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Flashcards in Multiple choice Deck (75):
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1: A nurse manager who structures her approach on the McClelland Model of Motivation would most likely focus on which of the following? Select all that apply.
a. Power d. Achievement
b. Affiliation e. Mentoring
c. Quality circles f. Collective decision making

ABD: McClelland’s Model of Motivation focuses on power, achievement, and affiliation. Ouchi’s model focuses on quality circles, collective decision making, long-term employment, and mentoring. FIGURE 1-1 KEY LEADERSHIP DIMENSIONS

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1: A nurse manager who follows Herzberg’s Two-Factor Theory would recognize that which of the following are hygiene-maintenance factors? Select all that apply.
a. Job security d. Relationships with others
b. Advancement opportunities e. Status
c. Working conditions f. Achievement

ACDE: Herzberg’s hygiene-maintenance factors include status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others. Advancement opportunities, achievement, recognition, the work itself, personal growth, and responsibility are all motivation factors. TABLE 1-2 MANAGEMENT THEORIES

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1: A nursing instructor determines that the nursing students understand the concept of “knowledge worker” if the students describe which of the following tasks of the knowledge worker? Select all that apply.
a. Provide service
b. Represent the organization
c. Interact with the customer
d. Focus on personal, life-long goals and achievement
e. Bring expert knowledge
f. Accomplish goals

ABCEF: According to Peter Drucker, knowledge workers provide service, interact with the customer, represent the organization, and accomplish its goals. These workers bring specialized, expert knowledge to the organization, and they are valued for what they know. The knowledge worker focuses more on organizational goals than personal goals. KNOWLEDGE WORKERS

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2: A group of faculty members is overhauling the curriculum for the nursing program based on recommendations set forth by the Institute of Medicine. The nursing program would most likely include which of the following in the outcomes for students attending the program? Select all that apply.
a. Ability to provide patient-centered care
b. Ability to work effectively with teams
c. Understanding evidence-based practice
d. Understanding that only medial diagnoses are important
e. Ability to use health information technology
f. understanding that nursing is more important than other health care professions

ABCE: Recommendations set forth by IOM include the ability to provide patient-centered care, ability to work effectively with teams, understand evidence-based practice, and the ability to use health information technology. There was no mention of any one profession being more important than another, nor was there any mention of the fact that only medial diagnoses are important. Nursing diagnoses are important to nurses because they identify areas of patient need that are addressed by nurses. IMPROVING QUALITY THROUGH HEALTH PROFESSIONS EDUCATION

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2: Which of the following may increase health services utilization? Select all that apply.
a. Expanded use of existing drugs
b. Growth in national population
c. Better understanding of risk factors for disease
d. Increase in chronic conditions
e. Quality standards for food and water distribution
f. More functional limitations associated with aging

ABDF: Health services utilization increases with the expanded use of existing drugs, growth in national population, increase in chronic conditions, and more functional limitations associated with aging. Other factors that would increase utilization include consumer documents and guidelines that recommend increased utilization, new procedures and technologies, as well as changes in clinician practice. If risk factors for disease were better understood, there would be a decreased use of services. Improved quality for food and water distribution would also cause reduced utilization. TABLE 2-5 FACTORS THAT AFFECT OVERALL HEALTH CARE UTILIZATION

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2: Which of the following are foundations of primary care? Select all that apply.
a. Longitudinality d. Second contact
b. Comprehensiveness e. Consensus building
c. First contact f. Coordination

ABCF: Foundations of primary care include first contact, longitudinality, comprehensiveness, and coordination. First contact involves the initial evaluation of the client, when the health dysfunction, treatment, and goals are defined. Longitudinality refers to sustaining a clinician-patient relationship over time. Comprehensiveness refers to managing a wide variety of health care needs across health settings and among different health professionals. Coordination involves referrals and follow-up. Second contact and consensus building are not related to the foundations of primary care. NEED FOR PRIMARY HEALTH CARE

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3: If a local hospital follows a Supportive Model of organizational behavior, which of the following would most likely be demonstrated? Select all that apply.
a. Passion
b. Passive cooperation
c. Meeting employee’s need for recognition
d. The basis of the model is leadership
e. The managerial orientation is authority
f. An employee orientation of self-discipline

ACD: The basis of the Supportive Model is leadership. This model is characterized by passion, support, good job performance, participation, acknowledgement of the employee’s need for status and recognition. Passive cooperation is characteristic of a Custodial Model, a managerial orientation of authority is characteristic of an Autocratic Model, and an employee orientation of self-discipline is characteristic of the Collegial Model. TABLE 3-1 MODEL OF ORGANIZATIONAL BEHAVIORS

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3: Which of the following are among the fourteen forces of magnetism? Select all that apply.
a. Quality care d. Autonomy
b. Image of nursing e. Quality of medical leadership
c. Professional development f. Management style

ABCDF: Quality care, image of nursing, professional development, autonomy and management style are part of the fourteen forces of magnetism. Quality of medical leadership is not one of the forces; however, quality of nursing leadership is. TABLE 3-6 THE FOURTEEN FORCES OF MAGNETISM

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3: A new graduate has been visiting several of the local hospitals to determine which facility would be a good place to begin a career. The graduate has visited both hospitals with and without magnet designation. Which of the following benefits related to organizational culture would be more apparent in the magnet-designated facilities? Select all that apply.
a. Shared decision making
b. Visible nurse leaders
c. Lower patient morbidity and mortality
d. Greater nurse empowerment structures
e. Increased culture of respect for nurses
f. Lower incidence of needle stick rates among nurses

ABDE: Shared decision making, visible nurse leaders, greater nurse empowerment structures, and increased culture of respect for nurses all relate to the organization’s culture. Lower patient morbidity and mortality relates to improved patient outcomes. A lower incidence of needle stick rates among nurses would be an enhanced safety outcome. TABLE 3-4 BENEFITS OF MAGNET DESIGNATION

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4: Which of the following would be considered direct costs in a nurse manager’s budget? Select all that apply.
a. Nurses’ salaries d. Heating cost
b. Maintenance costs e. Cost for air conditioning
c. Patient care supplies f. Utility costs such as electricity

AC: Nurses’ salaries and patient care supplies are considered direct cost. Maintenance cost, heating, air conditioning, and electricity costs are all indirect costs. FUNDAMENTAL COSTS

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4: In preventing infection of a central line, the nurse must perform which of the following hand hygiene protocols? Select all that apply.
a. Between each patient
b. Before, but not after, palpating catheter insertion site
c. Only when hands are obviously soiled
d. After using the bathroom
e. Before and after palpating catheter insertion site
f. Before and after invasive procedures

ADEF: Hand hygiene should be performed: before and after palpating catheter insertion site, before and after invasive procedure, and before and after donning gloves. In addition, hand hygiene must be performed between patients, after using the bathroom, and when hands are soiled. CENTRAL LINE BUNDLE

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4: A client is to have a central line inserted. According to the Institute for Health Improvement, which of the following are required? Select all that apply.
a. Cap d. Shoe covers
b. Mask e. Suction equipment
c. Clean gloves f. Large sterile drape

ABF: According to the Institute for Health Improvement, when inserting a central line, a cap, mask, sterile gloves, and a large sterile drape to cover the patient are required. Sterile instead of clean gloves are required. Shoe covers and suction equipment are not mentioned.THE INSTITUTE OF HEALTHCARE IMPROVEMENT

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5: A nurse researcher conducts a study of pregnant African American women between the ages of 15 and 35. The purpose of the study is to determine if weekly nutritional counseling sessions and participation in a structured weekly support group have any impact on the mother’s post-delivery B/P or the infant’s APGAR score. What would be the independent variable or variables in the study? Select all that apply.
a. Age of subjects d. Infant’s APGAR score
b. Nutritional counseling sessions e. African American female
c. Mother’s post-delivery B/P f. Structured weekly support group

BF: The nutritional counseling sessions and the structured weekly support group are the independent variables. Independent variables are the variables believed to cause or influence the dependent variables. Also, the independent variables are the variables that are manipulated. In this study, the age of the subject and her being an African American are considered demographic variables. The mother’s post-delivery B/P and the infant’s APGAR score are the dependent variables. TABLE 5-5 RESEARCH TERMINOLOGY

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5: A nurse researcher conducts a study of pregnant African American women between the ages of 15 and 35. The purpose of the study is to determine if weekly exercise classes and participation in a structured weekly support group have any impact on the mother’s post-delivery B/P, request for pain medication, or the infant’s APGAR score. What would be the dependent variable or variables in the study? Select all that apply.
a. Age of subjects d. Infant’s APGAR score
b. Weekly exercise classes e. Request for pain medication
c. Mother’s post-delivery B/P f. Structured weekly support group

CDE: The mother’s post-delivery B/P, request for pain medication, and the infant’s APGAR score are the dependent variables. Dependent variables are the outcome variables that are hypothesized or thought to depend on or be caused by another variable, called the independent variable. In this study, participation in weekly exercise classes and the structured support group are the independent variables. TABLE 5-5 RESEARCH TERMINOLOGY

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5: A nurse conducts a study of perceptions of caring on five oncology units. At the beginning of the study, all of the nurses on the oncology units were asked to complete a survey identifying what they perceived as nurses’ demonstration of caring. Prior to discharge, each patient that the nurses had cared for and their family members were given a short questionnaire to evaluate their perceptions of the nurses’ demonstration of caring. Which of the following were the dependent variables? Select all that apply.
a. Age
b. Gender
c. Ethnicity
d. Patients’ perception of nurse’s caring
e. Nurses’ caring behaviors
f. Family members’ perception of nurses’ caring

DF: The dependent variables of the study were patients’ and family members’ perceptions of nurses’ caring, Age, gender, and ethnicity were the demographic variables. Nurses’ caring behaviors were the independent variable. TABLE 5-5 RESEARCH TERMINOLOGY

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8: Which of the following would be considered a barrier to a nurse’s effective communication? Select all that apply.
a. Interrupting d. Experiencing stress
b. Attentive listening e. Developing trust
c. Being defensive f. Offering false reassurance

ACDF: Barriers to effective communication include interrupting, being defensive, and offering false reassurance. When an individual is experiencing stress, this may become a barrier to effective communication. Attentive listening, developing trust, clarifying, using silence, and providing information are strategies which will facilitate communication. TABLE 8-4 ADDITIONAL BARRIERS TO COMMUNICATION

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8: A nursing student wants to be able to communicate with clients who speak other languages. While enrolled in nursing school, the student learns four of the top spoken languages. These languages would most likely be which of the following? Select all that apply.
a. Spanish d. Arabic
b. Russian e. Mandarin Chinese
c. Hindi f. Japanese

ACDE: Today, Mandarin Chinese tops the list of most spoken language with approximately 1 billion speakers. The next most often spoken languages are Spanish, numbering 329 million; English, 328 million; Arabic, 221 million; and Hindi, 182 million. USE OF LANGUAGE

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8: A nurse manager works diligently to communicate effectively with the staff. In order to avoid barriers to communication, the nurse manager should do which of the following? Select all that apply.
a. Be sensitive to cultural differences d. Elicit verbal and nonverbal feedback
b. Enhance listening skills e. Avoid metacommunication
c. Communicate aggressively f. Be sensitive to gender differences

ABDF: Strategies that the nurse manager can implement to avoid barriers to communication include being sensitive to cultural and gender differences, enhancing listening skills, eliciting both verbal and nonverbal feedback. The nurse manager should also communicate assertively and utilize metacommunication. Each of these techniques help to develop rapport with the staff and become a foundation for the development of trust. TABLE 8-5 OVERCOMING COMMUNICATION BARRIERS

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11: Which of the following statements is true regarding status differences in teams? Select all that apply.
a. Status is the measure of worth conferred on an individual by a group.
b. Status differences have a profound effect on the functioning of teams.
c. High status individuals initiate communication more often.
d. Low status individuals have more influence over the decision making process.
e. Low status individuals may be intimidated or ignored by high status individuals.
f. There are no status differences among health professionals.

ABCE: The statements that status is the measure of worth conferred on an individual by a group, status differences have a profound effect on the functioning of teams, high status individuals initiate communication more often, and low status individuals may be intimidated or ignored by high status individuals are all true. In many situations, high status individuals have more influence over the decision making process. There are frequently status differences among health professionals. STATUS DIFFERENCES

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11: A nursing student is a member of several different groups. Which group(s) would be considered informal group(s)? Select all that apply.
a. Four students planning the holiday party
b. Student members of the Nursing Department Student Affairs Committee
c. Students meeting each day for lunch in the school cafeteria
d. Members of the National Student Nurses Association
e. Students studying together for a nursing quiz
f. Group of students who filed a petition regarding an unfair school policy

ACEF: Four students planning the holiday party, students meeting each day for lunch in the school cafeteria, students studying for a nursing quiz, and a group of students who filed a petition regarding an unfair policy would all be considered informal groups. Informal groups are not directly established or sanctioned by an organization, but they are formed naturally by individuals to fulfill personal or social interests or needs. INFORMAL TEAMS

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11: Several nurses have participated on a team which has demonstrated symptoms of the presence of groupthink. Which of the following may be occurring on the team? Select all that apply.
a. Collective rationalization d. Self-censorship
b. Pressure not to conform e. Avoidance of mindguards
c. Stereotyping others f. Illusions of unanimity

ACDF: The team my be demonstrating collective rationalization, stereotyping others, self-censorship, and illusions of unanimity if they have become involved in groupthink. Other characteristics of groupthink include pressure to conform and use of mindguards. AVOIDANCE OF GROUPTHINK

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12: A framework for nurses to develop their personal power would include which of the following? Select all that apply.
a. Find a mentor
b. Seek answers to questions
c. Maintain a source of evidence-based information
d. Introduce yourself to powerful people
e. Avoid professional organizations
f. Make a plan to develop sources of power

ABCDF: Nurses can develop personal power by finding a mentor, seeking answers to questions, maintaining a source of evidence-based information, introducing themselves to powerful people, and making a plan to develop sources of power. TABLE 12-2 A FRAMEWORK FOR BECOMING EMPOWERED

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12: In which of the following situations is the nurse manager using coercive power? Select all that apply.
a. Informing a staff member the he will receive a raise because of his excellent nursing care
b. Implying that an employee is at risk of losing his job due to lack of motivation
c. Telling staff members that if they want to be considered for promotion, they must join one of the organization’s committees
d. Threatening to fire a staff member if excessive tardiness continues
e. Writing a letter of recommendation for a nurse who has resigned
f. Threatening an employee with job loss if he does not agree to work overtime

BCDF: Coercive power comes from the ability to punish others or take disciplinary actions against others in an attempt to influence them to change their behavior. When the nurse manager implies that a nurse might lose his job, tells a staff that they must join a committee if they want a promotion, threatens to fire someone due to absence, or threatens job loss if the staff member is not willing to work overtime, the manager is using coercive power. Giving an employee a raise or writing a letter of recommendation are example of reward power. SOURCES OF POWER

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12: Strategies for nurses to implement in order to increase their organizational power include which of the following? Select all that apply.
a. Get involved beyond direct patient care
b. Continually improve and add to the knowledge you have in relation to your organizational unit, to the organization as a whole
c. Readily share appropriate knowledge with others who will value it and use it to a good end
d. Stay away from individuals who perceive themselves as powerful
e. Volunteer to be involved with health care at the local, state, and national level
f. Volunteer for committee assignments that will challenge you to learn and experience more than what is expected of you in a staff nurse role

ABCEF: All of the above are strategies for increasing a nurse’s organizational power except for option “d.” Instead of isolating oneself from individuals who perceive themselves as powerful, analyze the situation. These individuals may in fact be powerful within the organization and can possibly serve as mentors. TABLE 12-2 A FRAMEWORK FOR BECOMING EMPOWERED

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31: You are scheduled to take your NCLEX-RN examination tomorrow. Some things that you should consider doing to reduce your anxiety include which of the following? Select all that apply.
a. Practice breathing exercises
b. Drink several cups of coffee before the test
c. Think positive and avoid negative thoughts
d. Practice relaxation exercises
e. Eat a spicy, high fat, high protein diet for dinner tonight
f. Use your imagination to create a relaxing sensory scene on which to concentrate

ACDF: To reduce your anxiety, it is suggested that you practice breathing an relaxation exercises. Thinking positive and avoiding negative thoughts will also help. You should also consider using your imagination to create a relaxing sensory scene on which to concentrate. Drinking several cups of coffee can possibly increase your anxiety. Eating a spicy, high fat, high protein meal could cause digestive problems while taking the test.EXIT EXAMINATIONS

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31: NCLEX-RN questions come in a variety of formats. Which formats are included? Select all that apply.
a. true/false questions d. fill-in-the blank questions
b. multiple choice questions e. essay questions
c. multiple response questions f. questions with exhibits to examine

BCDF: NCLEX-RN question formats include: multiple choice, multiple response, fill-in-the blanks, and questions with exhibits to exam. True/false and essay questions are not included on the examination. HOW THE EXAMINATION IS CONSTRUCTED

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31: For a question regarding a patient who experiencing drowsiness as a result of a medication, which of the following are possible nursing strategies to address the drowsiness? Select all that apply.
a. monitor airway d. place in high fowler’s position
b. monitor temperature e. monitor pulse, respirations, and B/P
c. monitor level of consciousness f. evaluate diet

ACE: When a patient is experiencing drowsiness as a result of taking a medication, the nurse would consider monitoring airway, pulse, respirations, BP and level of consciousness (LOC). Monitoring temperature, evaluating the patient’s diet, or placing the patient in high fowler’s position will not specifically address the issue of drowsiness. GENERAL TIPS

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30: You decide that you want to improve your health by exercising more. Which of the following activities would be the best to achieve your goal? Select all that apply.
a. taking shorter naps d. listening to energizing music
b. jogging through the park e. practicing yoga and tai chi
c. playing golf every Saturday f. going dancing with friends

BCEF: The most appropriate activity to improve your health through exercising would include jogging through the park, playing golf every Saturday, practicing yoga and tai chi, and going dancing with friends. Other methods would include walking, cycling, swimming, skiing and team sports. PRACTICAL EXERCISE SUGGESTIONS

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30: One of your classmates is obese and tells you that exercise is too much work. To encourage your classmate to exercise more, you talk about some of the benefits of exercise which include which of the following? Select all that apply.
a. boosts the immune response to disease d. decreases fat deposition
b. improves flexibility and endurance e. increases fat deposition
c. makes you feel better mentally f. improves cardiovascular function

ABCDF: Some of the benefits of exercise is that it can boosts the immune response to disease, improve flexibility and endurance, makes you feel better mentally, decrease fat deposition (it does not increase fat deposition), and improve cardiovascular function by lowering cholesterol and blood pressure and strengthening heart muscle. BENEFITS OF EXERCISE

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30: According to Healthy People 2020, social determinants of health would include which of the following? Select all that apply.
a. sex d. physical stature
b. family e. income
c. geographic location f. access to health care

ABCEF: According to Healthy People 2020 social health determinants include family, community, income, education, sex, race/ethnicity, geographic location, and access to health care, among others. Physical stature is not a social determinant of health. GOALS FOR HEALTHY PEOPLE 2020 AND BEYOND

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29: A new nurse would most likely receive information on which of the following during the general orientation? Select all that apply.
a. Hospital procedures d. Safety issues
b. CPR competency e. IV monitoring equipment
c. Pulse oximetry set up f. Hospital policies

ABDF: The general orientation for the new nurse should include: hospital policies and procedures, CPR competency, and safety issues. Orientation on the pulse oximetry set up and IV monitoring equipment will most likely be done during the unit-specific orientation. GENERAL ORIENTATION

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29: A nursing instructor wants to determine if the students know the types of questions that should be asked when they are interviewing for their first position. Which of the following questions are appropriate? Select all that apply.
a. How long should I expect to be in orientation?
b. In case of short staffing, will I be pulled from orientation?
c. Will I be paid for time in education programs?
d. Is it tailored to my needs, or is it the same for everybody?
e. What ongoing education will be available to me?
f. Does it occur at the beginning of my new position or will it be offered in stages?

ABCDEF: Orientation is a key element for new nurses to become familiar with general policies, procedures, and requirements as well as unit-specific goals and criteria. All of the questions listed above are important for the nurse to ark regarding the orientation. ORIENTATION CONSIDERATIONS

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29: The nurse manager has asked you to provide information regarding your preceptor that you have been assigned to for the past two months. You feel the preceptor has been very supportive toward you and has demonstrated all the characteristics that you hoped to get in your first preceptor. When providing feedback, you would most likely include which of the following comments? “My preceptor: Select all that apply.
a. shows a commitment to the role of preceptor.”
b. often makes me feel like I am intruding on her time.”
c. helps me to practice and learn new clinical skills.”
d. seems to enjoy teaching me.”
e. makes me feel like I am incompetent.”
f. matches my learning style with her teaching style.”

ACDF: If you have had a good experience with the preceptor, you would most likely identify characteristics of a good preceptor such as showing a commitment to the role, enjoying teaching you new skills, and matching her teaching style with your learning style. You would not have a positive perception of the preceptor if she made you feel incompetent or like you were an intruding on her time. PRECEPTORS

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28: Statistical data from The American Association of Colleges of Nursing(AACN) and the National League for Nursing(NLN), 2010 reveals which for the following data on nursing as a profession? Select all that apply.
a. Nursing in the United States is the largest health care profession
b. There are more than 8 million Registered Nurses (RNs) nationwide.
c. Nurses deliver most of the nation's long-term care
d. Registered Nurses comprise one of the largest segments of the U.S. workforce as a whole
e. Registered nurses are among the lowest paid large occupations
f. From 1980 to 2004, the percentage of employed RNs working in hospitals increased from 56.2% to 66%

ACD: Data from the AACN and NLN revealed that nursing is the largest health care profession, with nurses delivering most of the nation’s long-term care. The reports also revealed that nurses compromise on the largest segments of the U.S. workforce. INTRODUCTION

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28: You have decided to become a nurse entrepreneur which will provide you with the flexibility of scheduling your day around your around your children’s schedule. Some of the important attributes that you will need to be a successful entrepreneur include which of the following? Select all that apply.
a. Demonstrate confidence and creativity
b. Act aggressively in order to achieve you goals
c. Be a visionary, self motivated, and a risk taker
d. Depend only on yourself
e. Possess good financial foresight
f. Recognize the possibility of success as well as the possibility of failure

ACEF: The attributes that you will need to be a successful entrepreneur include: being visionary, self motivated, and a risk taker; have common sense; make good decision and solve problems effectively; be self confident, assertive, autonomous, and creative; become responsive to a perceived need; become market driven, with good financial foresight; and recognize the possibility of success as well as the possibility of failure. As an entrepreneur you should be assertive and not aggressive or passive. It is also important that while you need to be independent, you must recognize when there are times that you may need to depend on others for assistance. NURSE ENTREPRENEUR

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28: A nurse has just been certified as a Case Manager. Which of the following activities will the nurse most likely be involved when implementing this role? Select all that apply.
a. interact with insurance companies
b. utilization review and quality management
c. follow only one or two acutely ill patients
d. work with community based vendors
e. work closely with multiple disciplines
f. provide direct patient care at the bedside

ABDE: A case manager is responsible for utilization and quality management, working with multiple disciplines, and interacting with community vendors and insurance companies. Most case managers carry a case load of patients. The do not provide the direct patient care at the bedside. CASE MANAGER

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27: When writing your resume you include person and professional characteristics that you believe will please potential employers. Some of those characteristics would include which of the following? Select all that apply.
a. accept constructive feedback d. reliable in attendance
b. work well with others e. sensitive to comments of others
c. take responsibility for own learning f. prefers to work alone

ABCD: Most employers are looking for employees who are able to accept constructive feedback, work well with others, take responsibility for own learning, and who are reliable in attendance. Individuals who are sensitive to comments of others or who prefer to work alone may not perform well in situations where teamwork is needed such as nursing. RESUME

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27: During a job interview the Nurse Recruiter asks you questions about your age, marital status, the number of children you have, your political affiliation, your past work experiences, and an example of when you demonstrated leadership. Questions regarding which of the following is considered a violation of the law? Select all that apply.
a. age
b. marital status
c. number of children
d. political affiliation
e. past work experience
f. example of when you demonstrated leadership

ABCD: Questions concerning family relationships such as your marital status or children cannot legally be asked during job interviews. Other topics that are not legal are questions related to your social organizations, political or sexual orientation, age, cultural heritage, or health/medical history. PREPARATION FOR THE INTERVIEW

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27: You have just arrived for you interview and the interviewer invites you into the office. Which of the following are appropriate actions for you to take? Select all that apply.
a. maintain good eye contact
b. don’t shake hands because of the possibility of spreading germs
c. continue to chew your gum to avoid smoker’s breath
d. smile and maintain good posture once seated
e. address the interviewer by his or her first name in order to develop rapport
f. sit down immediately because you had to walk a long distance from the parking lot and you are very tired

AD: You should maintain good eye contact, smile, and maintain good posture once seated. Other actions you would take include shaking hands and address the interviewer formally. You should never sit down until invited to do so. Also never chew gum PREPARATION FOR THE INTERVIEW

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26: You attend a meeting with other nurses employed at the hospital who are considering unionization. When you return home, you create a list of the pros and cons for unionizing. Your list of cons would most likely include which of the following? Select all that apply.
a. Other union members may outvote your decisions.
b. All union members and management must conform to the terms of the contract without exception
c. A process can be instituted to question a manager’s authority if a member feels something was done unjustly.
d. Unions may be perceived by some as not being professional.
e. Union dues must be paid even if individuals do not support unionization.
f. Union dues are required to make the union work for you.

ADE: Some of the cons that might be on you list include other union members may outvote your decisions, union dues must be paid even if individuals do not support unionization, and unions may be perceived by some as not being professional. In addition, the list could include the facts that there is reduced allowance for individuality, disputes are not handled with an individual and management only (there is less room for personal judgment), and some employees may not agree with the collective voice.. TABLE 26-6 PROS AND CONS OF UNIONIZATION

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26: The nurses at the hospital where you are employed are in the process of unionization. Your role during this process would include which of the following? Select all that apply.
a. Act clearly within the law at all times.
b. Know the rights of your manager.
c. If a manager acts unlawfully, report it to the NLRB.
d. Know your legal rights.
e. Demand an increase in salary.
f. If another nurse practices in an unsafe manner, report it to the NLRB.

ABCD: Your role would include acting clearly within the law at all times, knowing your legal rights, knowing the rights of your manager, and reporting unlawful acts by the manager to the NLRB. The process does not include demanding a salary increase or reporting unsafe nursing practice to the NLRB. Unsafe practices of another nurse should be reported to your immediate supervisor. TABLE 26-5 NURSE'S ROLE DURING INITIATION OF UNIONIZATION

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26: You are employed in a hospital where nurses are unionized. Which of the following situations would you report to the NLRB? Select all that apply.
a. A staff nurse gave a medication to the wrong patient.
b. A nurse is given a verbal warning because of consistent tardiness.
c. You were not paid overtime for the extra hours you worked last week.
d. A nurse was denied a promotion due to failure to provide quality care.
e. Nurses are being sexually harassed by many of the physicians.
f. Units are often understaffed and experiencing increased patient falls.

CEF: The issues that you should report to the NLRB include not being paid for overtime; sexual harassment; and the units’ being understaffed, resulting in increased patient falls. Salary issues and environmental safety issues are under the purview of the union. FACTORS INFLUENCING NURSES TO UNIONIZE

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25: You are a nurse manager who is attempting to develop generational diversity amongst your nursing workforce. Which of the following would be your key approaches? Select all that apply.
a. Utilizing effective approaches that are specific to the applicable staff generation
b. Continually exploring the workplace culture and conditions and maintaining the ability to be flexible in interventions and response mechanisms
c. Addressing the needs of the older generations first since they have been with the agency the longest
d. Working successfully with problems that arise due to generational differences
e. Creating an organizational environment that connects with all staff, thereby increasing retention rates
f. Addressing the needs of the younger generations because they have more years to contribute to the workforce

ABDE: The International Council of Nurses and the International Center for Human Resources in Nursing identified four approaches to developing generational diversity in the nursing workforce. They included utilizing effective approaches that are specific to the applicable staff generation; continually exploring the workplace culture and conditions and maintaining the ability to be flexible in interventions and response mechanisms; working successfully with problems that arise due to generational differences; and creating an organizational environment that connects with all staff, thereby increasing retention rates. GENERATIONAL PERCEPTIONS

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25: You have a client who is experiencing a spiritual need. You refer to Carson and Koenig's (2008) spiritual assessment because it involves five broad questions that you can use. Which of the following would be included among the questions? Select all that apply.
a. Does the medical care conflict with any of the patient’s spiritual beliefs?
b. Is the patient experiencing comfort or stress related to spiritual beliefs?
c. Will the health care provider’s spiritual beliefs negatively impact the patient?
d. Is there involvement or support from any religious community?
e. Do the patient’s spiritual beliefs impact health care decision-making practices?
f. Is there a need for additional referrals?

ABDEF: Carson and Koenig’s (2008) spiritual assessment involves five broad questions focusing around whether the medical care conflicts with any of the patient’s spiritual beliefs, whether the patient is experiencing comfort or stress related to spiritual beliefs, whether there is involvement or support from any religious community, how the patient’s spiritual beliefs impact health care decision-making practices, and if there is a need for additional referrals. The nurse’s spiritual beliefs are not an aspect of the patient assessment. SPIRITUAL ASSESSMENT

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25: As the nurse manager, you recognize that the elimination of disparities is a multifaceted challenge that includes interventions aimed at access to care as well as factors associated with prejudice and bias. Strategies to reduce health disparities would include which of the following? Select all that apply.
a. Improving access and infrastructures at the public health and health care systems levels
b. Encouraging all nursing staff members to return to school in order to be eligible for promotions
c. Increasing the diversity of the nursing staff to enhance patient and provider relations and reduce problems in cross-cultural communication
d. Examining the organization’s culture, condition, and training needs and then advocating for changes that reduce disparities
e. Only assigning nurses to patients who are members of the nurses’ own ethnic group and age group
f. Utilizing culturally and linguistically appropriate approaches to nursing care that can be flexible to patient needs while still identifying and addressing potential barriers that are specific to the individual patient

ACDF: As the nurse manager, you recognize that strategies to reduce health disparities include improving access and infrastructures at the public health and health care systems levels; increasing the diversity of the nursing staff to enhance patient and provider relations and reduce problems in cross-cultural communication; examining the organization’s culture, condition, and training needs and then advocating for changes that reduce disparities; and utilizing culturally and linguistically appropriate approaches to nursing care that can be flexible to patient needs while still identifying and addressing potential barriers that are specific to the individual patient. ELIMINATING HEALTH DISPARITIES

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24: As a new graduate, you strongly believe in the ethical principles. You plan to practice nonmaleficence by including which of the following in your practice as a nurse? Select all that apply.
a. Always work within your Standards of Nursing Practice
b. Observe all safety rules and precautions
c. Take shortcuts in order to reduce time-on-task so that you can accomplish more
d. Perform procedures according to facility protocols
e. Never ask for assistance because you are a BSN graduate and competent in all areas
f. Keep your education and skills up to date with competency building and life-long learning

ABDF: The principle of nonmaleficence is based on doing no harm. As a new graduate, you must always work within your Standards of Nursing Practice, observe all safety rules and precautions, perform procedures according to facility protocols, and keep your education and skills up to date with competency building and life-long learning. In addition, you must never give out information or perform duties you are not qualified to do, always keep areas safe from hazards, never take shortcuts, and always ask an appropriate person about anything you are unsure of. TABLE 24-2 ETHICAL PRINCIPLES

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24: A nurse manager wishes to assure that the hospital is in compliance with the Patient Care Partnership. The nurse manager goes on the AHA Web site, which has a checklist that can help assure compliance. On the checklist, the nurse manager would most likely find which of the following items? Select all that apply.
a. Ethics committee
b. Communication in-services for employees
c. Process for patient follow-up on concerns
d. Statement of patient rights
e. Assistance with paying hospital bills
f. Patient education on the use of advanced directives

ABCDF:The checklist would most likely include items such as an ethics committee, a statement of patient rights, in-services for employees, patient education on advance directives, and a process for follow-up on patient concerns. Assistance with paying hospital bills would not be an aspect of the hospital’s responsibility related to Patient Care Partnership.
PATIENT RIGHTS

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24: As an RN, you recognize that to practice the ethical principle of autonomy (i.e., respect for an individual’s right to self-determination and individual liberty) you would practice which of he following? Select all that apply.
a. Protect the physical privacy of patients
b. Be sure that patients have consented to all treatments and procedures
c. Provide attorney’s with all relevant information if it will help a patient’s legal case
d. Release patient information of any kind to all family members who request it
e. Discuss patients with other professional nurses who are not involved in the patient’s care
f. Become familiar with state laws and facility policies dealing with advance directives

ABF: To practice the principle of autonomy, an RN would protect the physical privacy of patients, be sure that patients have consented to all treatments and procedures, and become familiar with state and facility policies dealing with advance directives. Nurses should not release patient information of any kind unless there is a signed release. Patient information should not be discussed with anyone who is not professionally involved in the patient’s care. TABLE 24-2 ETHICAL PRINCIPLES

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23: A nurse asks an attorney specializing in health care about what constitutes negligence. Which of the following would the attorney say is needed to legally determine that a nurse has been negligent? Select all that apply.
a. The nurse had a duty to perform.
b. There was a breach of this duty, either by omission or commission.
c. There is proof that the breach of duty caused the harm.
d. The patient was not harmed.
e. There was actual harm, which can be physical, emotional, or financial, to the patient.
f. The nurse was overworked.

ABE: For a nurse to be found negligent, the following must occur: the nurse had a duty to perform; there was a breach of this duty, either by omission or commission; the patient was harmed (either physically, emotionally, or financially). NEGLIGENCE AND MALPRACTICE

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23: A nurse asks an attorney specializing in health care for examples of malpractice. Which of the following would the attorney give as examples of malpractice? Select all that apply.
a. A nurse administers digoxin to the wrong patient, and the patient dies.
b. A nurse hangs an IV after checking the label, but the pharmacist placed the wrong contents in the IV, and the patient dies.
c. A patient has been admitted to the hospital under an order of commitment, but she elopes and is killed by a drunk driver outside the hospital.
d. A nurse does not restart an IV for a client in sickle cell crisis when the original IV infiltrates. Lacking needed fluids, the patient dies.
e. A nurse places a patient in restraints without a physician’s order, and the patient suffocates while trying to get out of the restraints.
f. A client is experiencing complications of labor, and the nurse contacts the physician while he is at a major fundraising event.

ACDE: Administering the wrong medication, restraining a patient without a physician’s order, allowing a client who is admitted to elope, and neglecting to restart the IV on a client in a sickle cell crisis can all become situations of malpractice. The term malpractice refers to wrongful conduct in the discharge of professional duties or failure to meet standards of care for the profession that results in harm to an individual entrusted to the professional’s care. The nurse who hung the wrong IV would have followed standard practice; the issue of malpractice would be with the pharmacist. The nurse who contacted the physician when the patient experienced complications of labor was also acting responsibly. TABLE 23-4 NURSING MALPRACTICE CASES

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23: You are attending a conference on the legal aspects of nursing management. The speaker informs the participants that nursing malpractice can involve which of the following? Select all that apply.
a. Medication problems
b. Personal problems
c. Treatment problems
d. Personnel problems
e. Communication problems
f. Monitoring/observing/supervising problems

ACEF: Nursing malpractice cases can involve medication, treatment, communication, and monitoring/observing/supervising problems. Personal and personnel problems are not categories specific to malpractice. TABLE 23-4 NURSING MALPRACTICE CASES

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22: Which of the following may negatively affect a nurse’s decision-making or problem-solving ability? Select all that apply.
a. Failing to obtain all the necessary information
b. Jumping to conclusions without examining the situation thoroughly
c. Failing to involve the nurse manager and other experts in identifying a solution
d. Failing to choose and communicate a rational solution
e. Choosing decisions that are too broad, too complicated, or lack definition
f. Failing to intervene and evaluate the decision or solution appropriately

ABDEF: Delaune and Ladner (2011) have identified actions that may negatively affect the decision-making or problem-solving processes. They include jumping to conclusions without examining the situation thoroughly; failing to obtain all of the necessary information; choosing decisions that are too broad, too complicated, or lack definition; failing to choose and communicate a rational solution; and failing to intervene and evaluate the decision or solution appropriately. It may not be necessary to involve the nurse manager and other experts in identifying the solution if the nurse has obtain the needed information to make the decision. LIMITATIONS OF EFFECTIVE DECISION MAKING

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22: You recently graduated from nursing school and are now working on a pediatric unit. It is important for you to make sound decisions that can potentially affect your personal and professional life. In order to be effective in your decision-making ability, you decide to do which of the following each time a major issue occurs? Select all that apply.
a. Trust yourself
b. Make only those decisions that are yours to make
c. Procrastinate as long as possible since you are a recent graduate
d. Only consider your decision if it affects you
e. Leave patient care decisions to the more expert nurses
f. Write down pros and cons of an issue to help clarify your thinking

ABF: In order to make sound decisions, you should trust yourself, make only decisions that are yours to make, and consider not only yourself but how your decisions will affect others. Additional strategies to use include writing down pros and cons of an issue to help clarify your thinking; writing notes and keeping ideas visible about decisions in order to utilize all relevant information; and making decisions as you go along rather than procrastinating and letting them accumulate. While expert nurses can provide valuable information, you as a new graduate can still make decisions related to patient care. TABLE 22-6 DOS AND DON'T OF DECISION MAKING

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22: Which of the following are examples of reflective thinking? Select all that apply.
a. You develop a plan to study for the NCLEX-RN.
b. A nurse reviews all options for returning to school in order to obtain a Master’s Degree.
c. A nurse thinks about a decision she made to return to school.
d. A group of nurses share ideas about the upcoming Christmas party.
e. After completing a dressing change, you think about additional strategies to be used when changing a sterile dressing.
f. You have just completed the NCLEX-RN and wonder if your answers were the best.

CEF: Thinking about a decision which has been made, a better way of changing a dressing, or the way you answered questions on the NCLEX-RN are all examples of reflective thinking. Reflective thinking involves watching or observing ourselves as we perform a task or make a decision about a particular situation. REFLECTIVE THINKING

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21: The six areas of evidence-based practice interventions identified in IHI’s 100,000 Lives campaign included which of the following? Select all that apply.
a. Deploy Rapid Response Teams
b. Reduce Surgical Site Infections
c. Prevent Adverse Drug Events through Medication Reconciliation
d. Treat Central Line Infections
e. Reduce the Number of Ventilator-Associated Pneumonias
f. Deliver Reliable Evidence-Based Care for Acute Myocardial Infarction

ACF: The six areas were Deploy Rapid Response Teams, Deliver Reliable Evidence-Based Care for Acute Myocardial Infarction, and Prevent Adverse Drug Events through Medication Reconciliation. Other goals identified included Prevent Central Line Infections, Prevent Surgical Site Infections, and Prevent Ventilator-Associated Pneumonia. The goal was to prevent these last three from occurring and not just to treat these situations or reduce their occurrence. EVIDENCE-BASED PRACTICE

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21: The nurse is making a home visit to an elderly patient with a history of pressure ulcers. The patient lives with her son, daughter, an four grandchildren. The daughter-in-law, who is home today, tells the nurse, “She has to be able to take care of herself because the job and the children keep me very busy. I make sure there is food for her to eat, but she is still losing weight. I don’t know what else I can do.” The nurse proceeds to conduct an assessment of the patient. Which of the following assessed factors would indicate to the nurse that the patient’s wound will not heal? Select all that apply.
a. Walks independently
b. Eats independently
c. Wound is over 3 months old
d. Incontinent of feces
e. Incontinent of urine
f. Has lost more than 5 percent of her weight in the past 90 days

CDEF: The fact that the client walks and eats independently is a positive; however, the fact that the client has lost more than 5 percent of her baseline weight in the past 90 days, is incontinent of both feces and urine, and the wound is over 3 months old would indicate that the wound will not heal. HEALING PROBABILITY ASSESSMENT TOOL

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21: The 5Ps strategy for assessing skin changes, skin breakdown, and pressure ulcers include which of the following? Select all that apply.
a. Prevention d. Preservation
b. Prescription e. Palliation
c. Promotion f. Patient preference

ABDEF: The 5Ps include prevention, prescription, preservation, palliation, and patient preference. Promotion is not one of the 5Ps. PRESSURE ULCER MANAGEMENT

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18: Which of the following client care tasks would most likely be third priority in terms of assessing? Select all that apply.
a. Dressing change for a client who is 3-days post-op
b. Teaching a client about the importance of the ordered medications
c. Returning a call to a family member who is requesting information
d. Starting an IV on a client in a sickle cell crisis
e. Teaching family members about methods to prevent accidents in the home
f. Monitoring a client who is in the first 15 minutes of receiving a unit of blood

ABCE: Issues of comfort, healing, and teaching, while essential to a patient’s of care, can be addressed after first and second priority issues have been addressed. COMFORT, HEALING, AND TEACHING

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18: Three RNs are working in a busy ER when six patients enter at the same time. Which three patients will the RNs see first? Select all that apply.
a. A client with head trauma from a car accident who is unconscious
b. A child with a small laceration on the knee resulting from a fall
c. A client who has been stabbed and is bleeding profusely
d. A child experiencing a severe asthma attack
e. A client limping on a very swollen bruised ankle
f. An infant with a rash on the abdomen and extremities

ACD: The first priority assessments for RNs would include the client with the head trauma who is unconscious, the client who is bleeding profusely, the child having an asthma attack. FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

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18: Two RNs are working in the pediatric outpatient clinic when six patients enter at the same time. Which two patients will the RNs see first? Select all that apply.
a. A 2-month-old infant who has had bad vomiting and diarrhea for the past 3 days
b. A 3-year-old who needs his immunizations updated
c. An 5-year-old who needs to have a physical for school
d. A 7-year-old with an elevated temperature, severe headache, vomiting, and stiff neck
e. An 8-year-old who has not had a bowel movement in 2 days
f. A 10-year-old who is coughing and has a runny nose

AD: The two clients who will be assessed first include the 2-month-old infant and the 7-year-old. The infant is priority one because vomiting and diarrhea for 3 days may have compromised the infant’s fluid and electrolyte balance. The 7-year-old has presented with symptoms of possible meningitis. Both may need to be referred to the nearest acute care facility by ambulance. FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

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19: Which of the following are part of Gagne’s nine elements of instruction? Select all that apply.
a. Gain attention d. Present stimulus materials
b. Stimulate recall e. Elicit performance
c. Repeat lesson several times f. Assess performance

ABDEF: According to Gagne, the nine elements of instruction include gain attention, inform learner of objectives, stimulate recall, present stimulus materials, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention. DEVELOPMENT

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19: An instructor is planning to teach a group of students a new procedure. The analysis of the students’ learning style indicates that they are all predominantly kinesthetic learners. Which teaching strategies would best facilitate learning of individuals who are kinesthetic learners? Select all that apply.
a. Numerous handouts to be read
b. Activities to get learners up and moving
c. Opportunities for the students to physically practice using the equipment
d. Verbally lecturing to the students
e. Use of charts, pictures, and graphs
f. Models, equipment, or other objects the students can touch

BCF: Strategies that would facilitate learning by kinesthetic learners would include activities to get learners up and moving; opportunities for the students to physically practice using the equipment; and the use of models, equipment, or other objects the students can touch. Visual learners like handouts, charts, pictures and graphs, while auditory learners prefer things they can hear such as a lecture. TABLE 19-2 ROSE'S VISUAL-AUDITORY-KINESTHETIC (VAK) MODEL OF LEARNING

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19: A nurse is preparing to teach a group of elementary students, and she decides to write all of the objectives at the knowledge level. The objectives would most likely begin with which of the following words? Select all that apply.
a. Identify d. Name
b. Construct e. Compare
c. List f. Select

ACDF: The nurse would most likely develop objectives that begin with identify, list, name, or select. Asking students to construct would involve comprehension, while using the word compare would require them to analyze. TABLE 19-4 TAXONOMIES OF LEARNING: COGNITIVE DOMAIN

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17: The nurses on your unit are developing a vision statement that will be consistent with the vision statement of the organization. The unit vision statement would include which of the following elements? Select all that apply.
a. It is written down.
b. It is written in present tense, using action words, as though it were already accomplished.
c. It includes the unit’s policies related to patient care and staff behavior.
d. It covers a variety of activities and spans broad time frames.
e. It balances the needs of providers, patients, and the environment. This balance anchors the vision to reality.
f. It states the procedures to be used when providing safe, effective care.

ABDE: The unit’s vision statement would include the following elements: “It is written down,” “It is written in present tense, using action words, as though it were already accomplished,” “It covers a variety of activities and spans broad time frames,” and “It balances the needs of providers, patients, and the environment. This balance anchors the vision to reality.” The vision statement does not include policies or procedures; they would most likely be found in the policy and procedure manual. VISION STATEMENT

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17: A nurse complains to the supervisor that horizontal violence (bullying) is occurring on the unit. The nurse most likely indicates to the supervisor that which of the following was occurring on the unit? Select all that apply.
a. Intimidation d. Faultfinding
b. Verbal abuse e. Support
c. Camaraderie f. Elitist attitude

ABDF: Horizontal violence (HV), also known as bullying, is described as aggressive behavior towards individuals or group members by others (Hastie, 2002). It is a little-known phenomenon that recent evidence demonstrates is prevalent in the workplace of practicing Registered Nurses. Horizontal violence contributes to nursing turnover and undermines a culture of professional nursing practice. Examples of HV include acts of unkindness, dishonesty, and divisiveness such as gossip, verbal abuse, intimidation, sarcasm, elitist attitudes and faultfinding. It is often said that “nurses eat their young.” EVIDENCE FROM THE LITERATURE

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17: Which of the following are major components of Relationship-Based Care that support patients and families? Select all that apply.
a. Leadership d. Elitism
b. Teamwork e. Outcomes measurement
c. Resource-driven practice f. Professional nursing practice

ABCEF: The six major components of Relationship-Based Care that support patients and families include leadership, teamwork, resource-driven practice, outcomes measurement, professional nursing practice, and patient care delivery. Elitism is not a component of Relationship-Based Care. COORDINATING COUNCIL

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16: Which of the following can the charge nurse delegate to an LPN/LVN certified in medication administration? Select all that apply.
a. Catheterizing of a patient who has been unable to void
b. Performing the admission assessment of a newly admitted patient
c. Administering morning P.O. medications
d. Monitoring a patient during the first hour of a blood transfusion
e. Discharge teaching for a post CVA client
f. Developing the plan of care for a newly admitted patient

AC: The charge nurse could assign the LPN/LVN the tasks of catheterization and medication administration. Discharge teaching, admission assessments, monitoring a patient at the beginning of a blood transfusion, and developing the care plan are responsibilities of the RN. FIGURE 16-2 ELEMENTS TO CONSIDER WHEN DELEGATING

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16: Which of the following tasks can a nurse delegate to a Nursing Assistive Personnel (NAP)? Select all that apply.
a. Taking vital signs
b. Collecting a urine specimen
c. Suctioning a client’s trach tube
d. Feeding a 2-month-old infant
e. Performing a catheterization
f. Giving a bed bath to an elderly client whose condition is stable

ABDF: The NAP can take vital signs, collect a urine specimen, feed a baby, and give a bed bath as long as the clients’ conditions are stable. NAPs cannot suction a trach or catheterize a patient. These tasks should be assigned to an LPN/LVN. FIGURE 16-2 ELEMENTS TO CONSIDER WHEN DELEGATING

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16: Which of the following can the charge nurse delegate to an LPN/LVN? Select all that apply.
a. Administering pain medication
b. Teaching a patient how to crutch walk
c. Monitoring a patient’s blood sugar via Accu-Check
d. Changing a dressing on a patient 3 days post-surgery
e. Inserting a nasogastric tube
f. Hanging 2 units of blood for a patient with severe anemia

ACDE: The LPN/LVN can administer medications and assess the patient’s reactions to these medications in most states. They can also monitor blood sugar, insert a nasogastric tube, and change a dressing on a patient who is 3 days post-surgery. Teaching and hanging of blood should by done by the RN. FIGURE 16-2 ELEMENTS TO CONSIDER WHEN DELEGATING

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7: Which of the following statements is true regarding health disparities? Select all that apply.
a. Maternal mortality is higher among African American women.
b. Among the elderly, men’s health and functional status are worse than women’s.
c. Poor or fair health (contrasted with good, very good, or excellent health) is more prevalent among children in low-income families.
d. African American infants have a higher mortality rate than Caucasian infants.
e. Caucasian women are more likely than African American women to die from breast cancer.
f. In elderly adults, disability rates are inversely related to income.

ACDF: Some of the health disparities that exist in the United States include the fact that the infant and mortality rates are higher for African Americans than Caucasians. Also, poor or fair health (contrasted with good, very good, or excellent health) is more prevalent among children in low-income families, and disability rates for elderly adults are inversely related to income. POPULATION-BASED HEALTH CARE PRACTICE

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7: Nurses in a small town that experienced the devastation of a number of tornados last year have formed a group to address the issue of disaster planning in their community. Which of the following are actions the nurses might take to prepare for another potential disaster? Select all that apply.
a. Form a disaster plan for their own families
b. Complete continuing education in disaster preparedness
c. Encourage all residents of the town to move to a more urban area
d. Become a volunteer for local or national disaster relief organizations
e. Obtain information about rights and responsibilities in employment settings and under state law
f. Do nothing because disasters such as tornados cannot be prevented

ABDE: The nurses could take several actions including forming a disaster plan for their own families, completing continuing education in disaster preparedness, becoming a volunteer for local or national disaster relief organizations, and obtaining information about rights and responsibilities in employment settings and under state law. It would be unrealistic to encourage all residents of the town to move to a more urban area. While the nurses cannot prevent future tornados, they should be knowledgeable in methods related to disaster preparedness. DISASTER PREPAREDNESS AND RESPONSE

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7: Several nurses have completed a disaster preparedness and response course. When evaluating the nurses’ knowledge regarding the types of natural disasters that can occur, which response would indicate to the trainer that additional teaching is necessary? Select all that apply.
a. Famine d. Fires
b. Hurricanes e. Radiation leaks
c. Plane crashes f. Chemical spills

CDEF: Plane crashes, fires, radiation leaks, chemical spills, and motor vehicle accidents are all accidental human-made disasters. Natural disasters include famine, hurricanes, floods, earthquakes, epidemics, and volcanic eruptions. DISASTER PREPAREDNESS AND RESPONSE

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10: Some of the quality measures for an Emergency Department might include which of the following? Select all that apply.
a. Increase in patient satisfaction
b. Decrease in patient complaints
c. Reduction in market share
d. Increase in repeat asthma patient visits
e. Development of patient education material
f. Review of all Emergency Department deaths

ABEF: Quality measures would reflect improvements such as an increase in patient satisfaction, decrease in patient complaints, development of patient education material, and a review of all Emergency Department deaths. Reduction in market share and an increase in repeat asthma patient visits do not indicate improvement. FACTORS INFLUENCING ORGANIZATIONAL STRUCTURE

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10:Reasons for an organization to rethink its structure would include which of the following? Select all that apply.
a. A change in leadership
b. External review problems
c. Severe problems in staff performance
d. High morale among staff
e. Increased patient satisfaction
f. Development of new programs and project lines

ABCF: Shortell and Kalunzy identify situations in which an organization’s structure should be rethought. These include experiencing severe problems in performance, customer satisfaction, or internal/external review; and change in environment, programs, services, or leadership. FACTORS INFLUENCING ORGANIZATIONAL STRUCTURE

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10: An organization’s culture of safety is the result of shared values and behaviors that demonstrate which of the following? Select all that apply.
a. Agreement on the importance of safety
b. History of service to the community
c. Communications based on mutual trust
d. Mission statement that focuses on staff
e. Importance of being a decentralized organization
f. Confidence in the ability to prevent errors through the use of known safety practices

ACF: An organization’s culture of safety is the result of shared values and behaviors that demonstrate agreement on the importance of safety, communications based on mutual trust, and confidence in the ability to prevent errors through the use of known safety practices. History of service to the community does not specifically relate to a culture of safety. Most mission statements do not specifically focus on the staff. Both centralized and decentralized organization can have a culture of safety. HIGH RELIABILITY ORGANIZATIONS -- A CULTURE OF SAFETY