C HAPTER 25: P ROBLEM E MPLOYEES :
R ULE B REAKERS , M ARGINAL E MPLOYEES ,
AND THE C HEMICALLY OR
P SYCHOLOGICALLY I MPAIRED
1. A nurse is uncharacteristicall y extroverted on today’s shift, with an
unsteady gait. The manager suspects that the nurse may be chemicall y
impaired. What is the manager’s most appropriate action?
a. Document this finding and communicate with the personnel
department.
b. Monitor the nurse’s behavior closel y for the remainder of the shift.
c. Promptl y confront the nurse to discuss this suspicion.
d. Ask the oth er nurses and staff members on the unit if they have
noticed the same thing.
ANS: C
Feedback:
For safet y reasons and to protect clients, employees should be
confronted as soon as possible after chemical impairment is
recognized. Delaying could be unsa fe for clients. The manager has a
responsibilit y to collect data, but this should not take precedence if the
nurse is impaired at this point in time.
, PTS: 1 DIF: Moderate REF: Page: 707 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 25: Title:
Confronting the Chemicall y Impaired Employee KEY:
Integrated Process: Nursing Process BLM: Cognitive Level:
Appl y NOT: Multiple Choice
2. A manager is preparing to confront an employee regarding suspected
chemical impairment. What response should the manager anticipate?
a. Emphatic denial and defensiveness
b. Reluctant acceptance
c. Gratefulness for finall y being discovered
d. Silence
ANS: A
Feedback:
Employee denial and defensiveness are the most common behaviors in
those who are confronted with their impairment, even though the other
responses are possibilities.
PTS: 1 DIF: Easy REF: Page: 707 OBJ: 11 NAT:
Client Needs: Safe and Effective Care Environment: Management
of Care TOP: Chapter Number: 25: Title: Confro nting the
Chemicall y Impaired Employee KEY: Integrated Process:
Nursing Process BLM: Cognitive Level: Understand NOT:
Multiple Choice
, 3. The nurse-manager is contributing to the plan for the workplace reentry of
an employee with a history of substance use disorder. What should be
included in the reentry plan?
a. The nurse should have a 50% work assignment for the first several
months.
b. Clients and families should be made aware of the nurse’s history.
c. Reentry should not occur until the nurse has been chemical -free for
at least 18 months.
d. The employee should agree to random urine screening.
ANS: D
Feedback:
Most nurses successfull y return to work following a treatment program,
and this generall y takes 1 year. Often, the conditions that the employee
has successfull y changed his or her lifestyle and will submit to random
drug tests must be met before the employee can be allowed to return to
work. Informing clients of the nurse’s history would violate the nurse’s
right to confidentiality. A reduced work assignmen t is not t ypicall y
required.
PTS: 1 DIF: Moderate REF: Page: 712 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 25: Title: The
Chemicall y Impaired Employee's Reentry to the Workplace
KEY: Integrated Process: Nursing Process BLM:
Cognitive Level: Appl y NOT: Multiple Choice
4. What consideration should the nurse -manager prioritize when creating a
R ULE B REAKERS , M ARGINAL E MPLOYEES ,
AND THE C HEMICALLY OR
P SYCHOLOGICALLY I MPAIRED
1. A nurse is uncharacteristicall y extroverted on today’s shift, with an
unsteady gait. The manager suspects that the nurse may be chemicall y
impaired. What is the manager’s most appropriate action?
a. Document this finding and communicate with the personnel
department.
b. Monitor the nurse’s behavior closel y for the remainder of the shift.
c. Promptl y confront the nurse to discuss this suspicion.
d. Ask the oth er nurses and staff members on the unit if they have
noticed the same thing.
ANS: C
Feedback:
For safet y reasons and to protect clients, employees should be
confronted as soon as possible after chemical impairment is
recognized. Delaying could be unsa fe for clients. The manager has a
responsibilit y to collect data, but this should not take precedence if the
nurse is impaired at this point in time.
, PTS: 1 DIF: Moderate REF: Page: 707 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 25: Title:
Confronting the Chemicall y Impaired Employee KEY:
Integrated Process: Nursing Process BLM: Cognitive Level:
Appl y NOT: Multiple Choice
2. A manager is preparing to confront an employee regarding suspected
chemical impairment. What response should the manager anticipate?
a. Emphatic denial and defensiveness
b. Reluctant acceptance
c. Gratefulness for finall y being discovered
d. Silence
ANS: A
Feedback:
Employee denial and defensiveness are the most common behaviors in
those who are confronted with their impairment, even though the other
responses are possibilities.
PTS: 1 DIF: Easy REF: Page: 707 OBJ: 11 NAT:
Client Needs: Safe and Effective Care Environment: Management
of Care TOP: Chapter Number: 25: Title: Confro nting the
Chemicall y Impaired Employee KEY: Integrated Process:
Nursing Process BLM: Cognitive Level: Understand NOT:
Multiple Choice
, 3. The nurse-manager is contributing to the plan for the workplace reentry of
an employee with a history of substance use disorder. What should be
included in the reentry plan?
a. The nurse should have a 50% work assignment for the first several
months.
b. Clients and families should be made aware of the nurse’s history.
c. Reentry should not occur until the nurse has been chemical -free for
at least 18 months.
d. The employee should agree to random urine screening.
ANS: D
Feedback:
Most nurses successfull y return to work following a treatment program,
and this generall y takes 1 year. Often, the conditions that the employee
has successfull y changed his or her lifestyle and will submit to random
drug tests must be met before the employee can be allowed to return to
work. Informing clients of the nurse’s history would violate the nurse’s
right to confidentiality. A reduced work assignmen t is not t ypicall y
required.
PTS: 1 DIF: Moderate REF: Page: 712 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 25: Title: The
Chemicall y Impaired Employee's Reentry to the Workplace
KEY: Integrated Process: Nursing Process BLM:
Cognitive Level: Appl y NOT: Multiple Choice
4. What consideration should the nurse -manager prioritize when creating a
