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Exam 1: Leading, Managing, and Following

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Question 1

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

A) Leadership
B) Management
C) Decision making
D) Vision

E) All of the above
F) B) and D)

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Question 2

Multiple Choice

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

A) Arrange another meeting in a week's time so as to allow a cooling-off period.
B) Elevate the next negation session to the next manager, one level above.
C) Insist that participants continue to talk until a resolution has been reached.
D) Back the unit manager's actions and end the dispute.

E) A) and D)
F) None of the above

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Question 3

Multiple Choice

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

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

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

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

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

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults.She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient.Using complexity principles,what would be the best approach to take for implementation of this change?

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

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

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

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

As the RN charge nurse on the night shift in a small long-term care facility,you've found that there is little turnover among your LPN and nursing assistant (NA) staff members,but they are not very motivated to go beyond their job descriptions in their work.Which of the following strategies might motivate the staff and lead to greater job satisfaction?

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

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

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

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

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

A family is keeping vigil at a critically ill patient's bedside.Distant family members call the unit continuously asking for updates and expressing concern.The nurse speaks with the distant family members and states she is referring them to the hospital social worker,whose role is to work with family in this situation.What role is the nurse assuming through this action?

A staff nurse has been recently promoted to unit manager.During the time on the unit,the nurse formed a strong social network among staff,has promoted the development of relationships between staff and workers in other areas of the organization,and has formed relationships that generate ideas from patient organizations and the local nursing education program.According to complexity theory,what principle is being engaged?