Leadership EAQ

A nurse leader is setting priorities for achieving success by using the simplest and fastest method of communication. Which rules and responsibilities does the nurse fulfill by this action?
Correct 1
Maintaining balance
2
Building self-confidence
3
Generating self-motivation
4
Maintaining a positive attitude
An effective leader maintains work-life balance in his or her own life, as well as facilitating balance for followers. Making communication as efficient as possible is one way of helping to maintain this balance. Self-confidence can be established by performing honest self-appraisal on a regular basis. Spending time on the needs of the followers and offering frequent and lavish praise will help build self-motivation. A positive attitude can be maintained by consistently having answers to the question asked by others, knowing where the organization is going, and taking the initiative to get the group to its goal.

Test-Taking Tip: Look for the option based on the responsibilities of a nurse leader when setting the priorities of a team.

a

What are the major issues identified by the nurse leader as reasons for increased union activity? Select all that apply.
Correct 1
Low wages
Incorrect 2
Adequate staffing
Incorrect 3
Professional autonomy
Correct 4
Mandatory overtime requirement
Correct 5
Absence of reporting unsafe work environments
Low wages and poor benefits may lead to an increase in union activity. Mandatory overtime and work overload have led to increased union activity in nursing. The absence of procedures for reporting of unsafe work environments and poor quality of care may increase union activity. Inadequate staffing and unqualified caregivers may lead to increased union activity. Lack of professional autonomy and professional practice models may increase union activity.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

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Which theory states that leaders act as change catalysts and innovators?
1
Role theory
Incorrect 2
Trait theory
Correct 3
Quantum theory
4
McGregor’s Theory X
Quantum theory states that leaders must embrace uncertainty and understand behaviors before changing them. Therefore quantum leaders represent change catalysts and innovators. Role theory is a collection of concepts that predict circumstances under which certain type behaviors are expected. Trait theory is a leadership theory in which leadership traits such as a certain set of physical and emotional characteristics are innate and cannot be learned. McGregor’s Theory X describes the workforce motivation by assuming that people basically do not like their work and must be coerced by their manager to perform.

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A nurse encourages employees to implement a Magnet Recognition Program in the organization. The nurses think beyond their own personal needs and are clear about the group outcomes. Which leadership quality according to Gardner’s tasks is reflected in the activity of the nurse?
1
Developing trust
2
Serving as a symbol
Correct 3
Representing the group
4
Achieving workable unity
According to Gardner’s Tasks of Leadership, encouraging employees to implement a Magnet Recognition Program shows that the nurse is representing the group. Trust develops when leaders are clear when providing direction and refrain from misdirecting others in their thinking and actions. The leader may serve as a symbol by becoming involved in public relations events, for example. The nurse as leader can achieve workable unity between and among parties by avoiding, diminishing, or resolving conflicts.

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A nurse manager is selecting direct care nurses for a client-care project. The manager asks a direct care nurse about treatment priorities. Which answer provided by the direct care nurse would be appropriate?
1
"I will give preference to the problems that are encountered first."
Correct 2
"I will give preference to the problems that have the greatest urgency."
3
"I will give preference to the problems that appear to be easiest to resolve."
4
"I will give preference to the problems that take the shortest amount of time to resolve."
The preference for treatment should be always given to problems that have the greatest urgency such as life-threatening conditions. Secondary preference should be given to problems that are encountered first, problems that appear to be easiest to resolve, and problems that take the shortest amount of time to resolve.

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Which actions can an effective mentor expect from an aspiring leader? Select all that apply.
Correct 1
Being loyal
Correct 2
Assisting with projects
3
Sharing personal problems
Correct 4
Maintaining confidentiality
5
Giving a fee in terms of rewards
The mentor has a right to expect loyalty, respect, assistance with projects, and confidentiality from the aspiring leader. An effective mentor does not expect a fee or rewards and gives guidance to balance the professional and personal work of an aspiring leader.

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Which statement is true regarding leadership?
1
Having the title of chief executive officer indicates a good leader.
Correct 2
Leadership is an earned honor and an action-oriented responsibility.
3
Playing an administrative role can automatically place the title of leader on an individual.
4
Strengthening the mission of an organization purely depends on the leader himself or herself.
Leadership is an earned honor, right, and privilege and an action-oriented responsibility that requires a time commitment. Having a title such as chief executive officer or chief nursing officer does not guarantee that a person will be a good leader. Administrative or management roles do not automatically confer the title of leader on an individual. Strengthening the mission of organization depends on both a good leader and follower.

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The nurse leader noticed that the staff nurse recently promoted to the surgical unit is lacking confidence at work and is worried about a pending review by the nursing director. Which source of power is applicable in this situation?
1
Reward power
Correct 2
Coercive power
3
Referent power
4
Connection power
Coercive power stems from a real or perceived fear of another person. Reward power is perceived as being able to provide rewards or favors. Association with a powerful person grants referent power. Association with people who are powerful or who have links to powerful people gains connection power.

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While auditing unit documents, a nurse finds some omissions. Which term best describes when the nurse meets with the staff to discuss the findings and communicates ways to achieve the desired goals?
1
Leadership
2
Followership
Correct 3
Management
4
Decision making
The process of guiding, planning, and controlling others in a situation where communication is shared to improve clinical processes and outcomes is referred to as management. Leadership can be defined as a process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve goals. Followership is the process of following the leader or the manager to ensure the best clinical decision making and actions taken to achieve organizational outcomes. Decision making is a process of making crucial decisions.

Test-Taking Tip: Recall the responsibilities and traits of each role and choose the answer that suits best to the scenario in the question.

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The nurse is an active participant on human resource committees. What does this indicate?
1
The nurse is engaging in malpractice.
2
The nurse is pursuing higher education.
Correct 3
The nurse is staying clear on group outcomes.
4
The nurse is thinking only about personal needs.
When a nurse participates as a leader in any leadership opportunities such as on human resource committees, it indicates that he or she is staying clear on group outcomes. Participating on human resource committees does not indicate any involvement in malpractice. Active participation on human resource committees does not indicate pursuing a higher degree. Participating on human resource committees indicates that the nurse is thinking beyond his or her personal needs.

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The nurse leader mentors the staff on types of conflict. Which statement of the leader describes intrapersonal conflict?
1
It occurs due to difference in opinions with others.
2
It arises when a discord about policies and procedures exists.
3
It is related to hierarchical structure and role differentiation among employees.
Correct 4
It arises due to imbalances between the nurse’s personal and professional priorities.
Intrapersonal conflict arises due to imbalance between the nurse’s personal and professional priorities. The conflict due to a difference in opinions with others causes interpersonal conflicts. Organizational conflicts arise from a discord between policies and procedures. Organizational conflict also arises from hierarchical structure and role differentiation among employees.

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A client with a severe allergy has been administered a high dose of antihistamine. The nurse finds that the client is drowsy and dizzy. Which type of need would the nurse prioritize in the client according to Maslow’s hierarchy of needs?
Correct 1
Safety need
2
Belonging need
3
Self-esteem need
4
Self-actualization need
Clients suffering from the effects of a high dose of antihistamines have strong safety needs. The belonging need is fulfilled when the client is provided love and compassion. Self-esteem needs are fulfilled by providing recognition. Self-actualization needs may not be the priority of the client in the current situation.

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The nursing manger wants to transfer a nurse to the intensive care unit (ICU) and describes the roles and responsibilities of the position in detail to the nurse. After disclosing all details, the nurse manager inquires about the nurse’s decision. Which type of principle is the nurse manger following?
1
Justice
Correct 2
Veracity
3
Nonmaleficence
Incorrect 4
Respect for others
Veracity concerns telling the truth and demands involved, giving all the facts of a situation truthfully, and then assisting employees to make appropriate decisions. Justice is the principle of treating all persons equally and fairly and it often arises in times of short supplies for resources. Nonmaleficence states that one should do no harm. Respect for others acknowledges the right of individuals to make decisions and to live by these decisions.

Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses

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Which responsibility of the nurse manager differs from the responsibilities of a nurse leader?
Correct 1
Planning the budget
2
Motivating the team
3
Resolving the conflicts
4
Penalizing for poor performance
Budgeting is the responsibility of a nurse manager. The role of nurse leader is to motivate the nursing subordinates. Resolving conflicts is the responsibility of both the nurse leader and the nurse manager. Penalizing for poor performance is a behavior of transactional leadership.

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Which theory states that the leadership traits in an individual are born and not made?
1
Style theory
Correct 2
Great Man theory
3
Two-factor theory
4
Situational-contingency theory
The trait theory is sometimes referred as the Great Man theory. According to this theory, the leadership traits such as a certain set of physical and emotional characteristics are innate and cannot be learned. Style theory focuses on what leaders do, but not on the leadership qualities. Two-factor theory focuses on motivation and job satisfaction based on hygiene factors and motivational factors. Situational-contingency theory focuses on the challenge of a situation and encourages an adaptive leadership style particular to that situation.

Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response

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Which actions make the nurse a transformational leader?
1
Gaining higher education degrees
Correct 2
Introducing a vision for the future nurses
3
Implementing client-centered care effectively
4
Correcting errors of the followers in a reactive manner
A transformational leader creates and shares a vision or goal for future nurses. Gaining higher education does not indicate leadership. Effective implementation of client-centered care indicates professionalism but not leadership. A transformational leader corrects the errors of followers by coaching and mentoring, not by using a reactive manner.

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The count of hydrocodone is incorrect. After several minutes of searching the medication cart and medication records, no explanation is found. Who should the primary nurse notify about the discrepancy?
Correct 1
Nursing unit manager
2
Hospital administrator
3
Quality control manager
4
Healthcare provider prescribing the medication
Controlled substance issues for a particular nursing unit are the responsibility of that unit’s nurse manager. Responsibility flows directly from the staff of a nursing unit to the nurse manager; the nurse manager reports to a nurse administrator. There is no direct flow of accountability from the primary nurse to the quality control manager. Healthcare providers are responsible for medical management issues, not issues associated with management of a nursing unit.

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Which of Gardner’s tasks of leadership describes assisting the staff in interpreting organizational principles?
Incorrect 1
Managing
2
Motivating
Correct 3
Affirming values
4
Envisioning goals
The task of affirming values describes leaders assisting the staff in interpreting organizational values. Managing is assisting the staff with planning, decision making, and priority setting. Motivating is inspiring the staff to achieve the organization’s goals. Envisioning goals is visualizing client outcomes and creating a vision to support client care objectives.

Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

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Which statement is true regarding the satisficing decision model?
1
It involves shared decision-making.
2
A decision is made by analyzing pros and cons associated with each option.
Correct 3
It allows for a quick decision, which is important when lack of time is an issue.
4
It is more appropriate when conflict is likely to occur or when the problem is unstructured.
The satisficing decision model allows for quick decisions and is best to use when lack of time is an issue. With shared decision-making, decisions are made through an interactive, deliberate process. In the optimizing decision style, decisions are made by analyzing pros and cons associated with each option. Autocratic decision-making is more appropriate when conflict is likely to occur or when the problem is unstructured

STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it.

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Which theory states that leaders should expand and respond to a dynamic change rather than prescribing and approaching change as a lock-step, pre-prescribed method?
1
Role theory
2
Chaos theory
Correct 3
Complexity theory
4
Organizational theory
Complexity theory states that the leaders should expand and respond to engaging dynamic change and focus on relationships rather than on prescribing and approaching change as a lock-step, pre-prescribed method. Role theory is a framework used to understand how individuals perform within organizations. Chaos is the theoretical construct defining the seemingly random yet deterministic characteristics of complex organizations. Organizational theory is the systematic analysis of how organizations and their component parts act and interact.

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Which organizational outcomes are expected in followers under transformational leadership? Select all that apply.
Correct 1
Increased morale
2
Decreased loyalty
3
Limited job satisfaction
Correct 4
Increased performance
5
Increased stress to meet deadlines
6
Limited commitment towards work
Followers under a transformational leader have increased morale and performance. Followers under a transactional leader have decreased loyalty, limited job satisfaction, increased stress to meet deadlines, and limited commitment toward work.
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3.
A nurse manager in a cancer care facility finds that the nursing care team is demotivated due to consecutive deaths of two terminally ill cancer clients. Which action of the nurse manager would help renew the team’s energy?
1
Counseling the team members that death is an inevitable part of chronic diseases
2
Shifting the team to another nursing unit with less likelihood of deaths occurring
3
Instructing the team members to be emotionally detached from the clients they care for
Correct 4
Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team
A good leader keeps the team’s spirits high by helping them renew their energy levels. The nurse manager may post motivating messages or photos on the notice board to motivate the team members. Counseling the team members may not help in motivating them as there could be further similar incidences in the unit. Shifting the team to another nursing unit with less likelihood of deaths may make the team members emotionally weak. The reason for the team members to be low in energy is unlikely to be their emotional attachment to the clients; keeping them emotionally detached may not help motivate them for client care.
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4.
The nurse as a leader explains ethical principles to the student nurse. Which example does the leader give for autonomy?
1
Informing the client about the details of a surgery
2
Keeping the result of a client’s AIDS test confidential
3
Coming back within the time frame promised to the client
Correct 4
Accepting the client’s wish to donate his/her organs after death
Autonomy addresses personal freedom and self-determination. Therefore accepting the client’s wish to donate his/her organs after death is considered to be respecting his/her autonomy. Informing clients about details of a surgery is providing informed consent. Maintaining secrecy about AIDS test results is respecting client confidentiality. Fidelity involves keeping promises or commitments, such as returning within the time frame promised to the client.
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6.
Which behavior on the part of the nurse helps develop trust among subordinates?
Correct 1
Behaving with consistency
2
Creating a "Hall of Honor" to post photos
3
Being expedient in responding to the issues
4
Taking time to celebrate individual accomplishments
Behaving with consistency to make them believe in and count on the leader’s intention will help to develop trust among subordinates. Creating a "Hall of Honor" to post photos will help to renew the spirit of workers. Being expedient in responding to the issues will help to resolve conflict. Taking time to celebrate individual accomplishments will help renew the spirits of workers.
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7.
What are the desired attributes of the nurse as a leader? Select all that apply.
Correct 1
Identifying the needs of followers
2
Avoiding the use of personal intuition over facts
Correct 3
Motivating others assertively towards the objective
4
Focusing on a single option to accomplish the objective
Correct 5
Using a critical thinking approach while making a decision
A desired attribute of a nurse as a leader includes the identification of others’ needs. The nurse should assertively motivate others towards the objective. A critical thinking approach is the desired attribute to make decisions in nurse leadership. The nurse should rely on personal intuition as well as facts. While accomplishing any objective, multiple options should be discussed before making decisions.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
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11.
A client reported being administered the wrong dose of medication by the wrong route, which may lead to serious complications. The nurse leader is gathering information to determine what happened. Which phase of client care management is the nurse leader following?
1
Validation
2
Translation
Correct 3
Preparation
4
Comparative evaluation
Medication errors may occur due to the administration of the wrong dose through the wrong route, which may lead to serious complications in the client. According to Stetler’s model, the nurse leader is in the preparatory phase, which involves searching, sorting, and selecting sources of evidence. The validation phase focuses on utilization with an appraisal of study findings rather than the critique of a study’s design. The transactional, or application, phase involves practical aspects of implementing the plan for translating the research into practice at the individual, group, department, or organizational level. Comparative evaluation is also known as the decision-making phase and involves making a decision about the applicability of the study by synthesizing cumulative findings.

STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.
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12.
Which actions should a nurse leader avoid in order to implement changes effectively?
1
Answering tough questions raised by the staff
2
Asking the staff what is not working well for them
Correct 3
Maintaining a boss-employee relationship with the staff
4
Asking questions of the staff related to daily functions
To effectively implement change, a leader nurse should establish and maintain rapport with staff. Therefore maintaining a rigid boss-employee relationship should be discouraged. Answering tough questions faced by the staff will promote a good work culture of helping. Asking the staff about what is not working well for them helps identify problems and solve them. Asking questions of the staff related to daily functions will promote a friendly environment and help track their work.

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The nurse manager is explaining how intramuscular (IM) injection techniques are an example of the theory of diversion of innovation. Which statement made by the nurse manger is accurate?
Incorrect 1
The use of the dorsogluteal site is recommended.
2
The IM injection is used to deliver short acting antibiotics.
3
The technique of IM injection will be taught in the final nursing program.
Correct 4
The use of IM injections for pain management has decreased with the use of intravenous and epidural routes.
The practice of administering IM injections for pain management to adults in acute care settings has virtually disappeared with the use of intravenous and epidural routes. The use of the dorsogluteal site is no longer recommended. IM injections are used to deliver long acting antibiotics such as immunoglobulins, vaccines, and hormonal agents. Nurses learn this technique in their initial nursing program but may never subsequently alter their practices.

STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.
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5.
Which theory emphasizes that leadership effectiveness depends on the executive nurse’s interpersonal skills?
1
Hierarchy of needs
Incorrect 2
Transformational theories
Correct 3
Situational-contingency theories
4
Organizational behavior (OB) modification theory
Situational-contingency theories, which are leadership theories, hold that leadership effectiveness depends on a leader’s interpersonal skills. The hierarchy of needs explains that people are motivated first by physiological needs and safety, then by social and self-actualizing needs. Transformational leadership is a process through which the leader attends to the needs and motives of followers. OB modification theory says that the leader should use positive reinforcement to motivate followers and avoid situations that cause discomfort.
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8.
Which characteristics should a nurse focus on to become an effective transformational leader? Select all that apply.
1
Acquiring a mentor
Correct 2
Inspiring a shared vision
Incorrect 3
Upgrading self-knowledge
Correct 4
Improving interpersonal skills
Correct 5
Being able to motivate the nursing staff
Having a shared vision helps effective transformational leaders and their teams become inspired and committed to a shared goal. Being an effective transformational leader depends on one’s interpersonal skills; improving these can help in interactions with the staff. The ability to motivate the nursing staff is also important for a transformational leader because this helps one reach desired goals and improve performance. Acquiring a mentor is not a requirement of transformational leadership. Upgrading one’s self-knowledge is beneficial for a nurse leader in decision making.
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9.
Which statement of the nurse leader reflects the actions suggested by the Joint Commission for disruptive behavior by a direct care nurse?
1
"This is the last warning for you."
Correct 2
"You are terminated, effective now."
3
"This will affect your assessment markings."
Incorrect 4
"You should not behave this way because you are very talented."
According to the actions suggested by the Joint Commission, there is "zero" tolerance for an intimidating and/or disruptive behavior. The action to be taken for this type of behavior should be suspension, termination, loss of clinical privileges, and reporting to professional licensure bodies. The actions suggested by the Joint Commission do not include giving last a warning. The nurse who has behaved disruptively is not eligible for any assessment. By saying, "You should not behave this way because as you are very talented," the actions suggested by Joint Commission are not being carried out.

Test-Taking Tip: Try to recall the actions suggested by the Joint Commission for intimidating and/or disruptive behavior and provide the best answer.
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10.
The Case Management Society of America has identified the standards of practice for nursing case managers. What are the standards that provide effective care? Select all that apply.
Correct 1
Focusing on transitions of care
2
Maximizing fragmentation of care
Correct 3
Improving medication reconciliation
Correct 4
Expanding the interdisciplinary team
5
Decreasing the involvement of individuals in the decision-making process
Focusing on the transitions of care that includes a complete transfer to the next care setting or provider that is effective, safe, timely and complete is a standard that provides effective care. Improving medication reconciliation for the client through collaborative efforts with medical staff is a standard of practice for case managers. Expanding the interdisciplinary team to increase clients and/or their identified support system is a standard for effective care for case managers. Minimizing fragmentation of care within the health care system is essential for nursing case managers. Increasing the involvement of individuals in the decision-making process is important.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

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The nurse manager observes that the nurses in the unit take breaks during their shift longer than the organization policy of 15 minutes. What is the best action of the nurse manager?
Correct 1
The nurse manager should keep her/his break limited to 15 minutes.
2
The nurse manager should impose a monetary fine on the nurses for taking long breaks.
3
The nurse manager should appoint a nurse to keep a check on the breaks taken by the nurses.
4
The nurse manager should discuss a solution to the issue with the primary healthcare provider.
The nurse manager should lead by example and keep his/her breaks limited to 15 minutes, as per the organization policy, in an effort to motivate the other nurses to follow the nurse manager’s example. The nurse manager may not have the authority to impose a monetary fine. Allocating a nurse to keep a check on the breaks taken by the nurse would be misuse of human resources. It is not the responsibility of the primary healthcare provider to help the nurse manager with disciplinary issues.
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3.
Which critical factors would the nurse say are associated with situational-contingency theory? Select all that apply.
1
Environmental demands
2
The personal characteristics of followers
Correct 3
The ability of the leader to reward followers
Correct 4
The degree of trust and respect between leaders and followers
Correct 5
The task structure about goals and the complexity of the problems being faced
Situational-contingency theory considers three factors to be critical. It includes the ability of the leader to reward followers in terms of power and position. It is also comprised of the degree of trust and respect between leaders and followers. The task structure about goals and the complexity of problems faced is a critical factor. Environmental demands and the personal characteristics of followers are contingent variables.
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6.
Which organization advocates nurses taking a prominent role in the healthcare arena?
Correct 1
Institute of Medicine
2
National Quality Forum
3
Institute for Healthcare Improvement
4
Agency for Healthcare Research and Quality
The Leading Change Advancing Health report (2010) from the Institute of Medicine focuses on nurse coalitions and their prominent role in the healthcare arena. The National Quality does not address the issues of nurses; it focuses on client protections and healthcare quality through measurement and public reporting. The Institute for Healthcare Improvement provides rapid-cycle change projects designed to improve care rapidly. It focuses on partnering with clients and healthcare professionals to test new models of care. The Agency for Healthcare Research and Quality Outcomes provides resources for nurses and is the source of Five Steps to Safer Health Care.

Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
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7.
The nursing leader stated, "The reimbursed cost is less than the full charge for a service in the hospital." Which type of health reimbursement does the nurse leader describe?
Correct 1
Contractual allowance
2
Value-based purchasing
3
Cost-based reimbursement
4
Prospective payment system
When the reimbursed cost is less than the full charge for a service in the health organization, a contractual allowance or discount exists. Offering rewards and incentives to high performing organizations is value-based purchasing. In cost-based reimbursement, all allowable costs are calculated and used as the basis for payment. In a prospective payment system, the third-party payer decides in advance what will be paid for a service or episode of care.
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8.
A nurse is helping a client determine and articulate personal values about health problems. The nurse also explains the effect of these problems on lifestyle adjustments. Which Gardner’s task of leadership is the nurse leader applying?
1
Explaining
2
Managing
3
Motivating
Correct 4
Affirming values
Values are the connecting thoughts and inner driving forces that give purpose, direction, and precedence to life priorities. According to the Gardner’s tasks of leadership, helping the client sort out and articulate personal values that are related to health problems is affirming values. It also involves explaining the effect of these problems on lifestyle adjustments. Explaining includes teaching and interpreting information to promote well-being in the client. Managing involves assisting the client with planning, priority setting, and decision making. This also includes ensuring that organizational systems work on behalf of the client. Motivating includes inspiring clients or family members to achieve their vision.
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9.
The nursing leader is teaching the newly hired nurse about the use of computerized provider order entry (CPOE). Which statement by the new nurse indicates effective learning? Select all that apply.
Correct 1
"CPOE will provide clinical warnings."
2
"CPOE will increase variations in practice."
Correct 3
"CPOE will provide legible medication orders."
Correct 4
"CPOE will give automatic order notifications."
5
"CPOE will take more time for clarifying orders."
CPOE will alert the provider for allergies, pertinent laboratory data, drug-drug and drug-food interactions and supports decision and clinical warnings. It will provide legible, accurate, and complete order sets. It will provide automatic order notification. It will decrease variations in practice. It will take less time for clarifying orders.

STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.
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10.
The nurse manager of the unit comes to work obviously intoxicated. The staff nurse’s ethical obligation is to do what?
1
Call the security guard.
2
Tell the nurse manager to go home.
Correct 3
Have the supervisor validate the observation.
4
Offer the nurse manager a large cup of coffee.
The staff nurse should call the supervisor to confirm and deal with the problem. The security guard has no authority in this situation. Although sending the nurse manager home removes the nurse manager from the clinical setting, it does not provide for documentation of the situation; also, the nurse manager may be in no condition to go home independently. Drinking coffee does not make a person less intoxicated.

STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.
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12.
Which point should the nurse exclude when developing strategies to project a powerful image?
Correct 1
Using authoritative language
2
Maintaining good body posture
3
Making good eye contact with clients
4
Ensuring that clothing and hair are appropriate to the situation
The nurse should treat people with courtesy and respect. The use of authoritative language does not help in developing a powerful image. The nurse should also maintain good body posture because it conveys self-confidence. Good eye contact helps in developing trust. Appropriate dress and hair help convey a powerful image.

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A nurse is conducting a health campaign in a school. During the health campaign, the nurse finds that the school management has replaced the registered nurse (RN) with a trained clerk. What should the nurse, as a community opinion leader, do?
Incorrect 1
Suggest the school board hire and appoint a few trained clerks in the schools
2
Accept the decision of the school board and not become involved in the matter
Correct 3
Write a letter to a local newspaper editor opposing the decision of the school board
4
Avoid sharing the issue regarding the school board while participating in public forums
The job of a school nurse involves more than recording and verifying vaccinations and trained clerks may not be able to effectively perform these duties. Issues related to the community should be discussed in a public forum; therefore the nurse, as a community opinion leader, should write a letter to a local newspaper opposing the decision of the school board. Suggesting trained clerks, accepting the decision of the school board, and staying away from the issue can cause harm to the children.
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4.
The nurse notes a conflict between staff members during a meeting. Which principle should the nurse follow, as a leader, to put the focus on mutual interest?
Correct 1
Responding expediently to the issues
Incorrect 2
Providing a forum for open discussion
3
Reviewing with all parties the likely consequences of not proceeding
4
Working with staff or clients after the conflict to learn from the situation
Responding expediently to issues will help put the focus on interest in a process of conflict resolution. Providing a forum for open discussion will help build in consultation before and feedback after the negotiations. Reviewing with all parties the likely consequences of not proceeding will help build in "loop-backs" to negotiation. Working with staff or clients after the conflict to learn from the situation will help build in consultation before and feedback after the negotiations.

Test-Taking Tip: Multiple choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
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5.
A nurse manager agrees to mentor a newly recruited nurse who wishes to develop leadership qualities. Which statements hold true about this mentor relationship? Select all that apply.
Correct 1
The mentor should serve as a role model.
Incorrect 2
The mentor should not expect anything in return.
Incorrect 3
The mentor should be geographically close.
Correct 4
The mentor should provide advice whenever necessary.
Correct 5
The mentor should give appropriate feedback to promote improvement.
A mentor should serve as a role model for the newly recruited nurse and provide advice and appropriate feedback whenever needed to help the nurse improve the leadership qualities. The mentor, in return for the mentorship, can expect assistance in projects, and honesty and loyalty from the nurse. The mentor may be remotely placed, but well-connected.
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11.
Which characteristics should the nurse possess as a leader, according to theories of transformational leadership? Select all that apply.
Correct 1
Empowering staff
Correct 2
Creating enthusiasm for practice
Correct 3
Promoting scholarship of practice at the client side
Incorrect 4
Providing specific feedback about positive performance
5
Using positive reinforcement to motivate followers to repeat constructive behaviors
Transformational leadership is a process in which the leader attends to the needs and motives of followers. Transformational leadership activities include empowering staff, creating enthusiasm for practice, and promoting scholarship of practice at the client side. Expectancy theory holds that the nurse should provide specific feedback about positive performance. According to organizational behavior modification, the nurse, as a leader, should use positive reinforcement to motivate followers to repeat constructive behaviors.

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Which action of the nurse as a leader is supported by the Style theories of leadership?
1
Providing intellectual stimulation
Correct 2
Pursuing effective relationships with subordinates
3
Using positive reinforcement to motivate followers
4
Assessing the situation and determining the appropriate action
Style theories or group and exchange theories of leadership state that leaders should pursue effective relationships with their subordinates. Transformational theories of leadership focus on providing intellectual stimulation. The organizational behavior motivation theory of leadership indicates that leaders use positive reinforcement to motivate followers. Assessing the situation and determining the appropriate action based on the people involved characterize situational-contingency theories.
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5.
Which type of performance appraisal method is depicted when a nurse manager keeps a written record of positive and negative performance of employees in a designated time period?
Correct 1
Critical incident method
2
Graphic rating scale form
3
Management by objectives
4
Behaviorally anchored rating scale (BARS)
In the critical incident method of appraisal, the nurse manager uses a written record of the performance of an employee that includes positive and negative feedback. The graphic rating scale form is a performance appraisal checklist in which a nurse manager rates the employees’ performances. Management by objectives is a method of performance appraisal in which the nurse manager and employee address goals and objectives. The behaviorally anchored rating scale (BARS) is a method in which the description of every nursing assessment along a continuum is provided; the nurse manager describes the employee’s performance quantitatively and qualitatively.
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8.
Which constructive aspects of conflict does the nurse leader identify? Select all that apply.
1
Polarizes groups
Correct 2
Releases pent-up emotions
3
Promotes ineffective communication
Correct 4
Helps individuals grow personally
Correct 5
Builds cohesiveness among people
Conflict serves as a release for pent-up emotion, anxiety, and stress. It helps individuals to grow personally and apply what they learn to future situations. It helps to build cohesiveness among people sharing the conflict, celebrating in its settlement and learning more about each other. It polarizes groups so they increase internal cohesiveness and reduce intergroup cooperation; this is a destructive aspect of conflict. Authentic communication is an aspect of conflict but not improbable communication.
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9.
While providing feedback to nurse practitioners, the registered nurse uses the extinction approach to handle negative behaviors. Which theory of leadership is the registered nurse applying in this scenario?
1
Hierarchy of needs
2
Transactional theories
3
Transformational theories
Correct 4
Organizational behavior modification (OB Mod) theory
Extinction is purposefully ignoring negative behavior. According to the OB Mod theory, the nurse as the leader should ignore negative behaviors as a form of non-reinforcement. A leader employs the hierarchy of needs by developing an awareness of what motivates subordinates, beginning with physiologic needs and progressing to safety, social, esteem, and self-actualizing needs. Leaders using the transactional theory of leadership reward or punish subordinates while providing feedback. Transformational theories of leadership involve motivating subordinates by generating enthusiasm and promoting scholarship.
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12.
According to style theory of leadership, which is an action of a nurse leader?
Correct 1
Using feedback from superiors to measure own performance
2
Using feedback from the family to measure own performance
3
Avoiding using feedback from peers to measure own performance
4
Avoiding using feedback from followers to measure own performance
According to style theory of leadership, a nurse leader can use feedback from superiors to measure his or her performance. According to this theory, a nurse leader should not use feedback from the family to measure his or her leadership ability, as the family’s feedback may not be accurate. Style theory also explains that a nurse leader can use feedback from peers and followers to measure his or her leadership performance.

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Hospital management has replaced some equipment to provide more effective treatment. The nurse, as a leader, wants the team to support and implement this change successfully. Which actions of the nurse leader are effective in this situation? Select all that apply.
Correct 1
Conducting a dialogue with the team members
Correct 2
Encouraging the team members to develop new skills
Correct 3
Encouraging the team members to increase competency in different areas
Incorrect 4
Becoming knowledgeable about the change implemented in the organization
5
Instructing one half of the team to use the old equipment and the other half to use the new equipment
Dialogue allows the team members with different perspectives to come together and find common goals. Discussing the new equipment, developing new skills, and increasing competency in different areas ensure effective action of the leader to bring a change in an organization. Simply gaining knowledge about the change does not allow the team to support the change. The nurse leader should instruct the whole team to implement the change effectively.
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2.
The nurse manager is planning to develop leadership skills in direct care nurses. What activities should the nurse encourage the direct care nurses to participate in to develop these skills? Select all that apply.
Incorrect 1
Participate in public forums
2
Participate in civic gatherings
Correct 3
Serve on practice councils
Correct 4
Join local professional associations
Correct 5
Participate in American Heart Association activities
Direct care nurses can develop leadership skills in several ways. Employment opportunities such as practice councils, clinically focused opportunities such as the American Heart Association, and professional opportunities such as local professional associations are ways to bring out leadership skills in direct care nurses. Participation in civic gatherings and public forums provide a way for nurses to be community opinion leaders.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
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4.
The registered nurse is interviewing for a management position and wants to present a powerful image. What can the nurse focus on when preparing for the interview? Select all that apply.
Correct 1
Conveying positive body language
Correct 2
Appearing well groomed and well dressed
Correct 3
Showing confidence in work and abilities
4
Communicating a conservative, safe philosophy
Incorrect 5
Demonstrating an ability to work independently without the need for collaboration
Positive body language, appearing well groomed and well dressed, and conveying self-confidence are essential for establishing a powerful image. An effective leader should always be ready to take risks rather than maintaining a conservative, safe philosophy. A successful leader should also be comfortable collaborating and utilizing the assistance of others.
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6.
The nurse leader asks the team members not to talk to each other while writing their ideas for solving a predefined problem. Which type of group decision-making style does the nurse leader follow?
1
Focus group
Incorrect 2
Brainstorming
3
Delphi technique
Correct 4
Nominal group technique
In the nominal group technique, team members are asked to write their ideas for problem solving without talking to each other in order to avoid comments and elaboration of the ideas. Focus groups explore issues and generate information in identifying problems. The brainstorming method is used to generate a large volume of creative options. The Delphi technique involves collecting and summarizing opinions and judgments on a particular issue from respondents, such as expert panels, interviews, surveys, or questionnaires.
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7.
A nurse leader is promoted as nurse manager of a critical care unit. Which action would demonstrate the effectiveness of the nurse leader role as a manager?
Incorrect 1
Motivating the other staff members
2
Demonstrating positive feelings in the workplace
Correct 3
Establishing the goals considering the staff expertise
4
Using critical thinking in solving the problem of that unit
The role of the nurse manager is to establish the goals of that particular team. When these goals are established by considering the staff expertise, it becomes easier to exercise the role. Motivating other staff members and demonstrating positive feeling at the workplace are the responsibilities of the nurse leader. Using critical thinking for problem solving is not only the duty of nurse manager, but the duty of every registered nurse (RN) appointed in that particular unit.
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10.
According to chaos theory, what is the most important factor contributing to a successful organization?
Incorrect 1
Self-organizing structure
2
Managers who can take risks
Correct 3
Readiness to accept change
4
Leaders who are committed to lifelong learning
The most important characteristic of an organization according to chaos theory is the ability to adapt to change, which is important for survival in the face of instability and provides stability. Establishing a self-organizing structure, hiring managers who can take risks, and developing leaders who are committed to lifelong learning will help ensure that an organization is able to adapt to change.

Test-Taking Tip: Remember that chaos theory focuses on managing uncertainty and instability.
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11.
The nurse resolves a conflict with another nurse by using accommodation. In what situations is accommodation appropriate for resolving conflict? Select all that apply.
Correct 1
When facing trivial issues
Incorrect 2
When defensiveness is avoided
3
When people gather more information
Correct 4
When the other person’s solutions appear better
Correct 5
When harmonious relationships have to be preserved
Appropriate reasons for accommodating to resolve conflict include when the issues are trivial or not important, when the other person’s ideas or solutions are better, or when harmonious relationships have to be preserved. Avoiding defensiveness is not an appropriate reason to accommodate when resolving conflict. Gathering more information is not an appropriate reason to accommodate when resolving conflicts, unless that additional information has shown that the nurse has made a mistake.

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The healthcare unit reviews the evaluation report of a newly promoted nurse leader and rates the performance as excellent. At which qualities did the nurse excel? Select all that apply.
1
Enforcing contracts
Correct 2
Charting new paths that lead to progress
3
Interpreting established policies and procedures
Correct 4
Demonstrating positive feelings in the workplace
Incorrect 5
Demonstrating collaborative behaviors for client care
The trait of the nurse leader includes charting new paths that lead to progress. Nurse leaders should demonstrate a positive feeling in the workplace. Contracts are policy mandates that are enforced by the manager. The established policies and procedures are interpreted by the manager. Collaborative behavior should be demonstrated by followers taking care of the clients.

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The nurse leader is teaching the staff nurses about whistleblowing in the hospital organization. Which statement of the staff nurse indicates effective learning? Select all that apply.
Correct 1
"It is an act that protects federal workers."
2
"It covers both the public and private sectors."
Correct 3
"I understand the consequences of action and inaction."
Correct 4
"This is a warning issued by a current employee of an organization."
5
"It applies when employees respond to issues they deem as safe or legal."
The 1989 Whistleblower Protection Act protects federal workers. This act wants people to understand the consequence of action and inaction, as the protection it provides is imperfect. The Act refers to a warning issued by a current or former employee of an organization. The 1989 Whistleblower Protection Act does not cover the private sector. It applies when the people in the administrative structure within an organization fail to hear and respond to issues employees deem as unsafe or illegal.

Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
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2.
A nurse manager in a surgical unit finds that many clients are developing urinary tract infections post-operatively and wants to discuss the measures to prevent it with the team. Which action of the nurse manager reflects good communication practice?
Correct 1
Calling the team for a brief meeting
2
Texting every team member about the problem
3
Sending a detailed email about preventive measures
4
Requesting the nursing supervisor for a seminar to address all the nursing staff
Communication is a very important aspect of any leader. Solving a client care-related issue such as increasing incidences of urinary tract infections may require discussion with team and input from the team members to arrive at any decision. Therefore a face-to-face meeting with the team would be the best communication practice. Texting or sending emails to the team members would not facilitate feedback. Addressing all the nursing staff of the facility would not be needed, as the issue is limited to the surgical unit.
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4.
The hospital management is planning a study that compares the benefits and harms of a particular method to the benefits and harms of alternative methods when treating clients with chronic disorders. Which approach does the nurse manager follow to improve client care?
1
Diffusion of innovations
2
Practice-based evidence (PBE)
3
Participatory action research (PAR)
Correct 4
Comparative effectiveness research (CER)
CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. Diffusion of innovations describes how innovations spread through society in different stages of decision, implementation and confirmation. PBE is a research methodology that helps inform practice decisions by examining outcomes in the real world. In PAR, the members of the community being studied are integral members of the research team and are involved in identifying the questions and addressing the issues in the research project.

Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
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5.
Which statement is true regarding leadership theories?
1
Trait theory is sometimes referred to as the group and exchange theory of leadership.
2
Hierarchy of needs theory focuses on what leaders do in relational and contextual terms.
Correct 3
Expectancy theory states that leaders should provide specific feedback about positive performance.
4
Organizational Behavior Modification theory states that leaders use motivator factors to inspire staff.
According to the expectancy theory of leadership, the nurse as a leader should provide specific feedback about positive performance. This increases motivation and performance in subordinates. Trait theory is sometimes referred as the Great Man theory. Style theory focuses on what leaders do in relational and contextual terms. Organizational Behavior Modification theory states that leaders should uses positive reinforcement to motivate followers.

Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
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7.
The staff nurses complain the unit is disorganized and that there is no proper guidance from the nurse leader in regards to client services. Which type of leadership does the unit experience?
1
Directive
2
Autocratic
Correct 3
Laissez-faire
4
Participative
Laissez-faire is a hands-off style of leadership in which the nurse leader allows the staff nurses a high degree of autonomy and self-rule. In a directive style of leadership, the nurse leader sets clear objectives and rules for the nursing staff. Autocratic leadership occurs when the nurse leader places control within the position over a particular work area. Participative leadership is the type of leadership in which the nursing staff participates in the decisions made by the nurse leader.

STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals.
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10.
The nurse as a leader obtains feedback from superiors, followers, and peers. Which leadership theory is the nurse putting into practice?
Correct 1
Style theories
2
Trait theories
3
Two-factor theory
4
Situational-contingency theories
Style theories of leadership or the group and exchange theories of leadership focus on what leaders do in relational and contextual terms. In this type of leadership, the leader obtains feedback from superiors, followers, and peers so as to pursue effective relationships with subordinates. Trait theories of leadership focus on self-awareness of traits in self-development. Two-factor theory of leadership utilizes both hygiene and motivator factors to recruit and retain staff. Situational-contingency theories of leadership imply that the nurse should assess each situation and determine appropriate action.
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12.
Which group discussion technique involves a large number of respondents who may be participating in the discussion remotely?
1
Focus groups
2
Brainstorming
Correct 3
Delphi technique
4
Nominal group techniques
The Delphi technique includes the feedback of anonymous people who may not physically convene. These participants may be located throughout the country or the world. In the case of focus groups, the interaction is face to face. Brainstorming involves listing all ideas without critique or discussion. In the nominal group technique, participants are asked to not talk to each other as they write down their ideas to solve a predefined problem or issue.

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The healthcare unit reviews the evaluation report of a newly promoted nurse leader and rates the performance as excellent. At which qualities did the nurse excel? Select all that apply.
1
Enforcing contracts
Correct 2
Charting new paths that lead to progress
3
Interpreting established policies and procedures
Correct 4
Demonstrating positive feelings in the workplace
Incorrect 5
Demonstrating collaborative behaviors for client care
The trait of the nurse leader includes charting new paths that lead to progress. Nurse leaders should demonstrate a positive feeling in the workplace. Contracts are policy mandates that are enforced by the manager. The established policies and procedures are interpreted by the manager. Collaborative behavior should be demonstrated by followers taking care of the clients.
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6.
The direct care nurse, as a leader, finds that there is no formalized mechanism for providing input for organizational decision making. Which strategies does the nurse use in this situation? Select all that apply.
Correct 1
Filing official complaints
Correct 2
Creating unit campaigns
Correct 3
Holding informal discussions
Incorrect 4
Mobilizing volunteers for health fairs
Incorrect 5
Inspiring staff in changing the workplace
When there is no formalized mechanism for input into organizational decision making in a hospital, the direct care nurse uses some strategies for influence. These strategies include filing official complaints, creating unit campaigns, and holding informal discussions. Mobilizing volunteers for health fairs is the role of nurse as community leader. Inspiring staff in changing the workplace is the role of the nursing manager.
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8.
Which initiatives for leaders and managers are set forth in the Institute of Medicine’s core relevance report "The Future of Nursing?" Select all that apply.
Correct 1
Created state coalitions focused on nursing
2
Reinforced the disparities that occur within healthcare
3
Supported the concept of shared governance in nursing
Incorrect 4
Focused on outcomes, accreditation processes, and nurse’s roles
Correct 5
Provided a framework for considering how nurses could determine staffing requirements
The core relevance report "The Future of Nursing" created state coalitions focused on nursing and provided a framework for considering how nurses could determine staffing requirements. The core relevance report "Crossing the Quality Chasm" reinforced the disparities that occur within healthcare. The concept of shared governance was supported by the core relevance report "Keeping Patients Safe." The focus on outcomes and accreditation processes and nurses’ roles is developed by the core relevance emphasis on membership-based organization related to quality measurement and reporting from the National Quality Forum.
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9.
What are the roles and responsibilities of a senior nurse leader while implementing strategies for improving the quality of the organization? Select all that apply.
Incorrect 1
Participating actively in the quality improvement activities
Correct 2
Setting priorities for staff effectiveness and client health outcomes
Correct 3
Providing support systems for staff who have been involved in a sentinel event
Correct 4
Building infrastructure, providing resources, and removing barriers for improvement
Incorrect 5
Meeting regularly with staff to monitor their progress and help them improve their work
Setting priorities for staff effectiveness and client health outcomes are the responsibilities of senior leaders. This also includes providing a support system for staff who have been involved in a sentinel event. While preparing the quality improvement plan, the senior leader should build infrastructure, provide resources, and remove barriers for improvement. Participating actively in the quality improvement activities is the responsibility of a follower. The nurse manger has the responsibility of meeting with the staff regularly to monitor their progress and help them improve their work.
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11.
The nurse leader is teaching a student nurse about the modifications in the patient-focused care model. Which statement made by student nurse indicates ineffective learning?
Incorrect 1
"It improves client satisfaction."
2
"It improves worker job satisfaction."
3
"It increases the efficiency of the hospital."
Correct 4
"It requires a technician to provide client care."
The original patient-focused model required the use of cross-trained technicians who provided patient-side care. The modified model, however, includes team members providing direct care activities. In this model there is improved client satisfaction and worker job satisfaction. This, in turn. increases the efficiency of the hospital.

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What statements are related to a mentorship program organized by the nurse manager in a health organization? Select all that apply.
Correct 1
It expands the knowledge about cultural diversity.
2
It involves learning about the care of different ethnic groups.
3
It evaluates organizational policies that can hinder various cultural practices.
Correct 4
It involves selection of mentors who ascribe to transcultural values and beliefs.
Correct 5
It should not make people of different cultures pattern their behavior after the prevailing culture.
Mentorship programs are established to expand knowledge of cultural diversity among staff. For these programs, the nurse managers select mentors who ascribe to transcultural values and beliefs. These programs address the staff’s cultural diversity and do not try to make people of different cultures pattern their behavior after the prevailing culture. Continuing-education programs help in teaching about the care of different ethnic groups. Evaluating the organizational policies that can hinder various cultural practices is one of the techniques for managing multicultural clients in end-of-life care in a long-term care facility.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation. All options likely relate to the situation, but only some of the options may relate directly to the situation.

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The nurse manager sends the nursing team to perform a pediculosis screening at an elementary school and stays behind to catch up on administrative work. Which leadership quality does the manager fail to demonstrate in this instance?
1
Willingness to grow
2
Sharing of the reward
Correct 3
Leading by example
4
Having a clear vision
An effective leader actively leads members toward a mutual goal as a team, rather than simply sending them to do the job. Willingness to grow as a leader is demonstrated in activities like reading about new ideas and approaches and experimenting with new concepts to enhance their abilities. An effective leader shares the rewards of success by recognizing the positive contributions of each team member. Effective leaders with a clear vision see beyond where they are and see where they are going.
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2.
Which action of the clinical nurse is consistent with Gardner’s task of "achieving work unity"?
Correct 1
Helping clients accomplish optimal functioning
2
Relating to and inspiring clients to achieve their vision
3
Providing self-care to enhance the ability to care for staff, clients, and families
4
Representing nursing and the unit on task forces and shared governance councils
Helping clients accomplish optimal functioning is a behavior of Gardner’s task of "achieving work unity." It is applied in practice to benefit the transition to enhanced health functions. Relating to and inspiring clients to achieve their vision and enhancing health functions is involved in Gardner’s task of "motivating." Providing self-care to improve the ability to care for staff, clients, and families is the Gardner’s task of "renewing." Representing nursing and the unit on task forces and shared governance councils is involved in Gardner’s task of "representing."
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3.
What statements are related to a mentorship program organized by the nurse manager in a health organization? Select all that apply.
Correct 1
It expands the knowledge about cultural diversity.
2
It involves learning about the care of different ethnic groups.
3
It evaluates organizational policies that can hinder various cultural practices.
Correct 4
It involves selection of mentors who ascribe to transcultural values and beliefs.
Correct 5
It should not make people of different cultures pattern their behavior after the prevailing culture.
Mentorship programs are established to expand knowledge of cultural diversity among staff. For these programs, the nurse managers select mentors who ascribe to transcultural values and beliefs. These programs address the staff’s cultural diversity and do not try to make people of different cultures pattern their behavior after the prevailing culture. Continuing-education programs help in teaching about the care of different ethnic groups. Evaluating the organizational policies that can hinder various cultural practices is one of the techniques for managing multicultural clients in end-of-life care in a long-term care facility.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation. All options likely relate to the situation, but only some of the options may relate directly to the situation.
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4.
During an interview for a nurse manager position, the panel asks the nurse about the primary role of a leader. Which answer provided by the nurse would be most appropriate?
Correct 1
"To inspire followers"
2
"To provide training to the followers"
3
"To share views about the task with the followers"
4
"To increase the feeling of self-worth in the followers"
The primary role of a leader is to inspire the followers by actively participating in the task along with the followers. It also involves changing the workplace to increase work satisfaction. The other roles of a leader are to provide training to the followers, to share views about the task with the followers, and to increase the feeling of self-worth in the followers. All these are reflected in the concept of transformational leadership.
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5.
While serving as a leader, the nurse assists the client with planning, priority setting, and decision making. Which of Gardner’s leadership tasks is the nurse putting into practice?
Correct 1
Managing
2
Explaining
3
Developing trust
4
Envisioning goals
Managing is the Gardner leadership task that involves assisting the client with planning, priority setting, and decision making. Explaining involves teaching and interpreting information to promote functioning of the client and well-being. Developing trust involves keeping promises to clients and families and being honest in role performance. Envisioning goals involves envisioning client outcomes for client or families.
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6.
The nurse as a leader is using a transactional leadership style. Which effect on followers often results from this style of leadership?
1
The followers will have increased self-worth.
2
The followers will develop a sense of being valued.
Correct 3
The followers will correct errors in a reactive manner.
4
The followers will perform challenging and meaningful work.
Transactional leadership depends on the power of the organizational position and the formal authority to reward or punish the employees. Transactional leadership often results in followers correcting errors in a reactive manner. Increased self-worth is a typical effect of transformational leadership on followers. Likewise, a transformational leadership style fosters a sense of being valued and a feeling that the work is challenging and meaningful.

Test-Taking Tip: Transactional leadership involves rewarding or punishing the employees. Use this information to answer the question.
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7.
Why does the leader ask the direct care nurse, "Do you block cooperative efforts to resolve issues?"
Correct 1
The direct care nurse uses avoidance often.
2
The direct care nurse uses competing often.
3
The direct care nurse uses negotiation often.
4
The direct care nurse uses accommodation often.
Avoidance in conflict management style means that conflict is postponed. Often people do this when they have far more important issues pressing, when they have to gather more information, or when people need to cool down. Therefore the question asked by the leader to the direct care nurse, "Do you block cooperative efforts to resolve issues?," indicates that the direct care nurse may be using avoidance. Competing means perusing one’s own needs and goals at the expense of others. When a direct care nurse uses competing, often the leader may ask "Are you surrounded by people who agree with you all the time and who avoid confronting you?" Negotiating is similar to trading, and if the direct care nurse practices this often, the leader may ask "Do you ignore large, important issues while trying to work out creative, practical compromises? Accommodation in conflict management style means neglecting our own needs, goals, and concerns in favor of satisfying those of others. With regular use of accommodation by a direct care nurse, the leader may ask "Do you think people are using you?"

Test-Taking Tip: Read the stem carefully. Then the answer will be easy to guess. Now read the options and try to find the best answer.
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12.
A direct care nurse has great skill in teaching clients different self-care activities and is sought out by colleagues to teach their clients. Which power does the nurse possess?
1
Reward power
2
Position power
3
Connection power
Correct 4
Information power
The nurse has skill to teach clients and is sought out by colleagues to teach their clients. This indicates that the nurse has information power and possesses information that is needed by others. Reward power is based a person’s ability to provide rewards or favors. Position power is possessed by the virtue of the position within an organization. Connection power is gained by the people association that has links to the powerful people.

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A staff nurse states "I am sorry, I am responsible for the situation" while communicating to the nurse leader. Which communication pattern is the staff nurse using?
Correct 1
Placation
2
Irrelevant
3
Congruence
Incorrect 4
Attribution of blame
Placation means to appease. By saying "I am sorry, I am responsible for the situation," the staff nurse is taking the blame. An irrelevant pattern is used when someone is trying avoid a situation or ignore his or her feelings. Congruence is used when matching inner feelings with words. While blaming others for any situation, attribution of blame is applied.
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9.
The nurse manager is teaching the licensed practical nurse (LPN), the evidenced-based practice regarding the use of saline and the low-dose heparin flush solution for capped angiocatheters. Which statement by the LPN indicates they understood the teaching? Select all that apply.
Incorrect 1
"The use of small doses of heparin is safe."
Correct 2
"The use of heparin flushes disappeared in the late 1990s."
Correct 3
"The use of high doses of heparin solutions is not recommended in adults."
4
"The use of heparin in peripheral intravenous catheters is recommended in neonates."
Incorrect 5
"The catheters flushed with normal saline have shorter life spans than heparin-flushed catheters."
Although some organizations continued to use heparin flushes for a number of years, their use became less common and mostly disappeared in the late 1990s. It is not safe to use high-doses of heparin in adults because of serious adverse events. The concern that complications arose from lower doses of heparin and transition to saline flushes has diminished due to research. The use of heparin in peripheral intravenous catheters is not recommended in neonates. Research also shows that catheters flushed with normal saline lasted significantly longer than heparin-flushed catheters.
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10.
Which behavior is an example of the nurse’s role as an executive in the Gardner task of leadership?
1
Helping staff achieve optimal functioning to benefit transition
2
Representing nursing and the organization on assigned boards
Correct 3
Representing the organization and client care services on councils
Incorrect 4
Assisting the staff with planning, priority setting, and decision making
Representing the organization and client care services on councils are activities of an executive position, according to Gardner’s task of leadership. Representing nursing and the organization on assigned boards are management activities, per Gardner’s task of leadership. Helping the staff achieve optimal functioning to benefit transition is part of the management position, per Gardner’s task of leadership. Assisting the staff with planning, priority setting, and decision making refers to the management position as per Gardner’s task of leadership.
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11.
The nurse manager assigned 5 visits per day to a home health nurse, but the weekly average of the home health nurse is 4.8 visits per day. What reason does the nurse manager expect is the cause for this discrepancy?
Incorrect 1
The client condition is not critical.
2
The client does not require more visits.
3
The time spent on the client visit is nonproductive.
Correct 4
The time for one visit took twice the amount of time normally.
The difference might include the fact that one visit took longer than the expected time spent on a home visit because of the client needs, thereby preventing the nurse from meeting the standard 5 visits per day. If the client condition is noncritical, the nurse manager would recommend less visits, but this is not the staff nurse’s decision. The staff nurse should not decide on the number of visits required for the client; it is the nurse manager’s responsibility to give confirmation regarding the home visits for a client. The time spent on the client in treating or taking care of the client either in the hospital or at home is the measure of productivity.

STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.

…

he registered nurse is caring for an elderly client who is admitted with severe asthma. Which task delegated by the nurse is most suitable to be performed by the client attendant?
1
Assessing the vital signs
2
Monitoring respiratory rate
3
Administering inhalational medications
Correct 4
Assisting the client during nebulization
The client attendant is the unlicensed assistive personnel whose scope of practice is limited to providing basic care and comfort to the client. Assisting the client during nebulization is considered basic care and comfort and can be safely carried out by the client attendant. Assessing vital signs should be performed by the registered nurse. Monitoring respiratory rate can be delegated to the client attendant if the client condition is stable; however, since this client’s condition is not stable, this task should not be delegated. Administering inhalational medications is not performed by unlicensed personnel such as a client attendant.
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3.
When delegating a task, the delegator says, "Please tell me how you are going to perform this procedure, and I will share my expectations regarding how we need to communicate with each other." What can be inferred about the delegatee?
1
The delegatee has expertise and an established relationship with the delegator.
2
The delegatee has limited knowledge and ability to perform the task.
Correct 3
The delegatee has willingness and ability, but the relationship is new.
4
The delegatee has an established relationship with the delegator, but a new task has been delegated.
When the delegatee has the willingness and ability to perform the task but the relationship is new, the delegator tries to establish mutual expectations and conditions for performing the task. The delegator must open the lines of communication with the delegatee. When the delegatee has expertise and an established relationship with the delegator, the delegator asks the delegatee to communicate if any issue or concern arises. When the delegatee has limited knowledge and ability to perform the task, the delegator would provide more guidance to the delegatee by giving detailed instructions. If the delegatee has an established relationship with the delegator but a new task has been delegated, the delegator will need to provide explanation of what is needed to accomplish the task.

STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body’s energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.
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4.
The registered nurse suggested that a newly hired registered nurse delegate tasks to nursing assistants. Which is an element that fosters effective delegation decisions by the newly hired registered nurse?
1
Skills
Correct 2
Stability
3
Practice
4
Environment
Stability along with safety, critical thinking, and time for decision-making creates an integrative process, which fosters effective delegation decisions. Skills are important for making decisions based on critical thinking. Practice accomplishes safety in delegation. Environment with feedback about performance is the best strategy for shaping the future behavior of individuals.
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5.
The registered nurse assigns a task to a licensed practical nurse (LPN) to check the blood pressure and temperature of a client. Which factor is transferred to the LPN for the performance of the task?
1
Liability
2
Authority
Correct 3
Responsibility
4
Accountability
Delegation is the transfer of responsibility for the performance of the task. So, the LPN is responsible until the task is completed. Liability is the person’s responsibility and accountability for individual actions. Authority is the ability to perform duties in a specific role. Accountability is transferred when the work of one individual is performed by the other.
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7.
Which component of delegation is considered a "two way process"?
1
Authority
2
Supervision
Correct 3
Responsibility
4
Accountability
Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.
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8.
The registered nurse is evaluating the statements of the student nurse after teaching about delegation. Which statement made by the student nurse indicates a need for correction?
1
"Delegation is merely sharing a set of functions."
2
"Delegation ensures quality client care outcomes."
Correct 3
"Professional aspects of care can also be delegated."
4
"The final accountability of a task remains with the delegator."
Basic activities of daily living and personal hygiene can be delegated but professional aspects of care cannot be delegated and should be performed by the registered nurse only. Delegation is a process of merely sharing a set of functions in which the delegator shares functions with the delegatee. Because delegation involves sharing of functions, it ensures quality client-care outcomes. Though the delegator assigns work, the final accountability of a task remains with the delegator.
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11.
A registered nurse delegates a task to a licensed practical nurse (LPN). The nurse manager asks the registered nurse, "Are the equipment and resources available for the LPN to complete the task?" Which right of delegation is the nurse manager preserving?
1
Right task
2
Right direction
3
Right supervision
Correct 4
Right circumstance
Questions such as, "Is the environment conducive to completing the task safely?" and, "Are the equipment and resources available to complete the task?" ensure the right circumstance for delegation. Right task is ensured with a question such as, "Is the task appropriate to the delegate, according to institutional policies and procedures?" Delegation is taking the right direction if the answer to a question such as, "Do the delegator and delegatee understand a common work-related language?" is positive. Right supervision is evaluated with a question such as, "Is the delegator able to monitor and evaluate the client appropriately?"
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12.
A nursing assistant is working with a delegator. Which action of the nursing assistant may negatively affect client care management?
1
Addressing challenges together
Correct 2
Performing the same tasks as the delegator
3
Initiating conversation about the new roles and functions
4
Communicating the cultural perspectives with the delegator
Nursing assistants who have similar strengths as the delegator should adapt to changing situations. A nursing assistant performing the same tasks as the delegator may create a gap in the delivery of client care. Building on the strengths and minimizing the challenges of the team proves to be an effective strategy. Initiating a conversation about the new roles and functions in the organization can open lines of communication to explain why supervision is necessary. It also helps to eliminate or diminish any negative feelings about being supervised. The lines of communication between the delegator and the nursing client can be improved by appreciating and valuing cultural perspectives.

Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way.

…

After assigning a task, the delegator makes sure that the instructions are clear to provide feedback related to the task. Which delegation right is referred in this situation?
1
Task
2
Person
Incorrect 3
Direction
Correct 4
Supervision
Ensuring that the delegatee is clear to provide feedback related to the task refers to the right supervision. Knowing whether the task is appropriate to delegatee based on institutional policies and procedures refers to the right task. Knowing whether the delegatee has the knowledge and experience to perform the specific task safely refers to the right person. Knowing whether the delegatee understands the assignment and directions of the task refers to the delegation right direction.
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6.

Chart/Exhibit 1

The registered nurse (RN) delegates a task to a licensed practical nurse (LPN). Which client task can be assigned to the LPN?
1
Client A
Correct 2
Client B
3
Client C
Incorrect 4
Client D
Client B is delegated to the LPN to perform sterile dressing changes on acute and chronic wounds. Assessments such as evaluating fluid electrolyte needs in client A with dehydration are performed by the RN. In client C, notifying the registered nurse if the client reports pain is done by unlicensed nursing professional (UAP). In client D with presbycusis, helping the client with hearing aid replacement is performed by the UAP.
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9.
Which members of the health care team have dependent status under the registered nurse? Select all that apply.
1
Unit secretary
Correct 2
Certified nursing aide
Correct 3
Licensed practical nurse
Correct 4
Licensed vocational nurse
Correct 5
Unlicensed nursing personnel
Certified nursing aides, licensed practical nurses, licensed vocational nurses, and unlicensed nursing personnel are members of the health care team who have dependent status and work under supervision or direction of a registered nurse or physician. The unit secretary is a member of the health care team who has no legal recognition or dependant status among the health care team.
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10.
What would the nurse describe as the challenges of delegation? Select all that apply.
Correct 1
Limited resources
Incorrect 2
More staff availability
Correct 3
Larger geographic area
Correct 4
Care for vulnerable populations
5
Deciding if delegating is time-saving
Delegation can be more challenging when the resources are limited, when the geographic area is greater, and when care is given for vulnerable populations. Availability of more staff is a benefit of delegation. Decisions for delegation should not be solely based on time-saving considerations; they should also be based on the abilities of the nursing staff to complete the tasks effectively and safely.

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The nurse is caring for a pregnant client with hypertension. Which client care tasks are most suitable to be delegated to the patient care associate (PCA)?
Correct 1
Recording the vital signs
2
Monitoring the blood pressure
3
Administering intravenous fluids
4
Administering antihypertensive medications
A patient care associate (PCA) is an unlicensed assistive personnel whose scope of practice is very limited. A PCA can be delegated the task of recording the vital signs as communicated by the delegator even if the condition of the client is acute or unstable. In stable clients, the PCA may be instructed to monitor the blood pressure, but in this acute condition, only the registered nurse (RN) should monitor the blood pressure. Administration of intravenous fluids or medications is out of scope of practice of the PCA. A PCA is not suitable to be delegated the task of administering any medication to a client.
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4.
A client with chronic asthma is being cared for in the inpatient care unit. To assess the client on a regular basis would be delegated to which healthcare team member?
1
Charge nurse
Correct 2
Registered nurse
3
Patient care associate
4
Licensed practical nurse
The registered nurse is a licensed nursing professional and is responsible for assessing the asthmatic symptoms of the client for providing care. The charge nurse is responsible for the coordination and assignment of tasks for the client’s care. The patient care associate is an unlicensed assistive personnel whose scope of practice is limited from assessing the client. The licensed practical nurse does not assess the client’s condition, but rather is responsible for providing treatment prescribed by the healthcare provider and delegated by the RN.
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5.
A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply.
Correct 1
Case studies
Correct 2
Online learning
3
Teaching experience
Correct 4
Clinical nursing practice
5
Demographics of learning group
Competencies can be developed through different teaching strategies such as case studies, online learning, and clinical nursing practice. These strategies can help in improving the learning ability of the student nurses, licensed practical nurses, and unlicensed nursing professionals. Teaching experience and demographics may not be required to develop competencies.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation. All options likely relate to the situation, but only some of the options may relate directly to the situation.
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6.
The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey’s model is being applied?
1
Telling
2
Selling
3
Delegating
Correct 4
Participating
When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey’s model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.
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7.

Chart/Exhibit 1

Which client is most appropriate to be delegated to unlicensed assistive personnel (UAP) based on the given data?
1
Client A
2
Client B
3
Client C
Correct 4
Client D
The unlicensed assistive personnel (UAP) is delegated to work in long-term care settings and extended-care settings as the clients are more stable. The UAP may not be delegated to work in acute care, emergency care, and intensive care settings. In dementia, the client experiences confusion, so long-term care is essential for this client. Since UAPs generally work in long-term care, client D is most appropriate to be delegated to a UAP. As severe diarrhea needs acute care, client A may not be delegated to a UAP. Though a hand fracture may require extended care, the client can do work on his or her own when compared to the client with dementia. Therefore, client B may not be delegated to a UAP. Clients with bronchitis need acute care as they may experience breathing difficulties. Therefore, client C is not delegated to a UAP.

Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, healthcare provider orders, medication administration record, health history), physical assessment data, and assistant/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking.
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8.
The registered nurse (RN) is caring for a client with renal calculi. Which healthcare professional is most suitable to be delegated the task of administering urinary alkalinizer by mouth to the client?
1
Certified technician
2
Patient care associate
Correct 3
Licensed practical nurse
4
Unlicensed assistive personnel
Administering oral medications such as urinary alkalinizer can be safely delegated to a licensed practical nurse (LPN) or licensed vocational nurse (LVN) as per guidelines. Certified technician is a licensed assistive personnel whose scope of practice is limited for administering medications. The scope of practice of the patient care associate and unlicensed assistive personnel is limited to performing basic care, feeding, and hygiene.
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9.
The registered nurse is assisting a client who is hospitalized with high fever. Which task delegated to the unlicensed assistive personnel (UAP) would be appropriate? Select all that apply.
1
Assessing the vital signs
Correct 2
Performing all hygiene tasks
3
Administering oral medications
Correct 4
Helping the client in changing clothes
5
Administering intravenous medications
The UAP does all the hygiene tasks and also helps in changing the clothes. Assessing the vital signs may not be performed by the UAP. Administering the intravenous medications is performed by the registered nurse. Oral administrating of medication is performed by the licensed practical nurse.
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10.
Which among the Five Rights of Delegation is the cornerstone of delegation?
1
"Right person"
2
"Right supervision"
3
"Right circumstance"
Correct 4
"Right communication and direction"
Among the Five Rights of Delegation, "right communication and direction" is the most important right of delegation. It is the most useful in maintaining the quality and safety outcomes, as it involves communication and direction. "Right person" is useful for understanding which person has the appropriate skills to perform the task. "Right supervision" involves monitoring the tasks that are performed with the goal of improving outcomes. "Right circumstance" seeks to ensure that the appropriate equipment and resources are available for the delegatee.
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11.
A client is admitted to the emergency department following a motor vehicle accident. The client’s wounds are extensive. Which healthcare team member is best suited to care for this client in the emergency ward?
1
Charge nurse
Correct 2
Registered nurse
3
Licensed practical nurse
4
Unlicensed nursing personnel
A registered nurse should be the healthcare team member to care for the client in the emergency department. The charge nurse’s role includes making client assignments, scheduling breaks for staff members, and serving as a staff resource person. The licensed practical nurse is involved in fast-track emergency care. Unlicensed nursing personnel perform all hygienic tasks and are not required in the emergency care unit.

Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.
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12.
In a healthcare unit, there are 30 clients and the charge nurse delegates the healthcare team for providing client care. Which statements made by the delegator would indicate care responsibilities are assigned to unlicensed assistive personnel (UAP)? Select all that apply.
Correct 1
"Note the oxygen saturation reading."
2
"Administer oral antibiotic medications."
Correct 3
"Check whether the client is taking fluids."
4
"Admit the client to the intensive care unit."
Correct 5
"Ensure that the client has time for uninterrupted sleep."
Unlicensed assistive professionals are delegated to perform tasks such as collecting data that will be used to assess the client. Noting the oxygen saturation readings is a role of the UAP, as is checking the basic needs of the client such as the intake of fluids. The delegator would also assign ensuring whether the client is provided sufficient time to sleep without interruptions to the UAP. Administration of oral antibiotic medications should be delegated to the licensed nursing professionals but not to UAP. Admitting the client to intensive care unit is a task that should be delegated to the licensed nursing professionals.

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A registered nurse (RN) delegates the task of foot care for a client to an unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task, but was recently hired and is unfamiliar with the client’s condition. What should the RN do in this situation?
Incorrect 1
Provide guidance to the UNP.
2
Observe and motivate the UNP.
Correct 3
Establish mutual expectations and conditions.
4
Explain what to do and how to perform the task.
If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the RN should establish mutual expectations and conditions of performance to establish a good relationship. If the delegatee has limited knowledge and ability to perform a task, the delegator is expected to guide the UNP. The RN is expected to observe and monitor the task performed by the delegate to ensure the delegatee has the ability and willingness to establish a relationship and accomplish the work. The RN can also explain the task and how to execute it if the situation involves a new task and relationship is ongoing.
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3.
A registered nurse teaches a student nurse about delegation. Which statement made by the student nurse indicates appropriate learning?
1
"Licensed practical nurses are accountable for the tasks they perform."
2
"Complete client care can be delegated to the licensed practical nurse."
Incorrect 3
"Professional aspects of care can be carefully delegated to the licensed practical nurse."
Correct 4
"Licensed practical nurses can be expected to perform tasks with which they have experience."
The delegator can safely delegate the task to the LPN if the task is within the scope of function or if the LPN is very experienced in performing the task. The LPN, being a delegatee, is not held accountable for the delegated work; the LPN is held responsible for the delegated task. The delegator is held accountable for the LPN’s work. The delegator can never delegate complete client care to the LPN, but can only transfer functions and tasks. Basic skills such as activities of daily living and personal hygiene can be delegated by the delegator, but professional aspects of care should not be delegated.

Test-Taking Tip: Make certain the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

…

Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply.
Correct 1
Is the prospective delegatee a willing and able employee?
2
Does the delegatee understand the directions and expected results of the task?
3
Does the delegatee understand how, what, and when to report to the delegator?
4
Is it clear that the delegatee will provide feedback related to the task when appropriate?
Correct 5
Does the delegatee have the knowledge and experience to perform the specific task safely?
The right delegatee is chosen on the basis of the person’s willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee’s ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee’s understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate.
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3.
Which behavior does the delegator adopt when communicating with the delegatee if the relationship between them is new, the delegatee has limited knowledge, and the delegator does not expect the relationship to be ongoing?
Correct 1
Telling
2
Selling
3
Delegating
4
Participating
According to Hersey’s Situational Leadership Model, if the relationship between a delegator and a delegatee with limited knowledge is new and is not going to be ongoing, the delegator’s behavior is characterized as " telling." Delegator’s behavior is characterized as "selling" if the delegatee and delegator have an ongoing relationship and a new task is being delegated. The delegator’s behavior is characterized as "delegating" when the delegatee has expertise and an established relationship with the delegator. If the delegatee has willingness and ability, but the relationship with the delegator is new, then the delegator’s behavior is characterized as "participating."
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4.
Which feedback given by the registered nurse to the delegatee is constructive? Select all that apply.
1
"Well done. Nice job."
2
"I expected you to do better."
3
"You can do better when you concentrate."
Correct 4
"You performed that procedure safely and professionally."
Correct 5
"Let me demonstrate a more effective way to perform the task."
The best strategy is to provide open, honest, and constructive feedback, such as, "You performed that procedure safely and professionally" or "Let me demonstrate a more effective way to perform the task." It improves work performance and provides specific strategies for change. "Well done. Nice job," is vague and not specific feedback to the behavior. A verbal attack such as, "I expected you to do better," will not produce effective change. It may even undermine the long-term working relationship of the registered nurse and the delegate. "You can do better when you concentrate," may not elicit effective change.
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5.
The nurse says to the licensed practical nurse (LPN), "I know that you can accomplish the task with dedication. Report to me the expected outcomes and approach me for further assistance if needed." Which relationship is the nurse maintaining with the LPN?
1
Telling
2
Selling
Correct 3
Delegating
4
Participating
The statements, "I know that you can responsibly accomplish the task with dedication. Report to me the expected outcomes and approach me for further assistance if needed," indicate delegation. Delegation involves an established relationship and expertise with little guidance. Telling requires intensive guidance for a delegatee with limited knowledge and ability to perform the task. Selling requires explanation of the new task that is to be delegated. Participation requires involvement of both the delegator and delegatee to create mutual expectations and conditions for performance.

Test-Taking Tip: The statement in the question stem represents that a delegator assigned work for the delegatee and is trying to establish the healthy relationship. Apply your knowledge to answer this question based upon the information provided.
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6.
The client is admitted to the medical unit with a diagnosis of pulmonary edema. The client care is assigned to the registered nurse (RN) by the charge nurse. The RN admits and provides a written plan and assigns the client to a licensed practical nurse. Which healthcare personnel is accountable and responsible for the client if there is development of any complications in the client?
1
Charge nurse
2
Associate nurse
Correct 3
Registered nurse
4
Licensed practical nurse
The registered nurse is responsible and accountable for the client if complications develop. The registered nurse is responsible for the client because he or she delegated client care and wrote the care plan. The charge nurse may be accountable but may not be responsible since the charge nurse gets the task in the absence of the RN. The associate nurse is responsible for the client’s condition if the primary nurse’s written plan is implemented by the associate nurse. The licensed practical nurse (LPN) is not responsible because the LPN follows the written plan given by the RN.

Test-Taking Tip: Recall the tasks to be performed by various healthcare personnel and select the right option.
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7.
The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction?
1
Asking questions about the client’s respiratory rate
2
Asking the client to perform breathing exercises regularly
3
Administering oxygen to the client with shortness of breath
Correct 4
Providing constructive feedback about client care management
The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The nurse may assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Asking involves inquiring about the client care problems and issues such as the respiratory rate. Offering involves suggesting ways to achieve desirable client care outcomes, such as asking the client to perform breathing exercises regularly. Doing involves demonstrating the specific task to improve client care—for instance, administering oxygen to the client.
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8.
Which statement is true regarding the framework of delegation related to the Hersey’s Situational Leadership Model? Select all that apply.
1
Single factor influences the effectiveness of a leader
2
Ability relates to the individual’s attitude and commitment
Correct 3
Willingness relates to the individual’s attitude towards the task
Correct 4
Ability to diagnose performance is a core competency of a situational leader
5
Willingness is the sole factor that must be assessed to determine the readiness of the follower
Hersey’s Situational Leadership Model serves as a foundation for delegation decision making. Willingness is the individual’s attitude and commitment towards the task. The ability to diagnose the performance and commitment of others is a core competency of Hersey’s Situational Leadership Model. Multiple factors such as assessment of personality characteristics and readiness level of an individual influence the effectiveness of a leader. Willingness, not ability, relates to attitude and commitment. Willingness and ability are the two factors that are assessed when determining the level of follower’s readiness.

STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.
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9.
A registered nurse is caring for a client according to the total client care model of nursing. Which activity performed by the nurse manager would be appropriate in this situation? Select all that apply.
1
Providing care to group of clients
2
Providing care to clients in ambulatory clinics
3
Delegating tasks to licensed practical nurse (LPN)
Correct 4
Weighing the expenses of a registered nurse (RN) vs. LPNs
Correct 5
Deciding the type of care provided by nursing assistive personnel
Weighing the expenses of RNs versus LPNs and unlicensed assistive personnel (UNP) are performed by the nurse manager in the total client care model of nursing. Providing care to the group of clients is the responsibility of a direct care nurse in the functional nursing model. Providing care to a client in an ambulatory clinic is the responsibility of the nurse manger in the functional nursing model. Delegating a task to an LPN is not the responsibility of the nurse manager; it is the responsibility of the RN.

Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
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11.
What points should the nurse consider when delegating a task? Select all that apply.
Correct 1
Checking the skill set of the delegatee
Correct 2
Selecting the delegatee based on his or her competence levels
Correct 3
Being certain that the delegatee is capable of completing the task
4
Checking for the willingness of the delegatee to perform the task
5
Selecting the delegatee based on that employee’s length of tenure
Before selecting a delegatee for any particular task, it is important to understand the skill set and capabilities of the delegatee because selection of delegatees is based on specific skill sets. Selecting a delegatee based on his or her competency is an important aspect of delegation. Being certain about the capabilities is a crucial element of delegation. Willingness is not a crucial element for selecting a delegatee. In a rural setting the generally longer tenures of employees may make the delegation process easier.

Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question.
13268117095
Confidence: Nailed It
Stats
12.
The Joint Commission is surveying an organization’s nursing care. Which question is the surveyor most likely to ask regarding right supervision when delegating?
1
"Do you inform the delegatee the proper way of providing results?"
Correct 2
"Do you monitor and evaluate the client’s condition appropriately?"
3
"Do you maintain open lines of communication with the delegatee?"
4
"Do you provide clear and concise directions to the delegatee before delegating the task?"
Monitoring and evaluating clients’ conditions should be performed by the delegator. This falls under right of supervision of delegation. Assessing the delegatee’s knowledge regarding the importance of providing results falls under right communication of delegation. Maintaining open lines of communication with the delegatee and providing clear and concise directions to the delegatee falls under right communication of delegation.

Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

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Chart/Exhibit 1

The registered nurse is assessing the conditions of four different clients. Which client’s care should the registered nurse delegate to an unlicensed assistive personnel (UAP)?
1
Client A
Correct 2
Client B
Incorrect 3
Client C
4
Client D
Client B is delegated to the UAP since they are assigned to perform hygienic tasks and diarrhea is a sub-acute condition. Brain injury is a serious condition and care cannot be performed by the UAP. Uncontrolled diabetes is a chronic condition, so client C is not delegated to UAP. Hypertension is an acute condition, and client D is not delegated to the UAP.

Test-Taking Tip: Specific tasks are performed by the UAP. Recall the tasks performed by the UAP and choose the right option.
13263005819
Confidence: Pretty Sure
Stats
10.
The registered nurse (RN) is caring for a client who underwent knee surgery. Which activity delegated to the novice unlicensed assistive personnel (UAP) in the immediate postoperative period would be most appropriate to achieve an effective care outcome?
Correct 1
Feeding the client with fluids
2
Dressing the client’s surgical site
Incorrect 3
Monitoring temperature of the client
4
Administering oral medication to the client
The unlicensed assistive personnel (UAP) can feed the client with fluids. Dressing the client’s surgical site should be done by an experienced UAP. Monitoring the vital signs should be done only by the licensed practical nurse (LPN) in the immediate postoperative period. Administering oral medication should not be delegated to the UAP; it is the responsibility of the LPN.

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