Exam 1 Blueprint

Question 1

Characteristics of Professional Communication and Verbal Responses

Answer 1

• When conversation is escalating, try to move to private location
• Speak in a normal tone of voice
• Use “I” messages
• Maintain eye contact throughout
• Maintain an open body stance with your hands at your side or open toward the individual (but not invading the other person’s space)
• Do not physically back away unless you perceive you are actually in physical danger
• Offer explanations, but do not make excuses
• If you say you will take care of something, or report something, or change something, do it

Question 2

Conflict resolution styles

Answer 2

➤ Avoidance:
- one person uses passive behaviors and withdraws from the conflict; neither person is able to pursue goals

➤ Accommodation:
- one person puts aside his/her goals in order to satisfy the other person’s desires

➤ Force:
- one person achieves his/her own goals at the expense of the other person

➤ Compromise:
- both people give up something to experience partial goal attainment

➤ Collaboration:
- both people actively try to find solutions that will satisfy them both

Question 3

Conflict Resolution- Steps to resolve verbal conflict

Answer 3

• Recognize one’s own conflict resolution style
• Engage in active listening
• All people involved must view their conflict as a problem to be solved mutually.

Question 4

Positive communication techniques

Answer 4

🔸 Openness:
- Feelings and thoughts stated directly and honestly

🔸 Empathy:
- Feeling what the other person is feeling and seeing the situation as he/she sees it

🔸 Supportiveness:
- Feelings expressed with spontaneity rather than strategy

🔸 Positiveness:
- Using agreement as a basis for approaching disagreements and impasses

🔸 Equality:
- All participants in the process are equal

🔸 Developing trust
- keeping promises

🔸 Using “I” messages
- Using “U” is accusatory

Question 5

Good listening habits

Answer 5

• Give undivided attention to the sender
• Provide feedback by rephrasing the message in the receiver’s own words
• Give attention to positioning, so that sender and receiver are facing each other and are able to make eye contact
• Note nonverbal messages such as body language
• Finish listening before you begin speaking
• Active listening greatly improves the likelihood that the correct message will be received

Question 6

Phases of Shock

Answer 6

🔸 Honeymoon phase
- Orientation phase
- Happy phase

🔸 Shock or rejection phase
- Opposite of honeymoon phase
- Nurses feel frightened or may react by foaming a cold, hard shell

🔸 Recovery phase
- Novice nurse begin to understand the new culture
- Novice nurse experience less anxiety and healing begins

🔸 Resolution phase
- Novice nurse adjusts to the new environment

Question 7

Burnout/Compassion fatigue

Answer 7

🔸 Common symptoms of burnout:
- Fatigue,
- Negativity in personal relationships,
- Difficulty sleeping,
- Excessive stress,
- Anxiety,
- Vulnerability to disease,
- Depression,
- ETOH or substance abuse.

🔸 Compassion fatigue:
- CF occurs in highly emotional traumatic areas such as ED, hospice and mental health settings.
- CF is about ongoing exposure to emotional and
stressful situations at work without ways to ”disconnect.

Question 8

Keys to survival during transition

Answer 8

• Never fail to ask for help
• Use available facility resources
• Reenergize with professional associations
• Stay connected with friends
• Evaluate your growth realistically
• Stay focused on your goals

Question 9

Special needs of novice nurses

Answer 9

🔸 Interpersonal skills:
- lack of comfort with interpersonal skills (e.g., making rounds, clarifying orders, participating in team conferences)

🔸 Clinical skills:
- doubt in ability to perform skills without supervision

🔸Organizational skills:
- feeling disorganized
- May be based on being overwhelmed by the new environment

🔸 Delegation skills
➢ Uncertainty with delegation
➢ Related to:
* limited exposure to delegation activities
* the personnel to whom one is delegating

🔸 Priority-setting skills
- Important in the work world when ineffective priority setting may have serious consequences

🔸 Assertiveness skills
- Let the Doctor know if anything is out of wrack

🔸 Violence at work
- horizontal or lateral violence

Question 10

Promoting patient safety

Answer 10

🔸 National Database for Nursing Quality Indicators (NDNQI)

• National nursing quality measurement program that enables hospitals to compare measures of nursing quality against national, regional, and state norms
• Quality indicators include patient falls, physical restraints, nosocomial infections, nursing care hours provided per patient-day, and RN satisfaction surveys

🔸 Quality Safety and Education for Nurses (QSEN)

🔸 High Reliability Organizations (HROs)

Question 11

Nurses and Workplace Safety

Answer 11

🔸 Health hazards in the workplace
➢ Exposure to bloodborn pathogens
➢ Ergonomic Injuries
➢ Work place violence
➢ Fatigue

Question 12

Nursing shortages and workforce challenges, including education challenges

Answer 12

➤ Long-term impact of the COVID-19 pandemic requires burnout and psychological support be addressed

➤ Long history of cyclic shortages in nursing

➤ Unfortunately, most schools and universities find themselves unable to expand their nursing programs because of a serious shortage of nursing faculty

🔸 Demands require not simply more RNs, but more RNs with the right education and skill (Baccalaureate-prepared nurses)

Question 13

Magnet hospitals – How the Magnet status relates to nurses and patients

Answer 13

• Successful retention program; promotes standards for professional nursing practice and recognizes quality, excellence, and service

Question 14

Resume preparation

Answer 14

➤ Compress education and employment history into an attractive, easy-to-read summary
➤ Three essential sections
* Identifying information
* Education
* Work experience and employment history
➤ Optional information may include professional objectives, honors, achievements, and professional organization memberships
➤ References do not need to be included but should be prepared and ready for presentation when requested
➤ Produce the résumé neatly and inexpensively

Question 15

Job interview questions

Answer 15

• What positions interest you?
• Tell me about your work history,
• How did you choose to apply for a job here?
• Do you want a full-time or a part-time position, and what shift are you looking for?
• What are your strengths and weaknesses?
• What would you do if…?
• Why should we hire you?
• What questions do you have?
• Why did you become a nurse?

Question 16

Networking

Answer 16

• Research potential employers by networking at school, community sites, and student nurse organizations
• Explore websites of health care facilities; many have jobs posted and provide online applications
• Question faculty, other nurses, employees, former employees, and alumni of one’s own school
• Talk with nurses and other employees of potential institutions
• Review employment sections of job fairs and the Internet
• Listen to family members, neighbors, and friends who have been patients in facilities

Question 17

Exploring options

Answer 17

🔸 Knowing oneself
- The choice of the first nursing position deserves study
- Consult an instructor, a job counselor, or a trusted nursing mentor for objective input
- Review general interests, abilities, and strengths
- Consider physical and emotional stamina
- Consider energy level and responsibilities to others
- Consider long-term goals

Question 18

Leader vs. manager

Answer 18

🔸 Leader
- Attempt to influence the beliefs, opinions, or behaviors of a person or group
- Guide people and groups to accomplish common goals
- May not have formal authority but are still able to influence others

🔸 Manager
- Coordinate people, time, and supplies to achieve desired outcomes in a defined area of responsibility
- Have an appointed management position and a formal line of authority and accountability

Question 19

Leadership vs. managment

Answer 19

🔸 Leadership:
- ability to guide or influence others

➤ Formal leadership
* Practiced by the nurse who is appointed to an approved position and is given authority by the organization to act

➤ Informal leadership Loading…
* Exercised by the person who has no official authority to act but is able to influence others in the work group

🔸 Management:
- coordination of resources (time, people, supplies) to achieve outcomes
- Have an appointed management and a formal line of authority and accountability

Question 20

Types of Power – definition and examples

Answer 20

🔸 Power:
- Ability to motivate people to get things done with or without the formal right granted by the organization;

• Types of power:

🔸 Reward power
– Ability to reward people for compliance: money, desired scheduling or assignments, acknowledgement of accomplishments privately & publicly

🔸 Coercive power
– Opposite of reward power; based on fear of punishment for failure to comply, threats to or actual withheld/delayed pay increases; unwarranted verbal and written warnings and possibly termination. BULLYING

🔸 Legitimate power
– Power comes from the official position in which others are obligated to comply. Example: manager position

🔸 Referent power
– Ability to influence others due to respect and admiration from others who want to emulate the leader’s actions. Role Model

🔸 Expert power
– “Knowledge is Power” – based on knowledge, skills, and information expertise (work on unit for 15 yrs; consulted by new grads)

🔸 Informational power
- Similar to expert power, but based on holding any form of knowledge that others need

🔸 Connection power
- “Who you know”. Power based on a person’s affiliation with others who are perceived as being powerful.

Question 21

Management functions: Planning, Organizing, Staffing, Directing, Controlling

Answer 21

🔸 Planning
- Decide in advance what to do; how, when, and where it is to be done; and who is to do it
- All management functions based on planning

🔸 Organizing
- Establish formal structure to define the lines of authority, communication, and decision making
- Define roles and responsibilities for each level of management and staff
- Coordinate activities with other departments
- Communicate to ensure a smooth workflow

🔸 Staffing
- Determine the number and type of staff needed
- Recruit, interview, select, and assign personnel
- Orient, train, socialize, and develop staff members
- Implement ongoing staff development programs
- Implement creative and flexible scheduling

🔸 Directing
- Clearly communicate performance expectations

🔸 Controlling
- Ensure that employees accomplish goals while maintaining high-quality performance
- Establish performance or outcome standards
- Measure and evaluate performance against established standards
- Determine an action plan to improve performance

Question 22

Transformational vs. Transactional leadership – definitions, examples, be able to identify attributes of each

Answer 22

🔸 Transformational Leadership
- Empower the work group to accomplish goals
- They achieve higher levels of staff satisfaction and greater work group effectiveness

🔸 Transactional Leadership
- Also known as managerial leadership,
- Its a leadership style where leaders rely on rewards and punishments to achieve optimal job performance from their subordinates.
- The transactional executive leadership model is based on an exchange or transaction.

Question 23

Management theory – definition, examples of its use

Answer 23

🔸 Authoritarian:
- Makes all decisions with no staff input and uses the position to accomplish goals

🔸 Democratic:
- Encourages staff involvement in goal setting, problem solving, and decision making

🔸 Laissez-faire:
- Provides little direction or guidance and will forgo decision making

• Today’s health care system requires democratic (or participative) management
• Depending on the situation, the nurse manager may need to use different types of management styles

Question 24

How to be a good follower

Answer 24

🔸 Enthusiasm:
- cheerful attitude

🔸 Set the example:
- walk the talk

🔸 Know your responsibilities

🔸 Exhibit leadership PRIDE:
- Personal Responsibility In Developing Excellence in Everyone

🔸 Initiate followers:
- Don’t wait to be told what has to be done.

🔸 Life-long Learners

🔸 Emotional Awareness:
- self awareness of emotions
- self-regulation of emotions
- motivation
- empathy
- social skills

🔸 Seek to Serve:
- Assist others when necessary
- Put others first

Question 25

Bullying

Answer 25

➤ Also known as lateral violence or disruptive behaviors 🔸 Examples of bullying - Invalid criticism or unjustified blame - Profane or disrespectful language - Being gossiped about or being the target of rumors - Being yelled or shouted at in a hostile way - Being sworn at or verbally abused - Being assigned undesirable work differently from the rest of your colleagues - Being “put down” or humiliated in front of others 🔸 Consequences of bullying are significant - Victims may have problems with poor physical health, feelings of self-blame, reduced self-esteem, and work-withdrawal - Distress and low morale among other staff - Lower productivity and higher costs for the organization - Patient safety and quality concerns ➤ Nurses must provide the leadership to STOP bullying in the workplace

Question 26

HCAHPS- what factors determine this.

Answer 26

🔸 Hospital Consumer Assessment of Healthcare Providers and Systems (HSAHPS) standardized patient satisfaction survey ➢ Communication with nurses ➢ Communication with doctors ➢ Responsiveness of hospital staff ➢ Pain management ➢ Communication about medicines ➢ Cleanliness and quietness of hospital environment ➢ Discharge information

Question 27

Time management strategies

Answer 27

🔸 Planning - The most important step in time management - Create “To-do Lists” 🔸Organizing - Personal organization is an important component of time management 🔸Implementing ➢ Attack priorities ➢ Find “extra” time ➢ Avoid procrastination ➢ Delegate appropriately ➢ Control interruptions ➢ Manage meetings ➢ Learn the art of saying “no” ➢ Use technology to be more efficient ➢ Reward yourself

Question 28

Psychological Obstacles to Productive Work Habits

Answer 28

* Unclear goals and priorities * Constantly in chaos * Fear of downtime * Need to be a caretaker * Fear of failure * Fear of success * Fear of disrupting the status quo * Fear of completion * Need for perfection * Fear of losing creativity

Question 29

Sources of energy and distractions

Answer 29

🔸 Physical energy: - First component of a productive, highly energizing work life 🔸 Mental energy - Ability to maintain sustained concentration on a task and move flexibly through broad and narrow issues 🔸 Spiritual energy - Reflect on what’s important & identify your purpose and direction in life 🔸 Emotional energy - Ability to manage emotions skillfully, self regulation, social skills, empathy, motivation, self-awareness

Question 30

Research vs. EBP vs QI – compare/contract each, examples of each, be able to identify appropriate use of each

Answer 30

🔸 Research - It applies a methodology (quantitative or qualitative) to develop new knowledge. - Randomized Controlled Trials exploring new wound care methods. - Lived experience of pts with CHF 🔸 EBP - It seeks and applies the best clinical evidence (often from research) toward making patient- care decisions. - Heparinized saline for flushing peripheral IV catheter - Preventing and treatment of pressure ulcer 🔸 QI - It uses systematic processes to improve site specific patient outcomes. - Process to remove urinary catheter within a certain time frame. - Process to improve wound-care documentation

Question 31

Process Improvement tools- When to use them and what do they measure

Answer 31

🔸 Flowchart - Maps out what actually occurs in a work process Includes steps and sub-steps, and who does the work 🔸 Pareto chart - Bar chart Reflects frequency at which events occur, or the effect events have on a process 🔸 Cause-and-effect diagram - Fishbone 🔸 Run chart - Graph of data points as they occur over time - Sometimes referred to as time plots 🔸 A control chart is a more sophisticated run chart that helps to distinguish between “common” cause and “special” cause

Question 32

National Patient Safety Goals

Answer 32

1. Improve the accuracy of patient identification. 2. Improve the effectiveness of communication among caregivers. 3. Improve the safety of using medications. 4. Reduce the harm associated with clinical alarm systems. 5. Reduce the risk of health care–associated infections. 6. The hospital identifies safety risks inherent in its patient population. 7. Universal protocol is used for preventing wrong site, wrong procedure, and wrong person surgery.

Question 33

IOM Six Aims

Answer 33

🔸 Safe - Avoid injuries to pts caused by the care. 🔸 Timely - Reducing waits and harmful delays. 🔸 Effective - Providing services based on scientific knowledge to all who could benefit. 🔸 Efficient - Avoiding waste of equipment, supplies and energy. 🔸 Equitable - Providing core that does not vary inquality because of personal characteristics. 🔸 Patient-Centered - Providing care that is respect of and responsive to individual pt preference.

Question 34

Professional nurse and patient safety

Answer 34

➤ Answers for improved patient safety require all care providers to pull together to review critical circumstances and learn from key events ➤ Nurses’ challenge is to make patient safety a personal priority ➤ Two nursing functions closely influence patient safety and quality ➢ Monitoring for early recognition of adverse events, complications, and errors ➢ Initiating deployment of appropriate care providers for timely intervention and response/rescue of patients in these situations

Question 35

A patient understands that the hospital where he is currently having a procedure done is “Joint Commission” accredited. The patient asks the nurse how accreditation ensures that patients receive the best care possible. The nurse informs the patient that there are several quality initiatives required by The Joint Commission in order for the hospital to be accredited. One of these quality initiatives is known as: A) Pareto charts B) Never events C) National Hospital Quality D) Measures PDSA cycle

Answer 35

C) National Hospital Quality

Question 36

A quality improvement team was collecting data to determine how nurses use their time and to identify areas to improve nurses’ efficiency. The team found that 60% of nurses’ time was spent charting, 30% was spent in direct patient care activities, and 10% was spent on patient and family teaching. Which type of chart would best support the data collected by the quality improvement team? A) Cause and effect (Fishbone) B) Flowchart C) Pareto D) Time plot

Answer 36

C) Pareto

Question 37

A novice nurse completes a computer search on how to become an expert nurse. The novice nurse found Benner’s stages of becoming clinically competent and learned that most novice nurses enter the workforce at stage: A) one, when skills are learned by observation B) two, when limited judgment calls are based on understanding gained from previous experiences C) three, when long-term goals are established D) four, when solutions are easily achieved

Answer 37

B) two, when limited judgment calls are based on understanding gained from previous experiences

Question 38

In nursing school, it was required that a folder containing patient names be placed on the food cart so intake could easily and accurately be recorded. The novice nurse begins work after graduation and notices that often intakes are estimated because no recordings are made as the trays are picked up. At the staff meeting, the novice nurse suggests that the practice learned from school be incorporated on the unit, and this is accepted by the staff as a means to improve quality. This situation represents: A) role modeling B) biculturalism C) nurturing D) mentoring

Answer 38

B) biculturalism

Question 39

While making patient rounds, the charge nurse is told that a staff nurse sat in the room with the family and watched television, causing the patient’s medications to be late. When communicating with the staff nurse, the charge nurse states, “I will not tolerate lazy disorganized nurses on my unit. Either join my team or leave, and I don’t want to hear any of your excuses.” Which type of communication did the manager use? A) Straw man B) Aggressive C) Assertive D) Passive

Answer 39

B) Aggressive (forceful, conveying dominance

Question 40

A nurse is faced with choosing between returning to school for an advanced practice degree or accepting a position that is much coveted as a research assistant with a cardiology group. Time is spent at a local park contemplating how to best focus energy and vision for the future. The nurse is using which type of energy management? A) Physical B) Mental C) Spiritual D) Emotional

Answer 40

C) Spiritual

Question 41

A nurse is very interested in hospice care and is considering a position that has become open in that department. The nurse’s spouse and family are not in favor of the move. The nurse withdraws the application based on the obstacle of: A) fear of failure B) fear of success C) fear of disrupting the status quo D) fear of completion

Answer 41

C) fear of disrupting the status quo

Question 42

An RN suspects that an employer hires nursing students at a higher rate of pay and allows them to perform certain procedures that require the skills of an RN. The nursing students enjoy the autonomy and extra pay. Before the RN participates in whistle- blowing, he or she should: A) file a formal complaint to The Joint Commission to initiate an investigation and receive protection from retaliation by the employer. B) collect adequate documentation and, if possible, consult with the state nurses association before reporting to the state agency responsible for regulation of the employer. C) remember that protection from retaliation by the employer is provided until unethical or illegal actions are reported in writing. D) confront the individual suspected of wrongdoing and request that he or she stop the behavior.

Answer 42

B) collect adequate documentation and, if possible, consult with the state nurses association before reporting to the state agency responsible for regulation of the employer.

Question 43

Which of the following statements used in a résumé for a nurse just entering the workforce would produce the best results? A) “Graduation with high honors will be awarded along with my nursing degree” B) “I will graduate with honors” C) “A project on diverse populations will be presented to the state nursing association before graduation as part of my course requirements” D) “Every week, volunteer work is donated by students from my school for the local senior citizen’s agency”

Answer 43

B) “I will graduate with honors”

Question 44

Which of the following questions would be inappropriate for a nurse recruiter to ask during an interview? A) “What is your religious preference?” B) “Why did you leave your last job?” C) “Why do you want to be a nurse?” D) “Why are you applying to this organization?”

Answer 44

A) “What is your religious preference?”

Question 45

The hospital’s nursing administration wants to implement a policy that all wound care be implemented and monitored by the hospital’s certified enterostomal nurse because of a high rate of hospital-acquired wound infections. The nursing administrator refuses to hire an outside consultant suggested by the nurse managers, stating, “We can do this ourselves; no one needs to know our problems.” The nursing administrator is adhering to which management theory? A) Open systems B) Closed systems C) Chaos theory D) Participative theory

Answer 45

B) Closed systems ( they influence each other)

Question 46

Which of the following would have the greatest influence on the success of a health care organization? A) Effective protocols B) Clear goals and objectives C) A transactional nurse manager D) Human skills

Answer 46

B) Clear goals and objectives