Leading and Managing in Nursing 5th Edition by Patricia S. Yoder Wise Test Bank

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Leading and Managing in Nursing 5th Edition by Patricia S. Yoder Wise Test Bank


Yoder-Wise: Leading and Managing in Nursing, 5th Edition

Chapter 06: Making Decisions and Solving Problems

Test Bank


1. The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from the 7-3 shift.
c. Use institutional research.
d. Identify the problem.

Identification of a problem is the first step in problem solving and occurs before any other step. Improper identification of the problem is the most common reason for failure to resolve problems.

REF: Pages 108-110
TOP: AONE competency: Knowledge of Healthcare Environment

2. The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehab staff in the decision.
b. Involve the sales representative.
c. Make the decision alone.
d. Involve administration in the decision.

A democratic or participative approach involves appropriate personnel in the decision-making process. Involvement of others is essential in decisions involving patient care.

REF: Page 104 TOP: AONE competency: Business Skills

3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:
a. Evaluate problem solutions.
b. Critique the ideas of others.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.

Brainstorming encourages creativity when one is beginning to problem-solve and avoids premature shutting down of ideas through early evaluation.

REF: Pages 104, 105 TOP: AONE competency: Business Skills

4. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer a telling style.
d. Followers who cannot agree on a solution.

An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

REF: Page 101 TOP: AONE competency: Business Skills

5. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.

The nurse leader or manager needs to provide a nonthreatening and positive environment in which group members actively participate by controlling aggressive individuals and encouraging passive individuals. Diversity, managed conflict, and moderate cohesiveness are effective in reaching quality decisions.

REF: Pages 104, 105 TOP: AONE competency: Business Skills

6. To solve a problem, the nurse manager understands that the most important problem-solving step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.

To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

REF: Pages 108, 109 TOP: AONE competency: Leadership

7. A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:
a. Stay out of it.
b. Inform the nursing supervisor.
c. Fill out a notification form (incident report).
d. Assess the risk to the client and the agency before proceeding.

In assessing risk, the nurse engages in the initial step of the problem-solving process, which involves asking What benefits (or risks) will be derived from solving it? Purposeful inaction may not be appropriate when the individual cannot resolve the problem or when there is risk to patients.

REF: Pages 101-103
TOP: AONE competency: Knowledge of Healthcare Environment

8. The clinic nurse understands that problem solving is best defined as:
a. A higher-order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Identifying the gap between what is and what should be.
d. Determining creative approaches to resolving a problem or issue.

Critical thinking is a higher-order thinking process. Problem solving is a step in decision making that is focused on solving an immediate problem, which can be viewed as a gap between what is and what should be.

REF: Page 99 TOP: AONE competency: Knowledge of the Healthcare Environment

9. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:
a. Identify the root causes of problems.
b. List possible solutions to problems.
c. Help leaders select the best options.
d. Evaluate the outcomes of decisions made.

A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

REF: Page 110 TOP: AONE competency: Knowledge of Healthcare Environment

10. An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:
a. Select the least expensive brand.
b. Use a decision-making tool to evaluate brands.
c. Ask the nursing staff which brand they prefer.
d. Select the vendor the institution usually buys from.

Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options known.

REF: Pages 106, 107
TOP: AONE competency: Knowledge of Healthcare Environment

11. Select the statement that best defines the difference between problem solving and decision making:
a. Decision-making skills require critical thinking, problem-solving skills do not.
b. Problem-solving skills require critical thinking, decision-making skills do not.
c. Decision making is a goal-directed effort, problem solving is focused on solving an immediate problem.
d. Problem solving is a goal-directed effort, decision-making is focused on solving an immediate problem.

Problem-solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.

REF: Pages 99, 100 TOP: AONE competency: Leadership

12. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following?
a. Immediately fire the staff nurse.
b. Speak to the whistleblower and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.

Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action.

REF: Page 108 TOP: AONE competency: Business Skills

13. The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more user-friendly. The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process?
a. Assessment/Data collection
b. Planning
c. Data interpretation
d. Generating hypotheses

In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining if there is a problem or problems.

REF: Pages 110, 111 TOP: AONE competency: Business Skills

14. A good nursing decision maker is one who:
a. Uses various models to guide the process based on the circumstances of the situation.
b. Adopts one model and uses it to guide all decision making.
c. Decides not to use any models because they are all useless.
d. Develops a new model each time a decision has to be made.

Research has determined that a structured approach to decision making increases critical thinking and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses on proven processes.

REF: Page 101 TOP: AONE competency: Leadership

15. From the information supplied in this chapter, which statements best defines critical thinking? Critical thinking is a:
a. High-level cognitive process.
b. Process that helps to develop reflective criticism for the purpose of reaching a conclusion.
c. High-level cognitive process that includes creativity, problem solving, and decision making.
d. Discussion that guides the nursing process.

It is generally accepted by many authors and researchers that this statement best defines critical thinking.

REF: Page 99 TOP: AONE competency: Business Skills

16. Decision making is described by the nursing educator as the process one uses to:
a. Solve a problem.
b. Choose between alternatives.
c. Reflect on a certain situation.
d. Generate ideas.

The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

REF: Page 99 TOP: AONE competency: Leadership

17. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decision-making models did Justin use in making his decision?
a. Subjective model
b. Objective model
c. Optimizing model
d. Satisficing model

The Satisficing Model is a decision-making model whereby the decision maker selects the solution that is the simplest and provides for the quickest solution.

REF: Page 101 TOP: AONE competency: Business Skills

18. Which of the following decision-making solutions should Justin (Question 17) consider to have a more efficient department?
a. Replace staff only with qualified applicants.
b. Determine what the problem or problems are before hiring new staff.
c. Consult with the human resources department and develop a plan for hiring new staff.
d. Consider all the options listed.

Decision making involves a goal-oriented consideration of many options. All of the alternatives are very reasonable decision-making strategies in this instance.

REF: Pages 104-106 TOP: AONE competency: Business Skills

19. When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit managers first missed step in problem solving?
a. Not using a problem-solving model
b. Not considering a number of alternatives
c. Poor evaluation of outcomes
d. Incorrect problem identification

The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with why?

REF: Pages 108-110 TOP: AONE competency: Business Skills

20. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:
a. The policy was too lengthy and inundated readers with too much detail.
b. The policy made decisions for other departments in the company.
c. The staff did not believe that the new policy would be effective.
d. Testing should not be done in the lab.

Other departments were not involved in the problem-solving process; therefore, they lacked input into the concerns, issues, and possible solutions. Therefore, it is not surprising that they did not follow the new policy of another department. Problem solving should be a group process that should involve as many personnel as possible.

REF: Pages 103, 104 TOP: AONE competency: Business Skills

21. High-quality decisions are most likely to be made in nursing situations when:
a. Team leaders make the crucial decisions.
b. Individuals are advised of the problems.
c. Group size is neither too small nor too large.
d. Members are passively involved.

Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

REF: Page 103 TOP: AONE competency: Business Skills

22. Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends upon the situation and the desired outcomes. The autocratic process is used in which of the following situations?
a. The task and the outcome are relatively simple.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.

An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

REF: Page 101 TOP: AONE competency: Leadership

23. Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospitals restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.

This is based upon a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

REF: Page 101 TOP: AONE competency: Knowledge of Healthcare Environment

24. When decision making, critical thinking, and problem solving are considered, which of the following statements are accurate and valid points?
a. The professional decision maker approaches problem solving by beginning with an outcome already in mind.
b. Involvement in decision making is of little use unless you are an expert decision maker.
c. Many models aid the nurse in improving his or her decision-making skills.
d. The nursing decision maker who is successful recognizes that only those with similar experiences should be involved in decision making.

A nurse can draw upon many models in making a decision. It is critical to realize that decision-making expertise grows with exposure to decision making, and that diversity in expertise helps in developing options.

REF: Page 101 TOP: AONE competency: Leadership


1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have (select all that apply):
a. Identified the assumptions that were underpinning the issues.
b. Considered the context of the present problem or situation.
c. Gathered data before making her decision and evaluated all possible outcomes.
d. Attained a majority consensus of all staff.

ANS: A, B, C
Taking a majority consensus is not a step in the critical thinking process. Points A, B, and C are considered by most authors to be the essential steps in the process of critical thinking.

REF: Pages 99, 100 TOP: AONE competency: Leadership

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