Chapter 10: Delegation, Leadership, and Management My Nursing Test Banks

Chapter 10: Delegation, Leadership, and Management

Test Bank

MULTIPLE CHOICE

1. Leadership is best defined as a process that:

a.

motivates people to accomplish set goals.

b.

provides a framework for health care delivery systems.

c.

guides staff to use resources to meet patient needs.

d.

uses advanced management training.

ANS: C

A comprehensive process that guides staff to use resources to meet patient needs best defines leadership.

DIF: Cognitive Level: Knowledge REF: p. 123 OBJ: Theory #1

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

2. The best description of an autocratic leader is a leader who:

a.

is permissive.

b.

has confidence in the staff.

c.

tightly controls team members.

d.

accepts all responsibility for the team.

ANS: C

An autocratic leader tightly controls team members and closely monitors the work of each staff member.

DIF: Cognitive Level: Knowledge REF: p. 124 OBJ: Theory #1

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

3. A laissez-faire leader would be most likely to:

a.

consult staff members.

b.

tightly control team members.

c.

allow team members to function independently.

d.

set goals that are task oriented.

ANS: C

A laissez-faire leader does not attempt to control the team and offers little direction. The leader allows the team members to function independently.

DIF: Cognitive Level: Knowledge REF: p. 124 OBJ: Theory #1

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

4. A team leader with effective communication skills would:

a.

make precise authoritarian assignments to team members.

b.

give specific information in a tactful, friendly manner.

c.

maintain eye contact when giving directions.

d.

limit time for feedback and complaints.

ANS: B

Effective communication needs to be concise and delivered in a tactful and friendly manner and allows for feedback and two-way communication. Limitation of flow of feedback and complaints and precise authoritarian behavior limit two-way communication.

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: Theory #2

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. The most effective communication from a nurse leader to a team member that is most likely to have a positive outcome would be:

a.

Jane, be sure to get those vital signs recorded on time today.

b.

Jane, I need those vital signs before breakfast.

c.

Jane, please give me a list of those vital signs before breakfast.

d.

Jane, breakfast trays are being served. You need to get those vital signs.

ANS: C

Communication should be clear and concise, but also accompanied by a polite please and thank you. Effective communication demonstrates a sense of trust and respect toward others.

DIF: Cognitive Level: Application REF: p. 125 OBJ: Theory #3

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

6. Prior to addressing a situation, the nurse is aware that an effective leader must _____ the problem.

a.

define

b.

identify persons to address

c.

know the legal implications of

d.

look to alternatives to address

ANS: A

The nurse leader must first be clear about what a problem involves before attempting to address the situation.

DIF: Cognitive Level: Application REF: p. 125 OBJ: Theory #3

TOP: Problem Solving KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

7. The nurse is aware that the best way to evaluate an unlicensed assistive personnels (UAPs) ability to perform a skill or task is to:

a.

obtain verbal confirmation from another nurse that the nursing assistant is proficient.

b.

review documentation that the nursing assistant is competent in skills.

c.

observe the nursing assistant performing the skill or task.

d.

demonstrate the skill to the nursing assistant before his demonstration.

ANS: C

The best way to evaluate a persons ability to perform a skill is to observe him. Documentation and information from another nurse support a nurses decision to delegate the task to the nursing assistant but are not the best means for evaluation of competency.

DIF: Cognitive Level: Application REF: p. 126 OBJ: Theory #4

TOP: Delegation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

8. The nurses most appropriate selection of a task to be delegated to an unlicensed assistive personnel (UAP) would be:

a.

assessing circulation in the toes of a patient in a cast.

b.

changing a patients wound dressing.

c.

taking the blood pressure of a patient who has just returned from surgery.

d.

toileting a patient on a bladder-training regimen.

ANS: D

Assessing tissue perfusion, changing a patients wound dressing, and assessing a patient require interventions by licensed personnel. Toileting a patient on a routine basis is appropriate to delegate to a nursing assistant.

DIF: Cognitive Level: Application REF: p. 126, Box 10-2

OBJ: Theory #4 TOP: Delegation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

9. The nurse is aware that when a task is delegated to an unlicensed assistive personnel (UAP), the nurse is:

a.

no longer responsible to that patient.

b.

responsible to communicate outcome to appropriate senior staff.

c.

responsible for overall patient care.

d.

liable for all adverse outcomes.

ANS: C

Nurses are responsible for all patients care, regardless of tasks they have delegated to other staff members.

DIF: Cognitive Level: Comprehension REF: p. 126 OBJ: Theory #4

TOP: Delegation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

10. The nurse recognizes that one of the responsibilities of a charge nurse as opposed to the team leader is that the charge nurse is responsible for:

a.

evaluating members of the health care team.

b.

evaluating unlicensed assistive personnel.

c.

making rounds and assessing all patients on the unit.

d.

collaborating with physicians and other health team members.

ANS: C

The charge nurse is an advanced leadership role, which includes the assessments of all patients on the unit, and is responsible for the total nursing care during the shift.

DIF: Cognitive Level: Comprehension REF: p. 127 OBJ: Theory #6

TOP: Advanced Leadership Roles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

11. When transcribing a physicians orders, the nurse must:

a.

transcribe only the generic name of the drug.

b.

give a copy of the order to the nurse responsible for that patients care.

c.

review unclear orders with the charge nurse.

d.

transfer orders to the Medication Administration Record (MAR).

ANS: D

Transcribing orders means to transfer them to the Kardex and/or MAR. Preferably both the generic and trade name of the drug should be recorded. The nurse giving the actual care should be informed of the order change but does not need a copy of the order. Questions relative to unclear orders are clarified with the prescribing physician.

DIF: Cognitive Level: Application REF: p. 129 OBJ: Clinical Practice #5

TOP: Written Orders KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

12. The example of a physicians order that was received by telephone that has all the essential documentation is:

a.

Increase Coumadin to 3 mg daily: order from A. Doctor received by A. Nurse 11/11/11 @ 0930.

b.

11/11/11 @ 0930 TO. From A. Doctor: Increase Coumadin (Warfarin) to 3 mg daily. A. Nurse, LVN.

c.

TO: from A. Doctor: Increase Coumadin to 3 mg every day. A. Nurse.

d.

11/11/11 received TO to increase Coumadin (Warfarin) to 3 mg daily A. Nurse.

ANS: B

Documentation for a telephone order should be recorded as a TO with the date and time of the receipt of the order, the order as requested by the physician, and signed with a first initial and last name with professional designation.

DIF: Cognitive Level: Analysis REF: p. 130 OBJ: Clinical Practice #5

TOP: Transcribing Telephone Orders KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

13. The nurse in a long-term care facility is aware that the accuracy and comprehensiveness of the Minimum Data Set (MDS) facilitate the:

a.

patient receiving the appropriate treatments.

b.

effectiveness of the planning for quality improvement.

c.

reimbursement to the facility from Medicare and Medicaid payments.

d.

enhancement of the database for procedures related to risk management.

ANS: C

MDS sheets must be filled out correctly for facilities to receive the maximal Medicare or Medicaid payment for services rendered.

DIF: Cognitive Level: Comprehension REF: p. 131 OBJ: Clinical Practice #6

TOP: Documentation for Reimbursement KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

14. A nurse can best minimize the liability of a lawsuit against the facility by:

a.

strictly adhering to the policies and procedures of the facility.

b.

demonstrating concern and attending to patient complaints.

c.

advising the supervisor of significant events or problems with patient relations.

d.

giving a copy of the policy and procedures to each patient.

ANS: B

A nurse can best minimize liability for a lawsuit by demonstrating concern and attending to patient complaints and concerns. Adherence to procedures and policies may be a defense in a lawsuit but does not necessarily diminish the risk. Advising the supervisor of a significant event does not diminish the risk.

DIF: Cognitive Level: Comprehension REF: p. 131 OBJ: Clinical Practice #7

TOP: Risk Reduction KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

15. Nursing documentation that would best assist with reimbursement to a facility would be:

a.

Patient was up in chair for 2 hours after breakfast.

b.

Patient was ambulated in the hall three times this shift.

c.

Patient was assisted to a recliner chair to use the oxygen concentrator.

d.

Patient received bath in shower room.

ANS: C

Nurses should document care delivered and equipment used in order to get appropriate reimbursement.

DIF: Cognitive Level: Application REF: p. 131 OBJ: Clinical Practice #6

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

16. The behavior least likely seen in an autocratic leader would be a person who:

a.

provides close supervision of work by staff members.

b.

often consults staff when making decisions.

c.

quickly points out mistakes made by staff members.

d.

frequently gives out new directives.

ANS: B

The autocratic leader never consults staff relative to decision making. The autocratic leader tightly controls team members. This type of leadership style has been described as my way or the highway. The leader closely supervises the work of each staff member. When mistakes are made, they are quickly pointed out.

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: Theory #1

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

17. The nurse recognizes that the use of the democratic approach in leadership will:

a.

cause team members to feel that their feelings are secondary to the accomplishment of the goal.

b.

cause mistakes to be discovered and pointed out.

c.

take more time to accomplish goals.

d.

use the leaders skills and knowledge.

ANS: C

The democratic process will take more time to accomplish the goal because the leader frequently consults with staff members and seeks staff participation in decision making. The skills and knowledge of the team members are readily used to ensure that the team functions efficiently. Team members are respected as individuals, and there is an open and trusting attitude overall. The democratic leader is part of the team, not sitting above it, and accepts responsibility for the actions of the team.

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: Theory #1

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

18. An inappropriate delegation to an unlicensed assistive personnel (UAP) would be:

a.

applying a condom catheter.

b.

assessing a patients pain.

c.

giving a sitz bath.

d.

giving an enema.

ANS: B

Assessment or aspects of the analysis, planning, or evaluation phases of the nursing process must be performed by the registered nurse. These functions cannot be delegated to UAPs.

DIF: Cognitive Level: Application REF: p. 124 OBJ: Theory #4

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

19. The nurse is aware that assignment of an unlicensed assistive personnel

(UAP) differs from delegation in that in delegation, the:

a.

nurse has transferred the authority to perform the task.

b.

UAPs are covered by their own certification.

c.

UAPs are performing activities within the scope of their job description.

d.

licensed person must accompany the UAP to supervise the activity.

ANS: A

Delegation occurs when a licensed nurse transfers the authority to perform a specific task.

DIF: Cognitive Level: Comprehension REF: p. 125 OBJ: Theory #4

TOP: Delegation KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

20. The nurse is initially guided in the process of delegation to an unlicensed assistive personnel (UAP) by the:

a.

states nurse practice act.

b.

competencies of the UAP.

c.

policies of the facility.

d.

needs of the patient.

ANS: A

The initial delegation guidelines are described by the states nurse practice act. The policies of the facility may further limit what delegation may occur regardless of the competencies of the UAP.

DIF: Cognitive Level: Knowledge REF: p. 126 OBJ: Theory #4

TOP: Delegation Guidelines KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

21. When the team leader becomes concerned about the frequent tardiness of the unlicensed assistive personnel (UAP), the most appropriate documentation would be:

a.

Has been late to work 6 times in this pay period (January 2, 4, 6, 8, 10, and 14). States she overslept. Counseled on January 9. Unit management made aware.

b.

Frequently late to work. States she overslept. Co-workers state she is working elsewhere at night. Will follow up.

c.

Tardiness is causing inability to finish assignments without assistance from others.

d.

Oversleeping and active social life have caused tardiness six times in this pay period.

ANS: A

Documentation of the specific facts (not opinion) should occur. The unit manager should also be made aware of the problem.

DIF: Cognitive Level: Application REF: p. 127 OBJ: Theory #6

TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

22. The LPN/LVN who is transcribing orders is unclear about the intent of an order. The LPN/LVN should:

a.

consult the charge nurse.

b.

call the physician.

c.

transcribe the order as written.

d.

mark the order in red as UNTRANSCRIBED.

ANS: B

An order that is unclear should be clarified with the physician.

DIF: Cognitive Level: Application REF: p. 129 OBJ: Clinical Practice #5

TOP: Order Transcription KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

23. The best communication given by the nurse to the unlicensed assistive personnel (UAP) would be:

a.

Let me know if my patients temperature is high.

b.

Please measure each urine output and report it to me.

c.

Tell me if the patient seems more uncomfortable.

d.

Notify me when the dressing needs to be changed.

ANS: B

When delegating, the nurse should make it clear as to what the unlicensed assistive personnel (UAP) is to do. Nurses should not ask UAPs to perform assessments where professional judgment is required about patient condition.

DIF: Cognitive Level: Application REF: pp. 125-126 OBJ: Theory #4

TOP: Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

24. The team leader who is reviewing the list of the assigned patients would give priority to the patient who:

a.

has a scheduled medication due.

b.

requires dressing changes three times a day.

c.

is experiencing acute chest pain.

d.

is confused and disoriented.

ANS: C

Unstable patients take precedence over stable patients. Scheduled medications and treatments must be done before tasks that are ordered three times a day.

DIF: Cognitive Level: Analysis REF: p. 128 OBJ: Theory #6

TOP: Prioritization KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: basic care and comfort

25. A nurse is aware that the medication orders on the MAR/Kardex should be verified with the chart orders every:

a.

shift.

b.

12 hours.

c.

24 hours.

d.

48 hours.

ANS: C

Medications recorded on the MAR/Kardex should be verified with the chart orders every 24 hours.

DIF: Cognitive Level: Comprehension REF: p. 129 OBJ: Clinical Practice #5

TOP: Verification of Orders KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

26. The considerations for an LPN/LVN to be eligible for an advanced leadership role as a charge nurse include a minimum of staff nursing experience of _____ months.

a.

12

b.

18

c.

24

d.

36

ANS: A

A minimum of 12 months is required for an LPN/LVN to be considered for the role of charge nurse.

DIF: Cognitive Level: Knowledge REF: p. 127 OBJ: Theory #6

TOP: Prioritization KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

27. The nurse is aware that orders for a patient going to surgery are:

a.

pertinent only for the immediate preoperative period.

b.

canceled when the physician writes, resume previous orders.

c.

can be continued when the patient returns to the unit.

d.

canceled by the nurse in the operating room when the surgery is complete.

ANS: A

The preoperative orders are pertinent only for the preoperative period. All orders written preoperatively are considered canceled at the time the patient enters surgery. Brand new orders must be written in their entirety for the postsurgical patient. Resume previous orders is not acceptable by most institutional policies.

DIF: Cognitive Level: Application REF: p. 130 OBJ: Clinical Practice #5

TOP: Physician Orders KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

28. The nurse receiving a telephone order from a physician who is following the Joint Commission International Center for Patient Safety should:

a.

receive the order from the physician, transcribe the order to the chart, and ask the physician if he will confirm the order.

b.

receive the order from the physician, repeat the order to the physician, and then transcribe the order to the chart.

c.

receive the order from the physician, transcribe the order to the chart, and then read back the order to the physician.

d.

write the telephone order verbatim as the physician gives it and then read it back to the charge nurse.

ANS: C

The Joint Commission requires institutions to verify verbal or telephone orders by having the person receiving the order read back the order to the person initiating the order, usually the physician. This read back requires that the person accepting the order actually write the order down in the chart in order to be reading it back.

DIF: Cognitive Level: Application REF: p. 130 OBJ: Theory #9

TOP: Read Back KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

COMPLETION

29. Staff nurses have many responsibilities to their patients throughout their shift. However, the _________ is responsible for the total nursing care of patients during a shift and is also responsible for giving reports to the oncoming shift and evaluating members of the health care team.

ANS:

charge nurse

All nurses need to know the responsibilities of each person on the health care team, and the charge nurse is responsible for the total nursing care of patients during a shift.

DIF: Cognitive Level: Knowledge REF: p. 127 OBJ: Theory #6

TOP: Charge Nurse Role KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

MULTIPLE RESPONSE

30. Characteristics of effective communication would include: (Select all that apply.)

a.

using eye contact.

b.

using concise statements when giving information.

c.

addressing conflicts before delegation of duties.

d.

obtaining feedback about directions given.

e.

assigning responsibility for creation of any conflict.

ANS: A, B, D

Effective communication includes using direct eye contact between the persons involved, using concise statements for clarity, and obtaining feedback to ensure that information has been understood. Conflict resolution may or may not pertain to communication and may be addressed following instructions.

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: Theory #2

TOP: Effective Communication KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

31. Which statements are true regarding delegation of duties to unlicensed assistive personnel (UAPs) by a licensed nurse? (Select all that apply.)

a.

The LPN/LVN in charge must be familiar with the competency of staff.

b.

The LPN/LVN must be familiar with the job descriptions of UAPs.

c.

An LPN/LVN may delegate any skill or task to a UAP once the nursing assistant has demonstrated proficiency.

d.

A nurse must be familiar with the nurse practice act.

e.

The certification of the UAP makes nursing assistants liable for their actions.

ANS: A, B, D

Delegation requires that the LPN/LVN be familiar with the competency of the staff as well as their job description. Even if the nursing assistant is proficient in a skill, no delegation requiring professional judgment is allowed. The nursing assistant is not liable; the supervising nurse is.

DIF: Cognitive Level: Application REF: pp. 125-126 OBJ: Theory #4

TOP: Delegation KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

32. Important characteristics of delegation to an unlicensed assistive personnel (UAP) include: (Select all that apply.)

a.

use of effective communication.

b.

provision of constructive criticism immediately.

c.

direction for the desired result and time for completion.

d.

provision of tactful feedback.

e.

informing the patient that the delegated task will be performed by a UAP.

ANS: A, C, D, E

When delegating to UAPs, it is important to use effective communication, as well as direction for results. Patients should be informed that the task will be performed by a UAP. Constructive criticism should be done privately after the event and should always be done tactfully.

DIF: Cognitive Level: Comprehension REF: pp. 126-127 OBJ: Theory #4

TOP: Delegation KEY: Nursing Process Step: Evaluation MSC: NCLEX: N/A

33. Which responsibilities are common to an LPN/LVN team leader in both health care facilities and medical clinics? (Select all that apply.)

a.

Organizes staff meetings

b.

Assists in writing policies and procedures

c.

Assists in resolving staff conflicts

d.

Prepares the schedule for patient activities

e.

Evaluates unlicensed assistive personnel (UAPs)

ANS: B, C, E

Writing policies and procedures, assisting to resolve staff conflicts, and evaluating UAPs are duties common to LPN/LVN team leaders in health care facilities. Only in medical clinics do LPNs/LVNs generally attend staff meetings and oversee scheduling of patients.

DIF: Cognitive Level: Comprehension REF: p. 127 OBJ: Theory #7

TOP: Team Leader Responsibilities KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

OTHER

34. Place the steps of transcription of physicians orders in proper sequence. (Separate letters with a comma and space as follows: A, B, C, D, E.)

A. Transmit orders to pharmacy, dietary, or ancillary services.

B. Add medication changes to MAR.

C. Process the stat orders first.

D. Read through all of the order.

E. Sign off order with a red line across page.

ANS:

D, C, B, A, E

The nurse should read through all of the orders before transmission; process the stat orders first; add medications to the MAR; transmit orders to pharmacy, dietary, or ancillary services; and then sign off the order with name and title.

DIF: Cognitive Level: Analysis REF: pp. 129-130 OBJ: Clinical Practice #5

TOP: Transcribing Orders KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

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