- A staff nurse is facing a dilemma between upholding personal care standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to:
| a. | avoid applying any pressure to compromise personal values. |
| b. | change their work assignment until the dilemma is resolved. |
| c. | continually remind staff of consequences related to ignoring organizational goals. |
| d. | refer indecisive staff members for additional training. |
ANS: A
An important way in which those in health care facilities and their managers can assist nursing professionals in resolving ethical dilemmas effectively is by neither explicitly nor implicitly pressuring them to go against their own ethical values (Cooper et al., 2003).
DIF: Cognitive Level: Apply (Application) REF: Page 105
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
- One of the two mechanisms that ensures autonomy in the nursing profession is the:
| a. | American Nurses Association (ANA). |
| b. | Department of Health Professionals. |
| c. | Nursing Code of Ethics. |
| d. | Professional Regulatory Board. |
ANS: C
The ANA identified two mechanisms that frame nursing autonomy: the legal regulation of nursing practice via state licensure and the professional regulation of nursing practice via ethical codes of practice.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 94
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the:
| a. | ANA. |
| b. | current federal defense attorney. |
| c. | state nurse practice act. |
| d. | policy and procedure manual of the unit. |
ANS: C
Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.
DIF: Cognitive Level: Apply (Application) REF: Pages 94-95
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The major responsibility for upholding patient care standards belongs to the:
| a. | chief executive officer of the facility. |
| b. | nurse manager. |
| c. | on-call physician. |
| d. | staff nurse providing patient care. |
ANS: B
Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.
DIF: Cognitive Level: Analyze (Analysis) REF: Page 95
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The nursing manager has assumed responsibility for ensuring that tasks within her department are delegated legally and are performed appropriately. In so doing, she has accepted which of the following nursing roles?
| a. | Ethical |
| b. | Ombudsman |
| c. | Paralegal |
| d. | Supervisor |
ANS: D
Supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform.
DIF: Cognitive Level: Analyze (Analysis) REF: Page 95
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The court has found that a registered nurse (RN) harmed a patient by violating his rights. The nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a:
| a. | civil act. |
| b. | criminal act. |
| c. | critical wrong. |
| d. | quality breach. |
ANS: A
By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.
DIF: Cognitive Level: Apply (Application) REF: Page 95
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The most common source of legal liability for nurse managers is a(n):
| a. | medical malpractice suit. |
| b. | organizational nursing issue. |
| c. | tort. |
| d. | vicarious liability. |
ANS: C
The most common source of legal liability for nurses and nurse managers is a tort. Negligent acts or omissions (unintentional torts) and various intentional acts (intentional torts), such as invasion of privacy or assault and battery, commonly arise in clinical nursing practice (Aiken, 2004).
DIF: Cognitive Level: Understand (Comprehension) REF: Page 95
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse’s actions are an example of:
| a. | breach of contract. |
| b. | common negligence. |
| c. | intentional malpractice. |
| d. | medical oversight. |
ANS: B
Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physician’s orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment (Aiken, 2004).
DIF: Cognitive Level: Apply (Application) REF: Page 98
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
- On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse’s actions, the admitting hospital may be found to be:
| a. | a judicial risk. |
| b. | an ostensible authority. |
| c. | indemnified. |
| d. | vicariously liable. |
ANS: D
If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.
DIF: Cognitive Level: Apply (Application) REF: Page 95
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
- On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Being aware of the hospital policy for medication administration, the patient’s blood glucose level presented the nurse with a(n):
| a. | assessment option. |
| b. | clinical choice. |
| c. | ethical dilemma. |
| d. | moral decision. |
ANS: C
Ethical dilemmas require that decisions be made about what is right and wrong in situations in which an individual has to make a choice between equally unfavorable alternatives.
DIF: Cognitive Level: Apply (Application) REF: Page 102
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiological Adaptation
- A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Utilitarianism |
| d. | Confidentiality |
ANS: A
Autonomy refers to the client’s right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families?
| a. | Nonmaleficence |
| b. | Autonomy |
| c. | Beneficence |
| d. | Justice |
ANS: D
Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- “To do good for others” is an example of which ethical principle?
| a. | Nonmaleficence |
| b. | Fidelity |
| c. | Beneficence |
| d. | Confidentiality |
ANS: C
Beneficence means doing good for clients and providing benefit balanced against risk.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle?
| a. | Autonomy |
| b. | Justice |
| c. | Nonmaleficence |
| d. | Confidentiality |
ANS: C
Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
- A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for “happy hour” earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for:
| a. | maleficence. |
| b. | melange. |
| c. | nonmaleficence. |
| d. | nonmelange. |
ANS: A
Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
- The nurse on a medical unit is discussing a client with the case manager. Which of the following shows how the nurse should communicate with the case manager?
| a. | Discussing personal information that the client shared with the nurse in confidence |
| b. | Providing the case manager with any information required for continuity of care |
| c. | Explaining that client confidentiality prevents the nurse from disclosing information |
| d. | Asking the case manager to get the client’s permission before sharing information |
ANS: B
The case manager has a “need to know” to coordinate continuous care. Information that was shared in confidence is not necessary unless it has some bearing on the patient’s care needs. On admission to the hospital, the patient signed a “permission to treat” form, which allows all persons providing care to have information needed to provide the care.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The definition of veracity is:
| a. | being loyal and faithful to commitments and accountable for responsibilities. |
| b. | the norm of telling the truth and not intentionally deceiving or misleading clients. |
| c. | a prohibition of disclosure of information. |
| d. | a right of limited physical or informational inaccessibility. |
ANS: B
Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Nurse managers are able to respond better to ethical dilemmas when they have access to the organization’s:
| a. | mission and vision. |
| b. | patient safety plan. |
| c. | medical staff bylaws. |
| d. | ethics committee. |
ANS: D
It is critical that nurses and administrators have access to and inclusion on the health care organization’s ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 106
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
- Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive (select all that apply)?
| a. | Beneficence |
| b. | Veracity |
| c. | Confidentiality |
| d. | Autonomy |
ANS: A, C
Beneficence means “doing good for clients and providing benefit balanced against risk.” The hospital accountant had no need to know; therefore, there was no benefit for the patient for him to be told. Confidentiality prohibits disclosures of information gained in certain relationships to third parties without the consent of the original source of the information. Without the patient giving express consent, the hospital accountant has no need for this information, and it is a breach of confidentiality.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- An elderly client becomes confused after surgery. He is in a room farthest away from the nurse’s station. The client has been trying to get out of bed several times during the shift. The nurse documents this very well. The client falls out of bed and breaks his hip. Who can possibly be held negligent (select all that apply)?
| a. | Client’s wife |
| b. | Nurse manager |
| c. | Pharmacist |
| d. | Staff RN |
ANS: B, D
It is possible that the nurse and nurse manager could be held negligent. The nurse could be held negligent for not moving the patient closer to the nurse’s station, calling the physician or nurse practitioner for medications or change in medications, or obtaining an order for a vest restraint. The nurse manager may be held negligent because of 24-hour accountability for the care of patients on his or her unit and possible lack of supervision.
DIF: Cognitive Level: Apply (Application) REF: Pages 98-99, 101
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
- Which of the following are examples of intentional torts that may occur in the health care field (select all that apply)?
| a. | Slip and fall in the hospital cafeteria |
| b. | Patient restrained by the neck utilizing the nurse’s arm |
| c. | Ovary removal against the patient’s signed consent |
| d. | Restraining a patient without a physician’s order |
| e. | Hospital-acquired pressure ulcer |
ANS: B, C, D
Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.
DIF: Cognitive Level: Apply (Application) REF: Pages 96-97
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- To establish legal liability on the grounds of malpractice, the injured party must prove which of the following (select all that apply)?
| a. | A duty of care was owed to the injured party. |
| b. | An agreement was made to assume another party’s liability. |
| c. | There was a breach of duty. |
| d. | Causation was present. |
| e. | Actual harm or damages were suffered by the plaintiff. |
ANS: A, C, D, E
These four elements are required to establish legal liability on the grounds of malpractice.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 98
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit (select all that apply)?
| a. | Staffing levels in the medical unit |
| b. | Patient fall with injury |
| c. | Heparin error |
| d. | Failure to utilize rapid response team with change in vital signs |
| e. | Failure to ensure telemetry monitor is on the correct patient |
ANS: B, C, D, E
Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians’ orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 98-99
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
- The nurse manager in a large emergency department utilizes agency nursing for staffing. Which of the following should the nurse manager ensure (select all that apply)?
| a. | Assuming that the agency has reviewed the license status of the individual |
| b. | Considering skills, competency, and knowledge when delegating tasks and supervising actions |
| c. | Ensuring that the staff members are aware of facility policies and procedures |
| d. | Assigning the staff member to the role of mentor and educator |
ANS: B, C
The nurse manager should ensure that the references, credentials, and license status are on record at the time of hiring. A resource person should be assigned to each temporary staff member to serve as role of mentor and help prevent potential problems from occurring because of lack of familiarity with institution routine.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 99
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff (select all that apply)?
| a. | Justice |
| b. | Autonomy |
| c. | Veracity |
| d. | Confidentiality |
ANS: B, C
Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.
DIF: Cognitive Level: Apply (Application) REF: Page 103
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- The ANA’s Code of Ethics for Nurses is used to provide specific advice involving which of the following (select all that apply)?
| a. | How to document a patient fall |
| b. | Decisions about a patient’s right to die |
| c. | How to handle impaired nursing practice |
| d. | Chain of command when a physician does not return pages |
| e. | Handling situations where a client’s needs are beyond the scope of nursing competency |
ANS: B, C, E
The Code identifies and provides specific advice related to practitioner decisions about a client’s right to die, responding to questionable and impaired practice, and handling situations in which a client’s needs are beyond the qualifications and competencies of the nurse.
DIF: Cognitive Level: Apply (Application) REF: Pages 107-108
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Chapter 07: Communication Leadership
Test Bank
MULTIPLE CHOICE
- The art of being able to structure and transmit a message in a way that another can understand easily and accept is:
| a. | articulation. |
| b. | communication. |
| c. | evaluation. |
| d. | pronunciation. |
ANS: B
Communication is the art of being able to structure and transmit a message in a way that another can understand easily and accept.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Unspoken affective or expressive behaviors best describe which type of communication?
| a. | Effective communication |
| b. | Ineffective communication |
| c. | Nonverbal communication |
| d. | Verbal communication |
ANS: C
Nonverbal communication is unspoken. It is composed of affective or expressive behaviors. The effectiveness of verbal communication depends on vocabulary, language, phrases, sentence structure, sentence clarity, rate of speech, diction, tone, rhythm, and volume. Nonverbal behavior includes gestures, facial expression, eye contact, body language, and positioning (Hersey et al., 2008).
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A nursing theory used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being is the:
| a. | Humanizing Nursing Communication Theory (HNCT). |
| b. | situation, background, assessment, and recommendation (SBAR) Communication Theory. |
| c. | Behavioral System Model. |
| d. | Human Relationship Model. |
ANS: A
The HNCT is used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 115-116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as:
| a. | advisement. |
| b. | consultation. |
| c. | persuasion. |
| d. | suggestion. |
ANS: C
Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the following is true about negotiation?
| a. | It commonly results in a win-lose situation. |
| b. | It is aimed at solving problems, conflicts, or disputes. |
| c. | It is used only in contract and labor union disputes. |
| d. | It is the exchanging of favors or trading activity. |
ANS: B
Negotiation is used to solve problems, conflicts, or disputes.
DIF: Cognitive Level: Understand (Comprehension) REF: Pages 112-113
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, “You might want to be cognizant of your nonverbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns.” This preceptor is giving advice about:
| a. | interpersonal communication. |
| b. | clarity. |
| c. | image. |
| d. | intention. |
ANS: A
If the verbal message is clear, but the nonverbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse’s nonverbal behavior may suggest that she is not interested in interacting with the family.
DIF: Cognitive Level: Apply (Application) REF: Page 112
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- In an all-channel network of communication, the information is sent:
| a. | from the next person in command to above or below. |
| b. | in any direction without restrictions. |
| c. | from one person, who passes it on to others. |
| d. | from the boss, who sends selected information back. |
ANS: B
Organizations using an all-channel structure of communication send information in any direction without restrictions. Usually, an association exists between communication patterns and the organizational structure.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 123
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Most audience interpretations for speaker messages are determined by the speaker’s:
| a. | body language and facial expressions. |
| b. | literal words. |
| c. | pitch and volume of speech. |
| d. | vocal quality and tone. |
ANS: A
Research has shown that 55% of audience interpretations for speaker messages are determined by the speaker’s nonverbal communication, such as facial expression and body language; 38% by the speaker’s vocal quality, including tone, pitch, volume, and variation; and 7% by the literal words.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 125
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- _____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction.
| a. | Defensive |
| b. | Disruptive |
| c. | Negotiating |
| d. | Humanizing |
ANS: B
Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 125
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n):
| a. | breach of beneficence. |
| b. | example of maleficence. |
| c. | potential assault and battery charge. |
| d. | violation of the Health Insurance Portability and Accountability Act (HIPAA). |
ANS: D
HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient’s privacy in health care transactions. This is an example of breach of confidentiality.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Interpersonal communication is defined as:
| a. | the conscious intent by one individual to modify the thoughts or behaviors of others. |
| b. | a combination of written and spoken communication. |
| c. | a theory used to describe a manner of communicating. |
| d. | communication between two or more individuals involving face-to-face interaction. |
ANS: D
Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 115
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Whether it is intentional or not, leaders and managers always communicate their:
| a. | attitude. |
| b. | power. |
| c. | spirituality. |
| d. | decisions. |
ANS: A
Leaders and managers always communicate their attitudes, goals, and expectations. Leaders communicate vision and a sense of where they are going and what they expect from their followers.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which communication technique is used to handle patient complaints?
| a. | Persuasion |
| b. | Bargaining |
| c. | Negotiation |
| d. | Nonverbal cues |
ANS: C
Negotiation is used to educate clients and other professionals about nurses’ roles and contributions, to interact with vendors, and to deal with patient and client complaints.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 113
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Patterns of communication where assertiveness and confrontation are the norm will create a relationship of:
| a. | congruity. |
| b. | trust. |
| c. | listening. |
| d. | separation. |
ANS: D
As one moves to communicate with patterns of interaction that include assertiveness, confrontation, and conflict, perceptions will increasingly differ and ultimately end the relationship in separation.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Interpersonal communication that recognizes an individual’s human characteristics and addresses the health care issue with dignity and respect is called:
| a. | dehumanizing. |
| b. | humanizing. |
| c. | persuasion. |
| d. | bargaining. |
ANS: B
To humanize means to recognize the individual’s human characteristics and to address the presented health care issues with dignity and respect. To implement the spiritual aspect of holistic health care, concerted effort is needed by health care leaders in both education and practice to guide people in a careful exploration of interpersonal communication processes that are known to promote humanizing relationships not only between the nurse and client but also between and among health care colleagues.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 119
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the following reported a survey indicating the role that intimidation plays in the safe administration of medications?
| a. | Workplace Bullying and Trauma Institute |
| b. | Institute for Safe Medication Practices |
| c. | American Nurses Association |
| d. | HNCT |
ANS: B
The Institute for Safe Medication Practices reported a survey indicating the role that intimidation plays in the safe administration of medications.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 124
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
- Effective communication is fostered through which of the following ingredients (select all that apply)?
| a. | Trust |
| b. | Humility |
| c. | Respect |
| d. | Empathy |
| e. | Sympathy |
ANS: A, C, D
Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the following patterns of communication are utilized in HNCT (select all that apply)?
| a. | Detaching |
| b. | Communing |
| c. | Confronting |
| d. | Conflicting |
| e. | Negotiation |
ANS: B, C, D
The communication patterns of interaction are conveyed with an attitude that can be identified on the humanizing–dehumanizing continuum with HNCT. These include communing, asserting, confronting, conflicting, and separating.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- A client’s wife is concerned about her husband’s declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed “no breathing machine” for long-standing care, but she is unsure of his wishes if he were to need a “breathing machine” for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client’s physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client’s concerns with the rest of the team. What type of communication technique is being utilized by the nurse (select all that apply)?
| a. | Bargaining |
| b. | Negotiation |
| c. | Persuasion |
| d. | Spiritual assessment |
| e. | Collective action |
ANS: B, C
Persuasion and negotiation are used to ensure that all members of the team work together in a cooperative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.
DIF: Cognitive Level: Apply (Application) REF: Pages 112-113
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the following are examples of patient privacy or security breaches (select all that apply)?
| a. | Encrypted e-mail communications |
| b. | Fax transmission sent to incorrect physician office |
| c. | Prescription given to patient with wrong label attached |
| d. | Case management coordinator obtaining information about a patient’s diagnosis |
| e. | Discharge summary given to patient’s spouse |
ANS: B, C
Fax transmissions sent to the incorrect physician’s office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- During times of extreme crisis, what types of communication can be expected (select all that apply)?
| a. | Employees prefer to obtain communication from external sources. |
| b. | Normal communication flows are disrupted. |
| c. | Managers should remain at home to decrease the number of personnel on scene. |
| d. | Managers and leaders should stay focused on the business. |
| e. | Managers and leaders have a contingency and disaster plan in place. |
ANS: B, D, E
In times of extreme crisis, internal communication to employees takes precedence. It is important for leaders to be on the scene to lead, make decisions, and show compassion. Leaders choose communication channels carefully, because normal flows are often disrupted. Managers stay focused on the business at hand and have a contingency and disaster plan in place.
DIF: Cognitive Level: Apply (Application) REF: Page 114
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which of the dimensions of spirituality should nurses be responsible for in care delivery (select all that apply)?
| a. | Culture |
| b. | Beliefs |
| c. | Values |
| d. | Meanings |
| e. | Goals |
ANS: B, C, D, E
Although definitions of spirituality are endless, nurses need to be responsible for five dimensions: beliefs, values, meanings, goals, and relationships.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 115
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Numerous theories of communication are in place for use in nursing practice. What are some of the humanizing attitudes that are used in promoting relationships (select all that apply)?
| a. | Authenticity |
| b. | Monologue |
| c. | Equality |
| d. | Individual |
| e. | Tolerance |
ANS: A, C, D
Authenticity, equality, and individual are attitudes that promote relationships and communication.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Situational leadership focuses on three competencies deemed necessary for a leader’s success. Which of the following are correct statements (select all that apply)?
| a. | Communicating is a behavioral competency. |
| b. | Communicating is a process competency. |
| c. | Diagnosing is a behavioral competency. |
| d. | Diagnosing is a cognitive competency. |
| e. | Adapting is a behavioral competency. |
ANS: B, D, E
Situational leadership focuses on the following three competencies deemed necessary for success. Diagnosing is a cognitive—or cerebral—competency. It is the understanding of what the situation is now and knowing what it can reasonably be expected to be in the future. The discrepancy between the two is the problem to be solved. This discrepancy is what the other competencies are aimed at resolving. Adapting is a behavioral competency. It involves adapting behavior and other resources in a way that helps close the gap between the current situation and what the leader wishes to achieve. Communicating is a process competency. Leaders need to communicate effectively. If leaders cannot communicate in a way that people can understand and accept, they will be unlikely to meet their goals.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 121
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness (select all that apply)?
| a. | Members are organized and secure about their roles in the forming stage. |
| b. | At the forming stage, the group needs direction in defining goals. |
| c. | During the storming period, there is more willingness to accept the group goals. |
| d. | The group becomes self-managing during the norming period. |
| e. | During the performing period, the members willingly perform the task. |
ANS: B, C, E
At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 122-123
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
- Which are characteristics of interpersonal communication (select all that apply)?
| a. | Communication is unavoidable. |
| b. | Each person has an independent role as sender or receiver of messages. |
| c. | The sender and receiver are dependent in interpersonal communication. |
| d. | Interpersonal communication is the means by which we confirm and validate self. |
| e. | Interpersonal communication is irreversible and unrepeatable. |
ANS: A, D, E
Communication is unavoidable and inevitable when people are aware of one another. Each person assumes roles as both sender and receiver of messages in interpersonal communication. In interpersonal communication, the sender and the receiver are interdependent. Interpersonal communication is the means by which we confirm and validate self. Interpersonal communication is irreversible and unrepeatable and almost always functions in a context of change.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 121
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
