Exam 3 (Ch 8, 9, 10)

1. Which of the following is a positive side to conflict?

A. Identifying roadblocks to progress

B. Alleviation of stress symptoms

C. Recognition of the differences in individuals

D. Development of constructive methods of communication

D. Development of constructive methods of communication

Which of the following is an example of a relationship conflict?

A. A registered nurse (RN) who reports to the nurse manager that another staff member has refused an assignment

B. A discussion of how current policies restrict implementing evidence-based practice

C. A disagreement about continuity of care for high acuity patients

D. An issue with tardiness that is being handled through the creation of new policies

A. A registered nurse (RN) who reports to the nurse manager that another staff member has refused an assignment

Which of the following most accurately describes bullying?

A. Bullying involves an individual becoming overly demanding over another.

B. Bullying involves an individual trying to exert power over another.

C. Bullying only occurs laterally.

D. Bullies often have multiple targets.

B. Bullying involves an individual trying to exert power over another.

Which of the following is a cause of work intensification?

A. Inequities in care delivery

B. Physicians disregarding input from other team members

C. Behaviors intended to exert power over others

D. Emphasis on cost reduction

D. Emphasis on cost reduction

5. An RN is caring for a 93-year-old patient who has a living will, but whose children have decided their parent should be a full code. The patient has coded twice. The other staff members do not seem to have any issues with the situation, but the RN feels distressed. Which of the following best describes this source of conflict?

A. Scarcity, safety, and security

B. Competition between groups

C. Ethical conflict

D. Cultural differences

C. Ethical conflict

Which of the following is true regarding conflict resolution?

A. The purpose of conflict resolution is to improve team efficiency.

B. Compromise is the intent of conflict resolution.

C. If one side wins, the other side loses.

D. When a full-blown conflict occurs, problem-solving is necessary.

A. The purpose of conflict resolution is to improve team efficiency.

Which of the following is a reason why it can be difficult to get to the bottom of an issue?

A. Issues are emotionally charged.

B. Listening carefully will make what other people are saying clear.

C. Sometimes the parties involved are uncertain about what the problem really is.

D. A clearly defined scope of practice may be missing.

C. Sometimes the parties involved are uncertain about what the problem really is.

Which of the following is a good recommendation to assist a team to generate possible solutions?

A. Discuss solutions that have worked in the past.

B. Brainstorm individually and then discuss possible solutions.

C. Generate new ideas and then define the problem.

D. Ensure individual solutions take priority.

B. Brainstorm individually and then discuss possible solutions.

Which of the following correctly describes a step in the problem-solving process?

A. Assessment requires patience to determine if a solution may be workable.

B. Evaluation requires reviewing the issue after implementation of the selected recommendation to determine if the problem has been fully resolved.

C. Implementation requires taking the time to fully define the problem.

D. Evaluation requires the team to discuss each recommendation and arrive at the best option.

B. Evaluation requires reviewing the issue after implementation of the selected recommendation to determine if the problem has been fully resolved.

10. In order to best understand the scope of the situation, which of the following questions should be asked?

A. What caused the problem?

B. Who is involved in the problem?

C. What solutions have been recommended?

D. What problems am I likely to encounter?

D. What problems am I likely to encounter?

The unit manager is negotiating a conflict between the staff RNs and nursing assistants. The manager talked to everyone involved and created a list of the main issues. Which step in the negotiation process does this best describe?

A. Manage the emotions.

B. Set ground rules.

C. Clarify the problem.

D. Perform an opening move.

C. Clarify the problem.

During a meeting to resolve staffing issues and tardiness on a unit, the manager invites the staff to each take a turn speaking and asks that everyone listen respectfully and avoid making personal or professional disparaging remarks about one another. Which step in the negotiation process does this best describe?

A. Set ground rules.

B. Clarify the problem.

C. Perform an opening move.

D. Continue the negotiation.

A. Set ground rules.

Which of the following is the best description of formal negotiation?

A. An RN explains to the unit manager why a raise is deserved.

B. A unit manager justifies a request for more equipment to the chief nursing officer.

C. A charge RN makes assignments for the staff.

D. A group of RNs work together for collective bargaining.

D. A group of RNs work together for collective bargaining.

Which of the following is a management issue usually covered by the contract with collective bargaining?

A. Grievance processes

B. Sick leave

C. Length of the workday

D. Standards of care

A. Grievance processes

15. Which of the following is a practice issue addressed in the contract during collective bargaining?

A. Promotions

B. Holidays

C. Overtime

D. Adequate staffing

D. Adequate staffing

A new registered nurse (RN) with an organization is learning the layout of patient rooms. Which of the following organizational levels does this best describe?

A. Artifact level

B. Espoused beliefs

C. Underlying assumptions

D. Organizational culture

A. Artifact level

An organization focuses on improving interdisciplinary collaboration. Which of the following most likely is the focus of the organization?

A. Culture of safety

B. Care environment

C. Excellence

D. Meaningfulness

A. Culture of safety

Which of the following components of the care environment involves understanding and valuing the work individuals do?

A. Excellence

B. Meaningfulness

C. Regard

D. Learning and growth

C. Regard

In a health-care organization, all employees are ranked according to their level of authority. Which characteristic of a bureaucracy does this best describe?

A. Division of labor

B. Hierarchy

C. Rules and regulations

D. Technical competence

B. Hierarchy

20. An organization works hard to be the best in the market and drive out competition. This describes which of the following organizational goals?

A. Growth

B. Profit

C. Status

D. Dominance

D. Dominance

In which of the following types of networks is the main focus of supervisors on planning and providing resources?

A. Organic

B. Bureaucratic

C. Traditional

D. Innovative

A. Organic

A new RN asks a peer how the peer always seems to get timely responses from the laboratory department. The experienced RN explains the process she uses. This is most likely an example of which of the following?

A. Formal processes

B. Informal processes

C. Authority

D. Reward

B. Informal processes

The ability of an RN to conduct research, collect data, interpret it, and utilize it best describes which source of power?

A. Authority

B. Reward

C. Control of information

D. Coercion

C. Control of information

An RN has joined the practice council at the hospital network. The RN is able to have some say regarding nursing practice in the network and now feels as if network administration is listening to the RN's recommendations. Which of the following components of empowerment does this scenario best describe?

A. Meaning and decision making

B. Self-determination and autonomy

C. Impact and autonomy

D. Impact and decision making

D. Impact and decision making

25. Which of the following is true regarding nursing practice councils?

A. Practice councils are a form of shared governance, giving nurses the ability to participate in levels of decision making for the unit.

B. Practice councils give nurses the authority to control all aspects of their practice.

C. Genuine sharing of decision making occurs when managers retain control.

D. A nursing practice council works best for an organization when it is the only practice council in place.

A. Practice councils are a form of shared governance, giving nurses the ability to participate in levels of decision making for the unit.

A new RN in the critical care unit joined the professional organization for critical care nurses. The new RN took advantage of webinars and journal articles that offered continuing education credits. The new RN attended the national conference and began studying for the certification examination. Which benefit of professional organizations does this scenario best describe?

A. Collegiality

B. Commitment to improved patient outcomes

C. Recognition of achievement

D. Enhancement of nursing competence

D. Enhancement of nursing competence

Which of the following best describes the main purpose of collective bargaining?

A. To provide protection to employers

B. To promote cooperation

C. To equalize power between employees and employers

D. To promote a clinical ladder for staff

C. To equalize power between employees and employers

Which of the following is the best way a nurse manager can work with leaders of collective bargaining units?

A. Focus on staffing goals

B. Focus on a clinical ladder to support staff expertise

C. Focus on patient outcomes

D. Focus on shared goals

D. Focus on shared goals

For nurses to participate in decision making, they need to have the authority to make decisions without asking permission. Which source of power does this best describe?

A. Resources

B. Support

C. Information

D. Opportunity

B. Support

30. Which of the following best describes power?

A. Power increases with each step up in hierarchy.

B. Power is directly related to the amount of authority one has in an organization.

C. Those at the bottom of the hierarchy have no sources of power.

D. Sources of power exist at all levels of the hierarchy.

D. Sources of power exist at all levels of the hierarchy.

Which of the following is an example of a macro-level change?

A. Policy changes

B. Adjustments to shift change report

C. Implementing a new evidence-based practice (EBP)

D. Quality improvement changes

A. Policy changes

Management on a nursing unit has decided to upgrade to new beds in an effort to decrease occurrences of skin breakdown on the unit. The manager begins the staff in-service on the new beds by reviewing the recent incidence of skin breakdown and comparing it with statistics from similar units. Which stage of the change process is the manager addressing?

A. Change

B. Refreezing

C. Unfreezing

D. None of the above

C. Unfreezing

Which of the following is a way to appeal to feelings in order to increase receptivity for a change?

A . Present statistics on the number of patients with catheter-associated urinary tract infections during the next staff meeting.

B. Share a patient's story of how a catheter-associated urinary tract impacted him personally.

C. Provide staff with a report of infection control measures and their effectiveness.

D. Inform staff about the cost of individual supplies.

B. Share a patient's story of how a catheter-associated urinary tract impacted him

A nursing unit updated their barcode scanners because the batteries of the old ones were not replaceable and stopped holding charge. The proposed new scanners are wired so that batteries are not required. However, the registered nurses (RNs) resist this change because the placement of the scanners could make it difficult to reach the patients if they were not in bed. Which of the following most likely describes the source of the resistance?

A. Design flaws

B. Practical reasons

C. Personal needs

D. Position and power

B. Practical reasons

35. Nurses on a unit have prepared a presentation for their administrators on a proposal for a change in practice based on current evidence. They begin the presentation with a description of the current practice and evidence of why it is inefficient. This is an example of lowering resistance through which method?

A. Sharing information

B. Providing psychological safety

C. Dictating change

D. Disconfirming currently held beliefs

D. Disconfirming currently held beliefs

An RN is considering returning to school for a bachelor of science in nursing (BSN) degree. The RN realizes the knowledge gained will improve his practice and could impact patient outcomes. However, the RN is not sure about when to start the process. The RN's manager shares her own story with the RN, explaining why the manager decided to return to school and how this has impacted her professional life and personal life. Which of the following stages of change is the RN most likely in?

A. Contemplation

B. Preparation

C. Precontemplation

D. Action

A. Contemplation

Which of the following is true about behavior changes?

A. Crisis is a powerful motivation for change.

B. Change is motivated by fear.

C. Individuals who are active and engaged can learn to make a change.

D. Small changes are easier to make and sustain.

C. Individuals who are active and engaged can learn to make a change.

The first step in change is to plan carefully. Which of the following questions should be asked during the design stage of change?

A. Does everyone agree on the change?

B. Is the change really needed?

C. How difficult is the change to make?

D. How quickly should the change be made?

B. Is the change really needed?

Which of the following is a good recommendation when planning change?

A. Appoint a champion even for small changes.

B. Not all effective leadership skills are needed for effecting change.

C. Small changes do not require involving people who may be affected.

D. Motivating people may be required even for small changes.

D. Motivating people may be required even for small changes.

40. A nurse manager is planning for implementation of a change in practice based on current evidence. When planning for implementation, which of the following is the priority consideration?

A. Is this the only change taking place?

B. Will the change work on this unit?

C. Is the change necessary?

D. Where have past changes failed?

A. Is this the only change taking place?

A nurse manager reflects on current practice and notes that a recent change has become a part of daily practice. Which stage of change does this scenario best describe?

A. Implementation

B. Design

C. Planning

D. Integration

D. Integration

Which of the following best describes a reason why radical changes are often easier to maintain than relatively smaller changes?

A. Information is more abundant with radical changes.

B. Support groups for radical changes deal with emotional aspects of change.

C. It takes much longer to feel a difference.

D. Fear is often the motivation for making radical changes.

B. Support groups for radical changes deal with emotional aspects of change.

Which of the following is true about personal change?

A. The most effective leaders focus on improving the team, rather than themselves.

B. Radical changes are more important for leaders than small changes.

C. The process of personal change may follow the same steps as organizational change.

D. Small personal changes do not require much effort.

C. The process of personal change may follow the same steps as organizational change.

To increase the number of baccalaureate-prepared RNs on the unit, the manager has proposed starting a cohort of RNs in a BSN program at one time. The manager has scheduled an information session for all who are interested. During the session, six RNs sign up for assistance with the application process. Which stage of change are these RNs most likely in?

A. Precontemplation

B. Preparation

C. Contemplation

D. Action

B. Preparation

45. Which of the following will provide psychological safety when making a major change?

A. Provide opportunities for individuals to ask questions.

B. Allow individuals to agree to the change without consequences when they do not implement the change right away.

C. Provide details about why the change is necessary.

D. Recognize resistance and work to eliminate it.

A. Provide opportunities for individuals to ask questions.

The purpose of learning how to negotiate conflict is to:

1. Eliminate conflict entirely

2. Resolve conflicts more effectively

3. Win

4. Reduce stress

2. Resolve conflicts more effectively

Differences in statues and authority within the healthcare team can generate conflict. What is the most common cause of conflict?

1. Disrespect and incivility

2. Inappropriate language and sarcasm

3. Blaming and finger pointing

4. Physical violence.

1. Disrespect and incivility

The hospital has recently reorganized, therefore several departments closed. The pt census on the unit has increased. The staff have always had a strong team spirit, but the nurse manager knows that workflow changes can cause conflict. What can the nurse manager do to reduce the possibility of conflict among her team?

1. Monitor the quality of pt care

2. Ensure that supplies and equipment are readily available

3. Assess the equity of nursing assignments

4. All of the above

4. All of the above

Nursing and respiratory departments both experience job cuts. The nurse manager notices that members of his staff are having more trouble getting a fast response from a RT. What source of conflict is probably operating here?

1. Union-management conflict

2. Interpersonal problem

3. Cultural differences

4. Work intensification.

4. Work intensification.

50. What is the most desirable result of a problem resolution?

1. Win-lose

2. Lose-lose

3. Win-win

4. None of the above

3. Win-win

What is brainwriting?

1. A strategy to encourage the free flow of ideas

2. A mutually beneficial negotiation result

3. A winning approach to formal negotiation

4. A devaluation reaction to negotiation.

1. A strategy to encourage the free flow of ideas

Florence has 2 team members who continually criticize each other despite being told to stop. Which approach is the most appropriate for this situation?

1. refer each of them for employee counseling

2. Engage in problem resolution

3. Bring in a union representative

4. Engage in a formal negotiation process

2. Engage in problem resolution

Which of the following issues may be addressed in a collective bargaining agreement?

1. Shift differential

2. Safe working environment

3. Grievance procedures

4. All of the above

4. All of the above

Nursing management and the nursing union are having differences on several issues. There may be a need for negotiation. Which of the following is a serious disadvantage to using collective bargaining to resolve this conflict?

1. Protecting the right to fair treatment

2. Creating an adversarial relationship between staff and management

3. Lacking professionalism on the part of the collective bargaining unit members

4. Failing to uphold important standards of care

2. Creating an adversarial relationship between staff and management

55. if an informal negotiation session becomes too highly emotional, what should the nurse manager do?

1. Let the feelings flow

2. Cancel the negotiation

3. Deal with the feelings first

4. Tell them to ignore the feelings and deal with the issues.

3. Deal with the feelings first

If you are employed at a hospital owned by a corporation listed on the stock market, in which category does your facility belong?

1. Publicly (govt) supported

2. Voluntary, not-for-profit

3. For-profit

4. All of the above

3. For-profit

Creating a culture of safety requires organizational commitment to preventing harm. Which of the following is not a key feature of a culture of safety?

1. Provision of adequate resources to provide care and service

2. Use of interprofessional collaboration to solve problems and assess risk

3. Adherence to staffing ratios

4. encourages the reporting of errors and near misses

3. Adherence to staffing ratios

Organizational culture is best defined as

1. the stated vision and mission of an organization

2. Policies and procedures

3. The type of decor that was chosen for the facility

4. An enduring set of shared values and beliefs

4. An enduring set of shared values and beliefs

Communities and regulatory agencies continually challenge hospitals, skilled nursing facilities, and home health companies to enhance, improve, or change care delivery and the care environment to ensure safe, high-quality care. Which factors are important in improving a hospital's care environment?

1. Adequate staffing

2. Collegial relationships among staff

3. Emphasis on staff development

4. All of the above

4. All of the above

60. Which of the following is a characteristic of a bureaucratic organization?

1. Organic structure

2. Flexible teams

3. Rigid unit structures

4. Self-correction and self-control

3. Rigid unit structures

What is the best explanation of authority?

1. It is position dependent

2. It is based on the ability to lead others

3. It is expertise-driven

4. It resides primarily in the clients served

1. It is position dependent

There are numerous sources of power in an organization. Several are available to nurses. Which one is not?

1. Authority

2. Reward

3. Control of information

4. Coercion

1. Authority

Nurses who feel empowered can make significant contributions to a health-care organization. Feeling empowered includes feeling as if you make a difference, that colleagues value your opinion, and that your voice is important. What is essential to nurse empowerment?

1. Belonging to a professional organziation

2. Participating on a unit practice council

3. Reasonable work assignments

4. A rewards and recognition program

2. Participating on a unit practice council

You have been asked to serve on your unit practice council. This is an important role and one that you are excited to perform. What should you know about professional governance so that you are prepared for this work? Professional governance in nursing involves:

1. Working longer hours

2. Attending a lot of meetings

3. Nurses setting nursing standards for daily practice

4. Changing the organization's culture

3. Nurses setting nursing standards for daily practice

65. Several of your colleagues are going to join the American Nurses Association (ANA). YOu know the annual dues are a little more than you can afford right now, but you want to learn more. Your friends think that joining the ANA will help empower them. How do professional organizations empower nurses?

1. They represent nurses in the political arena

2. They equalize power between employees and staff

3. They provide opportunities for promotion

4. They provide health insurance

1. They represent nurses in the political arena

Which of the following is a macro-level change?

1. Shift in medicare payment policies

2. Change in shift differentials

3. Opening a new unit

4. Changing visiting hours

1. Shift in medicare payment policies

Which of the following best describes what is most likely to be within a nurse's comfort zone?

1. A new assignment

2. Tasks she's done many times

3. Change to a different shift

4. Addition of several new tasks

2. Tasks she's done many times

How can you increase your staff's receptivity to an important change in procedures?

1. Assign the new procedure to the newest staff member

2.Apologize for making their work more complicated

3. Provide them with a booklet on preparing for change

4. Give them time to learn the new procedure

4. Give them time to learn the new procedure

A new nurse manager plans to implement a new scheduling process. This was met with resistance from the staff who were very happy with the current scheduling process. How can the nurse manager lower their resistance to this change?

1. Tell the staff that their concerns about the new schedule are unfounded and plan to post the new schedule

2. Share information about the new schedule and discuss its impact on the unit

3. Post the schedule and deal with staff on an individual basis

4. Ask the staff to come up with an alternative for the nurse manager's consideration

2. Share information about the new schedule and discuss its impact on the unit

70. There has been a sudden increase in catheter-associated urinary tract infections that must be addressed on Jane's unit. What is the best way for Jane to persuade the staff to implement a new Foley catheter care protocol?

1. Tell them the change has been ordered by the administration

2. Present statistics proving the need to change

3. Tell a compelling story about why change is needed

4. Explain the importance of the change in simple terms

3. Tell a compelling story about why change is needed

What type of resistance to a change is the hardest to overcome?

1. The resistance that comes from inertia: "We always do it this way."

2. Active resistance to changing a preferred procedure

3. Passive resistance to an unpopular change

4. Resistance based upon fear of losing one's job

4. Resistance based upon fear of losing one's job

When is it most appropriate to dictate (order) change?

1. When the change is very complicated

2. In an emergency

3. When resistance is very high

4. If the change is unimportant

2. In an emergency

In which of the following situations would a personal change probably be the hardest to make?

1. When the need is immediate

2. If the benefits will be realized years from now

3. When the reward is immediate

4. If it is change that keeps you in your comfort zone

2. If the benefits will be realized years from now

When designing a technical change, which of the following should be considered?

1. Will it work better than the old way?

2. Is this change needed?

3. Is there a simple way to do this?

4. All of the above

4. All of the above

75. Which of the following is the best indication that a change has been integrated?

1. When no one talks about it anymore

2. If adoption occurred rapidly

3. When resistance turns from active to passive

4. When a full year has passed since the change was introduced

1. When no one talks about it anymore