Chapter 14: Assertiveness: Your Responsibility My Nursing Test Banks

Chapter 14: Assertiveness: Your Responsibility

Test Bank

MULTIPLE CHOICE

1. The instructor tells a nursing student to hurry with the assignment in order to help a classmate who is behind with work. The student has promised a patient shed return in 15 minutes to polish the patients nails. Which response would be considered assertive?

a.

Why me? Im still busy with my own patients. Ask one of the others who are standing around at the nurses station.

b.

I suppose I can, if you insist.

c.

Ive promised one of my patients that Ill come back to polish her nails. Id like to be able to keep that promise. Can you possibly ask someone else?

d.

Ill be glad to help. Then go and apologize to the patient saying the instructor wont let you polish her nails.

ANS: C

Telling the instructor of the promise and asking him or her to find someone else is an honest, positive response that protects ones own rights but does not infringe on the rights of others. Asking Why me? and stating, Im still busy with my own patients. Ask one of the others who are standing around at the nurses station is aggressive. The statement I suppose I can, if you insist is passive. Stating Ill be glad to help and then apologizing to the patient saying the instructor wont let you polish her nails is dishonest.

DIF: Cognitive Level: Application REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

2. A nursing students mother states, I need you to watch your younger siblings while I play bingo. The nursing student had planned to prepare for a unit examination. An assertive approach would be to say

a.

What youre asking isnt fair. I have an exam to study for. You never win at bingo anyway.

b.

OK. If your bingo means more to you than my passing a big exam, Ill watch the kids.

c.

Ill make a deal with you. Ill watch the kids if youll cook my favorite meal tomorrow night.

d.

Im sorry, but I wont be able to babysit. I have an exam tomorrow. I need the time tonight to study.

ANS: D

Telling the mother, Im sorry, but I wont be able to babysit. I have an exam tomorrow. I need the time tonight to study, is honest and protects the nursing students rights. Stating What youre asking isnt fair. I have an exam to study for. You never win at bingo anyway is aggressive. The statement OK. If your bingo means more to you than my passing a big exam, Ill watch the kids is passive aggressive. Ill make a deal with you. Ill watch the kids if youll cook my favorite meal tomorrow night is manipulative.

DIF: Cognitive Level: Application REF: pp. 164-165 OBJ: 2

TOP: Assertiveness KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

3. A staff nurse enters the room in which youre giving care to a patient in traction. She calls you aside and states, Ive watched you all morning. You dont seem to know how to do anything right. Look at you now! Youre bathing the patient and its almost time for lunch. An assertive approach would be to say

a.

Youre right. I am still bathing the patient. She was in pain earlier. I waited until her narcotic made her more comfortable.

b.

Im sorry you think I give poor care. Im still pretty new, and Im trying hard to learn.

c.

Ive watched you, too. Youve criticized every student. Is this some game you play?

d.

I hope you wont report this to my instructor.

ANS: A

Saying Youre right. I am still bathing the patient. She was in pain earlier. I waited until her narcotic made her more comfortable, assertively tells the staff nurse that the student has used critical thinking in arriving at a course of action. The statement Im sorry you think I give poor care. Im still pretty new, and Im trying hard to learn is passive. Stating Ive watched you , too. Youve criticized every student. Is this some game you play? is aggressive. Stating I hope you wont report this to my instructor is passive.

DIF: Cognitive Level: Application REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

4. The student nurse has a goal to become a more assertive person. To achieve this, the student nurse must be willing to

a.

keep a daily journal.

b.

be disliked by others.

c.

put down other people.

d.

take a positive stand.

ANS: D

Assertiveness is characterized by taking a positive stand in a persistent way. Keeping a daily journal is not a requirement of assertiveness. Assertiveness should not result in incurring the dislike of others. Putting down others is aggressive, not assertive.

DIF: Cognitive Level: Comprehension REF: pp. 164-165 OBJ: 5

TOP: Assertive behavior KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

5. A newly graduated LPN/LVN who is orienting to the unit tells a peer, You should have seen that new associate degree RN trying to take care of three patients! She was so disorganized that it made me glad Im an LPN/LVN. The LPN/LVN is demonstrating

a.

manipulation.

b.

assertiveness.

c.

projection.

d.

passiveness.

ANS: C

Projection is a coping mechanism that allows the individual to unconsciously attribute their own weaknesses to others.

DIF: Cognitive Level: Application REF: p. 165 OBJ: 3

TOP: Using coping mechanisms KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

6. When a nurse tells a peer, You have to watch out for the charge nurse. Sometimes shes OK, but sometimes shes just plain unreasonable. The best thing to do is to tell her off the first time she gets on your back about something. Keep me posted and Ill try to help you. An assertive reply would be

a.

Thanks for the warning. Ill be careful.

b.

You take care of yourself, and Ill watch out for myself.

c.

I think it would be best for me to work on my relationship independently.

d.

It seems to me that youre playing a manipulative game and giving out poor advice.

ANS: C

This response deals directly with the nurse who is labeling the charge nurse and attempting to divide and conquer. It makes it clear that the nurse is capable of making assessments and planning actions.

DIF: Cognitive Level: Application REF: pp. 164-165 OBJ: 5

TOP: Assertive behavior KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

7. Which statement shows a personal commitment to work on the goal of devoting more time to coursework for the LPN/LVN program?

a.

My friends have to stop asking me to do time-consuming favors for them.

b.

My family needs to take on more responsibility for household tasks so I have more time to study.

c.

The charge nurse should stop asking me to work overtime and instead ask other CNAs.

d.

I will say no when people ask me to do things that take time away from my studies.

ANS: D

This I statement shows that the individual can assume responsibility for implementing a goal. The other options are all statements indicating what others should do.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 5

TOP: Assertive behavior KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

8. Which nonverbal behavior is most congruent with a nurses assertive verbal statement?

a.

Firm voice, erect posture, direct eye contact

b.

Soft voice, shoulders relaxed, eyes down

c.

Loud voice, back stiff, eyes glaring

d.

Smile while speaking, touch persons arm, eyes lowered

ANS: A

Use of a firm voice with erect posture and direct eye contact describes nonverbal behavior that is congruent with assertive verbalization. Using of a soft voice with shoulders relaxed and eyes down is passive submissive. Smiling while speaking and touching the persons arm with lowered eyes is passive submissive. Use of a loud voice, back stiff, and eyes glaring is consistent with aggressive behavior.

DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 2

TOP: Nonverbal assertive behavior KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

9. Which behavior should be considered an early sign that a co-worker may have the potential for violence?

a.

Verbalization of a wish to harm someone

b.

A suicidal threat

c.

Destruction of agency property

d.

Lack of cooperation with supervisors

ANS: D

Lack of cooperation is an early covert sign of the potential for violent acting out. The other behaviors are seen later.

DIF: Cognitive Level: Comprehension REF: pp. 172-173 OBJ: 10

TOP: Workplace violence

KEY: Nursing Process Step: Assessment (Data Collection)

MSC: NCLEX: Safe, Effective Care Environment

10. A student nurse is assigned to care for a patient who is known to be angry. During the caregiving process, the patient hits the student nurse. The action the student nurse should initially take is to

a.

indicate that he does not like being hit and continue to provide care to the patient.

b.

leave the patient in a safe situation and immediately report the event to the instructor.

c.

immediately leave the room and call the patients physician for an order to medicate the patient.

d.

go to the telephone and call the local police to report the incident.

ANS: B

Leaving the patient in a safe situation and immediately reporting the event to the instructor should be the initial action of the student nurse, who needs both the support and guidance of the instructor. Indicating that he does not like being hit and continuing to provide care is dangerous. Immediately leaving the room and calling the physician for a medication order is inappropriate. Calling the local police to report the incident would not be the initial action.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: 8

TOP: Workplace violence KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

11. The intervention that is most effective at reducing patient violence against nurses is

a.

teaching nurses to communicate respect for patients and confidence in themselves.

b.

requiring nurses to work in groups rather than alone.

c.

having security personnel stationed on all units.

d.

assigning only male nurses to care for psychiatric or chemical dependency patients.

ANS: A

Violence prevention includes both respect for patients and self-confidence in nurses. Nurses who are passive and tentative are more likely to be victims of violence. Patients who feel they are not respected are more likely to use violence as a way of getting their needs met. Requiring nurses to work in groups rather than alone would not be possible. Having security personnel stationed on all units would not entirely eliminate violence; many patients would not be aware of the presence of security officers on the unit, whereas others impaired by medication or illness would not factor in the presence of security personnel. Assigning only male nurses to care for psychiatric or chemically dependent patients is neither practical nor desirable.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: 11

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

12. The nurse is assigned to park in a newly created parking lot that is far from the hospital building. Some of the lights in the new parking lot have not been installed. As the nurse is about to leave, she notices several young men loitering near the walkway she must take. The nurse should

a.

take a deep breath and walk rapidly toward the parking lot.

b.

try to use friendliness by greeting the young men as she passes them.

c.

wait inside the hospital until the young men leave.

d.

call for a security guard to serve as an escort to the car.

ANS: D

Calling for a security guard to escort her to her car is the safest option given.

DIF: Cognitive Level: Application REF: pp. 173-174, Box 14-3

OBJ: N/A TOP: Violence KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

13. A male nurse has been assigned to mentor a newly hired female nurse. Several times during the day, the new nurse perceives her mentor as touching her inappropriately. In the afternoon the mentor tells the new nurse, I think we should meet after work for a drink. I could give you the lowdown on other staff, and we could get our relationship off to a good start. With my help, youll be able to get raises and promotions regularly. The new nurse thinks, I dont want this mans help. The new nurse can correctly determine that these behaviors suggest

a.

assault.

b.

assertiveness.

c.

manipulation.

d.

sexual harassment.

ANS: D

Sexual harassment is about abuse of power. In this situation, the mentor has used unwanted touch and suggested that having a relationship with him would be a condition of advancement. Assault has not occurred. Assertive behavior is not demonstrated in the scenario. The scenario is more specific to sexual harassment than manipulation.

DIF: Cognitive Level: Application REF: p. 174 OBJ: 9

TOP: Sexual harassment KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

14. When a nurse is the target for unwanted behavior that she perceives as sexually harassing, she should first

a.

resign from the job.

b.

assertively tell the person that the behavior is unwanted.

c.

report the behavior to the nursing supervisor.

d.

report the behavior to the union representative.

ANS: B

The initial action should be to tell the individual that the behavior is unwanted and offensive. Use assertive verbal and nonverbal communication. Resigning from the job should be unnecessary. Reporting the behavior to the nursing supervisor and/or union representative should not be the first action but might be necessary if assertive communication does not stop the behavior.

DIF: Cognitive Level: Analysis REF: p. 174 OBJ: 9

TOP: Sexual harassment KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

15. A nurse demonstrates assertive behavior by doing which of the following?

a.

Limiting contact with a patient who is dying, because it causes the nurse to feel depressed

b.

Routinely telling patients who have questions about their medications to ask the physician

c.

When asked about something unfamiliar, admitting to not knowing but agreeing to find out

d.

Telling another nurse how ridiculous a doctor is for ordering hourly vital sign assessments

ANS: C

Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. Admitting to not knowing and agreeing to find out the answer is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, N/A

16. A nurse demonstrates assertive behavior by doing which of the following?

a.

Assuming a patient would like to skip the bath when the patients spouse comes to visit

b.

Being unable to continue suctioning a patient because she is concerned the patient will not like her for doing it

c.

Experiencing a feeling of devastation when the patient questions her ability to insert an intravenous catheter

d.

Requesting to speak with the physician privately when she feels that the physician has ordered an inappropriate treatment

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. Requesting to speak with the physician privately is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

17. A nurse demonstrates assertive behavior by doing which of the following?

a.

When a patient asks the nurse to stop and feed the patients cats on the way home, the nurse frowns but agrees to do so.

b.

The nurse feels the team leaders assignment is unfair, so the nurse drops hints to co-workers about feelings of unfairness.

c.

When the patient asks about the nurses personal life, the nurse answers the questions out of fear of not being liked for not answering.

d.

When working with a patient who is critical of the nurse, the nurse sits down with the patient and listens attentively to the patients concerns.

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. Sitting with the patient and listening attentively is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

18. A nurse demonstrates assertive behavior by doing which of the following?

a.

When making an error, the nurse overexplains and overapologizes and is unaware of the right to make a mistake.

b.

When asked by the charge nurse to accept an admission, the busy nurse hesitantly responds by saying, Well, I guess I could.

c.

When the nurse is very busy and needs help with an assignment, the nurse says nothing and refrains from expressing the need for help.

d.

A patient complains of pain when ambulating and asks not to walk. The nurse respects the patients feelings and medicates the patient as ordered for pain while supporting the need to carry out the physicians order.

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. Respecting the patients feelings but supporting the need to carry out the physicians order is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed on, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

19. A nurse demonstrates assertive behavior by doing which of the following?

a.

When the physician yells at the nurse in front of the patient, the nurse is angry but refrains from speaking about it.

b.

The nurse plans on seeking new employment out of fear of approaching the supervisor to tell his or her side of what happened.

c.

When working with a patient who has had the call light on repeatedly, the nurse tells the patient, Do not put your call light on again.

d.

When unexpected visitors arrive to visit the patient during breakfast, the nurse asks whether the patient would prefer to eat now or visit.

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. Giving the patient the choice between breakfast and visitors is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The nurse refraining from talking about being angry after a physician yells and the nurse planning on seeking new employment out of fear are examples of nonassertive behavior. Telling the patient not to put the call light on again is an example of aggressive behavior in which the rights of others are violated.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

20. A nurse demonstrates nonassertive behavior by doing which of the following?

a.

When a patient asks about the nurses personal life, the nurse responds to the patients questions out of fear of not being liked by the patient.

b.

When a patient asks about the nurses personal life, the nurse says that the information is personal and chooses not to discuss it.

c.

When a nurse feels the team leader has been unfair, the nurse approaches the team leader and asks to speak privately at a time that is convenient for the person.

d.

When pressured by staff members to help with their assignments, the nurse, who is too busy to help, refuses without feeling guilty but leaves the door open to help at a future date.

ANS: A

Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. Responding to the patients questions out of fear of not being liked is an example of nonassertive behavior. Assertiveness is a current name for honesty; it is a way to live the truth from ones innermost being and to express this truth in thought, word, and deed. The remaining options are examples of assertive behavior.

DIF: Cognitive Level: Analysis REF: p. 163 OBJ: 2

TOP: Assertive behavior KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

MULTIPLE RESPONSE

1. What are the expected outcomes of using assertive communication in the nursing workplace? (Select all that apply.)

a.

It enmeshes the person and the issue.

b.

It promotes positive relationships.

c.

It is clear and unequivocal.

d.

It respects the rights of oneself and others.

e.

It is focused on the personal needs of the nurse.

f.

It guarantees the user will get his or her way.

ANS: B, C, D

These statements about assertive communication outcomes are correct. Assertive communication in the nursing workplace does not enmesh the person and the issue; assertiveness separates the person and the issue. Assertive communication allows the nurse to focus on the patients needs rather than being inner focused. Assertive communication does not guarantee that the user will get his or her own way; instead, it guarantees that the user will feel in control of emotions and responses.

DIF: Cognitive Level: Analysis REF: pp. 164-165 OBJ: 1

TOP: Assertiveness KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

2. Which statements about manipulation would be useful to the nurse who interacts with both patients and peers? (Select all that apply.)

a.

Manipulation usually disregards the feelings and needs of others.

b.

Manipulation exploits the weaknesses of others.

c.

A divide-and-conquer strategy is often used by those who manipulate.

d.

Firm limit-setting rarely protects against manipulation.

e.

Manipulation often results in individuals being treated as objects.

f.

Manipulation should be permitted if it is consistent with the nurses needs.

ANS: A, B, C, E

Manipulation usually disregards the feelings and needs of others; manipulation exploits the weaknesses of others; a divide-and-conquer strategy is often used by those who manipulate; and manipulation often results in individuals being treated as objectsthese are all true statements that would help the nurse put manipulative behavior into perspective. The statement indicating that firm limit-setting rarely protects against manipulation is incorrect. Firm limit-setting is one of the better strategies for handling manipulative behavior. Permitting manipulation if it is consistent with the nurses needs is not an appropriate basis for interactions with either patients or peers.

DIF: Cognitive Level: Analysis REF: p. 171 OBJ: 6

TOP: Manipulation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Comprehension

3. Which of the following measures are most helpful to the nurse who makes a personal commitment to practice violence prevention in the workplace? (Select all that apply.)

a.

Get to know co-workers and look out for them.

b.

Treat patients and co-workers with courtesy and respect.

c.

Become familiar with policies relating to violence and harassment.

d.

Assume individuals will not act on threats they make.

e.

Interject opinions while attempting to clarify issues.

f.

Set clear, firm limits on unacceptable behavior.

ANS: A, B, C, F

Each of the correct answers is an example of general safeguards. All threats should be taken seriously and reported to management. Clarification requires questioning, listening to information given, and repeating what the individual said she or he thinks or feels. It is not a time to argue ones own point of view.

DIF: Cognitive Level: Analysis REF: pp. 173-174, Box 14-3

OBJ: 11 TOP: Workplace violence

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

4. A nurse is appointed to a workplace committee to plan changes in the emergency department. The committees task is to make recommendations that will provide an environment that deters violence. Which recommendations are consistent with this goal? (Select all that apply.)

a.

Install bullet-resistant glass in the nurses station.

b.

Install security alarm devices in examining rooms.

c.

Institute a limited toleration of violence policy.

d.

Develop a minimum safe staffing policy.

e.

Change security officers uniforms to shirt, tie, blazer, slacks.

ANS: A, B, D, E

Development of a minimum safe staffing policy and installation of bullet-resistant glass and security alarm devices are part of the OSHA National Guidelines for Deterring Violence. Surveys indicate that officers better convey authority when they wear a customer friendly uniform of jacket and tie. OSHA recommends a no toleration of violence policy.

DIF: Cognitive Level: Analysis REF: p. 172, Box 14-2

OBJ: 11 TOP: Workplace violence

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

5. A nurse experiences potential danger from a patient who is highly suspicious and fears being harmed. Which behaviors by the nurse will help alleviate the threat of violence? (Select all that apply.)

a.

Stand in the doorway of the room.

b.

Maintain an open position with the hands in view.

c.

Occasionally touch the patient gently on the forearm.

d.

Turn away from the patient to demonstrate lack of fear.

e.

Speak in a quiet, controlled voice.

ANS: B, E

Maintaining an open position with the hands in view suggests that the patient can trust the nurse not to have a weapon in his or her pocket. Speaking in a quiet, controlled voice is important, because it reduces the patients anxiety. Never block the doorway. The patient may cause harm when attempting to flee. Maintain a distance of 5 feet from the patient and never attempt to touch the patient without his or her permission. Never turn away from a potentially violent patient. Maintain observation at all times.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: 11

TOP: Violence KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

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