midterm leadership and management (mcn 107) exam

8/18/2019 Midterm Leadership and Management (MCN 107) EXAM

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Colegio De Kidapawan

Paramedical Department

MCN 107 Midterm Exam

Name :

1. A registered nurse is planning for theclient assignment for the day. Which of the following isthe most appropriate assignment for a nursing assistant?

A. a client requires tap water enemas

B. a client requiring colostomy irrigation

C. a client requiring continuous tube feeding

D. a client with difficulty swallowing food and fluid

. A registered nurse employed in long!term care facility is planning assignments for the clients

on a nursing unit. "he #$ needs to assign four clients and has a licensed practical %&ocational'

nurse and three nursing assistants on a nursing team. Which of the following clients would the

nurse most appropriately assign to (P$A. a client who requires a )!hour urine collection

B. an elderly client requiring assistance with bed bad and frequent ambulation

C. a client who requires a fleet and an oil retention enema

D. a client with an abdominal wound that requires irrigation and dressing changes e&ery * hours

*. A registered nurse has recei&ed the assignment for the day shift. After ma+ing initial rounds

and chec+ing all the assigned clients, which will the #$ plan to care for first?

A. a client who is ambulatory

B. a client who has fe&er and who is diaphoretic and restless

C. a client scheduled for physical therapy at 1- pm

D. a post!operati&e client who has recei&ed pain medications

). A nurse is assigned to care for four clients. /n planning client rounds, which client would the

nurse assess first?

A. a client recei&ing o0ygen &ia nasal cannula who had difficulty breathing the pre&ious shift

B. a post!operati&e client for discharge

C. a client scheduled for 0!ray

D. a client requiring daily dressing changes

. A registered nurse %#$' is implementing a team nursing approach. "he #$ has a licensed

practical nurse %(P$' and a nursing assistant on the team and is planning the client assignments

for the day. "he #$ appropriately assigns which of the following clients to the (P$?

a' a client who needs assistance with grooming

b' a client who needs frequent ambulation

c' a client who needs to be suctioned as needed %P#$'

d' a client who needs assistance with hygiene measures

2. A nurse is planning client assignments. Which of the following is the least appropriateassignment for the nursing assistant?

a' assisting a profoundly de&elopmentally disabled child to eat lunch

b' obtaining frequent oral temperatures on a client

c' accompanying a 1!year old man, being discharged to home following a bowel resection

d' collecting a urine specimen from a 3!year old woman admitted * days ago

1

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3.. A nurse is assigned to care for four clients. /n planning client rounds, which client would the

nurse assess first?

a' a client recei&ing o0ygen &ia nasal cannula who had difficulty breathing during the pre&ious

shift

b' a postoperati&e client preparing fro discharge

c' a client scheduled for a chest 0!ray

d' a client requiring daily dressing changes

4.. A nurse is planning the client assignments for the shift. Which of the following clients would

the nurse appropriately assign to the nursing assistant?

a' a client requiring twice !daily dry dressing changes

b' a client requiring frequent ambulation with a wal+er

c' a client on a bowel management program requiring rectal suppositories and a daily enema

d' a client with diabetes mellitus requiring daily insulin and reinforcement of dietary measures

5.. A client with a spinal cord in6ury de&elops a se&ere, pounding headache. "he client is

diaphoretic, hypertensi&e, and bradycardic and complains of nausea and nasal congestion. "he

nurse determines that the client is e0periencing autonomic hyperrefle0ia %autonomic dysrefle0ia'.

Which action would the nurse ta+e first?

a' notify the physician

b' document the findings

c' perform a rectal e0amination

d' place the client in a sitting position

1.A client who is mouth breathing is recei&ing o0ygen by face mas+. "he nursing assistant as+s

the registered nurse %#$' why a water bottle is attached to the o0ygen tubing near the wall

o0ygen outlet. "he #$ responds that the primary purpose of this feature is to-

a' pre&ent fluid loss from the lungs during mouth breathing

b' gi&e the client added fluid &ia the respiratory rate

c' humidify the o0ygen that is bypassing the client7s nose

d' pre&ent the client from getting nosebleed

11.. A nurse and a nursing assistant are assisting the respiratory therapist to position a client for

posturaldrainage. "he nursing assistant as+s the nurse how the respiratory therapists selects the

position used for the procedure. "he nurse responds that a position is chosen that will use gra&ity

to help drain secretions from which of the following areas?

a' trachea b' main bronchi

c' lobes

d' al&eoli

1. A registered nurse %#$' is obser&ing a licensed practical nurse %(P$' caring for a deceased

client whose eyes will be donated. "he #$ inter&enes if the (P$ performs which action?

a' ele&ates the head of the bed

b' closes the client7s eyes

c' places wet saline gau8e pads and ice pac+ on the eyes

d' closes the client7s eyes and places a dry sterile dressing o&er the eyes

1*. "he nurse has recently been assigned to manage a pulmonary progressi&e unit at a large

urban hospital. "he nurse7s leadership style is participati&e, with the belief that all staff members

assist in decision ma+ing and the de&elopment of the unit7s goals. "he nurse is implementing

which leadership style?

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a' democratic

b' laisse8 faire

c' auticratic

d' situational

1). A physician has written an order for a &est restraint to be applied on a client from 1- pm

to 3- am because the client becomes disoriented during the night and is at ris+ for falls. At11- pm, the charge nurse ma+es rounds on all of the clients with the &est restraint, which

obser&ation by the charge nurse would indicate that the nurse who cared for this client performed

an unsafe action in the use of the restraint?

a' a safety +not was used to secure the restraint

b' the client7s record indicates that the restraint will be released e&ery hours

c' the restraint was applied tightly

d' the call light was placed within reach of the client

1. 9atherine is a young :nit ;anager of the Pediatric Ward. ;ost of her staff nurses are senior

to her, &ery articulate, confident and sometimes aggressi&e. 9atherine feels uncomfortable

belie&ing that she is the scapegoat of e&erything that goes wrong in her department. Which of the

following is the best action that she must ta+e?

a. /dentify the source of the conflict and understand the points of friction

b. Disregard what she feels and continue to wor+ independently

c. " true?

a. Can be destructi&e if the le&el is too high

b. /s not beneficial hence it should be pre&ented at all times

c. ;ay result in poor performance

d. ;ay create leaders

13. 9atherine tells one of the staff, @/ dont ha&e time to discuss the matter with you now.


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15. " a benefit of conducting an informal appraisal?

a. "he staff member is obser&ed in natural setting.

b. /ncidental confrontation and collaboration is allowed.

c. "he e&aluation is focused on ob6ecti&e data systematically.

d. "he e&aluation may pro&ide &alid information for compilation of a formal report.

.


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.


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a. Collaborates with the physician b. Pro&ides care to a group of patients together with a group of nurses

c. Pro&ides care for !2 patients during their hospital stay.

d. Performs comprehensi&e initial assessment

*. Which pattern of nursing care in&ol&es the care gi&en by a group of paraprofessional wor+ers

led by a professional nurse who ta+e care of patients with the same disease conditions and arelocated geographically near each other?

a. Case method

b. ;odular nursing

c. $ursing case management

d. "eam nursing

**. fficer. " included?

a. ;easure actual performance

b.


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a. Agreed on le&el of nursing care b. Characteristics used to measure the le&el of nursing care

c.


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c. Country Club ;anagementd. "eam ;anagement

)). Jer former manager demonstrated passion for ser&ing her staff rather than being ser&ed.


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b. (eaders belie&e that people are basically good and need not be closely controlledc. (eaders rely hea&ily on &isioning and inspire members to achie&e results

d. (eadership is shared at the point of care.

1. ;s. Castro learns that some leaders are transactional leaders. Which of the following does

$>" characteri8e a transactional leader?

a. Eocuses on management tas+s

b. /s a careta+er

c. :ses trade!offs to meet goalsd. /nspires others with &ision

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c. >ne!to!one nurse!patient ratiod. Pro&ides continuous, coordinated and comprehensi&e nursing ser&ices

4. Eunctional nursing has some ad&antages, which one is an CP"/>$?

a. Psychological and sociological needs are emphasi8ed.

b. Kreat control of wor+ acti&ities.c. ;ost economical way of deli&ering nursing ser&ices.

d. Wor+ers feel secure in dependent role

5. Je raised the issue on gi&ing priority to patient needs. Which of the following offers the best

way for setting priority?

a. Assessing nursing needs and problems b. Ki&ing instructions on how nursing care needs are to be met

c. Controlling and e&aluating the deli&ery of nursing care

d. Assigning safe nurse- patient ratio

2. Which of the following is the best guarantee that the patients priority needs are met?

a. Chec+ing with the relati&e of the patient

b. Preparing a nursing care plan in collaboration with the patient

c. Consulting with the physiciand. Coordinating with other members of the team

21. When Jarry uses team nursing as a care deli&ery system, he and his team need to assess the

priority of care for a group of patients, which of the following should be a priority?

a. ach patient as listed on the wor+sheet

b. Patients who needs least carec. ;edications and treatments required for all patients

d. Patients who need the most care

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d. "he Kood


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c. stablish rapport with patients.d. #educe response time to two minutes.

3. Je wants to influence the customary way of thin+ing and beha&ing that is shared by the

members of the department. Which of the following terms refer to this?

a. >rgani8ational chart b. Cultural networ+

c. >rgani8ational structure

d. >rgani8ational culture

3*. Je asserts the importance of promoting a positi&e organi8ational culture in their unit. Whichof the following beha&iors indicate that this is attained by the group?

a. Proacti&e and caring with one another

b. Competiti&e and perfectionist

c. Powerful and oppositionald. >bedient and uncomplaining

3).


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a. ha&ing responsibility to direct others b. being accountable to the organi8ation

c. ha&ing legitimate right to act

d. telling others what to do

35. #egardless of the si8e of a wor+ group, enough staff must be a&ailable at all times toaccomplish certain purposes. Which of these purposes is $>" included?

a. ;eet the needs of patients

b. Pro&ide a pair of hands to other units as neededc. Co&er all time periods adequately.

d. Allow for growth and de&elopment of nursing staff.

4. Which of the following guidelines should be least considered in formulating ob6ecti&es for

nursing care?

a. Written nursing care plan b. Jolistic approach

c. Prescribed standards

d.


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client whose eyes will be donated. "he #$ inter&enes if the (P$ performs which action?

a' ele&ates the head of the bed

b' closes the client7s eyesc' places wet saline gau8e pads and ice pac+ on the eyes

d' closes the client7s eyes and places a dry sterile dressing o&er the eyes

42. "he nurse has recently been assigned to manage a pulmonary progressi&e unit at a largeurban hospital. "he nurse7s leadership style is participati&e, with the belief that all staff members

assist in decision ma+ing and the de&elopment of the unit7s goals. "he nurse is implementingwhich leadership style?

a' democratic b' laisse8 faire

c' auticratic

d' situational

43. A physician has written an order for a &est restraint to be applied on a client from 1- pm

to 3- am because the client becomes disoriented during the night and is at ris+ for falls. At11- pm, the charge nurse ma+es rounds on all of the clients with the &est restraint, whichobser&ation by the charge nurse would indicate that the nurse who cared for this client performed

an unsafe action in the use of the restraint?

a' a safety +not was used to secure the restraint

b' the client7s record indicates that the restraint will be released e&ery hours

c' the restraint was applied tightlyd' the call light was placed within reach of the client

NCLEX RN:

ANSWERS AND RA!"NALE

1# A

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! "he nursing assistant can perform enema. >ption B, C, and D will be done by the

(G$N(P$

$# D

! the (G$ can perform more complicated procedures li+e wound care. >ption A,

B, and C tas+s done by nursing assistants

%# &

! patients with unstable condition should be gi&en highest priority by the nurse.

"he client who has fe&er, and who is diaphoretic and restless is with unstable

condition

'# A

! the client with problem with airways and whose condition is unstable should be

gi&en first priority by the nurse. OABCO is a priority.

(# C

! When a nurse delegates aspects of a client7s care to another staff member, the

nurse assigning the tas+ is responsible for ensuring that each tas+ is appropriately

assigned on the basis of the educational le&el and competency of the staff member.

>ption C can be assigned to the (P$ because this staff member can performcertain in&asi&e procedures. $onin&asi&e inter&entions can be assigned to a

nursing assistant. "hese include the tas+s identified in options A, B, and D.

)# A

! "he nurse must determine the most appropriate assignment based on the s+ills of

the staff member and the needs of the client. /n this case, the least appropriate

assignment for a nursing assistant would be assisting with feeding a profoundly

de&elopmentally disabled child. "he child is li+ely to ha&e difficulty eating and

therefore a higher potential for complications such as cho+ing and aspiration. "he

remaining three options include no data indicating that these tas+s carry any

unforeseen ris+.

7# A

! Airway is always a high priority, so the nurse would attend to the client who has

been e0periencing an airway problem first. "he clients described in options B, C,and D would be an intermediate priority.

7*# &

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! Assignment of tas+s needs to be implemented on the basis of the 6ob description

of the nursing assistant, the le&el of clinical competence, and state law. >ptions A,

C, and D in&ol&e care that requires the s+ill of a licensed nurse. Although a nursing

assistant may be trained to administer an enema %depending on state practice acts

and agency policy', a rectal suppository needs to be administered by a licensed

nurse. >ption B is the most appropriate assignment for the nursing assistant.

+# D

! Autonomic hyperrefle0ia is an acute emergency that occurs as a result of

e0aggerated autonomic responses to stimuli that are innocuous in normal

indi&iduals. /t occurs only after spinal shoc+ has resol&ed. A number of stimuli

may trigger this response, including a distended bladder %the most common cause'

distention or contraction of the &isceral organs, especially the bowel %from

constipation, impaction', or stimulation of the s+in. When autonomic hyperrefle0ia

occurs, the client is immediately placed in a sitting position to lower the blood

pressure. "he nurse would then perform a rapid assessment to identify and alle&iate

the cause. "he client7s bladder is emptied immediately &ia a urinary catheter, the

rectum is chec+ed for the presence of a fecal mass, and the s+in is e0amined for

areas of pressure, irritation, or bro+en s+in. "he physician is notified, and the nurse

documents the occurrence and the actions ta+en.

After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:

N,r-ing .,e-tion- a/o,t Leader-ip and Management:

An-wer- and Rationale

10# C

! "he purpose of the water bottle is to humidify the o0ygen that is bypassing the

nose during mouth breathing. "he humidified o0ygen may help +eep mucous

membranes moist but will not substantially alter fluid balance %options A and B'. A

client who is breathing through the mouth is not at ris+ for nosebleeds.

11# C

! Postural drainage uses specific client positions that &ary depending on the

affected lobe%s'. "he positions usually in&ol&e ha&ing the head lower than the

affected lung segment%s' to facilitate drainage of secretions. Postural drainage

often is done in con6unction with chest percussion for ma0imum effecti&eness. "he

other options are incorrect.

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1$# C

! When a corneal donor dies, the eyes are closed and gau8e pads wet with saline

are placed o&er them with a small ice pac+. Within to ) hours, the eyes are

enucleated. "he cornea is usually transplanted with ) to )4 hours. "he head of the

bed should also be ele&ated. Placing dry sterile dressings o&er the eyes ser&es no

useful purpose.

1%# A

! Democratic leadership is defined as participati&e with a focus on the belief that

all members of the group ha&e input into the decision ma+ing process. "his leader

acts as a resource person and facilitator. (aisse8 faire leaders assume a passi&e

approach, with the decision ma+ing left to the group. Autocratic leadership

dominates the group, with maintenance of strong control o&er the group.


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). An-wer: 2D# Let te -ta33 entilate er 3eeling- and a-8 ow -e 5an /e o3

elp

#eaching out and helping the staff is the most effecti&e strategy in dealing

with burn out. 9nowing that someone is ready to help ma+es the staff feel

important hence her self!worth is enhanced.

. An-wer: 2D# 9o5,-ing a5tiit4 on te 5orre5tion o3 identi3ied /eaior

Performance appraisal deal with both positi&e and negati&e performance is

not meant to be a fault!finding acti&ity

2. An-wer: 2C# atient- are te /e-t -o,r5e o3 in3ormation regarding

per-onnel apprai-al

"he patient can be a source of information about the performance of the staff

but it is ne&er the best source. Directly obser&ing the staff is the best source

of information for personnel appraisal.

3. An-wer: 2C# e eal,ation i- 3o5,-ed on o/;e5tie data -4-temati5all4Collecting ob6ecti&e data systematically can not be achie&ed in an informal

appraisal. /t is focused on what actually happens in the natural wor+ setting.

4. An-wer: 2D# e -e--ion i- priate /etween te two mem/er-

"he session is pri&ate between the manager and the staff and remains to be

so when the two parties do not di&ulge the information to others.

5. An-wer: 2 Con-,ltatie

A consultati&e manager is almost li+e a participati&e manager. "he

participati&e manager has complete trust and confidence in the subordinate,always uses the opinions and ideas of subordinates and communicates in all

directions.

1. An-wer: 2D#


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1. An-wer: 2C# Rigtmo-t /ox

"he leftmost bo0 is occupied by the highest authority while the lowest le&el

wor+er occupies the rightmost bo0.

12. An-wer: 2D# romote- /etter interper-onal relation-ip

Decentrali8ed structures allow the staff to sol&e decisions by themsel&es,

in&ol&e them in decision ma+ing hence they are always gi&en opportunities

to interact with one another.

13. An-wer: 2 roide- 5are to a gro,p o3 patient- togeter wit a gro,p

o3 n,r-e-

"his function is done in team nursing where the nurse is a member of a team

that pro&ides care for a group of patients.

14. An-wer: 2 Mod,lar n,r-ing

;odular nursing is a &ariant of team nursing. "he difference lies in the fact

that the members in modular nursing are paraprofessional wor+ers.

15. An-wer: 2 !denti34 te al,e- o3 te department

/dentify the &alues of the department will set the guiding principles within

which the department will operate its acti&ities

. An-wer: 2 Rotation o3 d,t4 will /e done eer4 3o,r wee8- 3or all

patient 5are per-onnel


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3. An-wer: 2A# Span o3 5ontrol


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*5. An-wer: 2 Etnograp4

thnography is focused on patterns of beha&ior of selected people within a

culture

). An-wer: 2 Madeleine Leininger

;adeleine (eininger de&eloped the theory on transcultural theory based on

her obser&ations on the beha&ior of selected people within a culture

Anwrs from nos. )*!4.

1. An-wer: 2C# Co,ntr4 Cl,/ Management

Country club management style puts concern for the staff as number one priority atthe e0pense of the deli&ery of ser&ices. JeNshe runs the department 6ust li+e a

country club where e&ery one is happy including the manager.

. An-wer: 2C# Serant leader


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5. An-wer: 2D# !n-pire- oter- wit i-ion

/nspires others with a &ision is characteristic of a transformational leader. Je is

focused more on the day!to!day operations of the departmentNunit.

1. An-wer: 2A# ae 5onde-5ending tr,-t and 5on3iden5e in teir

-,/ordinate-

Bene&olent!authoritati&e managers pretentiously show their trust and confidence to

their followers

11. An-wer: 2A# Call 3or a -ta33 meeting and ta8e ti- ,p in te agenda

"his will allow for the participation of e&ery staff in the unit. /f they contribute to

the solutions of the problem, they will own the solutions hence the chance for

compliance would be greater.

1. An-wer: 2C# Low morale o3 -ta33 in er ,nit

(ow morale of staff is an internal factor that affects only the unit. All the rest of the

options emanate from the top e0ecuti&e or from outside the institution.

1*. An-wer: 2 Ma;orit4 r,le

;a6ority rule in&ol&es di&iding the house and the highest &ote wins.1N 1 is a

ma6ority.

1). An-wer: 2 -4-tem ,-ed to delier 5are

A system used to deli&er care. /n the 3s it was termed as methods of patient

assignment in the early 4s it was called modalities of patient care then patterns

of nursing care in the 5s until recently authors called it nursing care systems.

1. An-wer: 2A# Con5entrate- on ta-8- and a5tiitie-

Eunctional nursing is focused on tas+s and acti&ities and not on the holistic care of

the patients

12. An-wer: 2A# -45ologi5al and -o5iologi5al need- are empa-i=ed

When the functional method is used, the psychological and sociological needs of

the patients are neglected the patients are regarded as Mtas+s to be done M

13. An-wer: 2A# A--e--ing n,r-ing need- and pro/lem-

"his option follows the framewor+ of the nursing process at the same time appliesthe management process of planning, organi8ing, directing and controlling

14. An-wer: 2 reparing a n,r-ing 5are plan in 5olla/oration wit te

patient

"he best source of information about the priority needs of the patient is the patient

himself. Jence using a nursing care plan based on his e0pressed priority needs

would ensure meeting his needs effecti&ely.

15. An-wer: 2D# atient- wo need te mo-t 5are

/n setting priorities for a group of patients, those who need the most care should benumber!one priority to ensure that their critical needs are met adequately. "he

needs of other patients who need less care ca be attended to later or e&en delegated

to assisti&e personnel according to rules on delegation.

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. An-wer: 2C# !ntegrate te -ol,tion- to i- da4FtoFda4 a5tiitie-

/ntegrate the solutions to his day!to!day acti&ities is e0pected to happen during the

third stage of change when the change agent incorporate the selected solutions to

his system and begins to create a change.

1. An-wer: 2C# 9o5,-e- on ro,tine ta-8-

ptions AB, C and D

are all ob6ecti&es which are aimed at specific end.

*. An-wer: 2D# "rgani=ational 5,lt,re

An organi8ational culture refers to the way the members of the organi8ation thin+

together and do things around them together. /ts their way of life in thatorgani8ation

*1. An-wer: 2A# roa5tie and 5aring wit one anoter

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*. An-wer: 2A# "rgani=ational -tr,5t,re

>rgani8ational structure pro&ides information on the channel of authority, i.e., who

reports to whom and with what authority the number of people who directly

reports to the &arious le&els of hierarchy and the lines of communication whether

line or staff.

**. An-wer: 2 !n3ormal

"his is usually not published and oftentimes concealed.

*). An-wer: 2D# all organi=ation

"all organi8ations are highly centrali8ed organi8ations where decision ma+ing is

centered on one authority le&el.

*. An-wer: 2A# 1 G $

Centrali8ed organi8ations are needs only a few managers hence they are less

e0pensi&e and easier to manage

*2. An-wer: 2C# aing legitimate rigt to a5t

Authority is a legitimate or official right to gi&e command. "his is an officially

sanctioned responsibility

*3. An-wer: 2 roide a pair o3 and- to oter ,nit- a- needed

Pro&iding a pair of hands for other units is not a purpose in doing an effecti&e

staffing process. "his is a function of a staffing coordinator at a centrali8ed model.

*4. An-wer: 2D# Sta33 pre3eren5e-


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dominates the group# with maintenance of strong control oer the group. *ituational leadership is basedon the current eents of the day.

20) C

- +estraints should neer be applied tightly because that could impair circulation. The restraint should be

applied securely (not tightly) to preent the client from slipping through the restraint and endangering

himself or herself. A safety knot should be used because it can easily be released in an emergency.

+estraints# especially limb restraints# must be released eery % hours (or per agency policy) to inspect the

skin for abnormalities. The call light must always be within the client,s reach in case the client needs

assistance.

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midterm leadership and management (mcn 107) exam

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