Chapter 20: Leadership Skills My Nursing Test Banks

Chapter 20: Leadership Skills

Test Bank

MULTIPLE CHOICE

1. To discover the expanded role of the practical nurse, the LPN/LVN should investigate

a.

the states Nurse Practice Act.

b.

job descriptions for the practical nurse in local health care agencies.

c.

information gained from practical nurses working in various clinical settings.

d.

the opinions of physicians who service area nursing homes and extended care facilities.

ANS: A

The Nurse Practice Act of the state determines the parameters of LPN/LVN practice. The other options may be less detailed than the Nurse Practice Act, so they are not the best resources.

DIF: Cognitive Level: Comprehension REF: p. 252 OBJ: 1

TOP: LPN/LVN expanded role KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

2. The LPN/LVN day shift charge nurse in a nursing home usually reports to the

a.

owner of the nursing home.

b.

administrator of the nursing home.

c.

RN manager of the unit.

d.

board of directors of the nursing home.

ANS: C

Most organizational charts call for the LPN/LVN charge nurse to report to the RN manager of the unit. The other options are not logical.

DIF: Cognitive Level: Comprehension REF: p. 252 OBJ: 2

TOP: Organizational charts KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

3. The LPN/LVN nursing home charge nurse usually tells nursing assistants what to do and offers little opportunity for input or suggestions for how to improve care. This leadership style is called

a.

autocratic.

b.

democratic.

c.

situational.

d.

laissez-faire.

ANS: A

The charge nurse is task oriented and seeks no input from staff. This is consistent with autocratic leadership. The other options are not possibilities based on the description given in the scenario.

DIF: Cognitive Level: Application REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Autocratic Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

4. The LPN/LVN nursing home charge nurse encourages nursing assistants to make suggestions regarding improvement of nursing care and shows concern for the staff. This leadership style is called

a.

laissez-faire.

b.

democratic.

c.

autocratic.

d.

situational.

ANS: B

Democratic leadership style is demonstrated when the nurse is concerned about the work to be done and is also concerned about the team performing the work. The team is encouraged to participate in decision making about resident care. The other options are not possibilities based on the scenario description.

DIF: Cognitive Level: Application REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Democratic Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

5. A nursing assistant states, I have never learned how to transfer a resident with end-stage Parkinsons disease from the bed to the chair. The nursing assistant refuses to transfer the resident at this time. Select the appropriate approach for the LPN/LVN charge nurse to take.

a.

Reprimand the nursing assistant for not performing the job.

b.

Encourage the nursing assistant to carry through with the transfer.

c.

Arrange to teach the nursing assistant how to transfer the resident.

d.

Mention that nursing assistants can be charged with insubordination if they do not perform their jobs.

ANS: C

The nursing assistant should not perform tasks for which he or she has not been trained. The nurse should arrange to teach the nursing assistant so that he or she can safely perform the duty. Reprimanding the nursing assistant for not performing the job is unnecessary. Encouraging the nursing assistant to carry through with the transfer is unwise and unsafe. Mentioning that nursing assistants can be charged with insubordination if they do not perform their jobs is threatening.

DIF: Cognitive Level: Application REF: p. 258 OBJ: 6

TOP: Problem-solving KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment

6. A nursing assistant (NA) did an exceptionally good job by encouraging a resident to leave his room and go to an activity. Select the response by the LPN/LVN charge nurse that would best encourage the employee to continue this effort.

a.

Write a note for the NAs file explaining that she did not leave the resident in his room.

b.

Tell the NA she is a great nursing assistant and that the charge nurse wished all assistants were like her.

c.

Report the NAs good efforts to the nursing homes administrator and board of directors.

d.

Tell the NA that the charge nurse knows how hard she worked to get the resident out of his room and how pleased the nurse is that the NA is concerned with the residents need for socialization.

ANS: D

Providing positive reinforcement for the specific behaviors used makes it more likely that the NA will use these strategies in the future. The LPN/LVNs communication is straightforward and assertive. Writing a note for the NAs file explaining that she did not leave the resident in his room would not be effective as a motivator. Telling the NA she is a great nursing assistant and the charge nurse wished all assistants were like her is not specific enough. Reporting the NAs good efforts to the nursing home administrator and board of directors is not necessary at this point.

DIF: Cognitive Level: Application REF: pp. 256-257 OBJ: 6

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

MSC: NCLEX: Safe, Effective Care Environment

7. LPN/LVNs functioning in an expanded role are most often employed in

a.

critical care units.

b.

pediatric clinics.

c.

home health care.

d.

long-term care.

ANS: D

Long-term care lends itself to the use of LPN/LVNs functioning in the expanded role. The other practice environments involve patients who are less stable and therefore require greater direct supervision by the RN.

DIF: Cognitive Level: Comprehension REF: p. 253 OBJ: 1

TOP: Expanded role of the LPN/LVN KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

8. Which understanding about leadership would help the LPN/LVN become a more skillful leader?

a.

Leaders in nursing are appointed by management to accomplish organizational goals.

b.

Leaders rarely take risks and virtually never make mistakes.

c.

Leaders have little confidence in themselves until they develop a power base.

d.

Leaders see change as challenging and providing opportunities for improving quality of care.

ANS: D

The only accurate statement is that leaders see change as challenging and providing opportunities for improving quality of care.

DIF: Cognitive Level: Comprehension REF: p. 253 OBJ: 3

TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

9. Which quality is rarely found in democratic leaders?

a.

Assertiveness

b.

Arrogance

c.

Desire for new learning

d.

Effective communication

ANS: B

Arrogance is an undesirable quality. The other options are desirable qualities consistent with the democratic leadership style.

DIF: Cognitive Level: Comprehension REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Democratic Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

10. For an LPN/LVN to motivate staff members to meet the goals of the organization, it is helpful if the nurse

a.

practices intimidation.

b.

understands work motivators.

c.

offers laissez-faire leadership.

d.

emphasizes policies rather than people.

ANS: B

By understanding what motivates an employee, the nurse is better able to select appropriate motivational strategies. Intimidation is not an effective motivator. Laissez-faire leadership does not focus on motivating staff. People-oriented leaders are better at motivating workers.

DIF: Cognitive Level: Comprehension REF: p. 256 OBJ: 6

TOP: Work motivators KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

11. The LPN/LVN charge nurse asks the nurse manager, How can I motivate the nursing assistants on my shift? The best answer would be

a.

Motivation is an inner force. You cant motivate someone else, but understanding the things that are important to workers can be helpful.

b.

Encouragement is the only way. If you praise and encourage the workers, you will have them eating out of your hand and doing their best.

c.

Money is the only thing that motivates workers. Since you cant set a higher salary, you cant change their motivation.

d.

Communicate! Communicate! Communicate! Be clear and specific. Spell things out. Give the impression that you know what youre talking about at all times.

ANS: A

The idea that motivation is an inner force most accurately explains motivation. Encouragement and money are motivators but do not provide accurate information. Referencing communication does not provide information on motivation.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 8

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

MSC: NCLEX: Safe, Effective Work Environment

12. What LPN/LVN charge nurse behavior will best accomplish the goal of promoting team building?

a.

Using I statements exclusively when talking about the units mission and goals

b.

Never using rewards to change nursing assistant behaviors, because this strategy is manipulative

c.

Assuming each nursing assistant is fully informed about the units mission and goals

d.

Encouraging politeness, cooperation, respect, and trust

ANS: D

The charge nurse is a role model for the attitude and behavior expected of nursing assistants. Team building requires an environment in which employees feel valued. Politeness, cooperation, respect, and trust provide the foundation on which further team building proceeds.

DIF: Cognitive Level: Application REF: p. 259 OBJ: 7|12

TOP: Team building KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Work Environment

13. The LPN/LVN spends time exploring the agency mission statement with the nursing assistants who work that shift. They create a list of ways they can contribute to achieving the agency goals. This process is called

a.

stress management.

b.

problem-solving.

c.

team building.

d.

conflict resolution.

ANS: C

Team building is a process by which employees become committed to management goals. The scenario does not describe any of the other options.

DIF: Cognitive Level: Application REF: p. 259 OBJ: 6

TOP: Team building KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

14. The LPN/LVN notices that the nursing assistants are taking longer breaks than agency policy permits and wishes to change this behavior as quickly as possible. The LPN/LVNs initial actions should be to

a.

verbally confront the employees with their behavior.

b.

write reprimands to be placed in each employees file.

c.

ask for in-service classes on time management.

d.

determine the reason staff members are taking longer breaks.

ANS: D

Before attempting to solve any problem, the LPN/LVN must clearly identify the real problem. In this case, longer breaks may be the staffs reaction to a more fundamental workplace problem. Verbal confrontation should not be the initial action. Written reprimands should not be the initial action. In-service classes on time management would be not an inappropriate initial action.

DIF: Cognitive Level: Analysis REF: p. 258|p. 264

OBJ: 6 TOP: Problem-solving KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

15. The LPN/LVN reads this statement, Stress is the bodys reaction to the minds analysis of a situation. The LPN/LVN concludes that the critical factor to teach nursing assistants to help them control their stress levels is to

a.

manage how they think about a situation.

b.

consider the stressful situation as subjectively as possible.

c.

focus on developing good clinical skills.

d.

apply time management principles.

ANS: A

According to Ellis, managing ones thinking by replacing irrational thinking with rational thinking reduces stress. The key is to think objectively. Focusing on developing good clinical skills and applying time management principles are not relevant to the scenario.

DIF: Cognitive Level: Analysis REF: p. 260 OBJ: 13

TOP: Stress management KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

16. Which behavior should the LPN/LVN charge nurse identify as dysfunctional behavior that violates OBRA regulations by threatening resident quality of life, health, or safety?

a.

The nursing assistant praises a resident who is having post-stroke speech therapy for attempts to communicate verbally.

b.

The nursing assistant asks to talk to the LPN/LVN charge nurse about changes the nursing assistant would like to make in a residents plan of care.

c.

The nursing assistant uses a sharp tone of voice and body posture, suggesting impatience when feeding a resident.

d.

The nursing assistant offers to help co-workers after finishing his resident care assignment.

ANS: C

This behavior negatively affects the quality of life and safety of a resident. The other options do not negatively affect the residents quality of life.

DIF: Cognitive Level: Application REF: pp. 262-264 OBJ: 15

TOP: OBRA regulations KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

17. The action the LPN/LVN charge nurse takes independently that would most likely require conflict resolution at the unit level is

a.

organizing shift activities before morning report.

b.

making sure the necessary equipment and supplies are available.

c.

eliminating morning breaks and adding 10 minutes to the lunch hour.

d.

creating a calm, supportive environment.

ANS: C

Unilaterally changing working conditions will create stress and conflict and require conflict resolution. The other options are desirable actions.

DIF: Cognitive Level: Application REF: p. 264 OBJ: 13

TOP: Conflict resolution KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

18. Which of the following is an example of objective, rational thinking rather than subjective, irrational thinking about nursing assistants whom the LPN/LVN charge nurse supervises?

a.

I want nursing assistants to be on time for report.

b.

Neat appearance means good clinical skills.

c.

Nursing assistants who are late intend to take advantage of co-workers.

d.

Beware of nursing assistants who smile a lot. Theyre manipulative.

ANS: A

This is an objective, rational thought that reflects a reasonable expectation for nursing assistants. The other options exemplify subjective, irrational thinking.

DIF: Cognitive Level: Application REF: pp. 260-261 OBJ: 14

TOP: Irrational thinking KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

19. How can the LPN/LVN charge nurse meet needs for affiliation among staff on their shift?

a.

Reorient all staff to policies and shift routine.

b.

Encourage attendance at continuing education seminars.

c.

Arrange a social gathering for the staff on the shift.

d.

Offer training in violence prevention.

ANS: C

Affiliation needs are met by providing for good interpersonal relationships among staff. Planning a social gathering is a way of meeting affiliation needs. Reorienting all staff to policies and shift routine is probably unnecessary and would not address affiliation needs. Encouraging attendance at continuing education seminars addresses level 4 needs for recognition, growth, and responsibility. Offering training in violence prevention addresses level 2 safety needs.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 6

TOP: Understanding motivation and human needs KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

20. The LPN/LVN charge nurse notices that a nursing assistant has not weighed her assigned residents. The best statement by the nurse is

a.

You didnt weigh your assigned residents this morning. Lets get with the program.

b.

I need to have you weigh your assigned residents and report to me by 10 AM.

c.

Would you mind explaining why you didnt weigh your residents today?

d.

Youve been goofing off lately. Not weighing your assigned residents is a good example of this.

ANS: B

This is straightforward and assertive and resolves a clinical problem. The other options fail to provide a solution to the clinical problem created by the nursing assistants failure to obtain the weights.

DIF: Cognitive Level: Application REF: p. 257 OBJ: 10

TOP: Core knowledge and skills needed for Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

21. In which situation would the LPN/LVN charge nurse be in violation of OBRA provisions?

a.

Letting the unit secretary, who has completed 30 hours of instruction in a CNA program, bathe and ambulate a resident

b.

Allowing a son to feed his father, who is a resident on the unit

c.

Scheduling a nursing assistant to attend a 2-hour in-service training session

d.

Notifying the RN supervisor that a nursing assistant needs additional training in administration of tap water enemas

ANS: A

OBRA regulations call for all nursing assistants to be certified. Permitting an uncertified employee to perform the duties of a CNA violates OBRA regulations. Allowing a son to feed his father is permissible. Scheduling a nursing assistant to attend a 2-hour in-service training session and notifying the RN supervisor that a nursing assistant needs additional training are appropriate.

DIF: Cognitive Level: Analysis REF: pp. 262-264 OBJ: 15

TOP: OBRA regulations KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

22. A new LPN/LVN asks the LPN/LVN charge nurse what continuous quality improvement (CQI) is all about. The charge nurse should explain that the focus of CQI in a health care agency is

a.

saving time.

b.

better patient care outcomes.

c.

making money for the health care agency.

d.

reducing stress for employees.

ANS: B

The focus of CQI is quality of care, as indicated by patient outcomes. CQI does not focus on saving time, agency profit, or stress reduction.

DIF: Cognitive Level: Application REF: p. 264 OBJ: 16

TOP: Continuous Quality Improvement KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

23. When conducting an employee performance evaluation conference, the LPN/LVN charge nurse should understand that

a.

giving measurable feedback such as Youre doing fine promotes personal growth.

b.

positive feedback should be given at the beginning of the interview to set the tone.

c.

the employee should develop a plan for improvement without input from the charge nurse.

d.

the employee should be encouraged to identify strengths and ask questions for clarification.

ANS: D

Evaluation should be a joint interactive process rather than a one-way communication. Dialogue can clarify and enhance the process. Evaluation should focus on identification of strengths as well as behaviors to be modified. The statement Youre doing fine does not exemplify measurable feedback. The tone should be nonthreatening and objective but does not require the evaluation to begin with positive feedback. An employee may develop his or her own plan, but the individual needs to include problem areas identified by the charge nurse as well as the employees own goals.

DIF: Cognitive Level: Application REF: p. 266 OBJ: 7

TOP: Performance evaluation KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment

24. The long-term care agency has recently announced that it will soon lay off six LPN/LVNs and hire eight nursing assistants. Today, the RN charge nurse presents the LPN/LVN charge nurse with a certificate recognizing her ability to manage effectively despite short staffing. The LPN/LVN responds somewhat politely but seems more angry than pleased. In terms of the Howlett hierarchy of needs, which of the following is the best explanation for the employees reaction?

a.

The LPN/LVN is probably responding to the poor working conditions.

b.

When job security is threatened, recognition needs assume lesser importance.

c.

Achievement and advancement needs are more fundamental than recognition needs.

d.

The adequacy of benefits is more basic to job satisfaction than affiliation needs.

ANS: B

Job security is a level 2 need, whereas recognition is a level 4 need. The level 2 need is threatened; therefore, the level 4 need seems less important. Data are not present to support that the LPN/LVN is responding to poor working conditions. The remaining options are either not accurate or not relevant to the scenario.

DIF: Cognitive Level: Analysis REF: p. 258, Figure 20-5

OBJ: 8 TOP: Howlett Hierarchy KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

25. Evaluate the following documentation found in the medical record of a resident. It was provided by an LPN/LVN charge nurse relative to an incident that occurred while resident care was being provided by a nursing assistant.

July 1, 2009, 8:10 AM

While administering meds on Wing 1, I heard someone sobbing in the shower room on that wing. On entering the shower stall, I found Mrs. Garrity crying and shivering. She was sitting naked on the shower chair and was alone in the room. She stated that Becky, her nursing assistant, told her she had to leave for a phone call. I covered Mrs. Garrity with a bath blanket that was on the shelf in the bathroom. At that point Becky returned and confirmed that she had received a phone call. I think the in-service director needs to review the procedure for showering a resident with Becky and the policy about personal phone calls. Becky and I discussed the discomfort caused to Mrs. Garrity by her actions. She listened to my comments without defensiveness.

The documentation should be evaluated as

a.

complete and appropriate.

b.

appropriate but incomplete.

c.

meeting agency and regulatory standards.

d.

not meeting criteria for good documentation.

ANS: D

The nurse includes a subjective comment judging what is perceived as having taken place.

DIF: Cognitive Level: Analysis REF: p. 261 OBJ: 7

TOP: Documentation KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Safe, Effective Care Environment

26. A purely task-centered leadership style that thrives on power and involves telling someone what to do, with little regard for the employee as a person, is the

a.

autocratic style.

b.

situational style.

c.

democratic style.

d.

laissez-faire style.

ANS: A

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on peoples feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

27. A people-oriented leadership style that focuses on peoples feelings but ignores the task at hand and allows people to act without any direction is the

a.

autocratic style.

b.

situational style.

c.

democratic style.

d.

laissez-faire style.

ANS: D

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on peoples feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

28. A leadership style that focuses on both the task and the employee is the

a.

autocratic style.

b.

situational style.

c.

democratic style.

d.

laissez-faire style.

ANS: C

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on peoples feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

29. During an emergency, the charge nurse tells the LPN/LVN, I need you to place the patient on a nonrebreather mask now. The charge nurse has little regard for the LPN/LVNs input at this time. The charge nurse is displaying what leadership style?

a.

Autocratic

b.

Situational

c.

Democratic

d.

Laissez-faire

ANS: A

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on peoples feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Comprehension REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

30. During a staff meeting, the charge nurse encourages feedback from staff nurses about improving patient safety. The charge nurse is displaying what leadership style?

a.

autocratic

b.

situational

c.

democratic

d.

laissez-faire

ANS: C

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on peoples feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge REF: pp. 254-255, Box 20-1

OBJ: 5 TOP: Leadership styles KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

31. A nursing instructor has instructed a student nurse to document objectively. The student nurse demonstrates understanding when documenting

a.

Patient is noncompliant.

b.

Patient is drunk, confused, and uncooperative.

c.

Patient and family are nasty, abrasive, and difficult.

d.

Odor of alcohol on breath; refuses to stay in assigned room.

ANS: D

All charting must be specific, objective, and complete. One should avoid subjective comments and personal judgments in charting. The remaining options are examples of subjective charting. Listing facts such as the smell of alcohol and the behavior of the patient is an example of objective charting.

DIF: Cognitive Level: Application REF: p. 261 OBJ: 9

TOP: Subjective versus objective charting

KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A

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