Chapter 21 My Nursing Test Banks

Sullivan, Effective Leadership and Management, 8/e
Chapter 21

Question 1

Type: MCSA

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem?

1. The hospital is in a poorer part of town and offers a great deal of charity care.

2. The hospital pays about $.25 per hour less than other hospitals as a starting wage for nurses.

3. The hospital has a reputation for allowing bullying behavior to occur.

4. The other hospital in town has a more modern building and campus.

Correct Answer: 3

Rationale 1: While some staff may be put-off by the area of town and the fact that charity care is provided, this is not the most probably reason for the situation.

Rationale 2: Twenty-five cents is not enough of a difference in wages to explain this situation.

Rationale 3: People do not like to be bullied. If the hospital has this reputation it is unlikely to attract new employees and older employees are likely to leave.

Rationale 4: Physical facilities are important, but are not likely important enough to be the most probable cause of this situation.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 2

Type: MCSA

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?

1. Bullying behaviors make nurses uncomfortable.

2. Physicians do not want to admit clients to hospitals with an uncivil atmosphere.

3. Bullying and incivility are just not proper work practices.

4. Bullying and incivility are dangerous to client care.

Correct Answer: 4

Rationale 1: This is a reason for not tolerating harassing behaviors, but is not the most important reason.

Rationale 2: It is true that incivility may decrease the number of clients admitted to a hospital, but this is not the primary reason for this work.

Rationale 3: Bullying and incivility are not proper work practices, but this is not the primary reason for excluding them from the workplace.

Rationale 4: These behaviors can be dangerous to clients.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 3

Type: MCMA

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Nursing assistants

2. Physicians

3. Managers

4. Office personnel

5. Senior nurses

Correct Answer: 2,3,5

Rationale 1: Nursing assistants are often bullied, but are not the main bullies.

Rationale 2: Physicians are among those reported as being the worst bullies.

Rationale 3: Managers are among those reported as being the worst bullies.

Rationale 4: Office personnel are not among those listed as being the worst bullies.

Rationale 5: Senior nurses are among those listed as being the worst bullies.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 4

Type: MCSA

A nurse writes some scathing remarks about another nurses professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate?

1. I have no control over what the nurses do on their time away from work.

2. This does not meet the standards for bullying because it was not a face-to-face encounter.

3. You two are acting like a couple of high school kids.

4. I will follow up on this complaint and take action as needed.

Correct Answer: 4

Rationale 1: The remarks were about the nurses professionalism, which is a part of the nurses work. The manager does have input into this situation.

Rationale 2: Bullying can occur on the Internet, by text message, or face-to-face.

Rationale 3: This is not an appropriate or helpful remark for the manager to make in this situation.

Rationale 4: The manager must do an assessment of the complaint before acting.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 5

Type: MCMA

A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The unit clerk groans when the instructor enters the nursing station with the students.

2. A nurse quietly says, Please do not assign a student to me today. I have two very sick clients who are going to require my full attention.

3. A nurse whispers, Not students again today.

4. A nursing assistant asks the students how long they have been in school.

5. A transport worker says, Just great, more students to get in the way today.

Correct Answer: 1,3,5

Rationale 1: Any action that indicates the students are unwelcome is not civil.

Rationale 2: This nurse has not been uncivil, but is stating a fact about the acuity of clients.

Rationale 3: This whisper is not civil, despite the level at which it is spoken.

Rationale 4: This is a valid statement and is civil.

Rationale 5: The intent of this remark is probably not civil.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 6

Type: MCMA

A nurse says, I dont see what all the fuss is about bullying. Every new nurse has to go through it. Its just a part of the history of nursing. How should the manager respond?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I know. Its a shame that all the old ways are changing.

2. Why would you want to bully a new nurse? They are all so nave and cute.

3. The Joint Commission does not tolerate disruptive or abusive behavior.

4. The American Nurses Association does not approve of bullying behaviors.

5. New nurses bring new ideas. Why would you bully them?

Correct Answer: 3,4,5

Rationale 1: Agreeing with the nurse only serves to reinforce the behavior.

Rationale 2: A statement about the new nurse being nave and cute is a bullying behavior.

Rationale 3: The Joint Commission recommends a zero tolerance policy regarding disruptive or abusive behavior.

Rationale 4: The ANA recommends several strategies to combat these behaviors.

Rationale 5: New ideas are brought by new nurses. Bullying of any segment of the profession is wrong.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-2: Describe strategies to deal with bullying behaviors.

Question 7

Type: MCMA

A nurse makes a medication error and notifies the clients physician. The physician berates the nurse over the phone and states, You are an idiot. How should the manager deal with this situation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Tell the nurse to go home for the rest of the day.

2. Have the nurse call the physician back and demand an apology.

3. Document the facts of the encounter.

4. Privately tell the physician that the behavior was bullying.

5. Confront the physician during rounds and demand an explanation.

Correct Answer: 3,4,5

Rationale 1: There is no reason for the nurse to go home.

Rationale 2: The manager should not anger both parties more by creating another immediate encounter.

Rationale 3: The facts of the encounter must be documented.

Rationale 4: The manager should name the behavior.

Rationale 5: The manager should speak to the physician in a civil manner.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-2: Describe strategies to deal with bullying behaviors.

Question 8

Type: MCSA

A nurse manager does not like conflict and would like to allow instances of bullying to go away on their own. What rationale by the managers supervisor is the most important?

1. The Joint Commission requires that we address instances of bullying.

2. We dont want to run off good nurses.

3. If you let bullying go, it just gets worse and more frequent.

4. A bully makes the work environment unpleasant for everyone.

Correct Answer: 3

Rationale 1: The Joint Commission does have this requirement, but it is not the most important reason to address bullying.

Rationale 2: Bullying can make nurses leave the organization, but this is not the most important reason to address each situation.

Rationale 3: Bullying behavior tends to escalate if ignored.

Rationale 4: It is true that a bully makes the work environment unpleasant, but this is not the most important rationale.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-2: Describe strategies to deal with bullying behaviors.

Question 9

Type: MCSA

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?

1. Call a meeting of all night shift employees.

2. Review the staffing pattern and absentee list for the night shift.

3. Ask employees for their perceptions on missing narcotics.

4. Request that security search employee lockers and personal items.

Correct Answer: 2

Rationale 1: A staff meeting may be warranted at some point, but is not the first action.

Rationale 2: The first step is to assess the problem. By checking the staffing pattern on the nights in question, the manager can rule out some employees.

Rationale 3: Asking for staff perceptions about the missing drugs might be warranted, but is not the first step in assessment.

Rationale 4: Legal issues should be considered before planning to search employee lockers.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 10

Type: MCSA

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs?

1. Place the nurse on a different unit and allow the administration of all drugs.

2. Reassign the nurse for a period of time to a unit where no mood-altering drugs are given.

3. Retain the nurse on the original unit and allow the administration of mood-altering drugs.

4. Return the nurse to the original unit at a less stressful time, such as night shift.

Correct Answer: 2

Rationale 1: In many cases state law or administrative policy will restrict a recovering nurse in the early post-treatment period from handling controlled substances.

Rationale 2: Removal of the temptation is a positive step for the recovering nurse. The best action would be to temporarily have the nurse reassigned to a unit where there are no mood-altering drugs.

Rationale 3: If the nurse must be assigned to the original unit, he or she should not administer mood-altering drugs. However, this plan does require informing the other nurses of the situation, which can also be problematic.

Rationale 4: Recovering nurses should be discouraged from working evening or night shifts.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 11

Type: MCMA

What characteristics would cause the manager to classify an employee as marginal?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The employee works only when client census calls for additional staff.

2. The employees work does not improve with coaching.

3. The employee just made an error for which discipline has already been done twice.

4. The employee has worked at the facility for less than 1 month.

5. The employee does not mix well with the other staff, but stays on the margins of the group.

Correct Answer: 2,3

Rationale 1: An employee who works only on a prn basis is not necessarily a marginal employee.

Rationale 2: A marginal employee does not take instruction well.

Rationale 3: An employee whose work does not improve after discipline is a marginal employee.

Rationale 4: Length of employment has little to do with being classified as marginal.

Rationale 5: Marginal does not mean staying at the margins of the social group.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 12

Type: MCSA

A night shift charge nurse frequently points out nurses faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?

1. Lateral violence

2. Unprofessionalism

3. Lack of civility

4. Bullying

Correct Answer: 3

Rationale 1: Lateral violence is harassment between employees of equal rank.

Rationale 2: The behavior is unprofessional, but that is a very broad term and does not identify the issue in this particular case.

Rationale 3: Lack of civility is defined as disrespectful or rude behavior.

Rationale 4: Bullying is a broad term used to describe many behaviors. It is not specific to this situation.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 13

Type: MCSA

The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility?

1. Your behavior is rude and disrespectful towards your staff.

2. This behavior is unprofessional.

3. This behavior is unacceptable.

4. This behavior warrants a written warning.

Correct Answer: 1

Rationale 1: Lack of civility is rude, disrespectful, and impolite behavior.

Rationale 2: This behavior is unprofessional, but this term is not the most specific one provided.

Rationale 3: This behavior is unacceptable, but this term is not the most specific one provided.

Rationale 4: This behavior likely does warrant a written warning, but this is not the statement that most specifically describes the behavior.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3: Explain how to manage staff with problem behaviors.

Question 14

Type: MCSA

A night shift nurse is assuming a day shift nurses assignment, which includes two clients whose pain is being controlled with oral hydrocodone (Lortab). At shift assessment, both clients complain of pain. During shift report, the day shift nurse reports that both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take?

1. Repeat the medication.

2. Inform the manager of the situation.

3. Call the physician to obtain an order for IV narcotics.

4. Tell the clients that pain medication will be given at the next ordered time.

Correct Answer: 2

Rationale 1: Repeating the medication without further assessment is dangerous.

Rationale 2: While there is no clear indication that the day shift nurse is diverting drugs, the manager must be made aware of the situation so it can be investigated. The nurse and manager must determine if the clients actually received the medication and, if so, what time they were administered.

Rationale 3: Calling the physician with a request for IV narcotics would be dangerous.

Rationale 4: The issue in this situation is whether the clients actually received the medication. Telling the clients that they must wait until the next scheduled time for pain medication is not appropriate pain management.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 15

Type: MCSA

A nurse comes to the unit manager to report a coworkers behavioral changes. The nurse has noticed that the coworkers handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which should be the managers first action?

1. Meet with the coworker in private and discuss the behaviors.

2. Meet with other staff to determine if the coworker has issues at home.

3. Meet with human resources (HR) to determine the best method to terminate the employee.

4. Collect additional information regarding behaviors, absenteeism, and/or tardiness.

Correct Answer: 4

Rationale 1: The manager will meet with the nurse but should have information to support the investigation of substance abuse.

Rationale 2: Obtaining information from other staff is unprofessional and violates confidentiality.

Rationale 3: The manager should meet with HR to determine a course of action but should have documentation to support suspected abuse prior to HRs involvement.

Rationale 4: The manager should obtain information and documentation to determine if there is a problem.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 16

Type: MCSA

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organizations policies. Which statement by the HR director is appropriate?

1. We should meet with the nurse and offer access to the employee assistance program.

2. We should confront the employee and discuss involuntary or voluntary termination.

3. You need to meet with this nurse and confront these behaviors.

4. We need to set up a counseling session with a psychologist and this nurse.

Correct Answer: 1

Rationale 1: Most health care organizations offer substance abuse programs for employees.

Rationale 2: Termination is typically the last resort.

Rationale 3: Meeting with the employee should be to offer help, not to confront.

Rationale 4: The manager and HR director should offer the employee assistance program (EAP) but not schedule appointments for the employee without consent.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 17

Type: MCMA

The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurses work will improve. What risks has the manager taken by choosing this strategy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse may harm a client.

2. Other nurses on the unit may become disgruntled by having to cover for this nurse.

3. The nurse may never become a good employee.

4. The manager may be terminated.

5. The morale of the unit may decline.

Correct Answer: 1,2,3,5

Rationale 1: Marginal work may result in harm to clients.

Rationale 2: A marginal employee increases the workload on other, more competent employees.

Rationale 3: If marginal work is allowed to continue, the nurse may never change.

Rationale 4: It is unlikely that a manager would be terminated because of one marginal employee.

Rationale 5: Having a marginal employee who must be constantly coached and watched may negatively affect the morale of other staff and the entire unit.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 18

Type: MCSA

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, That probably happened when the nurse covering for me at noon or for my breaks was in charge. How should the manager interpret this statement?

1. This is a plausible explanation of who was in charge at the time of the error.

2. The coverage nurse is likely incompetent.

3. This nurse was not in charge when the error was made.

4. This nurse is scapegoating the coverage nurse.

Correct Answer: 4

Rationale 1: A statement this broad is likely not a clear explanation.

Rationale 2: There is no indication that the coverage nurse is incompetent.

Rationale 3: There is no evidence that this nurse was not in charge when the error was made.

Rationale 4: By raising the possibility (and being very sure) that the other nurse was in charge, the nurse has created a scapegoat. This is a form of lateral violence.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-1: Identify harassing behaviors, including bullying, incivility, and lateral violence.

Question 19

Type: MCMA

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Continue to be persistent in your work with these nurses.

2. You can fire them at any time.

3. Be fair and consistent with them.

4. You must continuously assess the rest of your staff as you work with these two nurses.

5. You must continue to address the issues with these nurses as they arise.

Correct Answer: 1,3,4,5

Rationale 1: Persistence is a key to being perceived as fair and just.

Rationale 2: Termination practices are governed by strict procedures that must be followed to protect both the manager and the institution.

Rationale 3: Fairness and consistency are keys to being perceived as just.

Rationale 4: The manager must be aware of the impact of marginal nurses on the remainder of the staff.

Rationale 5: The manager cannot ignore any issues that arise with these nurses.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 20

Type: MCSA

Two staff members have a long-standing dislike of one another. Generally they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?

1. Tell the two staff members to go to the managers office immediately.

2. Send both of the employees off the unit.

3. Immediately call for security.

4. Stand between the employees and tell them to calm down.

Correct Answer: 3

Rationale 1: The manager should not try to intervene when physical violence is occurring.

Rationale 2: The manager should not send these employees off the unit. Violence may continue or escalate.

Rationale 3: Security should be notified immediately when physical violence occurs or is imminent.

Rationale 4: The manager should not risk harm to self by standing between these employees.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3: Explain how to manage staff with problem behaviors.

Question 21

Type: MCSA

A nurse constantly complains about employee policies and procedures and frequently mentions how they are out to get us. The nurse is surprised when referred to by the manager as disgruntled during a discussion of this behavior. What information should the manager provide this nurse?

1. People who are constantly complaining decrease the morale of the rest of the unit.

2. You have complained so long, it will be impossible to change your behavior.

3. Being a complainer is a character trait.

4. Your attitude problem makes everyone else in the unit miserable.

Correct Answer: 1

Rationale 1: Disgruntled, complaining employees adversely affect everyone elses morale.

Rationale 2: Complaining is a behavior and it can be changed with time, work, and coaching.

Rationale 3: Complaining is a learned behavior and can be unlearned.

Rationale 4: Complaining is not an attitude problem as much as a learned behavior.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 22

Type: MCSA

A nurse manager has been working with a disgruntled employee for several weeks. Today the employee comes to the managers office with yet another complaint about a new hospital policy. The manager says, I am sick of your complaining. Leave me alone so I can get some work done. What should the manager do now?

1. Firmly shut the office door.

2. Tell the employee to go to human resources with complaints about the policy change.

3. Apologize to the employee for being unprofessional and ask what the issue with the policy is.

4. Tell the employee to go back to work.

Correct Answer: 3

Rationale 1: The manager has made a tactical error and should not just shut the door.

Rationale 2: There is no reason to send the employee to HR.

Rationale 3: The manager must remain professional at all times. In this case, when the manager was not professional, an apology is in order.

Rationale 4: The manager has made a tactical error and should not send this employee back to work.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 23

Type: MCSA

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first?

1. Tell the employee to go home and change.

2. Check the human resources policies regarding appropriate dress.

3. Ask the employee why the shirt was worn to this event.

4. Bring the employee a scrub shirt from surgery to change into.

Correct Answer: 2

Rationale 1: This is not the first step of this process.

Rationale 2: Before the manager does anything else, he or she must be certain that policy backs up the planned actions.

Rationale 3: This is not the first action the manager should take.

Rationale 4: This is not the first action the manager should take.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3: Explain how to manage staff with problem behaviors.

Question 24

Type: MCSA

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, The nurses who smoke always take longer lunches. No one says anything to them. What is the managers major consideration before replying to this statement?

1. Policies must be consistently applied to all employees.

2. Since the hospital is smoke free, those nurses who wish to smoke must leave campus for lunch.

3. This nurse complains about everything.

4. The human resources policy is that nurses get 60 minutes for lunch.

Correct Answer: 1

Rationale 1: No matter the situation, policies must be consistently applied.

Rationale 2: This may be a fact, but it is not relevant to this discussion.

Rationale 3: The fact that this nurse is a known complainer is not relevant to the issue.

Rationale 4: The length of the lunch break is not the most important aspect of this discussion.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3: Explain how to manage staff with problem behaviors.

Question 25

Type: MCSA

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employees competence. Which action by the manager would be appropriate?

1. Discuss the issues at a staff meeting and elicit methods to improve morale.

2. Use progressive discipline to manage the employee.

3. Monitor the staffs performance to determine the lack of civility.

4. Terminate the employee.

Correct Answer: 2

Rationale 1: Discussing the issue of morale and monitoring staff regarding civility will not address the issues regarding the marginal employee.

Rationale 2: Using progressive discipline to manage the employee allows for communication regarding poor performance and allows the employee the opportunity to improve their performance.

Rationale 3: Discussing the issue of morale and monitoring staff regarding civility will not address the issues regarding the marginal employee.

Rationale 4: Terminating the employee does not provide the employee with an opportunity to improve their performance.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Discuss how to handle marginal and disgruntled employees.

Question 26

Type: MCMA

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Chart review on effectiveness of pain control

2. Increase in clients with conditions requiring pain medications

3. Increase in use of doses of as-needed narcotics that results in wastage

4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others

5. Narcotic containers that look as if they have been altered

Correct Answer: 1,3,4,5

Rationale 1: If many clients report their pain is not controlled, diversion may be occurring.

Rationale 2: An increase in clients requiring pain medications is likely census related.

Rationale 3: If the nurse has a choice of doses and is trying to divert medications, a smaller dose might be given resulting in a larger wastage that is then diverted.

Rationale 4: If one shift is giving much more pain medication that the other, it may be because someone is diverting drugs on that shift. It may also mean that inadequate pain control is being given on the other shift because someone is diverting drugs.

Rationale 5: Altering the container is a method of diversion.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 27

Type: MCSA

A nurse admits to diverting narcotic drugs while working. The manager says, All nurses who admit diverting narcotics have to be reported to the state board of nursing. How should the nurse interpret this statement?

1. As true, because any nurse who admits diversion must be reported to the states board of nursing

2. As false, because in some states reporting depends on other factors

3. As beneficial, because the state board of nursing will help the nurse find a substance abuse program

4. As career ending, because the state board of nursing is required to suspend the license of any nurse who admits to diverting drugs

Correct Answer: 2

Rationale 1: This is not universally true.

Rationale 2: In some states if the nurse completes a substance abuse program, reporting is not done.

Rationale 3: This is true in some but not all states.

Rationale 4: This is not a true statement.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 28

Type: MCSA

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?

1. A certified letter outlining the accusation and investigation should be sent to the nurses home.

2. A certified letter outlining the accusation and investigation should be sent to the nurse at work.

3. The nurse should be contacted and asked to make an appointment with the nurse executive without giving cause.

4. The nurse should be approached at work with no prior notice and asked to come to the nurse executives office.

Correct Answer: 4

Rationale 1: Sending a letter to the nurses home will give the nurse opportunity to rationalize the abuse, to create a story, or to develop denial.

Rationale 2: Sending a letter to the nurse at work will give the nurse opportunity to rationalize the abuse, to create a story, or to develop denial.

Rationale 3: If a request to make an appointment with the nurse executive is made, a nurse who is abusing narcotics would likely be suspicious that administration had found out about the abuse.

Rationale 4: This surprise approach minimizes the amount of time the nurse has to create a story or to rationalize the abuse of narcotics.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 29

Type: MCSA

A nurse who has been abusing narcotics is in the nurse executives office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?

1. Health insurances generally pay 100 percent of treatment charges for medical professionals who are seeking help.

2. If you go to treatment, the state board will never know you were abusing.

3. Treatment is your best chance at returning to practice.

4. We will be able to follow your progress through reports from your treatment team.

Correct Answer: 3

Rationale 1: Unfortunately, this is not a true statement.

Rationale 2: Just going to treatment is not sufficient; the nurse must successfully complete treatment. In some states, the state board must be notified regardless of the decision to seek treatment.

Rationale 3: The nurse who successfully completes treatment stands the best chance at successfully reentering practice.

Rationale 4: Unless the nurse gives consent to release of information to the nurse executive, this is not possible.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Question 30

Type: MCSA

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse?

1. Administration reports the nurse to the state board of nursing.

2. The nurse is counseled and asked to participate in a treatment center plan.

3. The nurse is allowed to continue supervised practice while a treatment plan is being devised.

4. The nurse is terminated with no report made.

Correct Answer: 4

Rationale 1: If this occurs, the nurse is likely to be offered some kind of assistance back into health and the profession.

Rationale 2: If the nurse agrees to treatment, help is forthcoming.

Rationale 3: In this case the nurse is supervised and a treatment plan is forthcoming.

Rationale 4: If the nurse is terminated, employment at another facility may occur and the cycle may continue.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-5: Explain how to handle staff with a substance abuse problem.

Sullivan, Effective Leadership and Management, 8/e Test Bank

Copyright 2013 by Pearson Education, Inc.

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