LEADERSHIP & MANAGEMENT REFRESHER REVIEW NOTES

PROFESSOR RAYMUND KERNELL MAÑAGO

C. Laissez-faire
LEADERSHIP & - Little/no control and direction
- Communication and decision making among
MANAGEMENT members
- Requirements:
LEADERSHIP AND MANAGEMENT (1) highly motivated
Leadership vs Management (2) (2) self-directed members
1. Leadership:
- taking risks, achieving shared goals, inspiring 3) Situational/Contingency Leadership
others - Leadership style based on situation
2. Management:
- directing organization thru manipulation of
resources
MANAGEMENT THEORIES
ROLES Management Theories
LEADER MANAGER 1) Scientific Management (Frederick Taylor)
Power through influence Legitimate power by - One best way to do task, increase productivity
(Directs willing followers) authority
(Directs willing and 2) Bureaucracy (Max Weber)
unwilling - Strict rules and regulations, increase efficiency
subordinates)
May not be part of formal Position in formal 3) Management Functions (Henri Fayol)
org organization (Job title) - POSDC (Planning, Organizing, Staffing, Directing,
Focus: inspiring others Focus: getting work done Controlling)
Greater roles Expected duties

LEADERSHIP THEORIES MANAGEMENT FUNCTION:

Leadership Theories PLANNING
1) Great Man/ Trait Theory
- Leaders are born, not made PLANNING
- Leaders arise when situation demands. - Deciding in advance
- Choosing among alternatives
2) Leadership Styles - Failing to plan, planning to fail.
A. Authoritarian
- Strong control through commands. Strategic Planning
- Downward communication - Long-term (3 to 5 years), complex
- Sole decision-making
- Emergency situations Operational Planning
- e.g. armed forces - Short-term (< 3 years), less complex
- Daily basis/ Per shift
B. Democratic
- Control through guidance. SWOT Analysis
- Upward and downward communication - Strengths: internal advantage
- Collective decision making - Weakness: internal disadvantage
- Takes longer time - Opportunities: external advantage
- Threats: external disadvantage
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PROFESSOR RAYMUND KERNELL MAÑAGO

Planning Hierarchy ▪ Indirect: for expenses not related to product

1) Vision:

TYPES OF BUDGET
- future aims
- “What do you want to be?”
- e.g., “By 2020, Hospital X will be the leading Types of Budget
center for cancer in the Philippines.” 1. Personnel
▪ Salary of staff
2) Mission: ▪ Largest budget: health care is labor-intensive
- reason for existence
- “What do you want to do?” 2. Operating
- e.g. “Hospital X is a tertiary care facility that ▪ Day-to-day costs
provides evidence-based, holistic care to all ▪ Maintenance, bills, supplies
patients.”
2. Capital
3) Philosophy: ▪ Equipment and real property
- set of values and beliefs ▪ Long-term, expensive
- “What do you believe in?”
- e.g. “Hospital X believes that…” 3. Petty cash
Goals and Objectives: Desired result ▪ Emergency, repairs
A. Goal: general
B. Objectives: specific
Ex: “What do you want to happen?”
MANAGEMENT FUNCTION:
4) Policies:
- Guide for decision-making
ORGANIZING
- “How should you behave?” ORGANIZING
A. Expressed: written policies - Establishing a structure that improves coordination
B. Implied: expected to achieve objectives

5) Procedures: Organizational Structure

- Step-by-step plan for doing specific tasks Formal vs Informal
- “How should you do it?” 1. Formal:
- positions and power
6) Rules:
- Do’s and don’ts 2. Informal:
- Allows organizational structure - employee relationships
- “Should you do it?”
Components
Fiscal Planning Chain of Command
- Budget ▪ Formal paths of communication and authority
A. Cost-effectiveness: good value for money A. Line positions:
- legitimate authority
- Fixed vs Variable budget - (solid lines)
▪ Fixed: does not change, e.g. building mortgage B. Staff positions:
▪ Variable: changes, e.g. supplies, water bill - advisory positions,
- no legit authority
- Direct vs Indirect Costs - (broken lines)
▪ Direct: for production goods/service
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Unity of Command: 3. Legitimate

- employees report to 1 boss only (vertical solid line) - Formal position/title
Span of Control - Authority is source of power
▪ No. of people directly reporting to manager - Authority =/= Power
▪ Higher span, flatter structure - Limit commands
▪ Lower span, taller structure 4. Expert: knowledge, expertise
5. Referent: association with powerful people
Managerial Levels 6. Charismatic: personal influence
▪ Top-level 7. Informational: knowledge that others do not have
- Strategic planner
- Policy making
- Chief nurse
PATIENT CARE DELIVERY
▪ Middle-level
- Facilitate communication between top and first-level
METHODS
- Nursing supervisor Patient Care Delivery Methods
1. Total Patient Care or Case Method Nursing
▪ First-level - Nurse is responsible to meet all needs of assigned
- Operational planner patients
- Day-to-day operations - Oldest, common
- Head nurse - Requirement: Highly skilled staff

TYPES OF ORGANIZATIONAL
2. Functional Method
- Based on tasks, not patients

STRUCTURE
- Example: BP monitoring, Medications, Hygiene

Bureaucratic/ Line 3. Team Nursing

1. Tall - Staff follow the team leader (nurse)
- Centralized - Max. 5 per team
- Decision making at top - Requirement: Team leader is efficient and
- Narrower span of control organized
2. Flat
- Decentralized 4. Modular Nursing
- Decision making where work is done - Mini-team (3 members)
- Wider span of control - Care pairs (2 members)
3. Ad Hoc - Smaller teams
- Temporary
- Project-based 5. Primary Nursing
- 24-hour care
- Admission to discharge
POWER - Associate nurse: substitute when primary nurse is
off-duty
Power - Requirement: Primary nurse is self-directed
- Effect based on how it is used.
6. Case Management
Types of Power - Collaborative: Multidisciplinary action plan (MAP)
1. Reward: granting favors/rewards - Goal: Cost-effective outcomes
2. Coercive: fear of punishment - Requirement: Case manager
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PROFESSOR RAYMUND KERNELL MAÑAGO

- Promote belongingness of employee

MANAGEMENT FUNCTION: - Personnel policies: first-level
- manager (head nurse)
STAFFING C. Socialization
STAFFING - Learning the behaviors associated with role
- Healthcare as labor-intensive
- First step: Determine staffing needs 5. Scheduling Options
- Staffing Functions (ReSePI) - 8hrs or 12hrs/shift, 40 hrs/week
A. Float pools
Staffing Functions - Per diem employees
1. Recruitment B. Flexible:
- Active search for applicants - Higher pay, no benefits
- Ongoing process - Requirement: Orientation to unit, Core
Turnover: replacement of new staff competencies (basic)
A. No turnover: stagnation C. Flextime
B. Low turnover: retention, staff development - Time schedules based on staff
C. High turnover: expensive, decreased patient D. Self-scheduling
safety - Daily schedules based on staff
2. Selection
A. Requirements
- Minimal Criteria: minimum
MANAGEMENT FUNCTION:
- Preferred Criteria: ideal
B. Interview
DIRECTING
- Evaluates suitability for the position. DIRECTING (THE “DOING” PHASE)
C. Evaluation - Communication: exchange of thoughts through
- JOB DESCRIPTION: avoid under/overqualified speech or signals.
applicants
- NEVER ask discriminatory questions. Communication Process
- Age, race, marital status, sexual preference, Verbal vs Nonverbal
Etc. 1. Verbal: use of words (written or spoken)
D. Background Check: 2. Non-verbal: body language
- Check references, verify credentials
E. Preemployment Testing: 1. Verbal communication
- Personality and psychiatric tests - Assertive: direct, honest, acceptable. “I”statements
F. Physical Examination: - Passive: silence, avoids conflict
- physical requirements for the job - Aggressive: threatening, bullying
- Passive-aggressive: aggressive message
3. Placement conveyed passively.
- Assignment to department
- Proper placement 2. Nonverbal Communication
- Silence: use therapeutically
4. Indoctrination: - Space (Proxemics)
- Adjustment of employee to organization (IOS) - Appearance and posture
A. Induction - Eye contact
- General information - Gestures and facial expressions
-Employee handbooks - Note: verbals and non-verbals must be congruent.
B. Orientation
- Specific information for position
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CHANNELS OF 5 Rights of Delegation

- Right task
COMMUNICATION - Right circumstance
Channels of Communication - Right person
1. Upward: - Right direction
- subordinate to superior - Right level of supervision
2. Downward:
- superior to subordinate
3. Horizontal:
- peer to peer
LVN/UAP
4. Diagonal: Delegation to LVN and UAP
- different levels and jobs LVN/LPN
5. Grapevine:
Do’s ✔
- informal, random, source of rumor
- Administering medications except via

ISBAR
intravenous, intrathecal, intraosseous, or
endotracheal route
ISBAR: - Enteral or tube feedings
- communication tool to referrals - Ostomy care
- Inserting and removing Foley catheters
1. Introduction: name, ward - Oral suctioning
2. Situation: chief complaint - Non-complex sterile procedures
3. Background: patient info UAP:
4. Assessment: other findings
UAP tasks ✔
5. Recommendation: suggested action
- Routine vital signs (No admission)
LISTENING SKILLS - Hygiene
- Best communication skill - Feeding without oral/swallowing problems
- Communication failure: common cause of medical - Basic life support
error - Postmortem care
- ADLs, Ambulation, turning
- Elimination, Monitoring I&O

MANAGEMENT FUNCTION: - Obtaining specimens

Don’ts X

DELEGATION - ADPE, except routine assessment

- Baseline/Admission assessment
Delegation - Health teaching/Discharge Planning
- Getting work done through others - Nursing judgment
- Accountability: retained - Not within scope of practice
- Responsibility: transferred
- Pros:
 Productivity
 complex problems,
CONFLICT RESOLUTION
 empowers staff Conflict Resolution Strategies
- Cons: (Goal: Win-win solution)
 risk for improper/ overdelegating - Collaborating: set aside differences and work
together, win-win

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- Compromising: parties give up something,

lose-lose
- Competing: one party intends to win. win-lose
- Accommodating: one party sacrifices. Win-lose
- Smoothing: reducing the severity of problem,
temporary
- Avoiding: no resolution, temporary

CONTROLLING
CONTROLLING
- Tasks:
(1) Performance measured against standards,
(2) Praise/Correct actions

Performance Appraisal vs Nursing Audit

- Criteria: Job description
- Performance appraisal: nurse-centered
- Nursing Audit: patient-centered, chart
-
Evaluation
- Structure: resources, e.g. environment, staffing
(human resources)
- Process: how care is delivered, e.g. medications
- Outcome: end-result, e.g. health status

Quality Assurance vs Quality Improvement

- Quality Assurance: maintaining quality
- Quality Improvement: upgrading quality

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4. Focuses on getting tasks completed

6. Hospital departments with effective, supportive

managers share common indicators of employee
satisfaction. What are some of the indicators of a
1. In the Neurosurgery Ward, Chief Nurse Sanchez department with high employee satisfaction?
schedules a meeting to seek the suggestions and 1.Low employee turnover rate
comments of the ward staff in coming up with a feasible 2.Effective conflict resolution and communication
solution to the problem of increasing infection rate among 3.Employees functioning as an integral part of the
the patients. What is the leadership style of Chief Nurse multidisciplinary team
Sanchez? 4.High employee turnover rate
1. Democratic 1. 1, 2, 3
2. Laissez-faire 2. 1, 2, 4
3. Authoritarian 3. 2, 3, 4
4. Interactional 4. 1, 3, 4

2. The Head Nurse of the Neonatal Intensive Care Unit 7. Delegation is getting work done through others to
knows that she has highly skilled and motivated staff. Thus, accomplish organizational goals. Which of the following
she allows the nurses to work with minimal supervision statements about delegation is not true?
and empowers them to make decisions. Determine the 1. Managers must delegate routine tasks, so they are free to
Head Nurse’s leadership style. handle more complex problems requiring a higher level of
1. Transformational expertise.
2. Democratic 2. Accountability is transferred from the manager to
3. Interactional subordinate upon delegation.
4. Laissez-faire 3. The right to delegate is a reflection of legitimate authority.
4. Some nurses refuse to delegate because of excessive need
3. In the Medical Ward, Chief Nurse Feliz schedules a meeting to be perfect.
to discuss her proposed solution to the problem of increasing
mortality rate among the patients in their ward. What is the 8. Nora, a nurse manager in a medical ward, plans to
leadership style of Chief Nurse Feliz? delegate a task to an unlicensed assistive personnel (UAP).
1. Democratic In which of the following situations is the UAP eligible to
2. Laissez-faire handle?
3. Authoritarian 1. A patient in emergency room for admission assessment of
4. Interactional height and weight.
2. Post-colostomy patient requiring health teaching on
4. Which of the following questions does NOT pertain to colostomy care.
the Controlling function in managing nursing 3. Monitoring the vital signs of post-CABG male patient.
organizations? 4. Assisting a patient with leg fracture to ambulate to the
1. What are keys to good employee performance appraisals? comfort room.
2. How can nursing outcomes be measured?
3. How can delegation and assignments be used to 9. A registered nurse assigns tasks to an unlicensed
accomplish work? assistive personnel (UAP). Which of the following activities
4. What performance standards should be established? would the UAP be allowed to perform?
1. Formulating a nursing diagnosis for a cancer patien
5. Which of the following describes a manager? 2. Discharge planning for a patient with diabetes mellitus.
1. Focuses on interpersonal relationships 3. Taking routine vital signs of a patient recovering from
2. Gains power through influence elective surgery.
3. May or may not be a member of a formal organization 4. Feeding a patient who just had diagnostic bronchoscopy.
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14. During orientation, student-nurse Maxine learns that

10. You are a registered nurse who needs help from a the nursing model of practice implemented in the facility is
licensed vocational nurse (LVN). Which of the following a primary nursing approach. When she attends a report on
activities would be most suitable for the LVN to perform? the medical unit, she will verify with the staff which of the
1. Providing bed bath to a stable post-stroke patient on his 7th following characteristics of primary nursing?
hospital day. 1. critical paths are used when providing client care
2. Administering Enoxaparin subcutaneously to a 2. the nurse manager assigns tasks to the staff members
bed-bound patient on mechanical ventilator. 3. a registered nurse leads nursing staff in providing care to a
3. Performing dressing changes for a patient with burn wounds group of clients
of 30% TBSA. 4. a single RN is responsible for planning and providing
4. Evaluating the nursing care of a patient who had epistaxis. individualized nursing care to 4-6 clients

11. Mara, as the chief nurse in their hospital, knows that as 15. Maxine attends an in-service educational session for
the organizational design becomes flatter, there are staff and student nurses about case management
certain changes that will happen as an effect. Which of the conducted by the unit’s nurse manager. The clinical nurse
following is not true of a flat design? manager determines that a review of the material needs to
1. As the design becomes flatter, the organization be done if one of the staff nurse stated that case
becomes more centralized. management:
2. A single manager will have a wider span of control. 1. manages a client care by managing the client care
3. More authority and decision-making can occur where the environment
work is being carried out. 2. maximizes hospital revenues while providing for optimal
4. Larger organizations benefit from flat organizational client care
designs. 3. is designed to promote appropriate use of hospital
personnel and material resources
12. Which actions are appropriate in the scope of practice 4. represents a primary health prevention focus managed
of an experienced LPN? SATA by a single case manager
I. Auscultating breath sounds
II. Administering medication via metered dose inhaler 16. The nurse manager is planning to implement a change
III. Completing in depth admission assessment in the nursing unit from team nursing to primary nursing.
IV. Checking oxygen saturation using pulse oximetry She anticipates that there will be resistance to the change
V. Developing the NCP during the change process. The primary technique that
she should use in implementing this change is?
1. I, II, IV 1. Introduce the change gradually
2. II,IV 2. Confront the individuals involved in the change process
3. III,IV,V 3. Use coercion to implement that change
4. I,II,IV,V 4. Manipulate the participant in the change process.

13. A patient with sleep apnea has nursing diagnosis of 17. Which of the following is considered as indirect costs
sleep deprivation related to disrupted sleep cycle. Which in a fiscal plan?
action should you delegate to the UAP? 1. Medication supplies
1. Discussing the weight loss strategies such as diet and 2. Salary of health personnel
exercise with the patient 3. Diagnostic equipment
2. Teaching the patient how to set up the bilevel positive 4. Salary of housekeeping personnel
airway pressure machine before sleeping
3. Reminding the patient to sleep on his side instead of his 18. Which of the following actions by the nurse-manager
back would indicate adequate knowledge regarding
4. Administering modafinil to promote daytime wakefulness performance appraisal?
1. Use of job description as criteria for evaluation.
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2. Reviews charts of patients to evaluate progress. Which scheduling option is more likely being implemented
3. Provide written reprimand once she detects incompetence. in the ward?
4. Performance is measured against performance of other
staff. 1. Self-scheduling
2. Shift bidding
19. The nurse-manager is starting to receive complaints 3. Flextime
regarding the impending burnout of some nurses because 4. Float pools
of the unsafe nurse-patient ratio in their ward. Which of the
following actions by the nurse-manager would indicate 24. The following are characteristics of a leader, except:
superior communication skills? 1. Has wider/greater roles
1. Utilizes assertive communication to explain the reality of 2. May not be part of an organization
situation. 3. Focuses on inspiring others
2. Dismisses the idea of unsafe nurse-patient ratio because it 4. Has legitimate power through authority
is not what she sees.
3. Listens openly to the concerns of the staff. 25. The following statements correctly describe a
4. Conducts group meeting to present the factors leading to laissez-faire leadership style, except:
the problem. 1. Involves little or no control from leader
2. Communication between peers/members
20. The charge nurse is to refer a client to the primary 3. Requires highly dependent members
physician due to sudden aggression and restlessness 4. Effective if the members are skilled and expert in field
during their afternoon shift. Which is the priority action of
the charge nurse? 26. Staff Nurse Lily noticed that whenever their head nurse
1. Asserts the immediate problem of the client. encounters a problem, she would immediately look at the
2. Introduces self to the physician. hospital policies, rules, and regulations to arrive to a
3. Recommends further action to perform. decision. Which management theory does she practice?
4. Relays assessment findings. 1. Scientific Management
2. Participative Management
21. Nurse Ella requests to the head nurse if she could start 3. Theory X and Y
her shifts for this month as 2 hours earlier than usual. She 4. Bureaucracy
explains that she needs to get home early to attend to the
needs of her children. Which scheduling option is more 27. The nurse asks a nursing assistant to administer a
likely being implemented in the ward? preoperative bath to a client using special soap designed
1. Float pools to decrease the bacteria count on the client’s skin. The
2. Self-scheduling nursing assistant has no experience with this type of
3. Flexitime preoperative bath and asks the nurse for instructions. The
4. Shift bidding nurse replies, “Just read the directions on the soap bottle.
You will figure it out.” Which “right” of delegation did the
22. In which step in indoctrination of a newly employed nurse fail to perform while delegating the preoperative
registered nurse would require promotion of bath to the nursing assistant?
belongingness of employee, and the head nurse explains 1. Right task
the personnel policies? 2. Right circumstances
1. Induction 3. Right person
2. Orientation 4. Right direction
3. Socialization
4. Staff development 28. Which among the following criteria for nursing audit
refers to the way that nursing care is delivered to the
23. Nurse Mario requests to the head nurse if she could patients?
decide on the days where she will be on duty and off duty. 1. Structure
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2. Process C. Uses age and marital status as criteria for selecting

3. Outcome applicants
4. Input D. Minimizes the effect of personal biases when evaluating

29. Which among the following criteria for nursing audit 4. Which of the following institutions have the legal
refers to the patient’s status and patient satisfaction after capacity to hear cases regarding nurse practice, and
the nursing care has been provided? implement disciplinary actions and license revocation as
1. Structure deemed necessary?
2. Process A. Ombudsman
3. Outcome B. Professional Regulation Commission
4. Input C. Philippine Nurses Association
D. Professional Regulatory Board of Nursing
30. Performance evaluation is an essential activity of
controlling the quality of services provided. Which of the 5. Nurse Bobby believes that is it more important to
following is true regarding performance evaluation? consider the good of the most more than the good of an
1. Nurse-centered individual. What ethical principle does Nurse Bobby
2. Evaluation is measured against performance of other nurses practice?
3. Patient-centered A. Beneficence
4. Based on the chart/hospital documents B. Utilitarianism
C. Justice
D. Fidelity

EVALUATIVE EXAM 6. Which of the following describes a leader?

1. Aris is a 5 pack year smoker. He recently witnessed his A. Gains power through position
40-year old uncle die of lung cancer. After his uncle’s B. Focuses on interpersonal relationships
death, he begins to read about the effects of smoking and C. Focuses on getting tasks completed
how it can lead to lung cancer. At which stage is Aris at? D. Member of a formal organization
A. Precontemplation
B. Contemplation 7. Which of the following is considered as fixed cost in a
C. Preparation fiscal plan?
D. Action A. Utility bills
B. Mortgage of the hospital building
2. In which step in indoctrination of a newly employed C. Medication supplies
registered nurse would be provided with adequate general D. Salary of personnel
information about the organization?
A. Induction 8. The nurse is writing down his progress notes. Should a
B. Orientation recording mistake occur, which of the following should he
C. Socialization do?
D. Staff development A. Use multiple lines to strike through the erroneous entry then
write his initials or name above or near the lines.
3. The nurse-recruiter is to select prospect employees for B. Draw a single line through the erroneous entry and write
their district hospital. She conducts interview to the error above the said entry.
interested application. Which of the following would C. Erase the erroneous entry using correction fluid and write
require immediate intervention? down the new entry above the erased entry.
A. Views minimal criteria as the lowest level of requirements for D. Draw a single line through it and write his initials or
selection name above or near the line.
B. Conducts structured interview to all applicants to increase
interview reliability 9. The nurse decided to call the attending physician of one
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of his patients because latter suddenly collapsed. Which of D. Interactional Leadership

the following should avoid when giving a telephone report?
A. Include the client’s name and medical diagnosis. 15. The following statements correctly describe a
B. Specify that the nurse would like the attending physician to laissez-faire leadership style, except:
come and assess the client. A. Involves little or no control from leader
C.Inform the physician of the pertinent changes in the patient’s B. Communication between peers/members
baseline data. C. Requires highly dependent members
D. Immediately begin the report with the main reason for D. Effective if the members are skilled and expert in field
the telephone call.
16. Staff Nurse Lily noticed that whenever their head nurse
10. The nurse orientee is now on the ICU/CCU for her encounters a problem, she would immediately look at the
special area orientation. She recognized that a single hospital policies, rules, and regulations to arrive to a
nurse is providing direct total care to a single patient. The decision. Which management theory does she practice?
care delivery system applied in the ICU/CCU is? A. Scientific Management
A. Functional nursing B. Participative Management
B. Primary nursing C. Theory X and Y
C. Case method D. Bureaucracy
D. Modular method
17. The nurse prepares an intramuscular injection for a
11. A nursing assistant in the unit is resistant to the change client who has diagnosis of HIV. After giving the client the
and is not taking an active part in facilitating the process injection, the client moves, causing the nurse to get stuck
of change. Which of the following is the best approach of by the needle used for the injection. What should the nurse
the nurse manager in dealing with the nursing assistant? do first? Select all that apply.
A. Ignore the resistance I. Immediately flush the exposed area with water and express
B. Exert coercion with the nursing assistant blood from the puncture site.
C. Provide a positive reward system for the nursing assistant II. Notify employee health when the nurse’s shift is over.
D. Confront the nursing assistant to encourage III. Notify employee health nurse immediately and complete an
verbalization of feeling regarding the change incident report.
IV. Notify the physician of the incident.
12. Which of the following channels of communication is A. I, II
considered as informal, random, and usually a source of B. I, III
rumors? C. II, IV
A. Upward D. III, V
B. Downward
C. Horizontal 18. A well-known actor has been admitted to an
D. Grapevine ambulatory surgical unit. The nurse notices a staff member
who is not involved in the client’s care reading his medical
13. The following are characteristics of a leader, except: record. The nurse knows she should FIRST do which of the
A. Has wider/greater roles following?
B. May not be part of an organization A. Nothing. The staff member has a hospital ID badge and is
C. Focuses on inspiring others authorized to read the medical record.
D. Has legitimate power through authority B. Inform the staff member that without a legitimate need
for the information, staff should not be reading the medical
14. Which among the following leadership theories record.
describe leaders as born, and not made? C. Tell the client his medical records have been read by an
A. Transformational Leadership unauthorized individual.
B. Great Man Theory D. Page the physician and ask if it’s acceptable for the staff
C. Contingency Leadership member to access the medical records.
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19. A client is being treated for uncontrolled hypertension. and place the pump in the soiled utility room.
The nurse knows that the involvement of nursing, D. Turn the pump off, repair the broken area, and continue
pharmacy, cardiology, and nutritional services is an using the pump.
example of which of the following approaches?
A. Managed care 25. The nurse who works in the newborn nursery notices
B. Multidisciplinary that one of the babies is missing from the bassinet. Which
C. Case management action should the nurse take first?
D. Performance improvement A. Notify hospital security and the nurse manager, perform
a head count of infants, and begin to look for the baby.
20. This ethical issue happens when someone questions B. Notify the mother to inform her of the missing baby.
why morality is needed in practice. C. Notify the police that an infant abduction has occurred.
A. Moral indifference D. Notify the police, the mother, and the infant’s family and
B. Moral conflict provide comfort, answering questions as they arise.
C. Moral distress
D. Moral outrage 26. Workplace violence is a growing concern for nurses.
Major causes of violence in the hospital include:
21. This ethical issue happens when someone is unsure of A. Realistic client and staff expectations.
moral principles to apply to a specific situation. B. Increasing resources for mental health care.
A. Moral indifference C. The client’s understanding of the plan of care.
B. Moral conflict D. Lack of communication between nurses and clients and
C. Moral distress visitors.
D. Moral outrage
27. A confused client falls out of the bed. When the nurse
22. The patient asks the nurse if he could be discharged arrives, the siderails are up, the client has urinated in the
even though he still hasn’t completed the management. floor, and an abrasion is noted on the client’s forehead.
The nurse would allow the patient to be discharged Which information should not be included in the incident
because otherwise, she will be liable of: report?
A. False imprisonment A. The abrasion on the client’s forehead.
B. Invasion of Privacy B. The client’s confused state.
C. Defamation C. The nurse’s opinion as to how the client fell.
D. Assault D. The presence of urine on the floor

23. Which principle is applied when the health team must 28. Prior to administering medication to a client, the nurse
take over the decision-making of a client who is decides to check the dosage strength one more time. This
unconscious and in a critically unstable condition? check reveals a dosage error, and thus the medication is
A. Beneficence not administered. What immediate action should the nurse
B. Autonomy take?
C. Justice A. Nothing because an incident did not occur.
D. Paternalism B. Notify the physician of the potential error.
C. Inform the client that the wrong dosage of medication was
24. A nurse discovers that an IV pump is broken at the site almost given.
where the IV tubing is placed. However, the nurse is still D. Complete an incident report.
able to place the tubing into the pump without any
complications. The nurse should: 29. The transporter is on the floor to take a client to the
A. Continue to use the pump. radiology department for a left lung tissue biopsy. The
B. Turn the pump off, disconnect the pump from the client, nurse is performing a final check before the client is
and tag the pump for repair. transported to the radiology department. The nurse should
C. Turn the pump off, disconnect the pump from the client, ensure that:
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A. The consent form is signed, any ordered preoperative A. The unit charge nurse evaluates each client’s acuity level
medication is given, and the operative site is marked. and then makes client care assignments based on the nurses’
B. The consent form is signed, any ordered preoperative individual skill and competency levels.
medication is given, and the operative site is prepped with a B. A nurse has enrolled in a post-open heart surgery patient
razor. recovery course. The nurse is precepted by an experienced
C. The consent form is signed, the lab work is in order, any nurse on care and recovery of five post-open heart surgery
ordered preoperative medication is given, and the operative clients for completion of the clinical portion of the course.
site is marked. C. A registered nurse is newly assigned to a telemetry unit. The
D. The consent form is signed, the lab work is in order, and registered nurse is precepted for the first shift and oriented to
any ordered preoperative medication is given. the unit including policies, procedures, and safety equipment.
D. A student nurse in the final semester of nursing school
30. The nurse is about to receive a change-of-shift report. is allowed to give intravenous medications unsupervised
Which type report is acceptable? by either the nursing instructor or the nurse responsible
A. A taped report with all of the client’s information from the for the client assignment.
previous shift included.
B. A taped report with the ability to call the nurse from the 34. What is the role of the intensive care unit charge nurse
previous shift at home for questions. regarding supervision of a new nurse and the client’s
C. A taped report with the nurse from the previous shift safety?
available to answer questions. A. Observe the new nurse for care organization skills,
D. A taped report with one of the nurses on the previous shift prioritizing of care, nursing judgment and critical thinking, but
available to answer questions. should not intervene.
B. Assume care of the client if the new nurse becomes
31. The nurse takes a telephone order from a physician. overwhelmed. The client’s safety is ultimately the responsibility
Which statement most appropriately applies to the of the charge nurse.
implementation of the telephone order? C. Carefully observe the new nurse for client care and offer
A. The nurse transcribes the order and repeats the order advice and assistance when necessary.
back to the physician. D. Trust the judgment, critical thinking and skill level of the new
B. The nurse records the order in the client’s record at the end nurse and evaluate the nurse’s client care at the end of the
of the shift while performing all of other documentation. shift.
C. The nurse repeats the order back to the physician prior to
transcribing the order. 35. Supervision is an important aspect of nursing staff
D. The nurse transcribes the order in the client’s chart, and development and staff skill level development. Some of the
then phones the physician to repeat the order. components of appropriate staff supervision include the
following except:
32. The nurse is preparing to administer medications to a A. Delegation of client care to qualified staff with the
client. To properly identify the client, the nurse must use appropriate skill levels.
two client identifiers. Which statement is an example of B. Direct evaluation of staff performance.
two client identifiers? C. Knowledge of each staff member’s skill level and
A. The client’s room number and the client’s identification capabilities.
band. D. Direct performance of all client-related care without
B. The client’s date of birth and the client’s identification delegation.
band.
C. The client’s visitor and the client’s identification band. 36. Supervision of delegated client care responsibilities,
D. Two identifiers are not required. tasks, and activities is essential to the delivery of quality,
cost-effective, multidisciplinary client care. What is the
33. Supervision is an essential component of the correct definition of supervision?
appropriate delegation of client care. Which example A. Supervision is the process of transferring the responsibility
demonstrates inappropriate supervision? for the performance of selected tasks or jobs from one person
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PROFESSOR RAYMUND KERNELL MAÑAGO

to another. D. Resource management

B. Supervision involves direct oversight of the work or
work product of others. 41. The nurse establishes a nurse–client relationship and a
C. Supervision is the coordination of care between members duty to the client upon accepting the client care
of the multidisciplinary health care team. assignment. What is the correct definition of “breach of
D. Supervision is an informal role based on professional duty?”
knowledge and influence. A. The failure to act and provide client care consistent with
the applicable standards of care.
37. Staff education also impacts client care. Some of the B. The relationship established between the nurse and the
direct benefits of staff education and development to client when the nurse accepts the client care assignment.
client care are the following, except: C. The damages or alleged damages to the client that arise
A. The overall quality of client care increases. from the nurse’s failure to treat the client within the applicable
B. Clients are in danger while client care staff members standards of care.
attend education and development sessions. D.The relationship between the alleged damages and the
C. Mutual goal setting and learning promotes a nurturing work breach of duty.
environment and teamwork among staff members.
D. Learning increases both personal and group staff member 42. What is the correct definition of “duty?”
motivation to deliver service excellence. A. The failure to act and provide client care consistent with the
applicable standards of care.
38. Several nurses in the group decide to study for their B. The damages or alleged damages to the client that arise
certifications based on one of the certified nurse’s from the nurse’s failure to treat the client within the applicable
testimony of positive experience. This is an example of standards of care.
which type of staff education and development? C. The relationship established between the nurse and the
A. Formal staff education and development client when the nurse accepts the client care assignment.
B. Mandatory staff education D. The relationship between the alleged damages and the
C. Informal staff education and development breach of duty.
D. Compliance training.
43. A nurse who abandons a client assignment without
39. Staff education and development are important first procuring comparable and appropriate care for the
components of professional nursing development. Which client during the period of the nurse’s absence is guilty of:
of the following statements is accurate regarding staff A. Breach of duty
education and development? B. Duty
A. Staff education is the responsibility of the unit educator or C. Damages
facility’s continuing education department. D. Causation.
B. The head nurse is solely responsible for continuing
professional education and development. 44. Which scenario contains the elements of a legally
C. Staff education is the responsibility of the manager, charge appropriate informed consent?
nurses, and shift supervisors. A. The client states, “My doctor did mention that procedure to
D. Staff education and development is an ongoing process me, but I don’t understand what is going to be done.”
of professional learning and development that continues B. A client states, “I believe that I am well-informed about
for the entire career of the professional nurse. my procedure. I understand the risks and the benefits, and
my right to decline the procedure. May I have a clipboard
40. Programs that result in nursing job satisfaction and to write on so that I can sign the consent?”
nursing staff retention are examples of what client care C. A client diagnosed with Alzheimer’s disease is admitted
management principle? from an extended-care facility. The client is generally
A. Case management disoriented regarding place and circumstances.
B. Delegation D. A 14-year-old client brought to the ER states, “I can sign the
C. Collaboration with the multidisciplinary health care team consent for my procedure. My parents are at work and will not
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PROFESSOR RAYMUND KERNELL MAÑAGO

be here for a while.” B. Collaboration

C. Cooperation
45. The following information should me documented by D. Collegiality
the nurse when obtaining informed consent for an invasive
procedure from a client, except: 49.The nurse noticed an increase in the prevalence of
A. The client’s level of consciousness as alert and oriented pressure ulcers among clients in an intensive care unit.
B. The client’s stated understanding of information regarding She documented her findings and worked with her
the invasive procedure manager to develop and implement a new policy using a
C. The client’s vital signs pressure ulcer risk assessment scale. Which of the
D. The client’s voluntary signature of the consent following BEST describes the nurse’s actions?
A. Quality improvement
46. A legally recognized informed consent must meet B. Collaboration
specific criteria. The following statements are accurate C. Advocacy
regarding informed consent, except: D. Case management
A. Informed consent must be given voluntarily by a client.
B. Informed consent can only be given by an individual legally 50. Some patients in the hospital were killed by a sudden
competent to make informed health care decisions. attack of terrorists in the area who dropped bombs onto
C. Informed consent can only be given after the risks, benefits, the building. The health personnel are not liable for the
and reasonable alternative treatments of the proposed death of the patients by virtue of:
procedure have been explained as well as the health A. Res ipsa loquitur
consequences of declining the procedure. B. Respondeat superior
D. Informed consent can be obtained either from a client C. Force majeur
or from any member of a client’s immediate family. D. None of the above

47. Implied consent differs from informed consent for an

invasive procedure. Which scenario describes implied
consent?
A. The nurse enters a client’s room with the consent form for
an invasive procedure. The client reads and signs the consent
form but does not engage in conversation with the nurse.
B. A fully alert and oriented patient is intubated and unable to
speak, but nods, gestures, and writes notes to communicate.
C. A paraplegic client listens carefully to the physician’s
explanation of a proposed invasive procedure, the risks and
benefits, and then gives consent verbally.
D. A client arrives at the emergency department severely
short of breath, then collapses unconscious on the floor.
The ED staff provides emergent treatment to the client for
resuscitation and airway protection.

48. An 18-year-old client with acute lymphocytic leukemia

is admitted to the bone marrow transplantation unit. His
family is having trouble dealing with the emotional and
financial pressures of his disease. The nurse, case
manager, physician, and social worker meet to discuss the
plan of care. The nurse knows this type of interdisciplinary
interaction is BEST referred to as which of the following?
A. Case management
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