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1. Katherine is a young Unit Manager of the Pediatric Ward.

Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? 1. Identify the source of the conflict and understand the points of friction 2. Disregard what she feels and continue to work independently 3. Seek help from the Director of Nursing 4. Quit her job and look for another employment. 2. As a young manager, she knows that conflict occurs in any organization. Which of the following statements regarding conflict is NOT true? 1. Can be destructive if the level is too high 2. Is not beneficial; hence it should be prevented at all times 3. May result in poor performance 4. May create leaders 3. Katherine tells one of the staff, I dont have time to discuss the matter with you now. See me in my office later when the latter asks if they can talk about an issue. Which of the following conflict resolution strategies did she use? 1. Smoothing 2. Compromise 3. Avoidance 4. Restriction 4. Kathleen knows that one of her staff is experiencing burnout. Which of the following is the best thing for her to do? 1. Advise her staff to go on vacation. 2. Ignore her observations; it will be resolved even without intervention 3. Remind her to show loyalty to the institution. 4. Let the staff ventilate her feelings and ask how she can be of help. 5. She knows that performance appraisal consists of all the following activities EXCEPT: 1. Setting specific standards and activities for individual performance. 2. Using agency standards as a guide. 3. Determine areas of strength and weaknesses 4. Focusing activity on the correction of identified behavior. 6. Which of the following statements is NOT true about performance appraisal? 1. Informing the staff about the specific impressions of their work help improve their performance. 2. A verbal appraisal is an acceptable substitute for a written report 3. Patients are the best source of information regarding personnel appraisal. 4. The outcome of performance appraisal rests primarily with the staff.

7. There are times when Katherine evaluates her staff as she makes her daily rounds. Which of the following is NOT a benefit of conducting an informal appraisal? 1. The staff member is observed in natural setting. 2. Incidental confrontation and collaboration is allowed. 3. The evaluation is focused on objective data systematically. 4. The evaluation may provide valid information for compilation of a formal report. 8. She conducts a 6-month performance review session with a staff member. Which of the following actions is appropriate? 1. She asks another nurse to attest the session as a witness. 2. She informs the staff that she may ask another nurse to read the appraisal before the session is over. 3. She tells the staff that the session is manager-centered. 4. The session is private between the two members. 9. Alexandra is tasked to organize the new wing of the hospital. She was given the authority to do as she deems fit. She is aware that the director of nursing has substantial trust and confidence in her capabilities, communicates through downward and upward channels and usually uses the ideas and opinions of her staff. Which of the following is her style of management? 1. Benevolent authoritative 2. Consultative 3. Exploitive-authoritative 4. Participative 10. She decides to illustrate the organizational structure. Which of the following elements is NOT included? 1. Level of authority 2. Lines of communication 3. Span of control 4. Unity of direction 11. She plans of assigning competent people to fill the roles designed in the hierarchy. Which process refers to this? 1. Staffing 2. Scheduling 3. Recruitment 4. Induction 12. She checks the documentary requirements for the applicants for staff nurse position. Which one is NOT necessary? 1. Certificate of previous employment 2. Record of related learning experience (RLE) 3. Membership to accredited professional organization 4. Professional identification card

13. Which phase of the employment process includes getting on the payroll and completing documentary requirements? 1. Orientation 2. Induction 3. Selection 4. Recruitment 14. She tries to design an organizational structure that allows communication to flow in all directions and involve workers in decision making. Which form of organizational structure is this? 1. Centralized 2. Decentralized 3. Matrix 4. Informal 15. In a horizontal chart, the lowest level worker is located at the 1. Left most box 2. Middle 3. Right most box 4. Bottom 16. She decides to have a decentralized staffing system. Which of the following is an advantage of this system of staffing? 1. greater control of activities 2. Conserves time 3. Compatible with computerization 4. Promotes better interpersonal relationship 17. Aubrey thinks about primary nursing as a system to deliver care. Which of the following activities is NOT done by a primary nurse? 1. Collaborates with the physician 2. Provides care to a group of patients together with a group of nurses 3. Provides care for 5-6 patients during their hospital stay. 4. Performs comprehensive initial assessment 18. Which pattern of nursing care involves the care given by a group of paraprofessional workers led by a professional nurse who take care of patients with the same disease conditions and are located geographically near each other? 1. Case method 2. Modular nursing 3. Nursing case management 4. Team nursing 19. St. Raphael Medical Center just opened its new Performance Improvement Department. Ms. Valencia is appointed as the Quality Control Officer. She commits herself to her new role and plans her strategies to realize the goals and objectives of the department. Which of the following is a primary task that they should perform to have an effective control system?

1. Make an interpretation about strengths and weaknesses 2. Identify the values of the department 3. Identify structure, process, outcome standards & criteria 4. Measure actual performances 20. Ms. Valencia develops the standards to be followed. Among the following standards, which is considered as a structure standard? 1. The patients verbalized satisfaction of the nursing care received 2. Rotation of duty will be done every four weeks for all patient care personnel. 3. All patients shall have their weights taken recorded 4. Patients shall answer the evaluation form before discharge 21. When she presents the nursing procedures to be followed, she refers to what type of standards? 1. Process 2. Outcome 3. Structure 4. Criteria 22. The following are basic steps in the controlling process of the department. Which of the following is NOT included? 1. Measure actual performance 2. Set nursing standards and criteria 3. Compare results of performance to standards and objectives 4. Identify possible courses of action 23. Which of the following statements refers to criteria? 1. Agreed on level of nursing care 2. Characteristics used to measure the level of nursing care 3. Step-by-step guidelines 4. Statement which guide the group in decision making and problem solving 24. She wants to ensure that every task is carried out as planned. Which of the following tasks is NOT included in the controlling process? 1. Instructing the members of the standards committee to prepare policies 2. Reviewing the existing policies of the hospital 3. Evaluating the credentials of all nursing staff 4. Checking if activities conform to schedule 25. Ms. Valencia prepares the process standards. Which of the following is NOT a process standard? 1. Initial assessment shall be done to all patients within twenty four hours upon admission. 2. Informed consent shall be secured prior to any invasive procedure 3. Patients reports 95% satisfaction rate prior to discharge from the hospital. 4. Patient education about their illness and treatment shall be provided for all patients and their families. 26. Which of the following is evidence that the controlling process is effective?

1. The things that were planned are done 2. Physicians do not complain. 3. Employees are contended 4. There is an increase in customer satisfaction rate. 27. Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to: 1. Span of control 2. Unity of command 3. Carrot and stick principle 4. Esprit d corps 28. She notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority? 1. Evaluate the overall result of the unrest 2. Initiate a group interaction 3. Develop a plan and implement it 4. Identify external and internal forces. 29. Kevin is a member of the Nursing Research Council of the hospital. His first assignment is to determine the level of patient satisfaction on the care they received from the hospital. He plans to include all adult patients admitted from April to May, with average length of stay of 3-4 days, first admission, and with no complications. Which of the following is an extraneous variable of the study? 1. Date of admission 2. Length of stay 3. Age of patients 4. Absence of complications 30. He thinks of an appropriate theoretical framework. Whose theory addresses the four modes of adaptation? 1. Martha Rogers 2. Sr. Callista Roy 3. Florence Nightingale 4. Jean Watson 31. He opts to use a self-report method. Which of the following is NOT TRUE about this method? 1. Most direct means of gathering information 2. Versatile in terms of content coverage 3. Most accurate and valid method of data gathering 4. Yields information that would be difficult to gather by another method 32. Which of the following articles would Kevin least consider for his review of literature? 1. Story-Telling and Anxiety Reduction Among Pediatric Patients 2. Turnaround Time in Emergency Rooms 3. Outcome Standards in Tertiary Health Care Institutions

4. Environmental Manipulation and Client Outcomes 33. Which of the following variables will he likely EXCLUDE in his study? 1. Competence of nurses 2. Caring attitude of nurses 3. Salary of nurses 4. Responsiveness of staff 34. He plans to use a Likert Scale to determine 1. degree of agreement and disagreement 2. compliance to expected standards 3. level of satisfaction 4. degree of acceptance 35. He checks if his instruments meet the criteria for evaluation. Which of the following criteria refers to the consistency or the ability to yield the same response upon its repeated administration? 1. Validity 2. Reliability 3. Sensitivity 4. Objectivity 36. Which criteria refer to the ability of the instrument to detect fine differences among the subjects being studied? 1. Sensitivity 2. Reliability 3. Validity 4. Objectivity 37. Which of the following terms refer to the degree to which an instrument measures what it is supposed to be measure? 1. Validity 2. Reliability 3. Meaningfulness 4. Sensitivity 38. He plans for his sampling method. Which sampling method gives equal chance to all units in the population to get picked? 1. Random 2. Accidental 3. Quota 4. Judgment 39. Raphael is interested to learn more about transcultural nursing because he is assigned at the family suites where most patients come from different cultures and countries. Which of the following designs is appropriate for this study? 1. Grounded theory 2. Ethnography 3. Case study

4. Phenomenology 40. The nursing theorist who developed transcultural nursing theory is 1. Dorothea Orem 2. Madeleine Leininger 3. Betty Newman 4. Sr. Callista Roy

An unlicensed assistive personnel (UAP), who usually works on a surgical unit is assigned to float to a pediatric unit. Which question by the charge nurse would be most appropriate when making

delegation decisions? A) "How long have you been a UAP and what units you have worked on?" B) "What type of care do you give on the surgical unit and what ages of clients?" C) "What is your comfort level in caring for children and at what ages?" D) "Have you reviewed the list of expected skills you might need on this unit?" The correct answer is D: "Have you reviewed the list of expected skills you might need on this unit?" The UAP must be competent to accept the delegated task. Review of skills needed versus level of performance is the most efficient and effective way to determine this. Question Number 2 of 20 A client is admitted with a diagnosis of schizophrenia. The client refuses to take medication and states I dont think I need those medications. They make me too sleepy and drowsy. I insist that you explain their use and side effects. The nurse should understand that A) a referral is needed to the psychiatrist who is to provide the client with answers B) the client has a right to know about the prescribed medications C) such education is an independent decision of the individual nurse whether or not to teach clients about their medications D) clients with schizophrenia are at a higher risk of psychosocial complications when they know about their medication side effects The correct answer is B: The client has a right to know about the prescribed medications Clients have a right to informed consent which includes information about medications, treatments, and diagnostic studies. A client continuously calls out to the nursing staff when anyone passes the clients door and asks them to do something in the room. The best response by the charge nurse would be to A) keep the clients room door cracked to minimize the distractions B) assign 1 of the nursing staff to visit the client regularly C) reassure the client that 1 staff person will check frequently if the client needs anything D) arrange for each staff member to go into the clients room to check on needs every hour on the hour The correct answer is B: Assign 1 of the nursing staff to visit the client regularly Regular, frequent, planned contact by 1 staff member provides continuity of care and communicates to the client that care will be available when needed. Question Number 4 of 20 Which task could be safely delegated by the nurse to an unlicensed assistive personnel (UAP)? A) Be with a client who self-administers insulin B) Cleanse and dress a small decubitus ulcer C) Monitor a client's response to passive range of motion exercises D) Apply and care for a client's rectal pouch The correct answer is D: Apply and care for a client''s rectal pouch The RN may delegate the application and care of rectal pouches to a UAP. This is an uncomplicated, routine task.

Question Number 5 of 20 After working with a client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that demanding client. I just cant do anything that pleases him. Im not going in there again." The nurse should respond by saying A) "He has a lot of problems. You need to have patience with him." B) "I will talk with him and try to figure out what to do." C) "He may be scared and taking it out on you. Let's talk to figure out what to do." D) "Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day." The correct answer is C: "He may be scared and taking it out on you. Let''s talk to figure out what to do." This response explains the client''s behavior without belittling the UAPs feelings. The UAP is encouraged to contribute to the plan of care to help solve the problem. Question Number 6 of 20 Which statement by the nurse is appropriate when directing an unlicensed assistive personnel (UAP) to assist a 69 year-old surgical client to ambulate for the first time? A) "Have the client sit on the side of the bed for at least 2 minutes before helping him stand." B) "If the client is dizzy on standing, ask him to take some deep breaths." C) "Assist the client to the bathroom at least twice on this shift." D) "After you assist him to the chair, let me know how he feels." The correct answer is A: "Have the client sit on the side of the bed for at least 2 minutes before helping him stand." Give clear information to the UAP about what is expected for client safety. Question Number 7 of 20 A nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse? A client with A) a Dopamine drip IV with vital signs monitored every 5 minutes B) a myocardial infarction that is free from pain and dysrhythmias C) a tracheotomy of 24 hours in some respiratory distress D) a pacemaker inserted this morning with intermittent capture The correct answer is B: A myocardial infarction that is free from pain and dysrhythmias This client is the most stable with minimal risk of complications or instability. The nurse can utilize basic nursing skills to care for this client. Question Number 8 of 20 The unlicensed assistive personnel (UAP) reports a sudden increase in temperature to 101 degrees Fahrenheit for a post surgical client. The nurse checks on the clients condition and observes a cup of steaming coffee at the bedside. What instructions are appropriate to give to the UAP? A) Encourage oral fluids to prevent dehydration B) Recheck temperature 15 minutes after removing hot liquids from the bedside C) Ask the client to drink only cold water and juices D) Chart this temperature elevation on the flow sheet The correct answer is B: Recheck temperature 15 minutes after removing hot liquids from the bedside

Recheck temperature to eliminate possible artificial elevation of temperature. Hot liquids, smoking, eating, chewing gum, and talking can all elevate temperature. Waiting to take the temperature for 15 minutes will help the temperature return to its normal, in order to get an accurate reading. Avoid premature assumptions about explanations for findings. The other options are incorrect. Question Number 9 of 20 A client asks the nurse to call the police and states: I need to report that I am being abused by a nurse. The nurse should first A) focus on reality orientation to place and person B) assist with the report of the clients complaint to the police C) obtain more details of the clients claim of abuse D) document the statement on the clients chart with a report to the manager The correct answer is C: Obtain more details of the clients claim of abuse The advocacy role of the professional nurse as well as the legal duty of the reasonable prudent nurse requires the investigation of claims of abuse or violation of rights. The nurse is legally accountable for actions delegated to others. The application of the nursing process requires that the nurse gather more information, further assessment, before documentation or the reporting of the complaint. Question Number 10 of 20 When assessing a client, it is important for the nurse to be informed about cultural issues related to the client's background because A) normal patterns of behavior may be labeled as deviant, immoral, or insane B) the meaning of the client's behavior can be derived from conventional wisdom C) personal values will guide the interaction between persons from 2 cultures D) the nurse should rely on her knowledge of different developmental mental stages The correct answer is A: Normal patterns of behavior may be labeled as deviant, immoral, or insane Culture is an important variable in the assessment of individuals. To work effectively with clients, the nurse must be aware of a cultural distinctive qualities. Question Number 11 of 20 The charge nurse is planning assignments on a medical unit. Which client should be assigned to the practical nurse (PN)? A) Test a stool specimen for occult blood B) Assist with the ambulation of a client with a chest tube system C) Irrigate and redress a leg wound D) Admit a client from the emergency room The correct answer is C: Irrigate and redress a leg wound The PN is a licensed provider and can perform this complex task. Options A and B could be delegated to an unlicensed assistive personnel (UAP), and option D requires an RN. Question Number 12 of 20 A client with a diagnosis of bipolar disorder has been referred to a local boarding home for consideration for placement. The social worker telephoned the hospital unit for information about the clients mental status and adjustment. The appropriate response of the nurse should be which of these statements? A) "I am sorry. Referral information can only be provided by the clients providers" B) "I can never give any information out by telephone. How do I know who you are?"

C) "Since this is a referral, I can give you this information" D) "I need to get the clients written consent before I release any information to you" The correct answer is D: "I need to get the clients written consent before I release any information to you" In order to release information about a client there must be a signed consent form with designation of to whom information can be given, and what information can be shared. Question Number 13 of 20 A client has a nasogastric tube after colon surgery. Which one of these tasks can be safely delegated to an unlicensed assistive personnel (UAP)? A) To observe the type and amount of nasogastric tube drainage B) Monitor the client for nausea or other complications C) Irrigate the nasogastric tube with the ordered irrigant D) Perform nostril and mouth care The correct answer is D: Perform nostril and mouth care Skin care around a nasogastric tube is a routine task that is appropriate for UAPs. The other tasks would be appropriate for a PN or RN to do since they are advanced skills or require evaluation. Question Number 14 of 20 A client frequently admitted to the locked psychiatric unit repeatedly compliments and invites one of the nurses to go out on a date. The nurses response should be to A) ask to not be assigned to this client or to work on another unit B) tell the client that such behavior is inappropriate C) inform the client that hospital policy prohibits staff to date clients D) discuss the boundaries of the therapeutic relationship with the client The correct answer is D: Discuss the boundaries of the therapeutic relationship with the client The nurse-client relationship is one with professional not social boundaries. Consistent adherence to the limits of the professional relationship builds trust. Question Number 15 of 20 The nursing student is discussing with a preceptor the delegation of tasks to an unlicensed assistive personnel (UAP). Assigning which of these tasks to a UAP indicates the student needs further teaching about the delegation process? A) Assist a client post cerebral vascular accident to ambulate B) Feed a 2 year-old in balanced skeletal traction C) Care for a client with discharge orders D) Collect a sputum specimen for acid fast bacillus The correct answer is C: Care for a client with discharge orders A registered nurse (RN) is the best person to do teaching or evaluation that is needed at time of discharge. Question Number 16 of 20 The nurse receives a report on an older adult client with middle stage dementia. What information suggests the nurse should do immediate follow up rather than delegate care to the nursing assistant? The client A) has had a change in respiratory rate by an increase of 2 breaths

B) has had a change in heart rate by an increase of 10 beats C) was minimally responsive to voice and touch D) has had a blood pressure change by a drop in 8 mmHg systolic The correct answer is C: was minimally responsive to voice and touch A change in level of consciousness indicates delirium related to acute illness. This would require the assessment of a nurse. The other changes could occur within the range of normal fluctuations. Question Number 17 of 20 A client tells the nurse, "I have something very important to tell you if you promise not to tell." The best response by the nurse is A) "I must document and report any information." B) "I cant make such a promise." C) "That depends on what you tell me." D) "I must report everything to the treatment team." The correct answer is B: "I cant make such a promise." Secrets are inappropriate in therapeutic relationships and are counter productive to the therapeutic efforts of the interdisciplinary team. Secrets may be related to risk for harm to self or others. The nurse honors and helps clients to understand rights, limitations, and boundaries regarding confidentiality Question Number 18 of 20 The nurse is caring for a 69 year-old client with a diagnosis of hyperglycemia. Which tasks could the nurse delegate to the unlicensed assistive personnel (UAP)? A) Test blood sugar every 2 hours by Accu-Check B) Review with family and client signs of hyperglycemia C) Monitor for mental status changes D) Check skin condition of lower extremities Your response was "A". The correct answer is A: Test blood sugar every 2 hours by Accu-Check The UAP can do standard, unchanging procedures. Question Number 19 of 20 The nurse is responsible for several elderly clients, including a client on bed rest with a skin tear and hematoma from a fall 2 days ago. What is the best care assignment for this client? A) Assign an RN to provide total care of the client B) Assign a nursing assistant to help the client with self-care activities C) Delegate complete care to an unlicensed assistive personnel D) Supervise a nursing assistant for skin care Your response was "A". The correct answer is D: Supervise a nursing assistant for skin care The nursing assistant can inspect the skin while giving hygiene care, but the nurse should supervise skin care since assessment and analysis are needed. Question Number 20 of 20 A nurse is working with one licensed practical nurse (PN), a student nurse and an unlicensed assistive personnel (UAP). Which newly admitted clients would be most appropriate to assign to the UAP? A) A 76-year-old client with severe depression B) A middle-aged client with an obsessive compulsive disorder

C) An adolescent with dehydration and anorexia D) A young adult who is a heroin addict in withdrawal with hallucinations The correct answer is B: A middle-aged client with an obsessive compulsive disorder The UAP can be assigned to care for a client with a chronic condition after an initial assessment by the nurse. This client has minimal risk of instability of condition