1. The most important approach that a nurse manager can take with an emotionally troubled employee is to:
a. act as a therapist for the employee.
b. adjust the standard of care to assist the employee.
c. assist the employee in obtaining professional help.
d. adjust the employee’s work schedule to decrease stress.
2. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
a. using replacement personnel with new ideas may be beneficial.
b. salary costs are lower because personnel are fewer, and outcome is favorable.
c. absence on the part of the rest of the staff is decreased.
d. unacceptable patient care may result.
3. In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:
a. include a plan to correct them and to prevent future occurrences.
b. state a detailed history of past problems that are related to the current one.
c. be written at the convenience of the manager.
d. not be discussed until the formal performance evaluation.
4. Before terminating an employee, a nurse manager must:
a. be an expert in all legal aspects of termination and discipline practices.
b. follow the organization’s specific policies for addressing disciplinary problems and termination.
c. function as a counselor for problem employees.
d. do everything to assist and protect the employee by adjusting standards and policies.
5. A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:
a. verbal reprimand.
b. written reprimand.
c. reminder of employment standards.
d. day off without pay.
6. The chief nursing officer understands that clinical incompetence is best prevented by a(n):
a. flexible protocol for evaluating competency skills.
b. standardized clinical skills checklist.
c. administration of personality tests and competency assessments at point of hire.
d. formalized competency program with established standards for practice.
7. A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?
a. Use of the performance appraisal on an annual basis
b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up
c. A tally sheet of medication errors and other specific problems that will be used at annual review
d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee
8. The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behavior.
b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem.
c. The chemically impaired nurse affects the entire healthcare organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.
9. The chief nursing officer reviews the policy about “progressive discipline process.” The progressive discipline process includes which of the following? The manager:
a. acts as a counselor and friend to the employee.
b. should reprimand and suspend the employee as a last resort.
c. should rehire the employee after a reasonable length of time
d. should terminate the employee if the problem persists.
10. A nurse manager must be familiar with the agency’s policies regarding termination. Termination procedures include which of the following?
a. Following specific procedures from other organizations
b. Having an attorney present at the termination meeting
c. Having adequate written documentation to support the action
d. Having a friend present during the termination meeting
11. Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month
b. Increased attempts to discuss his concerns with his colleagues
c. Testing of workplace guidelines
d. Frequent defensiveness
12. All of the following are grounds for immediate dismissal except:
a. failing to pursue further medical help for a patient; patient dies.
b. selling narcotics obtained from the unit supply of narcotics.
c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.
d. grabbing the unit manager and threatening further physical harm after a poor performance appraisal.
13. The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use?
a. Dismiss or transfer Jean.
b. Document all problem areas and then discuss them with Jean.
c. Develop appropriate solutions and make recommendations to human resources.
d. Smooth over the problems if they are minor in nature.
14. Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency?
a. Personality and behavioral changes
b. Job performance changes
c. Changes in educational involvement and pursuit
d. Absenteeism
15. Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate?
a. The manager could refer Stacey to the human resources department.
b. The manager could assist in monitoring Stacey’s progress.
c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her.
d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.
16. Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step?
a. Suspending the staff member from work
b. Providing written admonishment that is discussed and placed in the employee’s file
c. Providing verbal admonishment
d. Terminating the staff member
17. Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee’s file, (C) Providing verbal admonishment, (D) Terminating the staff member
a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D
18. When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is:
a. transferred to another unit.
b. suspended indefinitely.
c. asked to attend a union grievance meeting.
d. terminated after the first infraction.
19. During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to:
a. discuss what you have observed with Marg.
b. file immediate documentation in Marg’s personnel file.
c. ask Julie to monitor Marg’s behavior during meetings.
d. ignore the behavior, as Marg is one of your strongest nurses.
20. Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance?
a. Ignore Ellen’s errors until she has more experience.
b. Instruct staff to avoid working with Ellen until she learns to how do things herself.
c. Ask Ellen to complete a self-assessment, using a standard skills checklist.
d. Encourage staff to report every behavior of Ellen’s that is different from theirs.
21. Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that:
a. not all absenteeism is voluntary.
b. high personal control contributes to absenteeism.
c. direct discussions with employees who have high levels of absenteeism are not recommended.
d. all absenteeism is related to personal issues and needs.
22. The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager’s unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? “As a manager, you:
a. need to be aware of ADA issues.”
b. should check with human resources regarding chemically dependent employees and employment practices.”
c. check the nurse practice acts for the state in which the nurse resides.”
d. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.”
23. The education consultant for the hospital is presenting a workshop titled “Documentation: A Manager’s Responsibility.” Which of the following points would she not include in her PowerPoint presentation? Documentation:
a. cannot be left to memory. A notation must be placed in the personnel file.
b. should avoid discussion of the problem.
c. should include what was done about the problem when it occurred.
d. needs to include date, time, and place.
24. The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed?
a. Employee morale is at a high level.
b. Patient care will be jeopardized and possibility below standards.
c. Existing staff have experienced little effect from the absenteeism.
d. Cost for the unit remains the same when new staff are hired.
1. Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah’s peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. “It is a nurse’s professional responsibility to maintain quality control.”
b. “All instances of clinical incompetence are to be reported.”
c. “It is not considered being disloyal when one nurse reports another for poor care.”
d. “Patient care is the number one concern. Meeting standards is mandatory and necessary.”
