers and those persons who have a high level of influence with the decision makers. Recognize the informal leaders within any organization may have more power than the formal leader because of more knowledge of the organization, more informational power, or more expertise.

Question 88

Literature on oppression in nursing has: a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

Answer 88

a. Verified the presence of behaviors associated with oppression within nursing. Oppressed group behavior is apparent when a population is dominated by another group and begins to take on the characteristics of the dominant group (Roberts, 1993), often bullying and abusing their peers. In the twenty-first century, bullying and incivility have become epidemic in both nursing education and clinical settings.

Question 89

Politics is usually: a. Confined to legislatures. b. Seen in dysfunctional workplaces. c. Found in all social organizations. d. A representation of self-interest.

Answer 89

c. Found in all social organizations. Politics involves social interaction among organizations and as such, politics permeates in all organizations, workplaces, legislatures, professions, and even families.

Question 90

Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because “Who knows? Nursing is a great job with a great pay and I may return someday.” Mary’s statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n): a. Profession. b. Occupation. c. Flexible discipline. d. Career with off and on ramps.

Answer 90

b. Occupation. Concern with nursing as potentially one in a series of possibly well-paid jobs reflects a view of nursing as an occupation.

Question 91

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. Limited, thereby necessitating involvement of others in implementing ideas. b. Restricted, which necessitates finding alternative means to achieve strong patient outcomes. c. Directed primarily toward those who are subordinate to her. d. Of unlimited capacity when shared with others.

Answer 91

d. Of unlimited capacity when shared with others. Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses.

Question 92

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. Mentorship. b. Politics. c. Networking. d. Empowerment.

Answer 92

c. Networking. Meeting individuals outside the normal workgroup to share ideas and gain support and encouragement is an example of networking.

Question 93

The workgroup on NU 23 is marked by apathy toward the ward’s patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. Powerlessness. b. Anger. c. Apathy. d. Oppression.

Answer 93

a. Powerlessness. Emotions such as anger and apathy result from a workplace in which powerlessness is exhibited.

Question 94

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian’s behavior is best described as: a. Insincere. b. Networking. c. Politically sophisticated. d. Collegial.

Answer 94

d. Collegial. Collegial behavior requires respect, not friendship.

Question 95

Which of the following interactions is MOST consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues. b. Join an online workplace forum to gain ideas about how to handle workplace conflict. c. Suggest that you and a new team member meet after work for coffee to review unit guidelines. d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

Answer 95

d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise. Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one’s place of employment. Successful networking involves sharing similar ideas and maintaining relationships within a system of individuals who serve as sources of information, advice, and support.

Question 96

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. Collaboration. b. A coalition. c. Networking. d. Policy building.

Answer 96

b. A coalition.. The formation of temporary groups to achieve particular goals involves the development of coalitions.

Question 97

Which of the following is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children. b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return. c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods. d. Jerry speaks with his supervisor about his supervisor’s concerns related to bedside reporting before presenting a proposal to change this process.

Answer 97

d. Jerry speaks with his supervisor about his supervisor’s concerns related to bedside reporting before presenting a proposal to change this process. Successful negotiators are well informed about not only their own positions but also those of the opposing side. Negotiators must be able to discuss the pros and cons of both positions. They can assist the other party in recognizing the costs versus the benefits of each position.

Question 98

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position power b. Expert power c. Personal power d. Competency power

Answer 98

b. Expert power According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.

Question 99

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that “nursing committees rarely get anything worthwhile done because of politics and conflicts.” According to the text, Tom’s view of involvement: a. Is rare in nursing today. b. Reflects a fear of power. c. Reflects the essential process of power. d. Reflects empowerment and capacity to make his own decisions.

Answer 99

c. Reflects the essential process of power. Tom’s response reflects a distancing from other nurses related to discomfort with conflict associated with human interactions. The text defines human interactions within organizations as politics, a component of which is the essential process of power.

Question 100

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, “I don’t know what they taught you in your nursing program, but if I see you do that again, I will write you up.” This example demonstrates: a. Coercive use of power. b. Appropriate application of control. c. Use of informatory power. d. Use of power to provide coaching.

Answer 100

a. Coercive use of power. Influence is the process of using power. Influence can involve the punitive power of coercion, as is used in this example.

Question 101

Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities? a. “I find your soft voice and manners very reassuring and calming to patients.” b. “Try using a wider vocabulary and big words so that people will think that you are knowledgeable.” c. “At times, you tend to slump and avoid eye contact when you are talking with colleagues and families.” d. “Don’t worry about what others think of you. If you feel like saying something, say it, even if it hurts other people’s feelings.”

Answer 101

c. “At times, you tend to slump and avoid eye contact when you are talking with colleagues and families.” A powerful image comes from thinking of oneself as powerful and effective, and this is communicated through posture, maintaining eye contact, treating others with courtesy and respect, and using a firm, confident voice with vocabulary that is appropriate (which does not necessarily involve using big-sounding words).

Question 102

As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.) a. Requesting increased compensation b. Speaking positively about one’s work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names e. Submitting a written complaint to senior administration regarding rude behaviors f. Developing a code of conduct for the ED staff.

Answer 102

ANS: B, C, D, F b. Speaking positively about one’s work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names f. Developing a code of conduct for the ED staff. Demonstrating a positive and professional attitude about being a nurse to nursing colleagues, patients and their families, other colleagues in the workplace, and the public facilitates the exercise of power among colleagues while educating others about nurses and nursing. A powerful image is an important aspect of demonstrating this positive professional attitude and includes how we identify ourselves, how we dress, whether we are punctual for commitments, and whether we speak positively about our work. Bullying and incivility are negative expressions of power that can affect patient outcomes. The Joint Commission standard demands that leaders ensure that a code of conduct is implemented to ensure patient safety and a culture of quality.

Question 103

13. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate’s lack of eye contact reflects the candidate’s ethnicity. You are exhibiting: a. Acculturation. b. Cultural sensitivity. c. Ethnocentrism. d. Transculturalism.

Answer 103

b. Cultural sensitivity. Cultural sensitivity refers to the effective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the candidate’s background in relation to eye contact demonstrates cultural sensitivity.