4: Chapter The Leadership Role of the Licensed Practical Nurse
MULTIPLE CHOICE 1. The LPN, as a regular staff member, knows all the patients and anticipates many of their needs. Other staff members are comfortable asking for advice. The advice is given freely with clear explanation and/or demonstration. This nurse can be said to be acting in the role of: 1. self-appointed teacher. 2. management-assigned instructor. 3. informal leadership. 4. designated supervisor. ANS: 3 Informal leaders are not appointed but are recognized by their peers as knowledgeable and skillful. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 1 TOP: Informal Leadership Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 37
2. A case conference is called to plan for a patient who has caused stress in the staff with constant calls and trivial requests. The nurse leader expresses personal views, leads the discussion about approaches to the problem, and then makes the decision for care based on the discussion. This is an example of: 1. autocratic leadership. 2. democratic leadership. 3. laissez-faire leadership. 4. participative leadership. ANS: 4 Participative leadership encourages group involvement and suggestion, but the decision is made by the leader. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 2 TOP: Leadership Styles Nursing Process Step: Planning NCLEX: Safe, Effective Care Environment REF: 38
3. To meet patient care needs, the LPN receives authority to delegate care to unlicensed personnel from: 1. the MD or RN who hired them. 2. the National Nurse Practice Act. 3. the 1994 Entry Level Competencies Report. 4. the Nurse Practice Act of the individual state. ANS: 4 Delegation of responsibilities must be in accordance with the states Nurse Practice Act.
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Knowledge 6 TOP: Delegation by LPN Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment
REF: 44
4. When the staff complains about being pulled to other areas to work without prior notice, the leader agrees with their request to develop a more effective system and does so with assistance and input from the entire staff. This is an example of leadership theory: 1. X. 2. Y. 3. Z. 4. Not representative of any theory. ANS: 3 Theory Z involves all workers in every phase of the operation. Theory X assumes that all workers desire direction. Theory Y assumes that all work gives satisfaction. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 3 TOP: Leadership Styles Nursing Process Step: Planning NCLEX: Safe, Effective Care Environment REF: 40
5. The LPN in charge of two wards on the evening shift notices that two of the nursing assistants (NAs) are constantly bickering. This appears to be interfering with patient care time. Both units are extremely busy with care needs. The solution that reflects the process of accommodation is which of the following? 1. Their issues are trivial and do not affect patient care actions. There is no time for extended discussions now. Send one of the NAs to another area and allow time to defuse. Good patient care in an expedient manner is a priority at this time. 2. Call the supervisor to send the arguing dissenters home. 3. Call the dissenters into the office. Listen to their concerns and make a decision about resolution of their trivial matters. 4. Allow the NAs to leave the building and settle their differences before they come back. Make no notation of the absence on the time sheet or in the report. ANS: 1 Patient care is the main priority. The leader cannot lose two caregivers but may separate them so that they can provide needed patient care, accommodating both NAs by separating them. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Conflict Resolution Styles Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 42, Table 4-3
6. The team leader is preparing to tape the evening shift report. The comment that should be included in the report is that: 1. client A complained of a headache until his wife arrived to visit. She was 20 minutes late because of unavoidable traffic.
2. client B ate everything on her dinner trayroast beef, mashed potatoes, and green beansand the dessert too, which is her usual pattern. 3. client C was so restless that the dressing on her sacrum came off and had to be replaced. There was no change in the assessment of the decubitus. 4. client D had her usual visitors. She is sleeping after her regular evening medications, which were given as ordered at 8 PM. ANS: 3 The shift report should contain only clear, concise, and thorough information without extra useless comments. PTS: 1 DIF: Cognitive Level: Application REF: 45 OBJ: 3 TOP: Shift Report KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 7. The director of nursing in a nursing home appoints an LPN to be project head to coordinate a review of end of shift reporting times and to develop a new, more timely format for the entire agency to use. This LPNs role would be as a(n): 1. goal-setting organizer. 2. organizing leader. 3. assigned manager. 4. manager-leader. ANS: 3 The LPN has been appointed to manage the implementation of a goal set by the leader. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 2 TOP: Management versus Leadership Nursing Process Step: Planning NCLEX: Safe, Effective Care Environment REF: 37
8. The head nurse puts a blank copy of the shift duty schedule on the table in the break room. The staff is permitted to fill in those shifts that they want to work during the next cycle. This example reflects the style of: 1. autocratic leadership. 2. democratic leadership. 3. laissez-faire leadership. 4. participative leadership. ANS: 2 Democratic leadership focuses on the individual abilities and problem-solving skills of group members to avoid power struggles. Decisions are made through group consensus. PTS: 1 DIF: Cognitive Level: Analysis REF: 38 OBJ: 2 TOP: Leadership Styles KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 9. The team leader is making out the patient care assignment. A new patient needs several extensive dressing changes for open diabetic wounds, an NG tube feeding, and irrigation of the Foley PRN. The member of the care team best suited for this assignment is:
1. nurse aide A, who has had 10 years experience working at this facility, especially because this room is on the hall area where this NA is usually assigned. 2. nurse aide B, who has just been employed but has recently been through the state nurse aide certificate program and needs the experience of these treatment modalities. 3. nurse aide C, who is always asking for something new to try out and who is attending LPN school in off-duty hours. 4. LPN C, because these treatments are covered under the LPN State Practice Act. ANS: 4 Invasive procedures may not be carried out by unlicensed personnel. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 6 TOP: Delegation of Nursing Care Nursing Process Step: Planning NCLEX: Safe, Effective Care Environment REF: 44
10. The role of the LPN as a team leader has been developed to broaden and improve patient care. The statement that reflects this role implementation is which of the following? 1. As LPN team leaders, these nurses are totally and only personally responsible, under the terms of licensure, for personal care actions and the nursing actions of the others assigned on their unit and shift. 2. As an LPN team leader, this nurse, under the supervision and guidance of an RN, is responsible for all aspects of patient care that is assigned to this team. 3. As an LPN team leader, this nurse uses those skills and judgments learned in school to guide and direct the team members in what the nurse feels is correct patient care. The LPN is accountable only to patients for the care provided. 4. The team leader LPN decides on patient care assignments, taking care to promote accident prevention and safety, and is accountable only to self-professionalism for the nursing actions of the team. ANS: 2 The LPN practices under the supervision of an RN, but is responsible for her own and for the teams performance. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 6 TOP: LPN as Team Leader Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment REF: 44
11. The team leader nurse is attending college classes for a degree after work and spends much of the day reading and writing. As a result, the staff is given few directions; they make their own patient assignments, time schedules, and solve problems among themselves. There is much confusion on the unit. This leader is practicing: 1. autocratic leadership. 2. democratic leadership. 3. laissez-faire leadership. 4. participative leadership. ANS: 3
The laissez-faire leader gives no direction to the activities of the staff, allowing them to do what they want. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 2 TOP: Leadership Styles Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 38
12. On the way to the biohazard disposal closet to dispose of IV tubing and a bag used on an HIV-positive client, the LPN drops the IV tubing and bag on the floor, causing a spill. The team leaders most appropriate action would be to do which of the following? 1. Quickly pick up the dropped supplies and dispose of them in the biohazard bag in the biohazard room. Ask housekeeping to place a small barricade over the spill until it can be mopped up later. 2. Find the floor maintenance person to up pick and dispose of the used equipment and mop the floor, reminding them to be sure and wash his or her hands with soap and water. Chart that the IV was infused and discontinued appropriately. 3. Call and report to designated personnel to come and cordon off the area from staff and patients; have the spill cleaned with approved infection and chemotherapy spill control procedures. 4. Chart the spill in the patients chart, inform the RN when convenient, and have housekeeping mop up the spill. ANS: 3 Blood and chemotherapy agents are biohazards. Each facility has a policy regarding an accidental spill, which includes immediate reporting to designated personnel. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 5 TOP: Biohazard Precautions Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 45
13. The process of management for the nurse leader consists of the application of steps similar to those of the nursing process. Which of the following contains all the steps of the management process? 1. At the end of the shift report, the team leader tells the staff that charting will be reviewed, medication Cardex checked, and patient rounds made a half-hour early today to obtain a more detailed patient profile of care provided during that shift. 2. The team leader has been unavoidably late, has missed most of the shift report, and grabs the staffing roster to make out patient assignments. The assignments are scheduled by alphabetical order by the geographic areas of the unit. No incidents appear to have occurred on the unit during the shift. 3. The nurse is perpetually late for duty and frequently leaves before the end of the shift report, asking others to help in completing the patient assignment. The team leader ignores this as long as patient care is completed. 4. The staff member is noted to leave some patients in strange positions on several occasions. On rounds, the team leader notices this and correctly repositions the patients. The team leader thinks that the staff could probably use some in-service training on proper positioning; however, she decides that there is no time to do
this. ANS: 1 Planning, organizing, and directing must be done for the provision of effective nursing care to meet standards. Evaluation or controlling is the process that checks delivered care for effectiveness. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 4 TOP: Functions of Management Nursing Process Step: Implementation NCLEX: Safe, Effective Care Management REF: 40-42
14. The team leader notices that a staff member has again omitted several pertinent items of patient assessment and care on the chart. The most appropriate action by the leader is to: 1. complete the chart with notation of items of which this nurse has personal knowledge. Counsel the errant nurse privately. 2. call the staff member at home and have him or her return to complete the patients charts correctly, without overtime. 3. pass the complete information verbally to the next shift via report. 4. write a report of reprimand on the nurse and forward it to the RN supervisor. Leave the charts as is. ANS: 1 Timely communication via charting is the legal and professional responsibility of LPNs. The team leader may make a signed addendum to a chart if the leader has personal knowledge of the events. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 5 TOP: LPN as Team Leader Nursing Process Step: Evaluation NCLEX: Safe, Effective Care Environment REF: 44
15. Leadership is different from management. Which of the following definitions best describes this difference? 1. The leadership function comes after the manager decides on it. 2. Management refers to providing the means to inspire people. 3. A leader selects the role and a manager is appointed. 4. A manager selects goals and the means to achieve them. ANS: 3 As defined in the text, leaders inspire people to strive to accomplish particular goals, whereas management provides the means to achieve these goals. PTS: 1 DIF: Cognitive Level: Comprehension REF: 37 OBJ: 1 TOP: Leadership versus Management KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
16. A 35-year-old patient, newly admitted to the facility, puts on the call bell, but by the time the nurse arrives, he is found unconscious and barely breathing. The charge nurse calls for a Code Blue and directs the staff on what to do without discussionone staff member calls the doctor, some to go to other rooms to comfort patients there, and so forth. This is an example of the style of: 1. autocratic leadership. 2. democratic leadership. 3. laissez-faire leadership. 4. participative leadership. ANS: 1 During an emergency such as a Code Blue, the person in charge correctly assumes an autocratic leadership role because there is no time for discussion of choices in activities. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application REF: 37 2 TOP: Characteristics of an Effective Leader Nursing Process Step: Implementation NCLEX: Safe, Effective Care Management
17. Some characteristics of both leaders and managers are the same. Such a characteristic is: 1. motivational skills. 2. sympathy skills. 3. authoritarian style. 4. participative style. ANS: 1 Although leaders and managers use different styles and responsibilities, they both must have motivational skills. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Knowledge REF: 37 1 TOP: Similarities in Leaders and Managers Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment
18. The recognition and utilization of the LPN began because of RN shortages and a reevaluation of LPNs as team leader. The approximate date of this change in staffing occurred in the: 1. 1940s. 2. 1950s. 3. 1960s. 4. 1970s. ANS: 2 Team nursing with LPN leadership was introduced in the 1950s as a result of the shortage of RN nurses and abundance of auxiliary nursing personnel, whose skills and leadership potential was reevaluated. PTS: 1 DIF: Cognitive Level: Knowledge OBJ: 5 TOP: Team Nursing KEY: Nursing Process Step: N/A REF: 38
MSC: NCLEX: Safe, Effective Care Environment 19. Laissez-faire leadership is the opposite of: 1. authoritarian leadership. 2. bureaucratic leadership. 3. democratic leadership. 4. participative leadership. ANS: 1 Laissez-faire is a hands-off leadership style; authoritarian is very directive and controlling. PTS: 1 DIF: Cognitive Level: Comprehension REF: 38, 39, Table 4-1 OBJ: 2 TOP: Leadership Style KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 20. A nurse tells the other staff members that she works only for the money and just wants to do the job and go home. The leadership style in which this nurse would be most comfortable is: 1. autocratic leadership. 2. democratic leadership. 3. laissez-faire leadership. 4. participative leadership. ANS: 1 Persons who just want to do their job seek a directive style of leadership, because it reduces their responsibility. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Leadership Styles Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment REF: 38
21. The team leader assigns LPN A to patient care in rooms 123 and 129, explaining some of the special higher level care that these patients will need. Nurse aides G and F are assigned to the rest of the hall, splitting the numbers of patients needing total care versus partial care. Their care duties are discussed in detail. Making assignments according to skill level is an example of: 1. planning. 2. organizing. 3. evaluating. 4. directing. ANS: 4 The management function of directing is found in the team leaders making assignments according to skill levels and explaining what is to be done. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension REF: 41 3 TOP: The Directing of Staff by the Team Leader Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment
22. The task to which nursing aides (nursing assistants) may be delegated is: 1. updating a nursing care plan. 2. developing a teaching plan. 3. weighing a patient. 4. evaluating pain medication responses. ANS: 3 Unlicensed persons may weigh a patient when directed to do so. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 4 TOP: Delegation of Nursing Tasks Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 44
23. The professional nurse has the skills and knowledge to direct the care provided by other staff through the nursing care organization of: 1. primary nursing. 2. functional nursing. 3. rehabilitative nursing. 4. team nursing. ANS: 4 In a team nursing situation, the skills of each team member are used to best advantage for efficient nursing care. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 3 TOP: Team Nursing Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 43
COMPLETION 1. An LPN took the responsibility of working with the equipment company representative to learn about some new equipment coming to the facility soon. The LPN then developed and presented an in-service teaching to the rest of the staff. This LPN is managing under management theory ____________________. ANS: Y PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Classic Management Theories Nursing Process Step: Implementation NCLEX: Psychosocial Integrity REF: 40
2. Planning, organizing, directing, and controlling are major functions of ____________________. ANS: Management
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Application 3 TOP: Major Functions of Management Nursing Process Step: Implementation NCLEX: Psychosocial Integrity
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