Chapter 9 My Nursing Test Banks

Sullivan, Effective Leadership and Management, 8/e
Chapter 9

Question 1

Type: MCSA

The nurse manager is concerned about a family members complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue?

1. Post a memo to the nursing staff about expected professional behavior.

2. Send an e-mail to the nursing staff about expected professional behavior.

3. Address the complaint with the individual nurse in a telephone conversation.

4. Discuss the complaint with the individual nurse face-to-face.

Correct Answer: 4

Rationale 1: The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy.

Rationale 2: The purpose of e-mail is to broadcast information to large groups; it has a low level of personal intimacy.

Rationale 3: A telephone conversation is less intimate than face-to-face communication, and the individuals response cannot be seen.

Rationale 4: More important or difficult issues should be communicated face-to-face to the nurse involved so that the individuals response can be seen and questions can be answered appropriately.

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: 9-3: Choose which communication mode to use depending on the message and the relationship.

Question 2

Type: MCSA

The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position?

1. Send an e-mail to the nurse manager, requesting a job interview.

2. Send a written letter and rsum in the mail.

3. Call the nurse manager to ask if any jobs are open.

4. Drop into the nurse managers office to discuss employment options.

Correct Answer: 2

Rationale 1: This approach is too informal.

Rationale 2: Applying for a job requires a high level of formality. A written cover letter and rsum are expected by most organizations offering employment opportunities. This submission would be done by e-mail only if that is the organizations specific request.

Rationale 3: This approach is too informal.

Rationale 4: Dropping in to the managers office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the rsum and cover letter are sent.

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: 9-3: Choose which communication mode to use depending on the message and the relationship.

Question 3

Type: MCSA

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate?

1. Lateral communication

2. Downward communication

3. Diagonal communication

4. Grapevine communication

Correct Answer: 3

Rationale 1: Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors).

Rationale 2: Downward communication involves direction given by management to the staff.

Rationale 3: Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing).

Rationale 4: Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 4

Type: MCSA

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect?

1. He will focus more on the issue than on personal experience.

2. He will strive to reach consensus within the group.

3. He will strive to avoid conflict within the group.

4. He will prefer to ask questions rather than make statements.

Correct Answer: 1

Rationale 1: Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences.

Rationale 2: Men can tolerate disagreement within the group.

Rationale 3: Men may be more apt to tolerate conflict than women.

Rationale 4: Women are more apt to ask questions to seek input.

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: 9-1: Identify the factors that influence communication.

Question 5

Type: MCSA

The nurse manager has instituted a policy of sending information to the staff via e-mail. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication?

1. Using text messaging instead of e-mailing

2. Requiring a return e-mail from everyone reading the information

3. Being certain that e-mails go only to the intended recipients

4. Sending all e-mails with a message line that says Important

Correct Answer: 3

Rationale 1: Text messaging can make the problem worse as it implies the need to respond quickly.

Rationale 2: Having everyone send a return e-mail will set the nurse manager up for an onslaught of messages that are really not important.

Rationale 3: E-mail communication is fraught with difficulties. The best of these options is to be certain that e-mails go only to the intended recipients. The use of reply to all or distribution lists is convenient, but can result in sending the e-mail to persons whom it does not affect. When this happens, people begin to ignore e-mail.

Rationale 4: Sending the message line Important with each e-mail is much like crying wolf, and recipients will soon realize that the term Important is meaningless.

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: 9-3: Choose which communication mode to use depending on the message and the relationship.

Question 6

Type: MCSA

The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration?

1. Timing of the request

2. Negative inquiry

3. Compromise

4. Persistence

Correct Answer: 1

Rationale 1: The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive.

Rationale 2: Negative inquiry is used after a request has been denied.

Rationale 3: Compromise occurs after a request has been denied. Persistence and repetition are used after a request has been denied.

Rationale 4: Persistence and repetition are used after a request has been denied.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 7

Type: MCSA

What is the most important reason that excellent communication skills are essential for nurses?

1. Nurses must communicate with all disciplines.

2. All nursing activities occur in relationships.

3. Interpersonal skills get the work done.

4. Good communication ensures no problems occur.

Correct Answer: 2

Rationale 1: While nurses do communicate with all disciplines, the correct reason is broader.

Rationale 2: Nursing activities occurring in relationships make communication skills essential.

Rationale 3: Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader.

Rationale 4: Excellent communication skills do not keep problems from occurring.

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: 9-6: Develop a plan to enhance your communication skills.

Question 8

Type: MCSA

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse?

1. Plan to be more assertive in all communication.

2. Work to manage fear of conflict.

3. First learn to delegate clearly to others.

4. Attend the hospital-based communication training.

Correct Answer: 4

Rationale 1: While being more assertive in communication could help this nurse, this is not the most complete option.

Rationale 2: Working to manage fear of conflict is not the most complete option.

Rationale 3: Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy.

Rationale 4: Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

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: 9-6: Develop a plan to enhance your communication skills.

Question 9

Type: MCSA

Which example represents a qualifier that may interfere with the message to be communicated?

1. Please notify me when this task is complete.

2. Are you satisfied with the care you are receiving?

3. I hate to bother you with this, but we have a problem.

4. How can I help you solve your issues with this physician?

Correct Answer: 3

Rationale 1: This is a direct command or request and does not contain a qualifier.

Rationale 2: This is a valid inquiry that does not include a qualifier.

Rationale 3: Qualifiers are often used as entry statements into important discussions, but they can interfere with the message being communicated. This qualifier (I hate to bother you) sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender.

Rationale 4: This is a valid inquiry and does not include a qualifier.

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: 9-6: Develop a plan to enhance your communication skills.

Question 10

Type: MCSA

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurses work to improve communication?

1. Think about the goals of the communication.

2. Develop an appropriate and thoughtful response.

3. Decide how to say what you want conveyed.

4. Ensure the communication is understood.

Correct Answer: 4

Rationale 1: Thinking about the goals is assessment.

Rationale 2: Developing an appropriate response is an implementation.

Rationale 3: Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan.

Rationale 4: Ensuring all parties understand the communication is the last step as it involves evaluation.

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: 9-6: Develop a plan to enhance your communication skills.

Question 11

Type: MCMA

The nurse has made several near errors in client care in the last 2 months. The nurse manager says, These are simple errors. You just arent listening. How could the nurse improve listening skills in 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. The nurse should try to think ahead about what the person talking is going to say.

2. The nurse should hold eye contact with the speaker at all times.

3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment.

4. The nurse should get sufficient time away from work to rest.

5. The nurse should be careful not to prejudge what the speaker is going to say.

Correct Answer: 3,4,5

Rationale 1: Thinking ahead in conversation interferes with the ability to listen and comprehend.

Rationale 2: Eye contact does not mean the nurse is listening.

Rationale 3: When many people are talking at one time, it is difficult to listen and comprehend.

Rationale 4: Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening.

Rationale 5: Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

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: 9-2: Discuss how communication can be distorted and misunderstood.

Question 12

Type: MCMA

A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem?

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

Standard Text: Select all that apply.

1. Schedule a staff meeting for discussion of the problem and its possible solutions.

2. Post a notice on the bulletin board explaining the issue.

3. Ask nurses individually for input.

4. Develop a possible solution and share it with nurses in a formal meeting.

5. Ask for input via text message and promise to respond to texts immediately.

Correct Answer: 2,3

Rationale 1: Generation X members do not like group problem solving and decision making. This is more the style of baby boomers.

Rationale 2: Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion.

Rationale 3: Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy.

Rationale 4: Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal.

Rationale 5: Generation Y is more likely to want immediate feedback from e-mails or text messages.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 13

Type: MCSA

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement?

1. I know it must be frustrating working with a new charge nurse, but how can we make this situation better?

2. This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it.

3. I know the charge nurse is new to the role, but you should get used to it or there will be more changes.

4. I know the new charge nurse is difficult to work with, but please help make the job easier to do.

Correct Answer: 1

Rationale 1: Acknowledging the persons frustration validates his or her feelings, and asking for input helps makes him or her part of the solution.

Rationale 2: This statement is confrontational and is unlikely to result in a positive response from the employee.

Rationale 3: Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response.

Rationale 4: Patronizing remarks are condescending and are not likely to result in a positive employee response.

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: 9-5: Improve your collaborative communication skills.

Question 14

Type: MCSA

When the nurse manager orders supplies for the unit, which communication mode is best?

1. Telephone

2. E-mail

3. In person

4. Voice mail

Correct Answer: 2

Rationale 1: Telephoning an order leaves room for misinterpretation or inaccuracy in recording what was ordered.

Rationale 2: To avoid misunderstanding of supplies needed, a written request is the most appropriate choice. It avoids misunderstanding, as the needs can be checked off a list.

Rationale 3: A verbal order in person may still result in misfilled orders because there is no written record of what was ordered.

Rationale 4: Voice mail may result in a mistake because there is no written record of what was ordered.

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: 9-3: Choose which communication mode to use depending on the message and the relationship.

Question 15

Type: MCSA

An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted?

1. I know I can better connect with my audience with good eye contact.

2. If I repeat a complicated section in another way, comprehension is improved.

3. If I know the background of the audience, it can help with tailoring the content.

4. The topic is not complicated, so I dont have to worry about misunderstanding.

Correct Answer: 4

Rationale 1: Eye contact can assist in keeping the message clear.

Rationale 2: Repeating the message can assist in keeping the message clear.

Rationale 3: Tailoring the message can assist in keeping it clear.

Rationale 4: It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur.

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: 9-2: Discuss how communication can be distorted and misunderstood.

Question 16

Type: MCSA

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff?

1. Dont forget, you are just as good as they are.

2. Physicians just dont listen as well as nurses.

3. Lets review the steps of the procedures that we know are the biggest problems.

4. Im going to listen to the physicians, but I think most of the problem lies with them, not the nurses.

Correct Answer: 3

Rationale 1: This statement sets up an us against them mentality. This mindset does not support respect for the physicians and could make communication more difficult.

Rationale 2: This statement sets up an us against them mentality. This mindset does not support communication.

Rationale 3: The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them.

Rationale 4: The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 17

Type: MCSA

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?

1. Make sure that anything you say is clear and concise.

2. Dont feel as if you are responsible for fixing every problem.

3. Avoid using phrases such as sort of when talking to females.

4. Dont personalize everything.

Correct Answer: 2

Rationale 1: Males tend to communicate clearly and concisely, especially in professional relationships.

Rationale 2: There are many gender differences in communication. Male tend to take responsibility and feel the need to fix things.

Rationale 3: Using phrases such as sort of is a more common trait of female conversation than of male conversation.

Rationale 4: Women tend to personalize, while men are more focused on the issues.

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: 9-1: Identify the factors that influence communication.

Question 18

Type: MCSA

In which situation should the nurse be most concerned that communication was distorted?

1. The nurse obtains an admission history from the parents of an adopted child.

2. The nurse gives discharge instructions to a couple in their early 80s.

3. The nurse manager hires a new nurse originally from the Philippines.

4. The emergency nurse receives a client who was transferred via ambulance for confusion.

Correct Answer: 4

Rationale 1: Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired.

Rationale 2: Just because a person is older does not mean that communication is impaired.

Rationale 3: Just because the person is from another country does not mean that communication will be distorted.

Rationale 4: Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate.

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: 9-1: Identify the factors that influence communication.

Question 19

Type: MCMA

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly?

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

Standard Text: Select all that apply.

1. Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths.

2. Go to the diet kitchen and get a cup of apple juice for the client in room 2112.

3. Ambulate the clients on the south wing.

4. Do you think youll have time to do shampoos today?

5. It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon.

Correct Answer: 1,2

Rationale 1: Saying Here are your directions alerts the assistant that an important statement is going to be made. The instructions are clear and concise.

Rationale 2: This is a clear and concise set of instructions.

Rationale 3: This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today?

Rationale 4: This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly.

Rationale 5: The nurse should be clear regarding what should be done before instruction is provided.

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: 9-5: Improve your collaborative communication skills.

Question 20

Type: MCSA

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication?

1. Intersender conflict

2. Intrasender conflict

3. Metacommunication

4. Downward communication

Correct Answer: 1

Rationale 1: Intersender conflict occurs when a person receives two conflicting messages from different sources.

Rationale 2: Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning.

Rationale 3: Metacommunication is the combination of oral messages with nonverbal messages.

Rationale 4: Downward communication occurs from manager to staff and is often directive.

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: 9-2: Discuss how communication can be distorted and misunderstood.

Question 21

Type: MCSA

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication?

1. Metacommunication

2. Intrasender conflict

3. Fogging

4. Intersender conflict

Correct Answer: 1

Rationale 1: Metacommunications are nonverbal messages conveyed by body language and environmental factors.

Rationale 2: Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication.

Rationale 3: Fogging is a communication technique in which one partially agrees with what was said.

Rationale 4: Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources.

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: 9-1: Identify the factors that influence communication.

Question 22

Type: MCSA

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, I dont understand why I cant leave early. I will use vacation time and this will help minimize personnel costs for the shift. This statement is an example of which technique of influencing the supervisor?

1. Fogging

2. Negative assertion

3. Negative inquiry

4. Compromise

Correct Answer: 3

Rationale 1: Fogging is a technique used when the person is in partial agreement with what was said.

Rationale 2: Negative assertion involves some acceptance of blame for what was said.

Rationale 3: Negative inquiry is a statement of I dont understand. Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught.

Rationale 4: Compromise implies that an agreement has occurred between the nurse manager and the nurse.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 23

Type: MCMA

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling?

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

Standard Text: Select all that apply.

1. Im sorry, Doctor, but I need for you to repeat the dosage on that medication order.

2. Doctor, what was the dosage on that medication you just ordered, and do you want the client to get up in the chair today?

3. How often did you want the furosemide given?

4. Uh, can you tell me if you need for this client to be NPO today?

5. Doctor, what rate did you want for the IV?

Correct Answer: 3,5

Rationale 1: Saying Im sorry discounts the message.

Rationale 2: The nurse should focus on one point at a time.

Rationale 3: This is a direct statement.

Rationale 4: This statement is weak. Avoid uh and um.

Rationale 5: This is a direct statement, and it starts with a name that gets the physicians attention.

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: 9-5: Improve your collaborative communication skills.

Question 24

Type: MCMA

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor?

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

Standard Text: Select all that apply.

1. I agree it was not effective years ago, but other units have now had success with it.

2. What were your specific concerns about the 12-hour shifts?

3. I think it is unfair to refuse my unit this opportunity based on the past.

4. Why are you always so opposed to change on my unit?

5. If we dont offer alternative staffing patterns, we arent going to be able to attract new hires.

Correct Answer: 1,2

Rationale 1: This is an example of using fogging, or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information.

Rationale 2: Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisors position, but also requires the supervisor to rethink the issue.

Rationale 3: Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational.

Rationale 4: This approach is confrontational.

Rationale 5: Threats, even veiled threats, are confrontational and should not be used.

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: 9-5: Improve your collaborative communication skills.

Question 25

Type: MCMA

A nurse manager is aware that there is a strong grapevine communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities?

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

Standard Text: Select all that apply.

1. The information may be rapidly disseminated.

2. The information may be altered as it moves across the grapevine.

3. Most people try to spread information accurately.

4. Most people do not pay any attention to the grapevine.

5. Professional nurses do not participate in grapevine communication.

Correct Answer: 1,2

Rationale 1: Grapevine communication is often rapid and complete.

Rationale 2: Grapevine communication is often altered as is goes from person to person.

Rationale 3: The grapevine is very prone to distortionsometimes significant distortion.

Rationale 4: Most people do believe or at least attend to the grapevine.

Rationale 5: Grapevine communication crosses all levels of professionalism.

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: 9-2: Discuss how communication can be distorted and misunderstood.

Question 26

Type: MCSA

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person?

1. The hospital administrator discussing next years budget

2. A staff nurse the manager has worked with for 25 years

3. A newly licensed nurse who is hesitant to address the manager

4. A physician discussing prognosis with the client and family

Correct Answer: 2

Rationale 1: The manager will probably pay close attention to the hospital administrator because of the position.

Rationale 2: When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations.

Rationale 3: The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs.

Rationale 4: The nurse manager will likely listen very closely to this conversation without preconceived beliefs.

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: 9-2: Discuss how communication can be distorted and misunderstood.

Question 27

Type: MCSA

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurses next step?

1. Check with the assistant to see how the assignment is going during the time breakfast is served.

2. Check the clients breakfast trays before they are returned to dietary.

3. Check with the clients to see if they had breakfast.

4. At the end of the shift ask the assistant how the clients ate.

Correct Answer: 1

Rationale 1: Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene.

Rationale 2: Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly.

Rationale 3: Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken.

Rationale 4: Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken.

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: 9:4: Explain how communication strategies vary according to the situation and those involved.

Question 28

Type: MCMA

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion?

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 I havent been too careful in keeping personnel costs low, but we are really going to need another position.

2. I dont see why another position cannot be funded. We have met our budget each year for the last 3 years.

3. I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress.

4. I can understand what you said about budget being tight, but we still need the position.

5. Do you not understand how hard my nurses are working?

Correct Answer: 1,3

Rationale 1: Negative assertion occurs when the speaker accepts some of the blame for the situation.

Rationale 2: This is an example of negative inquiry.

Rationale 3: Negative assertion is accepting some of the blame.

Rationale 4: This is an example of fogging.

Rationale 5: This is a confrontational statement and should be avoided.

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: 9-4: Explain how communication strategies vary according to the situation and those involved.

Question 29

Type: MCMA

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda?

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

Standard Text: Select all that apply.

1. Interdisciplinary respect

2. Understanding the role of the physician

3. Understanding the role of the nurse

4. Communication across disciplines

5. Active listening skills

Correct Answer: 2,3,4,5

Rationale 1: This topic is diffuse and hard to understand. More precise topics should be used.

Rationale 2: Role understanding is essential to collaboration. It must include both roles.

Rationale 3: Role understanding is essential to collaboration. It must include both roles.

Rationale 4: Communication is the key to collaboration.

Rationale 5: Listening is an essential part of communication.

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: 9-5: Improve your collaborative communication skills.

Question 30

Type: MCSA

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern?

1. The medium of the message

2. The relationship between the nurse and the receiver of the message

3. The timing of the message

4. What to include in the message

Correct Answer: 2

Rationale 1: The medium of the message is not the first consideration.

Rationale 2: The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make.

Rationale 3: Timing is essential, but it is not the first consideration.

Rationale 4: In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation.

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: 9-6: Develop a plan to enhance your communication skills.

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

Copyright 2013 by Pearson Education, Inc.

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