Leadership And Nursing Care Management 5th Edition By Diane Huber -Test Bank

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Leadership And Nursing Care Management 5th Edition By Diane Huber -Test Bank

Chapter 02: Change and Innovation

Test Bank

 

MULTIPLE CHOICE

 

  1. A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of:
a. emergent change.
b. planned change.
c. transformation.
d. innovation.

 

 

ANS:  B

Planned change is a decision to make a deliberate effort to improve a system.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 38

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The use of a new idea or method is the definition of:
a. change.
b. innovation.
c. resistance.
d. stereotyping.

 

 

ANS:  B

Innovation is the use of a new idea or method.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 38

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and roll-out of the new electronic system. The CNO could be viewed as the:
a. resistor.
b. innovator.
c. change agent.
d. strategist.

 

 

ANS:  C

The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 38

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate?
a. First-order change
b. Second-order change
c. Emergent change
d. Organizational change

 

 

ANS:  A

First-order change occurs in a stable system and is characterized by rational stepwise processes. It is useful for smaller scale changes at a unit-based level. Adaptation and adjustment occurs when nursing uses a new evidence-based protocol and puts it into practice.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 39

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Physiological Adaptation

 

  1. How is the refreezing stage of change similar to the nursing process?
a. Refreezing is similar to the assessment phase of the nursing process.
b. Refreezing is similar to the problem identification phase of the nursing process.
c. Refreezing is like the planning and implementation phase of the nursing process.
d. Refreezing is like evaluation in the nursing process.

 

 

ANS:  D

Refreezing is like evaluation in the nursing process.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 41

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo?
a. Complexity
b. Compatibility
c. Trialability
d. Relative advantage

 

 

ANS:  D

Relative advantage is one of the factors that helps determine successful planned change. It is the degree to which the change is thought to be better than the status quo.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 43

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The _____ is a tool which is useful in assessing the readiness for organizational change.
a. Organizational Change-Readiness Scale (OCRS)
b. five-dimensional scale
c. Rapid Cycle Change
d. plan-do-study-act model

 

 

ANS:  A

The OCRS is a 76-item inventory that is used to analyze the ability of an organization to manage change effectively. There are five dimensions that are a part of this assessment tool.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 46

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of:
a. rapid response teams.
b. Failure Modes and Effects Analysis.
c. root cause analysis.
d. Rapid Cycle Change.

 

 

ANS:  D

Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on the idea that changes are tried on a small scale to see how they work.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 46

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued?
a. “These changes need to be made because the state and CMS require it.”
b. “We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building.”
c. “We need to make this change because it will help our lawsuit.”
d. “This change is being made so that there is no further harm to another patient.”

 

 

ANS:  D

Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 46

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. _____ is an expected part of change and is often related to fear and anxiety.
a. Depression
b. Resistance
c. Acceptance
d. Denial

 

 

ANS:  B

Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 46

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change?
a. Early adopters
b. Late majority
c. Innovators
d. Laggards

 

 

ANS:  D

Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 43

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A process of intentional intervention to create something new is called:
a. altered direction.
b. organizational flux.
c. planned change.
d. status revision.

 

 

ANS:  C

Planned change is defined as a process of intentional intervention to create something new. From an organizational perspective, planned change is a decision to make a deliberate effort to improve the system.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 45

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The most difficult to change is:
a. attitudes.
b. group behavior.
c. knowledge.
d. individual behavior.

 

 

ANS:  B

Group behavior and performance changes are the most difficult to change and take the longest time.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 48

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts?
a. Budget-oriented change
b. Transformation
c. Resistance
d. Emergent change

 

 

ANS:  B

Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 38

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The first stage of planned change involves:
a. accepting the need for change.
b. cognitive redefinition.
c. integration and stabilization.
d. problem solving.

 

 

ANS:  A

Change must begin with an awareness of the need for change, and end with a general acceptance of the necessity of change.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 41

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The identification of forces that drive and restrain change is called a(n):
a. equilibrium evaluation.
b. force field analysis.
c. status quo analysis.
d. refreezing system.

 

 

ANS:  B

Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 42

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager’s actions characterize her as a(n):
a. change agent.
b. implementation expert.
c. restructuring motivator.
d. supervisory threat.

 

 

ANS:  A

The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

 

DIF:    Cognitive Level: Understand (Comprehension)               REF:   Page 43

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A nurse manager recognizes that her staff’s emotional responses to organizational change are similar to:
a. adaptation techniques.
b. integrative tactics.
c. symptoms of mental illness.
d. the grief model.

 

 

ANS:  D

The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 47

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A memo sent to the unit nurse manager reads that beginning next week, all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that she needs to use her positional power to trigger a(n) _____ change cycle.
a. automatic
b. directive
c. participative
d. positional

 

 

ANS:  B

A directive change cycle occurs when a change is imposed by some external force.

 

DIF:    Cognitive Level: Understand (Comprehension)               REF:   Page 48

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take?
a. Give 2 weeks’ notice and begin seeking employment at another hospital.
b. Discuss the situation with the nursing manager who interviewed him.
c. Talk to other employees about the staffing situation.
d. Notify the charge nurse that this was not what was explained to him prior to employment.

 

 

ANS:  B

The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Pages 46-48

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The nurse manager on a medical-surgical unit wants to change to “walking rounds” in the patients’ rooms for change of shift report. In the past, it has been “face to face” at the nurses’ station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses’ acceptance of this change?
a. Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this.
b. Inform all nurses that to reach Magnet status, this type of change of shift report is required.
c. Ask the nurses to participate in the planning and implementation of the change.
d. Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

 

 

ANS:  C

Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.

 

DIF:    Cognitive Level: Analyze (Analysis)                                         REF:    Pages 37-38

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. Which of the following statements are accurate descriptors regarding change (select all that apply)?
a. Organization-wide change is more sustainable when leadership imposes the change.
b. Change within an organization is often externally imposed.
c. Change within an organization may originate internally.
d. Nurses do not need to participate actively in the organizational changes.
e. Change is often complex and irrational.

 

 

ANS:  B, C, E

Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Pages 37-38

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations (select all that apply)?
a. Learning is conducted in individual parts rather than in groups.
b. Viewing the organization as an interrelated system is known as systems thinking.
c. Individuals utilize mental models to understand how their vision affects their decisions and actions.
d. Shared vision is conducted within a group to determine plans to get to the preferred future.
e. Personal mastery encourages individuals to create results as they see fit.

 

 

ANS:  B, C, D

Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 40

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members (select all that apply)?
a. Reframe difficult questions.
b. Communicate facts through e-mail.
c. Provide active listening.
d. Promote action steps and solutions.
e. Keep staff informed of decisions.
f. Communicate with participation.

 

 

ANS:  A, C, D, E, F

Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are: active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 47

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness (select all that apply)?
a. Explain the rationale for a change so that individuals understand it.
b. Simply announce the change without laying a foundation.
c. Give participants all the information they need.
d. Rely only on formal authority in implementing change.
e. Help individuals cope with change.

 

 

ANS:  A, B, E

Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 48

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A group of nurses is showing resistance to changes the manager is making with regards to staffing. Which of the following ways can the manager deal with the emotionality of the situation (select all that apply)?
a. Use persuasion.
b. Give the nurses adequate notice of change.
c. Avoid discussion.
d. Explain the rationale and patient impact.
e. Inform staff that senior leadership made the decision.

 

 

ANS:  B, D

A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 48

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

 

Chapter 04: Critical Thinking and Decision-Making Skills

Test Bank

 

MULTIPLE CHOICE

 

  1. What is the definition of the process of making choices that will provide maximum benefit?
a. Critical thinking
b. Problem solving
c. Decision making
d. Leading

 

 

ANS:  C

Decision making is the process of making choices that will provide maximum benefits.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 66

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. Which of the following examples best depicts Benner’s stages and appropriate critical-thinking processes in this situation?
a. Advanced beginner—thinks that the patient is trying to be funny
b. Competent—thinks that the patient is experiencing effects from cerebral edema
c. Novice—thinks that the patient is stressed and has had a surge of adrenaline
d. Proficient—thinks that the patient is waking up from a coma

 

 

ANS:  B

The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure.

 

DIF:    Cognitive Level: Analyze (Analysis)                                         REF:    Pages 67-68

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiological Adaptation

 

  1. A staff registered nurse (RN) has been struggling with the delivery system from central supply. He documents a delay of 1 to 3 hours from the time that the order is sent to central supply to the time that the requested equipment is sent to the floor. The RN asks, “Why does a central supply unit need to service the entire hospital? Why not consider a decentralized central supply established for each floor?” This is an example of what type of thinking?
a. Amiable thinker
b. Critical thinker
c. Traditional thinker
d. Unrealistic thinker

 

 

ANS:  B

A critical thinker challenges and questions the norm.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 67

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A staff RN is leading a quality improvement team on the care of the total hip replacement patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques?
a. Problem solving
b. Evaluating the consequences
c. Inclusive judgment
d. Problem processing

 

 

ANS:  A

Problem solving occurs when moving from an undesirable to a desirable state. It occurs in a variety of nursing contexts.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 66

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. How is leadership at the staff nurse level exemplified?
a. The staff nurse adapts to a challenging patient assignment.
b. The staff nurse refers issues to the performance improvement committee.
c. The staff nurse accepts the status quo.
d. The staff nurse questions current practice and refers to unit leadership for change.

 

 

ANS:  A

The challenges of leadership belong to every nurse, not just those in formal administrative or management roles. Leadership at the staff level may take a different form. For instance, a staff nurse adapting to a challenging patient assignment, taking initiative to change practice through performance improvement, or challenging the status quo is participating in unit culture construction.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 61

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Family members of a dying patient are arguing about terminating life support. The nurse educates the two opposing groups individually about terminating life support and discusses the dying process. This is an example of:
a. delegation.
b. negotiation.
c. clinical judgment.
d. purposeful inaction.

 

 

ANS:  C

Clinical judgment is a decision-making process in nursing related to quality of care that is patient-centered.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Pages 67-68

TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiological Adaptation

 

  1. A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager. This is an example of:
a. incrementalism.
b. optimizing.
c. mixed scanning.
d. strategic planning.

 

 

ANS:  B

An optimizing decision includes comparing all possible solutions with desired objectives and selecting the optimal solution that best meets objectives.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 70

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Nursing students are working on a long-term care unit at a new clinical site. The instructor is concerned because the clinical site is missing some needed components. In a discussion with the director of nursing, it is determined that the instructor should document the expected and actual outcomes of the experience and compare them. This type of decision making is made utilizing (the):
a. rational model.
b. process model.
c. political model.
d. outcome evaluation.

 

 

ANS:  B

The process model uses standard operating procedures and guidelines.

 

DIF:    Cognitive Level: Analyze (Analysis)                                         REF:    Page 74

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A family member of a patient files a complaint that her mother’s dentures were lost when the patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used?
a. Delegation
b. Direct intervention
c. Indirect intervention
d. Purposeful inaction

 

 

ANS:  B

Direct intervention is carrying out an activity to intervene in a situation and resolve a problem.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 77

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Basic Care and Comfort

 

  1. Which of the following problem definitions is matched with an accurate example?
a. Problem solving: A nurse ignores a client’s requests to stop his dialysis.
b. Dilemma: A nurse is scheduled to work over the weekend, and she has a family outing to attend.
c. Critical thinking: A nurse is counseling a woman with breast cancer about terminating her pregnancy and receiving chemotherapy or completing the pregnancy and possibly not surviving.
d. Purposeful action: A nurse has been offered an exciting new position with a dramatic increase in salary, but she would have to move out of state, away from her ailing parents.

 

 

ANS:  C

In this case, there may not be a logical solution to the problem, because the baby or mother may not survive. The nurse utilizes critical thinking in dealing with the situation, because the nurse uses reflection to analyze, conceptualize events, and obtain complex information to provide to the patient.

 

DIF:    Cognitive Level: Analyze (Analysis)                                         REF:    Page 66

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Nurses working on the intermediate care unit have had many hours of overtime in the last 6 months. Before forming a team, the nurse manager gathers data about patient condition severity, staffing ratios, educational levels of staff, and personality mixes on each shift. What level of decision making is this process?
a. Establishment of solution evaluation criteria
b. Evaluation of the alternative solutions
c. Identification of a problem, issue, or situation
d. Search for alternative solutions or actions

 

 

ANS:  C

Data should be collected to identify properly the actual problem, issue, or situation. The five core elements to decision making are the following: (1) identification of a problem, issue, or situation; (2) establishment of the criteria to be used to evaluate potential solutions; (3) search for alternative solution or actions; (4) evaluation of the alternative; and (5) selection of a specific alternative.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 69

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A continuous quality improvement team has considered all aspects of a decision to purchase two new computed tomography scanners to meet the needs of the community. The team decides to go with the less expensive, larger machines with few additional capabilities because of current budget restraints, even though it will mean purchasing newer smaller models with more capabilities in the future when moving to a new hospital in 3 years. This decision is known as a(n) _____ decision.
a. cost-conscious
b. group
c. optimizing
d. satisficing

 

 

ANS:  D

A satisficing decision results in an outcome that is sufficient, satisfies basic requirements, and minimally meets desired objectives.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 70

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The nursing education department is revising its orientation curriculum for nurse externs. A consultant has been hired to revise the program completely. When the curriculum is completed, most of the prior curriculum and activities are found to be the same. This is an example of which of the following decision-making distortions?
a. Anchoring trap
b. Confirming evidence trap
c. Framing trap
d. Status quo trap

 

 

ANS:  D

Status quo trap is the strong bias to choose alternatives that perpetuate the status quo, keeping the situation or environment as it has always been.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 70

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The marketing department of a major children’s hospital is hosting a fund-raiser for the local Ronald McDonald House. In the past, fund-raisers were successful when scheduled in the spring. This year, the fund-raiser is scheduled in the fall, when the city and several local organizations have community festivals. The first fund-raiser was scheduled 10 years ago in the fall and raised $50,000, only one eighth of the goal. This depicts an example of which of the following decision-making distortions?
a. Confirming evidence trap
b. Estimating and forecasting trap
c. Status quo trap
d. Sunk cost trap

 

 

ANS:  B

Estimating and forecasting trap is the natural tendency of human behavior to disregard negative outcomes and remember the positive ones. In this case, the marketing department is not taking the failure of a previous fall fund-raiser into account when planning this event.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 71

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. An intravenous infusion center is considering switching intravenous pumps to another vendor. A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team and the nurse leader vote to determine which pumps to use. This example depicts which of the following decision styles?
a. Autocratic
b. Consultative
c. Delegative
d. Facilitative

 

 

ANS:  D

The leader and followers work together to reach a shared decision.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 77

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making style?
a. Autocratic
b. Consultative
c. Delegative
d. Facilitative

 

 

ANS:  C

The leader gives up control to the group in the delegative decision-making style.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 77

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in the emergency medical service system. Questions are asked such as, “Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?” Which of the following decision-making strategies would work best in this situation?
a. Cost-benefit analysis
b. Decision tree
c. Problem critique
d. Trial and error

 

 

ANS:  B

A decision tree starts to the left and flows to the right, displaying the options, outcomes, and risks to be anticipated. Decision trees and algorithms are used for developing protocols for therapy administration.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 74

TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A team consisting of preoperative, operative, and postoperative health care professionals and ancillary staff is examining the turnaround time from the preoperative area to discharge for patients having tonsillectomies. The goal is to decrease waiting times for clients. Which of the following techniques would delineate processes that are delaying time for patients having tonsillectomies?
a. Cost-benefit analysis
b. Trial and error
c. Shared decision making
d. Scenario planning

 

 

ANS:  C

Shared decision making uses a variety of strategies to make decisions aimed at solving problems. A variety of strategies are utilized to achieve the goal.

 

DIF:    Cognitive Level: Understand (Comprehension)               REF:   Page 74

TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A disaster team is planning strategies to use in the event of multiple catastrophes. Various questions are posed such as, “If we lost all electricity in Kent County, what challenges would we face in providing care? If the Grand River flooded, which institutions would not be available for health care? What other facilities could be used as a backup system? Which roadways would be available in the event of a flood?” This is an example of which of the following decision-making strategies?
a. Creativity techniques
b. Decision trees
c. Simulated trial and error
d. Worst case scenarios

 

 

ANS:  D

Worst case scenarios are used to make decisions involving risk.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 75

TOP:   Nursing Process: Planning              MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A nationwide community health care nursing organization has formed a team to assist with disaster victim relocation and to plan for psychological, physical, and emotional needs that the victims may encounter. In which stage of decision making is this group?
a. Deliberation
b. Evaluation
c. Judgment
d. Selection

 

 

ANS:  A

Deliberation involves the beginning stages of identification of a problem, issue, or situation.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Page 69

TOP:   Nursing Process: Planning              MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. Two cognitive processes that nurses use in clinical judgments include (select two answers):
a. analysis.
b. brainstorming.
c. fish boning.
d. intuition.

 

 

ANS:  A, D

Two cognitive processes used in critical thinking for nursing judgments are analysis and intuition.

 

DIF:    Cognitive Level: Analyze (Analysis)                                         REF:    Page 65

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Nurses in clinical practice need to be able to make decisions based on the needs of the client, situations, or practice problems. Which of the following statements are true regarding critical thinking in nursing (select all that apply)?
a. Critical thinkers challenge the norm.
b. Critical thinkers consider unintended consequences when making decisions.
c. Critical thinkers utilize the step-by-step nursing process in order.
d. Critical thinkers are creative in their thinking.
e. Critical thinking should be left to the discretion of the nurse leader.

 

 

ANS:  A, B, D

Critical thinkers go beyond the step-by-step processes outlined in the nursing process and traditional problem solving. A critical thinker challenges and questions the norm and considers the context of the decision-making potential for unintended consequences. Critical thinkers are creative in their thinking. Nurse leaders and managers have an obligation to create climates that encourage critical thinking among staff.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Pages 67-68

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process (select two that apply)?
a. Develop and implement an action plan for problem solution.
b. Establish criteria for what you want to accomplish.
c. Define the problem and determine why anything should be done about it.
d. Evaluate the decision through monitoring, troubleshooting, and feedback.
e. Determine the best choice or alternative.

 

 

ANS:  C, D

The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Page 69

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A client becomes confused after surgery. He is in a room farthest away from the nurses’ station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize (select all that apply)?
a. Critical thinking
b. Problem solving
c. Autocratic decision
d. Financial decision

 

 

ANS:  A, B

Critical thinking and decision-making strategies were utilized in determining the measures that would promote patient safety and prevent a fall.

 

DIF:    Cognitive Level: Apply (Application)                             REF:   Pages 66-68

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following are examples of formal decision-making strategies (select all that apply)?
a. Trial and error
b. Anchoring
c. Pilot project
d. Creativity technique
e. Decision tree

 

 

ANS:  A, C, D, E

Examples of formal decision-making strategies include trial and error, the use of pilot projects, creativity techniques, and the use of a decision tree.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Pages 73-75

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Effective managers utilize group problem solving to discuss and participate in solving a problem. Which are examples of decision-making strategies that are useful in groups (select all that apply)?
a. Incrementalism
b. Scenario planning
c. Worst-case scenario
d. Six Sigma
e. Budgetary model

 

 

ANS:  B, C, D

Scenario planning, worst-case scenario, and the use of Six Sigma are all effective group problem-solving tools.

 

DIF:    Cognitive Level: Remember (Knowledge)                                 REF:    Pages 74-76

TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

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