NURSING 1234 Leadership Test#1 Chapter 1-13 (GRADE A) Questions and Answers, All Correct Rationales, Download to Score A

NURSING 1234 Leadership Test#1 Chapter 1-13 Chapter 1 Introducing Nursing Management 1) When planning client care the nurse must be aware that current changes in health care are primarily driven by: 1. Cost of care. 2. Access to care. 3. Availability of care. 4. Quality of care. Answer: 1 Explanation: 1. Cost is the primary factor driving the changes in health care. Rising costs also affect access to care, availability of care, and quality of care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 2) Which is the United Statesʹ largest and most expensive health care program? 1. Medicaid 2. Medicare 3. Social Security 4. Temporary Assistance for Needy Families (TANF) Answer: 2 Explanation: 2. Medicare is the government’s largest health care financing program. It serves 40 million people who are elderly and have disabilities. Medicaid is a smaller health care program that serves the poor. Social Security and TANF are not health care programs. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 3) The nurse explains to the family of an elderly client that the client cannot stay in the hospital for rehabilitation from a hip replacement because Medicare and personal insurance will not continue to pay for hospital care. Which is the correct way for the nurse to explain diagnostic-related groups (DRGs) to the family? 1. Group of clients with the same diagnosis 2. Fee for service payment plan 3. Group of related diagnoses applying to one client 4. Prospective system of payment for health care Answer: 4 Explanation: 4. DRGs are a prospective system of payment to providers and organizations for a set amount for a specific condition stipulated in advance. Health care providers have responded to this system by reducing hospital stays. All other answers are incorrect definitions for DRG. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 4) How would the nurse working in a school clinic that is part of an integrated health care network explain the focus of care to parents and teachers? 1. Hospital care 2. Primary care 3. Specialty care 4. Home care Answer: 2 Explanation: 2. Primary care is the focus of integrated health care systems. The goal is to keep the clients healthy, and to prevent hospital stays, visits to specialists, and home health care. Hospital care, specialty care, and home care are not the focus of integrated health care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) In order to evaluate the quality of client care in the hospital setting, the nurse manager may ask the nursing staff to: 1. Track the number of supplies used on surgical clients. 2. Document nursing time and tasks spent on direct client care. 3. Administer a client and family satisfaction survey. 4. Assess clients and report acuity to shift supervisors daily. Answer: 3 Explanation: 3. Client satisfaction surveys can be used to evaluate client needs and how the organization is meeting those needs. Tracking supplies, documenting nursing time, and reporting client acuity can be used for budgeting and staffing purposes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Health care organizations have used benchmarking to evaluate and enhance quality care by: 1. Comparing outcome indicators between organizations. 2. Comparing internal hospital units. 3. Establishing unit goals. 4. Maintaining effective unit policies. Answer: 1 Explanation: 1. Benchmarking uses an organizationʹs outcome data and compares it with a similar organization to address strengths and challenges. Evaluating the goals and policies of internal units are not benchmarking. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) It is known that fewer professional nurses on each unit will have which effect? 1. Cost savings passed on to the client 2. Negative outcomes with surgical clients 3. Decreased mortality rates 4. Increased quality of client care Answer: 2 Explanation: 2. Recent research has shown a direct relationship between fewer nurses and negative outcomes with surgical clients and increased mortality rates. There are higher client costs related to surgical complications and longer hospital stays. There is decreased quality of client care with fewer nurses. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) Which action by nurse managers and/or staff will positively impact the nursing shortage? 1. Current nursing faculty members return to work in acute care settings. 2. Shorter hospital stays resulting in decreasing need of nurses in acute care settings. 3. Focus on recruitment of middle school and high school students, men, and minorities to schools of nursing. 4. Increase nursing wages. Answer: 3 Explanation: 3. Aggressive recruiting in diverse populations and younger students is needed in nursing. More, not less, nursing faculty are needed to increase class size. As hospital stays are shorter, nurses are needed in settings outside of the hospital. Studies have shown that nurses are more interested in improved workplace settings than in increased wages. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) The first step in planning course content for in-service education for the nursing staff on cultural diversity is to: 1. Determine how many staff members speak Spanish. 2. Evaluate staff membersʹ knowledge of how religion impacts health care. 3. Plan for a guest speaker with knowledge of racial and ethnic health disparities. 4. Assess local community demographic data. Answer: 4 Explanation: 4. The first step in planning for cultural diversity is to assess the local community to determine what diversity exists in the community. The staff needs to be culturally sensitive to the needs of all members of the community. Until the assessment is done, it is unknown what language, religion, racial, or ethnic groups are represented in the community. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) For a new nurse working in a hospital, which management tasks are required? Select all that apply. 1. Supervise nonprofessional personnel. 2. Evaluate client care. 3. Delegate tasks to nonprofessional personnel. 4. Complete performance evaluations on staff. 5. Communicate with practitioners of other disciplines. 6. Plan unit budget with decreasing resources. Answer: 1, 2, 3, 5 . 11) The nurse is assisting a client move from bed to bathroom and notices a spill on the floor. Which is the nurseʹs first action? 1. Call housekeeping to clean up the spill while the client remains in bed. 2. Call housekeeping to clean up the spill after assisting the client to the bathroom. 3. Clean up the spill while the client moves to the bathroom. 4. Clean up the spill while the nursing assistant assists the client. Answer: 1 Explanation: 1. Calling for housekeeping to clean up the spill before moving the client is correct because the nurse is practicing quality management by addressing a problem before it causes a crisis. Taking care of the client is the first priority, which leaves out cleaning up the spill. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) The nurse manager is planning unit orientation for new employees. Which must be considered? Select all that apply. Employee: 1. Cultural diversity 2. Generational differences 3. Socioeconomic status 4. Shifts assigned 5. Retirements on unit Answer: 1, 2 13) A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career to ensure long-term stability. Which specialty is most likely to grow in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing Answer: 3 Explanation: 3. As Baby Boomers age, geriatric nursing will be needed more than any other. No other areas have such a demand due to better health practices as people age and living longer. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) The nurse manager overhears staff discussing the shortage of nurses. The staff is misinformed if which statement is made? 1. There are more nurses retiring than are entering the profession. 2. The demand for nurses is declining because of fewer hospital admissions. 3. There are insufficient numbers of nursing faculty to teach interested students. 4. The number of women in nursing still outnumbers men and minorities. Answer: 2 Explanation: 2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. It is true that more are retiring than are entering (especially Baby Boomers), there are insufficient nursing faculty numbers, and women outnumber men and minorities in the profession. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application . 15) Place the steps of evidence-based practice in the correct order. 1. Evaluate the evidence. 2. Identify the clinical question. 3. Apply the evidence. 4. Evaluate the outcome. 5. Find the evidence to answer the question. Answer: 2, 5, 1, 3, 4 Explanation: This follows very closely with the nursing process. The nurse must know the question to be answered before beginning the search for the evidence with which to answer it. Nurses always evaluate an action once it is complete. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 16) A nurse practicing evidence-based nursing practice would rely on which to assist in addressing a clinical issue? 1. Intuition 2. Clinical experience 3. Formal knowledge 4. Scientific evidence Answer: 4 Explanation: 4. Evidence-based practice focuses on addressing issues based on a thorough review of the evidence, usually through scientific literature, to obtain the most useful and appropriate solution. The remaining options rely on other types of knowledge. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Which is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the Internet. Answer: 4 Explanation: 4. Ensuring adequate training by itself is not enough. Recognition for those willing is also an insufficient motivator. Asking for opinions will also do little to encourage its use. There must be training, easy access, and recognition for using evidence in nursing practice. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 18) Which technology will make nursing care at the bedside more efficient? Select all that apply. 1. Robotics 2. Electronic Health Record 3. Handheld Personal Data Assistants 4. Online Charting Answer: 1, 2, 3, 4 19) The nurse is trying to understand why an electronic health record is useful to the nurse in the workplace. Which is an accurate reason for using them? 1. To increase medical errors 2. To increase health care costs 3. To reduce redundancies 4. To decrease efficiency Answer: 3 Explanation: 3. Electronic health records (EHRs) can reduce redundancies by allowing a clientʹs complete record to be kept in one place, to be accessed by those who are treating the client. They reduce errors, decrease costs, and increase efficiency by having a complete record for use when needed. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) For a nurse working in a hospital using a robotics pharmacy system, which describes the advantage for nurses? 1. The nurse will be able to leave out some of the 6 rights since the robot checks the medications. 2. The nurse should get medications quicker since the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant since they have already been checked. 4. The nurse can expect that medication administration will be easier and with less potential for error. Answer: 2 Explanation: 2. Robots should be able to get medications to the floor more quickly. However, since there is still great room for error, the registered nurse will still have to complete the six rights of medication administration to ensure client safety. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Why must nurses be prepared to respond to a disaster? 1. Nurses must be ready to provide care in risky circumstances without the use of technology. 2. Nurses must be ready to provide care regardless of circumstances that may occur during a disaster. 3. Regardless of what occurs, nurses cannot have fear. 4. Nurses must practice so they make no mistakes during practice drills to eliminate mistakes during a disaster. Answer: 2 Explanation: 2. Nurses must be prepared to react during a disaster, but no amount of practice drills will eliminate fear or mistakes. Nursing Process: Planning Category of Client Need: Psychosocial Integrity Cognitive Level: Application 22) The most important aspect of training and practicing for disasters is: 1. Allowing each nurse to take the role with which they are comfortable. 2. Ensuring each nurse can take on all roles as they occur. 3. Addressing concerns of each participating nurse at each disaster exercise. 4. Making sure each nurse can react instinctively regardless of situation. Answer: 3 Explanation: 3. It is most important, as nurses have concerns and fears at each practice or simulation, that their fears be addressed to ensure nurses are more comfortable in the role as provider of emergency care. Each nurse needs to take responsibility for all roles, and not just those with which they are comfortable. In addition, it is more important that a nurse react with the clientʹs and their own safety in mind. Nursing Process: Implementation Category of Client Need: Psychosocial Integrity Cognitive Level: Application 23) The most important nursing diagnosis that must be considered when taking care of clients involved in a disaster is: 1. Caregiver Role Strain, Risk for 2. Nutrition, Less than Body Requirements 3. Pain, Acute 4. Tissue Integrity, Impaired Answer: 4 Explanation: 4. Tissue Integrity, Impaired is the priority nursing diagnosis among these options. Caregiver role strain and pain are considered ʺpsychosocialʺ in nature according to NCLEX standards. While nutrition is important to skin integrity and the ability to repair damage, impaired tissue integrity would take priority as this may lead to hypovolemia and shock, or infection and shock. The well-prepared nurse would be able to prioritize these. Diagnosis Category of Client Need: Psychosocial Integrity Cognitive Level: Application 24) There are procedural changes on the unit as a direct result of client satisfaction surveys. The person most strategically placed to handle how these changes are initiated is the: 1. Hospital administrator. 2. Nurse manager. 3. Client. 4. Chief executive officer. Answer: 2 Explanation: 2. The nurse manager is situated on the front lines but is also responsible to the upper management. The manager can be supportive of the feelings of the staff while at the same time adequately and appropriately representing the needs/wants of the administration. The client, CEO, and hospital administrator would not have enough information about the daily unit activities to be effective in instituting these changes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 25) Which aspects of nursing in todayʹs health care system must an effective nurse manager be aware of? Select all that apply. 1. Consistency 2. Decreasing resources 3. Adequate staffing 4. Increasing retirees 5. Complicated technology Answer: 2, 4, 5 Chapter 2 Designing Organizations 1) Using the classical organizational theory model, the most appropriate method for the nurse to voice concern over unfair client workload assignments would be to: 1. Invite the director of nursing to a unit meeting. 2. Organize a unit meeting to discuss the problem on all shifts. 3. Discuss the problem with the team leader and then the charge nurse/unit supervisor if the problem remains unsolved. 4. Circulate a petition to all staff seeking support for change in assignment policy. Answer: 3 Explanation:3. Classical theory provides a formal chain of command and system for communication. The other options would be inappropriate and not take into consideration the chain of command inherent in classical theory. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) Which is an example of staff authority in classical theory? 1. Nurse/mentor relationship 2. Nurse/team leader relationship 3. Nurse/shift supervisor relationship 4. Nurse/manager relationship Answer: 1 Explanation: 1. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The other relationships have line authority. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The management of a local hospital has decided to close a postsurgical unit in the hospital due to the nursing shortage. Of which organizational theory is this an example? 1. Chaos theory 2. Classical theory 3. Systems theory 4. Contingency theory Answer: 4 Explanation: 4. Contingency theorists believe organizational performance can be enhanced by matching an organizationʹs structure to its environment. The environment is made up of internal and external forces. The nursing shortage is an external force that impacts the environment and performance of the organization. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) Which statement indicates a nursing student is in need of more study time? 1. ʺChaos theorists believe change is inevitable.ʺ 2. ʺClassical theorists believe in organizational hierarchy.ʺ 3. ʺSystems theorists discuss outputs and inputs.ʺ 4. ʺContingency theorists believe the environment forces organizational change.ʺ Answer: 3 Explanation: 3. According to systems theory the ʺinputʺ or employees are imported from the environment. The work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the environment. The student neglected to include ʺthroughputʺ and the remaining choices are correct. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment 5) The nurse manager is determining placement for a client in need of medical and nursing care in an inpatient setting for less than 30 days. Which statement indicates the correct placement? 1. ʺThe client requires a long-term care facility.ʺ 2. ʺThis client requires a managed care organization.ʺ 3. ʺThis client needs an ambulatory care center.ʺ 4. ʺThis client needs a hospital.ʺ Answer: 4 Explanation:4. The American Hospital Association defines an acute care hospital as a facility in which the average length of stay is less than 30 days. The other choices are not appropriate as they are either for different length of stays or related to how the overall care is organized. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 6) During the nurseʹs interview for a new job, the health benefits are described as a group of health care providers in the local town who have agreed to provide treatment and health services for the clinic employees. This is an example of a (an): 1. PPO. 2. HMO. 3. POS. 4. SSI. Answer: 2 Explanation: 2. An HMO is a geographically organized system that provides an agreed -upon package of health maintenance and treatment services. A PPO is a managed care organization that contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security insurance. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 7) Which indicates a weakness of a functional structure in a long-term care facility? 1. All nursing tasks fall under the nursing department. 2. The dietary department is responsible for nutritional assessment. 3. Physical and occupational therapy coordinate and evaluate activities of daily living. 4. The nursing department is responsible for writing the care plan. Answer: 4 Explanation: 4. Nursing tasks falling under the nursing department, the dietary department being responsible for nutritional assessment, and physical and occupational therapy coordinating and evaluating activities of daily living all reflect a functional structure in which individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a care plan without input from other departments while the other options relay stand- alone tasks with little required input from other departments. Nursing Process: Planning 8) A nurse practitioner collaborating with physicians and as a general business partner to provide needed services is an example of which diversification method? 1. Joint venture 2. Conglomerate diversification 3. Concentric diversification 4. Capitation Answer: 1 Explanation: 1. A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service. Conglomerate diversification is the expansion into areas that differ from the original service. Concentric diversification is expansion of services into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) In planning for discharge of a client needing follow-up for diabetic education, the nurse should contact a: 1. Long-term care facility. 2. Home health agency. 3. Temporary service agency. 4. Public health department. Answer: 2 Explanation: 2. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities are used for rehabilitation and care needed for extended periods of time. Temporary service agencies are used to provide health care agencies with professional and nonprofessional personnel when they are short staffed. The public health department focus is usually community health and not individual primary care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) A nurse manager who encourages the nursing staff members to assist in developing a new creative staffing pattern in response to recent resignations and people going back to school subscribes to what organizational theory? 1. Neoclassical theory 2. Systems theory 3. Chaos theory 4. Classical theory Answer: 3 Explanation: 3. Chaos theory proposes an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which statement indicates a reason why the parallel structure in hospitals is being used less frequently? 1. Parallel structure causes complex relationships. 2. Newer models of organizational structure exist. 3. Parallel structure creates two lines of authority. 4. Parallel structure calls for increased authority of medical staff. Answer: 3 Explanation: 3. Parallel structure exists when there are two lines of authority in an organization. Due to new models of organizational structure, medical staff may have less direct authority and may be included as staff members and adhere to hospital policy. The staff relationships are then less complex. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) Which structure is reflected by the statement ʺnursing practice is best determined by nursesʺ? 1. Heterarchy structure 2. Shared governance 3. Strategic planning 4. Matrix structure Answer: 2 Explanation: 2. Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered. Heterarchy structure is a relational design based on the concept of connections. Planning is an activity that projects the organizationʹs goals and actions into the future. Matrix structure combines functional structure and product structure into one overlapping structure. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) ʺWe want to be the hospital of choice in the Midwestʺ is which type of statement? 1. Mission statement 2. Vision statement 3. Value statement 4. Philosophy statement Answer: 1 Explanation: 1. The mission statement is a broad statement of the organizationʹs reason for existence. A vision statement describes the goal to which the organization aspires. The value statement is the beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the organizationʹs values, vision, and mission. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) What is the best example of a pediatric unitʹs organizational culture? 1. All client rooms are private. 2. Nurse-to-client ratio is 4 to 1. 3. Nurses wear colorful scrubs. 4. Primary nursing model is used for care. Answer: 3 Explanation: 3. Organizational culture is based on norms and traditions such as nurses wearing colorful attire. Organizational climate is based on physical attributes and policy and procedure. Private rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of organizational climate. Nursing Process: Implementation 15) Which are the traditional organizational structures? Select all that apply. 1. Heterarchical 2. Hybrid 3. Matrix 4. Hierarchical 5. Classical 6. Chaos Answer: 1, 2, 3 16) Students are trying to learn organizational structures. Which statement indicates more studying time is needed? 1. ʺSelf-organizing is a part of relationship organizing structures.ʺ 2. ʺShared governance believes all professions should share governance of others.ʺ 3. ʺHeterarchical structures are based on the connectedness between individuals.ʺ 4. ʺThe parallel structure exists only in health care organizations.ʺ Answer: 2 Explanation: 2. Shared governance is a type of structure in which the members of one profession govern that profession. Governance is not shared with other professions. The other options are correct statements and thus not the correct answer. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 17) Which portion of strategic planning is indicated by the statement: ʺThe nursing department will increase client satisfaction scores by 20% by Juneʺ? 1. Mission 2. Objective 3. Goal 4. Value Answer: 2 Explanation: 2. The objective statement is specific to each unit or department within the organization. Objectives specify how each department will meet the goals set for the entire organization. The goal statement applies to the entire organization, as does the mission statement. Nursing Process: Implementation Safe, Effective Learning Environment Cognitive Level: Application 18) Which indicate the purpose of strategic planning? Select all that apply. 1. Identify external strengths. 2. Identify external weaknesses. 3. Recognize potential changes. 4. Evaluate goals, objectives, and activities. 5. Determine the market position of competitors. 6. Determine market position once yearly. Answer: 1, 3, 4, 6 19) Which of the following statements represents an organizationʹs philosophy? 1. ʺWe will increase client satisfaction by 15%.ʺ 2. ʺWe will increase productivity by 10% on the 2nd floor.ʺ 3. ʺWe believe clients are most important.ʺ 4. ʺWe believe in honest communication.ʺ Answer: 3 Explanation: 3. The philosophy is a statement of beliefs held by the organization; values are specific aspects of personal relationships or specific situations; the vision statement is the overall outcome desired by the organization; the mission is the reason the organization exists. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 20) The house supervisor is instructing new nurse managers on positive managerial skills. Teaching has been effective if the house supervisor hears which comment? 1. ʺThere is no way I am leaving my door open for the staff to come in whenever.ʺ 2. ʺI expect my staff to be on time every day to work, without exceptions.ʺ 3. ʺI will help my staff whenever they might need an extra hand with something.ʺ 4. ʺI wonʹt call in my on-call person until I absolutely have no other choice. Answer: 3 Explanation: 3. Offering assistance when needed helps raise morale and foster a positive work environment. This in turn will affect the overall success of the organization. The others do not and would require further instruction. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Which are aspects of a positive organizational environment? Select all that apply. 1. Resonant leaders 2. Environmental dissonance 3. Client advocacy 4. Open communication 5. Staff recognition Answer: 1, 3, 4, 5 22) Which constitutes organizational culture? 1. All nurses know to take turns covering each otherʹs clients to facilitate eating breakfast and lunch on day shift. 2. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 3. The cafeteria opens at 0700 for breakfast, 1100 for lunch, and 1700 for dinner. 4. Every Friday the administrator allows everyone to wear crazy hats while on the units. Answer: 1 Explanation: 1. The unspoken rules of the organization make up the culture. Thus, nurses covering for each other is the appropriate option. The other options are part of the organizational environment. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 23) Why would a health care organization want to become a magnet hospital? Select all that apply. 1. To improve nurse recruitment 2. To foster ability to retain physicians 3. To attain higher client satisfaction 4. To broaden the use of evidence-based practice Answer: 1, 2, 3, 4 24) Organizations must apply for magnet status through which organization? 1. American Nurses Credentialing Center 2. American National Credentials Commission 3. Joint Commission for the Accreditation of Healthcare Organizations 4. Joint Credentialing Association for Healthcare Organizations Answer: 1 Explanation: 1. The American Nurses Credentialing Center awards magnet status after the organization applies for, and is accepted for the award. The American National Credentials Commission and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint Commission for the Accreditation of Healthcare Organizations is the agency that accredits hospitals. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 25) The organization that awards magnet status would look for environments in which: 1. Nurses are involved in decision making. 2. Rewards are given to those with money-saving ideas. 3. Decisions are made and then followed. 4. Nurses do not have to work overtime. Answer: 1 Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses becoming involved in decision making would fall under these attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients; demanding that all decisions are followed does not foster autonomy and independence; overtime is sometimes a necessity to ensure clients have quality care that is documented and completed by the end of the shift. Chapter 3 Delivering Nursing Care 1) Which statement describes functional nursing? 1. One nurse has responsibility for all the needs for three clients. 2. One nurse has responsibility for all the medications on the unit. 3. One nurse and one nursing assistant have responsibility for ten clients. 4. One charge nurse and one respiratory therapist have responsibility for all clients. Answer: 2 Explanation: 2. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. Total patient care is given by one nurse assigned to a few clients. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) Which has affected change in nursing care delivery systems? 1. Increased acute care client days 2. Decreased acuity level of clients 3. Availability of registered nurses 4. Enhanced hospital revenues Answer: 3 Explanation: 3. The availability of nurses has historically affected the method of client care delivery. Nursing shortages have required nurses to be creative in caring for clients. Increased acute care days, decreased acuity, and enhanced hospital revenues are incorrect because client days have decreased, acuity levels have increased, and hospital revenues have been challenged. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 3) The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy with physician visits and new client orders and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for one of the clients. What type of nursing care delivery system is in place in this hospital? 1. Total patient care 2. Functional nursing 3. Team nursing 4. Critical pathways Answer: 3 Explanation: 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. Total patient care is given by one nurse. Functional nursing breaks down the assignments into tasks. Critical pathways are a set of strategies used by health care providers to attain expected outcomes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) As the RN team leader, identify all potential disadvantages of using team nursing to deliver care to the assigned clients. Select all that apply. 1. Delegation/accountability 2. Client/staff communication 3. Cost savings/staffing 4. Continuity of care Answer: 1, 2, 4 5) Which has historically been the most the most successful client care delivery system in intensive care units? 1. Team nursing 2. Total patient care 3. Functional nursing 4. Modular nursing Answer: 2 Explanation: 2. In total patient care, one nurse cares for a client and can give continuous, holistic, and expert nursing care, being totally accountable for the client. Team nursing, functional nursing, and modular nursing have the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) Which describes the difference between total patient care and primary nursing? 1. One RN is accountable for the nursing care of one client for the duration of the hospital stay. 2. The fewest number of nurses are assigned to one client during the hospital stay. 3. One RN communicates with the physician and family members of the client. 4. One RN completes all tasks related to the care required by the client. Answer: 1 Explanation: 1. In primary nursing a single nurse is responsible for the client for the entire hospital stay. This is not so in total patient care. The remaining answers accurately describe both total patient care and primary nursing. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) Which is an ideal nursing care delivery system for a new RN graduate? 1. Functional nursing 2. Primary nursing 3. Total nursing care 4. Practice partnerships Answer: 4 Explanation: 4. Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN. Functional nursing, primary nursing, and total nursing care have the RN working more autonomously. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) In order to organize services needed to achieve specific client outcomes, the hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Primary nursing 3. Case management 4. Differentiated practice Answer: 3 Explanation: 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. Functional nursing, primary nursing, and differentiated practice do not focus on specific outcomes. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) The RN working on an orthopedic unit has a postoperative client with a hip replacement who is not transferring well from bed to chair and has fallen behind on the mobility training program. Which is the nurseʹs priority action? 1. Page the surgeon. 2. Contact the family to discuss pre-op mobility problems. 3. Instruct physical therapy to increase treatments to QID. 4. Inform the case manager of variance in critical pathway. Answer: 4 Explanation: 4. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. Paging the surgeon or contacting the family is not the first step. Ordering an increase in physical therapy is not within the scope of nursing. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) Hospital X is concerned about the low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Functional nursing 2. Total patient care 3. Patient-centered nursing 4. Team nursing Answer: 3 Explanation: 3. The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control. Functional nursing is cost effective but lacks continuity of care. Total patient care is costly and less efficient for nursing staff. Team nursing is cost efficient but may lack continuity of care, which can cause client dissatisfaction. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 11) Which indicates the new graduate nurse understands why it is necessary to structure nursing care? Select all that apply. 1. Coordinate care to a group of clients. 2. Organize responsibilities. 3. Ensure the staff leaves on time. 4. Improve physician efficiency. 5. Cluster care to allow rest periods. 6. Provide skilled care by skilled staff. Answer: 1, 2, 5, 6 12) Which is the most important consideration in choosing a structure for nursing care? 1. Cost 2. Timeliness 3. Client need 4. Efficiency Answer: 3 Explanation: 3. While all four options are important, client need takes precedence over the others because nursing provides a service to the client. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which indicates a teaching about different models of nursing care delivery systems has been unsuccessful? The models that exist are: 1. Total patient care. 2. Integrated care. 3. Hospital care. 4. Patient-centered care. Answer: 3 Explanation: 3. The hospital care delivery system does not exist. There is a 12-bed hospital model in use in Miami. All the others are correct. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) Which indicates the primary reason for the addition of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decision making is best made by nursing leaders for all units within that particular hospital. 3. Those nurses working in particular service area are best suited to make decisions for the clients in that area. 4. Clinical decision making is best made by the clients who are served by a particular unit. Answer: 1 Explanation: 1. The clinical microsystem method began to allow those who are involved in a particular unit make the decisions for that unit. The other options are not correct as they do not describe decision making by those on the ʺfront linesʺ on a particular unit. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) The newest delivery systems are organized around: Select all that apply. 1. Caring for older clients. 2. Giving care to pediatric clients. 3. Home care clients. 4. Smaller ʺunits within units.ʺ 5. Different populations. Answer: 1, 3, 4, 5 16) Regardless of which delivery system or combination of delivery systems is appropriate, which describes a skill required for effective use? 1. Strict adherence 2. Flexibility 3. Resistance to change 4. Persistence Answer: 2 Explanation: 2. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs, the organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to have the desired effects. Thus, strict adherence, resistance to change, and persistence are not correct. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 4 Leading, Managing, and Following 1) If a nurse is working in a department with several less-experienced nurses, which attribute should this nurse possess if the leadership is to be perceived as effective? 1. Accountability 2. Authority 3. Efficiency 4. Vision Answer: 4 Explanation: 4. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. The other three skills and characteristics are necessary for good nursing management, but are not essential for a nurse leader. A leader may have no formal accountability or authority. A leader is not necessarily a good manager and may not be efficient. Nursing Process: Assessment Safe, Effective Care Management Cognitive Level: Application 2) How are leaders formed according to behavioral theorists? Select all that apply. 1. Education 2. Experience 3. Traits 4. Training Answer: 1, 2, 4 3) The nurse manager of the childbirth center has been instructed to implement a cost savings plan by downsizing nonprofessional staff. Which is the most important task for the manager? 1. Reorganize workload and assign tasks. 2. Inspire staff to commit to the organization goals. 3. Evaluate outcomes and report to the administration. 4. Plan transitional activities. Answer: 2 Explanation: 2. A manager is hired to implement tasks to meet the organizational needs. In order to best change behaviors, the manager must convince the staff of the value of the organizational goal. All other answers are correct, but are not most important. After the staff buys into the goals, the manager can plan activities, implement the plan, and evaluate the outcomes. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A 58-year-old client has been admitted to CCU with a myocardial infarction. The client suddenly goes into cardiac arrest and team members rush into the room. What type of nurse leadership style would be best in this situation? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Bureaucratic Answer: 1 Explanation: 1. The autocratic leader makes all the decisions and has the authority. This would be the most effective type of leadership in a code situation. The other leadership styles would be ineffective in an emergency situation. Nursing Process: Implementation 5) A nursing faculty member is mentoring a graduate student in writing a thesis. Which type of leadership would be best in this situation? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Bureaucratic Answer: 2 Explanation: 2. The democratic leader assumes the individual is motivated by internal drive and wants active participation in getting the task done. The leader/follower participates in achieving the goal. The autocratic leader makes all the decisions. The laissez-faire leader gives no direction. The bureaucratic leader does not trust the follower and makes decisions based on the organizational policies. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 6) The nurse has scheduled a vacation to attend a resort with the family over the childrenʹs spring break. There is a flu epidemic and over 60% of the staff is unavailable to work. The nurse manager cancels all scheduled vacation and requires all staff to work the week of spring break. Using the managerial grid as a model, what type of management decision was made? 1. Country club 1,9 2. Team 9,9 3. Impoverished 1,1 4. Authority compliance 9,1 Answer: 4 Explanation: 4. Authority compliance has the highest regard for the work at hand and the lowest regard for the human elements. The opposite would be country club, in which the relationships between people are higher than the regard for work. The team style has high regard for both task and people. Impoverished decisions lack concern for the task and the people. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 7) The nurse manager is planning the holiday schedule for the staff on the oncology unit. The staff is highly experienced and has worked well together for over five years. Using situational leadership theory, which is the most effective leadership style for this management decision? 1. Telling 2. Selling 3. Participating 4. Delegating Answer: 3 Explanation: 3. The nurse manager could ask the staff for input and assistance in making the holiday schedule, keeping the final implementation to himself. The task is relatively low-end and the relationship is high-end supportive. The staff may not react well to a schedule presented with a telling style. A selling style may need to be used if the manager makes and implements an unpopular schedule. Delegating the holiday schedule could be a risky choice. The manager would be leaving responsibility for the decision and the implementation up to the staff. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 8) If a situation develops on a unit and the nurse manager has a meeting to discuss the necessary outcomes, and then asks for the group to discuss possible ways to achieve the outcome, which type of leadership is this? 1. Quantum 2. Contemporary 3. Contingency 4. Behavioral Answer: 1 Explanation: 1. Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. Quantum leadership is one type of contemporary theory and is not related to contingency or behavioral theory. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 9) Which statement is most likely made by a transactional leader? 1. ʺIf you work overtime tonight I will authorize double your hourly pay rate.ʺ 2. ʺJanʹs mother is ill. Is anyone able to cover her shift tonight?ʺ 3. ʺHow can we work together to cover Janʹs shifts until her mother is better?ʺ 4. ʺI can work an extra shift tomorrow night. Who can cover tonight?ʺ Answer: 1 Explanation: 1. Transactional leadership is based on the principles of social exchange theory. There is an exchange process between leaders and followers. The other three answers are examples of statements made by a transformational leader. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 10) What is the focus of transactional leadership? 1. Interpersonal relationships 2. Benefits and rewards 3. Common goals 4. Pursuit of higher values Answer: 2 Explanation: 2. In the transactional exchange process between leaders and followers, the focus is on benefits and rewards. The other three answers are examples of the focus of transformational leadership. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 11) The nurse manager in a long-term care facility wants to develop a unique plan of care for each client. The nurse invites representatives from dietary, physical therapy, social work, and nursing to attend a meeting to plan the care together. This nurse manager is demonstrating what type of leadership? 1. Transactional 2. Charismatic 3. Transformational 4. Relational Answer: 4 Explanation: 4. A relational leader has skills that create interconnections between caregivers and empowers nursing staff and interdisciplinary colleagues. The nurse manager may also be a transactional, charismatic, or transformational leader, but this example describes the interdisciplinary approach to leadership and client care. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 12) What is the most common skill effective nurse leaders share in any leadership theory or leadership model? 1. Political knowledge 2. Communication 3. Critical care experience 4. Informal power Answer: 2 Explanation: 2. Communication skills are the most important for an effective leader. Regardless of the type of leader or the type of unit a nurse manages, communication is the key to effective leadership. An effective leader may also have political knowledge or informal power. Critical care experience is not necessary for effective leadership. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 13) Which accurately describes shared governance? 1. Nurses working in groups managing themselves 2. Two nurses sharing the management role 3. Nursing leadership originating from a desire to serve and share 4. Nurses formally organized to make decisions regarding practice standards Answer: 4 Explanation: 4. Shared governance is a formal process. Decision making is done by designated nurse representatives. The other answers are incorrect definitions of shared governance. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 14) The hospital has developed a plan for an internal float pool of nurses to address the problem of increasing costs of staffing agencies. The float pool will be used when scheduled staff nurses call in sick for their shift. What type of planning has the administrative staff done? 1. Strategic 2. Contingency 3. Organizational 4. Directive Answer: 2 Explanation: 2. Contingency planning is a proactive response to problems that may interfere with getting work done. Strategic planning is prioritizing long-term goals. Organizing and directing are related to planning to get the work done. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 15) What is the most important role/task of nurse managers? 1. Strategic planning 2. Staff development 3. Fiscal resource management 4. Client care accountability Answer: 4 Explanation: 4. Although the nurse manager has a variety of roles and tasks, the most important role of nursing management is to assure quality client care. The nurse manager is accountable for quality care. The other answers are also tasks and roles of the nurse manager, but are secondary to quality care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 16) Which level of management is responsible for shift-by-shift coordination and promotion of quality client care? 1. Charge nurse 2. First level 3. Middle level 4. Upper level Answer: 1 Explanation: 1. The charge nurse is unique to the health care setting. A staff nurse is in charge shift by shift and accountable to the first-level manager. The first-, middle-, and upper-level managers are accountable for quality care 24 hours a day. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 17) The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, ʺI donʹt care how long I am a nurse, I will never be a manager.ʺ Which ways do nurses manage regardless of their official role? Select all that apply. 1. Delegation responsibilities 2. Coordination of client care 3. Working with the budget 4. Deciding on priorities 5. Being a liaison Answer: 1, 2, 4, 5 18) Which explains why nurses must be leaders to be successful in client care? 1. Nurses must be effective at giving orders. 2. Nurses must direct client care activities to reach outcomes. 3. Only nurses as leaders have physician respect. 4. Only nurses as leaders can function in managed care. Answer: 2 Explanation: 2. Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion. Nurses do not give ʺorders,ʺ and do not have to be leaders to be respected or work in managed care. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 19) Which is a difference between nurses as leaders and nurses as managers? 1. Leaders focus on a specific goal and managers focus on multiple goals. 2. Good leaders are always good managers, but managers are not always good leaders. 3. Leaders have good interpersonal skills while nurses as managers do not. 4. Nurses as leaders are born and nurses as managers is a learned skill. Answer: 1 Explanation: 1. Leaders focus on one specific goal and use interpersonal skills to bring others towards the goal. Managers focus on the many goals of the organization. Good managers are good leaders, but not necessarily the other way around. Both leaders and managers may have good interpersonal skills, but do not have to. Both leaders and managers can learn new skills to become effective as either or both. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 20) Which statement indicates further teaching is required? 1. ʺI think managers make it easier to see whatʹs expected.ʺ 2. ʺI know my manager is required to review my performance.ʺ 3. ʺManagers cannot affect motivation; it comes from within.ʺ 4. ʺI know if I have a problem with a client, I can go to him.ʺ Answer: 3 Explanation: 3. Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 21) Which indicates leadership or management positions in an organization with legitimate authority? Select all that apply. 1. Formal leaders 2. Informal leaders 3. Nurse managers 4. Staff nurse Answer: 1, 2, 3, 4 22) Why must leaders have followers? 1. Leaders must have followers to ensure there are enough people to get the work done by the deadline. 2. Leaders must have followers in order to make sure the activities are appropriate to get to the goal. 3. Leaders can only be leaders if they have followers to carry out their orders. 4. Leaders can only be effective in the role if there are followers who perceive the leader to be worth following. Answer: 4 Explanation: 4. Leaders cannot lead if there is no one to follow them. The other options are not true statements about the relationship between leaders and followers. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 23) In what ways can a leader also be a follower? Select all that apply. 1. The charge nurse can lead other staff nurses but also follow the house supervisor. 2. The staff nurse can lead other staff nurses but also follow another staff nurse. 3. The CEO can lead other administrators, but also follow the Board of Directors. 4. Nurses can lead some clients, but follow others. Answer: 1, 2, 3, 4 24) In a leadership training class, which statement indicates learning has been successful? 1. ʺRelationship building is essential to be successful in leadership.ʺ 2. ʺIf I am to be successful in leadership, I should make sure no followers are friends.ʺ 3. ʺLeadership means I do can delegate tasks I do not want to do.ʺ 4. ʺMost people would not be able to tell if I only act interested in them.ʺ Answer: 1 Explanation: 1. Authentic caring in relationships is an important method of improving respect and competence as a leader. Although the leader can show no favoritism, leaders can have friends. Authentic leaders are willing to take risks and are not afraid to do any task. Nursing Process: Evaluation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application Chapter 5 Initiating and Implementing Change 1) A new chairperson of the nursing department has been appointed and plans to institute new programs for faculty development with a focus on innovative teaching strategies. According to Lewin, which is the first step in initiating this plan? 1. Ask staff to assist in the development of a plan for implementing new teaching strategies. 2. Include the staff in actively participating in the identification of problems related to teaching strategies. 3. Implement interventions to improve the teaching strategies currently used. 4. Reinforce the efforts of faculty as they begin to use new teaching strategies. Answer: 2 Explanation: 2. The first step is to unfreeze the existing equilibrium by asking staff to become a part of the process of change, particularly in the first phase. Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. Implementing interventions is incorrect because interventions cannot be made until the problem has been identified and a plan has been developed. Reinforcing the efforts of faculty is incorrect because reinforcement of new patterns of behavior is the last phase of change. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 2) The nursing supervisor identified ineffective communication as a problem among the managers. According to Lippittʹs Phases of Change, which is the final stage of the improving this problem? 1. Develop the action and evaluation plan. 2. Determine the role of the change agent. 3. Communicate often to maintain the change. 4. Withdraw from the role of change agent gradually. Answer: 4 Explanation: 4. According to Lippittʹs Phases of Change, the final stage is terminating the helping relationship. Developing the action and evaluation plan is incorrect because an action and evaluation plan are developed with the assistance of the change agent. Determining the role of the change agent is incorrect because the role of the change agent must be determined early in the process of change. Communicating often is incorrect because communication is vital throughout the whole process of change. Nursing Process: Implementation Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 3) The nurse manager is planning to initiate new policies in the department. According to Havelockʹs Model, which behavior is characteristic of the moving stage? 1. Resources are acquired to facilitate change. 2. Solutions are identified to create change. 3. Relationships are formed among all participants. 4. Self-renewal among all participants occurs. Answer: 2 Explanation: 2. Choosing a solution and gaining acceptance occurs during the moving stage of change. Acquiring resources is incorrect because acquiring resources and diagnosing the problem occur during the unfreezing stage. Forming relationships is incorrect because building relationships occurs during the unfreezing stage. Self-renewal is incorrect because self-renewal and stabilization occur during the final or refreezing stage of change. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 4) A new IV pump has just been purchased by the facility. According to Rogers, which is the first step in introducing this new pump to the staff? 1. Introducing the decision-making unit to the innovation 2. Seeking reinforcement that the decision to make an innovation is correct 3. Deciding to adopt or reject the innovation 4. Forming a favorable or unfavorable attitude toward the innovation Answer: 1 Explanation: 1. The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained. Seeking reinforcement is incorrect because seeking reinforcement or confirmation that the decision to make an innovation is appropriate is the final step. Deciding to adopt or reject is incorrect because the decision to adopt or reject an innovation occurs after the knowledge and persuasion steps. Forming a favorable or unfavorable attitude is incorrect because the second step involves persuasion, which occurs when a favorable or unfavorable attitude toward an innovation forms. Nursing Process: Planning Category of Client Need: Safe, Effective Care Environment Cognitive Level: Application 5) Which step is critical for change to be initiated? 1. Data collection and analysis 2. Minimize anxiety about the change 3. Develop operational indicators of success 4. Make people uncomfortable with status quo Answer: 1 Explanation: 1. Emphasis is placed on the assessment phase of change, particularly data collection and analysis of the issue. Minimizing anxiety is incorrect because once the proposed change is introduced, the change agent will attempt to minimize anxiety. Developing indicators is incorrect because operational indicators of success are developed once the planning phase is near completion. Making people comfortable is incorrect because planting the seeds of discontent about the status quo occurs after the problem has been assessed. Nursing Process: Assessment Category of Client Need: Safe, Effective Care Environment Cognitive Level: Comprehension 6) Which strategy is most accurate about creating effective change? 1. Providing information addresses the motivation to change 2. Educating people opposed to change creates new opinions 3. Disseminating information is a prerequisite to change 4. Terminating people opposed to the idea of change if necessary Answer: 3 Explanationl:3. Providing information is a prerequisite to change implementation, but is inadequate unless lack of information is the only obstacle to effecting change. Providing information is incorrect because although providing information is a prerequisite to change, it does not address the motivation to change. Educating people opposed to change is incorrect because some people are vested in their opinions and may remain resistant to change regardless of how well informed they are. Terminating people is incorrect because people who refuse to consider change may be transferred to another department within the organization. Others may gradually open themselves to the idea of change once the plan has been implemented. Nursing Process: Imple