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Exam 1: Leading, Managing, and Following

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Question 1

Multiple Choice

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After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying.What is the most likely basis for the nurse manager's request?

A) An established clinical pathway
B) Confirmatory scientific evidence
C) Unit protocol
D) Experience

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Question 2

Multiple Choice

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You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her.As a nursing colleague, what do you know to be true in regard to the statement?

A) The statement is correct.Leadership is not the role of the staff nurse.
B) The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.
C) The new graduate has been influenced by nurse leaders and managers who leave for other positions.
D) The general perception is that nurse leaders and managers are not satisfied in their jobs.

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B

Question 3

Multiple Choice

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As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions.Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas.What is the leadership you are employing?

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.What is the appropriate next step?

A grievance brought by a staff nurse against the unit manager requires mediation.At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions.What would be the best course of action at this time?

Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications.The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals.What is the manager demonstrating?

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients.The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea.What would be the best initial strategy for implementation of this change?

The charge nurse walks into Mr.Smith's room and finds him yelling at the LPN.He is obviously very upset.The charge nurse determines that he has not slept for three nights because of unrelieved pain levels.The LPN is very upset and calls Mr.Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr.Smith's behavior was aggressive but was related to lack of sleep and to pain.The charge nurse asks, "Can you, together with Mr.Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what?

The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively.The program is to be implemented across the entire facility.What illustrates effective leadership in this situation?

According to the complexity theory, what would be the focus of measurement?

As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care.The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role.What is this view of the role consistent with in this situation?

A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent, confused patients.The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article.What is the new nurse demonstrating in this situation? (Select all that apply.)

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed.What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission?

A dispute arises between an RN and an LPN over a patient issue.The tension continues between the two and begins to affect other staff members, who are drawn into the conflict.Over time, the team becomes polarized toward either the RN or the LPN.How might this situation be prevented?

The manager of a unit is finding it difficult to work with a new graduate nurse.The new nurse has many ideas; however, his manner of presenting them irritates the manager.After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior.She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation.What is the nurse manager demonstrating in this situation?

The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit.What action would be appropriate to motivate the staff?

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving.His behavior is so disruptive that it is overheard by staff, physicians, and other visitors.The family member leaves the unit abruptly, and the nurse is left feeling frustrated.Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?

The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions.Staff members are becoming distanced from the family.After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families.The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations.What is the role of the nurse manager in this situation?

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility.While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program.What behavior by the staff development coordinator is most appropriate in this situation?

A family is keeping vigil at a critically ill patient's bedside.The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes.The nurse suggests that the patient's provider may need to discuss the treatment plan with the family.The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions.What is the role of the nurse in this situation?