Chapter 25

Question 1

What is the primary difference between constructive and destructive discipline?
A) The manager is friendlier to the employee in constructive discipline than in
destructive discipline, so that the employee likes the manager as a person
B) Constructive discipline includes verbal and written reprimands, whereas
destructive discipline includes suspension without pay and termination
C) The person who has received constructive discipline always appreciates and
believes the feedback given, whereas it is resented and disbelieved in destructive
discipline
D) Constructive discipline helps the person to grow and to behave in a manner that
allows him or her to be self-directive in meeting organizational goals. Destructive
discipline focuses more on punishment

Answer 1

D) Constructive discipline helps the person to grow and to behave in a manner that
allows him or her to be self-directive in meeting organizational goals. Destructive
discipline focuses more on punishment

Constructive discipline uses discipline as a means of helping the employee grow. It is
not used as a punitive measure. Destructive discipline focuses more on punishment. The
remaining options are not necessarily true statements

Question 2

Which statement concerning self-discipline is true?
A) It is one of the least effective forms of discipline
B) It decreases as an awareness of the rules and regulations that govern behavior
increases
C) It increases when employees identify with the goals of the organization
D) It is internalized, and thus the leader can do little to create an environment that
promotes self-discipline in employees

Answer 2

C) It increases when employees identify with the goals of the organization

The highest level and most effective form of discipline is self-discipline. When
employees feel secure, validated, and affirmed in their essential worth, identity, and
integrity, self-discipline is enhanced.

Question 3

Which statement about rules is correct?
A) If a rule or regulation is worth having, it should be enforced
B) Most rule breaking is a result of the actions of a few employees
C) Organizations should have as many rules and regulations as possible so
employees are clear about what they are to do
D) Managers should increase monitoring efforts if a particular rule is constantly
broken by many staff members

Answer 3

A) If a rule or regulation is worth having, it should be enforced

If a rule or regulation is worth having, it should be enforced. When rule breaking is
allowed to go unpunished, other people tend to replicate the behavior of the rule
breaker. An organization can have too many rules making enforcement very difficult.
Evaluation of a rule that is being constantly broken is more effective than simple
increased monitoring.

Question 4

What is the process involved in progressive discipline?
A) A written warning precedes verbal warnings
B) Formal warnings are followed up with informal warnings
C) Written warnings are advocated only in the most serious of offenses
D) The initial step is the delivery of a verbal warning by the manager

Answer 4

D) The initial step is the delivery of a verbal warning by the manager

The first step of the progressive disciplinary process is an informal reprimand or verbal
warning. This reprimand is followed by a formal reprimand or written warning when the
behavior has not been changed.

Question 5

What would be the most appropriate level of employee discipline for a first infraction of
gross mistreatment of a patient?
A) Suspension with pay
B) Suspension without pay
C) Termination
D) Written admonishment

Answer 5

C) Termination

For a first infraction of gross mistreatment of a patient, the most appropriate level of
employee discipline would probably be termination. The organization’s first
responsibility is in the protection of patients.

Question 6

Which statement accurately describes a disciplinary conference?
A) It is generally a highly charged emotional event, so the manager should try to
soften criticisms to reduce the employee’s defensiveness
B) It should be scheduled in advance at a time agreeable to both the employee and
the manager
C) When it is held in front of peers it can be used as a teaching tool
D) It requires the manager to adopt nurturing and counseling roles

Answer 6

B) It should be scheduled in advance at a time agreeable to both the employee and
the manager

All formal disciplinary conferences should be scheduled in advance at a time agreeable
to both the employee and the manager. Both will want time to reflect on the situation
that has occurred. Allowing time for reflection should reduce the situation’s
emotionalism and promote employee self-discipline, because employees often identify
their own plan for keeping the behavior from recurring. None of the other options
accurately describe this process.

Question 7

What should an employee expect when a manager terminates his/her employment for
continuous rule breaking?
A) The employee will be escorted from the building by security staff
B) The employee will be allowed to work out a 2-week termination period
C) The manager will describe what, if any, references will be supplied to future
employers
D) The manager will arrange for a meeting between the employee and senior
administration

Answer 7

C) The manager will describe what, if any, references will be supplied to future
employers

When a manager terminates an employee for continuous rule breaking, the manager
should tell the employee what, if any, references will be supplied to future employers.
The remaining options are not generally associated with such a termination.

Question 8

Which statement is accurate when describing performance deficiency coaching?
A) It is less spontaneous and requires more planning than ongoing coaching
B) It is a one-time way of solving problems
C) It requires the manager to assume the role of enforcer rather than supporter or
enabler
D) It occurs as a component of an employee’s annual performance appraisal

Answer 8

A) It is less spontaneous and requires more planning than ongoing coaching

This form of coaching is less spontaneous and requires more managerial planning than
ongoing coaching. In performance deficiency coaching, the manager actively brings
areas of unacceptable behavior or performance to the attention of the employee and
works with him or her to establish a plan to correct deficiencies.

Question 9

Which statement most accurately describes how discipline in a unionized organization
may vary from one that is nonunionized?
A) Nonunionized organizations require a demonstration of just cause, whereas
unionized organizations do not
B) Discipline in nonunionized organizations tends to entail more procedural,
legalistic safeguards than unionized organizations
C) Only unionized organizations have grievance procedures
D) Unionized employees must generally be disciplined according to specific steps
and penalties within an established time frame

Answer 9

D) Unionized employees must generally be disciplined according to specific steps
and penalties within an established time frame

Unionized employees must generally be disciplined according to specific, preestablished
steps and penalties within an established time frame. The remaining options
do not accurately describe unionized organizational discipline procedures.

Question 10

What does the filing of a grievance by an employee do?
A) It serves as evidence that a manager’s actions have been unfair or arbitrary
B) It means that the conflict will have to be resolved in arbitration
C) It negates the need for the manager to attempt to solve the conflict through
communication, negotiation, compromise, or collaboration
D) It requires a great deal of time and energy from both the employee and the
manager

Answer 10

D) It requires a great deal of time and energy from both the employee and the
manager

Although grievance procedures extract a great deal of time and energy from both
employees and managers, they serve several valuable purposes. However, most
grievances or conflicts between employees and management can be resolved informally
through communication, negotiation, compromise, and collaboration before grievance
procedures need to be undertaken. The remaining options are not the result of a
grievance filing.

Question 11

What action will the manager take when implementing the second step in the
progressive disciplinary process?
A) Suspend the employee from work for a specified period of time
B) Explain in detail the nature of the inappropriate behavior
C) Complete a formal written reprimand
D) Verbally instruct the employee not to repeat the infraction

Answer 11

C) Complete a formal written reprimand

The second step in the progressive disciplinary process is for the manager to complete a
formal written reprimand signed by the employee and the manager. The second step in
the progressive disciplinary process does not involve any of the other options.

Question 12

A nursing aide has been given a formal written warning regarding arguing repeatedly
with the team leader about the given assignment. Today the nursing aide has taken four
lengthy personal phone calls during work time. This is the first offense of this nature.
How will the manager deal with this disciplinary situation?
A) Provide a verbal warning that includes the rules related to personal telephone calls
B) Determining whether there is a legitimate personal problem that justifies the
telephone calls
C) Presenting the nursing aide with a formal written reprimand
D) Suspending the nursing aide for a week

Answer 12

A) Provide a verbal warning that includes the rules related to personal telephone calls

The best choice of action in this case would be to provide an explanation for the rule
and proceed to give a verbal admonishment. Since this is a new infraction, the
progressive discipline starts with a verbal warning again and none of the other options.

Question 13

How do managers view their responsibility to discipline staff?
A) It is a necessary means for controlling an unmotivated and self-centered
workforce
B) It is a ìBig stickî that management can use to eliminate behavior that conflicts
with organizational goals
C) It is a means to assist in the development of self-discipline in an employee
D) It is necessary to the organization if established rules are to be enforced

Answer 13

D) It is necessary to the organization if established rules are to be enforced

Managers use discipline to enforce established rules, policies, and procedures. The other
options are very limited views regarding discipline.

Question 14

What is the manager’s role when dealing with employees who break the rules?
A) To terminate their employment
B) To be a good listener
C) To act as counselor
D) To ensure organizational goals are met

Answer 14

D) To ensure organizational goals are met

To act as coach and supporter, counselor, or good listener could be enabling to the
employee who breaks the rules. The manager should be humanistic, however, and not
scold or blame. Not all situations would result in employment termination.

Question 15

Which statement is true regarding chemical addiction among nursing professionals?
A) Most chemically impaired nurses obtain drugs by stealing them from work
B) Morphine is the most commonly abused drug by nurses
C) Most nurses obtain their drugs on the street and avoid taking drugs from work
D) Most chemically impaired nurses cannot be diverted from drug use

Answer 15

A) Most chemically impaired nurses obtain drugs by stealing them from work

Most chemically impaired nurses abuse drugs they were taking for legitimate health
reasons, or they steal drugs from work. The remaining options are not statements
supported by research.

Question 16

Which statement concerning the recognition of chemical impairment in an employee is
correct?
A) It is relatively easy to identify employees who are chemically impaired
B) It is easier to recognize if the employee is impaired by alcohol than by drugs
C) Impairment should result in an immediate intervention by the manager
D) Impairment must be supported by data gathering before intervention occurs

Answer 16

C) Impairment should result in an immediate intervention by the manager

For safety reasons and to protect clients, employees should be confronted as soon as
possible after chemical impairment is recognized. None of the remaining options are
true statements regarding the recognition of a chemically impaired employee.

Question 17

What is the most common initial response of an employee to a manager’s confrontation
regarding suspected chemical impairment?
A) Emphatic denial and defensiveness
B) Reluctant acceptance
C) Gratefulness for finally being discovered
D) Silence

Answer 17

A) Emphatic denial and defensiveness

Employee denial and defensiveness are common behaviors in those who are confronted
with their impairment. Often, these individuals are in self-denial.

Question 18

Which statement identifies a truth regarding the generally accepted plan for the reentry
of the chemically impaired employee into the workplace?
A) It is successful in only a small number of cases despite active treatment programs
B) It is discouraged by the board of registered nursing
C) It should not occur until 3 years after the employee has completed the treatment
program
D) It often includes an employer requirement that the employee agree to random
urine screening on request by the employer

Answer 18

D) It often includes an employer requirement that the employee agree to random
urine screening on request by the employer

Most nurses successfully return to work following a treatment program, and this
generally takes 1 year. Often, the conditions that the employee has successfully changed
his or her lifestyle and will submit to random drug tests must be met before the
employee can be allowed to return to work.

Question 19

Which statement represents a correct statement regarding the identification and assisting
interventions provided employees with substance abuse problems?
A) It is done as an altruistic and benevolent action by the organization
B) It should not be undertaken by management or the personnel department
C) It should include screening that focuses on early detection
D) Is best handled through disciplinary action of the personnel department

Answer 19

C) It should include screening that focuses on early detection

The personal and professional cost of chemical impairment demands that nursing
leaders and managers recognize the chemically impaired employee as early as possible
and provide intervention since such behavior is a serious safety issue associated with
patient care. The remaining options are not correct.

Question 20

Which statement is true concerning the management of an employee who performs at
the marginal level?
A) Marginal performance is generally a result of employee burnout
B) Poor motivation is the most common reason for marginal performance
C) Improving skill should be the focus when assisting the marginal employee
D) Some marginally performing employees will never improve their function levels

Answer 20

D) Some marginally performing employees will never improve their function levels

It is important for the manager to remember that each person and situation is different
and that the most appropriate strategy depends on many variables. Looking at past
performance will help to determine if the employee is merely burnt out, needs
educational or training opportunities, is unmotivated, or just has very little energy and
only marginal skills for the job. If the latter is true, then the employee may never
become more than a marginal employee, no matter what management functions and
leadership skills are brought into play.

Question 21

What is the manager’s initial progressive initial response when a staff member is caught
stealing $3.00 from a patient’s bedside stand?
A) Dismissal
B) Suspension
C) Written notice
D) Verbal notice

Answer 21

C) Written notice

An employee caught stealing is initially presented with a written warning.

Question 22

Which statement accurately describes the initial deterrent against breaking a rule
according to McGregor’s Hot Stove Rules?
A) All discipline should be administered immediately after rules are broken
B) Each time the rule is broken; there are immediate and consistent consequences
C) All employees must know the rule beforehand and be aware of the punishment
D) Everyone must be treated in the same manner when the rule is broken

Answer 22

C) All employees must know the rule beforehand and be aware of the punishment

All employees must be forewarned that if they break a rule, they will be punished or
disciplined. They must know the rule beforehand and be aware of the punishment.

Question 23

What is the principle that guides constructive discipline?
A) Constructive discipline is punitive in its nature
B) The focus of constructive discipline is employee growth
C) Constructive discipline employs the manager as a resource not a helper
D) Behavior modification is the desired outcome of constructive discipline

Answer 23

B) The focus of constructive discipline is employee growth

Constructive discipline uses discipline as a means of helping the employee grow, not as
a punitive measure.

Question 24

Which is a management function associated with dealing with a problem employee?
A) Forewarns the employee of the consequences of breaking a rule
B) Encourages employees to be self-disciplined in conforming to rules
C) Serves in the role of coach in performance deficiency coaching
D) Recognizes and reinforces the intrinsic self-worth of each employee

Answer 24

A) Forewarns the employee of the consequences of breaking a rule

Clearly identifies performance expectations for all employees and confronts employees
when those expectations are not met. The other options are leadership roles.

Question 25

What is the fundamental rational for conducting a disciplinary conference for a staff member who has failed to significantly modify the practice of arriving late for assigned shifts? A) This behavior disrupts the efficiency of the nursing team B) The tardiness is costing the facility money C) This behavior encourages other staff to disregard rules D) The problem will get worse if it is ignored

Answer 25

D) The problem will get worse if it is ignored Disciplinary problems, if unrecognized or ignored, generally do not go away; they only get worse. The other options are likely outcomes of the staff member's unacceptable behavior but not the fundamental rational for the disciplinary action.

Question 26

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem? 1. The hospital is in a poorer part of town and offers a great deal of charity care. 2. The hospital pays about $.25 per hour less than other hospitals as a starting wage for nurses. 3. The hospital has a reputation for allowing bullying behavior to occur. 4. The other hospital in town has a more modern building and campus.

Answer 26

3. The hospital has a reputation for allowing bullying behavior to occur. Rationale 3: People do not like to be bullied. If the hospital has this reputation it is unlikely to attract new employees and older employees are likely to leave.

Question 27

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility? 1. “Bullying behaviors make nurses uncomfortable.” 2. “Physicians do not want to admit clients to hospitals with an uncivil atmosphere.” 3. “Bullying and incivility are just not proper work practices.” 4. “Bullying and incivility are dangerous to client care.”

Answer 27

4. “Bullying and incivility are dangerous to client care.” These behaviors can be dangerous to clients.

Question 28

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors? Select all that apply. 1. Nursing assistants 2. Physicians 3. Managers 4. Office personnel 5. Senior nurses

Answer 28

2. Physicians 3. Managers 5. Senior nurses Rationale 2: Physicians are among those reported as being the worst bullies. Rationale 3: Managers are among those reported as being the worst bullies. Rationale 5: Senior nurses are among those listed as being the worst bullies.

Question 29

A nurse writes some scathing remarks about another nurse’s professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate? 1. “I have no control over what the nurses do on their time away from work.” 2. “This does not meet the standards for bullying because it was not a face-to-face encounter.” 3. “You two are acting like a couple of high school kids.” 4. “I will follow up on this complaint and take action as needed.”

Answer 29

4. “I will follow up on this complaint and take action as needed.” The manager must do an assessment of the complaint before acting.

Question 30

A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students? Select all that apply. 1. The unit clerk groans when the instructor enters the nursing station with the students. 2. A nurse quietly says, “Please do not assign a student to me today. I have two very sick clients who are going to require my full attention.” 3. A nurse whispers, “Not students again today.” 4. A nursing assistant asks the students how long they have been in school. 5. A transport worker says, “Just great, more students to get in the way today.”

Answer 30

1. The unit clerk groans when the instructor enters the nursing station with the students. 3. A nurse whispers, “Not students again today.” 5. A transport worker says, “Just great, more students to get in the way today.” Rationale 1: Any action that indicates the students are unwelcome is not civil. Rationale 3: This whisper is not civil, despite the level at which it is spoken. Rationale 5: The intent of this remark is probably not civil.

Question 31

A nurse says, “I don’t see what all the fuss is about bullying. Every new nurse has to go through it. It’s just a part of the history of nursing.” How should the manager respond? Select all that apply. 1. “I know. It’s a shame that all the old ways are changing.” 2. “Why would you want to bully a new nurse? They are all so naïve and cute.” 3. “The Joint Commission does not tolerate disruptive or abusive behavior.” 4. “The American Nurses Association does not approve of bullying behaviors.” 5. “New nurses bring new ideas. Why would you bully them?”

Answer 31

3. “The Joint Commission does not tolerate disruptive or abusive behavior.” 4. “The American Nurses Association does not approve of bullying behaviors.” 5. “New nurses bring new ideas. Why would you bully them?” Rationale 3: The Joint Commission recommends a zero tolerance policy regarding disruptive or abusive behavior. Rationale 4: The ANA recommends several strategies to combat these behaviors. Rationale 5: New ideas are brought by new nurses. Bullying of any segment of the profession is wrong.

Question 32

A nurse makes a medication error and notifies the client’s physician. The physician berates the nurse over the phone and states, “You are an idiot.” How should the manager deal with this situation? Select all that apply. 1. Tell the nurse to go home for the rest of the day. 2. Have the nurse call the physician back and demand an apology. 3. Document the facts of the encounter. 4. Privately tell the physician that the behavior was bullying. 5. Confront the physician during rounds and demand an explanation.

Answer 32

3. Document the facts of the encounter. 4. Privately tell the physician that the behavior was bullying. 5. Confront the physician during rounds and demand an explanation. Rationale 3: The facts of the encounter must be documented. Rationale 4: The manager should name the behavior. Rationale 5: The manager should speak to the physician in a civil manner.

Question 33

A nurse manager does not like conflict and would like to allow instances of bullying to “go away on their own.” What rationale by the manager’s supervisor is the most important? 1. “The Joint Commission requires that we address instances of bullying.” 2. “We don’t want to run off good nurses.” 3. “If you let bullying go, it just gets worse and more frequent.” 4. “A bully makes the work environment unpleasant for everyone.”

Answer 33

3. “If you let bullying go, it just gets worse and more frequent.” Bullying behavior tends to escalate if ignored.

Question 34

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager? 1. Call a meeting of all night shift employees. 2. Review the staffing pattern and absentee list for the night shift. 3. Ask employees for their perceptions on missing narcotics. 4. Request that security search employee lockers and personal items.

Answer 34

2. Review the staffing pattern and absentee list for the night shift. The first step is to assess the problem. By checking the staffing pattern on the nights in question, the manager can rule out some employees.

Question 35

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs? 1. Place the nurse on a different unit and allow the administration of all drugs. 2. Reassign the nurse for a period of time to a unit where no mood-altering drugs are given. 3. Retain the nurse on the original unit and allow the administration of mood-altering drugs. 4. Return the nurse to the original unit at a less stressful time, such as night shift.

Answer 35

2. Reassign the nurse for a period of time to a unit where no mood-altering drugs are given. Removal of the temptation is a positive step for the recovering nurse. The best action would be to temporarily have the nurse reassigned to a unit where there are no mood-altering drugs.

Question 36

What characteristics would cause the manager to classify an employee as marginal? Select all that apply. 1. The employee works only when client census calls for additional staff. 2. The employee’s work does not improve with coaching. 3. The employee just made an error for which discipline has already been done twice. 4. The employee has worked at the facility for less than 1 month. 5. The employee does not mix well with the other staff, but stays on the margins of the group.

Answer 36

2. The employee’s work does not improve with coaching. 3. The employee just made an error for which discipline has already been done twice. Rationale 2: A marginal employee does not take instruction well. Rationale 3: An employee whose work does not improve after discipline is a marginal employee.

Question 37

A night shift charge nurse frequently points out nurses’ faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior? 1. Lateral violence 2. Unprofessionalism 3. Lack of civility 4. Bullying

Answer 37

3. Lack of civility Lack of civility is defined as disrespectful or rude behavior.

Question 38

The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility? 1. “Your behavior is rude and disrespectful towards your staff.” 2. “This behavior is unprofessional.” 3. “This behavior is unacceptable.” 4. “This behavior warrants a written warning.”

Answer 38

1. “Your behavior is rude and disrespectful towards your staff.” Lack of civility is rude, disrespectful, and impolite behavior.

Question 39

A night shift nurse is assuming a day shift nurse’s assignment, which includes two clients whose pain is being controlled with oral hydrocodone (Lortab). At shift assessment, both clients complain of pain. During shift report, the day shift nurse reports that both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take? 1. Repeat the medication. 2. Inform the manager of the situation. 3. Call the physician to obtain an order for IV narcotics. 4. Tell the clients that pain medication will be given at the next ordered time.

Answer 39

2. Inform the manager of the situation. While there is no clear indication that the day shift nurse is diverting drugs, the manager must be made aware of the situation so it can be investigated. The nurse and manager must determine if the clients actually received the medication and, if so, what time they were administered.

Question 40

A nurse comes to the unit manager to report a coworker’s behavioral changes. The nurse has noticed that the coworker’s handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which should be the manager’s first action? 1. Meet with the coworker in private and discuss the behaviors. 2. Meet with other staff to determine if the coworker has issues at home. 3. Meet with human resources (HR) to determine the best method to terminate the employee. 4. Collect additional information regarding behaviors, absenteeism, and/or tardiness.

Answer 40

4. Collect additional information regarding behaviors, absenteeism, and/or tardiness. The manager should obtain information and documentation to determine if there is a problem.

Question 41

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization’s policies. Which statement by the HR director is appropriate? 1. “We should meet with the nurse and offer access to the employee assistance program.” 2. “We should confront the employee and discuss involuntary or voluntary termination.” 3. “You need to meet with this nurse and confront these behaviors.” 4. “We need to set up a counseling session with a psychologist and this nurse.”

Answer 41

1. “We should meet with the nurse and offer access to the employee assistance program.” Most health care organizations offer substance abuse programs for employees.

Question 42

The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse’s work will improve. What risks has the manager taken by choosing this strategy? Select all that apply. 1. The nurse may harm a client. 2. Other nurses on the unit may become disgruntled by having to cover for this nurse. 3. The nurse may never become a good employee. 4. The manager may be terminated. 5. The morale of the unit may decline.

Answer 42

1. The nurse may harm a client. 2. Other nurses on the unit may become disgruntled by having to cover for this nurse. 3. The nurse may never become a good employee. 5. The morale of the unit may decline. Rationale 1: Marginal work may result in harm to clients. Rationale 2: A marginal employee increases the workload on other, more competent employees. Rationale 3: If marginal work is allowed to continue, the nurse may never change. Rationale 5: Having a marginal employee who must be constantly coached and watched may negatively affect the morale of other staff and the entire unit.

Question 43

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, “That probably happened when the nurse covering for me at noon or for my breaks was in charge.” How should the manager interpret this statement? 1. This is a plausible explanation of who was in charge at the time of the error. 2. The coverage nurse is likely incompetent. 3. This nurse was not in charge when the error was made. 4. This nurse is scapegoating the coverage nurse.

Answer 43

4. This nurse is scapegoating the coverage nurse By raising the possibility (and being very sure) that the other nurse was in charge, the nurse has created a scapegoat. This is a form of lateral violence.

Question 44

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager? Select all that apply. 1. “Continue to be persistent in your work with these nurses.” 2. “You can fire them at any time.” 3. “Be fair and consistent with them.” 4. “You must continuously assess the rest of your staff as you work with these two nurses.” 5. “You must continue to address the issues with these nurses as they arise.”

Answer 44

1. “Continue to be persistent in your work with these nurses.” 3. “Be fair and consistent with them.” 4. “You must continuously assess the rest of your staff as you work with these two nurses.” 5. “You must continue to address the issues with these nurses as they arise.” Rationale 1: Persistence is a key to being perceived as fair and just. Rationale 3: Fairness and consistency are keys to being perceived as just. Rationale 4: The manager must be aware of the impact of marginal nurses on the remainder of the staff. Rationale 5: The manager cannot ignore any issues that arise with these nurses.

Question 45

Two staff members have a long-standing dislike of one another. Generally they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation? 1. Tell the two staff members to go to the manager’s office immediately. 2. Send both of the employees off the unit. 3. Immediately call for security. 4. Stand between the employees and tell them to calm down.

Answer 45

3. Immediately call for security. Security should be notified immediately when physical violence occurs or is imminent.

Question 46

A nurse constantly complains about employee policies and procedures and frequently mentions how “they” are “out to get us.” The nurse is surprised when referred to by the manager as “disgruntled” during a discussion of this behavior. What information should the manager provide this nurse? 1. “People who are constantly complaining decrease the morale of the rest of the unit.” 2. “You have complained so long, it will be impossible to change your behavior.” 3. “Being a complainer is a character trait.” 4. “Your attitude problem makes everyone else in the unit miserable.”

Answer 46

1. “People who are constantly complaining decrease the morale of the rest of the unit.” Disgruntled, complaining employees adversely affect everyone else’s morale.

Question 47

A nurse manager has been working with a disgruntled employee for several weeks. Today the employee comes to the manager’s office with yet another complaint about a new hospital policy. The manager says, “I am sick of your complaining. Leave me alone so I can get some work done.” What should the manager do now? 1. Firmly shut the office door. 2. Tell the employee to go to human resources with complaints about the policy change. 3. Apologize to the employee for being unprofessional and ask what the issue with the policy is. 4. Tell the employee to go back to work.

Answer 47

3. Apologize to the employee for being unprofessional and ask what the issue with the policy is. The manager must remain professional at all times. In this case, when the manager was not professional, an apology is in order.

Question 48

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first? 1. Tell the employee to go home and change. 2. Check the human resources policies regarding appropriate dress. 3. Ask the employee why the shirt was worn to this event. 4. Bring the employee a scrub shirt from surgery to change into.

Answer 48

2. Check the human resources policies regarding appropriate dress. Before the manager does anything else, he or she must be certain that policy backs up the planned actions.

Question 49

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, “The nurses who smoke always take longer lunches. No one says anything to them.” What is the manager’s major consideration before replying to this statement? 1. Policies must be consistently applied to all employees. 2. Since the hospital is smoke free, those nurses who wish to smoke must leave campus for lunch. 3. This nurse complains about everything. 4. The human resources policy is that nurses get 60 minutes for lunch.

Answer 49

1. Policies must be consistently applied to all employees. No matter the situation, policies must be consistently applied.

Question 50

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee’s competence. Which action by the manager would be appropriate? 1. Discuss the issues at a staff meeting and elicit methods to improve morale. 2. Use progressive discipline to manage the employee. 3. Monitor the staff’s performance to determine the lack of civility. 4. Terminate the employee.

Answer 50

2. Use progressive discipline to manage the employee. Using progressive discipline to manage the employee allows for communication regarding poor performance and allows the employee the opportunity to improve their performance.

Question 51

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit? Select all that apply. 1. Chart review on effectiveness of pain control 2. Increase in clients with conditions requiring pain medications 3. Increase in use of doses of as-needed narcotics that results in wastage 4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others 5. Narcotic containers that look as if they have been altered

Answer 51

1. Chart review on effectiveness of pain control 3. Increase in use of doses of as-needed narcotics that results in wastage 4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others 5. Narcotic containers that look as if they have been altered Rationale 1: If many clients report their pain is not controlled, diversion may be occurring. Rationale 3: If the nurse has a choice of doses and is trying to divert medications, a smaller dose might be given resulting in a larger wastage that is then diverted. Rationale 4: If one shift is giving much more pain medication that the other, it may be because someone is diverting drugs on that shift. It may also mean that inadequate pain control is being given on the other shift because someone is diverting drugs. Rationale 5: Altering the container is a method of diversion.

Question 52

A nurse admits to diverting narcotic drugs while working. The manager says, “All nurses who admit diverting narcotics have to be reported to the state board of nursing.” How should the nurse interpret this statement? 1. As true, because any nurse who admits diversion must be reported to the state’s board of nursing 2. As false, because in some states reporting depends on other factors 3. As beneficial, because the state board of nursing will help the nurse find a substance abuse program 4. As career ending, because the state board of nursing is required to suspend the license of any nurse who admits to diverting drugs

Answer 52

2. As false, because in some states reporting depends on other factors In some states if the nurse completes a substance abuse program, reporting is not done.

Question 53

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled? 1. A certified letter outlining the accusation and investigation should be sent to the nurse’s home. 2. A certified letter outlining the accusation and investigation should be sent to the nurse at work. 3. The nurse should be contacted and asked to make an appointment with the nurse executive without giving cause. 4. The nurse should be approached at work with no prior notice and asked to come to the nurse executive’s office.

Answer 53

4. The nurse should be approached at work with no prior notice and asked to come to the nurse executive’s office. This surprise approach minimizes the amount of time the nurse has to create a story or to rationalize the abuse of narcotics.

Question 54

A nurse who has been abusing narcotics is in the nurse executive’s office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make? 1. “Health insurances generally pay 100 percent of treatment charges for medical professionals who are seeking help.” 2. “If you go to treatment, the state board will never know you were abusing.” 3. “Treatment is your best chance at returning to practice.” 4. “We will be able to follow your progress through reports from your treatment team.”

Answer 54

3. “Treatment is your best chance at returning to practice.” The nurse who successfully completes treatment stands the best chance at successfully reentering practice.

Question 55

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse? 1. Administration reports the nurse to the state board of nursing. 2. The nurse is counseled and asked to participate in a treatment center plan. 3. The nurse is allowed to continue supervised practice while a treatment plan is being devised. 4. The nurse is terminated with no report made.

Answer 55

4. The nurse is terminated with no report made. If the nurse is terminated, employment at another facility may occur and the cycle may continue.

Question 56

A nurse manager is investigating a report made by a staff nurse. The nurses states that a visitor backed the nurse up against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the human resources (HR) director? 1. As an encounter with a disgruntled family member 2. As violence against the nurse 3. As an incident with a family member 4. As a physical attack against an employee

Answer 56

2. As violence against the nurse This incident is an example of violence against the nurse.

Question 57

A chief nurse officer (CNO) is contacted by the organization’s supervisor on a Saturday night regarding a problem in the hospital’s emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report? 1. This is a typical occurrence in the emergency department. 2. Health care violence is more likely to occur in emergency departments. 3. Health care violence generally occurs on the weekend. 4. Health care violence is likely to occur on the night shift.

Answer 57

2. Health care violence is more likely to occur in emergency departments. In health care, violence is more likely to occur in psychiatric settings, emergency departments, waiting rooms, and geriatric units.

Question 58

The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matrix and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff over the past 2 days. To which of these distractions is the absenteeism most likely related? 1. The staffing dilemma caused by the scheduler 2. The change in the staffing matrix 3. The decline in staff morale due to a hostile environment 4. The miscommunication between management and nursing administration

Answer 58

3. The decline in staff morale due to a hostile environment The hostile work environment may cause a decline in morale or staff may be frightened to come to work.

Question 59

An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate? 1. “The unit has been so busy, I must allow for the nurses to have time to provide client care.” 2. “The visitor hours have not been adjusted in years. It was time to change them.” 3. “The physicians have requested limited visiting hours.” 4. “The visiting hours allowed for added stress and commotion to the nursing staff.”

Answer 59

4. “The visiting hours allowed for added stress and commotion to the nursing staff.” Open visiting hours do allow for added stress and commotion. When visitors are aggressive toward nurses, restricting visiting hours may be essential.

Question 60

An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days the client’s son has been increasingly verbally abusive to the nursing staff. The unit secretary tells the nurse that the son is at the nurse’s station demanding to see the client. Which action by the nurse is most important? 1. Remove the central line tray from the room. 2. Inform the son regarding the client’s condition. 3. Ignore the son as he enters the client’s room. 4. Limit the son’s visitation.

Answer 60

1. Remove the central line tray from the room. Health care staff should be aware when and where to store medical instruments that may be used as weapons.

Question 61

The hospital operator announced over the paging system, “Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing.” A newly hired nurse asks another nurse, “Who is Dr. Strong?” The nurse replies, “This is the announcement that alerts security there is violent behavior on that unit.” Which statement would be an appropriate report to this unit’s manager? 1. “Our new nurse does not know what ‘Dr. Strong’ means.” 2. “There was an incident in which a staff person did not know what ‘Dr. Strong’ meant. Could we have an in-service on this policy?” 3. “The operator paged a ‘Dr. Strong’ and we didn’t know what to do.” 4. “Why do they use ‘Dr. Strong’ when there is trouble? They should just call for help.”

Answer 61

2. “There was an incident in which a staff person did not know what ‘Dr. Strong’ meant. Could we have an in-service on this policy?” Since this is a newly hired nurse, one would expect that the ‘Dr. Strong’ page would have been covered in orientation. Since this nurse did not understand the meaning of the page, it is likely others will not. An in-service is needed.

Question 62

A hospital’s safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Select all that apply. 1. Reserving parking spaces closest to the facility for staff 2. Security cameras throughout the facility 3. Curved mirrors in the corridors 4. Using restraints on all confused clients 5. Requiring all personnel to take physical self-defense training

Answer 62

2. Security cameras throughout the facility 3. Curved mirrors in the corridors Rationale 2: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety. Rationale 3: Instituting environmental controls such as security devices and curved mirrors are measures to ensure safety.

Question 63

A nurse manager has required that all nursing staff attend an in-service on dealing with verbal threats. A staff nurse wonders why this is necessary since, “Words don’t hurt me. I just ignore them.” What is the nurse manager’s most appropriate response to this statement? 1. “Don’t argue with me, I said everyone has to be in-serviced.” 2. “Verbal threats often precede physical violence.” 3. “I want my staff to be prepared to handle anything.” 4. “This is a requirement from our accrediting agency.”

Answer 63

2. “Verbal threats often precede physical violence.” Verbal aggression often precedes physical violence; if the situation can be defused at the verbal stage, physical violence may not occur.

Question 64

An emergency department (ED) client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions? 1. Distract the client. 2. De-escalate the situation. 3. Determine the client’s real reason for seeking treatment. 4. Assess the client’s level of pain.

Answer 64

2. De-escalate the situation. The physician’s tactics is an attempt to de-escalate the situation until security arrives.

Question 65

The emergency department (ED) staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate? 1. Arrange an agreement with law enforcement for rapid response on these incidents. 2. Post a sign stating that pain management medications are not given unless the client is admitted to the hospital. 3. Develop a team of staff who would be on call for these types of situations. 4. Organize a training program to educate staff on how to manage these types of situations.

Answer 65

4. Organize a training program to educate staff on how to manage these types of situations. The staff needs to be prepared in case of an emergency such as this one. This preparedness can occur through education.

Question 66

A newly formed task force is addressing the prevention of violence in the health care organization. Which group of employees is most likely to experience violence? Select all that apply. 1. Private practice physicians 2. Nurses working in a geriatric unit 3. Nurses working in a pediatric clinic 4. Nurses whose work space includes large waiting rooms 5. Technicians working in the medical laboratory

Answer 66

2. Nurses working in a geriatric unit 4. Nurses whose work space includes large waiting rooms Rationale 2: Geriatric units are among the sites in which violence is most likely to occur. Rationale 4: Waiting rooms are among the most common sites of health care violence.

Question 67

A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says, “We have lots of threatening behaviors on our unit.” What is the most important question for the supervisor to ask? 1. “Why is so much threatening behavior happening on your unit?” 2. “Why haven’t you reported that?” 3. “Where do you work?” 4. “When you report threats to your manager, is action taken quickly?”

Answer 67

4. “When you report threats to your manager, is action taken quickly?” This is the most important question. If the staff is reporting threats, yet nothing is done, it is very important for the supervisor to act.

Question 68

The nurse is caring for a client who is aggressive, demanding, and verbally abusive toward staff and visitors. The client says, “I’m getting out of here. I’m going to end it all.” What immediate action should the nurse take? 1. Attempt to block the exit door. 2. Call security. 3. Attempt to administer a sedative to the client. 4. Notify the client’s family.

Answer 68

2. Call security. This client is a danger to self and perhaps to others. Security should be notified.

Question 69

The nurse has just been notified that a client is to be admitted from the emergency department (ED) with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client’s lethargic state. Which action is an appropriate intervention by the nurse? 1. Approach the client with caution when obtaining vital signs and shift assessments. 2. Place the client in a room farthest from the nurse’s station so as not to disturb other clients. 3. Place the client in four-point restraints as a protective measure. 4. Post an armed security person at the client’s door.

Answer 69

1. Approach the client with caution when obtaining vital signs and shift assessments. Alcohol withdrawal clients may lash out in violence.

Question 70

The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Select all that apply. 1. When addressing the client, use powerful body language. 2. Remain calm and speak in a moderate tone. 3. Approach the client with an aggressive “I’m in charge” attitude. 4. Speak in simple terms. 5. Allow the client to speak.

Answer 70

2. Remain calm and speak in a moderate tone. 4. Speak in simple terms. 5. Allow the client to speak. Rationale 2: A calm manner and moderate tone are calming to the client. Rationale 4: The nurse should use simple terms when talking to this client. Rationale 5: The client should be allowed to speak, and the nurse should respectfully listen.

Question 71

An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name the baby’s father. A male visitor who comes to visit the client raises the nurse’s concern that he might be violent. Which behavior would raise this concern? 1. The visitor states, “I am the baby’s father.” 2. The client is very anxious with the visitor present. 3. The visitor moves into the nurse’s personal space when asking about the client’s status. 4. The visitor sits in a chair in the corner of the client’s room, rocking and smiling constantly.

Answer 71

3. The visitor moves into the nurse’s personal space when asking about the client’s status. The most concerning behavior is the lack of respect for the nurse’s personal space when asking questions. This behavior can indicate that the person can become threatening or violent.

Question 72

When a nurse enters the room, the client states, “He has a gun,” and points toward a male visitor. The nurse does not see a gun. What should the nurse do? 1. Question the visitor regarding the statement. 2. Contact security. 3. Call for another nurse to assist in confronting the visitor. 4. Notify the client’s physician.

Answer 72

2. Contact security. The nurse should contact security immediately and should implement any other strategies outlined in the security plan.

Question 73

A nurse hears screaming from a client’s room. A male visitor leaves the client’s room. Which is the nurse’s priority action? 1. Call the police. 2. Notify the client’s physician. 3. Follow the visitor. 4. Check on the client.

Answer 73

4. Check on the client. The priority action for the nurse is to ensure the safety of the client and the other staff.

Question 74

The nurse appears in the nursing station with multiple facial lacerations and says, “A visitor hit me.” What is the manager’s priority action? 1. Ask the nurse why the visitor became violent. 2. Ask a nurse to accompany the employee to the emergency department. 3. Call security to report the incident. 4. Call administration and inform them of the incident.

Answer 74

2. Ask a nurse to accompany the employee to the emergency department. The manager’s first priority is to arrange treatment for the injured employee.

Question 75

A manager is following up on an employee’s injuries. The manager has contacted human resources to initiate the process of worker’s compensation. Which action would be appropriate by the manager? 1. Contact the employee’s physician and inform him or her of the injuries. 2. Follow up with human resources regarding scheduling staff to cover the employee’s absences. 3. Follow up with the employee to express concern and answer any questions regarding the situation. 4. Follow up with the worker’s compensation nurse.

Answer 75

3. Follow up with the employee to express concern and answer any questions regarding the situation. The manager should contact the injured employee to express concern for their well-being and follow up with any questions they may have.

Question 76

During orientation a newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says, “Well, I guess you should call 911.” What is incorrect about this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 3. The nurse should never call 911 from the hospital. 4. The nurse should have been told to follow the reporting policy. 5. The nurse should have been reported as suspicious for asking the question

Answer 76

1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 4. The nurse should have been told to follow the reporting policy. Rationale 1: The person conducting the orientation should be aware of the policy and relay the information accurately and with certainty. Rationale 2: Notification of security is essential. Rationale 4: The hospital must have a bomb threat reporting policy. This would be a good time to introduce it to the orientation group.

Question 77

A night shift supervisor has been called to the emergency department to assist in managing a violent situation with a visitor. Once the violent person has been contained and security and police have responded, what should be the supervisor’s next action? 1. Notify staff on other nursing units. 2. Notify the violent person’s physician. 3. Complete an incident report. 4. No action is necessary; the situation has been managed.

Answer 77

3. Complete an incident report. An incident report is a part of the reporting process for violent events.

Question 78

A nurse enters a client’s room and sees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation? 1. Keep a safe distance from the visitor. 2. Yell for another nurse to assist with the visitor. 3. Leave the room. 4. Threaten the visitor with assault charges.

Answer 78

1. Keep a safe distance from the visitor. The nurse should recognize threatening behavior and keep a safe distance from the visitor exhibiting the behavior.

Question 79

The emergency department (ED) has seen an increase in violent behavior over the past year. The manager has voiced concerns to the chief nurse officer (CNO) regarding the safety of the ED staff. What should be done as a first step in addressing this issue? 1. The manager should consult with local law enforcement. 2. The CNO should review the management of violent incidents procedure policy. 3. The CNO should discuss the matter with hospital security. 4. The CNO should have the manager discuss the matter with the ED staff.

Answer 79

2. The CNO should review the management of violent incidents procedure policy. The first step should be to review and revise policies and procedures so they are reflective of effectively managing the types of incidents seen in the department.

Question 80

An emergency department (ED) has doubled its client visits within the past year. This has led to increased wait times and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the chief nurse officer (CNO) would be most effective? 1. Increase the size of the waiting room and add more beds to the ED unit. 2. Hire more ED nursing staff to manage the increased volume of clients. 3. Hire another ED physician. 4. Hire another registration employee to improve the intake process and reduce the volume in the waiting areas.

Answer 80

2. Hire more ED nursing staff to manage the increased volume of clients. The department has doubled in volume of clients, so it is necessary to increase staff to manage this volume. Increased wait times and overcrowding may lead to violent behavior.

Question 81

A geriatric client in a long-term-care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Select all that apply. 1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 3. The client suddenly becomes alert and oriented. 4. The client raises his fist. 5. The client says, “I know where there is a gun.”

Answer 81

1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 4. The client raises his fist. Rationale 1: The client may be about to flee the room, or may be blocking the nurse’s exit. Rationale 2: A blank stare could be related to pathology such as dementia or may signal a violent episode. Rationale 4: Preparing for battle signals impending violence.

Question 82

Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, “I’m sorry you are upset. What can I do for you?” The visitor continues to complain more loudly. What should the other nurse do? Select all that apply. 1. Quietly direct other people out of the room. 2. Leave the room and call security. 3. Say, “Who are you?” 4. Move toward the visitor and say, “Keep your voice down.” 5. Stay next to the other nurse.

Answer 82

1. Quietly direct other people out of the room. 2. Leave the room and call security. Rationale 1: Isolating a person who is angry and aggressive helps by taking away part of the audience. This is also a strategy to protect others. Rationale 2: It may be that the visitor is just upset and will calm down quickly with the other nurse’s verbal intervention, but that is not assured.

Question 83

A highly intoxicated client is brought to the emergency department. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Select all that apply. 1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 3. Ask the paramedics to place the client in leather restraints. 4. Enter the room calmly, with a smile. 5. Give the client 20 minutes or so to calm down before the assessment begins.

Answer 83

1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 4. Enter the room calmly, with a smile. Rationale 1: The nurse should remove any potential weapons. Rationale 2: A stethoscope hung around the neck is a convenient “handle” for anyone who would like to gain control of the nurse. Rationale 4: Being calm and pleasant can help defuse potentially violent situations.

Question 84

As part of a presentation on health care workplace violence, the speaker says, “Injuries to nurses from violent acts in the workplace are probably underreported.” What rationale should the speaker offer for this statement? Select all that apply. 1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. 5. Most violence against nurses is initiated by physicians, and nurses are afraid to report them.

Answer 84

1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. Rationale 1: The definition of workplace violence may not be clear. Rationale 2: Reporting policies may not be in place. Rationale 3: For many years, violence was tolerated in health care. Rationale 4: Some believe that being the target of a violent act is the result of poor job performance.

Question 85

A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. The behavior has never been violent, but today it is becoming more threatening. The nurse just came into the station and said, “My nurse assistant is stupid. I’m not going to put up with that much longer. She needs to be put in her place.” How should the manager respond to this situation? Select all that apply. 1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 3. The manager should explain that this is a good nurse who has difficulty tolerating stress. 4. Security should be notified of the behaviors. 5. The manager should warn other staff to stay clear of this nurse for the rest of the shift.

Answer 85

1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 4. Security should be notified of the behaviors. Rationale 1: The nurse should be removed from the situation. Rationale 2: This behavior should be documented. Rationale 4: As the behaviors are escalating, security should be notified.