leadership final

Authoritative or Autocratic style includes the which of following scenarios: (select ALL that apply).
A nurse manager changes the policy regarding the sterile dressing changes and directs the staff to follow the new procedure.

A nurse manager decides which staff will work on the weekend without asking for staff preferences.
Correct Answers:

A nurse manager changes the policy regarding the sterile dressing changes and directs the staff to follow the new procedure.

A nurse manager decides which staff will work on the weekend without asking for staff preferences.

Documenting nursing interventions as soon as completed will facilitate accurate and thorough documentation is considered a “Time Saver”?
true
The phases of the management process include the following functions.

Please select the major managment functions (select ALL that apply).

Planning

Organizing

Staffing

Page 4 of ATI Leadership book (6th Ed)

Planning, organizing, staffing, directing and controlling.

Scenario 1: A nurse manager does not participate but delegates the staff scheduling to the nurses on the unit.

Scenario 2: A nurse manager allows the staff nurses to participate in the trial use of new IV pumps and contribute input when choosing a new product?

Scenario 3: A nurse manager makes a decision for the staff to wear blue scrubs without consulting the staff nurses.

1, Laissez- Faire
2. Democratic
3. Autocratic
Which tasks are appropriately delegated to a licensed practical nurse (LPN) or assistive personnel (AP)? Select ALL that APPLY.
Intake and output is assigned to an AP.

Activities of daily living is assigned to an AP.

Tracheostomy care should is assigned to an LPN.

Priority setting requires that decisions be made regarding the order in which (Select the best answer)?
Clients are seen
Assessments are completed
Interventions are provided
Steps in a client procedure are completed
Components of client care a completed
Time management and prioritization involves critical thinking and organizing care according to client care needs and priorities. Which of the following is NOT considered a Priority Setting Frameworks?
Using CAB: circulation, airway and breathing
Leaders have a combination of personality traits and leadership skills. Characteristics of leaders include the following (select the best answer).
A leader listens to the perspective of others, and manages the emotions of self and others.
After a newly hired director of nursing has reviewed the hospital’s strategic plans, she develops a timeline for achieving those plans. The new leader is:
d. Translating a global document into realistic plans for nursing.
While explaining the importance of developing leadership skills among nurses to a group of first year nursing students, Natalie, a nursing unit manager emphasizes that:
d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.
A nurse executive is hired to restore a unit’s productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles?
Correct a. The leader sets the tone, which allows nurses to feel in control of the environment.
What is the most important role/task of nurse managers?
Client care accountability
A nurse has been employed by a healthcare facility for 20 years. The nurse is knowledgeable, has excellent ideas, and actively participates in meetings. The nurse manager submits the nurse’s name for an agency award to reward which types of leadership exemplified by the nurse?
informal
Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
c. Post a tentative schedule, and request feedback.
To solve a problem, the nurse manager understands that the most important problem-solving step is:
c. Accurate identification of the problem.
During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:
b. Crisis situations.
The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehab staff in the decision.
The nurse (RN) must delegate activities thoughtfully, taking into account individual job descriptions, knowledge base, and skills demonstrated. True or False?
true
The nurse (RN) cannot delegate the following (Select ALL that Apply)?
The Nursing Process

Client Education

Tasks that require nursing judgment (including care of unstable clients)

Which situation is an example of reverse delegation?
The licensed practical nurse asks the nurse manager to administer insulin to her client.
Which statements would be important for the charge nurse to make when delegating a responsibility? Select all that apply.
I think it would be important to our organization if you represent the unit on the policy and procedure committee.”

“I think your attendance at the task force meeting will be a good reflection

Which statement made by the nurse manager is an example of the first step of delegation?
“I am going to delegate the responsibility of creating the vacation schedule.”
The nursing supervisor is assessing the organization by spending time on each unit. The nurse manager seems overwhelmed and stressed trying to address many client complaints. The charge nurse is trying to help everyone at once. In this situation, what might this supervisor conclude based on this assessment? Select all that apply.
The unit culture fosters distrust and poor communication among staff.

Client complaints are usually an indicator of a larger unit problem.

Nurses on the unit are in need of additional training and skills.

Delegation may be seen as too time consuming to undertake

The charge nurse on the cardiac unit is making the shift assignments. Which client should be assigned to the most experienced nurse (RN)?
The client diagnosed with fulminant pulmonary edema.
Nurses (RNs) must continuously set and reset priorities in order to safely care for multiple clients. Please match the prioritizing principles in client care with the examples provided.
Prioritize systemic before local.

Correct D.
Prioritizing interventions for a client in shock, over interventions for a client with a localized limb injury.

Prioritize acute before chronic.

Correct F.
Prioritizing the care of client with a new injury/illness or acute exacerbation of previous illness, over the care of client with long-term chronic illness.

Prioritize actual problems before potential future problems.

Correct A.
Prioritize administration of medication to a client experiencing acute pain, over ambulation of a client as risk for thrombophlebitis.

Prioritize according to Maslow’s Hierarchy of Needs.

Correct G.
Prioritizing the care of the client needs according to physiological needs is higher priority than self-esteem.

Recognize and respond to trends vs. transient findings.

Correct E.
Recognizing a gradual deterioration in a client’s level of consciousness and/or Glasgow Coma Scale score.

Recognize signs of emergency and complications vs. “expected client findings.”

Correct C.
Recognizing signs of increasing intracranial pressure in a client newly diagnosed with a stroke vs. the clinical findings expected following a stroke.

Recognizing the application of clinical knowledge to procedural standards to determine the priority action.

Correct B.
Recognizing that the timing of administration of antidiabetic and antimicrobial medications is more important than administration of some other medications.

Determination of Evelyn’s educational preparation and certification (Question 18) is related to the concept of:
Authority
With delegation, responsibility and accountability remain with the:
b. Professional who delegates.
Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah, the delegator, and Leslie, the delegatee, are named. Sarah is named in the suit because she:
d. Retains accountability for the outcomes of care for the patient.
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah’s activity in the example described is termed:
c. Active delegation.
Sarah (Question 21) provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of:
Assignment
A nurse (RN) should first assess the following clients after returning from break. Place in order of prioritization.
1.
A client with expiratory wheezes after receiving intravenous contrast for a CT scan.
2.
A client two (2) days postoperative colon resection with an oral temperature of 103.6 degrees F.

3.
A client who is 2 hours post cardiac catherterization with capillary refill less than 3 seconds.

4.
A client with chronic kidney disease who has a creatinine level of 2.3 mg/dL.

A nurse manager lives in a state that does not allow LPN/LPNs to administer intravenous push (IVP) medications. A charge nurse gives in to time pressusres and allows two LPNs to give IVP medications. The nurse manager is aware that the following agency will take action after being notified of this incident:
State Board of Nursing
A RN delegates complicated wound care to a LPN. The LPN has only changed this type of dressing once. Which component of delegation has the RN neglected?
Competency
Place in order of priority who the nurse (RN) should assess first after morning report (Select in order of priority).
1.
A client receiving morphine sulfate (Morphine) via PCA pump with respirations of 8/min.

2.
A client who has a heart rate of 110 beats per minute after an albuterol respiratory treatment.

3.
A client two (2) days postoperative right knee replacement who has not had a bowel movement.
4.
A client with a left below knee amputation who is having difficulty with body image.

The client diagnosed with peptic ulcer disease has a blood pressure of 88/42, an apical pulse of 132, respirations are 28. The nurse (RN) writes the nursing diagnosis “altered tissue perfusion related to decreased circulatory volume.” Which intervention should the nurse (RN) implement FIRST?
Insert 18-gauge catheter and infuse lactated Ringer’s.
The nurse (RN) is caring for a client diagnosed with CHF (Congested heart failure) who is currently complaining of dyspnea. Which intervention should the nurse implement first?
Check the client for adventitious lung sounds.
The nurse (RN) must follow the 5 Rights of Delegation, which includes the following:
Right Person
Right Task
Right Circumstances
Right Direction and Communication
Right Supervision and Evaluation
The nurse manager often gives preferential treatment to one of the staff nurses on the unit. This behavior is an example of:
Difficulty managing one’s interpersonal relationships.
The nurse manager is planning a meeting for members of her staff and wants to describe the word “team” when describing the desired behavior for the staff. Which is appropriate to use in this description?
All members of the team contribute their talents.
Expectations from the nurse manager as team leader include: Select all that apply.
Offer constructive criticism.

Encourage group discussions.

Facilitate group processes.

Which statement indicates a nursing student needs further instruction if discussing the characteristics of a task force?
“This group must work toward problems on a specific unit.”
Which situation best exemplifies the nurse manager as a team leader?
The nurse manager posts the unit’s positive accomplishments from the past month in the break room.
A nurse manager is working with a committee of nurses whose task is to update the policies for new employee orientation. The nurse manager directs the team to collect as much data as possible and recommend several options. Which of the following decision-making styles is being demonstrated by the nurse manager?
Integrative
A nurse on a telemetry unit is caring for a client who was admitted 2 hr ago and has angina. The client becomes angry and tells the nurse that there is nothing wrong with him and that his is going home immediately. The should base her actions on which of the following? (Select all that apply.)
In th event the client leaves the hospital without a discharge order, the nurse should document that the client left the facility “against medical advice” (AMA).

It is the nurse’s responsibility to explain to the client the risks involved if he chooses to leave.

Most facilities have a form that clients are asked to sign if they leave the facility prior to discharge.

A nurse who tries to prevent a client from leaving the hospital may be faced with legal charges.

A nurse who has just assumed the role of Director in a hospital is examining her skills in interprofessional collaboration. Which of the following actions support interprofessional collaboration? (Select all that apply.)
Recognize the knowledge and skills of each member of the team.

Support team member suggestions for referrals to link clients to appropriate resources.

A nurse is participating in an inter-professional conference for a client who has a recent C8 Spinal cord injury. The client worked as an electrician prior to his injury.

Which of the following members of the inter-professional team should also participate in planning care for this client? (Select all that apply.)

Physical Therapist

Occupational Therapist

Psychologist

Vocational Counselor

The nurse on the cardiac unit is discussing case management with a client who asks, “Why do I need a case manager for my heart disease?” Which statements are more appropriate for the nurse to respond? (Select all that apply).
“Case management helps contain the costs of your healthcare.”

“It decreases the fragmentation of care across many healthcare settings.”

“We try to provide quality care along the healthcare continuum.”

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, “One can agree to disagree with another team member’s perspective even when one doesn’t necessarily see that perspective as being the correct one.” In being creative, which of the following basic rules was she talking about?
d. Committing to resolution
Which of the following would not be a characteristic of an effective team nurse leader?
a. An autocratic perspective
The nurse manager was upset with the staff nurse and said, “You did not understand what I said.” Which element in the communication process was she referring to?
d. A set of barriers that may occur between sender and receiver
The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?
d. Cultivate a desire to learn about the other person.
The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:
Commitment
The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone:
a. Work together in a respectful, civil manner.
The SBAR system of communications is one of the most used communication systems in health care because:
c. It focuses on a system in which information is provided and gleaned in an honorable way.
The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, “We will speak supportively,” prevents:
b. Gossip and backbiting.
John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn’t understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John’s experience represents what aspect of the current consumer experience?
b. Fragmentation of care results in lack of respect and trust.
The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the:
d. Outcomes for clients and their perceptions of care.
In order to delegate, which must be present? Select all that apply.
Accountability for the assignment on the part of the delegate

Accountability for the assignment on the part of the delegator

Authority by the delegator to assign the task to the delegate

Responsibility for task completion on the part of the delegate

Authority of the delegate to accomplish the task as assigned

Which situation is an example of reverse delegation?
The licensed practical nurse asks the nurse manager to administer insulin to her client.
In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered?
Pennsylvania
Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with:
Privacy
In which of the following situations should a nurse act as a client advocate? Select all that apply.
Verifying that a client understands what is done during a cardiac catheterization

Informing members of the health care team that a client has DNR status

Reporting that a health team member on the previous shift did not provide care as prescribed

A charge nurse is responsible for a caseload of clients on a surgical unit. Which of the following occurrences during the shift requires the completion of an incident report?
A client’s IV solution infused over 6 hours instead of the prescribed 8 hours.
A nurse realizes that a client was administered an antihypertensive medication intended for another client. Number the following actions in the appropriate sequence that the nurse should follow.
1.Take the client’s vital signs
2.Instruct the client to remain in bed until further notice
3.Call the client’s primary care provider
4.Complete an incident report
5.Notify the risk management officer
The case manager is initiating the plan of care for a client receiving warfarin who had a stroke. Which of the following is most important for the case manager to include in the clients plan of care?
Scheduling follow-up for prothrombin time and INR
When preparing the discharge of a client who has had a cerebrovascuclar accident and has a gastrostomy tube, the nurse should ensure that:
Instructions are provided for the enteral feedings that are to be done at home.
A nurse receives a call from a client’s son who is requesting specific information about the client’s diagnosis for “insurance purposes”. How should the nurse respond to the client’s son?
“Privacy regulations preclude me from disclosing information about our clients”
Which of the following is the best measure for the professional nurse to use in reducing personal liability for malpractice litigation?
Adhere to professional national standards of care
On admission to the hospital a client gives the nurse a document naming an individual to make choices in the event of the loss of decision-making capacity. The nurse communicates during intershift report that the client has a copy of which document in the medical record?
Durable power of attorney
A newly licensed nurse is explaining to a potential applicant to nursing school how nursing practice is regulated. The nurse identifies which of the following as a state statute that constitutes statutory law?
Nurse practice act
The RN has completed making client assignments for the shift and is preparing to delegate appropriate nursing care activities for the staff. Which tasks may the RN delegate to the CNA? (Select all that apply)
Ambulating a client in the hallway

Recording intake and output from meal trays

Measuring and recording vital signs

Assisting with hygiene care

A nursing assistant asks a nurse, “Why is a national examination required to get a license as a nurse?”. What is the nurse’s best response?
“The national licensure exam identifies whether nurses are safe or unsasfe to practice”
Examples of sentinel events include (select all that apply):
a. Forceps left in an abdominal cavity.
b. Patient fall, with injury.
d. Administration of morphine overdose.
e. Death of patient related to postpartum hemorrhage.
During orientation a newly employed nurse asks the human resources manager the reporting process of reporting threats in the organization. The human resources manager states, “You should call 911.” What is inappropriate regarding the manager’s response?
The organization should have a policy for employees regarding reporting potential threats.
The ER (emergency room) staff experienced a violent client who had demanded pain medication and threatened the staff if he did not receive it. The ER nurse called the police, and the emergency room physician talked to the client in a calm manner. The physician’s ploy to ask questions regarding the client’s level and location of pain was an attempt to:
De-escalate the situation.
A nurse is caring for a client who is confused and refuses to let the nurse insert an NG tube. The provider tells the nurse to restrain the client in order to insert the tube. The nurse recognizes that following the provider’s order is
False imprisonment
A nurse is notified that a client has filed a complaint about care received on the nursing unit from one of the assistive personnel (AP). The nurse should understand that the delivery of quality care to a specific client is primarily the responsibility of the
staff member providing the care
A nurse is discussing the requirements of the Joint Commission for accreditation regarding disaster planning. Which of the following statements indicates a need to further teaching?
A disaster drill needs to be held at least once a year.

needs to be at least every 6 months?

What are the major roles of nursing leadership in disaster planning. Select all that apply
Providing clearly defines roles for staff nurses in a disaster situation

Providing policies that speak to expected hours of work in a disaster

Being familiar with the organization’s emergency operations plan (EOP)

Sharing written identified roles with every department to ensure disaster preparedness

The nurse in a clinic is planning a community diabetes management program and developing goals for this program. Which of the following is an appropriate goal?
Clients will have a decreased incidence of foot amputations.
A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients is apporpriate to discharge?
50-year old adult with type 2 diabetes mellitus being admitted for rotator cuff surgery
Which of the following statements are true of incident reports? (Select all that apply)
A description of the incident should be documented in the nursing notes (only pertinent facts)

Incident reports are confidential and should not be shared with the client

Incident reports include a description of the incident and actions taken

The risk management department investigates the incident

A charge nurse on a medical unit hears the firm alarm and announcement that a fire is occurring on the unit. Which of the following is the priority action by the charge nurse?
Instruct ambulatory clients to go to safe area
When transcribing a prescription into a paper or electronic chart, the nurse must: Select all that apply.
Include all necessary elements of a prescription (date, time written, medication, route of administration, etc.)

Follow institutional policy regarding the time frame within which the provider must sign the order (usually within 24 hours)

To avoid errors when taking a medical prescription verbally or over the phone, make sure you repeat back the prescription given (including spelling if necessary, dosage, time, route)

A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse?
A student nurse is photocopying his assigned client’s diagnostic test results
A nurse is reinforcing car seat safety with the parent of an infant who weighs 4.5 Kg (10 lbs). Which of the following car seat positions should be included in the teaching?
Rear-facing in the middle of the back seat.
A nurse is discussing restraints with a newly licensed nurse. Which of the following should the nurse identify as an acceptable indication for placing a client in mechanical restraints?
Continued self-destructive behavior
A nurse is caring for a client who is confused and has pulled the peripheral IV catheter out three times. Which of the following should the nurse consider?
Place mitten restraints on the client’s hands.
A client who is confused is found walking outside of the inpatient facility. Which of the following should be the nurse’s initial action?
Placing a seat alarm in the cleint’s chair
A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.
Which of the following would be most in line with Hersey and Blanchard’s concepts?
a. The team of caregivers on day shift is familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.
The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with:
c. Matching tasks with qualified persons.
Ali, an RN on your unit, is consistently late to work and makes remarks such as “Do you really want me to do that?” when patients and care are assigned to her. You have spoken with her frequently about her:
attitude
The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the:
d. Complexity of the task and the potential for harm.
The nurse (RN) must follow the 5 Rights of Delegation, which includes the following:
Right Person
Right Task
Right Circumstances
Right Direction and Communication
Right Supervision and Evaluation
The charge nurse on the cardiac unit is making the shift assignments. Which client should be assigned to the most experienced nurse (RN)?
The client diagnosed with fulminant pulmonary edema.
You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to:
d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.
A nurse manager lives in a state that does not allow LPN/LPNs to administer intravenous push (IVP) medications. A charge nurse gives in to time pressusres and allows two LPNs to give IVP medications. The nurse manager is aware that the following agency will take action after being notified of this incident:
State Board of Nursing
The nurse pours the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast. This is an example of:
negligence
The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of:
work allocation
Which concept is necessary for the delegate to understand when accepting delegation?
Clarify the time line and expectations.