Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is
asked to assess and adapt the unit to better meet the unique needs of the older adult patient.
Using complexity principles, what would be the best approach to take in making this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and
planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit, and omit the hospital and community environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore, all levels of staff would be involved in decision making.
REF: Page 8
TOP: AONE competency: Communication and Relationship-Building
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has
called in sick five times in the past month. He tells the manager that he very much wants to come
to work when scheduled but must often care for his wife, who is undergoing treatment
for breast cancer. According to Maslow’s need hierarchy theory, what would be the best
approach to
satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be
calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off
around his wife’s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs
and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
patient care and threaten the needs of staff to feel competent. Arranging the schedule around
the wife’s needs meets the needs of the staff and of patients while satisfying the nurse’s need
for affiliation.
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REF: Page 10
TOP: AONE competency: Communication and Relationship-Building
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first
mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit
manager continues to reiterate the reasons for her actions. What would be the best course of
action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
ANS: C
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the
interests and involvement of participants in the conflict by examining the real issues of all
parties.
REF: Page 16
TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.
It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the dispute.
ANS: B
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is
recommended if resolution fails.
REF: Page 16
TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of RN
assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have
always practiced in a primary nursing–delivery system and are very resistant to this idea. The
best initial strategy in this situation would include:
a. Exploring the values and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is
implemented.
c. Dropping the idea and trying for the change in a year or so when some of the present RNs
have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling
relationships, deepening self-awareness in self and others, motivating others, and managing
emotions. Motivating others recognizes that values are powerful forces that influence
acceptance of change. Leaving the RNs alone for a period of time before implementation does
not provide opportunity to explore different perspectives and values. Avoiding discussion
until the team changes may not promote adoption of the change until there is opportunity to
explore perspectives and values related to the change. Hiring of the assistants demonstrates
lack of empathy for the perspectives of the RN staff.
REF: Page 7 | Page 15
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that
there is little turnover among your LPN and nursing assistant (NA) staff members, but they are
not very motivated to go beyond their job descriptions in their work. Which of the following
strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night
LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their
positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual
workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign
contracts that guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with
Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction.
Motivator factors such as recognition and satisfaction with work promote a satisfying and
enriched work environment. Transformational leaders use motivator factors liberally to inspire
work performance and increase job satisfaction.
REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating factors, which
action would you select?
a. Collaborate with the human resource/personnel department to develop on-site daycare
services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
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ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore all levels of staff would be involved in decision making. This
principle is the foundation of shared governance.
REF: Pages 8-11
8.
TOP: AONE competency: Communication and Relationship-Building
A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who
begins to complain loudly about the quality of care his mother is receiving. His behavior is so
disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects
any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the
nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined
leadership skills in an emotionally intelligent practitioner?
a. Reflect to gain insight into how the situation could be handled differently in the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
Goleman suggests that emotional intelligence involves insight and being able to step outside
of the situation to envision the context of what is happening as well as being able to manage
emotions such as frustration effectively.
REF: Page 7 | Page 8
9.
TOP: AONE competency: Leadership
The chief nursing officer has asked the staff development coordinator to facilitate the
development of a clinical competency program for the facility. While making rounds on the
units, the staff development coordinator overhears RN staff complaining that they feel it is
insulting to be required to participate in a competency program. Which behavior by the staff
development coordinator is most appropriate in this situation?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a requirement for JCAHO accreditation.
c. Schedule a meeting with the chief nurse executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about a competency
program.
ANS: D
The manager role involves guiding others through a set of derived practices that are evidencebased and known to satisfy preestablished outcomes such as participation in a competency
program. This involves engagement of staff through sharing of concerns and ideas. A close
analysis of the IOM report and the summary of the PPACA suggests that no health reform can
unfold without active nursing engagement. Each document emphasizes that nurses must lead,
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manage, and behave as active collaborators with other members of the health team and with
those being served.
REF: Page 3
TOP: AONE competency: Communication and Relationship-Building
10. As the manager, you have been asked to implement an evidence-based approach to teach
ostomy patients self-management skills postoperatively that is being operationalized throughout
your organization. Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar
to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs
that the new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in
mentoring and teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting where a
team has gathered to ensure the best clinical decision making and actions are taken to achieve
clinical or organizational outcomes. Followership promotes good clinical decisions and use of
clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
11. You overhear a newly graduated RN telling one of your colleagues that leadership and
management belong to the unit manager and not to her. As a nursing colleague, you respond by
demonstrating understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence
may affect the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied in
their jobs.
ANS: B
Care coordination that involves the intersection of individual, family, and community-based
needs requires that nurses have self-confidence, knowledge of organizations and health
systems, and an inner desire to lead and manage. There is often a view that leadership is
isolated to those holding managerial positions and that a direct care nurse is subject to
following by adhering to the direction of others. Such views fail to acknowledge that to be a
nurse requires each licensed individual to lead, manage, and follow when practicing at the
point-of-care and beyond.
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REF: Page 3 | Page 4
TOP: AONE competency: Leadership
12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously
very upset and after you speak with him regarding his behavior, you determine that he has not
slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith
and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest
that Mr. Smith’s behavior was aggressive but is related to lack of sleep and to pain. You say to
Miss Jones, “Can you both, together with Mr. Smith, determine triggers for the pain and
effective approaches to controlling his pain?” This approach demonstrates:
a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr. Smith.
c. Leadership behavior.
d. Management behavior.
ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved
patient symptoms and aggressiveness toward a staff member. Providing engaged,
collaborative guidance and decision making in a complex situation where there is no
standardized solution reflects leadership.
REF: Page 4
TOP: AONE competency: Leadership
13. After assessing an older adult patient in long-term care who has been slowly deteriorating for
weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The
nurse manager’s decision and actions are based on:
a. An established clinical pathway.
b. Confirmatory scientific evidence.
c. Unit protocol.
d. Experience.
ANS: D
The nurse manager is employing knowledge and experience in determining that the patient is
dying, because the course of dying is not standardized and cannot be determined by clinical
pathways.
REF: Page 4
TOP: AONE competency: Knowledge of the Health Care Environment
14. Chart audits have revealed significant omissions of data that could have legal and funding
guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings
and to find approaches that will address the gaps in charting and achieve desired goals. This is
an example of:
a. Leadership.
b. Management.
c. Decision making.
d. Vision.
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ANS: B
The process of guiding others to meet established goals, outcomes, and procedures is
management. This can require collaborative decision making to determine how best to reach
pre-determined goals and follow established practices.
REF: Page 5
TOP: AONE competency: Knowledge of the Health Care Environment
15. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. What role are you
assuming through this action? a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
As a manager, you are concerned with managing and coordinating resources to achieve
outcomes in accordance with established clinical processes. Referral to a social worker
alleviates demand on staff time and is consistent with hospital procedures.
REF: Page 5
TOP: AONE competency: Communication and Relationship-Building
16. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. In response to this
situation, you approach the unit manager to apprise her of your concerns that the family
dynamics of the patient involved may lead to staff-family and patient-family conflicts. You
suggest that the physician may need to discuss the treatment plan with the family. The unit
manager advises that he will arrange this discussion. If, after the meeting with family members,
this is identified as a desired approach, you support the manager’s decision. Your actions
indicate that you are acting in what role? A
. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
In the followership role, you bring to the manager your concerns about potential litigation and
maximization of outcomes and accept the direction given by the manager in response to your
concerns.
REF: Page 3 | Page 4
TOP: AONE competency: Knowledge of the Health Care Environment
17. You pull staff together to assess a situation in which the family of a seriously ill patient is
anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning
of treatment decisions. Staff members are becoming distanced from the family. After inviting
the concerns of staff, you explain that the organization values patient-centered care and that
evidence supports that acting as an advocate and a listener is helpful to families. You ask the
staff for ideas as to strategies that are effectively patient-centered in these situations. In this
situation, you are taking on which role?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
As a leader, you provide and communicate vision and direction based on evidence and
experience, and you engage others in decision making that moves them toward the vision with
a reasonable level of risk taking.
REF: Page 4 | Page 5
TOP: AONE competency: Leadership
18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas
has many ideas, and his manner of presenting them irks Joan. After reflection and discussion
with others, Joan recognizes that she also feels threatened by his behavior. She comes to
understand that Thomas is trying to establish his own role on the unit, is not trying to challenge
her, and needs guidance, coaching, and affirmation. Joan is demonstrating:
a. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
According to Goleman (1995), stepping outside oneself to envision the situation while
assuming ownership is a component of emotional intelligence.
REF: Page 7 | Page 8
TOP: AONE competency: Professionalism
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19. As the head of a nursing program, you consistently invite the ideas of your team about
innovations in teaching, community partnerships, and curriculum design and invite participation
in decisions. Many of these ideas have been implemented successfully, and your staff members
are keen to try on other ideas. You are employing _____ leadership.
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
Transformational leadership involves attending to the needs and motives of followers, which
results in creativity, improvement, and employee development.
REF: Page 10 | Page 11
TOP: AONE competency: Professionalism
20. As a leader on a rehab unit, you encourage all staff members to see themselves as having a role
in decision making and quality care. You see your role as involving particular responsibilities in
decision making but not as a hierarchal role. This view of decision making and leadership is
consistent with:
a. Trait theories.
b. Complexity theory.
c. Situated theory.
d. Emotional intelligence.
ANS: B
Complexity theory involves envisioning each member of the team involved in decision
making, management, and leadership, with the leader not seen in a hierarchal relationship to
other team members.
REF: Pages 8-11
TOP: AONE competency: Leadership
21. You recently acquired a position as a unit manager. During your time on the unit, you have
formed a strong social network among your staff, have promoted the development of
relationships between your staff and workers in other areas of the organization, and have
formed relationships that generate ideas from patient organizations and the local nursing
education program. According to complexity theory, you are engaging which principle?
a. Empowerment
b. Systematic thinking
c. Development of networks
d. Bottom-up interactions
ANS: C
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According to complexity theory, social networks evolve around areas of common interest and
are able to respond to problems in creative and novel ways.
REF: Page 12
TOP: AONE competency: Knowledge of the Health Care Environment
22. According to the complexity theory, which of the following should be the focus of
measurement?
a. Cost per hospital day
b. Bed utilization
c. Infection rates
d. Staff morale and budgets
ANS: D
According to complexity theory and the principle “Think systematically,” you cannot ignore
objective data or nonmeasurable data, as both inform decisions.
REF: Page 13
TOP: AONE competency: Business Skills
23. During a staff meeting held to discuss developing a mission statement for the unit, the idea of
placing patient needs first is:
a. Empowering.
b. A leadership tag.
c. A symbol.
d. A management task.
ANS: B
According to complexity theory, leadership tags, which are similar to values, reflect the
patient-centered philosophies and values-driven characteristics that define an organization and
give it personality.
REF: Page 12
TOP: AONE competency: Knowledge of the Health Care Environment
24. A dispute arises between an RN staff member and an LPN over a patient issue. The tension
between the two begins to affect other staff members, who are drawn into the conflict;
eventually, the team becomes polarized toward either the RN or the LPN. This situation might
have been prevented through:
a. Expediency in responding to the initial dispute, once it became apparent that it could
not be resolved by the two parties themselves.
b. Asking other staff members what the real issues were in the dispute between the RN
and the LPN.
c. Reassigning one of the parties to another unit when it became apparent that the two
individuals could not resolve the dispute themselves.
d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and
LPN to discuss the initial dispute.
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ANS: A
The initial step in conflict resolution should have involved an expedient response to the issues
and putting a focus on the issues involved in the dispute between the LPN and RN through
negotiation involving the two parties, before the dispute involved others.
REF: Page 16
TOP: AONE competency: Communication and Relationship-Building
25. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff
members are angry and ask for a meeting to discuss the change. After hearing their
concerns related to reduction in professional autonomy and care quality, you:
a. Acknowledge the loss.
b. Explain the reasons for change, emphasizing the need to reduce costs.
c. Repeat the information several times, giving detailed budget overviews.
d. Adjourn the meeting and provide explanation through e-mail.
ANS: A
Visioning involves engaging with others to assess the current reality, specify the end point,
and then strategize to reduce differences. This requires trusting relationships that acknowledge
the differences in values and ideas. When done well, the nurse and the nurses within a unit
experience creative tension that inspires working in concert to achieve desired goals.
REF: Page 15
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. Sarah wonders about the direction that you have given regarding management of
incontinent, confused patients. She brings you evidence that she has found regarding
incontinence interventions and asks you if she and you could talk about the guidance that you
have given after you have had an opportunity to read the articles she has given you. This is an
example of (select all that apply):
a. Assertiveness.
b. Followership.
c. Management.
d. Insubordination.
ANS: A, B
This is an example of followership in which a staff nurse is demonstrating assertive behavior
and presenting evidence that may influence the decision making of her nurse leader and
manager.
REF: Page 5
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Chapter 02: Safe Care: The Core of Leading and Managing
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital
reduced the number of its managers and increased the number of units for which each manager
was responsible. Within a year, the number of adverse events on the units had doubled. This may
be attributable to:
a. The overload of staff nurses.
b. Resistance to change by staff.
c. A change in reporting systems.
d. Fewer clinical leaders to remove barriers to care.
ANS: D
Eliminating barriers to the implementation of best practices is the role of managers and
leaders. When there are insufficient resources for leadership to encourage a culture in which
evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for
delivering quality care.
REF: Page 24
TOP: AONE competency: Knowledge of the Health Care Environment
2. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the
following interventions might assist to reduce the number of falls on the unit?
a.
b.
c.
d.
Determining who is responsible for the falls
Strengthening unit policies to avoid inappropriate admissions
Encouraging involvement of nurses in education related to falls and safety
Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use
evidence and best practices to inform practice and ensure safety.
REF: Page 27 | Page 32
TOP: AONE competency: Professionalism
3. To increase safety in patient care areas of the Valley Hospital, the executive begins by:
a. Asking the community what the safety issues are.
b. Consulting with a management expert about staffing schedules.
c. Ensuring that the senior nursing officer attends the board meetings.
d. Instituting improved practices to reduce needle-stick injuries.
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ANS: C
The IOM report (2004) highlighted the importance of the attendance of the senior nurse
executive at board meetings to be a key spokesperson on safety and quality issues.
REF: Page 25 | Page 26
TOP: AONE competency: Knowledge of the Health Care Environment
4. During review of back injuries, it is determined that a large number of injuries are occurring in
spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In
addressing this concern, the unit manager:
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review
the correct procedure.
b. After consultation with the staff about the review, orders new lifts to replace older ones
that are malfunctioning.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting incidents to ensure that appropriate reporting is
occurring.
ANS: A
The IOM report (2004) points to the need to involve nurses in decisions that affect them and
the provision of care.
REF: Page 25 | Page 26
TOP: AONE competency: Communication and Relationship-Building
5. The IOM Health Professions Education report highlighted patient safety concerns as:
a. A normal risk in professional practice.
b. A result of disciplinary silos.
c. A reflection of frontline staff.
d. Related to systems errors.
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health
disciplines in silos as a major concern in patient safety and endorsed five recommendations.
REF: Pages 25-27
6.
TOP: AONE competency: Knowledge of the Health Care Environment
If you are supporting the steps in the AHRQ document “Five Steps to Safer Health Care,” you
would ensure that:
a. Patients are actively encouraged to make decisions related to care.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
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d. Preference is given to increasing staff numbers rather than staff credentials.
ANS: A The Agency for Healthcare Research and Quality (AHRQ) outlines “Five Steps to Safer
Health Care,” which suggests that safe, patient-centered care is facilitated by assisting patients
to become active partners in their own care.
REF: Page 27
7.
TOP: AONE competency: Knowledge of the Health Care Environment
After consulting with practice environments about quality and safety concerns in health care,
the Dean of Health Programs at U.S. University develops:
a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that
emphasizes collaborative learning teams.
ANS: D
Health Professions Education identified that education related to health disciplines in silos
leads to compromised communication and inability to function as an integrated whole for
patient-centered care.
REF: Pages 25-27
8.
TOP: AONE competency: Knowledge of the Health Care Environment
In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
a. Evidence-based practice.
b. Informatics.
c. Staffing.
d. The patient.
ANS: D
Focusing on the patient moves care from concern about who controls care to a focus on what
care is provided to and with patients, which was an aim identified in the IOM report Crossing
the Quality Chasm.
REF: Page 25 | Page 26
TOP: AONE competency: Knowledge of the Health Care Environment
9.
As a patient care advocate, you regularly coach patients on how to stay safe in health care by
educating them about:
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
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c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
ANS: A
The Five Steps to Safer Health Care for patients include keeping a list of medications that
patients are taking.
REF: Page 27
TOP: AONE competency: Knowledge of the Health Care Environment
10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety
and reducing morbidity and mortality on your unit. Which of the following recommendations
would be consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
ANS: D
The Future of Nursing advocates for having 80% of the nursing population at a baccalaureateprepared level. This recommendation reflects research that suggests that improved mortality
and morbidity rates occur with a better educated workforce.
REF: Page 27
TOP: AONE competency: Knowledge of the Health Care Environment
11. On the West Surgery unit, you want to institute a new system for checking armbands that
evidence suggests may increase safety in medication administration. The system involves
technology. Which of the following strategies may assist with rapid adoption of the technology
and system?
a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation.
ANS: D
The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient
care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses
innovation and changes quickly through early adopters who share information and energy
over time and act as role models for others.
REF: Page 26 | Page 29
TOP: AONE competency: Knowledge of the Health Care Environment
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12. To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the
following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
The National Quality Forum (NQF) outlines nursing-centered intervention measures related to
prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing
care hours per day, and skill mix of staff.
REF: Page 28
TOP: AONE competency: Knowledge of the Health Care Environment
13. You notice that Sally, a student on your unit, is giving information to an anxious young teen
who seems very uncertain about preparation for an upper GI series. After Sally leaves the room,
you ask her how she thought her conversation with the patient went and:
a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent’s parents.
ANS: A
The Five Steps to Safer Health Care for Patients includes the step of asking questions if there
are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking
these steps and by providing patients with coaching in the steps.
REF: Page 27
TOP: AONE competency: Communication and Relationship-Building
14. The NQF provides a model for advancement of healthcare quality that could be used in
healthcare organizations. The use of this model by the Centers for Medicare & Medicaid
Services specifically affects the interaction between adverse events and:
a. Staffing.
b. Funding.
c. Composition of executive councils.
d. Composition of consumer-based councils.
ANS: B
The Centers for Medicare & Medicaid Services (CMS) have adopted a policy based on the
NQF’s “never events.” The CMS will no longer pay for patient conditions or events that result
from poor practice while patients are under the care of a health professional.
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REF: Page 28
TOP: AONE competency: Knowledge of the Health Care Environment
15. In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends
its safety practices and policies to emphasize:
a. Safety goals specific to Pleasant Valley.
b. Decision-making processes.
c. Sufficient staffing for safe care.
d. Increased numbers of baccalaureate-prepared RNs.
ANS: A
When the TJC, a not-for-profit organization that accredits healthcare organizations, changed
its focus from processes to outcomes, it emphasized patient safety and issues setting-specific
annual patient safety goals.
REF: Page 28
TOP: AONE competency: Knowledge of the Health Care Environment
16. Which of the following would managers and staff review annually in order to ensure
compliance with the Joint Commission (TJC) to improve patient safety?
a. Appropriateness of charting terms and abbreviations
b. Nursing hours per patient
c. Acuity of patient admissions
d. Wait times for care
ANS: A
The Joint Commission issues setting-specific patient goals annually, as well as a list of
“do-not-use” terms, abbreviations, and symbols and sentinel events.
REF: Page 28
TOP: AONE competency: Knowledge of the Health Care Environment
17. In preparation for redesignation as a MagnetTM Hospital, how would you prepare?
a. Commit staff resources over a 6-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate answers to
questions.
c. Prepare a manual that outlines orientation procedures and ensure that all safety issues
are addressed.
d. Ensure that there are empirical data to support review of patient outcomes, actions
taken, and results of actions.
ANS: D
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Through the MagnetTM model, organizations must demonstrate how they provide excellence
in five areas. Between designation and redesignation as a MagnetTM organization, greater
emphasis is placed on empirical quality results.
REF: Page 29
TOP: AONE competency: Knowledge of the Health Care Environment
18. Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient
that she “always” checks patients’ bracelets before giving medication and she is not sure how
the nurses on the unit “get away with” not making more errors than they do. The clinical
instructor pulls Sarah aside and explores with her how her communication might affect the
patient and what it reflects about her beliefs related to the team. The actions of the clinical
instructor reflect competencies outlined by:
a. QSEN.
b. IHI.
c. DNV/NIAHO.
d. AHRQ.
ANS: A
The Quality and Safety Education for Nurses (QSEN) project provides resources related to
competencies that prelicensure and graduate students need to develop to serve as safe
practitioners. These competencies include leading and managing, teamwork and collaboration.
REF: Page 29
TOP: AONE competency: Knowledge of the Health Care Environment
19. The SBAR approach to patient safety encourages:
a. Consistency in assessment and practices.
b. Continuing education.
c. Multidisciplinary approaches.
d. Patient feedback.
ANS: A
The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are
designed to decrease omission of important information and practices.
REF: Page 30
TOP: AONE competency: Knowledge of the Health Care Environment
20. As a manager in a new nursing home, where might you consult for guidance and evidence to
support the development of safe patient practices?
a. Hospitals
b. Business
c. Industry
d. Outpatient clinics
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ANS: A
Practices that were once mostly studied in hospital settings are now scrutinized for
implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.
REF: Page 30
TOP: AONE competency: Knowledge of the Health Care Environment
21. As a manager, the development of your decision-making skills related to safe patient care is
facilitated by:
a. Regular reflection on decisions.
b. A culture of perfectionism.
c. Recognition of who should be held responsible for individual errors.
d. A culture of trust between the staff and you.
ANS: A
Reflection on how well decisions were enacted enables knowledge of the complexity of
situations and ramifications of the decisions made. Reflection enables elimination of strategies
and methods that are inappropriate in meeting needs and aids in narrowing choices of best
actions to take.
REF: Page 30
TOP: AONE competency: Leadership
22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders
continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the
unit manager, you have initiated a least restraint practice. An appropriate action in this situation
would be:
a. Setting up a nursing team meeting to review practices.
b. Calling the family to inform them of the practice.
c. Initiating a multidisciplinary and family meeting to focus on Mary’s needs.
d. Restraining Mary to satisfy the family’s wishes.
ANS: C
Crossing the Quality Chasm emphasizes the importance of rendering care with the client
(client-centered) rather than to the client. In this situation, the patient includes family in
transparent discussions about quality needs and takes a team approach that involves healthcare
professionals, the family, Mary’s needs, and evidence associated with safe practice.
REF: Pages 24-26
TOP: AONE competency: Knowledge of the Health Care Environment
23. A client requires an appendectomy. The surgeon explains the procedure and asks the client to
sign the consent. The patient speaks very little English and looks worried. As a nurse, you
would:
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
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b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.
ANS: A
The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when
there are doubts and concerns and ensuring understanding before surgery is performed are
ways in which nurses can support patients in having greater influence in their own care. In this
situation, asking an interpreter to help enables access to information for the patient and active
assessment of his understanding.
REF: Page 27
TOP: AONE competency: Knowledge of the Health Care Environment
24. As the manager on an acute care medical unit, you note that the incidence of medication errors
has increased since the implementation of staffing changes. As part of your strategy to reduce
errors, it is important to
a. Re-visit reporting standards for medication errors in your organization.
b. Ensure that medication errors are consistently reported.
c. Provide staff with additional education related to safe practice in medication
administration.
d. Involve RN staff in determining reasons for errors and practice solutions to increase the
safety of medication administration.
ANS: D
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many
past practices that had a negative impact on nurses, and thus on patients, and recommended
the inclusion of nurses in direct care in decision making involving their practice. Future of
Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as
leaders in changes that improve health.
REF: Page 25 | Page 27
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
1. Which of the following patients would be at greatest risk in a healthcare visit (select all that
apply)?
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not
include an herbal supplement.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She
is eager to accept all suggestions, including those that she does not yet understand.
d. Claude is booked for bowel surgery. His doctor explains about the colostomy.
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Later, Claude tells his wife that he really doesn’t know what the doctor meant by
colostomy.
ANS: A, C, D
Safer health care involves the patient as an active consumer who keeps and brings a list of all
medications, including natural remedies, and questions if there are doubts, concerns, or lack of
understanding.
REF: Page 25 | Page 27
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 03: Developing the Role of Leader
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
As the clinical director of 24 employees, you have been asked to explain to staff members why
they are not getting a raise this year, even though they have been working short-handed for
many months and patient satisfaction scores have never been higher. Because you believe
yourself to be a transformational leader, you will approach this problem by:
a. Telling the assistant clinical director and asking her to share the bad news with the other
staff members.
b. Posting a note on the bulletin board that includes the phone number of the chief nursing
officer, so anyone who has complaints may express them.
c. Showing staff members the budget and asking for input about how to cut costs so that
raises will be possible in the future.
d. Meeting with a small group of seasoned staff members and asking them how to break the
news.
ANS: C
Transformational leadership involves engaging those being led and inspiring shared vision in
moving toward a goal that all will accept as desirable. This involves enabling and
empowering others to believe that their input and effort will make a difference in solving
problems.
REF: Page 38 | Page 39 | Page 48
TOP: AONE competency: Communication and Relationship-Building
2.
After a newly hired director of nursing has reviewed the hospital’s strategic plans, she develops
a timeline for achieving those plans. The new leader is:
a. Not expecting that novice leaders will have a vision.
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b. Demonstrating mistrust of the abilities of her staff to implement the plans.
c. Instituting deadlines against which the performance of staff will be evaluated.
d. Translating a global document into realistic plans for nursing.
ANS: D
Followers need three things from leaders: direction, trust, and hope. Developing timelines for
the strategic plan involves translating a vision into reality and being able to communicate a
vision meaningfully, which is an example of a leader’s influencing behavior.
REF: Page 35 | Page 36
TOP: AONE competency: Communication and Relationship-Building
3.
A nurse executive is hired to restore a unit’s productivity, which has decreased as the result of
low staff morale. The nurse executive utilizes which of the following leadership principles?
a. The leader declares the intent and goals to enhance productivity and assumes that the
unit also wishes to increase productivity, which allows nurses to feel in control of the
environment.
b. If staff members increase productivity, then they are given opportunity to engage in
learning events such as workshops and conferences. If the staff members are not
satisfied, they will insist on a different leader, who will get them what they want.
c. Leaders at the national level who are seeking relief for nurses in the workplace are
seen as the solution to the nursing shortage.
d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition
reimbursement, and these are things the leader can control.
ANS: A
Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations.
Smart Trust Actions include declaration of the leader’s intent and assumption by the leader
that others also have positive intentions. Building trust involves signaling goals and intended
actions in advance. Actions such as promising external rewards such as additional learning
opportunities, workload relief, and compensation are consistent with transactional leadership,
which leads to low to stable commitment and limited satisfaction.
REF: Page 38 | Page 42
TOP: AONE competency: Communication and Relationship-Building
4.
The director of nursing has been observing staff interactions in a 20-bed coronary care unit.
Based on her observations, which of the following staff members is an obvious leader?
a. The unit secretary who knows everyone’s business
b. The chief nursing officer who is in charge and is responsible for nursing services
c. The chief cardiologist who admits the largest number of patients and brings in more
revenue than any other physician
d. The staff nurse who persuades other staff members to practice by making evidence-based
decisions
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ANS: D
Leaders are those who do the best job of sharing their vision of where the followers want to be
and how to get there. It is the ability to inspire others to bring a vision (such as evidencebased decision making) to reality and is not necessarily tied to status or information flow.
REF: Page 35 | Page 40
TOP: AONE competency: Communication and Relationship-Building
5.
After being interviewed for the unit manager position, the staff nurse reflects on the interview
process. The staff nurse is aware that leadership begins:
a. Within.
b. Through a relationship with a mentor.
c. With the job description.
d. With the chief nursing officer of the organization.
ANS: A
People notice differences in workplaces and tend to choose those that evidence a high degree
of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with
self and that leaders must focus first on developing character and confidence, which is their
credibility. Credibility enables leaders to trust themselves and gives others someone or
something that they can trust.
REF: Page 40
6.
TOP: AONE competency: Leadership
The nurse manager in the Emergency Department needs to implement new staffing patterns.
As a transformational leader, the nurse manager should:
a.Explain in detail how well the new idea will work.
b. Reinforce how this change will respond to the ideas and solutions generated by staff
members.
c. Reason with staff members that the new idea will save money and allow more free time.
d. Imply that raises will be smaller than anticipated if the new idea is not accepted.
ANS: B
Transformational leadership inspires and motivates others through influence and persuasion
rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of
leader listens to the views of others (such as those of the staff members), empowers others to
lead (such as in generating solutions for staffing problems), finds ways to remove barriers,
and serves as an advocate for those who care for patients.
REF: Page 38 | Page 39
TOP: AONE competency: Leadership
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7.
To retain supervisory staff members, the director of nursing develops a mentoring program. The
best person to be a mentor for a new supervisor in a leadership position is someone who has:
a. Been in exactly the same position and can relate to the new supervisor’s problems.
b. Had vast leadership opportunities and likes to talk about his or her past experiences.
c. Leadership experience and time to spend communicating with the new supervisor about
his or her experiences.
d. People who can help the new supervisor get what he or she needs to make the organization
grow quickly and prosper in the process.
ANS: C
Mentors need to have experience and some success in the leadership area of interest, as well
as interest in the future development of the novice. The mentor can be geographically distant
or close and able to provide advice and feedback.
REF: Page 40 | Page 41
8.
TOP: AONE competency: Leadership
Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare
agencies. Marketing brochures should address the leadership and vision of the healthcare
agency. Which of the following workplace environments will attract applicants in the emerging
workforce?
a. A highly professional environment
b. A nurturing and receptive environment
c. An environment highlighted by lots of meetings, so staff members can have lots of input
d. A totally online environment, so staff members will not have to interface with uncaring
colleagues
ANS: B
A study of student nurses who represent this age group indicates that they want a leader who
is receptive, approachable, a team player, and motivating.
REF: Page 43
9.
TOP: AONE competency: Communication and Relationship-Building
A nurse executive who considers herself a Baby Boomer will have the challenge of convincing
the emerging workforce of the necessity of committee meetings. One of the primary reasons
that the Baby Boom generation appears to have so many meetings in the work environment is
that:
a. They feel more comfortable in a group.
b. They find that the journey to the solution is as important as the solution itself.
c. They were deprived of collective action opportunities in the past and now feel that
solutions are better when many people have input.
d. Baby Boomers are aging and need the respite from work that meetings offer, so they can
recuperate from the physical demands of the work environment.
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ANS: B
Baby Boomers mistrust authority and trust in collective action, based on successes with social
movements in their formative years.
REF: Page 43
TOP: AONE competency: Leadership
10. The hospital administration is discussing the possibility of closing hospital beds in your unit
because of a nursing shortage and the increased amount of overtime required to care for
patients. As the leader on the unit, which of the following examples best demonstrates your
transformational leadership style?
a. Your entire staff walks out on strike.
b. Your staff sends an ultimatum to the clinic director demanding higher pay.
c. A group of your staff members goes to the administration to propose closing of a different
unit.
d. A group of your staff members goes to the administration to request that they be
allowed to work the overtime hours.
ANS: C
Commitment to the vision that has been created is seen in the ability of the leader to influence,
motivate, and persuade others. The transformational leader can motivate employees by
encouragement of novel, innovative thinking. Drenkard (2013) describes true transformational
leadership as occurring when the leader “created an environment that brought leaders and
followers together to solve problems, create new ways of doing work, and manage change
together” (p. 57).
REF: Page 38 | Page 39
TOP: AONE competency: Leadership
11. John is interested in leadership positions within his nursing organization. Al-though he has been
on the same unit for 10 years, he has attended two workshops during that time and has
steadfastly refused opportunities to engage in leadership development opportunities or other
learning offered as part of the hospital’s succession planning strategy. He says that he is
interested in a leadership role primarily because it will give him a more stable work schedule
and will enable him to spend more time with his family. In coaching John, it would be
important to:
a. Affirm that his years of service and stability on the unit are the most important attributes
for assumption of a leadership role.
b. Reinforce that his concern with maintaining balance outside work would be a key factor in
selecting him for a leadership position.
c. Encourage him to consider the financial rewards of the position, as well as the positive
effect on his work schedule.
d. Encourage him to seek out new experiences and learning that will complement his
existing strengths derived from experience and his interest in life-work balance.
ANS: D
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According to Covey, effective leaders continually engage in learning and self-renewal, as well
as in maintaining a balanced life, radiating positive energy, believing in other people, being
concerned with the common good, and being synergistic.
REF: Page 36 | Page 49
TOP: AONE competency: Professionalism
12. Becky graduated five years ago and is keenly interested in pursuing leadership opportunities.
She has been active in learning about leadership through workshops and Internet research and
recently began a graduate degree program with a focus on nursing administration. She has
excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her
sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit.
In coaching Becky, you:
a. Suggest that she reflect on situations in which she has had a positive influence and
consider how her interactions contributed to the situation.
b. Suggest that she not consider leadership roles because her interaction skills are more
suited to roles in which she has limited opportunities to work with others.
c. Ask staff members on the unit with whom she works to provide her feedback about ways
in which her behavior irritates or turns them away.
d. Encourage her to continue her graduate courses, as information about strategies and
technical aspects of the role will compensate for negative interactions.
ANS: A
Leadership involves radiating positive energy and the ability to inspire and motivate others.
Management can be taught through formal instruction, but leadership is attained through
reflection on rich personal experience.
REF: Page 36
TOP: AONE competency: Leadership
13. The Sunny Long-Term Care Facility has experienced numerous difficulties with staff
relationships, despite its success in maintaining financial viability and judicious use of
resources. Staff members complain that the primary concerns of the facility include applying
policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and
involvement of, staff members. This facility may be:
a. Well managed and well led.
b. Overly managed and not well led.
c. Poorly managed and well led.
d. Overly led and overly managed.
ANS: B
This organization is concerned primarily with coordination of resources, application of current
policy, and economic issues connected to the present. These behaviors are consistent with the
management role. There is little evidence that the organization displays leadership, which
involves trust, belief, hope, and vision.
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REF: Page 36 | Page 37
TOP: AONE competency: Leadership
14. While explaining the importance of developing leadership skills among nurses to a group of
first-year nursing students, Natalie, a nursing unit manager, emphasizes that:
a. Most nurses are not expected to assume leadership roles.
b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed
according to established standards.
c. Only individuals in formal leadership roles are expected to be leaders.
d. The public depends on nurses to assume leadership in moving consumer advocacy
concerns forward.
ANS: D
The complexity of nursing and the healthcare environment demands that all nurses assume
roles of manager, leader, and follower, depending on the situation. Nurses are involved in
providing leadership in direct patient care, in leading others at a unit or organizational level,
in moving the profession forward, and in participating in legislative and policy arenas.
Consumers depend on nursing leadership to carry the healthcare agenda forward.
REF: Pages 35-37 | Page 45 | Page 46
TOP: AONE competency: Knowledge of the Health Care Environment
15. Which of the following nurses is MOST likely to inspire others to do their best?
a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves
notes for the next shift about what has been done incorrectly or omitted.
b. Jim, RN, has been involved in nursing for several years and is well liked by patients and
families. He continually searches for new knowledge and skills, and his sense of humor
and optimism are infectious.
c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and
their families. She has not been to a conference in years because the unit is her entire life.
d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is
treated fairly in assignments. She is also very conscientious about care and regularly
checks up on what everyone is doing to ensure that it is done correctly.
ANS: B
To be inspired, people must have a positive leader who radiates energy, a zest for learning,
and an interest in the common good, and is engaged in self-renewal. This leader is hopeful
and optimistic. Leaders, not managers, inspire others to work to their highest level.
REF: Page 36 | Page 37
TOP: AONE competency: Leadership
16. The new head nurse on G Unit has been the subject of a great deal of discussion and
complaining during breaks. She is a competent nurse of tremendous integrity with
approximately 30 years’ experience. Her predominant method of problem solving and
communication is through meetings, which can go over the allotted time. The staff may:
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a. Be represented by a high number of Baby Boomers.
b. Be presenting different generational values and attitudes than the head nurse.
c. Be unresponsive to her transactional leadership style.
d. Want a leader rather than a manager.
ANS: B
Leaders who come out of the Baby Boomer generation may be more comfortable with
collective action than followers who come out of the Emerging Workforce generation, who
are more comfortable with interactions if they are seen as having value for them and with
activities if they are seen as having benefit. A group that is highly weighted toward the
Emerging Workforce generation may find the approach of a leader who is part of the Baby
Boomer generation frustrating and may not understand the meaning or value of the meetings.
REF: Page 42 | Page 43
TOP: AONE competency: Communication and Relationship-Building
17. The adage “leaders are born and not made” reflects which of the following ideas around
leadership?
a. Management can be taught; leadership depends on abilities.
b. Mentorship is important in developing innate skills of leaders.
c. Leadership is a natural skill that cannot be refined or developed.
d. Succession planning and formal education related to leadership are ineffective.
ANS: A
Leadership is an abilities role that is reflective of rich personal experience. It can be
developed and refined through such strategies as coaching, mentorship, and reflection.
Management can be taught and learned.
REF: Page 36 | Page 37
TOP: AONE competency: Leadership
18. Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that
budget cuts are likely. She discusses this at the next unit meeting and tells staff members that
unless they do their jobs well, their positions may be terminated, and there will be no
replacement. Kari is enacting which management style?
a. Transformational
b. Transactional
c. Trusting
d. Truthful
ANS: B
Transactional leaders tend to rely on position and power, and they tend to reward and punish
according to performance and conformity with expectations.
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REF: Page 37 | Page 38
TOP: AONE competency: Leadership
19. Susan, a new graduate on the dialysis unit, appears to take Kari’s remarks very seriously and
works even harder, often volunteering for extra assignments. She also is often in Kari’s office,
advising of successes with her patients and of the extra effort that she is committing. This
behavior suggests that Susan:
a. Is fearful of losing her job.
b. Lacks understanding of Kari’s leadership style.
c. Is not intimidated by Kari’s leadership style.
d. Knows how to “play the game.”
ANS: D
Followers under transactional leadership feel secure about what will happen next or what is
needed to be rewarded; therefore, they learn to “play the game.”
REF: Page 37
TOP: AONE competency: Leadership
20. The style of leadership that Kari is exhibiting is likely to:
a. Ensure that the organization is financially stable.
b. Stifle innovative thinking about ways to move out of financial jeopardy.
c. Lead to apathy and disinterest in the organizational goals.
d. Lead to decreased attrition of staff on her unit.
ANS: B
Whether or not the organization achieves financial stability is a function of financial
envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating
is likely maintaining the status quo within the organization, without generating creative and
innovative ideas to address the financial issues. Staff commitment is low to stable, and
conformity to organizational goals is motivated by external rewards.
REF: Page 45
TOP: AONE competency: Leadership
21. A group of managers is meeting to discuss ideas related to the successful implementation of
evidence-based practice on their units. Susan has been asked by the director of care to assume
leadership of these discussion groups. After two such sessions, Susan expresses disappointment
to her mentor that the group seems disinterested in her ideas and that they are listening to Ken,
who has much less experience with leadership. In discussing this with Susan, the mentor
understands that leadership:
a. Is a designated role.
b. Must be earned.
c. Is more likely to be taken by someone who is more talkative.
d. Rarely is taken over by someone with less experience.
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ANS: B
A person can have an impressive title, but title or designation does not make the person a
leader. A leader must have the ability to inspire others to follow.
REF: Page 35
TOP: AONE competency: Leadership
22. The senior executive praises John for the positive patient evaluations that his unit has received.
As an effective leader, John:
a. Thanks the senior executive for having confidence in him and celebrates by going out to a
special restaurant.
b. Points out the impact that the changes he has initiated have had on the unit.
c. Advises the senior executive that the mission statement and goals are important to him.
d. Points out the contributions of his staff to the outcomes and shares the praise with his
staff.
ANS: D
An effective leader is eager to share the glory with those who have worked with him or her to
achieve outcomes and success. The act of acknowledging the achievement to the senior
executive and of sharing the positive feedback with his staff empowers the staff and builds a
support base for the leader.
REF: Page 41
TOP: AONE competency: Communication and Relationship-Building
23. During a discussion of concern about approaches used with aggressive patients in the
Emergency Department, several staff members express concern for their safety. As a leader, the
nurse manager should:
a. Look directly at speakers and acknowledge their comments.
b. Promise to implement each suggestion that is made.
c. Implement the idea that receives the most discussion.
d. Listen but implement the plan that she had in mind before the discussion began.
ANS: A
One of the five rules for leaders is to listen to the constituents—in this instance, the staff
members who have safety concerns. Active listening in the United States means establishing
direct eye contact and asking probing questions. Listening does not obligate the leader to any
one course of action. Action will be based on what is best for the group.
REF: Page 44
TOP: AONE competency: Leadership
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
24. In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in
self-appraisal and to know her strengths. This observation is based on an understanding that: a.
Self-confidence comes automatically out of leading.
b. Self-confidence requires constant self-affirmation of strengths.
c. There is little external motivation and affirmation in leadership.
d. Supervisors of leaders rarely provide feedback.
ANS: C
Followers usually hold opinions about decisions that are made; these opinions can be
favorable or not, which means that external motivation and affirmation are rare. Leaders have
to be confident in their own abilities and enthused about the vision that they have created.
REF: Page 44
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. As a senior executive, you are keen to develop your hospital as a learning organization.
Part of your purpose in translating this vision into practice is to (select all that apply):
a. Retain funding from third-party payers.
b. Develop leaders.
c. Maintain and/or improve quality of care.
d. Stay abreast of new knowledge and evidence.
ANS: B, C, D
Learning organizations are concerned with providing opportunities and incentives for
individuals and groups to engage in lifelong learning, in recognition of the positive impact
that learning has on patient outcomes and staying abreast of new knowledge. Lifelong
learning and reflection are also characteristics of leaders.
REF: Page 36
TOP: AONE competency: Leadership
Chapter 04: Developing the Role of Manager
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. Role theory has its underpinnings in management theory. Management theories influence
managers’ leadership styles. Which of the following theories would a nurse manager be most likely
to follow when redesigning the staffing schedule? a. Humanistic
b. Productivity
c. Psychological
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Quantum
ANS: D
Quantum theory is one way a manager can serve as an agent of change when patient care
work/workflow must be redesigned. Quantum theory recognizes the need to understand
behaviors and relationships before changing them, the connectedness of parts such as
workflow and relationships, and the need to be analytical, flexible, and empathetic.
REF: Page 57 | Page 58
TOP: AONE competency: Leadership
2. A nurse manager has worked rapidly to bring the staff to accept changes in the unit’s mission, so
that downsizing can be avoided. This nurse manager is using quantum leadership by: a. Focusing
on past concerns related to the mission.
b. Teaching staff members how to self-manage themselves.
c.d. Determining accurately the direction of change in the institution.Requiring all staff members to
review and reinforce their technological sNURSINGTB.COM
kills.
ANS: C
Quantum leadership assumes that change will occur and that managers assume an influential,
facilitative role that encourages forward movement in change and encourages the view that
problems are opportunities.
REF: Page 57 | Page 61 | Page 62
TOP: AONE competency: Leadership
3. The nurse manager, as the leader of the unit’s “customer (client) first” initiative, has asked the
staff nurses to develop and administer a survey to every client before discharge. In asking the staff
nurses to accomplish this task, the nurse manager is demonstrating:
a. Accountability.
b. Shared leadership.
c. A common purpose.
d. Independence in the nursing manager’s role.
ANS: B
Healthy work environments are facilitated by involving staff and others in decision making;
gaining access to information is one characteristic of shared decision making. Shared decision
making enables staff to feel valued in policy development and in directing and leading.
REF: Page 58
TOP: AONE competency: Communication and Relationship-Building
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
4. A nurse manager is experiencing considerable conflict among staff members because of weekend
staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to
meet as a group and determine the best staffing practices. In doing this, the nurse manager is using
the concept of collaboration to:
a. Demonstrate interdependence.
b. Depict flexibility and broadmindedness.
c. Focus all energies of staff members on a best possible strategy.
d. Defuse the possibility that staff members will escalate their discontent when staffing the
unit on weekends.
ANS: C
When collaboration is used to solve a conflict or to create new directions, the energies of all
parties are focused on solving the problem versus defeating the opposing party and creating
the “best possible” versus an “okay” direction. When groups come together and mutual
expectations are discussed and fostered, communication and collaboration are enhanced,
which results in a more structurally empowered workforce.
REF: Page 62 | Page 67
TOP: AONE competency: Communication and Relationship-Building
5. A nurse manager’s responsibility for financial management involves making budgetary decisions.
Budgets that allow the nurse manager to allocate resources at the unit level allow:
a. Minimal nurse manager input.
b. Limited rationale for budgetary requests.
c. Budgetary allocations at the executive nurse level.
d. Budgetary decision making at the point-of-service (POS).
ANS: D
In organizational structures where decision making occurs at the POS, nurse managers are
given some self-control, which includes preparing and implementing a budget that meets the
long- and short-term needs of their unit without requiring hierarchical approval.
REF: Page 64
6.
TOP: AONE competency: Business Skills
The nurse manager is anticipating changes on the unit because of managed care. It is up to the
manager to “sell” the staff on this care concept. A goal of managed care that the staff must
understand is that managed care is: a. Grounded in business theory.
b. Useful for long-term patients only.
c. Designed to reduce unit resources and staff.
d. Not concerned with the best interests of clients.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Managed care combines delivery of needed care with business principles of efficiency and
cost. Nurse managers who know business principles become conduits for ensuring safe,
effective, affordable care.
REF: Page 63
7.
TOP: AONE competency: Knowledge of the Health Care Environment
The hospital administrator approves a case management position for a new rehabilitation unit to
help reduce costs. In developing the job description, the nurse manager understands that a key
element of case management is:
a. Managing of care by nurse managers.
b. Coordination of resources for effective outcomes.
c. Rapid discharge of clients to decrease costs.
d. Managing of care for outpatient clients only.
ANS: B
The key to effective case management is proactive coordination of care from the point of
admission to accomplish appropriate and effective outcomes. Case management involves
components such as case selection, multidisciplinary assessment, collective planning,
coordination of events, negotiation, and evaluation and documentation of the outcomes of
patient status in measures of cost. Case management is employed in a variety of settings.
REF: Page 63 | Page 64
TOP: AONE competency: Knowledge of the Health Care Environment
8.
In planning a new wing, the nurse manager complies with the workplace safety requirements of
the Occupational Safety & Health Administration (OSHA). Which of the following groups is
considered to be at high risk for violence in the workplace? a. Pediatric staff
b. Postsurgical unit staff
c. Emergency Department staff
d. Medical oncology unit staff
ANS: C
Nurse managers have responsibility for both patient and staff safety.
HighNURSINGTB.COM
-risk areas, such as the Emergency Department, require
special attention.
REF: Page 60
9.
TOP: AONE competency: Knowledge of the Health Care Environment
Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the
staff on Unit 4 complain to the manager that acquiring the technologic skills required is too
time consuming. They question its value in patient care. The manager responds that: a. The use
of technology is inevitable in our technologically oriented society.
b. The hospital is no longer able to find the space to accommodate paper record keeping.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. The initiative is being driven by decision makers higher up in the hierarchy and there is no
choice.
d. EHRs will increase effectiveness of care by enhancing coordination and improving patient
outcomes.
ANS: D
As technology improves, informatics must be integrated with budget and personnel as a
critical resource element. Basing practice on evidence-based care can assist in making solid
decisions about resources and in leading and encouraging staff toward positive changes in
patient outcomes. EHRs, for example, are expected to enhance coordination of care, improve
health outcomes, and increase accuracy of diagnoses.
REF: Page 63 | Page 64
TOP: AONE competency: Leadership
10. Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that
“nothing is ever good enough for him.” These statements suggest that the nurse manager’s goals
may be:
a. Measurable.
b. Unrealistic.
c. Attainable.
d. Too low.
ANS: B
Nurse managers who are successful in motivating staff often provide an inclusive
environment that facilitates clearly set, achievable goals that can result in both team and
personal satisfaction.
REF: Page 54
TOP: AONE competency: Leadership
11. While interviewing for a nurse manager position, Ann is asked to give an example of a situation
in which she demonstrated leadership. Which of the following examples exemplifies
leadership?
a. Through research and investigation of best practice and practice-based evidence, she
proposed a change in the management of incontinence in elderly patients.
b. She ensures that new policies related to parenteral infusions are implemented
consistently within her team.
c. When asked by her students about institutional policies, she readily and patiently
interprets policies to facilitate quality care.
d. She organizes the team and delegates responsibilities effectively in providing nursing
care.
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ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Nurse managers have the responsibility of day-to-day decisions for their units and interpret
established policy, procedures, and mandates. They meet their goals by organizing,
staffing, controlling, and solving problems. By contrast, leaders develop a vision and translate
that direction into action.
REF: Pages 53-56
TOP: AONE competency: Knowledge of the Health Care Environment
12. Budgeting and protection of revenues is a function of:
a. Leadership.
b. Management.
c. Team leadership.
d. Followers.
ANS: B
Managers address complex issues such as planning, budgeting, and allocating resources,
whereas leaders address change.
REF: Page 54 | Page 55
TOP: AONE competency: Knowledge of the Health Care Environment
13. Which of the following is not important in a positive work environment, as defined by the
AONE?
a. Clear, open, trustful communication
b. Accountability and clarity of roles and responsibilities
c. Participatory decision making
d. Challenge and striving for excellence
ANS: D
Clear and open communication, accountability and clarity of roles, and participatory decision
making are considered by the AONE to be important to a healthy environment. Challenge and
excellence are not specifically identified by the AONE as important to healthy work
environments.
REF: Pages 60-63
TOP: AONE competency: Communication and Relationship-Building
14. As a nurse manager on a urology unit, you note that there has been a marked increase in
medication errors on the unit. Which of the following actions would be consistent with the
National Database of Nursing Quality Indicators (NDNQI) measures?
a. Staff are consulted regarding improvements in interprofessional approaches to patient
care.
b. Nursing staff are asked for input regarding the purchase of new medication carts.
c. A recognition program is developed to acknowledge nurses who have provided safe and
exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Recent changes in staffing mixes are examined to determine if the timing of changes
coincides with the increase in errors.
ANS: D
The NDNQI measures are specifically concerned with patient safety and aspects of quality of
care that may be affected by changes in the delivery of care or staffing resources. The quality
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indicators address staff mix and nursing hours for acute-care
settings, as well as other care components. The NDNQI project is designed to assist healthcare
organizations in identifying links between nursing care and patient outcomes.
REF: Page 64 | Page 65
TOP: AONE competency: Knowledge of the Health Care Environment
15. A nurse manager in a hospital is deeply concerned that senior administration makes decisions
about budgetary directions that affect staffing and other resources without sharing the rationale
for changes or demonstrating concern as to how these changes may affect patients or staff. She
says she does not feel respected and is emotionally tired as a result. This situation represents:
a. Bureaucratic organization.
b. Realities of current health care.
c. Negative organizational culture.
d. Quantum leadership.
ANS: D
Organizational culture refers to the basic assumptions and values of an organization and
whether they contribute to relationships and decision making that is marked by empowerment,
information sharing, and truthfulness. Positive work cultures contribute to a perception of
being respected in the work environment. Collaborative organizational cultures are essential
for nurse managers to proactively work in today’s complex healthcare environment in a
manner that engages them in their work. Interpersonal relationships can be fostered with
organizational designs fostering a culture of collaboration, reward and recognition,
communication, and a mentoring environment.
REF: Pages 56-58
TOP: AONE competency: Communication and Relationship-Building
16. As a nurse manager, you identify that a shift in nursing care models might increase patient and
staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach
because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. Ask
staff to send e-mails to administration encouraging consideration of your option.
b. Invite a senior member of administration to your staff meeting, so you can tell him what
you are planning.
c. Write a letter of complaint to a member of the institutional board about the lack of
openness of the administration.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Identify influential members of your nurse manager group with similar ideas and request
an opportunity to meet with administration to discuss options.
ANS: D
Staff members often look to nurse managers to lead them in addressing workplace issues with
higher levels of administration. To do this, nurse managers must possess the ability to address
power sources in the work environment and to define powerorganizing a following of other nurse
managers with similar concerns.NURSINGTB.COM
-based strategies, such as in
REF: Page 62
TOP: AONE competency: Leadership
17. Nurses on Unit 17 complain that their manager frequently “checks up on them” and encourages
little involvement in decision making and yet, during performance reviews, praises them for
their outstanding performance. Nurses on Unit 18 indicate that their experience is different from
that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision
making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18
reflect.
a. Differences in the managers’ expectations of their role.
b. Shaping of the workplace behavior of employees.
c. Different approaches to cooperation and collaboration.
d. Recognition of institutional priorities.
ANS: A
Management theory addresses how managers address employees’ concerns and needs and the
interactions of managers with employees. Expectations of the managerial role affects
expectations of self as the manager and of others. McGregor’s (1960) Theory X and Theory Y
made two basic opposing assumptions about employees and how the manager should interact
with them. Theory X suggests that people do not like their work and that lower-order needs
are more important. Theory Y adopts an optimistic view in which people are seen as capable
of self-direction and autonomy.
REF: Pages 52-53 | Page 57 | Page 58
TOP: AONE competency: Leadership
18. The successful integration of informatics into healthcare settings is key to:
a. Quality decision making related to management of resources and patient care.
b. Accessing current information about business practices.
c. Meeting the modern-day expectations of staff regarding technology use.
d. Speeding up calculations and decisions in budget development.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
The use of informatics to research evidence and alternative models of delivery, to compare
data and solutions with those of other managers, and to enhance the coordination and delivery
of patient care can assist managers in making solid decisions about resource utilization. The
use of informatics is embraced by Generation X-ers and Millennials who grew up with
technology, but may be more difficult for older staff.
REF: Page 63 | Page 64
TOP: AONE competency: Business Skills
19. As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior
is important to:
a. Budget development.
b. A manager’s role.
c. Succession planning.
d. Encouragement of staff utilization of technology.
ANS: D
Informatics such as Smart Bed facilitates effectiveness and efficiency in care. By becoming an
early adopter of technology, staff members, particularly older staff, who may be less
comfortable with technology, are encouraged to value its use in care delivery and
NURSINGTB.COM management.
REF: Page 64
TOP: AONE competency: Business Skills
20. A manager who is concerned with ensuring that patients on her surgical unit have the necessary
information to make informed choices is: a. Practicing legal nursing care.
b. Demonstrating respect for patient rights.
c. Avoiding risks.
d. Likely experiencing staff issues with informed consent.
ANS: B
In demonstrating respect for and advocacy for informed consent, the nurse manager is
reflecting a professional philosophy. Professional nurses are ethically and legally accountable
to the standards of practice and the accompanying nursing actions delegated to others.
Conveying high standards, holding others accountable, and shaping the future of nursing are
inherent behaviors in the role of a manager.
REF: Page 65 | Page 66
TOP: AONE competency: Professionalism
21. The nurse manager plays a unique role in institutional management in that the nurse manager:
a. Encourages shared decision making.
b. Models professional nursing behavior.
c. Interprets healthcare trends and their impact on revenues.
d. Coordinates care and allocates resources.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Encouragement of shared decision making, coordination of resources, and interface between
internal and external factors and a unit are all associated with effective management but could
be performed by a manager from any discipline. The nurse manager’s unique role is modeling
professional behavior.
REF: Page 65
TOP: AONE competency: Professionalism
22. In developing an orientation program, the hospital educator breaks essential organizational
information down into chunks, which she develops as online modules. This is an application of
which of Drucker’s functions of management? a. Establishment of goals and objectives
b. Motivation and communication
c. Analysis and interpretation of performance
d. Organization of activities into manageable tasks
ANS: D
Organizing the information into online modules is an application of Drucker’s organizational
analysis and the division of activities, decisions, and relations into manageable tasks.
REF: Page 54
TOP: AONE competency: Business Skills
23. Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are
experiencing difficulty with the new lift and wonders what your thoughts are on
organizing an in-service training. Nancy is exhibiting which trait of a
follower?NURSINGTB.COM a. Provides a vision for safety that is
communicated
b. Thrives on taking risks in identifying the problem with safety
c. Coordinates the development of knowledge and skills necessary to use the lift
d. Assumes responsibility for identifying a safety concern and concedes authority for
solution to you
ANS: D
Communication of a vision and risk taking are leader traits, whereas coordination is
associated with manager traits. Taking responsibility while conceding authority to the leader
is characteristic of followers.
REF: Pages 56-58
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
1. A nurse manager is discussing with unit staff the repeated lack of staff compliance in
documenting exercise activity for post–cardiac surgery clients. The unit’s licensed
practical/vocational nurses are responsible for ensuring that clients carry out the prescribed
exercise regimen and that the activity is documented. Using Drucker’s five basic functions of
a manager, identify appropriate functions for the nurse manager to use when addressing this
situation (select all that apply):
a. Divide the necessary activities into manageable tasks, so clients adhere to the exercise
regimen.
b. Establish objectives and goals for each area and decide who is accountable for them.
c. Allow clients to organize the activities.
d. Engage in activities that motivate the team, and communicate effectively with the
responsible staff members.
e. Analyze, appraise, and interpret the performance of responsible staff, and communicate
these findings to staff management.
f. Allow clients to establish objectives and goals.
ANS: A, B, D, E
Drucker’s five basic functions include division of work into tasks, development and
communication of goals and outcomes, motivation and communication, and analysis,
approval, and interpretation of staff performance.
REF: Page 54
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Chapter 05: Legal and Ethical Issues
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. The manager in the coronary care unit believes that the most important ethical considerations in
performance evaluations are that they include the employee’s good qualities and that they give
positive direction for professional growth. This belief is an example of: a. Justice.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Fidelity.
c. Beneficence.
d. Nonmaleficence.
ANS: D
Nonmaleficence refers to “doing no harm.” For a nurse manager following this principle,
performance evaluation should emphasize an employee’s good qualities and give positive
direction for growth. Destroying the employee’s self-esteem and self-worth would be
considered doing harm under this principle.
REF: Page 92
TOP: AONE competency: Professionalism
2. A staff nurse in the area that you manage has excelled in the delivery of patient education. You
are considering implementing a new job description that would broaden her opportunity to
teach patients and orient new staff members to the value of patient education. The ethical
principle that you are most directly reinforcing is:
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a.b. Justice.Fidelity.
c. Paternalism.
d. Respect for others.
ANS: C
The principle of paternalism allows one person to make partial decisions for another and is
most frequently deemed to be a negative or undesirable principle. Paternalism, however, may
be used to assist persons to make decisions when they do not have sufficient data or expertise.
Paternalism becomes undesirable when the entire decision is taken away from the employee.
REF: Page 92
TOP: AONE competency: Professionalism
3. A patient refuses a simple procedure that you believe is in the patient’s best interest. The two
ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice.
b. Veracity and fidelity.
c. Autonomy and beneficence.
d. Paternalism and respect for others.
ANS: C
Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence
to doing good (performing a procedure that will benefit the patient).
REF: Page 91 | Page 92
TOP: AONE competency: Professionalism
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
4. An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic.
The nurse manager understands that the Americans with Disabilities Act of 1990 requires that
employers:
a. Make reasonable accommodations for persons who are disabled.
b. Allow modified job expectations for persons recovering from alcoholism.
c. Hire disabled individuals before hiring other qualified, non-disabled persons.
d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.
ANS: A
The purposes of the ADA are to eliminate discrimination against persons with disabilities and
to provide consistent, enforceable standards to address discrimination in the workplace.
REF: Page 86 | Page 87
TOP: AONE competency: Business Skills
5. A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a
whistleblower lawsuit against the former employer. Reasons that the court would use in
upholding a valid whistleblower suit claiming retaliation include that the nurse:
a. Had previously reported the complaint, in writing, to hospital administration.
b. Had threatened to give full details of the patient abuse to local media sources.
c. Was discharged after three unsuccessful attempts at progressive discipline had failed.
d. Had organized, before filing the complaint, a work stoppage action by fellow employees.
ANS: A
An employer is unable to fire an employee who, in good faith, reports what is believed to be a
violation of a law, rule, or state or federal law.NURSINGTB.COM
REF: Page 89
TOP: AONE competency: Knowledge of the Health Care Environment
6. In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an
orientation for new staff members. As part of the orientation, the nurse manager reviews the
employee handbook. Employers may be bound to statements in the employee handbook: a.
Under the doctrine of apparent agency.
b. Under the doctrine of respondeat agency.
c. Based on the employee’s or the employer’s expectations.
d. Based on the theory that the handbook creates an explicit contract.
ANS: C
The handbook is an implied contract and frames the employment contract.
REF: Page 89
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
7. To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk
manager. Risk management is a process that attempts to identify potential hazards and: a.
Compensate for previous injuries.
b. Eliminate these risks before anyone else is harmed.
c. Supersede the need for staff members to file incident reports.
d. Discipline staff members who have been involved in previous incident reports.
ANS: B
Risk management involves taking proactive steps to identify and eliminate risks and liability.
REF: Page 84
TOP: AONE competency: Knowledge of the Health Care Environment
8. One means of ensuring that nurses floated to other patient care areas in healthcare organizations
are qualified to work in those areas is:
a. Employing additional staff to assist with orientation processes.
b. Cross-educating staff members to other areas of the institution.
c. Transferring patients to units where the staffing pattern is optimal.
d. Orienting staff members to all patient care areas as part of their general orientation to the
institution.
ANS: B
Nurses should be floated to units as similar as possible to their own to decrease the potential
for liability. Negotiating cross-training, a proactive approach to temporary staffing problems,
reduces the potential for liability.
REF: Page 80
TOP: AONE competency: Knowledge of the Health Care Environment
9. A colleague asks you to give her your password access so that she can view her partner’s
healthcare record. This request violates the patient’s right to: a. Privacy.
b. Confidentiality.
c. Undue authorization of treatment.
d. Protection against slander.
ANS: A
Privacy refers to the right to protection against unreasonable and unwarranted interference
NURSINGTB.COM with the patient’s solitude. Privacy standards limit how personal
health information may be used or shared and mandate safeguards for the protection of health
information. Institutions can reduce potential liability in this area by allowing access to patient
data, either written or oral, only to those with a “need to know.” Persons with a need to know
include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
service workers, and patient advocates. Others wishing to access patient data must first ask the
patient for permission to review a record.
REF: Page 83 | Page 84
TOP: AONE competency: Knowledge of the Health Care Environment
10. On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to
be familiar with at least:
a. Two nursing practice acts.
b. Two nursing practice acts in most states.
c. At least one nursing practice act.
d. One nursing practice act and a medical act.
ANS: C
In all states, you will need to be familiar with at least one nursing practice act. In some states,
there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing
boards.
REF: Page 71 | Page 72
TOP: AONE competency: Knowledge of the Health Care Environment
11. A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks
toward a patient with a previous history of sexual abuse. The patient sues, claiming
malpractice. Which of the following conditions may not apply in this situation? a. Injury
b. Causation
c. Breach of duty
d. Breach of duty of care owed
ANS: A
By virtue of employment, the nurse owes a duty of care to the patient; this care has been
breached by a nurse, who would be expected to know that this behavior violates usual
standards of care. The resultant injury, the fifth malpractice element, must be physical, not
merely psychological or transient. In other words, some physical harm must be incurred by
the patient before malpractice will be found against the healthcare provider, which is not
evident in this situation where the action did not involve physical harm.
REF: Page 73 | Page 74 | Page 92
TOP: AONE competency: Knowledge of the Health Care Environment
12. As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by
notifying a child’s physician of his concerns about deterioration in the child’s status at 0330
hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you
could be held liable for:
a. Professional negligence.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Assault.
c. Avoidance.
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d. Murder.
ANS: A
Professional negligence can be asserted when there is failure to do what a reasonable and
prudent nurse would do in the same situation. In this situation, the charge nurse might have
advocated further for the patient in light of the evident seriousness of the child’s condition.
REF: Page 72
TOP: AONE competency: Knowledge of the Health Care Environment
13. The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that
the failure of nurses to pursue concerns related to their son’s deteriorating condition contributed
to his death. The senior nurse executive is named in the suit: a. As a global respondent.
b. Under the doctrine of respondeat superior.
c. As a frivolous action.
d. Under the element of causation.
ANS: B
Known as vicarious liability, the doctrine of respondeat superior makes employers
accountable for the negligence of their employees, using the rationale that the employee could
not have been in a position to have caused the wrongdoing unless hired by the employer.
REF: Page 75
TOP: AONE competency: Knowledge of the Health Care Environment
14. During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong
IV medication that results in cardiac arrest and a difficult recovery for the patient.
Liability in this situation:
a. Is limited to the temporary agency.
b. Is restricted to the RN.
c. Could include the RN, the agency, and your institution.
d. May depend on the patient’s belief regarding the employment relationship.
ANS: D
Apparent agency may apply here because your liability and that of your institution could be
established if it can be shown that the patient believes that the RN was an employee of yours
and of your institution.
REF: Page 80
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
15. You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed
with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-
defined age of legal consent is 18; therefore, no treatment can be delivered.
b. The teen is underage and should be referred to the family general practitioner.
c. Care can be provided as long as consent is voluntary and information about treatment and
options is provided.
d. Treatment is provided as long as telephone consent is obtained from a parent or legal
guardian.
ANS: C
All states have a legal age for consent; generally, this age is 18. However, emancipated
minors, minors seeking treatment for substance abuse, and minors seeking treatment for
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REF: Page 80
communicable diseases can provide their own consent.
TOP: AONE competency: Knowledge of the Health Care Environment
16. Three gravely ill patients are candidates for the only available bed in the ICU. As the
supervisor, you assign the bed to the patient with the best chance of recovery. This decision
reflects which of the following ethical principles? a. Beneficence
b. Autonomy
c. Veracity
d. Nonmaleficence
ANS: A
Beneficence refers to doing what’s good for the patient; in this situation, doing what’s good
means providing care to the patient with the best likelihood of recovery.
REF: Page 92
TOP: AONE competency: Professionalism
17. Which ethical principle is primarily involved in informed consent?
a. Veracity
b. Autonomy
c. Beneficence
d. Nonmaleficence
ANS: B
Autonomy refers to the right to choose freely, which is inherent in informed consent.
REF: Page 92
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
18. The principle that requires nurses to uphold a professional code of ethics, to practice within the
code of ethics, and to remain competent is which of the following? a. Veracity
b. Autonomy
c. Fidelity
d. Honesty
ANS: C
Fidelity refers to promise keeping or upholding one’s promise to practice as a reasonable and
prudent nurse would do and in an ethically competent manner.
REF: Page 92
TOP: AONE competency: Professionalism
19. Mr. M. complains to you that one of your staff asked him details about his sexual relationships
and financial affairs. He says that these questions were probing and unnecessary to his care, but
he felt that if he refused to answer, the nurse would be angry with him and would not provide
him with good care. Mr. M.’s statements reflect concern with: a. Privacy.
b. Confidentiality.
c. Veracity.
d. Informed consent.
ANS: A
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Privacy protection includes protection against unwarranted intrusion into the patient’s affairs.
REF: Page 83
TOP: AONE competency: Knowledge of the Health Care Environment
20. To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the
following except:
a. Notifying staff of changes to policies related to medication administration.
b. Scheduling and staffing to ensure safe care.
c. Delegating in accordance with practice acts.
d. Supervising the practice of the physician.
ANS: D
Legally, the nurse manager is accountable to nursing practice standards, standards for nurse
administrators, and hospital policies and procedures.
REF: Page 73
TOP: AONE competency: Knowledge of the Health Care Environment
21. In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides
teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to
provide significant information about a potential side effect, which led to delay in seeking
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
treatment and untoward harm. Under which state nurse practice act and standards would this
situation be considered? a. New York
b. Pennsylvania
c. Neither New York nor Pennsylvania
d. Both New York and Pennsylvania
ANS: B
Under the law, the state in which the patient resides and not the state where the nurse holds his
or her license determines the state nurse practice act that is considered.
REF: Page 72
TOP: AONE competency: Knowledge of the Health Care Environment
22. A member of a patient’s family calls the nurse manager of the palliative care unit to express
concern that a member of the family, who died on the weekend, had requested analgesics from
the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient
had died. The manager is aware that the unit was especially busy that weekend because many
patients were seriously ill, staff had called in ill, and the staffing manager was unable to
completely replace staff who were absent. The manager is deeply troubled that the family
member had to die in pain because it violates what she knows should have been done. This
manager is experiencing:
a. Compromised agency.
b. Moral distress.
c. Moral sensitivity.
d. Moral dilemma.
ANS: B
Moral distress is experienced when nurses cannot provide what they perceive to be best for a
given patient. Examples of moral distress include constraints caused by financial pressures,
limited patient care resources, disagreements among family members regarding patient
interventions, and/or limitations imposed by primary healthcare providers.
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REF: Page 93 | Page 94
TOP: AONE competency: Professionalism
23. While walking past a patient’s room, you overhear one of the RN staff telling a patient that the
patient has no right to refuse chemotherapy treatment because the family and the doctor think
the treatment is the best option for the patient. This patient is 40 years of age and alert.
When you meet later to discuss what you heard with the RN, it is important to:
a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure
that patients comply with recommended treatment plans.
b. Discuss that statute law provides for patient autonomy and refusal of treatment.
c. Remind the nurse to provide clearer explanations to aid in the patient’s
comprehension of the treatment and compliance.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Acknowledge the nurse’s role in ensuring that she does not fail in her duty of care for
the patient.
ANS: B
Statute law states that the patient must be given sufficient information, in terms he or she can
reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine
of informed consent is the right of the patient to informed refusal. Patients must clearly
understand the possible consequences of their refusal.
REF: Page 81
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
1. One of your staff nurses asks for your advice because a patient refuses to sign a consent for
surgery. The patient says that he won’t sign because he doesn’t understand the nature of the
surgery. You advise that (select all that apply): a. Consent must not be coerced.
b. The patient has a right to choose not to consent.
c. The patient must sign the consent because the doctor wants him to sign.
d. Witnessing a consent is related only to the voluntary nature of the signature.
ANS: A, B, D
Consent must be voluntary and not coerced; the patient must understand what he is signing,
must have legal capacity, and must understand the consequences of refusal. Witnessing a
consent means attesting to the voluntary nature of the patient’s signature.
REF: Page 81
TOP: AONE competency: Knowledge of the Health Care Environment
2. With regard to nursing practice, nurse managers are held responsible for (select all that apply):
a. Practicing within legal guidelines established under state law and nurse practice acts.
b. Ensuring that nursing staff under their supervision are currently licensed to practice.
c. Referring all errors in nursing judgment to state discipline boards.
d. Ensuring that physicians are properly licensed to provide care on patient care units.
ANS: A, B
Nurses are responsible for knowing and practicing under state law and nurse practice acts.
Managers are responsible for monitoring staff practice and ensuring that staff hold current,
valid licensure.
REF: Page 71
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TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 06: Making Decisions and Solving Problems
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
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.
ANS: D
Identification of a problem is the first step in problem solving and occurs before any other
step. The most common cause for failure to resolve problems is the improper identification of
the problem/issue; therefore, problem recognition and identification are considered the most
vital steps.
REF: Page 109 | Page 110
TOP: AONE competency: Knowledge of the Health Care 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.
ANS: A
In a shared decision model, the decisions are made through an interactive, deliberate process
and the staff may express and discuss options and preferences. The shared decision model has
been shown to increase work performance and productivity, decrease employee turnover, and
enhance employee satisfaction.
REF: Page 103
TOP: AONE competency: Communication and Relationship-Building
3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming
unmanageable on the 0700-1900 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.
ANS: C
Brainstorming encourages creativity when one is beginning to problem-solve and avoids
premature shutting down of ideas through early evaluation. The goal is to generate ideas, no
matter how seemingly unrealistic or absurd.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 106 | Page 107
TOP: AONE competency: Communication and Relationship-Building
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.
ANS: B
An autocratic style is appropriate when rapid decision making is required, such as in a crisis
situation.
REF: Page 103 | Page 104
TOP: AONE competency: Leadership
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.
ANS: D
Groups are more likely to be effective if members are involved, the group is cohesive,
communication is encouraged, and members demonstrate some understanding of the group
process. The nurse leader or manager should provide a nonthreatening and positive
environment in which group members are encouraged to participate actively.
REF: Page 105
TOP: AONE competency: Communication and Relationship-Building
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.
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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: Page 109 | Page 110
TOP: AONE competency: Knowledge of the Health Care Environment
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.
ANS: D
If the situation is subjective, non-routine, and unstructured or if outcomes are unknown or
unpredictable, the nurse leader and manager may need to take a descriptive or behavioral
approach. More information (such as degree of risk to the client and to the agency) needs to
be gathered to address this situation effectively.
REF: Page 103
TOP: AONE competency: Knowledge of the Health Care Environment
8. In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A
52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to
deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is
a recent graduate who has not yet been orientated to the labor room and has limited cardiac
nursing experience. An unregulated assistant is also available. You must decide which patient
situation you will take and where the RN’s skills can best be used. Given the limitations in skills
and experience, number of staff available, and time constraints, you must make a decision that
involves:
a. A higher-order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Optimizing.
d. Satisficing.
ANS: D
With this approach, the decision maker selects an acceptable solution, one that may minimally
meet the objective or standard for a decision. This approach allows for quick decisions and
may be the most appropriate when lack of time is an issue.
REF: Page 103
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: A
A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the
reasons (causes) for an effect (falls).
REF: Page 111
TOP: AONE competency: Knowledge of the Health Care 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.
ANS: B
Decision-making tools such as decision grids and SWOT analyses are most appropriate when
information is available and options are known.
REF: Page 108 | Page 109
TOP: AONE competency: Knowledge of the Health Care 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.
ANS: C
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: Page 101
TOP: AONE competency: Leadership
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: D
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 109 | Page 110
TOP: AONE competency: Leadership
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
ANS: A
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: Page 112 | Page 113
TOP: AONE competency: Leadership
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.
ANS: A
The decision model that a nurse uses depends on specific circumstances. Is the situation
routine and predictable or complex and uncertain? Is the goal to make a decision that is “just
good enough” (conservative) or one that is optimal?
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 101 | Page 102
TOP: AONE competency: Leadership
15. From the information supplied in this chapter, which statement 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.
ANS: C
It is generally accepted by many authors and researchers that this statement best defines
critical thinking.
REF: Page 101 | Page 102 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.
ANS: B
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 101
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. Despite his need
for staff, Justin decides to review each application thoroughly and interview candidates
carefully because he recognizes that it is important to hire staff who can best provide highquality care and who will fit well with the team. 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
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Optimizing is a decision style in which the decision maker selects the option that is best, based
on an analysis of the pros and cons associated with each option. A better decision is more
likely when using this approach, although it takes longer to arrive at a decision.
REF: Page 103
TOP: AONE competency: Business Skills
18. 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. Despite his need
for staff, Justin decides to review each application thoroughly and interview candidates
carefully because he recognizes that it is important to hire staff who can best provide highquality care and who will fit well with the team. Which of the following decision-making
solutions should Justin 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.
ANS: D
Decision making involves a goal-oriented consideration of many options that are objectively
weighed according to their possible risks, consequences, and positive outcomes. The options
should be ranked in the order in which they are likely to result in the desired goals or
objectives. The solution selected should be the one that is most feasible and satisfactory and
has the fewest undesirable consequences. In this instance, all of the options listed might be
considered and weighed.
REF: Page 101 | Page 112 | Page 113
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 manager’s first missed step in problem solving? a. Not using a problemsolving model
b. Not considering a number of alternatives
c. Poor evaluation of outcomes
d. Incorrect problem identification
ANS: D
The unit manager did not begin with an accurate identification of the problem. Problem
solving needs to begin with “why?”
REF: Page 109 | Page 110
TOP: AONE competency: Business Skills
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: B
Two primary criteria make for effective decisions. First, the decision must be of a high
quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who
are responsible for its implementation must accept the decision. Higher-quality decisions are
more likely to result if groups are involved in the decision-making and problem-solving
process. Taking ownership of the process and outcome provides a smoother transition in
changes.
REF: Page 105
TOP: AONE competency: Leadership
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.
ANS: C
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 105
TOP: AONE competency: Leadership
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 on 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 and defined
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.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
An autocratic style is appropriate when rapid decision making is required and in situations
where the task and the potential outcome are well-defined.
REF: Page 103 | Page 104
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 hospital’s 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.
ANS: D
This is based on 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 | Page 102
TOP: AONE competency: Knowledge of the Health Care Environment
24. The agency in which you are a nursing leader makes a decision to reduce the number of RN
positions in favor of PN positions because agency data suggest that the clients in the agency can
receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding
and without restructuring, some clients might not receive services at all. You provide this
information on this decision to the staff and ask them to advise you if they have any feedback,
concerns, or alternative solutions. This decision-making style is known as: a. Paternalistic.
b. Shared.
c. Reasoned
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d. Informative.
ANS: D
The informative model offers the staff the ability to make a decision after the information has
been shared and without the active involvement of the manager.
REF: Page 103
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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 what assumptions were underpinning the issues.
b. Considered why it was important to make this change or the context for the change.
c. Considered how this change might affect staff relationships. 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 “what,” “why,” and “how” questions that are part of effective critical thinking processes.
REF: Page 101 | Page 102
TO: AONE competency: Leadership
Chapter 07: Healthcare Organizations
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
1.
To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation
outlining the concept of healthcare networks. Healthcare networks are: a. Units that provide
only primary care services.
b. Owned by the institutions.
c. A feature of all public institutions.
d. Units that serve large populations.
ANS: D
Healthcare networks are interconnected units. Their aim is serving large regional populations.
REF: Page 123
2.
TOP: AONE competency: Knowledge of the Health Care Environment
A local hospital has formed a corporate partnership with a reputable HMO (health maintenance
organization). The nurse manager has had to educate staff and personnel about the financial
implications of this partnership. An HMO:
a. Provides more expensive care than other types of insurance plans.
b. Has a centralized administration that directs and compensates physician services.
c. Pays physicians on a fee-for-service basis.
d. Does not pay as much for acute care as other practice plans.
ANS: B
The HMO is a configuration of healthcare agencies that provide basic and supplemental health
maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee
without regard to the amount of services used. HMOs have a centralized administration that
directs and pays salaries for physician practice (e.g., HMOs).
REF: Page 123 | Page 124
TOP: AONE competency: Knowledge of the Health Care Environment
3.
With the help of a federal grant, the local school nurse has established a spreadsheet that
contains relevant nursing data so that she can analyze children’s health. School health programs
are:
a. Increasingly seen as primary care sites for children.
b. Providing only health education programs for children and their parents.
c. Capable only of providing referrals for health problems to primary care providers.
d. Funded exclusively by local authorities.
ANS: A
Traditionally, school health programs were organized to control infectious disease outbreaks,
treat and control on-site injuries, and educate parents and children about basic health.
Increasingly, schools are being seen as primary healthcare sites for children.
REF: Page 125
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
4.
The local health department nurse manager has developed and implemented a disaster readiness
plan as part of a community service. Community services:
a. Care for the specific needs of individual families in the community.
b. Focus on the treatment of community-wide problems rather than on individual health
problems.
c. Do not include services provided by public health departments.
d. Provide personal health follow-up for all acute care hospitalizations.
ANS: B
Community services, including public health departments, are focused on the treatment of the
community rather than that of the individual. These funds provide personal health services,
care for communicable diseases, services for children with birth defects, mental health care,
investigation of epidemiology, and treatment of bioterrorism threats and attacks. Monies are
allocated also for environmental services and for health resources.
REF: Page 125
5.
TOP: AONE competency: Knowledge of the Health Care Environment
A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers
benefit package for a prepaid fee that uses specific standards to approve a period of time for the
use of inpatient and community health services) is participating in:
a. Critical pathways.
b. Healthcare networks.
c. Health maintenance organizations.
d. Managed care.
ANS: D
Managed care strives to contain costs (e.g., through limitation of time in care) while
maintaining quality. Managed care combines care delivery with financing and provides
comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One
form has a centralized administration that directs and pays salaries for physician practice (e.g.,
HMOs).
REF: Page 123
6.
TOP: AONE competency: Knowledge of the Health Care Environment
A merger has occurred between a hospital and a local home health agency, creating new roles
for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and
revise patient care processes and systems. With the merger, the healthcare organization’s
changes are:
a. Creating more jobs in the community for registered nurses.
b. Resulting in an overall loss of jobs for registered nurses.
c. Controlled by the federal and state governments.
d. Controlled by the insurance agency.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Home care agencies staffed appropriately with adequate numbers of professional nurses have
the potential to keep older adults, those with disabilities, and persons with chronic illnesses
comfortable and safe at home. Home care is the fastest growing segment in health care and
the volume of home health care may have a subsequent impact on the numbers of nurses
required.
REF: Page 125
7.
TOP: AONE competency: Knowledge of the Health Care Environment
You are a nurse manager in a facility that is part of a national system of specialized hospitals
that provide services to children and that is funded and managed through a religious charity
organization. This system emphasizes compassionate, faith-based care. What level of
consolidated system is represented in this example? a. First level
b. Second level
c. Fourth level
d. Fifth level
ANS: D
Consolidated systems tend to be organized into five levels. The fifth level involves special
interest groups that own and operate units along religious lines, teaching interests, or related
special interests that drive their activities. In this example, the facilities are funded and
managed by a religious organization that provides care that is congruent with its particular
faith-based values.
REF: Page 123
8.
TOP: AONE competency: Knowledge of the Health Care Environment
A nurse manager at a home healthcare service has resigned to take a position at a local
ambulatory care center. She has been hired because of her expertise in TJC accreditation. To
initiate the changes, the nurse manager has to be knowledgeable about the differences between
a home healthcare institution and an ambulatory care center, which is a primary care institution.
Primary care institutions are facilities that provide:
a. Rehabilitative or long-term care.
b. Disease-restorative care.
c. First access to care.
d. Only outpatient services.
ANS: C
The spectrum of care services provided are typically described as primary care (first-access
care), secondary care (disease-restorative care), and tertiary care (rehabilitative or longterm care). Ambulatory care centers are an example of primary care.
REF: Page 120
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
9.
A nurse manager working for a not-for-profit organization should be familiar with the
regulations that impact the organization. Not-for-profit organizations: a. Pay dividends to
stockholders.
b. Can refuse clients who are unable to pay.
c. Have no paid employees.
d. Pay no taxes.
ANS: D
Not-for-profit organizations, often referred to as voluntary organizations, are controlled by
voluntary boards and provide services to both paying and charity clients. Funds are redirected
toward maintenance and growth as opposed to profit shares for stockholders. Historically,
non-profit organizations have been exempt from paying taxes as they commit to providing an
important community service.
REF: Page 121
TOP: AONE competency: Knowledge of the Health Care Environment
10. In reviewing the current delivery model, the nurse manager is aware that a demographic change
that will have a significant effect on the healthcare delivery systems of the future is: a. Changes
in staffing patterns.
b. Increasing reports of violence in the workplace.
c. The increasing percentage of the population that will be over age 65.
d. Escalations in the cost of health care.
ANS: C
A demographic change that will significantly impact the healthcare system of the future is the
increasing proportion of individuals 65 years and older. By 2025, more than 18% of the
population is expected to be 65 years and older, which means that new healthcare
organizations will evolve as the system attempts to maintain older adults in the community for
as long as possible.
REF: Page 130
TOP: AONE competency: Knowledge of the Health Care Environment
11. A facility that provides care for patients whose average length of stay is less than 30 days and to
patients whose average length of stay is longer than 30 days, and who require inpatient and
ambulatory care for addictions, through a spectrum of wellness and illness services and
providers, would be considered: a. A healthcare network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Healthcare networks embrace and provide wellness and illness services, including primary,
secondary, and tertiary care, through a network of providers.NURSINGTB.COM
REF: Page 120
TOP: AONE competency: Knowledge of the Health Care Environment
12. Healthcare organization XYZ provides women’s health services on an inpatient basis (average
stay of less than 30 days). This facility would likely be considered:
a. Primary care, specialized.
b. Tertiary care, long-term.
c. Acute care, specialized.
d. Public care, specialized.
ANS: C
The AHA defines an acute care hospital as a facility in which the average length of stay is less
than 30 days. Because of the focus on women’s health services, it would also be considered
specialized.
REF: Page 119 | Page 120
TOP: AONE competency: Knowledge of the Health Care Environment
13. You are the nurse manager for a not-for-profit health service for the homeless and for drug
users in an impoverished neighborhood. As the manager, your concern about sustainability is
related to:
a. The possibility of violence.
b. An increase in prescription drugs available for abuse.
c. Decisions of the public board.
d. An increase in uncompensated care events.
ANS: D
Public and non-profit hospitals are tax exempt and have a concomitant responsibility to
provide mandated community service such as delivering care to the poor and indigent. To
keep a non-profit status, facilities must make a good-faith effort to provide community service
and charity care Non-profit organizations located in impoverished urban and rural areas are
often economically disadvantaged by the amount of uncompensated care that they provide.
REF: Page 121 | Page 122
TOP: AONE competency: Business Skills
14. A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may
be most related to aggressive profit goals and:
a. Lower salary compensation for staff.
b. Rising expectations of impoverished and indigent individuals for services.
c. Poor orientation and retention practices for staff.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. An overwhelming emphasis on accepting learners from health disciplines.
ANS: A
For-profit hospitals tend to have lower wage and salary costs that are most likely connected to
aggressive goals for profit.
REF: Page 122
TOP: AONE competency: Business Skills
15. Which of the following is an example of an HMO?
a. Nurse practitioners are paid promptly at discounted fees for each service rendered
b. at a women’s health clinic.Physicians in a large urban center are reimbursed for visits
made to their clients.
c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan.
d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization
of health services.
ANS: D
Fee-for-service systems provide compensation to healthcare providers in group practices
based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted
rate. HMOs are configurations of healthcare agencies that provide health maintenance and
services for enrolled patients for a fee that is preestablished regardless of utilization of
service.
REF: Page 123 | Page 124
TOP: AONE competency: Knowledge of the Health Care Environment
16. As a nurse manager, you have been asked to assist in designing a subacute facility for open
heart patients who require further complex care after hospitalization. In setting up the facility,
which of the following would require reassessment?
a. Patients admitted to the facility must have adequate health insurance to cover the services
provided.
b. A local nurse education program asks you if nursing students can gain clinical experience
with recovering surgical patients in the facility.
c. Public funding will be provided to enable care of patients who have an ordinary
course of recovery.
d. The facility is an older house that is more than 30 minutes away from the acute care
center.
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Because of the types of patients being accepted for care and the distance of the subacute
facility from acute care, emergency response and seamless transfer issues in the event of an
unanticipated crisis must be addressed. As a nurse manager, an important part of your position
may be assisting to develop strategies to maximize the benefits and minimize the risks in this
situation.
REF: Page 124
TOP: AONE competency: Knowledge of the Health Care Environment
17. Which of the following would be the most appropriate focus in developing a business plan for a
nurse-owned home healthcare service?
a. Programs to educate the community on preparing healthy meals for a limited cost
b. Reduction of injuries from alcohol-related accidents
c. Pain management for patients with low back pain
d. Reduction of falls among seniors
ANS: C
Nurse-managed and nurse-owned healthcare services are part of a growing number of
organizations that extend health care beyond that offered through traditional services. Growth
in these organizations and services has been spurred by the implementation of the prospective
payment system, which resulted in early discharge of many patients from acute care facilities.
These nurse-managed and nurse-owned services focus on the care of individuals and families
rather than on community-based outcomes for populations such as older adults, or on
community-based issues such as injuries related to drunk driving.
REF: Page 124
TOP: AONE competency: Knowledge of the Health Care Environment
18. As a nurse manager, you have been offered a position at a Veterans Administration hospital. In
accepting the position, it is important for you to understand that veterans hospitals provide:
a. Primary care and are privately funded.
b. A range of services and are responsible to government and taxpayers.
c. Secondary care only and are publicly administered and funded.
d. Services to veterans under an HMO.
ANS: B
Veterans Administration hospitals provide a range of services to veterans and are responsible
to government and thus to taxpayers, who support the hospitals.
REF: Page 121
TOP: AONE competency: Knowledge of the Health Care Environment
19. A group of patients with early Alzheimer’s disease and their spouses approach you regarding
help with the establishment of a local Alzheimer’s Society for the support and education of
affected individuals and their families. As a manager in an ambulatory care clinic, what
suggestion or advice would you offer this group?
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and
therefore, the patients and families should need no help from your clinic.
b. Your healthcare organization would be pleased to help as long as your
organization financially takes over responsibility for direction, leadership, and
management.
c. Through partnership, you will provide supports, if possible, that the patients and spouses
themselves identify as necessary in the establishment of the group.
d. The services that the patients and spouses are proposing are likely being offered
somewhere else already.
ANS: C
Self-help groups often are made up of, and are directed by, peers who have healthcare needs.
A growing trend is the development of community-based geriatric organizations in
partnership with healthcare organizations. The request of the patients and their spouses
indicates that this service is needed in the community and that they are looking for assistance
in setting up the Alzheimer’s Society rather than having your agency take over the
management of the group.
REF: Page 126
TOP: AONE competency: Knowledge of the Health Care Environment
20. Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid.
Tracy’s responsibilities most likely would include: a. Managing physician-led research.
b. Monitoring physician documentation of the need for medical care.
c. Determining which services are designated fee-for-service.
d. Identifying errors in physician diagnoses.
ANS: B
Nurse case managers serve as interfaces for the Centers for Medicare & Medicaid Services
(CMS) and are key in monitoring compliance with Conditions of Participation (CoP)
elements. The case managers routinely monitor for appropriate physician documentation of
medical necessity and other required CoP elements.
REF: Page 126 | Page 127
TOP: AONE competency: Knowledge of the Health Care Environment
21. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the
CMS. This means that the Wellington facility:
a. Cannot accept mental health patients who are Medicare beneficiaries.
b. Can care for only Medicaid and not Medicare beneficiaries.
c. Has not met the standards set by the CMS as determined by an external review panel.
d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
CMS accreditation or external review of an organization’s compliance with the standards set
by the CMS can be conducted by the AOA, which is a deeming authority for CMS.
REF: Page 127
TOP: AONE competency: Knowledge of the Health Care Environment
22. As a nurse manager in a hospital, you would expect which of the following to be the major
contributor to funding and revenues in your organization?
a. The federal government
b. Medicare
c. Medicaid
d. Blue Cross/Blue Shield
ANS: A
The federal government is responsible for both Medicare and Medicaid and is the largest and
most influential health insurance program in the United States. The federal government is the
primary payer of healthcare costs in the United States.
REF: Page 126
TOP: AONE competency: Knowledge of the Health Care Environment
23. As a nurse manager, you have been asked to be part of a design team for health services that
have vertical integration. In planning for these services, your team will design a proposal that
will:
a. Cluster like services together, such as outpatient clinics for the care of children with
various developmental and medical needs.
b. Plan for the smooth transition of patients from the emergency services department to other
units in the hospital.
c. Ensure that funding follows the patient from acute care to long-term care services.
d. Bring together acute care, ambulatory, home care, and palliative care services for the
management of patients diagnosed with cancer.
ANS: D
When organizations align to provide a full array or continuum of services, the arrangement is
referred to as vertical integration. Benefits attributed to vertical integration include enhanced
coordination of services, efficiency, and customer services.
REF: Page 129
TOP: AONE competency: Knowledge of the Health Care Environment
24. Which of the following patients would be most likely covered under Medicare?
a. Jim, who lives on the street and has occasional infections
b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear
infections
c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family
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d. Dan, who is 68 years of age and in good health
ANS: D
Medicare is a federal government program for individuals over 65 and with certain permanent
illnesses, such as end-stage renal disease. Medicaid provides financing of health care for the
medically indigent.
REF: Page 126
TOP: AONE competency: Knowledge of the Health Care Environment
25. Which of the following is an outcome of managed care?
a. Shift of patients to outpatient and home health services
b. Less complexity in funding sources
c. Less complexity in rules for consumers to follow
d. Greater consistency in the quality of care
ANS: A
A goal of managed care is to reduce the cost of expensive acute hospital care by focusing on
out-of-hospital preventive care and illness follow-up care, which has led to shifts in where
health care is delivered.
REF: Page 123
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. As a nurse manager in a for-profit hospital, you are interested in promoting teaching
programs for physicians, because evidence suggests that hospitals with teaching programs
tend to promote better care for patients. Your administration indicates that it cannot support
your ideas or proposal because of (select all that apply): a. Increased salary costs.
b. Duplication of tests and procedures.
c. Graduate medical education.
d. Potential damage to reputation through learner error.
ANS: A, B, C
Teaching hospitals tend to incur higher costs because of the salaries required for supervision
of physicians, duplication of tests and procedures through the learning process, longer times
required to process patients, costs of state-of-the art technology, biomedical research, and
stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies
and organizations support teaching programs.
REF: Page 122
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Chapter 08: Understanding and Designing Organizational Structures
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a
busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship
and guidance to new staff. As the manager, you propose the addition of a nurse in advanced
practice to provide consultation and education for staff. This position is termed a(n):
a. Hierarchical position.
b. Ancillary.
c. Line position.
d. Staff position.
ANS: D
Line personnel have authority for decision making, whereas personnel in staff positions
provide education, support, advice, and counsel. The nurse in the advanced practice is
providing advice and support through education as well as consultation.
REF: Page 144
2.
TOP: AONE competency: Business Skills
A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware
that professional nursing departments of the future will:
a. Not be directed by nurses.
b. Be virtual organizations.
c.Be designed to maintain nursing standards of practice.
d. Be entitled to have client care departments.
ANS: C
Hospitals that are successful in recruiting and retaining nurses have found that the major
contributing characteristic to success is a nursing department that is structured to provide
nurses the opportunity to be accountable for their own practice. Accountability is guided by
nursing standards of practice and thus, successful nursing departments emphasize
maintenance of these standards.
REF: Page 149
3.
TOP: AONE competency: Knowledge of the Health Care Environment
The chief nursing officer and the dean of the School of Nursing believe that by establishing
rules and regulations and controlling the environment, this partnership will:
a. Promote professional medical authority, autonomy, and responsibility.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Need a degree of flexibility to engender success.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.
ANS: B
Bureaucratic structures have a centralized command structure (chain of command). with a
clear division of labor and well-articulated and commonly accepted expectations for
performance. Rules, standards, and protocols ensure uniform actions and limit
individualization of services and variance in workers’ performance. Although bureaucracy
enhances consistency, by nature, it limits employees’ autonomy and thus the potential for
innovations.
REF: Page 143
4.
TOP: AONE competency: Leadership
In matrix organizational structures, a nurse manager understands that this type of structure:
a. Is a simplified organizational structure.
b. Has both a functional manager and a service or product-line manager.
c. Arranges departments strictly according to function.
d. Promotes harmony in organizational decision making.
ANS: B
Matrix structures are complex, integrated organizational structures that involve both
functional and service or product-line managers. In this structure, team members or teams
from various functional departments may combine to complete a project or program, thereby
becoming responsible to both their functional department manager and their product-line
manager.
REF: Page 147
5.
TOP: AONE competency: Business Skills
Collaborative partnerships between hospitals and schools of nursing are examples of hybrid
organizational structures. A hybrid organizational structure:
a. Has many divisions of labor.
b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
d. Places the authority for decision making closest to the places where workers perform.
ANS: C
Hybrid structures include characteristics of various organizational types and reflect the needs
of the situation and the environment.
REF: Page 148
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
6.
In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit.
This philosophy needs to:
a. Reflect the culture of the unit and its values.
b. Be developed by the nursing manager on the unit.
c. Identify the clients that will be served on the unit.
d. Replicate the organization’s philosophy.
ANS: A
A philosophy expresses the values and beliefs that members of the organization hold about the
nature of their work, about the people to whom they provide service, and about themselves
and others providing the services.
REF: Page 137
7.
TOP: AONE competency: Knowledge of the Health Care Environment
The hospital administration gives approval to the chief nursing officer to hire clinical nurse
specialists in staff positions rather than in administrative positions. A clinical specialist who has
staff authority but no line authority typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of clients.
c. Interview and hire staff nurses for designated nursing units.
d. Be granted functional authority to determine standards of nursing care and enforce them.
ANS: A
Staff positions provide support to line positions but have no direct accountability for staff or
patient outcomes and therefore function through influence.
REF: Page 143 | Page 144
TOP: AONE competency: Knowledge of the Health Care Environment
8.
A new director of nursing in a small rural hospital wants to make changes from the traditional
model of governance to a shared-governance model. Select the characteristic below that best
describes the traditional organizational structure in which a staff nurse is assigned to carry out
nursing tasks for clients but is not given the chance to provide input into forming the policies
and procedures by which care is delivered or the standards by which care is evaluated:
a. Bureaucratic
b. Decentralized
c. Delegated authority and responsibility
d. Delegated responsibility but no authority
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
making authority (right to act) is held by a centralized
In traditional structures, decisiondecision-making body, so that staff members have responsibility for certain functions but do
not participate in decisions related to those functions.
REF: Page 142
9.
TOP: AONE competency: Knowledge of the Health Care Environment
The chief nursing officer is given the task of reviewing and revising the organization’s mission,
philosophy, and technology. In reviewing them, the chief nursing officer understands that they
should be reflected in:
a. The organizational structure.
b. Line and staff responsibilities.
c. The policies and procedures.
d. Government regulations.
ANS: A
The mission statement is an important foundation for the organizational structure and defines
technology and human resources required for the organization.
REF: Page 138
TOP: AONE competency: Knowledge of the Health Care Environment
10. The facilities department is experiencing some challenges and is undergoing reorganization.
Because of your familiarity with systems theory, you:
a. Know that this challenge is their issue and that it has nothing to do with your unit.
b. Understand that such events are localized and do not have an impact on the
organizational culture.
c. Know that the nature of challenges and reorganization in facilities will have an impact on
other areas.
d. Anticipate that your prior experiences with facilities have no effect on the current
situation.
ANS: C
By nature, a system such as an organization is an interacting collection of parts that together
make up the whole. Changes to one part will affect other parts and the system as a whole.
REF: Page 138
TOP: AONE competency: Leadership
11. “Georgia Hospital will provide care that is a national example of consumer service” is a:
a. Vision statement.
b. Statement of philosophy.
c. Mission statement.
d. Rationale for care.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
A vision statement is an articulated goal that provides an inspirational target to which the
organization aspires at some future time. A statement of philosophy expresses values and
beliefs, and a mission statement provides the reason for the existence of the organization.
REF: Page 137
TOP: AONE competency: Knowledge of the Health Care Environment
12. “At Thoroughcare, we provide health care for women and children in transition” is an example
of a:
a.Vision statement.
b.Mission statement.
c. Goal statement.
d. Statement of philosophy.
ANS: B
Mission statements provide a reason or rationale for the existence of the organization and are
indicative of the structure of the organization and of who consumes the services provided.
REF: Page 137
TOP: AONE competency: Knowledge of the Health Care Environment
13. Which of the following would be the most appropriate mission statement for a nursing center?
a. “At Plentyville, we provide rehabilitative services for addicted adolescents.”
b. “Georgiatown provides treatment and prevention services for county residents.”
c. “At Heart, our aim is to provide services that lead the nation in health education and
research.”
d. “At Coeur, we strive to achieve optimal pain management with patients who are
experiencing chronic pain.”
ANS: D
The mission statements of nursing centers are oriented toward achieving optimal health status
for a defined group of patients or consumers rather than being treatment or maintenance or
social-support oriented.
REF: Page 138
TOP: AONE competency: Knowledge of the Health Care Environment
14. A primary care clinic is established in Pleasantville to provide comprehensive services to
infants, children, and families within the community. The executive director of the clinic
oversees physician and nursing services for infants, children, and families; a
neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional
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counseling; speech and hearing services; and physiotherapy. This type of organizational
structure is known as:
a. Hierarchical.
b. Bureaucratic.
c. Service-line.
d. Matrix
ANS: C
In service-line structures (sometimes called product lines), the functions necessary to
produce a specific service or product are brought together into an integrated organizational
unit under the control of a single manager or executive.
REF: Page 145
TOP: AONE competency: Knowledge of the Health Care Environment
15. In which of the following situations would you expect low morale and frustration?
a. Statement of philosophy indicates “We value our staff.” When staff members leave,
careful evaluation is done to determine whether staff should be replaced by full- or
part-time employees.
b. Practices include annual staff recognition celebrations. During times of change, staff
members are actively included in issue identification and solution finding.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions
are given only to individuals with long-standing service and entrenched
relationships.
d. The vision indicates that there is strong commitment to lead in research. The
organization has tried to implement a strong campaign to attract leading nurse
researchers but has experienced difficulty in doing so.
ANS: C
Although frustration may occur with external factors that affect ability to act on values and
aspirations, lack of congruence between what is espoused as a value within the organization
(such as promising advancement as an incentive to join the organization) and what is actually
done (such as restricting advancement to internal candidates with much organizational
history) can cause low morale and confusion.
REF: Page 139 | Page 140
TOP: AONE competency: Communication and Relationship-Building
16. At Orangetown Hospital, the nursing department is developing a mission statement for nursing.
Which would be a suitable mission statement?
a. “Nursing provides services for patients admitted to Orangetown Hospital.”
b. “To participate fully in the professional services offered by Orangetown Hospital.”
c. “To lead by the lamp; services for seniors.”
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. “At Orangetown, the nursing department provides caring services that recognize the
diversity of clients and promote optimal health with clients through partnership, education,
and interprofessional collaboration.”
ANS: D
A nursing mission statement within an organization needs to establish the reason for nursing
within the organization and lays out relationships with clients, the community, and other
disciplines.
REF: Page 139
TOP: AONE competency: Knowledge of the Health Care Environment
17. At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years.
Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling
and other processes are routinely left to the last minute. Staff members approached Donna first
and then administration with their concerns about Donna’s effectiveness as a leader. The staff
was told that the problem is likely staff related, that it is simply an unhappy group, and that
there is nothing that will be done further about their concerns. The philosophy of the
organization indicates that “open, transparent communication between staff and management is
desired and supported,” and that “innovation and creative thinking are the foundation of the
organization’s progress.” In assessing this situation as a newly hired senior executive, you
anticipate that:
a. Staff members will resolve the conflict on their own.
b. The situation will lead to ongoing disgruntlement and attrition.
c. No further discussion or concerns will come out of the situation.
d. The head nurse will be able to resolve the conflict on her own.
ANS: B
Lack of congruence between the stated philosophy of the hospital and the experienced
organizational culture does not support either the staff or the head nurse and likely will result
in ongoing frustration, confusion, and morale, which could result in increased attrition.
REF: Page 139 | Page 140
TOP: AONE competency: Communication and Relationship-Building
18. A new CEO has been hired at Valley Hospital who proposes to change the centralized
organizational structure that was put in place ten years ago, based on widespread consultation
with staff. The proposed structure involves substantial flattening of the organizational structure,
with significant decision making being made at the point-of-care and an emphasis on
interprofessional collaboration. There is a great deal of discussion about the balance between
hospital-wide budget decision making and unit-based decision making. This discussion
represents:
a. Chaos theory.
b. Organizational redesign.
c. Organizational reengineering.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Restructuring.
ANS: C
Reengineering involves a total overhaul of an organizational structure. It is a radical
reorganization of the totality of an organization’s structure and work processes. In
reengineering, fundamentally new organizational expectations and relationships are created.
Redesign is a technique to analyze tasks to improve efficiency, and restructuring is a
technique to enhance organizational productivity.
REF: Page 140 | Page 141
TOP: AONE competency: Knowledge of the Health Care Environment
19. With revenue reductions and cost-saving measures, the number of managers has been reduced,
which has increased the number of team leaders supervised by managers by as many as three.
This change may result in:
a. Decreased patient satisfaction.
b. Increased efficiency in costs.
c. A more positive perception of managers.
d. Little change to manager-staff relationships.
ANS: A
When a span of control becomes too large, supervision can become less effective, which can
have a negative effect on staff-manager relationships and on the overall quality of patient care.
REF: Page 141 | Page 142
TOP: AONE competency: Knowledge of the Health Care Environment
20. Taylor Hospital has well-defined organizational units that provide maintenance, financial
services, care for cardiac patients, care for surgical patients, and so on. The organizational chart
indicates that surgical units report to a surgical manager and all nursing units report to a vice
president of nursing; financial services to an accountant and then to a business executive; and so
on. The primary disadvantage of this organizational structure is:
a. Breakdown in function and communication across specialties.
b. Lack of congruence in culture and organizational values.
c. Highly centralized decision making and authority.
d. Wide span of control.
ANS: A
In a functional organizational structure, departments and services function according to
specialty. This model supports professional expertise but can lead to silos in communication
and decision making and discontinuity in patient services.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 145
TOP: AONE competency: Knowledge of the Health Care Environment
21. In the Unity Healthcare organization, decisions, including those at the unit level, are made by a
group of senior executives. Rules for employees are clear, and nursing care is delineated by
procedures and protocols. This exemplifies:
a. Transformational leadership.
b. Transactional leadership.
c. Bureaucratic organization.
d. Chaos theory.
ANS: C
Organizational structure refers to the organization of a work group, rather than to its
leadership, and includes where decisions are made and what the relationships are between
groups. In the example given, power is centrally located, with all decisions regarding policies
and procedures flowing from this central location, which is characteristic of bureaucratic
organizations.
REF: Page 143
TOP: AONE competency: Knowledge of the Health Care Environment
22. In the Unity Healthcare organization, communication flows:
a. Laterally.
b. Bottom to top.
c. Top to bottom.
d. Intermittently.
ANS: C
In a bureaucratic organization, communication flows vertically top to bottom.
REF: Page 143
TOP: AONE competency: Knowledge of the Health Care Environment
23. Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides
education, consultation, and training support. Sarah has:
a. Direct responsibility for patient care.
b. Direct accountability for patient outcomes.
c. An authority relationship to staff.
d. An influence over patient outcomes.
ANS: D
In a staff position, Sarah supports line positions in accomplishing the primary goals and
objectives of the unit and provides support, counsel, and advice, but she has limited or no
authority for decision making.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 143 | Page 144
TOP: AONE competency: Knowledge of the Health Care Environment
24. A statement such as “We believe in the right of patients to make choices and to have care that is
sensitive to their preferences and needs” is a
a. statement.
b. MissionGoal
c. Vision
d. Philosophy
ANS: D
Philosophy statements capture significant beliefs and values of the organization.
REF: Page 137
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Organizational culture includes (select all that apply):
a. Norms.
b. Traditions.
c. Behaviors.
d. Values.
ANS: A, B, C, D
Organizational culture, the reflection of the norms or traditions of the organization, is
exemplified in behaviors that illustrate values and beliefs.
REF: Page 139 | Page 140
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 09: Cultural Diversity in Health Care
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. According to Leininger, “cultural imposition” is a major concern in nursing because nurses have
a tendency to impose their values, beliefs, and practices on patients of other cultures.
The discussion topic most likely to be without cultural imposition would be:
a. Abortion.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Wound management.
c. Blood transfusion.
d. Advance directives.
ANS: B
Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs,
and practices that may be different between patients and nurses.
REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
2. Cultural diversity is the term used to describe a vast range of cultural differences. Events have
symbolic meanings for the nurse manager and the staff. The event that would be most likely to
provide symbolic meaning to a nurse manager and staff is a:
a. Task force formed to commemorate a New Year’s celebration in the Western tradition.
b. Project to provide Christmas gifts to the children in a daycare program.
c. Celebration of National Nurses Week with the focus on cultural care.
d. Task force to develop a poster for the unit depicting religions of the world.
ANS: C
Human cultures have material items or symbols such as artifacts, objects, dress, and actions
that have special meaning in a culture. National Nurses Week, with a focus on nursing
interests, reflects the culture of nursing.
REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
3. One of the staff nurses on your unit makes the comment, “All this time I thought Mary was
black. She says she is Jamaican.” The best response would be to say:
a. “Who cares what she is?”
b. “What did you think when you learned she was Jamaican?”
c. “Why did you assume she was black?”
d. “We have never had a Jamaican on this unit.”
ANS: B
The response of the nurse manager invites cultural awareness, which involves selfexamination and in-depth exploration of one’s own biases, prejudices, and assumptions.
REF: Page 156
TOP: AONE competency: Communication and Relationship-Building
4. As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask
her if something is wrong, she becomes tearful and says, “Why is it that when John and I work
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
together in giving patients care, he jokes about my being “a little fat Mexican”? The nurse
manager’s best response is, “Do you think he:
a. Is sensitive to your culture?”
b. Wants to learn more about you?”
c. Has been hurt and wants to hurt others?”
d. Is stereotyping you without thinking?”
ANS: D
Prejudices “enable us to make sense of the situations in which we find ourselves, yet they also
constrain understanding and limit the capacity to come to new or different ways of
understanding. It is this contradiction that makes prejudice paradoxical.” (Spence, 2004, p.
163). Prejudices enable us to predict behaviors and make sense of situations but constrain our
understanding and development of new insights.
REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
5. The nurse manager of a unit is asked by a family member of a dying Native American patient if
it is possible to have the patient’s eight-member family recite the rosary by the bedside. The
manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to:
a. Acculturation.
b. Ethnocentricity.
c. Cultural diversity.
d. Cultural sensitivity.
ANS: D
Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions
unique to a group of people.
REF: Page 155
6.
TOP: AONE competency: Communication and Relationship-Building
A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse
manager about seeing his “acupuncture doctor” for treatment of his migraine headache. The
best response to this patient would be:
a. “How long have you been using acupuncture treatment?”
b. “Do you think acupuncture relieves your pain satisfactorily?”
c. “What have you told your heart specialist about your migraines and treatment?”
d. “Have you tried nonprescription pain medication or been given a prescription drug for
your headaches?”
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Acknowledging the patient’s use of acupuncture demonstrates cultural sensitivity through
acknowledgement of treatments that would be consistent with the patient’s cultural
interpretation of illness and responses to it. The other responses indicate lack of cultural
sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward
interventions that would be common to the nurse’s experience of health care in Western
cultures.
REF: Page 155
7.
TOP: AONE competency: Communication and Relationship-Building
Maintaining a culturally diverse staff and working with a culturally diverse patient population is
an important function of a nurse manager who works in the hospital of a large medical center.
On your palliative care unit, you have recently received complaints from families about
ineffective pain management for their family members and you determine this occurs primarily
when certain nurses are working. What approach might you take to resolve the concerns of the
families, patients, and potentially, the staff?
a. Reinforce to staff that practice guidelines support as-needed analgesia for the
terminally ill.
b. Ask staff input on the development of stricter guidelines to ensure that all terminally
patients are given sufficient analgesia.
c. Encourage conversation with patients and among staff that facilitates learning about
cultural beliefs and priorities in dying.
d. Advise families that the administration of analgesia is based on the expert clinical
judgment of nurses who are familiar with care of patients in palliative care.
ANS: C
The cultural and religious backgrounds of nurses influence their perceptions of dignityconserving care. For example, foreign-born Catholic nurses stated the dying experience
should not be altered by analgesics to relieve suffering or by attempts to hasten death by
forgoing curative therapy or by other means. Approaches to working with differences in the
diverse cultural and religious backgrounds of patients, families, and nurses alike include
taking time to have conversational chats with patients in end-of-life and with colleagues that
will facilitate learning about each other and provide care that fits with the patient's cultural
beliefs about dying.
REF:TOP: Page 159 | Page 160AONE competency: Communication and Relationship-Building
8.
Because an increasing number of Hispanic patients are being admitted, a nurse manager designs
a staff-development program to help her staff understand the Hispanic culture. A nurse should
understand that culture is determined by which of the following?
a. Behavior
b. Love for people
c. Shared vision
d. Genetic predisposition
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Culture is determined by behaviors and beliefs and develops slowly.
REF: Pages 154-156
TOP: AONE competency: Communication and Relationship-Building
9.
The nurse manager for a unit’s culturally diverse staff creates a staff-development program so
the professional nursing staff members can enhance their understanding of cultures on the basis
of published literature. The literature reveals that the following characteristic is inherent in a
culture. It:
a. Develops over time.
b. Maintains a strong work ethic.
c. Changes easily.
d. Develops quickly.
ANS: A
Culture is a patterned behavioral response that evolves slowly as times change. The culture
may or may not maintain a strong work ethic.
REF: Pages 154-156
TOP: AONE competency: Communication and Relationship-Building
10. In designing programs through your institution to address the health needs of Hispanics in your
community, you most likely would develop programs related to:
a. Diabetes.
b. Cardiovascular disease.
c. Cancer.
d. Asthma.
ANS: A
Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics.
REF: Page 157
TOP: AONE competency: Knowledge of the Health Care Environment
11. Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact
English) and ASL (American Sign Language). This is indicative of:
a. Dominant versus nondominant behaviors.
b. The need to recognize diversity within groups.
c. The impact of cross-culturalism.
d. How language separates subgroups.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
When working with various cultural groups and diversity, it is important to recognize that
diversity also exists within groups. Cultural differences among groups should not be taken in
the context that all members of a certain group or subgroup are indistinguishable.
REF: Page 161
TOP: AONE competency: Communication and Relationship-Building
12. When interviewing a candidate for a nursing position who has an Aboriginal background, you
recognize that the candidate’s lack of eye contact reflects the candidate’s:
a. Lack of confidence.
b. Professional behavior.
c. Cultural sensitivity.
d. Ethnicity.
ANS: D
Ethnicity refers to groups of people who are classified according to common racial, tribal,
religious, linguistic, or cultural backgrounds.
REF: Page 154
TOP: AONE competency: Communication and Relationship-Building
13. When interviewing a candidate for a nursing position who has an Aboriginal background, you
recognize that the candidate’s lack of eye contact reflects the candidate’s cultural sensitivity.
You are exhibiting:
a. Acculturation.
b. Cultural sensitivity.
c. Ethnocentrism.
d. Transculturalism.
ANS: B
Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits,
customs, or traditions unique to a group of people. In this situation, acknowledgement of the
candidate’s background in relation to eye contact demonstrates cultural sensitivity.
REF: Page 154
TOP: AONE competency: Communication and Relationship-Building
14. Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns
that some of her “book learning” is being criticized by her colleagues, so she adapts her practice
to what others on the unit are doing. She is demonstrating:
a. Cultural awareness.
b. Cultural sensitivity.
c. Acculturation.
d. Cultural marginality.
ANS: C
In accepting the practices of the dominant group on the unit, Mary is demonstrating
acculturation.
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REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
15. At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of
error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate
that mistakes are hidden and that areas of concern related to the functioning of the unit are
discussed in tub rooms and are never openly discussed during periodic meetings. New staff
members are quickly made to realize that silence is expected. The situation described is an
example of:
a. Ethnicity.
b. Work environment.
c. Work culture.
d. Marginalization.
ANS: C
Culture develops over time, is essential to survival, is learned and shared by members, and
changes with difficulty.
REF: Pages 154-156
TOP: AONE competency: Knowledge of the Health Care Environment
16. As a nurse manager, you have hired two new staff members who have recently come to the
United States from other countries. Which of the following strategies might indicate your
efforts to assist these staff members with acculturation to your unit?
a. Analyze a recent situation with them in which an order with a physician was not
clarified and explore their beliefs about nurse-physician relationships.
b. Expect them to behave in ways that are expected of staff who have grown up and been
educated in the United States.
c. Stress to these new staff that your unit is a “family” and that staff members take pride
in saying that they are from Unit 4.
d. Recognize that culture develops over time and leave them alone to figure out
differences between their culture and that of the unit.
ANS: A
Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals
now define themselves as members of the dominant culture and is evidenced by when
individuals say they are from where they live and practice. When individuals grow up within a
culture and take on the characteristics of that culture, it is referred to as socialization.
Assisting the staff to recognize differences in the relationships between physicians and nurses
on the unit and those in their country of origin is assisting adaptation or acculturation and is
promoting positive patient outcomes.
REF: Page 154 | Page 161
TOP: AONE competency: Communication and Relationship-Building
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
17. During managers’ meetings, Lindsay is surprised by the forthrightness of male managers. She
finds that, during discussions, she would be more likely to say:
a. “I wonder if we should consider changing our policy on performance appraisals? What
do you think?”
b. “Sean, your approach to appraisal is completely off track and does not reflect available
evidence.”
c. “The system that has been developed needs to be implemented. We have already spent
enough time in discussion.”
d. “Forget about change in this policy. It is fine as it is.”
ANS: A
Males and females in the workplace are likely to have different management styles, and
although not all males are authoritative or females more participatory, women are likely to use
more participatory and inclusive methods.
REF: Page 161 | Page 162
TOP: AONE competency: Communication and Relationship-Building
18. As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit.
The organization and relationships on these units are distinct and very different from one
another. Your decision has been to support the uniqueness of these units because each is
effective in different ways in providing patient care. This approach is consistent with which
principle?
a. Transculturalism
b. Cross-culturalism
c. Multiculturalism
d. Acculturation
ANS: C
Multiculturalism refers to maintaining several different cultures, such as the uniqueness of
different work units. Cross-culturalism means mediating between/among cultures, and
transculturalism denotes bridging significant differences in cultural practices.
REF: Page 161
TOP: AONE competency: Communication and Relationship-Building
19. During performance appraisal, you praise Xia for her attention and care to nursing details. You
suggest that her care would be further enhanced by greater acknowledgment of patients’
feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived
as akin to failure in Xia’s culture. You reflect on how you could modify your approach in the
future to acknowledge different cultural interpretations of feedback. Your response is indicative
of:
a. Bias.
b. Cultural awareness.
c. Cultural diversity.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Ethnocentricity.
ANS: B
Cultural awareness involves self-examination and in-depth exploration of one’s own cultural
and professional background, including biases, prejudices, and assumptions, including
assumptions about thinking modes and decision making.
REF: Page 156
TOP: AONE competency: Communication and Relationship-Building
20. Individuals living with asthma, who also live in poverty, are much less likely to seek early care
and are more likely to go to emergency rooms for assistance. This example reflects:
a. Stereotyping.
b. Cultural diversity.
c. Ethnocentricity.
d. Transcultural care.
ANS: D
Transcultural care involves consideration of health beliefs and practices between genders
among races, ethnic groups, and those with different socioeconomic status.
REF: Page 160
TOP: AONE competency: Communication and Relationship-Building
21. Sarah, RN, complains to you that a male nurse from a different culture sits very close during
charting and leans toward her when speaking. In responding to Sarah, you consider that
differences across cultures that are relevant to this situation include:
a. Eye contact.
b. Personal space.
c. Harassment.
d. Expressions of feeling.
ANS: B
Body movements, eye contact, gestures, verbal tone, and physical closeness when
communicating are all part of a person’s culture. For the nurse manager, understanding these
cultural behaviors is critical in accomplishing effective communication within the diverse
workforce population.
REF: Page 160 | Page 161
TOP: AONE competency: Communication and Relationship-Building
22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers
on the unit and compares their practices negatively to what she learned in her nursing program.
She also is vocal about how she has learned so much here that she did not learn in her program.
She is best described as:
a. Having cultural sensitivity.
b. Experiencing cultural diversity.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Experiencing cultural marginality.
d. Experiencing acculturation.
ANS: C
The new graduate is caught between two cultures at this point—work and education—and
expresses feelings of belonging to neither.
REF: Page 155 | Page 156
TOP: AONE competency: Communication and Relationship-Building
23. In caring for a patient from an East Indian culture, the staff expresses frustration that many
people are in the room at any one time, which interferes with care. As the nurse manager, you
provide leadership in understanding that this behavior of the family and friend network reflects:
a. Lack of understanding of the seriousness of the patient’s illness.
b. Lack of communication between family members.
c. The social organization of friendships and family networks in East Indian culture.
d. Lack of caring about the hospital environment by the friends and family.
ANS: C
The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision
of care for patients who are from different cultures, including social organizations, which
include how relationships are formed and expressed in different cultures.
REF: Page 156
TOP: AONE competency: Knowledge of the Health Care Environment
24. Sarah, one of your RNs, tells you that she can’t understand why Jim, an Aboriginal patient,
wants to do a smudge. Sarah’s response is based on her:
a. Cultural marginality.
b. Circle of familiarity.
c. Cultural understanding.
d. Acculturation.
ANS: B
The “circle of familiarity” refers to constrained interpretation based on one’s values, attitudes,
and beliefs.
REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
25. Sarah, one of your RNs, tells you that she can’t understand why Jim, an Aboriginal patient,
wants to do a smudge. In coaching Sara, you suggest which of the following?
a. “Explain to Jim that there is no smoking in the hospital.”
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. “Inform Jim that fires are not allowed in the hospital.”
c. “Insist that he give you his tobacco because it is unhealthy for him.”
d. “Ask him what he means by a smudge and what meaning it has for him.”
ANS: D
By talking with Jim, Sarah is able to step outside her “circle of familiarity” and find and
enhance her understanding of personally held prejudices. Prejudice enables Sarah to find
meaning in situations, but it also limits understanding. Paradox describes this tension. We
have the responsibility to acknowledge the “possibility of tension” as a potential for new and
different understandings derived from our communication and interpretation. Possibility,
therefore, presumes a condition for openness with a person from another culture (Spence,
2004).
REF: Page 155
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. As a nurse manager, you have to be effective in managing a culturally diverse staff. Which
of the following nurse manager attributes would assist you in addressing the cultural needs of
your staff (select all that apply)?
a. Stereotyping of others
b. Respecting others
c. Understanding the importance of language
d. Encouragement of potential in all staff
e. Age bias
f. Disrespect for others
ANS: B, C, D
Cultural competence involves knowledge of diverse cultural and ethnic groups, including
knowledge of staff members and respect for others and their cultural differences.
REF: Page 160 | Page 161
TOP: AONE competency: Communication and Relationship-Building
Chapter 10: Power, Politics, and Influence
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse manager is experiencing poor staff morale on her unit. While participating in a
baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power
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today is probably because of the past. In the early decades of the profession, nurses lacked power
because:
a. Nurses freely chose to defer to physicians and administrators with more education.
b. Women lacked legal, social, and political power because of legal and cultural barriers.
c. The first nursing licensure laws prohibited nurses from making most decisions.
d. Nurses astutely recognized the risks of grabbing too much power too soon.
ANS: B
Nursing mirrored the lack of legal, social, and political power that was prevalent in the early
decades of the profession.
REF: Page 169
TOP: AONE competency: Leadership
2. Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid
political advocacy through membership in nursing organizations:
a. Refuse to believe that they are acting like members of groups that suffer socioeconomic
oppression.
b.
Do not understand how their failure to exercise power can limit the power of the
whole
profession.
c. Purposefully choose to exercise their power in the workplace through indirect means.
d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.
ANS: B
Becoming an active, productive, collegial member of groups and teams within the workplace
and in professional associations and community groups ensures that the nursing voice is heard
on healthcare issues and problems and is an appropriate exercise of power.
REF: Page 176 | Page 177
TOP: AONE competency: Professionalism
3. A nurse belongs to several professional organizations, serving on a state-level committee of one
group and on two task forces at work. The nurse is committed to a range of health issues and
knows the state senator from the nurse’s district, as well as the name of the representative in
Washington, DC. This nurse exemplifies which level of political activism in nursing? a.
Gladiator
b. Buy-in
c. Self-interest
d. Political astuteness
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Political involvement is a professional responsibility and nurses’ perspectives of the critical
issues for improving the healthcare system can shape the policy agenda of the nation’s
political leadership. This nurse exemplifies several of the skills associated with political
astuteness.
REF: Page 179
TOP: AONE competency: Professionalism
4. A manager relies on his director (immediate supervisor) for advice about enrolling in graduate
school to prepare for a career as a nurse executive. The director may exercise what kinds of
power in the relationship with the manager in this advisory situation? a. Expert, coercive, and
referent
b. Reward, connection, and information
c. Referent, expert, and information
d. Reward, referent, and information
ANS: C
Because the director is in a leadership role, he comes with knowledge or expertise that is
required to assume a leadership role, and he has information that he is willing to share, which
gives him the power of information. The employee sees him as credible and seeks his advice,
which gives him referent power.
REF: Page 170 | Page 171
TOP: AONE competency: Business Skills
5. A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should
the manager use to most effectively empower the staff of the unit?
a. Discuss the guidelines for the budget cuts with the staff, making the decisions with
those who participate.
b. Inform the staff of the budget cuts in a series of small group meetings and accept
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their ideas in writing only.
c. Provide the staff with handouts about the budget cuts and let them make
recommendations in writing.
d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the
cuts.
ANS: A
Empowerment is the process of exercising one’s own power to facilitate the participation of
others in decision making and taking action so they are free to exercise power It means
releasing authority and enabling others to have accountability, for participation and decisions.
REF: Page 171
TOP: AONE competency: Communication and Relationship-Building
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
6. During orientation of new nurse managers, the chief nursing officer stresses strategies that help
nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a
powerful image for the nurse manager?
a. Greeting patients, families, and colleagues with a handshake and a smile; listening
carefully when problems arise
b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit
and high-heeled shoes
c. Maintaining a soft voice during times of conflict; making unbroken eye contact during
interactions
d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman,
wearing no jewelry
ANS: A
A powerful and positive approach is communicated through confident behaviors such as
greeting others, smiling, and showing respect for the opinions of others through listening.
Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to
be firm and confident.
REF: Page 172 | Page 173
TOP: AONE competency: Leadership
7. Two nurses approach their manager about a conflict regarding the next month’s schedule. The
nurses are talking loudly and at the same time. The manager most effectively uses
communication skills to resolve the conflict by:
a. Taking both nurses aside, separately and then together, and charging them with
resolving the problem without her direct intervention.
b. Listening to each nurse speak to the other without interruption and asking clarifying
questions to help them resolve the issue themselves.
c. Separating the nurses, instructing each to decide how the problem can be resolved, and
meeting with them the next day.
d. Calling an emergency scheduling committee meeting and asking volunteers to resolve
the conflict between the two nurses.
ANS: B
Negotiation involves the presentation of an opening position with each party, then moving on
until they achieve a mutually agreeable result or until one or both move away from a failed
negotiation. Negotiation occurs when one party has something that the other party values,
such as a desired schedule.
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REF: Page 178
8.
TOP: AONE competency: Communication and Relationship-Building
A nurse manager recognizes the need to expand her professional network as she begins a job
search for a middle-management position. Which of the following actions is least likely to
expand her job-searching network?
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a. Reviewing her address book or card file for names and phone numbers of former
colleagues who are now in middle-management positions
b. Making an appointment to meet with a former instructor from her graduate program in
nursing administration
c. Making a long overdue return call to a former colleague who is now a chief nurse
executive
d. Attending a state-level conferences for nurse managers and executives and volunteering to
help with professional organizations’ informal luncheons and receptions
ANS: C
Networking is the result of identifying, valuing, and maintaining relationships with a system
of individuals who are sources of information, advice, and support. Many nurses have
relatively limited networks within the organizations where they are employed. Active
participation in nursing organizations is the most effective method of establishing a
professional network outside one’s place of employment.
REF: Page 174 | Page 175
9.
TOP: AONE competency: Professionalism
A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse
manager turns in the request to the human resources office with a note indicating that the staff
nurse has demonstrated excellent working skills and is a valued employee. The nurse manager
has used the influence of her position to help this staff member. Influence is the process of: a.
Using power.
b. Empowering others.
c. Understanding power.
d. Moving past apathy.
ANS: A
Influence involves the use of power to effect certain outcomes—in this situation, to arrange
days off for a valued employee.
REF: Pages 168-169
TOP: AONE competency: Communication and Relationship-Building
10. A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative
session regarding the new role of medication assistants. Nurses should be involved in shaping
public policy primarily because:
a. Involvement will enable nurses to take over the healthcare system at some point in the
future.
b. Other healthcare professions are less concerned about the essential needs of clients.
c. Such activities are important career builders for nurses who seek top-level executive
positions.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. They are closest to the front line of health care and see how it affects clients and families.
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ANS: D
Nurses can no longer be passive observers of the political world. Political involvement is a
professional responsibility. Nurses’ perspectives of the critical issues for improving the
healthcare system can shape the policy agenda of the nation’s political leadership.
REF: Page 179
TOP: AONE competency: Knowledge of the Health Care Environment
11. Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where
she is the youngest and newest staff member. Although she has limited experience, she has a
strong knowledge base, is confident, and was considered to have strong entry-level skills on
graduation. Sondra meets with her former instructor and confides that she is very frustrated that
others do not seem to accept her leadership. What might you suggest that would help Sondra to
understand what is happening in terms of power and influence?
a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of
other staff, including aides and practical nurses.
b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are
not from their community.
c. Morale on her unit can be improved by engaging in shared decision making.
d. Identify the informal leaders on her unit and how they affect care decisions.
ANS: D
Developing organizational savvy includes identifying the real decision makers and those
persons who have a high level of influence with the decision makers. Recognize the informal
leaders within any organization may have more power than the formal leader because of more
knowledge of the organization, more informational power, or more expertise.
REF: Page 176
TOP: AONE competency: Knowledge of the Health Care Environment
12. Literature on oppression in nursing has:
a. Verified the presence of behaviors associated with oppression within nursing.
b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes.
c. Failed to establish that oppression is present in nursing groups.
d. Indicated that nurses use oppression negatively.
ANS: A
Oppressed group behavior is apparent when a population is dominated by another group and
begins to take on the characteristics of the dominant group (Roberts, 1993), often bullying and
abusing their peers. In the twenty-first century, bullying and incivility have become epidemic
in both nursing education and clinical settings.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 169
TOP: AONE competency: Knowledge of the Health Care Environment
13. Politics is usually:
a. Confined to legislatures.
b. Seen in dysfunctional workplaces.
c. Found in all social organizations.
d. A representation of self-interest.
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ANS: C
Politics involves social interaction among organizations and as such, politics permeates in all
organizations, workplaces, legislatures, professions, and even families.
REF: Page 169 | Page 170
TOP: AONE competency: Knowledge of the Health Care Environment
14. Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing
in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give
patients excellent care and to learn as much as she can, because “Who knows? Nursing is a
great job with a great pay and I may return someday.” Mary’s statements most accurately
exemplify which orientation to the concept of nursing? Nursing as a(n): a. Profession.
b. Occupation.
c. Flexible discipline.
d. Career with off and on ramps.
ANS: B
Concern with nursing as potentially one in a series of possibly well-paid jobs reflects a view
of nursing as an occupation.
REF: Page 174
TOP: AONE competency: Professionalism
15. Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can
work together with other disciplines to provide more effective care for patients on the unit.
Lucy likely knows her power is:
a. Limited, thereby necessitating involvement of others in implementing ideas.
b. Restricted, which necessitates finding alternative means to achieve strong patient
outcomes.
c. Directed primarily toward those who are subordinate to her.
d. Of unlimited capacity when shared with others.
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Those like Lucy, who share power, tend to be the strong collaborators and see power as an
unlimited quantity when shared. Empowered nurses make professional practice possible,
creating a culture that satisfies all nurses.
REF: Page 172
TOP: AONE competency: Leadership
16. One day, at coffee, your co-worker suggests that you and she sit with unit members of the
hospital research committee. She suggests that this would be an excellent way to get to know
people who share her interest in research. Her actions are an example of: a. Mentorship.
b. Politics.
c. Networking.
d. Empowerment.
ANS: C
Meeting individuals outside the normal workgroup to share ideas and gain support and
encouragement is an example of networking.
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REF: Page 174 | Page 175
TOP: AONE competency: Leadership
17. The workgroup on NU 23 is marked by apathy toward the ward’s patients, high absenteeism,
open conflict among team members, and high turnover of personnel, including managers. The
underlying behavior in this situation may be characterized as: a. Powerlessness.
b. Anger.
c. Apathy.
d. Oppression.
ANS: A
Emotions such as anger and apathy result from a workplace in which powerlessness is
exhibited.
REF: Page 169 | Page 171 | Page 172
TOP: AONE competency: Leadership
18. During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and
offers support and advice when Mary presents ideas to the group. You are surprised because
Vivian has often confided that she does not like Mary. Vivian’s behavior is best described as: a.
Insincere.
b. Networking.
c. Politically sophisticated.
d. Collegial.
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Collegial behavior requires respect, not friendship.
REF: Page 177
TOP: AONE competency: Communication and Relationship-Building
19. Which of the following interactions is MOST consistent with the idea of networking?
a. Meet with the same colleagues daily to have coffee and share concerns about the
workplace and stories about colleagues.
b. Join an online workplace forum to gain ideas about how to handle workplace conflict.
c. Suggest that you and a new team member meet after work for coffee to review unit
guidelines.
d. Join a nurse executive interest group to meet other executives for support and for sharing
ideas of expertise.
ANS: D
Networking is the result of identifying, valuing, and maintaining relationships with a system
of individuals who are sources of information, advice, and support. Many nurses have
relatively limited networks within the organizations where they are employed. Active
participation in nursing organizations is the most effective method of establishing a
professional network outside one’s place of employment. Successful networking involves
sharing similar ideas and maintaining relationships within a system of individuals who serve
as sources of information, advice, and support.
REF: Page 174 | Page 175
TOP: AONE competency: Communication and Relationship-Building
20. The institution where you are a nurse manager has resisted the adoption of a new document
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management software, citing cost as a concern. You meet with
other nurse managers who are in favor of the software and prepare a proposal to take to the
senior executive with the goal of persuading the executive to adopt the software. This is an
example of: a. Collaboration.
b. A coalition.
c. Networking.
d. Policy building.
ANS: B
The formation of temporary groups to achieve particular goals involves the development of
coalitions.
REF: Page 178
TOP: AONE competency: Leadership
21. Which of the following is the best example of skilled negotiation?
a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits
of a walk-in preoperative area for children.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program.
She proposes to accept less popular rotations during peak vacation time, in return.
c. George, the head nurse in ER, asks for additional staff for his department and points out
the benefits of being able to keep patients for longer periods.
d. Jerry speaks with his supervisor about his supervisor’s concerns related to bedside
reporting before presenting a proposal to change this process.
ANS: D
Successful negotiators are well informed about not only their own positions but also those of
the opposing side. Negotiators must be able to discuss the pros and cons of both positions.
They can assist the other party in recognizing the costs versus the benefits of each position.
REF: Page 178
TOP: AONE competency: Leadership
22. Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by
other nursing staff regarding protocols and policies on the unit. What type of power is Amy
using?
a. Position power
b. Expert power
c. Personal power
d. Competency power
ANS: B
According to the types of power outlined in the text, Amy is most likely evidencing expert
power in that she is being consulted regarding areas of knowledge and competency on the unit
and is at the same level, potentially, in the hierarchy as her colleagues.
REF: Page 170 | Page 171
TOP: AONE competency: Leadership
23. Despite repeated invitations by his colleagues to become involved in regional and state nursing
practice committees, Tom refuses. His reason is that “nursing committees rarely get anything
worthwhile done because of politics and conflicts.” According to the text, Tom’s view of
involvement:
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a. Is rare in nursing today.
b. Reflects a fear of power.
c. Reflects the essential process of power.
d. Reflects empowerment and capacity to make his own decisions.
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Tom’s response reflects a distancing from other nurses related to discomfort with conflict
associated with human interactions. The text defines human interactions within organizations
as politics, a component of which is the essential process of power.
REF: Page 169 | Page 170
TOP: AONE competency: Professionalism
24. A unit manager watches a new RN graduate interacting with a patient. When the RN comes out
of the room, the unit manager says, “I don’t know what they taught you in your nursing
program, but if I see you do that again, I will write you up.” This example demonstrates: a.
Coercive use of power.
b. Appropriate application of control.
c. Use of informatory power.
d. Use of power to provide coaching.
ANS: A
Influence is the process of using power. Influence can involve the punitive power of coercion,
as is used in this example.
REF: Page 171
TOP: AONE competency: Communication and Relationship-Building
25. Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated
that others in her working environment seem to pay little attention to her creative ideas or place
her in informal leadership positions. As her colleague, you want to provide her with helpful
feedback. Which of the following statements will provide feedback as to how she might
communicate power and demonstrate that she is capable of handling other leadership
responsibilities?
a. “I find your soft voice and manners very reassuring and calming to patients.”
b. “Try using a wider vocabulary and big words so that people will think that you are
knowledgeable.”
c. “At times, you tend to slump and avoid eye contact when you are talking with colleagues
and families.”
d. “Don’t worry about what others think of you. If you feel like saying something, say it,
even if it hurts other people’s feelings.”
ANS: C
A powerful image comes from thinking of oneself as powerful and effective, and this is
communicated through posture, maintaining eye contact, treating others with courtesy and
respect, and using a firm, confident voice with vocabulary that is appropriate (which does not
necessarily involve using big-sounding words).
REF: Page 173
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
1. As a new manager in the ED, you meet with each of the staff to ask about their priorities
and NURSINGTB.COM what they think is going well in the department or what is of
concern to them. Almost all of the staff express frustration and distress at being treated rudely
or disrespectfully by patients, staff from other departments, and physicians and complain that
they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the
profile of nurses. Which of the following strategies would be most effective? (Select all that
apply.) a. Requesting increased compensation
b. Speaking positively about one’s work
c. Dressing and grooming in a clean and neat manner
d. Using titles (e.g., Mr., Mrs., Ms.) and last names
e. Submitting a written complaint to senior administration regarding rude behaviors
f. Developing a code of conduct for the ED staff.
ANS: B, C, D, F
Demonstrating a positive and professional attitude about being a nurse to nursing colleagues,
patients and their families, other colleagues in the workplace, and the public facilitates the
exercise of power among colleagues while educating others about nurses and nursing. A
powerful image is an important aspect of demonstrating this positive professional attitude and
includes how we identify ourselves, how we dress, whether we are punctual for commitments,
and whether we speak positively about our work. Bullying and incivility are negative
expressions of power that can affect patient outcomes. The Joint Commission standard
demands that leaders ensure that a code of conduct is implemented to ensure patient safety
and a culture of quality.
REF: Page 169 | Page 177
TOP: AONE competency: Communication and Relationship-Building
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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Chapter 11: Caring, Communicating, and Managing with Technology
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
A nurse manager was orienting new staff members to computerized charting. To understand
computerized charting, staff members must understand informatics. The three core concepts in
informatics are:
a. Hardware, software, and printers.
b. Data, information, and knowledge.
c. Decision making, data gathering, and reporting.
d. Wireless technology, voice recognition, and handheld devices.
ANS: B
Informatics is the application of technology to all fields of nursing to facilitate and extend
nurses’ decision-making abilities and to support nurses in the use, storage, and linkage of
clinical information to provide effective and efficient patient care.
REF: Page 187
2.
TOP: AONE competency: Business Skills
The nursing manager of a surgical unit has been asked by administration to evaluate client
outcomes post cardiac catheterization. Using data about client outcomes post cardiac
catheterization for the past 6 months so as to modify practice is an example of: a. Information.
b. Cost-effective care.
c.d. Meeting standards.Evidence-based practice. N URSINGTB.COM
ANS: D
Technology enables evidence-based practice by collecting good clinical knowledge,
translating nursing knowledge into reference materials that can be accessed at the point-ofcare, and, potentially, assisting nurses to take action based on best evidence for practice
(Lang, 2008; Lang et al., 2006; Staggers & Brennan, 2007).
REF: Page 205
3.
TOP: AONE competency: Knowledge of the Health Care Environment
Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back
pain. He shows the clinic nurse a Webpage he thinks is great and tells her that he has been
following the exercises recommended by the author. He wants to know what she thinks about
the site. When the clinic nurse evaluates this site, she discovers that its author is a personal
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
trainer. No credentials are listed. In several testimonials on the page, people (their pictures are
included) say how wonderful they feel after having done these exercises. The exercises all have
animated demos when you click on the pertinent highlighted text or icon. They seem easy to
follow. The site was posted five years earlier and was last updated three years before.
The clinic nurse advises Mr. Cruiser to: a.
Avoid this site.
b. Check with his primary healthcare provider.
c. Continue with the exercises.
d. Contact the author for additional exercise and feedback.
ANS: A
Patients need coaching as to how to use and decipher information that is available through the
Internet. In this situation, the provider on the site lacks credibility because no credentials are
listed, and the information is not current.
REF: Page 206
4.
TOP: AONE competency: Business Skills
A primary care clinic in a small urban center sees a high volume of cardiology patients. Patients
who attend the clinic have smart cards that they use at hospitals, clinics, and emergency
departments within that region of the state. A primary benefit of the smart card for these
patients would be:
a. Rapid and accurate treatment in emergency situations.
b. Reduced wait times to see specialists.
c. E-mail notification of test results.
d. Readily available information regarding medications.
ANS: B
Credit card–like devices called smart cards store a limited number of pages of data on a
computer chip and serve as a bridge between the clinician terminal and the central repository
of the electronic health record (EHR), making patient information available to the caregiver
quickly and cheaply at the point-of-service. Smart cards provide information to healthcare
providers regarding the patient’s demographic and contact information, allergies,
immunizations, lab results, and past patient care encounters and are presented at the point-ofservice.
REF: Page 198
5.
TOP: AONE competency: Business Skills
The clinic nurse has just accessed a client’s chart on the computer. The resident comes over
NURSINGTB.COM and asks her to stay logged on because he needs to add a note to
that client’s chart. She should say:
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. “I’m sorry, but you will have to enter the information using your own password.”
ANS: D
System users must never share the passwords that allow them access to information in
computerized clinical information systems. Each password uniquely identifies a user to the
system by name and title, gives approval to carry out certain functions, and provides access to
data appropriate to the user. All users must be aware of their responsibilities for the
confidentiality and security of the data they gather and for the security of their passwords.
REF: Page 206
6.
TOP: AONE competency: Business Skills
A home health nurse has been assigned to cover a 300-square-mile area of remote Montana.
Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy.
She will need daily contacts for at least two weeks and then regular weekly contact following
that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the
other clients, the nurse gives her a laptop computer with net meeting software installed. Each
morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse
assesses whether or not the client needs to be seen that day and is able to view the colostomy
site. This type of technology is called: a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.
ANS: C
Telecommunications and systems technology facilitate clinical oversight of health care via
telephone or cable lines, remote monitoring, information links, and the Internet. Patients
sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and
educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.
REF: Page 204
7.
TOP: AONE competency: Business Skills
At a newly built outpatient surgical center, an integrated information system has been
purchased. The chief nursing officer creates a series of staff development classes to orient the
staff to this new system. One of the advantages of an integrated information system is that
client-care data from all sites can be stored in and retrieved from a: a. Nursing information
system.
b.c. Central data repository.Nurse expert system.
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d. Handheld device.
ANS: B
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Computer information systems manage large volumes of data, examine data patterns and
trends, solve problems, and answer questions. In other words, computers can help translate
data into information from both within and among organizations. Data from all patient
encounters with the healthcare system are stored in a central data repository, where they are
accessible to authorized users. Patient information in a centralized database is organized,
legible, and easily retrievable from a variety of sources and reflects a variety of data.
REF: Page 193
8.
TOP: AONE competency: Business Skills
Nurses need to know how to operate a computer, compare data across time, and look for
patterns in client responses to treatments. These are examples of: a. JCAHO standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.
ANS: C
The Quality and Safety Education for Nurses (QSEN) project identified informatics
competency as a necessary component of the knowledge, skills, and attitudes for quality
patient care. Nurses are anticipated to be able to use information and technology to
communicate, manage knowledge, mitigate error, and support decision making. Nurses must
utilize hospital database management, decision support, and expert system programs to access
information and analyze data from disparate sources for use in planning for patient care
processes and systems.
REF: Page 187
9.
TOP: AONE competency: Business Skills
The chief nursing officer understands that to be able to compare data across client populations
and sites, it is important that nurses use: a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Structured nursing languages.
ANS: D
Data are standardized and use structured terminology, which enables cross-site comparisons.
REF: Page 205
TOP: AONE competency: Business Skills
10. Leaders in nursing must advocate for information and knowledge systems that support nursing
practice. This is best accomplished by:
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Sending staff nurses to conferences that discuss cuttingNURSINGTB.COM -edge
technologies.
ANS: A
Nurse leaders and direct care nurses must be members of the selection team, participate
actively, and have a voice in the selection decision. The information system must make sense
to the people who use it and fit effectively with the processes for providing patient care.
REF: Page 205 | Page 206
TOP: AONE competency: Business Skills
11. You are in the process of designing a patient education program that will provide education and
monitoring for patients with hypertension. To support your planning, you draw out and present
patient data from: a. A clinical database.
b. Biomedical technologies.
c. E-mail.
d. Internet sources.
ANS: A
Clinical databases are collections of elements organized and structured for the processing,
organization, and presentation of data for interpretation as information, which, in this
particular instance, includes outpatient data.
REF: Page 191
TOP: AONE competency: Business Skills
12. You document your patient’s vital signs into a bedside documentation device and are able to
compare your patient’s vital signs with patients who have similar diagnoses and similar
medications, and who are of a similar age. You are accessing: a. E-mail.
b. Telecommunications.
c. A database.
d. Technology.
ANS: C
A database is a collection of data elements stored and organized together for the purposes of
interpreting information such as vital signs.
REF: Page 203 | Page 204
TOP: AONE competency: Business Skills
13. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen
levels, and intracranial pressure. These devices involve: a. Biomedical technology.
b. Telecommunications.
c. Retrieval of patient history information.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Internet.
ANS: A
Physiologic monitoring devices and patient surveillance systems involve biomedical
technology.
REF: Page 188
TOP: AONE competency: Knowledge of the Health Care Environment
14. As the head nurse involved in leading determination of which patient surveillance systems to
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acquire for your unit, one of your aims is to avoid adverse events
through the implementation of appropriate technology. This particular aim recognizes that:
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore, misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot provide.
d. Physiologic monitoring systems enable detection of early changes before an adverse event
occurs.
ANS: D
Data about adverse events suggests that a majority of physiologic abnormalities are not
detected early enough and may be present hours before the event actually occurs. Physiologic
monitoring aids in early detection of changes.
REF: Page 188
TOP: AONE competency: Knowledge of the Health Care Environment
15. A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to
the hospital when a donor kidney is available, it is important that he can be reached anywhere
and at any time. To ensure that he receives the message, what type of technology is most
effective? a. Internet
b. Telecommunications
c. WL pager
d. CDS
ANS: C
Wireless (WL) communication is an extension of an existing wired network environment and
uses radio-based systems to transmit data signals through the air without any physical
connections. Patients awaiting organ transplants are provided with WL pagers so that they can
be notified if a donor is found.
REF: Page 197
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
16. A recent nursing graduate in a busy emergency department triages a patient who has sustained a
large, deep puncture wound in his foot while working at a construction site. He is bleeding and
is in pain. The nurse enters the triage data that she has obtained from the patient into a
computerized, standard emergency patient classification system. After she enters the assessment
data, she notices an alert on the computer screen that prompts her to ask the patient about the
status of his tetanus immunization. What system of technology is involved in generating the
alert?
a. Clinical decision support
b. WL technology
c. Computerized provider order
d. Electronic health record
ANS: A
Clinical decision support (CDS) is a clinical computer system, computer application, or
process that helps health professionals make clinical decisions to enhance patient care. The
clinical knowledge embedded in computer applications or work processes can range from
simple facts and relationships to best practices for managing patients with specific disease
states, new medical knowledge from clinical research, and other types of
information.NURSINGTB.COM
REF: Page 191
TOP: AONE competency: Business Skills
17. Despite the implementation of bar-code medication administration (BCMA) on your busy
medical unit, you notice that the number of medication errors has not significantly decreased.
Which of the following reasons might explain the lack of change in errors?
a. A number of new medications have been introduced into the hospital pharmacy that
are not yet recognized in the CDS.
b. There have been an unusually high number of patients on the unit who have been
unable to confirm their identity at the time of medication administration.
c. Lack of staff understanding and support for BCMA has led to overrides or failures to
scan bar codes during busy times.
d. Clinical data that have been entered into the system to guide administration of the
medications are outdated.
ANS: C
Most errors related to technology involve mislabeled bar codes on medications, mistakes at
order entry because of confusing computer screens, or issues with management of
information. Errors also are related to dispensing devices and human factors, such as failure to
scan bar codes or overrides of bar-code warnings.
REF: Page 200
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
18. A rural-urban health consortium enables physicians in a rural remote setting to consult with
specialists in care through electronic conferencing, which includes consultation using intranet
radiology images. This system may be in which phase of electronic medical technology
adoption, according to the Healthcare Information and Management Systems Society (HIMSS)?
a. 0
b. 1
c. 3
d. 6
ANS: D
According to the HIMSS, this healthcare organization may be in phase 6, which includes the
capacity to transmit all radiology images through intranet or another secure source. Level 1
refers to the installation of major ancillary clinical systems (such as radiology) and level 3 to
the retrieval of radiology images from picture archives and communication systems.
REF: Page 194 | Page 195
TOP: AONE competency: Business Skills
19. As a nurse manager representative on a clinical information system selection team, you would
be particularly concerned if the favored system:
a. Involves screen displays that are best configured for non-clinical users.
b. Requires an upgrade to servers in the facility.
c. Requires staff orientation and training during implementation of the software.
d. Minimizes the amount of data entry necessary.
ANS: A
An ideal hospital information system should include as much instrumentation as possible to
minimize data entry. As a clinical end user, you would expect orientation and training on how
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the screen display can be configured so as to suit the purposes and
preferences of users in clinical areas.
REF: Page 196 | Page 197
TOP: AONE competency: Business Skills
20. When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to
consider the advantages, which include: a. Lower cost relative to PCs.
b. Small display screen.
c. Font size.
d. Speed of operation.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
PDAs offer a lower-cost method of documentation and communication than PCs, as well as
easy portability. Disadvantages of PDAs include small screen size, suboptimal readability,
and slowness in situations when speed is most needed.
REF: Page 197
TOP: AONE competency: Business Skills
21. A nurse manager is excited by the possible use of speech recognition (SR) systems for
documentation of patient care, especially during crisis situations when staff members need to
focus on performing rapid assessments and implementation of procedures. She learns, however,
that SR systems would be impractical at this point. What would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely to occur in a pressured
situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.
ANS: B
Speech recognition systems rely on staccato-like speech, pauses between words, and
programming for each user, any and all of which would be unlikely in a pressured crisis
situation. SR is being used primarily for therapeutic purposes and in situations where data
entry is stable.
REF: Page 198
TOP: AONE competency: Business Skills
22. As a nurse manager, one challenge is to orient new staff to your agency’s policies and
procedures, as well as to provide training across various shifts. A cost-effective and effective
learning strategy would be:
a. Development of new learning modules and software to support document retrieval.
b. E-mail distribution to staff home e-mail addresses regarding important policies.
c. Preparation of DVDs that can be viewed on computers at the nursing station during
“down times.”
d.
Linking policies and procedures to the network for access when required at the
care.
point-of-
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ANS: D
Knowledge technology consists of systems that generate or process knowledge and provide
clinical decision support (CDS). The clinical knowledge embedded in computer applications
can range from simple facts and relationships to best practices for managing patients with
specific disease states, new medical knowledge from clinical research, and other types of
information. The most accessible and cost-effective approach would be utilization of what is
already available in the work environment, such as the systems that provide CDS.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 191
TOP: AONE competency: Business Skills
23. A necessary, basic condition for successful integration of clinical information systems is: a.
Software.
b. Standard medical nomenclature.
c. Confirmatory evidence from nursing-led studies.
d. Strong interdisciplinary cultures.
ANS: D
An integrated clinical information system draws on specific knowledge from many involved
disciplines that interface at the patient. Successful integration of clinical information systems
requires that the various disciplines work together collaboratively to transform the data into
meaningful knowledge.
REF: Page 199 | Page 200
TOP: AONE competency: Communication and Relationship-Building
24. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based
practice (EBP) project. The goal of this project is to:
a. Enable detection of variations in clinical outcomes from well-researched standards that
are supported by confirmatory evidence.
b. Gain quick access to literature based on studies of patients and families who have
experienced stroke.
c. Develop a list of articles that could be accessed to address clinical issues and problems
with stroke patients.
d. Advance the development of staff who are able to conduct independent nursing
research on stroke outcomes.
ANS: A
Several “intelligent” clinical information systems are in place that collect good data and then
translate nursing knowledge, such as well-researched standards, into reference materials at the
point-of-care. In addition, computer applications assist nurses to take action and provide
patient care based on the best evidence for practice.
REF: Page 205
TOP: AONE competency: Business Skills
25. As part of an information technology implementation team, you are implementing a clinical
decision support system. Particular considerations for successful implementation of this project
include:
a. Ensuring that the system is reliable.
b. Ensuring that patient information is reliable.
c. Developing unique identifiers for individuals.NURSINGTB.CO M
d. Developing rules that support inferences.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Clinical decision support systems provide support for novice nurses, in particular, as they
enable entry of real-time data from patient situations and inferences that apply the logic that
expert nurses would use. These inferences require rules to be developed for the system.
REF: Page 192
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. As a nurse manager, you want to institute point-of-care devices on your unit. The
rationale that you provide to support the point-of-care devices includes (select all that
apply): a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Comparison of patient data with previous data.
d. Immediate access to staffing schedules.
ANS: A, B, C
Point-of-care devices that allow documentation of assessment, care, and teaching at the
bedside reduce the gap in time between care and documentation, thereby reducing error,
increasing accuracy, and improving communication of care. Medication devices and patient
databases enable accurate clinical decision making.
REF: Page 187 | Page 189 | Page 194
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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Chapter 12: Managing Costs and Budgets
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
The chief nursing office of a Magnet™ hospital has conducted a study of ways to improve
healthcare services. Healthcare services that add value for clients: a. Accomplish healthcare
goals.
b. Minimize costs.
c. Decrease the number of services used.
d. Use high-technology treatments.
ANS: B
Models of reimbursement affect which services and approaches (e.g., decreasing the number
of services used) might be financially viable and add value for clients. It is critical to
determine and advertise the value of nursing care. Services that add value are of high quality,
affect health outcomes positively, and minimize costs.
REF: Page 217
2.
TOP: AONE competency: Business Skills
The difference between a nurse practitioner’s charge of $45 for an office visit and the
insurance company’s payment of $34 is: a. A contractual allowance.
b. A profit.
c. A flat rate.
d. Revenue.
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ANS: A
Because the amount that is allowed for an office visit is less than the amount that the NP
charges, this is known as a contractual allowance or discount. If the amount allowed were
more than what the NP charges, then a profit would be realized. All of the answers represent
sources of revenue.
REF: Page 215
3.
TOP: AONE competency: Business Skills
The chief nursing office continues to seek ways to improve healthcare services to clients and
to save the hospital money. However, with the federal guidelines of paying agencies based on
capitation, the chief nursing office faces a challenge. Capitation provides incentives for
healthcare providers to control costs by:
a. Providing fewer services to fewer clients.
b. Using fewer services per client.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Using high-technology treatments.
d. Requiring second opinions.
ANS: B
In a capitated environment, a single fee is paid for all services provided. To be financially
viable under this reimbursement model, organizations would be interested in decreasing the
volume of services used and increasing the volume of patients. High-technology treatments
and second opinions may increase the number of services used.
REF: Page 218
4.
TOP: AONE competency: Business Skills
In a nurse managers’ meeting, the chief nursing officer encourages the managers to
brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs
by managing:
a. Supplies.
b. Staffing.
c. Fixed costs.
d. Medication costs.
ANS: B
Because staffing constitutes the largest portion of any healthcare budget, managing the mix
and numbers of staff required for patient care to meet identified outcomes will have the largest
impact on budgets.
REF: Page 220
5.
TOP: AONE competency: Business Skills
The chief nursing officer works with her nurse managers by helping them understand how to
develop and implement a budget. A nurse manager can best describe a budget as a: a. Day-today plan for operations.
b. Unit of service.
c. Statement of revenues and services.
d. Financial plan.
ANS: D
The budget is an overall financial plan that reflects organizational assumptions, objectives,
and standards, and various types of budget planning, including operational and capital
budgets, which, in turn, reflect revenues and costs.NURSINGTB.COM
REF: Page 222
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
6.
A nurse manager approves two staff nurses to attend a national conference. When reviewing
the budget, the nurse manager looks at which line item? a. Cash budget
b. Capital budget
c. Operating budget
d. Supply and expense budget
ANS: C
The operating budget includes a personnel budget, which takes into account productive and
nonproductive paid work hours. Education hours are covered under nonproductive paid work
hours in the operating budget.
REF: Page 223
7.
TOP: AONE competency: Business Skills
A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other
week. How many FTEs is this position? a. 0.6
b. 0.7
c. 0.8
d. 1
ANS: B
Assuming that a full-time RN works 2080 hours/year (40 hours 52 weeks), the nurse works
(24 hours 52 weeks + 8 hours 26 weeks)/2080, which is 0.7 FTE.
REF: Page 223
8.
TOP: AONE competency: Business Skills
After reviewing her monthly budget report, the nurse manager sees that she has a negative
variance, which prompts her to change the staffing schedule. A negative or unfavorable
variance in a monthly expense report may result from: a. Overestimation of inflation.
b. Higher than expected client acuity.
c. Net revenue exceeding net expenses.
d. Not replacing staff who called in sick.
ANS: B
Variance reflects the difference between what was projected and the actual performance in a
budget. When the variance is negative or unfavorable, the amount spent is more than what
was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help
managers interpret and use variance information better, some institutions use flexible budgets
that automatically account for census variances.
REF: Page 226 | Page 227
9.
TOP: AONE competency: Business Skills
An example of an initiative that may reduce total healthcare costs would be:
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Offering nurse practitioner–led clinics that educate parents about nonpharmacologic
strategies for managing ear infections.
b. Educating seniors about the comparative costs of medications that are prescribed to them.
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c. Lowering copayments for prescription drugs for seniors.
d. Advocating for more readily available MRI services to ensure early diagnosis.
ANS: A
Total healthcare costs are a function of prices that are established for various services and the
volume or quantity of services used. Utilization of high-tech diagnostic services and lowering
of copayments have been implicated in increasing total healthcare costs (thus C and D would
not be correct), as well as attitudes and behaviors of consumers of health care. In general,
consumers prefer to “be fixed” when something goes wrong rather than to practice prevention.
Many consumers still believe that the physician knows best, so they do not seek much
information related to costs and effectiveness of different healthcare options. When
information is sought, it is not readily available or understandable. Also, consumers are not
accustomed to using other, less costly healthcare providers, such as nurse practitioners.
REF: Page 213
TOP: AONE competency: Business Skills
10. Which of the following factors is not implicated in rising healthcare costs?
a. Rising expectations of consumers for cure and care
b. Marketing of drugs to consumers
c. Large administrative staffs to process medical billings
d. Rising Medicare costs
ANS: D
Unintentional injuries, socioeconomic conditions (e.g., poverty and violence), marketing of
pharmaceuticals, and the rising expectations of consumers with regard to what should be done
to manage health concerns all contribute to rising healthcare costs. The costs of Medicare are
not considered in relation to rising costs of health care.
REF: Pages 212-214
TOP: AONE competency: Knowledge of the Health Care Environment
11. An older adult couple with limited means and on Medicare is considering options after the
hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with
bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized
with a mild myocardial infarction last year. Considering their means and health concerns,
which of the following might be the best option? a. Hospice care
b. Custodial nursing home care
c. Home care
d. Hospital care
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
Of the options presented, C is the best alternative . Custodial nursing care is not covered under
Medicare and therefore, the financial burden of this option may cause further stress for the
couple. Medicare Part A is an insurance plan for hospital, hospice, home health, and skilled
nursing care that is paid for through Social Security. Because Mrs. A. is stable and not
terminal, she does not require hospice care. The assistance provided through home care is
covered under Medicare and provides assistance for needs such as those of Mrs. A.
REF: Page 214
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
12. After a major flu vaccination campaign, an agency bills a private insurance company for
allowable costs for administration of each vaccination according to the schedule established by
the insurance company for reimbursement. This is an example of which major payment
method?
a. Cost-based reimbursement
b. Charges
c. Contractual allowance
d. Prospective reimbursement
ANS: A
Because the agency is submitting costs after the campaign is completed and in accordance
with an established schedule of allowable costs, a retrospective, cost-based reimbursement
payment method is being utilized. If a desire for profit was indicated, then the answer would
be “charges.”
REF: Page 214 | Page 215
TOP: AONE competency: Business Skills
13. Physicians in a small urban hospital are reluctant to discharge older adult patients because many
of the patients lack private insurance and the resources to travel distances for follow-up care.
The hospital administration pressures the physicians to discharge patients sooner and to be more
consistent with the number of hospitalization days specified within the DRGs. Which of the
following would most likely prompt the action of administrators?
a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs
and costs of care.
b. Local home care services are expressing concern about the increased acuity of patients
being discharged into their care.
c. The resource-based relative scale for physicians does not account for the increased length
of stay.
d. Acute care patients are being denied entry to the hospital because of the increased stay of
patients.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Length of stay (LOS) is the most important predictor of healthcare costs and extra days are a
cost to the organization in terms of both the extra days and decreased patient volume. The
situation, as outlined, does not indicate that there is a bed shortage and therefore, there is no
evidence that other patients are being denied access to services or that additional patient
volume is not being captured. The hospital would be concerned about the impact on its
income because of the additional, uncompensated care costs incurred for patients who exceed
the usual length of stay explicitly calculated under PPS and the DRGs.
REF: Page 215 | Page 219
TOP: AONE competency: Business Skills
14. Within a healthcare environment, where the gap between revenues and costs can mean the
difference between sustainability of an organization and nonsustainability of an organization or
services, it is critical for nurse managers to:
a. Maintain a clear vision of how to trim healthcare costs.
b. Balance value-added services against costs and revenues.
c. Consistently delete programs that are of high cost.
d. Implement programs that bring in additional revenues.
ANS: B
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To achieve and maintain financial viability, nurse managers must be able to think strategically
financially and in terms of nursing care. Cutting costs by deleting programs and bringing in
additional revenue through new programs and services are not in themselves strategic unless
the decisions made lead to quality care, have positive outcomes, and are efficient in terms of
cost.
REF: Page 217
TOP: AONE competency: Business Skills
15. Because of the complexity of reimbursement systems and its implications for the services
available to patients, the nurse has a key role in:
a. Advocacy for patients with regard to services required and services utilized.
b. Increasing the volume of services and decreasing the number of patients served.
c. Accomplishing more with each visit and decreasing the volume of services used.
d. Decreasing the volume of services used and the number of return visits.
ANS: A
The specific strategies employed by organizations and nurses to contain costs and increase
revenues depend on the reimbursement system(s) within which the organization operates and
therefore on whether the volume of services is increased or whether the volume of services is
decreased by placing greater emphasis on efficacy in each visit and reducing the number of
return visits. Because of the complexity of the reimbursement environment, the nurse is
placed in a position of advocacy in terms of what the patient needs and how those needs can
be best met within the funding structures.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 218
TOP: AONE competency: Knowledge of the Health Care Environment
16. Of the following, which is the most effective strategy that a nurse manager could employ to
reduce unnecessary costs in specific healthcare settings?
a. Training nurses on accurate documentation of supplies used for patient care
b. Reducing the number of overtime hours worked by staff
c. Reducing the number of staff on a unit
d. Making decisions for patients about which care is important to their health
ANS: A
Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g.,
staff overload, recent illnesses, increased acuity) in terms of whether this reflects an ongoing
or temporary situation and therefore whether it is a necessary variance or not. Reducing staff
may or may not be effective, depending on the services being provided. Making decisions for
the patient misses an important opportunity to invite the patient into discussion about patient
priorities and needs and relative costs of options, which may lead to improved adherence with
regimens and less waste of resources. An effective approach to cost containment is ensuring
that supplies are accurately accounted for and charged in a timely manner.
REF: Page 219
TOP: AONE competency: Business Skills
17. In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN
positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager
has determined that the budget will provide for _____ hours. a. 12,480 productive
b. 10,820 productive
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c. 12,480 paid
d. 10,800 patient care
ANS: C
From the information given, it is not possible to determine how many nonproductive hours
(vacation, holiday, sick time, education) the nurse manager has accounted for in her budget
calculations and therefore whether the total number of hours (40 hours 52 weeks 6 staff =
12,480 paid hours) is productive (paid time that is worked) or nonproductive hours. 12,480
accurately reflects the total number of hours of work paid per year.
REF: Page 223
TOP: AONE competency: Business Skills
18. In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN
positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of
vacation and 3 days of education, and has averaged 3 sick days a year. RN 2 has 6 weeks of
vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of
sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate
2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no
education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no
educational opportunities planned, and has been off ill for 4 weeks. How many hours of
productive paid time can be anticipated for the budget? a. 12,480
b. 11,200
c. 10,848
d. 10,688
ANS: C
From the information given, there are 32 weeks of vacation (40 hours 32 weeks = 1280
hours), 11 days of education (11 days 8 hours = 88 hours), 15 days of orientation (15 days
8 hours = 120 hours), and 18 days of sick time anticipated (18 days 8 hours = 144) or 1280
+ 88 + 120 + 144 = 1632 hours of nonproductive time. This will leave 10,848 hours of
productive time available, based on the information available and the fact that the manager is
not anticipating sick time for RN 6 in the upcoming budget year.
REF: Page 223
TOP: AONE competency: Business Skills
19. The primary reason for calculating productive hours paid instead of simply calculating work
paid per year is that productive hours enable the manager to: a. Anticipate total costs for patient
care.
b. Know how much time staff will likely be unavailable because of illness.
c. Determine when orientation needs to occur for new staff.
d. Determine the number of hours available for patient care.
ANS: D
Total hours are critical for determining the total number of hours that need to be paid for the
year. Productive hours are needed to determine what hours are actually available for patient
care. The number of FTEs required is determined by dividing the total patient care hours
required by the number of productive hours.
REF: Page 223
TOP: AONE competency: Business Skills
NURSINGTB.COM
20. In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health,
life insurance, pension and retirement plans). Based on the usual cost of benefits, how much
should a nurse manager include for a total full-time salary cost of $312,000? a. $78,000$93,600
b. $62,400-$78,000
c. $46,800-$93,600
d. $31,200-$46,800
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
The average cost of benefits is approximately 25% to 30% of a full-time employee’s salary.
In this example, the correct response is obtained by multiplying the total full-time salary cost
by .25 and .30.
REF: Page 224
TOP: AONE competency: Business Skills
21. A nurse manager is planning to request three new infusion pumps at a cost of approximately
$1500 each. This item would typically be included in which budget? a. Operating
b. Strategic
c. Unit of service
d. Capital
ANS: D
Items that have a useful life of longer than a year, which is likely with the pumps, and that
have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are
considered capital items. Operating budget items include what is used on a day-to-day basis,
such as staffing.
REF: Page 225
TOP: AONE competency: Business Skills
22. A nurse manager is planning to request three new infusion pumps at a cost of approximately
$1500 each. What would BEST support the capital request? a. Number of patient care hours
anticipated for the year
b. Cost comparisons; how much and how often infusion pumps are used; condition of
existing pumps
c. Outline of cost for each pump
d. Estimation of total cost; no further details
ANS: B
Complete well-documented justifications are needed because the competition for limited
resources is stiff. Justifications should be developed using the principle of any business case
and should include, at minimum, projected amount of use; services duplicated or replaced;
safety considerations; need for space, personnel, or building renovation; effect on operational
revenues and expenses; and contribution to the strategic plan.
REF: Page 225
TOP: AONE competency: Business Skills
23. As an experienced nurse manager who is new to an organization, it would be important to:
a. Know the difference between operating and capital budgets.
b. Understand the budget timetable and level of involvement expected of individual
managers in budget preparation.NURS INGTB.COM
c. Know why a budget is essential to the well-being of an organization.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Understand what factors drive up healthcare costs in the healthcare system.
ANS: B
Although all of the answers reflect knowledge that is critical to budgeting for nurse managers,
an experienced nurse manager would likely be already familiar with general knowledge
related to budgeting. The nurse manager, however, would need to become familiar with
budget timetables and level of involvement expected in this specific organization because
these elements of budgeting vary from work environment to work environment.
REF: Page 225 | Page 226
TOP: AONE competency: Business Skills
24. A nurse manager discovers that the actual number of visits per patient in a home health
service is 3.8 visits per day when the standard is 5 visits per day. Based on this information,
the nurse manager:
a. Concludes that the complexity of care in each visit has arisen.
b. Concludes that patient volume has been decreased.
c. Decides that more information is needed before a conclusion can be reached.
d. Initiates a training session regarding the importance of ensuring that visits are made.
ANS: C
Variance from measures of productivity or ratio of outputs to inputs does not necessarily offer
an explanation of whether or not care was delivered as needed. Before proceeding to any
further conclusion, the nurse manager will need to investigate reasons for the decreased
output.
REF: Page 227
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. Which of the following are considered variable costs? (Select all that apply.)
a. Salaries for the minimum number of staff
b. Utilities and rent
c. Managed care
d. Supplies
e. Medication and treatment supplies
ANS: D, E
The total fixed costs in a unit are those costs that do not change as the volume of patients
changes. In other words, with either a high or a low patient census, expenses related to rent,
utilities, loan payments, administrative salaries, and salaries of the minimum number of staff
to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to
patient volume or acuity. Examples include nursing personnel, supplies, and medications.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 220 | Page 221
TOP: AONE competency: Business Skills
2. During the budgeting process, nurse managers are typically responsible for which of the
following? (Select all that apply.)a. Determining inflationary rates for the upcoming yearNUR
SINGTB.COM
b.
c.
d.
e.
Developing unit operation objectives
Justifying capital equipment requests
Predicting cash flow
Negotiating budget with other managers and administration
ANS: B, C, E
Although involvement in budget processes will vary from institution to institution, these are
typical responsibilities for nurse managers during the budget process.
REF: Page 225 | Page 226
TOP: AONE competency: Business Skills
Chapter 13: Care Delivery Strategies
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated
nursing practice as its model of care delivery. The concept of differentiated nursing practice is
based on:
a. Licensure status.
b. Experience in the agency.
c. Leadership capabilities.
d. Education and expertise.
ANS: D
Differentiated nursing practice models are models of clinical nursing practice that are
defined or differentiated by level of education, expected clinical skills or competencies, job
descriptions, pay scales, and participation in decision making.
REF: Page 245
TOP: AONE competency: Knowledge of the Health Care Environment
2. The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of
the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this
nurse’s:
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Clinical expertise.
b. Leadership ability.
c.d. Communication style.Conflict-resolution skills. N URSINGTB.COM
ANS: A
Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking,
clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner
(2001), however, identified five stages of clinical competence for nurses: novice, advanced
beginner, competent, proficient, and expert. She suggests that competence is typified by a
nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are at
the novice or advanced beginner stage would be less likely than their more experienced
counterparts to implement any type of delivery model effectively and thus, this assignment
overlooks the nurse’s level of clinical expertise and leadership experience.
REF: Page 237 | Page 245
TOP: AONE competency: Knowledge of the Health Care Environment
3.
When interviewing an applicant for a position, the nurse manager describes the unit’s care
delivery system as one in which each nursing assistant is cross-trained to perform specific
tasks, and the RNs do all treatment, medication administration, and discharge teaching. The
nurse applicant knows this nursing care delivery strategy to be: a. The case method.
b. Functional nursing.
c. Primary nursing.
d. Nurse case management.
ANS: B
The functional model of nursing is a method of providing patient care by which each
licensed and unlicensed staff member performs specific tasks for a large group of patients.
REF: Page 234 | Page 235
TOP: AONE competency: Knowledge of the Health Care Environment
4.
You are the nurse manager of a nursing service organization that provides around-the-clock
care to clients in their homes. To achieve maximum reimbursement for a client who is
recovering from a hip replacement, the nursing staff most likely will follow the nursing care
guidelines presented in the: a. Nursing care plan.
b. Physician’s orders.
c. Critical pathway.
d. Clinical practice guidelines.
ANS: C
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
A critical pathway outlines outcomes, clinical standards, and interventions for a patient in
each phase of treatment. The goal of critical pathways is effective coordination of care across
various staff and levels of care.
REF: Page 242
5.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse case manager is working with a client admitted for end-stage renal disease. The
case manager’s major goal during this hospitalization is to: a. Implement the care pathway on
admission.
b. Provide direct nursing care throughout the hospitalization.
c. Supervise the nursing staff members who implement the care
map.NURSINGTB.COM
d. Prevent additional hospitalizations resulting from complications of the client’s disease.
ANS: D
The goals and outcomes established in a critical pathway are designed to support the aims of
case management, which are shortened hospital stays and prevention of hospital readmissions.
REF: Page 241
6.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model.
Which of the following methods would be the most cost-effective? a. Functional method
b. Case management method
c. Primary care method
d. Team method
ANS: B
Team nursing, functional nursing, and case management are all considered efficient, costeffective methods of care delivery because they enable utilization of various types of
healthcare providers (rather than baccalaureate nurses in direct care, which is the primary
nursing method). Case management is considered particularly cost-effective in patient care
settings because it maintains quality care while streamlining costs for high-risk, high-volume,
high-cost patient populations and seeks the active involvement of the patient, the family, and
diverse healthcare professionals.
REF: Page 241 | Page 242
7.
TOP: AONE competency: Business Skills
In an acute care unit, the nurse manager utilizes the functional nursing method as the care
delivery model. The nurse manager’s main responsibility is the needs of the: a. Department.
b. Unit.
c. Staff.
d. Patient.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
In a functional nursing model, where other team members are focused on performing specific
tasks, the nurse manager assumes primary responsibility for patient outcomes.
REF: Page 235
8.
TOP: AONE competency: Knowledge of the Health Care Environment
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him
and then provides a written plan of care. What type of educational preparation best fits the
role of primary nurse? a. Baccalaureate
b. Associate
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c. Diploma
d. LPN/LVN
ANS: A
Because of the breadth of nursing knowledge required, baccalaureate education is preferred
for primary nurses.
REF: Page 238
9.
TOP: AONE competency: Knowledge of the Health Care Environment
In a small rural nursing home, a director of nursing decides, because of a shortage of nurses,
to implement a partnership model to help with basic tasks that comply with state rules
regarding delegation. What type of design constitutes a partnership care delivery model? a.
RN and LPN/LVN
b. RN and RN
c. RN and medication assistants
d. RN and certified nurses’ aides
ANS: C
The partnership care delivery model is a variation of primary nursing in which an RN works
with a consistent assistant, who performs basic nursing functions consistent with state
delegation rules.
REF: Page 241
TOP: AONE competency: Knowledge of the Health Care Environment
10. The case method of care delivery could be best justified in which of the following scenarios?
a. Stable patient population with long-term care and family needs
b. Acute care surgical unit with predictable postsurgical outcomes and many technical
procedures
c. Pediatric intensive care unit that heavily involves families as well as patients
d. Home healthcare environment with patients at varying levels of acuity
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
This model is especially useful in the care of complex patients who need active symptom
management provided by an RN, such as the care of the patient in a hospice setting or an
intensive care unit. This method would be justifiable delivery in the pediatric intensive care
unit, where the status of patients can change rapidly and where complex functions of care
involve both patients and families.
REF: Page 234
TOP: AONE competency: Knowledge of the Health Care Environment
11. During times of nursing shortages and increased nursing costs in health care, which of the
following nursing care delivery models might come under greatest scrutiny? a. Case method
b. Team nursing
c. Functional nursing
d. Nurse case management
ANS: A
The case method may involve total patient care provided by a registered nurse, which, in
today’s costly healthcare economy, is very expensive. In times of nursing shortages, there
may not be enough resources or nurses to use this model.
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REF: Page 233
TOP: AONE competency: Knowledge of the Health Care Environment
12. A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one
nurse for my pills and she says, ‘That’s not my job.’ I ask the pill nurse about my lab tests and
she says that I should ask another nurse.” The nursing care delivery model most likely
employed in this situation is: a. Differentiated practice.
b. Team nursing.
c. Functional nursing.
d. Case management.
ANS: C
Functional team nursing involves licensed and unlicensed personnel who perform specific
tasks for a large number of patients. A disadvantage of functional team nursing is the
fragmentation of care. The physical and technical aspects of care may be met, but the
psychological and spiritual needs may be overlooked. Patients become confused with so many
different care providers per shift. These different staff members may be so busy with their
assigned tasks that they may not have time to communicate with each other about the patient’s
progress.
REF: Page 235
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
13. A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one
nurse for my pills and she says, ‘That’s not my job.’ I ask the pill nurse about my lab tests and
she says that I should ask another nurse.” This nursing care delivery model employed in this
situation might be particularly effective in:
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient-provider conflict.
d. Developing competence and confidence in unskilled workers.
ANS: D
An advantage of functional nursing is that both unskilled assistive personnel and skilled staff
are involved in performance of specific tasks, and the repeated performance of tasks enables
staff to become very efficient in specific functions. Disadvantages of the model include
difficulty in being able to assess the patient’s nonphysical needs effectively and the potential
for ineffective communication because of the focus on specific tasks.
REF: Page 235
TOP: AONE competency: Knowledge of the Health Care Environment
14. For a nurse manager in the functional nursing model, an approach that will assist in maintaining
staff satisfaction in this specific model is: a. Rotation of task assignments.
b. Frequent opportunities for in-service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.
ANS: A
Although repetition of tasks increases confidence and competence, it can also lead to
boredom. Rotation of tasks can assist specifically in thiNURSINGTB.COM s model to
reduce the boredom that is a potential disadvantage of this model.
REF: Page 236
TOP: AONE competency: Knowledge of the Health Care Environment
15. In comparing team and functional models of care, a nurse manager favors the team model. In
particular, she finds that the team model:
a. Can be effective in recognizing individual strengths and backgrounds of staff.
b. Promotes autonomy and independence for the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.
ANS: A
Team nursing delivers care to a small group of patients, using a mix of licensed and
unlicensed personnel. Team nursing uses the strengths of each caregiver.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 238
TOP: AONE competency: Knowledge of the Health Care Environment
16. To effectively delegate in a team nursing environment, the RN team leader must be familiar
with the legal and organizational roles of each group of personnel and must: a. Be able to
effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to her supervisor.
ANS: C
A particular challenge in team nursing is that staff mixes and staff may change daily because
of individual schedules and shortages.
REF: Page 238
TOP: AONE competency: Leadership
17. A nurse manager questions the true difference between primary nursing and total patient care.
After careful consideration of both models, the nurse manager concludes that primary nursing
differs significantly from total patient care in:
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Degree of task orientation.
d. Levels and types of assessment.
ANS: C
Significant overlap can be seen between primary nursing and total patient care in terms of
breadth of assessment and knowledge required to provide holistic care. A primary difference
is that nurses in the total care model assume accountability while on shift, whereas primary
nurses assume responsibility from time of admission to discharge and 24 hours a day.
REF: Page 233 | Page 236 | Page 239
TOP: AONE competency: Knowledge of the Health Care Environment
18. A conflict develops between an associate nurse and a primary nurse over the assessment of a
patient with pulmonary edema. Based on her assessment of the patient, the associate nurse
insists that it is her role to change the care plan because she is the one who has made the
assessment. As the nurse manager, you clarify that:
a. It is the role of the primary nurse to make alteraNURSINGTB.COMtions based on
assessment data and input.
b. The associate nurse is accountable and responsible while the primary nurse is off duty and
therefore is able to alter the care plan.
c. Neither the primary nor the associate should make changes without first consulting you as
the manager.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. It really does not matter who alters the nursing care plan as it depends on situation and
time to do so.
ANS: A
The primary nursing model assumes that the primary nurse is accountable for patient care,
even while off duty. The primary nurse is responsible for establishing the patient plan of care
and therefore for altering it with the input of an associate. The associate is responsible for
implementation of the established care plan when the primary nurse is off duty.
REF: Page 240
TOP: AONE competency: Communication and Relationship-Building
19. When comparing functional nursing and primary nursing, a nurse manager, after evaluating
particular models of nursing care for potential adoption, determines that patient and nurse
satisfaction in primary nursing are:
a. Similar to those in functional nursing.
b. Not of significance in either model.
c. Low by comparison with functional nursing.
d. High when compared with functional nursing.
ANS: D
Although some studies suggest there is little difference between functional nursing and
primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level
of accountability and autonomy in decision making. Patient satisfaction is also high, as
patients form close therapeutic relationships with the nurse because of the continuity of the
relationship. Functional nursing is criticized for low patient satisfaction and potential staff
dissatisfaction related to boredom and an autocratic approach to management.
REF: Page 239
TOP: AONE competency: Knowledge of the Health Care Environment
20. In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a
high level of control over patient care to understand that his or her decision making at the
patient care level: a. Is increased.
b. Is decreased.
c. Is relinquished.
d. Remains the same.
ANS: B
The nurse manager who is considering movement to primary nursing needs to consider how
the role of the manager changes, as well as the roles of the staff. The role of decision making
at the patient care level is relinquished to the primary nurse, and the role of manager becomes
that of facilitator, coach, mentor, role model, and clinical resource.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 240
TOP: AONE competency: Knowledge of the Health Care Environment
21. You are considering putting forward a proposal to move the model of care from team nursing to
a primary nursing hybrid: patientNURS-Ifocused care model. In considering this proposal,
you NGTB.COM recognize that significant costs specific to operationalizing this model are
related to: a. Implementation of an all-RN staff complement.
b. Significant changes in the physical structure of units.
c. Orientation of staff to new roles and responsibilities.
d. Testing and piloting technology at the bedside.
ANS: B
This particular model includes a focus on patient care that includes multidisciplinary teams
and assistants at the bedside. Services, including laboratories and pharmacies, are
decentralized to bring them closer to where care is delivered.
REF: Page 241
TOP: AONE competency: Knowledge of the Health Care Environment
22. When hiring a case manager for a rehabilitation setting, you would most likely consider a:
a. Registered nurse with a master’s degree.
b. Physiotherapist with a background in stroke rehabilitation.
c. Social worker with a background in counseling.
d. Health professional with advanced background who is client and outcome focused.
ANS: D
Case managers can come from a variety of disciplines but should have advanced preparation
with the particular at-risk population being served, be comfortable in an advocate role, and be
outcome and patient focused.
REF: Page 243
TOP: AONE competency: Knowledge of the Health Care Environment
23. Case managed care may enhance profit in a for-profit health organization by:
a. Minimizing costs in high resource consumption areas.
b. Combining licensed and non-licensed care providers in delivering patient care.
c. Increasing reimbursement from third-party payers.
d. Reducing the amount of technology used to support clinical decision making.
ANS: A
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Case managed care is not revenue generating but rather revenue protecting in that better
coordination of care enables efficient achievement of patient outcomes, can result in shorter
length of stay, and can prevent readmission.
REF: Page 241
TOP: AONE competency: Business Skills
24. In hiring nurses during the transition from team nursing to a primary nursing model, Benner’s
work would suggest that you give priority to nurses who are at least at which level of
competency?
a. Advanced beginner
b. Competent
c. Proficient
d. Novice
ANS: B
Nurses who have less than 2 or 3 years’ experience in primary nursing and/or less than 2 or 3
years of nursing experience will likely require more assistance than other nurses, which will
put a greater demand on the unit during a time of transition.NURSINGTB.COM
REF: Page 245 | Page 246
TOP: AONE competency: Business Skills
25. In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital,
you look at an environment that you might encounter as a head nurse at the hospital. You
determine that you could expect to:
a. Find it difficult to recruit new staff.
b. See rapid turnover of staff on your unit.
c. Find nurses who exemplify interest in quality care.
d. Find limited interest in excellence in the nursing environment.
ANS: C
Magnet™ hospitals exemplify hospitals whose focus processes attract and retain nurses who
value and promote quality care and excellence in nursing environments.
REF: Page 247
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Your organization has made a decision to implement TCAB in your hospital. As a manager,
what strategies would you use to implement TCAB? (Select all that apply.)
a. Encourage recognition among staff of their knowledge of the patient-care environment.
b. With staff, select small changes for consideration.
c. Select only projects that have widespread impact.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Secure external advisors to evaluate innovation.
e. Present ideas based on best practices and ask staff for advice on implementation.
ANS: A, B, E
Transforming care at the bedside (TCAB) relies on active involvement of staff in the
generation of innovative ideas to improve patient care. Staff are actively engaged in selecting
innovation, planning, and evaluation of the innovations. Critical to practice changes, rapid
cycle change is a process that encourages testing creative change on a small scale while
determining potential impact.
REF: Page 247 | Page 248
TOP: AONE competency: Leadership
NURSINGTB.COM
Chapter 14: Staffing and Scheduling
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. The number of adverse events such as falls and pressure ulcers on your unit is increasing. An
ideal staffing plan to address this issue would include which of the following? Increasing the: a.
Total number of staff on the unit.
b. Staff and RN hours per patient.
c. Total number of staff, and implementing 12-hour shifts.
d. Number of RNs and number of RNs with experience on the unit.
ANS: D
A number of studies have identified that adverse events such as falls and pressure ulcers can
be reduced by increasing the number of RNs on a unit (relative to other personnel) and
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of
errors.
REF: Page 264
TOP: AONE competency: Knowledge of the Health Care Environment
2. A small rural hospital has been designated as a critical access hospital. It has 40 beds and an
average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the
occupancy as being: a. 90%.
b. 85%.
75%.
d. 60%.
NURSINGTB.COM
ANS: B
A way to assess a unit’s activity level is to calculate the percentage of occupancy. Formula:
daily patient census (rounded) divided by the number of beds in the unit The
occupancy level is calculated as 34/40, or 85%.
REF: Page 272 | Page 273
3.
TOP: AONE competency: Business Skills
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time.
When calculating paid nonproductive time, the nurse manager considers: a.
Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.
ANS: C
Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or
sick time.
REF: Page 270
4.
TOP: AONE competency: Business Skills
An important aspect of managing the costs on a unit is to plan accurately for staffing needs.
Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular staff.
ANS: C
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
A nurse manager needs to manage financial resources by developing staffing plans. Staffing
plans plan for minimum number of professional nurses required on a unit at a given time or
to the amount of minimum staffing in an extended-care facility or prison, based on regulatory
guidelines.
REF: Page 263
5.
TOP: AONE competency: Business Skills
A nurse manager must consider a number of external variables when preparing the personnel
budget and projecting the unit’s staffing needs. An external variable to be considered is: a.
Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.
ANS: D
Licensing regulations of the state can determine staffing models. Staffing regulations can
dictate the number of professional nurses required on a unit at any given time.
REF: Page 276
6.
TOP: AONE competency: Business Skills
A nurse manager must also consider a number of internal variables that will
affeNURSINGTB.COM
ct staffing patterns. An internal variable to be considered is: a.
Organizational staffing policies.
b. State licensing standards.
c. American Nurses Association.
d. Consumer expectations.
ANS: A
State licensing standards outline what a nurse can do. Internal policies determine what a nurse
may do in a particular setting as well as the amount of flexibility that is allowed to manage
times of high and low volumes, as well as changes in acuity. Organizational policies can put
the nurse manager in a situation where patient safety cannot be maintained or financial
obligations met.
REF: Page 264
7.
TOP: AONE competency: Business Skills
A nurse manager uses many sources of data when planning the unit’s workload for the year.
Which of the following data must be considered in the planning? a. Hours of operation of the
unit
b. Trends in acuity on the unit
c. Maximum work stretch for each employee
d. Weekend requirements
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Acuity levels are determined through classification systems, which determine the nursing
resources required.
REF: Page 257 | Page 258 | Page 274
TOP: AONE competency: Knowledge of the Health Care Environment
8.
Scheduling is a function of implementing the staffing plan by assigning unit personnel to work
specific hours and specific days of the week. To retain nursing staff, the nurse manager must
schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.
ANS: C
Creating a flexible schedule with a variety of scheduling options that leads to work schedule
stability for each employee is one mechanism likely to retain staff, which is within the control
of nurse managers.
REF: Page 270 | Page 271
9.
TOP: AONE competency: Business Skills
The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Looks after interpretation of benefits and compensation.
NURSINGTB.COM
ANS:Nursing staffing A
involves planning for hiring and deploying qualified human resources to
meet the needs of a group of patients. Scheduling, on the other hand, is a function of
implementing the staffing plan by assigning unit personnel to work specific hours and days of
the week.
REF: Page 256
TOP: AONE competency: Business Skills
10. A busy neurologic ICU and step-down unit most likely would use which patient classification
system?
a. Factor evaluation
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Prototype evaluation
c. Hybrid system
d. AHRQ system
ANS: A
A factor evaluation system is considered more objective than a prototype evaluation system. It
gives each task, thought process, and patient care activity a time or rating. Some patient types
with a single healthcare focus, such as maternal deliveries or outpatient surgical patients,
would be appropriately classified with a prototype system. Patients with more complex care
needs and a less predictable disease course, such as those with pneumonia or stroke, are more
appropriately evaluated with a factor system.
REF: Page 258
TOP: AONE competency: Business Skills
11. A factor evaluation system:
a. Utilizes financial data to determine number of staff-to-patient ratios.
b. Utilizes DRGs to determine acuity on a unit.
c. Combines interventions and time required for interventions to determine levels of care
required.
d. Combines financial resources and nursing interventions to determine patient contact
hours.
ANS: C
A factor evaluation system considers tasks, thought processes, and patient care activities and
gives them a time or rating. These are then used to determine the number of patient care hours
required.
REF: Page 258
TOP: AONE competency: Business Skills
12. Staff members on your unit raise concern that there is rising acuity on the unit and lack of
responsiveness in addressing these needs through appropriate staffing. They point to increased
incidences of adverse and sentinel events on the unit. To address this concern, your hospital
organization would do best to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those of
institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because acuity is variable.
ANS: B
Staff morale suffers both when acuity models indicate a gap between staffing and acuity and
when there is no model but perceived acuity that is not being addressed. A truer approach is to
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
NURSINGTB.COM
monitor patient outcomes and participate in national databases
that measure staffing levels through comparison with like institutions.
REF: Page 258
TOP: AONE competency: Knowledge of the Health Care Environment
13. A particular classification system assigns revenue according to the functional capacity of
patients and the progression of patients during their stay in rehabilitation units. More
independent patient activities, such as prompted voiding, require higher staff utilization than
dependent activities but do not result in increased staff resources. This is an example of: a.
Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgments about staffing.
ANS: B
Validity of categories and implications for staffing levels are in question in this situation
because staffing levels are not reflective of the levels of activity required for patient care.
REF: Page 258
TOP: AONE competency: Business Skills
14. In the past year, you have noticed an increase in patient falls on your unit. In reading studies
related to staffing and patient outcomes, you realize that you will need to plan for: a. Higher
patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.
ANS: D
Lower fall rates are shown to be related to higher total nursing hours and a higher percentage
of nursing hours supplied by RNs.
REF: Page 259 | Page 260
TOP: AONE competency: Business Skills
15. A strategy to increase RN staff retention at Valley Hospital includes:
a. Better compensation and benefits.
b. Clearer position descriptions.
c. Lay-offs of nursing assistants.
d. Adequate staffing to meet acuity levels.
ANS: D
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Over the past decade, a significant amount of research has been done in the United States to
evaluate links among nursing staffing, workloads, skills mix, and patient outcomes. An
analysis of this research demonstrates that ensuring adequate staffing levels has been shown,
among other things, to improve nurse retention and job satisfaction.
REF: Page 256
TOP: AONE competency: Business Skills
16. In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that
they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head
nurse focuses on:
a.b. Availability of diagnostic personnel.Availability of physicians.N URSING TB.COM
c. Communication with on-call providers.
d. Acuity level of patients.
ANS: C
Studies to date of off-peak hours (weekends and nights) are limited, but those that have been
done indicate increased mortality during weekends and nights, when staff work with fewer
and often less experienced staff and when there may be strained communication among oncall healthcare providers.
REF: Page 263 | Page 264 | Page 276
TOP: AONE competency: Knowledge of the Health Care Environment
17. A nurse staffing plan takes into account:
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff.
d. The occupancy load of a unit.
ANS: B
Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse
experience, and unit configuration rather than set nurse-to-patient ratios. The American
Nurses Association has opted to support the nurse staffing committee as the approach to
ensure safe staffing. In 2013, national legislation was introduced that requires all acute care
hospitals to establish a committee made up of 55% direct care RNs.
REF: Page 261 | Page 262
TOP: AONE competency: Knowledge of the Health Care Environment
18. As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed
at:
a. Maintaining unit morale.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.
ANS: A
Hospitals are responsible for monitoring the extent to which actual staffing matches the
staffing plans, making revisions as necessary. The Joint Commission accreditation reviews
staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of
the staffing plan is required in some states so that staff may view it. Adequate staffing, as
demonstrated through a staffing plan, and compliance reports contribute to staff morale.
REF: Page 261 | Page 263
TOP: AONE competency: Knowledge of the Health Care Environment
19. To maintain patient safety, studies suggest that scheduling should avoid:
a.
b.
c.
d.
Rotating shifts.
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Weekends.
8-hour shifts.
Mandatory overtime.
ANS: A
Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase
nurse error and jeopardize patient safety.
REF: Page 265
TOP: AONE competency: Knowledge of the Health Care Environment
20. In a job interview for a staff position, which of the following indicates your knowledge of
patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”
ANS: C
Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both
patients and nurses because it is more likely to lead to compromised decision making and
technical skills because of fatigue.
REF: Page 265
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
21. To reduce reliance on overtime hours, an organization develops a strategy for floating nurses
during staff shortages. To maximize patient safety and reduce costs, the healthcare organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased acuity levels.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.
ANS: A
A centralized pool usually includes experienced nurses who maintain a broad range of
competencies. Other approaches are less satisfying for nurses, are less efficient, and may be
less safe.
REF: Page 266
TOP: AONE competency: Knowledge of the Health Care Environment
22. To project staffing needs and to avoid understaffing, it is important that nurse managers
consider which of the following? a. Maximum productive hours
b. Average nonproductive hours
c. Minimum benefit hours
d. Maximum vacation time
ANS: B
To avoid understaffing, average nonproductive or benefit hours need to be taken into account,
so the unit is properly staffed when staff members are off.
REF: Page 270
TOP: AONE competency: Business Skills
NURSINGTB.COM
23. Your healthcare organization has a decentralized system for scheduling. As part of this
process, after you have developed a draft schedule, you may need to: a. Seek
budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.
ANS: D
In a decentralized model, you may be completely responsible for approving all schedule
changes and for development of the schedule, or you may need to submit a draft to a
centralized office for review and determination of supplemental staff. Balancing personal
schedules and negotiation describes staff self-scheduling models.
REF: Page 271
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
MULTIPLE RESPONSE
1. In reviewing the job description of a nurse manager, the staff becomes aware that a nurse
manager’s role is complex. Which of the following duties are required of a nurse manager?
(Select all that apply.)
a. Ensure unit productivity reports.
b. Develop policy and legislation to protect nurses’ well-being.
c. Plan staffing of UNPs only.
d. Prepare a unit budget that reflects unit staffing needs.
e. Monitor nurse-sensitive indicators such as falls and incidence of infections.
ANS: A, D, E
A nurse manager manages financial resources by developing business and staffing plans.
REF: Page 257 | Page 259 | Page 264
TOP: AONE competency: Business Skills
NURSINGTB.COM
Chapter 15: Selecting, Developing, and Evaluating Staff
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. The nurse manager schedules evaluations of staff members using a newly developed
performance appraisal tool. The development of a performance appraisal tool should include: a.
Organizational mission, philosophy, and position requirements.
b. A generalized overview of the duties of a position.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. A skills checklist and accreditation requirements.
d. An ordinal scale that ranks all employees.
ANS: A
Performance appraisal tools and processes should reflect the organizational mission and
philosophy, as well as position requirements.
REF: Page 286
TOP: AONE competency: Business Skills
2. John, a new graduate, reviews the employee evaluation for his new position. The first section
requires that he list his own specific objectives to be accomplished. This is an example of: a. The
traditional rating scale.
b. Learning goals, or management by objectives.
c. A forced distribution scale.
d. A behavior-anchored rating scale.
ANS: B
In management by objectives, the employer and the employee jointly establish clear and
NURSINGTB.COM
REF: Page 286
measurable objectives for the next performance period.
TOP: AONE competency: Business Skills
3. John notes that the next section is specific to the organizational philosophy and has a four-point
ordinal scale that describes performance from “always meets expectations” to
“does not meet expectations.” This type of evaluation is most commonly known as: a.
A behavior-anchored rating scale.
b. Management by objectives/learning goals.
c. The forced distribution scale.
d. A graphic rating scale.
ANS: D
Graphic rating scales are commonly used in evaluation and reflect generalizations rather than
specific behaviors.
REF: Page 286
TOP: AONE competency: Business Skills
4. On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is
ongoing. Nonetheless, you want to proceed with developing a systematic and effective
performance appraisal system. Which of the following approaches would be most appropriate for
you to implement? a. Peer review
b. A combination of tools
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Anecdotal notes
d. Rating scale
ANS: B
A combination of tools is likely superior to any one method in any situation.
REF: Page 286
TOP: AONE competency: Business Skills
5. As part of orientation to your unit, you decide to administer Kolb’s Learning Style Inventory
(LSI) to new staff. The most likely reason for your decision is that the use of Kolb’s LSI: a.
Reduces the cost of orientation.
b. Determines if there is fit between learner and organizational values.
c. Develops the strengths of the new staff member.
d. Enables individualization of learning to the learner’s needs.
ANS: D
Administration of Kolb’s LSI enables identification of the learning styles of new employees,
which assists in focusing the implementation of orientation goals and in individualizing
learning to the needs and learning style of the employee.
REF: Page 283
TOP: AONE competency: Business Skills
6. Which of the following might best conclude an interview?
a. “Thank you for your interest. Someone will be in touch with you soon.”
b. “Before you go, we will make sure that we have your contact information. Thank you for
coming.”
c. “I will be in contact with all candidates by telephone by next Friday. It has
beenNURSINGTB.COM
a pleasure to meet you.”
d. “We have several excellent candidates so I am not sure about the outcome of the
interview, but I will let you know. Thank you for coming.”
ANS: C
An employment interview should always conclude with information as to how and when
follow-up to the interview will occur.
REF: Page 282
TOP: AONE competency: Business Skills
7. In determining the fit of a candidate with the culture on your unit, which of the following
interview questions might be asked?
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. “Could you review your resume for us, highlighting your certifications and experience?”
b. “If we were to ask your references, what would they list as your strengths? Weaknesses?”
c. “We have a number of older adult patients on this unit. If you noticed another staff
member addressing one of these patients impatiently, how would you respond?”
d. “Tell us about your work and academic experiences and qualifications.”
ANS: C
The nurse manager wants the most qualified individual for the position who also fits the
culture of the organization. Asking behavioral questions in the interview allows you to assess
how a candidate may function in real-life situations and to assess if this behavior is
compatible with the culture on the unit.
REF: Page 280 | Page 281
TOP: AONE competency: Business Skills
8. The biggest challenge in the recruitment of staff is:
a. Finding well-qualified candidates who can function well within your particular work
culture.
b. Recruiting individuals with the appropriate qualifications and experience.
c. Screening out candidates who are unable to function well within a team.
d. Determining if candidates have had previous negative experiences in a work environment.
ANS: A
Choosing the right individual is the challenge for managers and involves finding qualified
candidates who will work well within your culture.
REF: Page 281
TOP: AONE competency: Business Skills
9. Anecdotal notes:
a. Should be completed only when there are performance concerns.
b. Can be used to support and justify fairness in termination discussions.
c. Are unnecessary if the evaluation instrument is thorough.
d. Need to be completed at the end of a performance period.
ANS: B
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Anecdotal notes should be kept consistently throughout the evaluation period and should
reflect both negative and positive behaviors if they are to provide an accurate assessment of
performance. Anecdotal notes provide documentation to support rating scales and narrative
evaluation summaries.
REF: Page 285
TOP: AONE competency: Business Skills
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
10. An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse
manager should:
a. Review the position description and performance expectations for the opening.
b. Place an ad in the local newspaper and on the telephone job line.
c. Review all current applications on file.
d. Look for employees within the system who might best fill the position.
ANS: A
The position description provides the basis for this position within the organization and
communicates expectations for the role. When applying for a position, researching the facility
and position description will help an applicant gain insight into the organization; therefore, the
position description should be current and communicate expectations.
REF: Page 281 | Page 282
TOP: AONE competency: Business Skills
11. The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and
you find out that because of the rapid turnover, new staff are frequently required to assume full
responsibilities soon into the position and before training is completed. In considering
approaches that will reduce turnover rates, the staff and you decide to implement: a. An
employee recognition program.
b. Coaching for new staff.
c. A new performance appraisal system.
d. A committed orientation and training program.
ANS: D
Retention of new nursing personnel begins on the day of their hire. This includes an effective,
appropriate orientation and training program, which has a measurable impact on reducing
turnover.
REF: Page 283
TOP: AONE competency: Business Skills
12. The validity of comments and ratings related to performance is enhanced by:
a. Maintenance of anecdotal notes over the entire evaluation period.
b. Quantity of information gathered for appraisal purposes.
c. Agreement of the employee with the ratings and comments.
d. Whether or not other individuals have contributed to the observations.
ANS: A
Anecdotal notes compiled consistently over the entire rating period are a much more equitable
method of providing an accurate summary of the employee’s performance.
REF: Page 285
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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13. A nurse manager in the ICU works with his staff to develop an appraisal instrument that
includes quantitative data and respects standards for an RN working on that unit. This type of
appraisal is a:
a. Rating scale.
b. Collaboratively based appraisal system.
c. Narrative instrument.
d. Behaviorally anchored rating scale.
ANS: D
Behaviorally anchored rating scales (BARSs) describe performance quantitatively and
qualitatively.
REF: Page 286
TOP: AONE competency: Business Skills
14. You have hired a new RN to replace a well-respected and experienced nurse in your outpatient
department. The new RN recently graduated and is nervous about stepping into a role that was
previously filled by someone who was so competent. You recognize anxiety and set up regular,
frequent meetings during which you explore how she is dealing with her anxiety, provide
feedback, and discuss strategies/ideas that will enhance her performance.
What development approach are you using? a.
Performance appraisal.
b. Counseling.
c. Empowerment.
d. Coaching.
ANS: D
The overall evaluative process can be enhanced if the manager employs the technique of
coaching. Coaching is a process that involves the development of individuals within an
organization. This coaching process is a personal approach in which the manager and the
employee interact on a frequent and regular basis with the ultimate outcome that the employee
performs at an optimal level.
REF: Page 285
TOP: AONE competency: Business Skills
15. Sue, a nurse manager, discusses her concerns about the hospital’s employee appraisal system
with her work group, noting that it includes only one rating scale and that it means nothing
unless the manager has effective relationship skills. Sue’s concerns reflect which best practices
associated with performance appraisal?
a. Rating scales are too generalized to be considered valid or reliable.
b. The effectiveness of appraisal is enhanced by a combination of methods and effective
communication skills.
c. BARS is considered superior to simple rating scales in terms of performance appraisal.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Rating scales need to be designed by users to be well accepted.
ANS: B
A combination of several methods is probably superior to any one method. The primary
success of any performance appraisal lies in the skills and communication abilities of the
manager.
REF: Page 286 TOP: AONE competency: Business SkillsNURSINGTB.COM
16. During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty
mentoring students on the unit. Alysha responds that this is not her responsibility. In responding
to Alysha, Joanne needs to consider:
a. Alysha’s level of confidence.
b. Whether mentoring is included in the position description.
c. Whether mentoring is an essential component of the position description.
d. Whether mentoring can be accurately observed and measured.
ANS: B
Employees must have clear role expectations, clearly understand what is expected of their
performance, and understand the ramifications of not meeting those expectations. Position
descriptions provide written guidelines detailing the roles and responsibilities of a specific
position within the organizational context.
REF: Page 280 | Page 281
TOP: AONE competency: Business Skills
17. The final section of a performance appraisal is a rating scale. This scale is very detailed and
relates to competency standards specific to surgical clients. The scale is a summary of
performance directly observed or documentation reviewed and is specific to client care
situations in which the employee has been involved. This type of evaluation is most commonly
known as:
a. A traditional rating scale.
b. Management by objectives/learning goals.
c. A forced distribution scale.
d. A behaviorally anchored rating scale.
ANS: D
BARS contain both quantitative (rating scales) and qualitative data. They are specific to
situations and positions.
REF: Page 286
TOP: AONE competency: Business Skills
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
18. John’s performance was satisfactory during the first month, but after that time, he was found to
be very inconsistent in the provision of nursing care. One month before the end of the rating
period, he cared for a very wealthy and influential client, who is best friends with the clinical
manager. This client donated new furniture for the staff lounge in John’s name to show
appreciation for his care. John’s subsequent performance appraisal resulted in outstanding
ratings in all areas. This is an example of:
a. A performance rating based on justifiable evidence.
b. A bias related to recent events.
c. The impact of personality on the appraisal of performance.
d. The effective use of a behaviorally anchored rating scale.
ANS: B
To gain and to provide an accurate evaluation of performance over time, anecdotal notes need
to be maintained throughout the evaluation period. This process assists in avoiding bias
related to recent or sensational events that make a particularly strong impression.
REF: Page 285
TOP: AONE competency: Business Skills
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19. As a manager, you are interested in developing behavioral questions for an interview. Knowing
that there is team conflict at times on your unit, which of the following questions would satisfy
your interest in behavioral questions?
a. “Tell me about a time you were involved in a conflict related to a project. What was your
role in the conflict? In the resolution of the conflict?”
b. “If you were to employ one strategy for managing conflict, what would it be?”
c. “What is your preferred style of conflict resolution?”
d. “How effective are you in working in a group? In dealing with conflict?”
ANS: A
Behavioral questions seek demonstrated examples of behavior from the candidate’s past
experiences; behavioral-based interviewing can be a strong predictor of a future employee.
REF: Page 282
TOP: AONE competency: Business Skills
20. Which of the following strategies might be effective in empowering staff?
a. Communication book in which new information on policies and processes is
communicated and mistakes are highlighted.
b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas
and presentations on best practices for implementation on the unit.
c. Once-yearly summative evaluations based on what the manager best likes about the
individual.
d. Focus on discussion of errors in care with direction as to how errors are to be
prevented in the future.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Empowerment is a process that acknowledges the values and judgments of others and trusts
their decisions. It allows freedom for making decisions while retaining accountability and
provides an environment that is safe in which to explore.
REF: Page 284
TOP: AONE competency: Knowledge of the Health Care Environment
21. The chief nursing officer establishes a shared governance model to help empower the nursing
staff, thus empowering the organization. Common characteristics of empowered organizations
are:
a. Shared values, high salaries, and a human focus.
b. Shared values, flexibility, and a human-capital focus.
c. Commitment to communication, high salaries, and flexibility for evaluations.
d. Creation of community and of effective stress management in the midst of divergent goals.
ANS: B
Shared governance involves valuing the contributions of each member of the team, releasing
the need to control, and understanding that accountability rests with members of the team.
REF: Page 284
TOP: AONE competency: Leadership
22. Joanne, a new nurse manager, writes certain assumptions regarding the organization’s
objectives into her budget. Her supervisor tells her that the objectives implied in her
assumptions are not entirely consistent with the organization, and that she needs to clarify these
objectives with her supervisor. Joanne apologizes and says she had more latitude with
NURSINGTB.COM the budget where she previously worked. This is an example of: a.
Role complexity.
b. Role ambiguity.
c. Role conflict.
d. Time-dependent roles.
ANS: B
Role ambiguity in the workplace creates an environment for misunderstanding and hinders
effective communication. Without clear expectations of performance, missteps in performance
can occur.
REF: Page 280
TOP: AONE competency: Business Skills
23. A survey of staff satisfaction is conducted. The survey indicates that staff members are
satisfied, are loyal to the organization, and feel that they have reasonable control in their
individual responsibilities. The findings best exemplify: a. Clarity in roles and valuing of
contributions.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Satisfaction but not empowerment.
c. Effective coaching of new staff.
d. Role attachment.
ANS: A
Commitment, a sense of control, and satisfaction are linked to clear role expectations and a
feeling that contributions are valued.
REF: Page 280 | Page 281
TOP: AONE competency: Business Skills
24. You have hired Chelsea as a new staff member on your unit. Although she is an experienced
ICU nurse, this is her first educator role. A month into her new position, she confides that she
feels really incompetent in her new position and bursts into tears. Your response is based on
application of your understanding of: a. Role acquisition.
b. Role conflict.
c. Role complexity.
d. Performance appraisal.
ANS: A
Acquisition of a role is time dependent and involves application of life experiences to each
role and interpretation of the role within one’s own value system. As roles become more
complex, an individual may take longer to assimilate the components of each role.
REF: Page 281
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. During the performance appraisal session, the manager should (select all that apply):
a. Maintain a relaxed and professional manner.
b. Inquire about the employee’s personal life and how it is affecting performance.
c. Allow the employee to express opinions orally and in writing.
d. Plan to give specific examples only for poor performance.
ANS: A, C
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During a performance appraisal, it is important to provide examples of both strong and
problematic performance and to provide opportunities to express opinions. The supervisor
needs to maintain a relaxed professional manner.
REF: Page 287 TOP: AONE competency: Business Skills
Chapter 16: Strategic Planning, Goal-Setting, and Marketing
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
MULTIPLE CHOICE
1. Planning is a process designed to achieve goals in dynamic, competitive environments. As a
new manager, what is the first step you will undertake to develop a strategic plan of action for a
congestive heart failure program?
a. Search the environment to determine changes that may affect the organization.
b. Appraise the organization’s strengths and weaknesses.
c. Identify the major opportunities for and threats to the organization.
d. Identify and evaluate the various strategies available to the organization.
ANS: A
Assessment of the external environment is the first step in the strategic planning process.
REF: Page 293
TOP: AONE competency: Business Skills
2. A community-based pain management program is being planned for your region. As a
coordinator of a home care agency, you have been requested to develop a conceptual
framework, mission statement, philosophy, and objectives for the program. In what order will
you pursue this endeavor?
a. Objectives, philosophy, and mission statement
b. Philosophy, objectives, and mission statement
c. Philosophy, mission statement, and objectives
d. Mission statement, philosophy, and objectivesNURSINGTB.CO M
ANS: D
The development of the mission statement is the first step in defining the purpose and
direction of the organization after an assessment has been completed.
REF: Page 294
TOP: AONE competency: Business Skills
3. Northwestern Hospital has decided to implement peer review. As a clinical leader in the
Emergency Department, you have overall responsibility for ensuring that this is in place by next
month. The most important step in this process is to:
a. Provide an educational session for staff on peer review.
b. Revise the mission statement, objectives, and performance standards.
c. Develop objectives and performance standards with employees.
d. Implement objectives and performance standards.
ANS: A
Once a strategic plan has been developed, the next step is open communication and execution
of the specific plan, which, in this instance, is peer review.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 296 | Page 298
TOP: AONE competency: Leadership
4. The clinic nurse understands that the advantages of planning include:
a. Assisting staff in critical thinking and improving decisions.
b. Orienting people to react instead of act.
c. Forcing managers to be cost-efficient and effective.
d. Focusing on activities, not results.
ANS: A
Effective planning means that everyone in the organization manages his own work and sees
how it relates to organizational goals. Being proactive means “aggressive planning” that
ensures that decisions are improved and are oriented toward organizational goals.
REF: Page 292
TOP: AONE competency: Leadership
5. As a nursing leadership student, you have had the opportunity to develop a palliative care
manual that will be utilized by the palliative care network (PCN) in your region for teaching
healthcare professionals. The PCN has requested that you provide a prioritized plan of action for
marketing the manual on a regional and state basis. What is the first priority? a. Motivate the
target market.
b. Research the target market.
c. Communicate benefits to the target group.
d. Package the product.
ANS: B
To put a strategic plan into place for marketing, it is necessary to conduct an external
assessment.
REF: Page 299
TOP: AONE competency: Business Skills
6. The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic
planning process is:
a.b. Assessment of the external and internal environment.Review of mission statement, goals,
and objectives.NURSINGTB.COM
c. Identification of strategies.
d. Implementation of strategies.
ANS: A
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Determination of strengths, weaknesses, opportunities, and threats requires openness to what
is being said and observed and is critical to setting the stage for relevant responses in the
latter phases of strategic planning.
REF: Page 293
TOP: AONE competency: Business Skills
7. The reasons cited by nursing administrators for not planning in a systematic manner include:
a. Lack of understanding of the planning process.
b. Lack of knowledge regarding the internal and external operations of the organization.
c. Not enough hours in the day for both day-to-day operations and planning.
d. Delegation of the task to subordinates.
ANS: A
The nurse manager should participate in strategic planning and quality initiatives with the
governing body. Lack of knowledge is a common reason for nonparticipation in planning
initiatives.
REF: Page 293
TOP: AONE competency: Knowledge of the Health Care Environment
8. From your observation of planning activities in the organization, you have noticed that planning
and decision making occur at various levels of the organization. The nurse manager has overall
responsibility for which of the following? a. Sending out postcards
b. Organizing a telephone follow-up
c. Monitoring ongoing activities and projects
d. Listing the patient population
ANS: C
The nurse manager should articulate organizational decision making for the criteria model
adopted by the organization and monitor ongoing implementation of the plan.
REF: Page 295
TOP: AONE competency: Knowledge of the Health Care Environment
9. Which of the following represents a well-written objective?
a. Hospital-acquired infections are reduced, and procedures to reduce infections are
implemented.
b. To increase staff satisfaction and to decrease burnout
c. To increase the health of the community
d. To implement evidence-based practice on nursing units, as evidenced by adoption of
evidence-based processes, by June 1, 2015
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Objectives are specific (begin with word to followed by an action word; specify single result
to be achieved; and specify a target date for attainment) and measurable (provide level of
accomplishment at the end).
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REF: Page 295 | Page 296
TOP: AONE competency: Business Skills
10. To conduct assessment of the internal environment, the strategic planning team for Pacific
Hospital:
a. Invites community members and staff of the hospital to an evening focus group session.
b. Discusses what it sees as the primary threats and opportunities in demographic shifts
affecting the hospital.
c. Invites all levels of staff to focus groups on the effectiveness of the hospital environment,
including information systems and staffing.
d. Asks the board to provide a summary of major opportunities for the future.
ANS: C
Assessment of the internal environment should include all levels of staff and facilitates
feedback on effectiveness of strengths and weaknesses of systems and processes within the
institution.
REF: Page 294
TOP: AONE competency: Business Skills
11. In assessing the internal environment, the strategic planning team at Pacific Hospital discovers
that 90% of staff members have no idea what the current mission statement means. This is most
likely related to:
a. The level of abstraction inherent in mission statements.
b. Development of the statement by the administration team with no other staff involvement.
c. Outdated goals and objectives contained in the mission statement.
d. Failure to provide action statements within the mission statement.
ANS: B
A mission statement reflects the beliefs of the organization in relation to those it serves and
services it provides, and it communicates the direction of an organization. Covey (1990)
believes that the process of developing the mission statement is vital to an organization’s
success and should involve everyone.
REF: Page 294 | Page 295
TOP: AONE competency: Business Skills
12. Pacific Hospital’s team develops a process to include staff in development of the mission
statement. Which of the following statements would indicate that the staff has been able to
develop an effective mission statement?
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Pacific Hospital will increase its sustainability by increasing revenue streams within the
next three years. Revenue streams are important to our hospital and are a driving force in
our sustainability in the face of insurer and government funding changes.
b. Pacific Hospital has a desire to relate to its community to enable appropriate identification
of programming needs by July 2012.
c. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is
committed to delivering a full spectrum of services that foster collaborative partnerships
among clients, families, and the hospital, and it utilizes evidence-based practice to guide
planning and interventions.
d. To provide health promotion programs for schoolNURSINGTB.COM-aged children
ANS: C
An effective mission statement reflects the values and direction of the organization. Included
in the statement are beliefs about individuals, health, practitioners, and the relationship of the
organization to practice, research, professionalism, and/or education.
REF: Page 294 | Page 295
TOP: AONE competency: Business Skills
13. At the beginning of its strategic planning processes, Pacific Hospital learns that nursing staff
members are uncomfortable with utilizing evidence-based practice, and that staff perceives that
only limited resources are available to support translation of evidence into their usual practice.
Because this issue has been identified, the management team determines that a plan of action is
required to address the issue. Who should be involved at this point? a. Nursing unit managers
b. Staff nurses
c. All staff
d. Administration
ANS: C
The first phase in planning is conducting an assessment of the external and internal
environments. Assessment of the internal environment should include all levels of staff and
facilitates feedback on effectiveness of strengths and weaknesses of systems and processes
within the institution.
REF: Page 294
TOP: AONE competency: Business Skills
14. In implementing the strategic plan for effective utilization of evidence to guide nursing practice
at Pacific Hospital, the nursing unit managers take the next step, which is the implementation.
Implementation most likely would involve: a. Revisiting the mission statement and objectives.
b. Reevaluating external and internal factors affecting evidence-based practice.
c. Preparing a budget to support implementation.
d. Developing unit-based objectives related to the plan.
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
The previous planning (assessment of internal and external environments, development of a
mission and plan, and allocation of resources) has already been completed. The next step
involves adapting the strategic plan to the nursing units.
REF: Page 298
TOP: AONE competency: Business Skills
15. To meet the social and human needs of a target market, it is critical to:
a. Assess the needs and priorities of the target market.
b. Revise the organization’s mission statement to reflect external needs.
c. Assess the internal culture and needs.
d. Develop highly sophisticated media.
ANS: A
Marketing emphasizes the identification and meeting of human and social needs, which can
only be known through assessment of the needs of the consumer (as opposed to the needs of
the organization).
REF: Page 298 TOP: AONE competency: Business SkillsNURSINGTB.COM
16. Assessment of the needs of the consumer or client (in developing a strategic marketing plan)
focuses on:
a. Present needs only.
b. Present and future needs.
c. The development of surveys.
d. Secondary analysis of existing data.
ANS: B
Assessment of needs takes into account needs of the consumer now and for the future, using a
variety of data-gathering techniques. Future orientation aids in anticipating how marketing
and programs will need to shift to meet those needs.
REF: Page 299 | Page 300
TOP: AONE competency: Business Skills
17. After an extensive campaign to ensure that the community surrounding Pacific Hospital has
been exposed to the emphasis of excellence in clinical care that occurs through the use of
evidence, the marketing team finds that the public perception has changed little. This
determination is made possible through: a. Marketing surveys.
b. Focus groups.
c. Informal feedback.
d. Comparison of data against benchmarks.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Developing benchmark data at the beginning of a project enables comparison of later data
against the benchmark to determine if a marketing plan has met its objectives.
REF: Page 299
TOP: AONE competency: Business Skills
18. Nurses are valuable partners in marketing strategies because they:
a. Are more likely than other members of the organization to use marketing tools.
b. Have a strong background in using evidence to support decisions.
c. Have close involvement with patients, who are the target group for marketing.
d. Constitute the largest staff group in most healthcare organizations.
ANS: C
As nurses are directly involved with patients who use services and who are the target group
for marketing efforts, nurses have excellent insights into patient needs.
REF: Page 299
TOP: AONE competency: Communication and Relationship-Building
19. Shifts such as changes in the percentage of seniors in the population, governmental initiatives
in health care, and the influence of income on health status are factors in the __________
environment. a. Public
b. Macro
c. Competitive
d. Social
ANS: B
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The external environment in strategic marketing planning includes the public, competitive,
and macro environments. Demographic, social, and political factors are included in the macro
environments.
REF: Page 299
TOP: AONE competency: Business Skills
20. A private ambulance clinic established a few streets away from Pacific Hospital markets its
services as quality-based within caring relationships. The clinic is part of the __________
environment. a. Public
b. Macro
c. Competitive
d. Social
ANS: C
The competitive environment includes factors and elements that compete for resources with
another organization. These elements may include those in public and macro environments.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 299
TOP: AONE competency: Business Skills
21. Which of the following represents an effective goal statement?
a. Involve patients and families in planning health care.
b. To revise clinical guidelines for incontinence care from evidence within 6 months
c. Patients and families are partners first in care planning.
d. To acquire $4 million in additional funding within 12 months to support clinical
education programs for dementia
ANS: A
Goal statements formalize targets for an organization. Objectives include the word to and an
action word, and specify dates for attainment. Mission statements convey values and beliefs of
the organization.
REF: Page 295
TOP: AONE competency: Business Skills
22. After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based
practice has gone poorly. In responding to this situation, the strategic planning team at Pacific
Hospital:
a. Recommends that the mission, objectives, and goals of the hospital be reassessed.
b. Revises the goal statements in the strategic plan.
c. Consults an external team on preparation of materials on evidence-based practice.
d. Holds focus groups with staff to determine what kinds of issues, challenges, and obstacles
have occurred in implementation.
ANS: D
On a consistent basis, the strategic plan is reviewed at all levels to determine whether the
execution of goals, objectives, and activities is on target. As stated, a sense of flexibility
regarding the objectives is important to consider, and objectives may change as a result of
legislation, budget changes, and change in structure or other environmental factors. Involving
staff enables development of creative methods to ensure that necessary changes occur.
REF: Page 298 TOP: AONE competency: Business SkillsNURSINGTB.COM
23. Benchmarks in the strategic marketing planning process are useful in:
a. Establishing programs.
b. Setting targets.
c. Rewarding employees.
d. Measuring progress.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Establishing benchmarks enables measurement of the interim and final achievements of
programs.
REF: Page 299
TOP: AONE competency: Business Skills
24. The executive team at Hospital XYZ develops a polished strategic plan that includes a mission
statement, goals, and objectives.. The executive team involves the marketing team, so that the
plan can be communicated internally and externally. After 2 years, no significant progress has
been made toward any of the goals. What has been omitted in the plan? a. Planning
b. Marketing
c. Integrated financial planning
d. Customer focus
ANS: C
Without the inclusion of a business plan with the strategic plan and integration of financial
planning and allocation of resources execution of the strategic plan can become paralyzed,
even with the most effective communication of the strategic plan itself..
REF: Page 293
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. A clinic nurse developed objectives for a diabetic education program. The characteristics
of well-written objectives include that they should be what? (Select all that apply.) a.
Achievable
b. Understandable and specific
c. People-oriented
d. Manager-oriented
e. Means-oriented
f. Measurable
ANS: A, B, F
The S.M.A.R.T. acronym describes the attributes of objectives: specific, measurable, agreedupon, reasonable (achievable), and time-bound.
REF: Page 295 | Page 296
TOP: AONE competency: Business Skills
N
Chapter 17: Leading Change
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
When goals/outcomes are somewhat unclear in early preparation for a complex change, the
manager and the change management team develop several acceptable goals/outcomes. This
change in management approach is termed: a. Unfreezing.
b. Nonlinear.
c. Cybernetic.
d. Linear.
ANS: B
While Lewin’s theory was designed to describe planned or first-order changes, many scholars
think the theory is too simplistic to address how unplanned or second-order change occurs. In
complex situations with an uncertain change environment, a nonlinear approach that involves
flexibility improves overall outcomes. Linear change is appropriate to stable, less complex,
and more predictable situations.
REF: Page 309
2.
TOP: AONE competency: Leadership
The home health agency hired an expert in financial management to evaluate and propose a
plan for reversing growing expenses and decreasing revenues. The expert is well respected,
both personally and professionally, by members living in this small community. To be
taff will need to perceive this change agent as:
effective, sa. Trusted, quiet.
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b. Flexible, informal.
c. Credible, enthusiastic
d. Communicative, personable.
ANS: C
To influence the decision, the expert must be seen as having knowledge of what matters to the
people that they lead and of the change area itself. The expert also must be enthusiastic and
communicative and have referent power.
REF: Page 311
3.
TOP: AONE competency: Leadership
The nurse manager frequently interacts with staff and other hospice facility employees.
Communication is purposeful because the manager assesses current issues, such as specific
satisfactions and dissatisfactions with the newly implemented computerized documentation
system. Informally, the manager gathers available staff members to address similar learning
needs. Many times, staff members are found coaching other staff about improving use of the
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
new system. According to Senge (1990), the activities demonstrated in this example are: a.
Dialogue, team learning.
b. Resilience, personal mastery.
c. Shared vision, systems thinking.
d. Mental models, teachable moments.
ANS: A
Building shared vision occurs when leaders involve all members in moving personal visions
of the future into a consolidated vision common to members and leaders.
REF: Page 314
4.
TOP: AONE competency: Leadership
The clinical coordinator expects the position description of the new wound care specialist to
change nurses’ responsibilities in caring for clients with skin integrity problems. The best
approach to address this need for change, yet to have the best outcomes for clients, staff nurses,
and the organization, is to:
a. Select one of the change models.
b. Use Lewin’s model and principles of change.
c. Apply both planned and complexity theory approaches.
d. Form a task force of nursing staff and wound care specialists.
ANS: C
In the second stage, the moving or changing stage of Lewin’s theory, planned interventions
and strategies, such as education, vision building, and incremental steps towards the change,
are executed to support the implementation of the change. This situation potentially also
involves complexity theories that recognize that change involves engagement of individuals
and subsystems throughout the unit and organization.
REF: Page 308 | Page 309
5.
TOP: AONE competency: Leadership
Complex change situations require that the change leader promote ongoing visioning among
staff members. One strategy is to:
a. Consciously evaluate invisible mental models.
b. Allow for individual outcomes.
c. Encourage cooperative activities.NURSI NGTB.COM
d. Operate between order and disorder.
ANS: A
Senge’s theory on change suggests that each individual or organization bases activities on a
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
set of assumptions, or a set of beliefs, or mental pictures about the way that the world should
work. When these invisible models are uncovered and consciously evaluated, it is possible to
determine their influences on work accomplishment.
REF: Page 314
6.
TOP: AONE competency: Leadership
To effectively achieve a change goal/outcome in a change situation, the wound care specialist
will:
a. Preserve the status quo.
b. Diminish facilitators and reinforce barriers.
c. Weigh the strength of forces.
d. Strengthen facilitating forces.
ANS: D
For change to be effective, the facilitators must exceed the force of the barriers; thus,
strengthening the facilitating forces would achieve this aim.
REF: Page 307
7.
TOP: AONE competency: Leadership
The wound care nurse decided to involve those to be affected by change early in the change
management process. This can positively result in: a. Coordination.
b. Resistance.
c. Anticipation.
d. Participation.
ANS: D
Successful change means persistence and advancement of the change, which requires the
undivided focus of all team members. Early involvement and participation are critical to
capturing the undivided focus of team members.
REF: Page 316
8.
TOP: AONE competency: Business Skills
The oncology clinic manager and the educational coordinator asked nursing staff to complete a
brief written survey to assess their attitudes and knowledge related to having used the new
infusion equipment for 6 weeks. The stage of change in this situation is: a. Developing
awareness.
b. Experiencing the change.
c. Integrating the change.
d. Perceiving awareness.
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
This particular initiative assesses the success with which the change has been integrated into
everyday practice after it has been experienced, or the degree to which staff members have
accepted using the new infusion equipment.
REF: Page 308 TOP: AONE competency: LeadershipNURSINGTB.COM
9.
An example of one strategy to improve participation in the change process by staff fitting the
behavioral descriptions of laggards, early majority, late majority, and rejecters is to: a.
Encourage teamwork.
b. Transfer to a different unit.
c. Require attendance at staff meetings.
d. Delegate the roles and tasks of change.
ANS: D
According to Rogers’s work, the individual’s decision-making actions pass through five
sequential stages. The decision to not accept the new idea may occur at any stage. However,
peer change agents and formal change managers can facilitate movement through these stages
by encouraging the use of the idea and providing information about its benefits and
disadvantages.
REF: Pages 309-311
TOP: AONE competency: Leadership
10. An example of one strategy used to improve participation in the change process by staff fitting
the behavioral description of innovators and early adopters is to: a. Repeat the benefits of the
change.
b. Share change experiences early in the process.
c. Initiate frequent interactions among staff.
d. Provide select information to the staff.
ANS: B
Connecting innovators and early adopters to new ideas and with new peers keeps them at the
cutting edge.
REF: Page 311
TOP: AONE competency: Professionalism
11. As a new manager, you are shocked to learn that your unit is still using heparin in heparin
locks. You are aware of evidence related to this practice and want to change this practice as
quickly as possible on your unit. You are in which stage of Lewin’s stages of change? a.
Unfreezing
b. Experiencing the change
c. Moving
d. Refreezing
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Although you may be at a higher level of change in relation to your individual practice and
knowledge of the use of change, in this situation, you are recognizing the need for change in
relation to practice on the unit that you are managing. This phase is the initial phase in firstorder change and will involve listening to staff to see if they perceive a similar problem.
REF: Page 308
TOP: AONE competency: Leadership
12. To engage your staff in awareness of their current practice and how it is affirmed or not by
evidence, you plan a short series of learning presentations on evidence and use of heparin and
saline to maintain IV patency. You meet with the educator to plan out the goals for each
session with the overall purpose of increasing knowledge and awareness of staff in readiness to
consider questions related to the IV practice. This learning approach is an example of which
change management approach?
b. First-order
c. Facilitative
d. Integrative
NURSIN GTB.COM
a. Linear
ANS: A
In the second stage, the moving or changing stage of Lewin’s first-order, planned change
process, planned interventions and strategies are executed to support the implementation of
the change. One commonly used method is educating staff about the need for the change.
REF: Page 307
TOP: AONE competency: Leadership
13. To engage your staff in awareness of their current practice and how it is affirmed or not by
evidence, you plan a short series of learning presentations on evidence and use of heparin and
saline to maintain IV patency. You meet with the educator to plan out the goals for each
session with the overall purpose of increasing knowledge and awareness of staff in readiness to
consider questions related to the IV practice. Staff nurses who gain information on current IV
therapy practices are engaging in which phase of Rogers’ decision-making process? a.
Persuasion
b. Knowledge
c. Confirmation
d. Decision
ANS: B
Rogers’ innovation-decision process involves five stages for change in individuals, the first of
which is knowledge.
REF: Page 310
TOP: AONE competency: Leadership
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
14. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of
the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there has
never been any adverse effects.” According to Havelock (1973), this comment may originate
from failure in which phase of the six phases of planned change? a. Generating self-renewal
b. Choosing the solution
c. Diagnosing the problem
d. Building a relationship
ANS: D
The first phase of this model of planned change involves building a relationship as a basis for
later phases, which include diagnosing the problem and choosing the solution. At this point, as
a new manager, the relationship may not have yet developed sufficiently with Elizabeth.
REF: Page 310
TOP: AONE competency: Leadership
15. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of
the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there has
never been any adverse effects.” You follow up with Elizabeth and discover that she is really
quite angry about the information sessions because she feel
NURSINGTB.COM
s
that you are implying that
“what she has been doing all these years means that she is incompetent and doesn’t care about
her patients.” Your response to her indicates that: a. Elizabeth will never adopt the change.
b. Elizabeth is insecure in her practice.
c. Elizabeth requires more information about the practice.
d. Change involves emotions.
ANS: D
Change, whether proactively initiated at the point of change or imposed from external sources,
affects people. Responses to all or part of the change process by individuals and groups may
vary from full acceptance and willing participation to outright rejection or even rebellion. It is
critical to be able to “read” people and to recognize that communication should involve
people’s emotions and feelings.
REF: Page 309
TOP: AONE competency: Communication and Relationship-Building
16. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of
the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there has
never been any adverse effects.” You follow up with Elizabeth and discover that she is really
quite angry about the information sessions because she feels that you are implying that “what
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
she has been doing all these years means that she is incompetent and doesn’t care about her
patients.” Which of the following would be the most effective response to Elizabeth?
a. “I understand how you feel, but you are going to have to change.”
b. “It is unfortunate that you feel this way. Others seem quite excited about the new
information.”
c. “It is difficult sometimes to change what we know very well. Sometimes it can be
frightening.”
d. “Perhaps I can arrange some more information sessions for you, so you can see just how
important this change is to patient safety.”
ANS: C
Dialogue can reveal areas where individuals feel inept or overwhelmed, providing the leader
with an understanding of what programs need to be developed to increase personal ability to
change and what educational initiatives need to be implemented to support change. To
promote dialogue, leaders must serve as facilitators, promoting the sharing of ideas, fears, and
honest reactions to the change proposal.
REF: Page 315
TOP: AONE competency: Communication and Relationship-Building
17. Elizabeth is an example of a(n):
a. Early adopter.
b. Late majority.
c. Laggard.
d. Resister.
ANS: C
Laggards prefer keeping traditions alive (“We have always done it this way”) and openly
express their resistance to ideas (speaking out against the change). Late majority individuals
are openly negative but will engage with new ideas when most others adopt the change.
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REF: Page 311
TOP: AONE competency: Leadership
18. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of
the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there has
never been any adverse effects.” You follow up with Elizabeth and discover that she is really
quite angry about the information sessions because she feels that you are implying that
“what she has been doing all these years means that she is incompetent and doesn’t care about
her patients.” After speaking with Elizabeth a few days later you discover that she is now fine
with the change but is concerned that other areas of the organization might resist the change
because of perceptions related to patient safety and cost. She suggests that it is important to
bring pharmacy on board as they have had previous concerns about the use of heparin. In
relation to change theory, this is indicative of: a. Systems level thinking.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Linear thinking.
c. Interprofessional collaboration.
d. First-order change.
ANS: A
Senge’s complexity theory, Bevan’s Seven Change Factors, and general systems theory all
highlight connectivity and the idea that changes are not isolated events.
REF: Page 307 | Page 308 | Page 314 | Page 316
TOP: AONE competency: Leadership
19. Based on Elizabeth’s insights and suggestions, you involve pharmacy, only to discover that the
change in practice involves practice committees, a medical practice committee, and concerns
from administration about potential costs and safety of the proposed change to the IV protocols.
The change process at this point is: a. Linear.
b. Nonlinear.
c. Sabotaged.
d. Neutralized.
ANS: B
Complex change involves nonlinear processes and a variety of strategies to negotiate
influences on change. Complexity theories alter the traditional systems thinking approach by
asserting that system behavior is unpredictable. This theory views change as emergent,
nonlinear, and highly influenced by all individuals and subsystems in an organization.
REF: Page 309
TOP: AONE competency: Leadership
20. Resistance is most likely when change:
a. Is not well understood.
b. Involves many layers in an organization.
c. Involves nonprofessional workers.
d. Threatens personal security.
ANS: D
Resistance and reluctance commonly occur when personal security is threatened and may
involve loss of confidence in abilities or loss of job or financial security.NURSINGTB.COM
REF: Page 309
TOP: AONE competency: Leadership
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
21. As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth
is very valuable in terms of her observations about other units and her knowledge of
organizational processes, and now in discussing the new procedure with others. Elizabeth might
be considered an: a. Engager.
b. Innovator.
c. Informal change agent.
d. Informant.
ANS: C
Informal change agents are those who do not have formal, positional power but who have
credibility through expertise and can model the new way of thinking, or who offer
suggestions, ideas, and concerns.
REF: Page 315
TOP: AONE competency: Leadership
22. As the unit manager, you spend a day performing direct patient care and work with a new
system that is designed to capture patient documentation at the bedside. During discussions with
staff while giving care, you discover that the number of screens that need to be opened during
documentation makes charting more complex and time-consuming than traditional manual
charting approaches. On the basis of this feedback, you: a. Assume that the system is doing
what it needs to do.
b. Provide reassurance to staff that the unit has achieved its goals in implementation of
the system.
c. Ask some of the staff if they have had similar experiences with the system.
d. Consult chart audit data and end user consultation reports to determine if errors and
problems are occurring.
ANS: D
In Kotter’s eight-step change model, removing obstacles means keeping alert for barriers in
structure and processes that limit the ability to change and then removing those barriers once
they have been found.
REF: Page 315
TOP: AONE competency: Leadership
23. You anticipate that your region will soon move towards an e-health record system. You begin to
discuss this with your staff and are disappointed that you receive little positive response from
the staff about this possibility. One staff member, in particular, seems to sum it up by saying “ehealth? Won’t happen in my working life! There are too many problems with it, like privacy
issues.” This response is most likely motivated by: a. Lack of urgency regarding the need to
change.
b. Lack of evidence to support importance of technology.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c.d. Deficits in education and experience.Lack of organizational support for
change.NURSING TB. COM
ANS: C
For leaders to inspire change, they must have intimate knowledge of what matters to the
people they manage. Kotter (2012) characterizes this as establishing a sense of urgency, and
this involves overcoming complacency. This is especially hard when there doesn’t seem to be
any visible crisis, or the crisis seems irrelevant to the people being asked to change (Kotter,
2012).
REF: Page 314 | Page 315
TOP: AONE competency: Leadership
24. Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on
preparing educational materials for patients. On the basis of this workshop, she would like to
develop an information Website for patients who are being admitted to the ward. An
appropriate response to Sarah’s suggestion would be:
a. “That is a great suggestion, but we have no resources for such an expensive
undertaking right now.”
b. “Perhaps you can keep that in mind as we redesign our charting system.”
c. “We have too many seniors as patients, and you know that they don’t use technology.”
d. “There is a great group here that meets to look at technology pilots. Let’s see if you
can join them and discuss your idea further.”
ANS: D
Involving Sarah with others who enjoy new ideas and who are able to try out new ideas in
pilot projects enables her to remain on the cutting edge and to try out innovative solutions
with the least amount of disruption.
REF: Page 311
TOP: AONE competency: Leadership
25. Edith has been vocal about her negative concerns related to a new charting system and
frequently expresses the view that keeping the “old system” would have been “just fine.” In
facilitating change, your best approach to Edith would be to:
a. Put her in the pilot planning group for the change.
b. Determine if she has considered retirement.
c. Schedule her work assignment so that it coincides with those of two staff members who
are confident with technology and the change.
d. Avoid discussion of the change, and trust that with sufficient training and information,
she will change.
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Laggards prefer keeping traditions and openly express their resistance to new ideas. Having a
group of change agents and innovators on board to champion an idea builds what Patterson
et al. call “social motivation” and “social ability.” This group can help staff, such as
laggards, who are less adept at change.
REF: Page 311 | Page 315
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. Which of the following are examples of application of the Leadership Rounding Tool?
(Select NURSINGTB.COM all that apply.)
a. “What is working well for you during bedside reporting?”
b. “What has not worked for you today?”
c. “Is there someone on your team who deserves special recognition for her efforts in the
implementation?”
d. “Did you have a good vacation?”
ANS: A, B, C, D
The Leadership Rounding Tool suggests establishing and maintaining rapport and asking what
is working well, what was a barrier, and who should be recognized, as well as answering
tough questions.
REF: Page 316 TOP: AONE competency: Communication and R
Chapter 18: Building Teams Through Communication and Partnerships
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse manager is experiencing conflicts between herself and staff members. She had tried to
develop a team by using a shared leadership model to empower the staff. Staff members are
functioning:
a. As a team.
b. Independently.
c. Interdependently.
d. As a group.
ANS: D
A group is a collection of interconnected individuals working together, with a high degree of
interdependence, for the same purpose. A team is a unified group that is committed to a
common purpose, performance goals, and approach, for which they hold themselves mutually
accountable. The conflict indicates that the staff may not be united in a common purpose.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 322
TOP: AONE competency: Communication and Relationship-Building
2. The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation
process, the nurse manager saw signs of potential team-building. One key concept of an effective
team is: a. Conflict.
b.c. Task clarity.Commitment.
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d. A designated leader.
ANS: C
Team-building involves moving toward a common vision, which requires commitment.
Conflict and clarification of tasks are components in the development of this commitment.
REF: Page 323
TOP: AONE competency: Communication and Relationship-Building
3. A mediator suggested that the nurse manager and staff members decide on a method to resolve
conflicts. It is important to have agreements about how team members will work together
because:
a. If there are no agreements, each member will make up rules about how to handle
disagreements and relationships.
b. People are naturally difficult and will not work well together without such agreements.
c. People will naturally ask for agreements about how to be together.
d. A way to eliminate nonproductive team members must be available.
ANS: A
People must agree on the goals and mission with which they are involved. They have to reach
some understanding of how they will exist together. Tenets or agreements such as “I will
respectfully speak promptly with any team member with whom I have a problem” go a long
way to avoid gossiping, backbiting, bickering, and misinterpreting others. Without agreement,
people have implicit permission to behave in any manner they choose toward one another,
including angry, hostile, hurtful, and acting-out behavior.
REF: Page 333
TOP: AONE competency: Communication and Relationship-Building
4. By following a shared leadership model, the nurse manager believes that staff members will
learn to function synergistically. Some teams function synergistically because members: a. Do
not volunteer unwanted information.
b. Actively listen to each other.
c. Listen to the person who believes he or she is an expert.
d. Do not speak unless they are absolutely sure they are correct in their views.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Active listening in a group creates synergy in that team members really hear one another’s
ideas and share in decision making.
REF: Page 335
TOP: AONE competency: Professionalism
5. The chief nursing officer decided that the nurse managers need a series of staff development
programs on team-building through communication and partnerships. She understood that the
nurse managers needed to build confidence in ways of handling various situations. The greatest
deterrent to confidence is: a. Lack of clarity in the mission.
b. Lack of control of the environment.NURSIN GTB.COM
c. Fear that one can’t handle the consequences.
d. Fear that the boss will not like one’s work.
ANS: C
Fear of not being able to manage consequences undermines confidence and a sense of
competency.
REF: Page 341
TOP: AONE competency: Professionalism
6. The mediator noticed that tension was still evident between the nurse manager and staff
members. He informed the chief nursing officer that to begin team-building, it would be
important that everyone:
a. Work together in a respectful, civil manner.
b. Use avoidance techniques when confronted with a conflict.
c. Develop a personal friendship with each other.
d. Socialize frequently outside of work.
ANS: A
For team-building to occur, team members need to be able to listen actively and respect one
another’s opinions, while feeling comfortable in openly expressing their own.
REF: Page 338
TOP: AONE competency: Communication and Relationship-Building
7. The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a
project or event, describes: a. Commitment.
b. Control.
c. Willingness to cooperate.
d. Communication.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Commitment is described as having a sense of passion and commitment to a project without
necessarily having a need to control.
REF: Page 329
TOP: AONE competency: Professionalism
8. The mediator suggested to the unit staff that a group agreement needed to be made so meetings
could become productive. For example, the group agreement, “We will speak supportively,”
prevents:
a. Expression of opposing ideas.
b. Gossip and making negative comments about absent team members.
c. Efforts to ensure that everyone thinks alike.
d. Votes that oppose motions.
ANS: B
This is an example of a rule that a team can implement to prevent certain negative behaviors
such as gossip, backbiting, and bickering that undermine the productivity and functioning of a
group.
REF: Page 323 | Page 324 | Page 333
TOP: AONE competency: Professionalism
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9.
The mediator asked each staff member to reflect on his or her communication style. Which of
the following best describes communication? Communication: a. Is a reflection of self-analysis.
b. Is a result of thoughtful consideration.
c. Consists of thoughts, ideas, opinions, emotions, and feelings.
d. Focuses on the sender of the message.
ANS: C
Communication involves both senders and receivers and may or may not be a reflection of
self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas,
opinions, emotions, and feelings.
REF: Page 325
TOP: AONE competency: Communication and Relationship-Building
10. The staff development educator developed strategies to help nurse managers actively listen.
Guidelines for active listening include which of the following?
a. Speed up your internal processes so that you can process more data.
b. Realize that the first words of the sender are the most important.
c. Be prepared to make an effective judgment of the communication sender.
d. Cultivate a desire to learn about the other person.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Active listening means suspending judgment about what is about to be said and listening to all
that is said (and not just the first or last words). It is motivated by a genuine desire to learn
about the other person.
REF: Page 335 | Page 336
TOP: AONE competency: Communication and Relationship-Building
11. The nurse manager was upset with the staff nurse and said, “You did not understand what I
said.” Which element in the communication process was she referring to? a. Feedback between
receiver and sender
b. A message channel
c. A receiver who decodes the message
d. A set of barriers that may occur between sender and receiver
ANS: D
Problems can occur at any point in communication and result in miscommunication. In this
instance, it can be assumed that there was a sender, a receiver, a channel, and feedback. In this
scenario, barriers such as distractions, inadequate knowledge, differences in perceptions, and
emotions and personality may have resulted in misunderstanding between the manager and
the staff nurse.
REF: Page 326 | Page 327
TOP: AONE competency: Communication and Relationship-Building
12. As the nurse manager on a rehab unit, you are asked to come to the tub room immediately
because two nursing assistants are having a loud disagreement in front of a patient. You ask the
nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to
care for the patient, you speak with the two nursing assistants. Which of the following
NURSINGTB.COM would you ask first?
a. “How long have you two been working together?”
b. “Have you experienced disagreements like this before?”
c. “How do you think this patient’s perception of her care has been changed?”
d. “What happened to bring on this disagreement today?”
ANS: D
Conflicts are usually based on attempts to protect a person’s self-esteem or to alter perceived
inequities in power. When a nurse recognizes upset and reaction, the following steps can be
helpful (Sportsman, 2005): Identify the triggering event (“What happened to bring on this
disagreement today?”). Discover the historical context for each person.
Assess how interdependent each person is on the other.
Identify the issues, goals, and resources involved in the situation.
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REF: Page 328 | Page 329
TOP: AONE competency: Communication and Relationship-Building
13. Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa
worked on the unit. Sally has confided to another colleague that she doesn’t even know why the
conflict started or what it was about. This is an example of:
a. How expectations and objectives need to be made clear in team situations.
b. The need to encourage open discussion of disagreements in opinions.
c. The importance of involving all staff in discussions in group settings.
d. The enduring nature of first impressions.
ANS: D
First impressions are lasting and, as Sally indicates to her colleagues, are often an unconscious
response.
REF: Page 325
TOP: AONE competency: Communication and Relationship-Building
14. After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having
animated discussions that end abruptly when she approaches. Sharon reflects on this
observation and realizes that:
a. Two very outspoken members tend to dominate discussions in meetings.
b. This behavior is indicative of a high level of communication among her staff.
c. Staff members are very committed to the team and have strong opinions.
d. Ongoing discussion outside of meetings is conducive to creativity.
ANS: C
When team communication is dominated by a few members, leaving others uninvolved or
bored, disagreement is not expressed openly. As a result, team members “stuff” their feelings
and wait until after meetings to voice their opinions.
REF: Page 323 | Page 324
TOP: AONE competency: Communication and Relationship-Building
15. You are charged with developing a new nursing curriculum and are committed to developing a
curriculum that reflects the needs of the profession and of the workplace. To address deficits
that mcontent and skills development related to:ay already be present in nursing curricula
related to the workplace, you include more NURSINGT B.COM
a.
b.
c.
d.
Therapeutic communication with patients.
Effective communication in the workplace.
Increased emphasis on sender-receiver dyads.
Generational differences in communication.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Nursing programs teach therapeutic communications with patients and their families. Little
focus, however, is placed on effective communication in the workplace, although
communication is essential to building and maintaining smoothly functioning teams.
REF: Page 325
TOP: AONE competency: Communication and Relationship-Building
16. The SBAR system of communications is one of the most used communication systems in health
care because:
a. It deals with all aspects of communications in patient care except communication with the
physician.
b. The nurse is on the same communication level as administration.
c. It honors a familiar, structured transfer of information among health professionals.
d. It honors an unstructured transfer of information.
ANS: C
The SBAR system was developed by professionals in the California Kaiser Permanente
System and involves direct, respectful communication skills among professionals with the aim
of quality patient care.
REF: Page 328
TOP: AONE competency: Communication and Relationship-Building
17. In the cardiac intensive care unit, there has been simmering discontent about the new nurse
manager, who avoids any discussion about her scheduling and practice decisions. The staff have
begun to sort into “different camps” depending on how they feel about the manager or the
decisions. Which of the following statements MOST accurately describes this situation? a. The
tension that has been generated will result in creative solutions.
b. Staff will become a cohesive group that takes a stand against the manager.
c. The conflict will result in increased dialogue about practice and scheduling options.
d. Patient care may suffer because attention and energy is being diverted toward the unit
relationships.
ANS: D
Destructive conflict polarizes groups, saps group morale, deepens differences in values, and
diverts energy from more important activities, such as patient care. Constructive conflict
opens up issues of importance, results in solutions to problems, and enables authentic
communication.
REF: Page 337
TOP: AONE competency: Communication and Relationship-Building
18. From the information presented in this chapter, which of the following statements best defines
an accomplished team? Effective teams:
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Can create a form of synergism in which the outcome is greater than the sum of the
NURSINGTB.COM
individual performances.
b. Do not necessarily need goals, objectives, vision, and a clearly stated purpose.
c. Do not always have effective communication patterns.
d. May or may not have a clear plan that is followed and revisited and has an ongoing
evaluation scheme.
ANS: A
Research on team-building over many years has established that high-functioning teams are
characterized by synergy that takes the team from a collection of individuals to an outcome
that is greater than the sum of the parts.
REF: Page 335
TOP: AONE competency: Communication and Relationship-Building
19. “I really wish that my supervisor would realize and acknowledge all the things I do well.” In
nursing, this has been identified as a problem. Which statement is part of the solution? Focus
on:
a. New staff.
b. Care assignments with which the individual is not familiar.
c. Making corrections.
d. The strengths of the individual rather than the weaknesses.
ANS: D
The research of Rath (2007) included many recommendations, one of which was that focusing
on mediocre behaviors and on a person’s weaknesses will not lead to excellence. Focusing on
weaknesses tends to decrease the appreciation, and thus the acknowledgements.
REF: Page 335 | Page 336
TOP: AONE competency: Communication and Relationship-Building
20. Trust is an important aspect of helping relationships, therapeutic communications, and the
positive communications model. Which statement does not involve or define trust? Trust: a.
Involves decisions to manipulate situations to gain advantage over another.
b. Is the basis by which leaders facilitate the activities and progress of a team.
c. Is low among members and leaders in poorly performing teams.
d. Involves what we say and not necessarily what we do.
ANS: A
Trust is high in high-performing teams and involves not consciously taking advantage of
others and behaving in a way that inspires trust. It is the basis by which leaders facilitate the
activities and progress of a team.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 333 | Page 334
TOP: AONE competency: Communication and Relationship-Building
21. Team Member A and Team Member B engage in heated disagreements on a frequent basis in
team meetings. Their behavior is characterized by insistence on their points of view and refusal
to back down or to negotiate alternative solutions once their ideas have been expressed. This
behavior is characteristic of: a. Autocratic leadership.
b. Constructive conflict. NURSINGTB.COM
c. Dualism.
d. Creativity.
ANS: C
Our society tends to be dualistic in nature. Dualism means that most situations are viewed as
right or wrong, black or white. Answers to questions are often reduced to “yes” or “no.” As a
result, we sometimes forget a broad spectrum of possibilities actually exists. Exercising
creativity and exploring numerous possibilities are important. This allows the team to operate
at its optimal level.
REF: Page 337
TOP: AONE competency: Communication and Relationship-Building
22. The unit manager was addressing nursing students in the lounge area and was discussing team
leadership and team effectiveness. She stated, “One can agree to disagree with another team
member’s perspective even when one doesn’t necessarily see that perspective as being the
correct one.” In being creative, what did she mean? a. Championing one’s own opinion.
b. Being compassionate
c. Being flexible
d. Committing to resolution
ANS: D
Caregivers must listen to the other person’s perspective, listen to the message accurately,
identify differences, and creatively seek resolutions.
REF: Page 336
TOP: AONE competency: Leadership
23. Which of the following would not be a characteristic of an effective team nurse leader? a. An
autocratic perspective
b. Excellent communication skills
c. Awareness of everyone’s abilities
d. A genuine interest in team members
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
In ineffective teams, leadership tends to be autocratic and rigid, and the team’s
communication style may be overly stiff and formal. Members tend to be uncomfortable with
conflict or disagreement, avoiding and suppressing it rather than using it as a catalyst for
change. When criticism is offered, it may be destructive, personal, and hurtful rather than
constructive and problem-centered. Team members may begin to hide their feelings of
resentment or disagreement, sensing that they are “dangerous.” This creates the potential for
later eruptions and discord.
REF: Page 323
TOP: AONE competency: Communication and Relationship-Building
24. As a nurse manager, you notice that one of your new nurses has provided exceptional care for a
patient with especially complex needs. What would be the MOST effective way of recognizing
the nurse’s performance?
a. At the next performance review, note specifically what the nurse did to make the patient
comfortable.
b. To avoid embarrassing the nurse in front of others, find NURSINGTB.COM
a
way to compliment the nurse in private.
c. When the nurse comes out of the room, tell the nurse specifically what you appreciated
about the care that was provided.
d. Encourage the patient to note the care on the patient feedback form so that the institution
can recognize the nurse’s efforts.
ANS: C
Acknowledgement is most effective when it is specific, timely, given in public, sincere, and
on an eye-to-eye basis. The more time that elapses between the event and acknowledgement,
the less effective it becomes.
REF: Page 336
TOP: AONE competency: Communication and Relationship-Building
25. What is not a key concept in a well-functioning team?
a. Absence of disagreement or conflict
b. Special work that is understood and supported by all
c. Willingness to work together respectfully
d. Dedication to a mission
ANS: A
The challenge in teams is not to eliminate disagreement or conflict but to recognize when a
breakdown in communication occurs. Singleness of mission, willingness to cooperate, and
commitment are all key concepts in a well-functioning team.
REF: Page 328 | Page 333
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. Mobilizing others to accomplish extraordinary things requires what leadership behaviors?
(Select all that apply.)
a. Celebrating the successes of others
b. Demonstrating exceptional technical skills
c. Imagining possibilities
d. Establishing a sense of “being in this together”
ANS: A, C, D
Leaders who inspire teams to accomplish extraordinary things or to display synergy model the
way, inspire shared vision, challenge the status quo, and encourage the heart by celebration of
success.
REF: Page 324 | Page 325
TOP: AONE competency: Leadership
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Chapter 19: Workforce Engagement and Collective Action
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. The staff members in a local Emergency Department are experiencing stress and burnout as the
result of excessive overtime. The staff decides to unionize to negotiate for better working
conditions. The increase in unionization within health care may be attributed to the: a.
Movement from being “blue-collar workers” to being “knowledge workers.”
b. Excess profits in health care.
c. Level of risk that exists for health care.
d. Number of people who are involved in health care.
ANS: D
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
As technology replaces unskilled workers, fewer workers are available for trade-union
organizing, which has led to declines in union memberships. Nurses represent a large pool of
workers who may be available for union organizing in the face of the declining pool available
elsewhere.
REF: Page 355
TOP: AONE competency: Business Skills
2. The Emergency Department nurses’ decision to organize for the purpose of collective
bargaining is being driven by a desire to:
a. Establish the staffing pattern that will be used.
b. Determine the hours that one is willing to work.
c.d. Create a professional practice environment.Protect against arbitrary discipline and
termination.NURSINGTB. COM
ANS: C
Historically, nurses were reluctant to unionize. However, concern with safety of care and
quality of care, especially when tension is present in a work environment, makes unionization
more desirable. U.S. Supreme Court rulings have provided for RN-only units and protection
to practice according to what the profession and licensure status require nurses to do.
REF: Page 356
TOP: AONE competency: Business Skills
3. The Emergency Department staff decides to use a collective bargaining model for negotiation
rather than a traditional trade union model. A traditional trade union model is characterized by:
a. Positional conflict.
b. Management support of labor’s initiatives.
c. A spirit of trust between management and labor.
d. An ability to resolve complaints.
ANS: A
Collective bargaining encompasses management support of labor’s initiative, a spirit of trust
between labor and management, and resolution of problems. It replaces the positional conflict
that has been associated with traditional trade unions. Models such as the interest-based
problem solving (IBPS) model seek to avoid positional conflicts such as those between labor
and management that do not take into account the opposing party in any way.
REF: Page 354 | Page 357
TOP: AONE competency: Business Skills
4. The chief nursing officer utilizes the hospital’s workplace advocacy to help the overwhelmed
Emergency Department staff. Workplace Advocacy is designed to assist nurses by: a. Creating
professional practice climates in their institutions.
b. Equipping them to practice in a rapidly changing environment.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Negotiating employment contracts.
d. Representing them in labor-management disputes.
ANS: B
Workplace advocacy encompasses a number of activities that enable nurses to control the
practice of nursing and to address challenges that they face in the practice setting. These
activities include career development, employment rights, employment opportunities, and the
labor-management relationship. The aim of workplace advocacy is to proactively equip nurses
to practice within a rapidly changing environment, rather than to negotiate contracts or
provide representation in employment disputes.
REF: Page 352
TOP: AONE competency: Business Skills
5. Nursing labor management partnerships:
a. Engage nurses at all levels in problem solving for better patient care.
b. Require unions and management to negotiate in good faith regarding hours of work
and wages.
c. Have been shown to have negligible effects on nurse turnover and patient outcomes.
d. Have typically resulted in increased polarization of nurses and management, leading
to formation of collective bargaining units.NURSINGTB.COM
ANS: A
The development of a nursing labor management partnership is an approach that can be used
in most professional nursing environments. This process recognizes nurses as leaders on all
levels and provides formal and informal mechanisms for professional nurses to work together
to achieve shared goals through collaboration and shared decision making or decentralized
decision making. A study of a nursing labor management partnership suggested that nurse
satisfaction was higher, turnover was lower, and more time was available for patient care.
REF: Page 355
TOP: AONE competency: Business Skills
6. A Magnet™ hospital surveys the staff about job satisfaction. This type of environment, in
which nurses have authority and autonomy, is linked with: a. Client satisfaction with the
healthcare organization.
b. Organizations with a limited number of nurse managers.
c. Private, specialty organizations in urban areas.
d. Sophisticated academic health sciences universities.
ANS: A
Autonomy and authority in decision making that is consistent with scope of practice are linked
both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is
an important indicator of the quality of patient care.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 350
TOP: AONE competency: Business Skills
7. In a nurse managers’ meeting, strategies for ways to help retain staff are discussed. One
strategy for assisting nurses in developing collective action skills is: a. Accepting the practice of
“going along to get along.”
b. Attending as many workshops as practical.
c. Spending as much time as possible in clinical settings.
d. Taking the opportunity to work with a mentor.
ANS: D
Mentoring facilitates development and adoption of positive interaction and other skills that
facilitate good decision making. Optimism, trust, and decision making are important in
collective action and shared decision making and contribute to job satisfaction and lower
turnover in staff.
REF: Page 351 | Page 353
TOP: AONE competency: Business Skills
8. While making rounds, a night supervisor finds a unit with a low census and too many staff
members. The night supervisor is performing as a statutory supervisor when he or she: a.
Assigns nurses to care for specific clients.
b. Develops a protocol for unlicensed personnel.
c. Recommends transferring a nurse to another service.
d. Teaches a nurse to use a new piece of equipment.
ANS: C
The night supervisor is acting in accordance with the National Labor Relations Act, which
would enable the supervisor to assign nurses to care.
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REF: Page 349
9.
TOP: AONE competency: Business Skills
The Emergency Department staff members are concerned that working long hours without rest
puts patient safety at risk. One staff member decides that she will risk her job and become a
whistleblower. Whistle-blowing is an appropriate recourse when management: a. Disregards
due process when disciplining a nurse.
b. Delays responding to repeated efforts to provide safe care.
c. Hires nurses who are not a part of the union during a strike.
d. Refuses to bargain in good faith with the elected bargaining agent.
ANS: B
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Whistle-blowing is often a result of organizational failure, including failure of the
organization to respond to serious danger or wrongdoing created within the environment,
which, in this instance, involves conditions that put the patient at risk.
REF: Page 349
TOP: AONE competency: Business Skills
10. As a new nurse manager who has “inherited” a unit with high nurse turnover and complaints of
patient dissatisfaction, your first course of action would be to: a. Determine levels of nurse
engagement on the unit.
b. Review the personnel files of nurses who have resigned.
c. Interview upper management about their vision for the unit.
d. Meet with your staff to clarify your vision for the unit.
ANS: A
Multiple studies demonstrate that a healthcare organization that provides a climate in which
nurses have authority and autonomy has better patient outcomes, retains nurses at a higher
rate, is more cost-effective, and has evidence of greater patient satisfaction than an
organization in which such a climate does not exist (Aiken, Clarke, Sloane, Sochalski, &
Silber, 2002; Dunton, Gajewski, Klaus, & Pierson, 2007). Organizational assessment assists in
identifying the reasons for high nurse turnover and patient complaints.
REF: Page 349 | Page 350
TOP: AONE competency: Knowledge of the Health Care Environment
11. In an inner-city area, a group of nurses meet and develop a plan to negotiate with local
businesses to support a breakfast program for young elementary schoolchildren. This is an
example of:
a. Community development.
b. Collective bargaining.
c. Collective action.
d. Shared governance.
ANS: C
Collective action refers to activities undertaken by a group of people with common interests
and, in this example, by a group of nurses who are interested in the welfare of children in their
community.
REF: Page 347
TOP: AONE competency: Communication and Relationship-Building
12. In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly
effective in approaching businesses with the needs that the group has determined
NURSINGTB.COM and articulating the ways that the group has found for businesses to
participate. Leanne is exemplifying:
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a.
b.
c.
d.
Leadership.
Followership.
Professionalism.
Knowledge of context.
ANS: B
Effective followership involves active and loyal involvement in an agenda that has been
established. In this role, Leanne is supporting and operationalizing the agenda and strategies
that have been established within the group.
REF: Page 349
TOP: AONE competency: Communication and Relationship-Building
13. Awareness and use of power have been challenging for nurses in general because of:
a. Incidences of punishment by authority figures.
b. Too little time in the workplace to collectively develop power strategies.
c. Lack of cohesiveness and unity among nurses.
d. A tradition of obedience to authority.
ANS: D
Rituals and traditions such as the Nightingale Pledge have emphasized the need for the “good
nurse” to be obedient to authority. This prevailing attitude has made it difficult for nurses,
who typically spend considerable time in the workplace and who have opportunity through
their work in teams to develop cohesiveness and unity, to develop awareness and use of
power.
REF: Page 348
TOP: AONE competency: Knowledge of the Health Care Environment
14. Collective action is effective in:
a. Ensuring that needs of nurses are placed ahead of other disciplines.
b. Defining nursing as a profession.
c. Advising patients of the needs of nurses.
d. Amplifying the influence of individuals.
ANS: D
Individuals may have limited influence in achieving various purposes such as advancement of
quality care or of the profession, whereas collective action helps to define and sustain
individuals in achieving the desired purposes.
REF: Page 348
TOP: AONE competency: Business Skills
15. Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming
near misses in terms of wrong administration of fluids. They take this concern to the unit
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
manager. As an advocate of nurse autonomy, the most appropriate response in this situation
would be to:
a. Ensure that the nurses are aware of the reasons for the change and how the decision was
made about the new labels.
b. Discuss concerns about the labels and develop potential solutions that take into
NURSINGTB.COM account changes that can be made at the local level and those
that need system intervention.
c. Suggest that the staff wait until they have become more familiar with the labels before
taking further action.
d. Tell the staff that you will notify the pharmacy about these concerns and leave it up to the
pharmacy to decide what should be done.
ANS: B
Participation in decision making regarding one’s practice is an appropriate expectation for
professional nurses, provides for greater autonomy and authority over practice decisions,
contributes to supporting the professional nurse, and is a major component of job satisfaction
(Kramer et al., 2008; Pittman, 2007). Autonomy is encouraged through supportive
management and through unit-level support of changes without the need for complex,
multilevel approval of changes that can be made locally.
REF: Page 348 | Page 349
TOP: AONE competency: Leadership
16. Martin, the unit manager, receives complaints from community agencies that patients who have
been discharged from his unit seem to lack understanding about their disorder and immediate
strategies for managing elements of their care. Martin checks the patient teaching sheets and
notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has
been done. Martin’s follow-up to complaints from the community is:
a. Appropriate and indicates that he has assumed accountability for the actions of his
staff.
b. Indicative that he does not clearly understand the concept of accountability.
c. Indicative of strong support for his staff and their autonomy.
d. Important in clarifying the difference between his accountability and that of the
community in patient care.
ANS: B
Accountability refers to the achievement of desired outcomes. If community agencies are
noticing that limited or no change in patient behavior has occurred despite teaching on the
unit, then the staff has not achieved accountability, and he is not holding his unit responsible
for the outcomes. Martin is also demonstrating lack of accountability.
REF: Page 350
TOP: AONE competency: Professionalism
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
17. Sarah determines, in partnership with her patient, that current medications are not enabling her
patient, a married account executive with fibromyalgia, to continue with her employment and
family responsibilities. After searching for additional information on fibromyalgia, Sarah finds
nonpharmacologic interventions that are supported through credible evidence. Sarah suggests
that the patient, her physician, and she meet to discuss the medications and possible options and
a plan of care for the patient’s discharge. This action exemplifies which of the four historical
concepts identified by Lewis and Batey? a. Authority
b. Responsibility
c. Communication of conflict
d. Autonomy
ANS: A
Authority refers to the use of professional status and power to act in the patient’s best
NURSINGTB.COM interests. In this example, Sarah is using her professional status
and power to set up a conference in which her patient, the prescribing physician, and she can
discuss what is not working for the patient and potential options.
REF: Page 349
TOP: AONE competency: Professionalism
18. In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the
senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how
nursing is viewed within the organization. Jennifer’s comments reflect: a. A concern that
resource allocation will be made on a business and not a professional model.
b. The dissatisfaction that occurs when lack of autonomy is given to nurses.
c. Concern with the nonadvancement of nursing practice in the institution.
d. An awareness of how organizational culture is reflected in organizational structure.
ANS: D
The organizational chart reflects the formal structure of the organization and can reflect
predominant beliefs, values, and relationships in the organization. Exclusion at senior
executive levels of nurse leaders may reflect institutional beliefs about how resources are
allocated, the degree of autonomy given to staff, and involvement of key groups in decision
making.
REF: Page 350
TOP: AONE competency: Knowledge of the Health Care Environment
19. Government and third-party payers announce reduction of compensation for the delivery of
patient services. Hospital STV has a flat organizational structure. After the funding
announcements, senior officials at the hospital meet and make decisions regarding cost
containment of new revenue streams. This action is consistent with:
a. The practice of leaving financial decisions with senior officials who understand the total
context of funding.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. A tendency to concentrate decision making during economic downturns at the top
administrative level.
c. A need to make expedient decisions that are likely to be poorly received by staff.
d. Ensuring that decisions with regard to cost are made equitably across all departments.
ANS: B
During times of economic downturn, decisions tend to become very centralized to avoid risk.
History demonstrates that increasing the breadth of input during these times is more effective
than narrowing it.
REF: Page 351
TOP: AONE competency: Knowledge of the Health Care Environment
20. In Hospital STV, senior administration is strongly oriented toward fiscal and social
conservatism. The nursing department is deeply concerned with the provision of quality to the
community, which includes a high number of poor and unemployed. To accomplish the goals of
the nursing department, resources need to be allocated that administration is not able to allocate.
Nursing and administration:
a. Are engaged in shared governance.
b. Are involved in an irreconcilable conflict of interests.
URSINGTB.COM
c. Represent separate subcultures in the institution.N
d. Represent union and nonunion conflict.
ANS: C
Institutions can have several subcultures, which are represented by unique features and
distinct ideologies. Subcultures can be congruent and can support healthy relationships in the
organization, or they may be separated and characterized by tensions that may be
irreconcilable and destructive. From the information given in this scenario, it is not evident
that shared governance, union presence, or irreconcilable differences are present.
REF: Page 351
TOP: AONE competency: Knowledge of the Health Care Environment
21. On Unit 62, the nurses and the unit manager have been involved in shared decision making
related to the model of nursing care delivery that the unit will adopt. All individuals have
participated and been involved in decision making and implementation of changes. When issues
arise during implementation, it is expected that:
a. Accountability resides entirely with the unit manager.
b. Individual expertise will be utilized to provide solutions, but that responsibility for the
change is shared.
c. No one really has any accountability or responsibility for the changes.
d. This will contribute to widespread skepticism among the staff about the probability of
success.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
High-performing organizations provide for participation by all stakeholders, and each
stakeholder shares responsibility and risk. This kind of environment is more satisfying for
nurses and is characterized by optimism and trust.
REF: Pages 350-352
TOP: AONE competency: Knowledge of the Health Care Environment
22. Senior executives at Hospital A determine that the hospital will engage in a strategic planning
process after changes in healthcare funding and concerns expressed in the community about
care that is being delivered at the hospital. The senior executives decide on a participatory
process in which staff are widely consulted regarding input about the organization and the
external environment and are actively invited to be part of decisions related to the mission
statement, goals, and objectives. For true shared governance to be seen as part of this approach:
a. It must be evident in the outcomes of the process that staff and senior executives have
partnered on the decisions.
b. Stakeholders must be assured of the value of their input even though final decisions rest
with senior executives.
c. Publications must clearly outline how staff input was solicited and obtained.
d. Staff must be reassured that significant concerns will be kept in mind even if they have not
been addressed in planning documents.
ANS: A
Shared governance demands participation in decision making. When partnership, equity, and
ownership are not involved, then shared governance has not occurred, and publication and
expressions of appreciation for input will not be seen as representative of shared governance.
REF: Page 351 | Page 352
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TOP: AONE competency: Knowledge of the Health Care Environment
23. Nurses in an Emergency Department, in an inner-city neighborhood characterized by high
levels of violence, are concerned with low levels of security presence in their department.
Security levels have recently been decreased and the nurses question why this has occurred.
An appropriate action would be to:
a. Provide nurses with information about rationale for recent changes in security staffing.
b. Refer the matter to the head of security and let her deal with it.
c. Provide mentors who can help nurses diffuse aggressiveness.
d. Accept the security levels as a consequence of funding realities.
ANS: A
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Workplace advocacy is an umbrella term encompassing activities within the practice setting.
Workplace advocacy includes an array of activities undertaken to address the challenges faced
by nurses in their practice settings. The focus of these activities is on career development,
employment opportunities, terms and conditions of employment, employment rights and
protections, control of practice, labor-management relations, occupational health and safety,
and employee assistance. The objective of workplace advocacy is to equip nurses to practice
in a rapidly changing environment. One manifestation of workplace advocacy is ensuring that
relevant information is shared about decisions that affect practice so that further data
gathering and decision making (in this instance about security levels and nurse safety) is
informed.
REF: Page 352
TOP: AONE competency: Communication and Relationship-Building
24. You are hired as a new manager. When the offer of employment is made, you agree to at-will
employment. Later, you become very concerned about the policies and practices of your
organization and their impact on patient care. You speak with your supervisor several times
about your concerns, but no action is taken. In considering your next steps, you: a. Consider
your increased vulnerability under the terms of your employment.
b. Recognize that your supervisor is more vulnerable than you are because of her more senior
position.
c. Are more likely as a leader to take action because you are well protected from
repercussions by federal and state regulations.
d. Contact your union to discuss your concerns and review your options.
ANS: A
Managers of at-will employees have greater latitude in selecting disciplinary measures for
specific infractions. State and federal laws do provide a level of protection; however, an atwill employee may be terminated at any time for any reason except discrimination. At-will
employees, in essence, work at the will of the employer. Nurses in these positions need to
know their rights and accountability.
REF: Page 356
TOP: AONE competency: Business Skills
25. Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination
room. The physician orders a medication to be given through IV. Sandra questions the order,
based on her knowledge of the patient’s history and of other medications that the patient has
been given. The physician reiterates the order and Sandra refuses to give it. In this instance,
Sandra is demonstrating:
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a. Autonomy.
b. Accountability.
c. Authority.
d. Best practice.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
In this situation, Sandra is exemplifying autonomy, which is the act of making independent
decisions in the best interests of the patient, based on her knowledge and experience. This is
analogous to the example in the text where the workers on the manufacturing floor have the
independence to say “Stop the line” when something is wrong. Key to the concept of
autonomy is decision making and the level of independence that is given. Accountability
refers to achievement of outcomes, and authority refers to the capacity to make decisions.
REF: Page 349
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Martin, the unit manager, receives complaints from community agencies that patients who
have been discharged from his unit seem to lack understanding about their disorder and
immediate strategies for managing elements of their care. Martin checks the patient teaching
sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that
teaching has been done. Potential outcomes of Martin’s actions include (select all that apply):
a. Poor morale on the unit.
b. Disruption in community relationships.
c. Corruption of patient-staff relationships.
d. Patient outcomes for quality care are met.
ANS: A, B, C
Kupperschmidt (2004) points out that when accountability is not accepted, then relationships
suffer, professional practice is diminished, and self-esteem suffers.
REF: Page 350
TOP: AONE competency: Professionalism
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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Chapter 20: Managing Quality and Risk
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
A new graduate is asked to serve on the hospital’s quality improvement (QI) committee. The
nurse understands that the first step in quality improvement is to: a. Collect data to determine
whether standards are being met.
b. Implement a plan to correct the problem.
c. Identify the standard.
d. Determine whether the findings warrant correction.
ANS: C
Before further action (data collection, decision making related to correction, and
implementation of a plan) can occur, it is necessary to identify the standards against which
data collection and decision making will occur. Institutions may or may not adopt standards
that are already established by organizations such as the ANA.
REF: Page 369
2.
TOP: AONE competency: Knowledge of the Health Care Environment
The chief executive officer asks the nurse manager of the telemetry unit to justify the
disproportionately high number of registered nurses on the telemetry unit. The nurse manager
explains that nursing research has validated which statement about a low nurse-to-patient ratio?
It:
a. Promotes teamwork among healthcare providers.
b.c. Increases adverse events.Improves outcomes. N URSINGTB.COM
d. Contributes to duplication of services.
ANS: C
Studies related to staffing and patient outcomes suggest that patient outcomes are improved
with a low nurse-to-patient ratio and especially with a low registered nurse-to-patient ratio.
REF: Page 376
3.
TOP: AONE competency: Knowledge of the Health Care Environment
A nurse manager wants to decrease the number of medication errors that occur in her
department. The manager arranges a meeting with the staff to discuss the issue. The manager
conveys a total quality management philosophy by:
a. Explaining to the staff that disciplinary action will be taken in cases of additional errors.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Recommending that a multidisciplinary team should assess the root cause of errors in
medication.
c. Suggesting that the pharmacy department should explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year
without penalty.
ANS: B
Quality management stresses improving the system, and the detection of staff errors is not
stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive
measures such as disciplinary action or blaming.
REF: Page 365 | Page 366
TOP: AONE competency: Knowledge of the Health Care Environment
4.
The nurse educator of the pediatric unit determines that vital signs are frequently not being
documented when children return from surgery. According to quality improvement (QI), to
correct the problem, the educator, in consultation with the patient care manager, would initially
do which of the following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care for postoperative
patients.
d. Document which staff members are not recording vital signs, and write them up.
ANS: B
Leadership must identify safety shortcomings and must locate resources at patient care levels
to identify and reduce risks. One method of doing this is to invite all staff into a discussion
related to solutions to an identified concern. This approach encourages teamwork.
REF: Page 364
5.
TOP: AONE competency: Knowledge of the Health Care Environment
A nurse is explaining the pediatric unit’s quality improvement (QI) program to a newly
employed nurse. Which of the following would the nurse include as the primary purpose of QI
programs?
a. Evaluation of staff members’ performances
b. Determination of the appropriateness of standards
c. Improvement in patient outcomes
d. Preparation for accreditation of the organization by the Joint Commission on
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Accreditation of Healthcare Organizations (JCAHO)
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
The primary purpose of QI is improvement of patient outcomes, which relates to prevention of
error, quality patient care, and patient satisfaction.
REF: Page 362 | Page 367
TOP: AONE competency: Knowledge of the Health Care Environment
6.
Before beginning a continuous quality improvement project, a nurse should determine the
minimal safety level of care by referring to the: a. Procedure manual.
b. Nursing care standards.
c. Litigation rate of unsafe practice.
d. Job descriptions of the organization.
ANS: B
Standards establish the minimal safety level of care. Procedure manuals provide information
about how standards are to be achieved.
REF: Page 367
7.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient,
the nurse completes an incident report. The nurse notifies the nursing supervisor of the
medication error and calls the physician to report the occurrence. The nurse who administered
the inaccurate medication understands that: a. The error will result in suspension.
b. An incident report is optional for an event that does not result in injury.
c. The error will be documented in her personnel file.
d. Risk management programs are not designed to assign blame.
ANS: D
QM stresses improving the system, and the detection of staff errors is not stressed. If errors
occur, reeducation of staff is emphasized rather than imposition of punitive measures such as
disciplinary action or blaming.
REF: Page 365 | Page 366
TOP: AONE competency: Knowledge of the Health Care Environment
8.
The nurse manager is concerned about the negative ratings her unit has received on patient
satisfaction surveys. The first step in addressing this issue from the point of view of quality
improvement is to:
a. Assemble a team.
b. Establish a benchmark.
c. Identify a clinical activity for review.
d. Establish outcomes.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
In theory, any and all aspects of clinical activity could be improved through the QI process.
However, QI efforts should be concentrated on changes to patient care that will have the
NURSINGTB.COM greatest effect.
REF: Page 364 | Page 366 | Page 380
TOP: AONE competency: Knowledge of the Health Care Environment
9.
With the rise of violence in the psychiatric department, the nurse manager decides that she
should work with the risk manager in violence prevention. The nurse manager should: a.
Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behavior.
d. Hire more police security.
ANS: B
Active involvement of staff in risk management activities is key to prevention of adverse
events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing
patient care issues, and mitigating adverse events. Accountability for safety can be one aspect
of performance evaluations.
REF: Page 362
TOP: AONE competency: Knowledge of the Health Care Environment
10. A new RN staff member asks you about the difference between QA and QI. You explain the
difference by giving an example of QI.
a. “Last year, the management team established new outcomes that addressed issues
such as medication errors.”
b. “At a staff meeting last year, two of our staff commented on the number of recent falls
and asked, ‘What can we do about it?’”
c. “A process audit was done recently to determine how much time was being spent on
patient documentation.”
d. “Errors are reported on our new computerized forms, and I follow up with staff to
make sure that they understand the seriousness of their error.”
ANS: B
In QI, followers invest in the process by continually asking “What makes this indicator
important to measure?” “What has been done to improve it?” “What can I do to improve it?”
REF: Page 365
TOP: AONE competency: Knowledge of the Health Care Environment
11. Healthcare organization X is committed to improving patient outcomes and, as part of the QI
process, examines its executive structure and organizational design. This approach recognizes:
a. The importance of decentralized structure in QA.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. That structure influences nurse burnout and participation in quality improvement
initiatives.
c. The need to ensure sufficient supervisory staff to respond in a corrective manner when
mistakes occur.
d. That a narrow hierarchy ensures accountability for errors and outcomes.
ANS: B
Common organizational characteristics of Magnet™ hospitals include structure factors (e.g.,
decentralized organizational structure, participative management style, and influential nurse
executives) and process factors (e.g., professional autonomy and decision making, ongoing
professional development/education, active qualNURSINGTB.City improvement
initiatives). ANCC OM Magnet™ designated hospitals and other high-reliability
organizations in the United States and Europe generally have lower burnout rates, higher
levels of job satisfaction, and provide higher levels of quality care resulting in greater levels
of patient satisfaction (Aiken et al., 2012; Kelly, McHugh, & Aiken, 2011).
REF: Page 362
TOP: AONE competency: Knowledge of the Health Care Environment
12. Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD
because it:
a. Facilitates active staff participation in decision making related to quality nursing care.
b. Has implemented a graduate nurse orientation program.
c. Espouses commitment to excellence in patient care.
d. Is establishing career ladders for nurses.
ANS: A
Magnet™ hospitals are particularly successful in implementing excellence in patient care
through use of standards, evidence, and participatory decision making in quality
improvement. Organizations that cannot pursue Magnet™ status can implement strategies
such as career ladders.
REF: Page 362
TOP: AONE competency: Knowledge of the Health Care Environment
13. A nursing-led classification system that has led to greater reliability and standardization in data
utilized for QI processes is:
a. NANDA.
b. AHRQ.
c. NIOSH.
d. Nursing process.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
NANDA has been developed by nurses and uses standardized terminology that enables study
of health problems across populations, settings, and caregivers.
REF: Page 373
TOP: AONE competency: Knowledge of the Health Care Environment
14. In determining the relationship between injury-producing falls and proposed preventive
measures as part of the QI process, a QI team might turn to which of the following for
confirmatory evidence? a. NDNQI
b. NANDA
c. NIOSH
d. AHRQ
ANS: A
The National Database of Nursing Quality Indicators is a national, nursing quality
measurement program from the American Nurses Association that provides hospitals with
unit-level performance reports with comparisons to national averages and rankings.
REF: Page 372 | Page 373
TOP: AONE competency: Knowledge of the Health Care EnvironmentNURSINGTB.COM
15. A method commonly used in Quality Assurance to monitor adherence to established standards
is:
a.
b.
c.
d.
A Pareto chart.
Brainstorming.
Patient interviews.
Chart audit.
ANS: D
Chart audits are a common method of addressing process standards. Chart audits over time
yield trend charts.
REF: Page 375
TOP: AONE competency: Knowledge of the Health Care Environment
16. Hospital Magnet™ decides against creating a separate department to lead and monitor quality
activities because:
a. Total organizational involvement is critical to QI.
b. Data generated by a single, separate department are generally flawed.
c. Monitoring and commitment to QI can come only from senior-level managers.
d. Staff resent suggestions for improvement that originate outside of their unit.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Decentralized approaches are effective in developing unit-level solutions, as well as
commitment to strategies and implementation of changes.
REF: Page 362
TOP: AONE competency: Knowledge of the Health Care Environment
17. As a nurse manager, you know that the satisfaction of patients is critical in making QI
decisions. You propose to circulate a questionnaire to discharged patients, asking about their
experiences on your unit. Your supervisor cautions you to also consider other sources of data
for decisions because:
a. The return rate on patient questionnaires is frequently low.
b. Patients are rarely reliable sources about their own hospital experiences.
c. Hospital experiences are frequently obscured by pain, analgesics, and other factors
affecting awareness.
d. Patients are reliable sources about their own experiences but are limited in their ability to
gauge clinical competence of staff.
ANS: D
Patients are reliable and motivated sources of their own experience but often do not have
sufficient knowledge of clinical procedures to provide feedback about clinical competence.
REF: Page 366
TOP: AONE competency: Knowledge of the Health Care Environment
18. An example of an effective patient outcome statement is:
a. Eighty percent of all patients admitted to the Emergency Department will be seen by a
nurse practitioner within 3 hours of presentation in the Emergency Department.
b. Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs.
c. The hospital will reduce costs by 3% through the annual budget process.
d. Quality is a desired element in patient transactions.
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ANS: A
Patient outcomes must be measurable, specific, and patient-centered.
REF: Page 367
TOP: AONE competency: Knowledge of the Health Care Environment
19. Patient perceptions are useful in:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Providing one source of data for QI initiatives.
d. Establishing blame for poor-quality care.
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Customers define quality and patient dissatisfaction as useful indicators of which areas are of
greatest concern to patients and of what matters then to nurses and organizations. Patient
perceptions guide areas of inquiry; however, they do not establish what disciplinary decisions
will be made.
REF: Page 366 | Page 367
TOP: AONE competency: Knowledge of the Health Care Environment
20. Through the QI process, the need to transform and change the admissions process across
administrative and patient care units is identified. In this particular situation, what method of
data organization will be most effective? a. Flowchart
b. Histogram
c. Narrative
d. Line graphs
ANS: A
Flowcharts are useful in identifying and visualizing sequential steps, such as the admissions
process.
REF: Page 369
TOP: AONE competency: Business Skills
21. A nursing unit is interested in refining its self-medication processes. In beginning this process,
the team is interested in how frequently errors occur with different patients. To assist with
visualizing this question, which organizational tool is most appropriate? a. Histogram
b. Flowchart
c. Fishbone diagram
d. Pareto chart
ANS: A
Histograms are bar graphs that are useful in outlining and identifying frequency.
REF: Page 369
TOP: AONE competency: Knowledge of the Health Care Environment
22. The outcome statement “Patients will experience a ten percent reduction in urinary tract
infections as a result of enhanced staff training related to catheterization and prompted
voiding” is:
a. Physician-sensitive and nonmeasurable.
b.c. Measurable and nursingPrecise, measurable, and physician-sensitive.NURSI N-
sensitive.GTB.C OM
d. Patient care–centered and nonmeasurable.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Nursing-sensitive outcomes refer to outcomes that are affected by nursing activity and are
precise, measurable, and patient-centered.
REF: Page 367 | Page 368
TOP: AONE competency: Knowledge of the Health Care Environment
23. Your institution has identified a recent rise in postsurgical infection rates. As part of your QI
analysis, you are interested in determining how your infection rates compare with those of
institutions of similar size and patient demographics. This is known as: a. Quality assurance.
b. Sentinel data.
c. Benchmarking.
d. Statistical analysis.
ANS: C
Benchmarking is a widespread search to identify the best performance against which to
measure practices and processes.
REF: Page 371
TOP: AONE competency: Knowledge of the Health Care Environment
24. At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in
patients during surgery and surgeries on the wrong limbs. These are known as: a. Sentinel
events.
b. Medically sensitive events.
c. Nurse-sensitive events.
d. Never events.
ANS: D
The NQF and CMS define never events as errors in medical care that are clearly identifiable,
preventable, and serious in their consequences for patients and that indicate a real problem in
the safety and credibility of a healthcare facility. Examples of never events include surgery on
the wrong body part, foreign body left in a patient after surgery, mismatched blood
transfusion, major medication error, severe pressure ulcer acquired in the hospital, and
preventable postoperative deaths.
REF: Page 377
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Examples of sentinel events include (select all that apply):
a. Forceps left in an abdominal cavity.
b. Patient fall, with injury.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Short staffing.
d. Administration of morphine overdose.
e. Death of patient related to postpartum hemorrhage.
ANS:Sentinel events are serious, unexpected occurrences involving death or physical or A, B,
D, E
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psychological harm.
REF: Page 376 | Page 377
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 21: Translating Research into Practice
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
The chief nursing officer at a local hospital seeking Magnet™ status creates staff development
classes concerning translation of research into practice (TRIP). What best describes TRIP? a.
Conducting an integrative review of the literature
b. Searching the literature for a systematic review
c. Providing the results of research studies to practitioners
d. Applying strategies that aid in adoption of research in practice
ANS: D
The science of how research is adopted is known as translation science, the science of
translating research into practice (TRIP). The primary aim of research utilization is to
activate the change process to move research findings into practice to improve patient
outcomes.
REF: Page 394
2.
TOP: AONE competency: Leadership
The chief nursing officer at a local hospital seeking Magnet™ status creates staff development
classes about incorporating evidence-based practice in nursing. What best describes evidencebased practice?
a. Applying best research evidence to care of patients
b. Using research-based information to develop practice guidelines
c.
Conducting a randomized control trial to determine effectiveness of handwashing
techniques
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Developing standards for practice
ANS: A
Evidence-based medicine is derived from evidence-based medicine and involves integration
of the best research evidence with clinical expertise and the patient’s unique values and
circumstances in making decisions about the care of individual patients. It is focused on
searching for, appraising, and synthesizing the best evidence to address a particular clinical
practice problem.
REF: Page 385
3.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse manager decides to change staffing schedules in the intensive care unit. She chooses
to use Rogers’ diffusion of innovations theory to implement the change. What are the elements
of Rogers’ diffusion of innovations theory?
a. Assessment, planning, intervention, and evaluation
b. Preparation, validation, synthesis, and evaluation
c. Knowledge, persuasion, decision, implementation, and evaluation
d. Scanning, diagnosis, decision making, application, and reevaluation
ANS: C
Nurse managers disseminate research findings to patient care team members. Rogers’
diffusion of innovations theory provides a useful model for integration of evidence into
practice.
REF: Page 391
4.
TOP: AONE competency: Leadership
As a nurse manager, you trial a new pain scale on your unit that is supported by numerous
research studies. You compare the patient outcomes with the new scale against the existing
scale. Feedback from staff suggests that the new scale is too difficult for patients who have
limited language skills and who are already under duress to understand. The difficulty in
implementing the new scale refers to testing: a. Efficacy.
b. Effectiveness.
c. Practice failure.
d. Comparative error.
ANS: B
Comparing the effectiveness of interventions can help to address the needs of clinicians in
determining best practices for their patients. Comparative effectiveness research (CER) is the
"generation and synthesis of evidence that compares the benefits and harms of alternative
methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the
delivery of care" (Institute of Medicine, 2009, p. 29). Efficacy is testing an intervention or
treatment in a traditional randomized clinical trial under carefully controlled conditions and is
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
used to determine whether an intervention or treatment works, whereas effectiveness is testing
whether the intervention or treatment works in the real world of practice.
REF: Page 389
5.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse manager wants to use evidence-based recommendations to prevent ventilatorassociated pneumonia. In order to effectively gather evidence to guide practice, what is the
critical first step?N URSINGTB.COM a. Develop the clinical question.
b. Identify the databases to be used.
c. Appraise the evidence.
d. Integrate available evidence with unit expertise.
ANS: A
Identifying the question may be the most challenging part of the process. Once the clinical
question has been identified, writing it down will help in moving on to the next step of
gathering evidence.
REF: Page 395 | Page 396
6.
TOP: AONE competency: Leadership
A strategic goal developed by the chief nursing officer is to implement an evidence-based
practice program. What is an appropriate strategy that can be used by a nurse manager who is
beginning to implement an evidence-based practice program?
a. Conducting a review of adverse events and incident reports
b. Soliciting input from staff members
c. Reviewing specialty organization guidelines
d. Identifying patients with extended lengths of stay
ANS: B
Stakeholders need to be involved early, and staff members need to be involved when
initiatives involve direct patient care. Involvement assists in understanding issues and
concerns, motivations, and unmet needs.
REF: Page 398
7.
TOP: AONE competency: Communication and Relationship-Building
The nurse manager of an ICU wants to implement the revised policy and procedure on central
line catheter care. What would be the most effective method of getting the staff nurses to
incorporate a new evidence-based practice into their care? a. Conducting an interactive
educational workshop
b. Distributing educational materials on clinical units
c. Sharing the results of a chart audit with staff
d. Providing staff with a short DVD on the topic
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
Dobbins et al. suggest that effective strategies for promoting behavioral change in health
professionals include active involvement strategies such as face-to-face information sessions
in small groups and one-to-one interactions. Other approaches have mixed or few results.
REF: Page 394
8.
TOP: AONE competency: Communication and Relationship-Building
Before implementation of the new policy and procedure on central line catheter care, the nurse
manager uses an appraisal system to evaluate the evidence. What is important in using an
appraisal system to evaluate the evidence gathered in preparation for development of a new
protocol?
a. Limiting the search to randomized clinical trials
b. Matching the appraisal tool to the type of evidence
c. Eliminating qualitative research studiesNURSINGT B.COM
d. Using only pre-processed evidence
ANS: B
Appraisal tools are specific to the number of studies, as well as to the study design (type of
evidence), type of review, and strategy for determining the applicability of evidence to your
practice.
REF: Page 397
9.
TOP: AONE competency: Knowledge of the Health Care Environment
To help staff nurses adjust to using research in practice, what strategy would the nurse manager
use?
a. Attendance at a regional research conference
b. Formal classes in electronic search techniques
c. Establishing a journal club
d. Issuing reports on the adverse consequences of outdated practices
ANS: C
Journal clubs provide opportunities for engagement in reading research and considering how it
might be applied to clinical practice problems, which is considered very effective in
behavioral change.
REF: Page 402
TOP: AONE competency: Communication and Relationship-Building
10. What is a strategy that can be used by a small community hospital with limited resources to
develop an evidence-based nursing practice program? a. Hiring a nurse researcher
b. Partnering with nurse researchers at a local university
c. Subscribing to journals devoted to evidence-based nursing
d. Including research competencies in managers’ job descriptions
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Partnering with nurse researchers assists in providing nurse researcher expertise and
leadership to organizations that do not have the size or the resources to hire nurse researchers.
REF: Page 400
TOP: AONE competency: Communication and Relationship-Building
11. Tara, the unit manager, is telling her colleague about her recent project, which involves seeking
the most effective approaches to incontinence care, with the intention of adopting evidencesupported approaches on her dementia care unit. Her colleague suggests that translation of
research into practice is:
a. Less important than knowledge-generating research, which is required to advance the
nursing profession.
b. A priority of all healthcare practitioners to improve patient care.
c. Characterized by lack of knowledge about how to use evidence to guide practice.
d. So difficult that it is useless to begin the query in the first place.
ANS: B
The National Institutes of Health identified translational research, or getting research into the
hands of practitioners to improve patient care, as a priority.
REF: Page 385
TOP: AONE competency: Knowledge of the Health Care
EnvironmentNURSINGTB.COM
12. After searching the literature, Tara, the unit manager develops a table that outlines the findings
of studies on management of incontinence. She then examines the studies in terms of risk and
whether the findings fit within her practice context and for her population of moderately to
severely cognitively impaired patients. This is which phase of Stetler’s research utilization
model? a. Preparatory
b. Validation
c. Evaluation
d. Application
ANS: C
The third phase, comparative evaluation and decision making, involves making a decision
about the applicability of the studies by synthesizing cumulative findings; evaluating the
degree and nature of other criteria, such as risk, feasibility, and readiness of the finding; and
actually making a recommendation about using the findings of the studies.
REF: Page 386
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
13. The clinical guidelines for management of incontinence developed by the Registered Nurses
Association of Ontario (RNAO):
a. Reflect practice that is fiscally directed and sound.
b. Articulate practice recommendations developed from synthesis and review of
evidence.
c. Are intended to increase awareness of issues in incontinence management.
d. Reflect a compilation of information from a variety and range of sources related to
incontinence.
ANS: B
The evidence-based practice (EBP) movement has grown exponentially with scientific
publications, establishment of collaboration centers, resources on the Web, and grants focused
specifically on translating of research into practice. A number of evidence-based nursing
centers have been established around the world. These centers have teams of researchers who
critically appraise evidence and then disseminate protocols for the use of evidence in practice.
In this example, clinical guidelines have been developed by a professional nursing
organization on the basis of best possible evidence on incontinence management. Although
issues may be raised in the recommendations, the purpose is to guide practice for the purposes
of better patient care.
REF: Page 388
TOP: AONE competency: Knowledge of the Health Care Environment
14. Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt
evidence-based recommendations related to family-centered care on the unit. Marie’s response
has been that she rarely has time to provide care to patients, let alone families, and that there is
no good reason to do anything different than what she is already doing. An approach that may
gain Marie’s support of the idea is to: a. Invite Marie to review the studies for herself.
b. Suggest that she does not need to provide family-centered care.
c. Avoid discussion of the idea with her until she initiates it.
d. Secure the support of her closest colleagues on the unit.NURSINGTB.COM
ANS: D
As a skeptic, Marie, who is a late majority adopter, needs pressure from colleagues to move
her towards support of the recommendations. The translation of research into practice requires
that nurse leaders and managers understand group dynamics, individual responses to
innovation and change (such as the response of late majority adopters), and the culture of their
healthcare organization.
REF: Page 392
TOP: AONE competency: Communication and Relationship-Building
15. You are excited by evidence supporting the use of PDAs at the bedside to improve
documentation and patient outcomes. You have disseminated the information through
discussions and e-mails and are now ready to begin the process of considering implementation
on the unit. To develop positive attitudes toward the use and implementation of the technology,
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
you would discuss your ideas with (Rogers’ diffusion of innovations theory): a. Harvey, RN, a
technology guru, who enthusiastically tries on all new software.
b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new
approaches in her practice.
c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas about
whether or not to try something new.
d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at all.
He says that he will use it when there is no chance of security breaks.
ANS: B
Berta is the one with whom you should now have informed conversations, because she is an
early adopter who is respected for her thoughtful acquisition and critique of knowledge and
application of knowledge to practice. Berta, an early adopter (Rogers’ characteristics of
innovation adopters), is more effective in this stage than Harvey, an innovator who may be
seen as open to all new ideas regardless of merit.
REF: Page 392
TOP: AONE competency: Communication and Relationship-Building
16. The implementation of saline flushes for capped angiocatheters is an example of:
a. How multilevel and interprofessional application of a procedure can slow adoption of
EBP.
b. How competition among disciplines can lead to negative patient outcomes.
c. The reluctance of hospital administrators to act on recommendations from EBP.
d. How a safe, well-known practice outweighs the benefits of adopting a newer practice.
ANS: A
The translation of research into practice operates at four levels: The individual healthcare
professional, healthcare groups or teams, organizations, and the larger healthcare system or
environment. The adoption of saline flushes illustrates the challenges of communicating EBP
to other disciplines and organizations and of the involvement of different levels. This
particular innovation needed endorsement by nurses, physicians, and pharmacists, as well as
by administrators who needed evidence of lost savings to support adoption.
REF: Page 395 | Page 401
TOP: AONE competency: Leadership
17. Which of the following would be most effective in implementing the findings of Dobbins et
al. on treating problems associated with bowel
motility?NURSINGTB.COM a. Lecture by a nurse
practitioner
b. Workshop for surgical nurses that involves discussion of case studies and application of
evidence
c. Discussion of the findings on the bulletin boards at the workstation
d. Education of unit opinion leaders regarding the evidence presented in the studies
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Work by Dobbins et al. suggests that translation of research into practice is best facilitated
through interactive learning such as workshops. Least effective strategies included didactic
learning and distribution of learning materials.
REF: Page 394 | Page 395
TOP: AONE competency: Communication and Relationship-Building
18. Which of the following is an effective approach in the appraisal of research studies?
a. Accept only studies that use a RCT design.
b. When ranking research studies, choose RCTs over qualitative studies.
c. Select only studies with a large sample size.
d. Evaluate the quality of the research against the standards for that type of research.
ANS: D
While randomized controlled trials (RCTs) are generally considered the gold standard for
research, it is important to assess not only the method but the quality of the study and its
applicability to the question that is being asked. The quality of all studies should be appraised
against the standards accepted for that that type of research.
REF: Page 398
TOP: AONE competency: Knowledge of the Health Care Environment
19. Within a multisite healthcare system, the most appropriate strategy for translation of research
would be:
a. Widespread development of protocols using EBP at unit levels.
b. Dissemination of EBP and recommendations to individuals, units, and the organization.
c. Development of the skills of individual managers on how to build guidelines based on
EBP.
d. Establishment of an interdisciplinary center to guide and lead the translation of research
findings into practice.
ANS: D
At a systems level, the most appropriate approach would be establishing a center that leads in,
guides, and promotes EDP across and at various levels.
REF: Page 395
TOP: AONE competency: Knowledge of the Health Care Environment
20. At an organizational level, which of the following strategies would assist in ensuring that EBP
is incorporated into nursing care?
a. Formation of nursing-only implementation teams
b. Restriction of evidence to RCTs
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Formation of a network of individuals doing research and/or interested in research
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utilization
d. Avoidance of partnership with experienced researchers
ANS: C
Collaboration, partnerships, and consideration of a variety of evidence appropriate to the
clinical questions are important in ensuring translation of evidence into practice.
Collaboration is considered particularly critical and can occur through practice-based
networks.
REF: Page 401
TOP: AONE competency: Knowledge of the Health Care Environment
21. Which of the following is most accurate regarding evidence-based practice?
a. Evidence-based practice replaces continuous quality improvement.
b. Evidence-based practice began with medicine and assists in determining which medical
models can be applied in nursing practice.
c. Effective and efficient care can already be demonstrated, which means that EBP will soon
become redundant.
d. EBP is generally recognized across disciplines and by policymakers as state-of-the-art
clinical practice.
ANS: D
EBP is recognized across nursing and other disciplines as reflective of state-of-the-art clinical
practice, as it is based on best available evidence.
REF: Page 385
TOP: AONE competency: Knowledge of the Health Care Environment
22. Which of the following is a meta-analysis?
a. Review of 35 studies on nurse work satisfaction to determine the significance of the
aggregated research findings
b. Review of multiple chart audits to determine which errors are being reduced through
implementation of evidence-based guidelines
c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of
venipuncture in young children
d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency room
sites
ANS: A
Meta-analysis statistically combines the results of several similar studies to determine whether
aggregate findings are significant.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 393
TOP: AONE competency: Knowledge of the Health Care Environment
23. Once evidence related to the use of prompted voiding in patients with cognitive impairment has
been appraised and integrated with practice, it is important to:
a. Consider whether patients’ families see this as necessary for the well-being of family
members.
b. Search large databases such as CINAHL to amass further evidence.
c. Clarify the clinical practice question.
d. Solicit input regarding integration with practice.
ANS: A NURSINGTB.COM
EBP is the integration of best research evidence with clinical expertise and the patients’
unique values and circumstances. In this situation, the family’s values and preferences would
be considered. Search of databases, clarification of the question, and gaining staff input would
occur in the process.
REF: Page 384 | Page 385
TOP: AONE competency: Knowledge of the Health Care Environment
24. As the unit manager, you are interested in determining whether patient autonomy is preserved
through informed consent in surgical settings. You determine that participatory action research
is the best method to address this question. Which of the following is consistent with a
participatory action research design?
a. You interview 125 patients who have recently undergone surgery and transcribe the
interviews to determine themes. Themes are validated with an expert in informed
consent.
b. You circulate a questionnaire to patients who recently underwent surgery and ask for
their opinions regarding consent. Data are analyzed and the findings distributed to
administration and other groups.
c. An audit is undertaken of signed consents for treatment, to determine if the consent
is properly witnessed and signed. Findings are used to inform changes in policies.
d. You meet with a patient group to determine which questions should be asked about
patient informed consent and what issues might be encountered and addressed
during the research.
ANS: D
In participatory action research (PAR), the members of the community being studied are
integral members of the research team and are involved in identifying the questions and
addressing the issues involved in the implementation of the research project (Chevalier &
Buckles, 2013).
REF: Page 390
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
25. Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an
herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a
control group where a placebo is administered. This is an example of a(n): a. Longitudinal
study.
b. RCT.
c. Meta-analysis.
d. Appraisal tool.
ANS: B
RCTs, or randomized controlled trials, always involve testing of a treatment through the
random assignment of subjects in the study to an experimental or treatment group or to a
control group that receives a placebo.
REF: Page 398
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. A nurse manager introduces prompted voiding into nursing practice on a unit, which is
supported by clinical guidelines based on evidenceNURSINGTB.CO-Mbased practice.
The nurses on the unit resist implementation, indicating that the bathroom facilities are too far
away for efficient implementation of the guidelines, and that resources are too few to
accomplish the initial voiding observations. For the nurse manager in this situation, it is
important to have further discussion with the staff regarding (select all that apply):
a. Compatibility of this intervention with the values of staff on the unit.
b. Advantages of prompted voiding over incontinence products and catheterizations.
c. Usefulness of prompted voiding with the particular population of patients on the unit.
d. Feasibility of the program with respect to unit design.
ANS: A, B, C, D
Various theories related to the translation of evidence into practice point to strategies for
success in introducing innovation and EBP on units, including determination of how well the
innovation fits with the values of the staff; benefits of this practice or innovation over current
practice; appropriateness of the innovation or practice for the target group for which the
practice is intended; and the feasibility of the innovation from a variety of perspectives,
including the physical design or layout of a unit.
REF: Page 386 | Page 387
TOP: AONE competency: Leadership
Chapter 22: Consumer Relationships
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
MULTIPLE CHOICE
1. The chief nursing officer decides to establish a client advocacy position in an oncology unit.
Advocacy is best represented by:
a. Establishing private and professional networking systems.
b. Asking social services to handle clients’ concerns.
c. Identifying community support groups.
d. Empowering others by promoting self-determination.
ANS: D
Advocacy involves empowering and promoting self-determination in others.
REF: Page 420
TOP: AONE competency: Professionalism| AONE competency: Knowledge of the Health Care
Environment
2. As part of performance appraisal, the nurse manager designs strategies to acknowledge staff
members. What practices by the nurse manager best acknowledge staff accountability and
contribution?
a. Providing new and varied learning experiences for staff members
b. Fostering group cohesiveness through standardization of unit activities
c. Allowing professionals greater influence over their practices
d. Giving recognition for success and support for failure to staff members
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ANS: C
Facilitating greater control over practices implies trust and acknowledges expertise and
performance.
REF: Page 425 | Page 426
TOP: AONE competency: Professionalism
3. The nurse manager understands that the three Ps associated with client education are philosophy,
priority, and performance. Effective client education programs start with a shared philosophy
that such programs are worth the investment. Evidence of a philosophic commitment to client
teaching is best represented by: a. Investing time and energy in teaching clients.
b. Developing teaching skills among the nursing staff.
c. Assuming that clients lack the knowledge they need.
d. Having a teaching checklist on clients’ charts.
ANS: A
A philosophy that patient education is an investment with a significant positive return is one
of the three Ps of a successful consumer education focus. Money invested in teaching is
money well spent.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 420
TOP: AONE competency: Communication and Relationship-Building
4. The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The
nurse manager understands that ultimately, positive relationships with consumers of care are
evaluated by the:
a. Cultural sensitivity of staff.
b. Cost-effectiveness of care delivery.
c. Economic value of service.
d. Outcomes for clients and their perceptions of care.
ANS: D
Trend-setting organizations such as MagnetTM organizations need to demonstrate excellence
in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality
of care are affected by the quality of the nurse-patient relationship. Valid measurement of
patient satisfaction is an evolving science; nurses do not always accurately gauge what factors
are most important to patients. Satisfaction measures are often skewed in a positive direction
with scores clustered at the top of the scale.
REF: Page 416 | Page 417
TOP: AONE competency: Professionalism
5. The nurse manager has to develop a patient satisfaction survey. What is one of the critical
elements in selecting a patient satisfaction instrument?
a. Being able to use the same instrument for all clinical units
b. Including items that are important from the patient’s perspective
c. Being able to administer the instrument before a patient’s discharge from the hospital
d. Being sure that the reading level is no higher than third grade
ANS: B
Because satisfaction is a measure of service and service is a measure of perception of
whatNURSINGTB.COM matters to the patient, to measure satisfaction, surveys must
include items that reflect the perspective of the patient. The quality of human contacts
becomes the measure by which the consumer forms perceptions and judgments about nursing
and the health agency. Consumers may not be able to evaluate the quality of interventions, but
they always can evaluate the quality of the relationship with the person delivering the service.
REF: Page 417
TOP: AONE competency: Professionalism
6. In writing the patient satisfaction survey, the nurse manager is aware of the education levels of
the families. What is the most critical element in the concept of health literacy? a. Providing
instructional materials at appropriate reading levels
b. Facilitating access to translators for persons with language barriers
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Obtaining, processing, and understanding basic health information so appropriate
decisions can be made
d. Knowing that most people have limited health literacy skills
ANS: C
The definition of health literacy used by the federal government is “the degree to which
individuals have the capacity to obtain, process, and understand basic health information and
services needed to make appropriate health decisions” (U.S. Department of Health and
Human Services, 2010).
REF: Page 412
TOP: AONE competency: Communication and Relationship-Building
7. The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse
manager do to strengthen service recovery and improve consumer relationships? a. Post
comparisons of patient satisfaction scores with those of other units on a monthly basis.
b. Involve the staff in resolving consumer issues quickly and effectively.
c. Ensure that staff members apologize to patients when they complain about services.
d. Ask that patients with complaints about services place them in a written format.
ANS: B
Consumers need to be treated with fairness, given explanation, and provided with information
about how errors will be prevented in the future. Staff can be assisted to respond to patient
concerns through scripting, support, and an atmosphere that places an emphasis on learning
and solutions rather than on blaming.
REF: Page 415 | Page 418
TOP: AONE competency: Communication and Relationship-Building
8. Based on data from the patient satisfaction survey, the nurse manager decides that a change
should be made in communication with family members. What would be important for a nurse
manager to consider when instituting a change to improve customer service?
a. Assess the perceptions of the nursing staff regarding the particular service problem.
b. Include community representatives on a planning committee to address the change.
c. Involve physicians, other healthcare professionals, and ancillary staff.
d. Review all patient complaints with the nursing staff.
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ANS: A
Nurses are the healthcare providers who spend the most time with the consumer and are in an
opportune position to understand the issues, structures, and processes that affect patients. The
nurse acts as the primary person to be alert to circumstances that may prevent a successful
outcome for the patient and to intervene on the patient’s behalf. As a nurse manager, it is
important to support staff in their use of power to be in control and to make decisions at the
consumer-staff level of interaction.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 410 | Page 424
TOP: AONE competency: Communication and Relationship-Building
9.
The chief nursing officer is pleased with the nurse manager’s strategy of improving patient
satisfaction in the pediatric intensive care unit. She decides to implement these changes
throughout the hospital. What would be important to consider in implementing a new program
focused on improving relationships with consumers?
a. Recognition of the nursing staff for excellence in promoting consumer relationships
b. Holding the staff accountable for resolving patient complaints
c. Selecting a staff nurse leader to implement the program
d. Identifying key staff members who have already demonstrated excellence in consumer
relationships
ANS: A
The nurse leader should allow professionals more influence over their practice;give staff
opportunities to learn new and varied skills; give recognition and reward for success and
support and consolation for lack of success; and foster motivation and belief in the importance
of each individual and the value of his or her contribution.
REF: Page 425
TOP: AONE competency: Communication and Relationship-Building
10. In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff
nurses to answer the following question: “What is an important consideration in providing
information to parents of a critically ill child?”
a. Making sure that they receive complete information during each encounter with a member
of the nursing staff
b. Assessing parents’ preferences for the amount of information desired
c. Allowing parents to observe key aspects of their child’s nursing care
d. Making sure that patient education brochures explaining ICU protocols are readily
available
ANS: B
Consultation with the parents regarding the amount of information that they desire reflects a
service orientation, in which preferences and needs of the consumer are placed first. The other
answers reflect nurse-directed decisions in which the nurse decides what information and how
much information is needed and how it is to be delivered.
REF: Page 415
TOP: AONE competency: Knowledge of the Health Care Environment
11. In designing a program for young adults regarding safe sexual practices, which of the following
might reach the greatest number in your target group? a. Web-based applications
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NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Print-based media such as newspapers
c. Television advertisements
d. Brochures in kiosks in malls
ANS: A
Mobile technology is changing the digital divide, with young adults, minorities, those with no
college experience, and those with lower household incomes being more likely to indicate that
phones are their main source of Internet access (Zickuhr & Smith).
REF: Page 412
TOP: AONE competency: Knowledge of the Health Care Environment
12. A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they
have explained several times her medication regimen, and yet, when she goes on passes, she
fails to follow it. The staff believe that, as a nurse, she should be able to understand what is
expected. The nurse’s failure to follow the regimen indicates: a. Early cognitive impairment.
b. Lack of motivation.
c. Lack of health literacy.
d. Worsening health state.
ANS: C
What is evident from the response is that she lacks health literacy or the capacity to obtain,
process, and understand basic health information and services. Using a Health Literate Care
Model involves weaving health literacy strategies into care by assuming that patients do not
understand their health conditions or what to do about them, and then, subsequently assessing
patients' understanding (Koh, Brach, Harris, & Parchman, 2013). For example, a nurse who is
an expert clinician in a specialty practice area, when diagnosed with a serious chronic illness,
may not have the appropriate background to make informed healthcare decisions.
REF: Page 412
TOP: AONE competency: Knowledge of the Health Care Environment
13. John is an older adult patient who comes regularly to the multigroup practice in which you are a
nurse practitioner. He says that he doesn’t understand what he is supposed to be doing about his
medications, because every time he comes to the clinic, he sees someone else who has different
ideas. John’s experience represents what aspect of the current consumer experience? a. Nurses
are well-trusted members of the healthcare team.
b. Fragmentation of care results in lack of respect and trust.
c. Care providers often have conflicting ideas about care.
d. The public does not trust care providers other than nurses.
ANS: B
When consumers visit a multigroup practice, they do not have the option of selecting a
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
specific healthcare provider, and thus, there is less opportunity to build a trusting relationship
with a provider.
REF: Page 412
TOP: AONE competency: Knowledge of the Health Care Environment
14. The complexity of the healthcare environment for consumers is increased by:
a.
b.
c.
d.
Falling levels of education among the public.NURSINGTB.C OM
Increased levels of poverty.
Complex compensatory systems and a variety of delivery systems.
Increased numbers of uninsured or underinsured.
ANS: C
The complexity of options in health care and the processes and policies involved in funding
health services for patients, as well as fragmented relationships with a growing variety of
healthcare providers, contribute to the complexity of the system for patients, especially for
those who might need it most, such as the poor, uninsured or underinsured, and homeless.
REF: Page 443 | Page 444
TOP: AONE competency: Knowledge of the Health Care Environment
15. Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term
means. As a nurse leader, you explain that this is a reference to the: a. Assessment and
admission of patients into care.
b. Orientation of patients to services once they are admitted.
c. Function of controlling which patients see the physician and which do not.
d. Coordination of care, services, advocacy, and access for patients within the healthcare
system.
ANS: D
As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for
patients across all providers, settings, and levels of care.
REF: Page 414
TOP: AONE competency: Professionalism
16. A 27-year old woman is admitted to your ICU in a coma, following an accident. The family of
the patient, who is a Native American, places a medicine pouch in the bed with the young
woman. As the nurse in this situation, it is important to:
a. Explain to the family that the medicine pouch may contain herbs that may bother other
patients.
b. Ask the family about the significance of the medicine pouch for them.
c. Remove the pouch when the family is not present.
d. Put the medicine pouch on the shelf beside the bed.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: B
Diversity encompasses more than differences in nationality or ethnicity and may include a
variety of ways that patients are different from their healthcare providers. Nurses need to
recognize the culture of their work setting, realizing that it may differ markedly from the
culture of the consumer, and move beyond ethnocentrism to provide culturally competent
care. This competence includes cultural knowledge, which involves actively learning about a
community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and
practices of the people being served; and collaboration within a community (Flaskerud, 2007).
In this instance, it is important to understand the meaning of the pouch for the family; removal
from the bed without discussion does not demonstrate respect for the values and beliefs of this
family.
REF: Page 420 | Page 421
TOP: AONE competency: Communication and Relationship
NURSINGTB.COM
-Building
17. You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this
clinic might be:
a. Development of services that are identified in various studies as important for this
target group.
b. Partnership with area city councilors and health professionals to provide services that
are consistent with their vision and funding sources.
c. Provision of immunization and addictions services and health screening services for
women in the area.
d. Development of services that have been identified by the women and neighborhood
advocates as necessary for their health care.
ANS: D
Involvement of persons in their own health care is a cornerstone of healthcare reform and is
important for improving health outcomes and patient experiences. While studies and
partnership with key informants are important sources of information in the design of
services, engagement of the women through their neighborhood advocates may increase
activation and resulting behavior. Patient activation refers to patients' willingness and ability
to take independent actions to manage their health and care.
REF: Page 415
TOP: AONE competency: Knowledge of the Health Care Environment
18. Which of the following exemplifies a service orientation?
a. Staff members on the unit are encouraged to chart details about family support
networks.
b. Chart audit reveals that details related to assessment of family history are missing.
c. The palliative care unit organizes a “tree of light” fundraiser each year to highlight
the importance of palliative care.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. A children’s preoperative holding area is initiated in response to requests from
families and nurses who care for them..
ANS: D
A service orntation needs to translate caring into appropriate, timely action that meets the
needs of patients. Activities such as documentation of details or promotion of services may
remain at the technical or conceptual level without a commitment to caring interactions. The
institution of a holding area where families can be with children represents a caring action that
arises out of interactions and knowledge of patient needs and thus, is service oriented.
REF: Page 415
TOP: AONE competency: Communication and Relationship-Building
19. As a head nurse, you are concerned about the service orientation on your unit. Which of the
following findings and approaches might provide useful information for you?
a. Patients find nurses friendly and accessible; data are aggregated for the institution as
a whole.
b. Data indicate that nurses are responsive to requests for assistance; data are available
for the unit and the institution.
c. Specific questions related to management of comfort are included for the institution
as a whole.
d. The survey asks for a range of responses for the unit and the organization, with a
focus on facilities, such as cleanliness and responsiveness of administr
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services.
ative
ANS: B
The National Database of Nursing Quality Indicators (NDNQI®) is a national repository for
unit-based quality data that can be used by organizations to benchmark the outcomes of care
against those of other institutions (ANA, n.d.). Unit-based quality indicators, including
satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being
provided with their own and comparison data, researchers are able to access de-identified data
in order to answer important questions about nursing care quality. Pain management, the
discharge process, and post-discharge patient callbacks are specific areas where nurses can
make significant improvement in patient satisfaction. Because patients and nurses may differ
in what they see as factors that produce satisfaction, total reliance on nursing perceptions of
patient satisfaction may not provide a complete picture.
REF: Page 417
TOP: AONE competency: Knowledge of the Health Care Environment
20. As a nurse manager, you see an opportunity for patients to be well serviced through the medical
home concept. You recognize that the concept of medical homes:
a. Currently does not include nurses in its vision of multifaceted primary care.
b. Includes nurses as part of an interdisciplinary and multidisciplinary team.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Restricts nurses to services related to direct care and procedures.
d. Cannot encompass nurses within this framework.
ANS: A
The concept of medical homes encompasses the idea of multifaceted medical homes that
provide a usual source of health care. Current discussions have focused on physician-directed
care even though nurses in advanced practice are well suited to lead teams in this model.
REF: Page 414 | Page 415
TOP: AONE competency: Knowledge of the Health Care Environment
21. Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered
approach that focuses on the meaning of the experience for the patient and family, primary
nursing, and a health literacy approach. Sue is: a. Using high-tech–low-touch approaches.
b. Using high-tech–high-touch approaches.
c. Providing products.
d. Providing tangible products of satisfaction.
ANS: B
The provision of humanistic care within a high-tech environment is characteristic of high
tech–high touch approaches and reflects the idea that the more that high-tech is used, the more
patients also desire high-touch.
REF: Page 417
TOP: AONE competency: Knowledge of the Health Care Environment
22. Which of the following actions best exemplifies advocacy?
a. Developing a list of agencies that will provide free services for the homeless
b. Working in a needle exchange program for individuals in an inner-city environment
c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
d. Working in a free clinic for immigrant workers
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ANS: C
Advocacy means making known and defending and protecting the rights and interests of
others, as well as ensuring the dignity and respect due to others. Simply being employed in an
environment where this might be a focus of practice does not necessarily ensure that advocacy
is actually occurring.
REF: Page 420
TOP: AONE competency: Professionalism
23. During review of a patient’s progress, the healthcare team determines that a patient requires
treatment that is generally accepted at that time in the usual illness trajectory of a patient. The
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the
treatment. You are:
a. Empowering the patient.
b. Avoiding litigation.
c. Advocating for the patient.
d. Supporting the clinical pathway.
ANS: C
Advocacy means defending the rights and interests of others and, in this situation, the right of
a patient to receive care, as determined by standards utilized in a critical pathway.
REF: Page 420
TOP: AONE competency: Professionalism
24. A nurse makes a medication error that is not serious and does not cause harm to the patient. As
the head nurse, your best action would be to:
a. Call attention to it by posting the critical incidents report at the nursing station.
b. Include the mistake on the nurse’s performance appraisal.
c. Apologize to the patient for the error, and indicate that discipline has occurred.
d. Educate the nurse on how to provide an apology to the patient.
ANS: D
Service recovery ensures responsiveness to the patient, and as part of service recovery, it is
important to address an error in the most productive way, which also includes the nurse who
made the error offering an apology to the patient.
REF: Page 419 | Page 420
TOP: AONE competency: Communication and Relationship-Building
25. An example of a factor that would impede a patient’s learning is:
a. Poverty.
b. Limited health insurance.
c. Being an older adult.
d. Heavy sedation.
ANS: D
Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care:
persons of a different race or ethnic group, women, children, older adults, rural residents, and
those with limited or no health insurance, low health literacy, and/or low socioeconomic
status. It is important that lower expectations for persons who are disadvantaged, have a low
literacy level, or have limited English proficiency are not unintentionally communicated.
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REF: Page 423
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Which of the following activities would represent a customer-friendly approach in a
healthcare setting? (Select all that apply.)
a. Using a local anesthetic before inserting a needle into a child’s arm
b. Repeating patient history information to the admitting clerk, the admitting nurse, and the
ultrasound technician
c. Ensuring that birthing preferences are on file and available when a laboring mother comes
in
d. Providing support to families when a family member is brought into trauma
ANS: A, C, D
A service orientation means delivering services in a manner that is least disruptive. When
possible, services should come to the patient and should be as easy, comfortable, pleasant, and
effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is
important.
REF: Page 415 | Page 416
TOP: AONE competency: Communication and Relationship-Building
Chapter 23: Conflict: The Cutting Edge of Change
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse
manager. The staff wants to keep their old procedures, and they resist the changes. Conflict
arises from:
a. Group decision-making options.
b. Perceptions of incompatibility.
c. Increases in group cohesiveness.
d. Debates, negotiations, and compromises.
ANS: B
Conflict involves disagreement in values or beliefs within oneself or between people that
causes harm or has the potential to cause harm. Folger, Poole, and Stutman (2012) add that
conflict results from the interaction of interdependent people who perceive incompatibility
and the potential for interference.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 432
2.
TOP: AONE competency: Communication and Relationship-Building
Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying
to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a.
Risk taking seems to be unavoidable.
b. People see events differently.
c.d. Personal and professional priorities do not match.The ways in which people should act do not
match the ways in which they do act.NURSINGTB.COM
ANS: B
By definition, conflict involves a difference in perception between two or more individuals.
REF: Page 433
3.
TOP: AONE competency: Communication and Relationship-Building
The nurse manager is aware that conflict is occurring on her unit; however, she is focused on
preparing for a state health department visit, so she ignores the problem. A factor that can
increase stress and escalate conflict is: a. The use of avoidance.
b. An enhanced nursing workforce.
c. Accepting that some conflict is normal.
d. Managing the effects of fatigue and error.
ANS: A
Avoidance as a conflict-management style prolongs conflict and has a tendency to escalate
conflict.
REF: Page 436
4.
TOP: AONE competency: Communication and Relationship-Building
The nurse manager decides to use a mediator to help resolve the staff’s conflict. A basic
strategy for truly addressing this conflict is to: a. Identify the conflicting facts.
b. Be determined to resolve the conflict.
c. Schedule a meeting time for resolution.
d. Have a clear understanding of the differences between the parties in conflict.
ANS: D
It is important for each person in the conflict to clarify the conflict as “I see it” and how “it
makes me respond” before all the persons involved in the conflict can define the conflict,
develop a shared conceptualization, and resolve their differences.
REF: Page 435
TOP: AONE competency: Communication and Relationship-Building
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
5.
Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to
remain friends with her colleague and worries that confrontation with her colleague or reporting
her colleague will destroy their relationship. Sarah is experiencing which type of conflict?
a. Intrapersonal
b. Interpersonal
c. Organizational
d. Professional
ANS: A
Intrapersonal conflict occurs within a person when confronted with the need to think or act in
a way that seems at odds with that person’s sense of self. Questions often arise that create a
conflict over priorities, ethical standards, and values. Some issues present a conflict over
comfortably maintaining the status quo and taking risks to confront people when needed,
which can lead to interpersonal conflict.
REF: Page 433
TOP: AONE competency: Communication and
RelationshipNURSINGTB.COM
6.
-Building
The chief nursing officer plans a series of staff development workshops for the nurse managers
to help them deal with conflicts. The first workshop introduces the four stages of conflict,
which are:
a. Frustration, competition, negotiation, and action.
b. Frustration, conceptualization, action, and outcomes.
c. Frustration, cooperation, collaboration, and action outcomes.
d. Frustration, conceptualization, negotiation, and action outcomes.
ANS: B
Thomas (1992) determined that conflict proceeds through these four stages in this particular
order.
REF: Page 434
7.
TOP: AONE competency: Communication and Relationship-Building
After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the
chief nursing officer decides to:
a. Observe to make sure the conflict has been resolved.
b. Fire both staff nurses.
c. Reassign both staff nurses.
d. Reassign the nurse manager.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
The nurse leader should follow up to determine if the conflict has been resolved because, in
professional practice environments, unresolved conflict among nurses is a significant issue
that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient
satisfaction and poorer quality in patient care.
REF: Page 432 | Page 436
8.
TOP: AONE competency: Leadership
A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the
class that conflict in an organization is important, and that an optimal level of conflict will
generate:
a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its
workers.
b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its
workers.
d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.
ANS: C
Differences in ideas, perceptions, and approaches, when managed well, can lead to creative
solutions and deepened human relationships. Work on conflict suggests that complete
resolution of conflict is counterproductive to the achievement of organizational goals,
organizational change, and cohesiveness of employees.
REF: Page 432
9.
TOP: AONE competency: Communication and Relationship-Building
Jane has transferred from the ICU to the CCU. She is very set in the way she makes
assignments and encourages her new peers to adopt this method without sharing the rationale
for why it is better. This is a good example of a process and procedure that creates which type
NURSINGTB.COM of conflict?
a. Organizational
b. Intrapersonal
c. Interpersonal
d. Disruptive
ANS: C
Interpersonal conflict transpires between and among nurses, physicians, members of other
departments, and patients.
REF: Page 433
TOP: AONE competency: Communication and Relationship-Building
10. Two nurses on a psychiatric unit come from different backgrounds and have graduated from
different universities. They are given a set of new orders from the unit manager. Each nurse
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
displays different emotions in response to the orders. Nurse A indicates that the new orders
include too many changes; Nurse B disagrees and verbally indicates why. This step in the
process is which of the following in Thomas’ Stages of Conflict? a. Frustration
b. Conceptualization
c. Action
d. Outcomes
ANS: B
Thomas’ Stages of Conflict include conceptualization, which involves different ideas and
emphasis on what is important or not or about what should occur.
REF: Page 434 | Page 435
TOP: AONE competency: Communication and Relationship-Building
11. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral
feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some
noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was
the doctor’s decision. An hour later, the nurse returned and found Mr. Hill feeding his wife
again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was
trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to
walk away and documented the event in Mrs. Hill’s chart. According to Thomas’ Four Stages
of Conflict, in which stage could the nurse have been more effective? a. Frustration
b. Conceptualizing
c. Action
d. Outcomes
ANS: C
By walking away, the nurse is engaged in an action or a behavioral response, which is the
action stage of conflict that is outlined in the four stages of conflict (Thomas, 1992). In this
stage, the nurse might have used more effective strategies, such as clarifying Mr. Hill’s views
on feeding his wife and engaging in dialogue with Mr. Hill to clarify his concerns and attempt
to reach a common goal.
REF: Page 435
TOP: AONE competency: Communication and Relationship-Building
NURSINGTB.COM
12. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral
feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some
noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was
the doctor’s decision. An hour later, the nurse returned and found Mr. Hill feeding his wife
again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was
trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to
walk away and documented the event in Mrs. Hill’s chart. The outcome as depicted by
Thomas’ conflict stages can be considered to be: a. Compromising.
b. Confronting.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. Constructive.
d. Destructive.
ANS: D
Resolution was absent because the nurse did not have time to effectively deal with the issues
in the conflict. This can lead to negativity, increased frustration, and further distancing
between individuals or groups, including between patients and nurses.
REF: Page 439
TOP: AONE competency: Communication and Relationship-Building
13. Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing
and blaming each other, and a resolution has not occurred in months. To solve the existing
conflict, which is the most creative conflict resolution?
a. Avoiding
b. Competing
c. Compromising
d. Collaborating
ANS: D
Collaboration, although time-consuming, is the most creative stance. The collaboration
technique involves both sides in the conflict working together to develop an optimal outcome.
This results in a win-win solution.
REF: Page 439
TOP: AONE competency: Communication and Relationship-Building
14. A nurse educator is giving a workshop on conflict. During the sessions, he makes various
statements regarding conflict. All of the statements are true except:
a. Conflict can decrease creativity, thus acting as a deterrent for the development of new
ideas.
b. Horizontal violence involves those with similar status but little power in the larger context.
c. Interprofessional collaboration reduces unresolved conflicts.
d. All conflicts involve some level of disagreement.
ANS: A
The opposite is true because research has shown that conflict, like change, increases creativity
and allows for the development of new ideas.
REF: Page 432 | Page 444 | Page 445
TOP: AONE competency: Communication and Relationship-Building
N
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
15. Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a
URSINGTB.COM
staff nurse) and one of the maintenance personnel. Sarah explains to
Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in:
a.
b.
c.
d.
Decreased frustration between the maintenance worker and her.
A good relationship with the maintenance department.
Eventual resolution of the problem without further intervention.
Decreased productivity on her part.
ANS: D
Research by Saltman et al. (2006) determined that productivity decreases with destructive
conflict, whereas constructive conflict strengthens relationships.
REF: Page 435
TOP: AONE competency: Communication and Relationship-Building
16. Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to provide
quality patient care, and they express their concerns to senior management. The CEO of Valley
Hospital makes the following statement: “We need to contain costs because our funding has
been decreased.” This is a good example of which of the following conditions that propel a
situation toward conflict? a. Incompatible goals
b. Role conflicts
c. Structural conflict
d. Competition for resources
ANS: A
Conflicts arise in four areas: goals, facts, approaches, and values. Conflicts among goals arise
from competing priorities such as the provision of quality patient care and containment of
costs.
REF: Page 433 | Page 436
TOP: AONE competency: Communication and Relationship-Building
17. Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the
following statement, “I will sit on the hospital taskforce on improving morale if you send me to
the hospital’s leadership training classes next week, so I can further develop my skills and thus
be more effective.” Which of the following conflict management styles is Kala using? a.
Collaborating
b. Avoiding
c. Negotiating
d. Accommodating
ANS: C
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Negotiation involves an exchange of concessions (membership on a committee in return for
attendance at a workshop) or trading. This strategy supports a balance of power.
REF: Page 439
TOP: AONE competency: Communication and Relationship-Building
18. John is a circulating nurse in the operating room. He is usually assigned to general surgery, but
on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies
the doctor’s preference cards before each patient. The fourth patient comes into the room and
John prepares a site for a biopsy using a Betadine solution. The surgeon prefers another
solution. He notices what John has done and immediately corrects him by rudely
NURSINGTB.COM insulting John. Which of the following is the most appropriate
approach to conflict resolution in this example?
a. Collaboration
b. Compromising
c. Avoiding
d. Withdraw
ANS: B
Compromise involves negotiation or an exchange of concessions and supports a balance of
power.
REF: Page 439
TOP: AONE competency: Communication and Relationship-Building
19. Factors that influence the ease with which conflict is resolved include all except which of the
following?
a. Level of interdependence of the parties
b. Interprofessional collaboration.
c. Expression of one’s own needs and ideas.
d. Avoidance of the issue or concern.
ANS: D
Conflict involves a level of interdependence and is a condition for conflict but not necessarily
for continuance of the conflict. Expression of one’s ideas and concerns is considered assertive
and effective in resolving conflict if the concerns and needs of the other are also considered.
Interprofessional collaboration has been shown to be effective in resolving conflict.
Avoidance tends to prolong and sometimes escalate conflict.
REF: Page 432 | Page 436 | Page 438
TOP: AONE competency: Communication and Relationship-Building
20. The head nurse and a staff nurse are having a conflict over how to use and apply a new
procedure for dressings in the medical/surgical unit. The staff nurse wishes to use the new
procedure based on newly released nursing research. The head nurse wishes to use a protocol
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
that has been used in the department for a number of years. The head nurse later makes
comments to other staff on her unit about the credibility of the staff nurse. This behavior is
associated with:
a. Lateral violence.
b. Horizontal violence.
c. Confrontation.
d. Bullying.
ANS: D
Bullying involves aggressive or destructive behavior or psychological harassment of a
recipient who is in a position of power differential with the perpetrator (the head nurse).
Bullying is closely related to lateral or horizontal violence and involves such behaviors as
incivility or intimidation.
REF: Page 439 | Page 444
TOP: AONE competency: Communication and Relationship
NURSINGTB.COM
-Building
21. Which of the following exemplifies the predominant conflict management style of nurse
managers?
a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is
irritable in relation to any suggestions or new ideas, and so she comes in to work
after Tom leaves the unit.
b. The technology committee has recommended a clinical system for implementation
on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff
for ideas on how to meet the technology goals and to meet staff needs.
c. During management meetings, George, the head nurse on nephrology, dominates
meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to
miss the management meetings.
d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head
nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor
evening staff in the use of the new clinical information system.
ANS: D
Compromise involves trading and negotiation and is the predominant conflict management
style of managers.
REF: Page 439 | Page 440
TOP: AONE competency: Communication and Relationship-Building
22. Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days
to discuss concerns about Jillian’s relationships with her team members. Lee hopes to offer
Jillian coaching so that Jillian’s relationships can be more satisfying for Jillian and her team
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation,
Lee and Jillian are demonstrating:
a. Similar conflict management strategies.
b. Escalation of conflict.
c. Avoidance and compromise strategies.
d. Competing and compromise strategies.
ANS: C
Jillian is demonstrating avoidance by staying away from meetings to discuss her team
relationships, and Lee is demonstrating compromise by offering coaching in return for
Jillian’s being able to engage in more satisfying relationships.
REF: Page 436
TOP: AONE competency: Communication and Relationship-Building
23. Which of the following best exemplifies the predominant style of conflict management for staff
nurses?
a. Sarah and Jonas, two RNs, disagree about the best approach to assisting a family that
has complex needs. They decide that they will consult with family and together will
decide what is best.
b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with
Nancy, who wants a day off next to a 3-day break.
c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating
that she has already helped out for two days by staying late for Lindsay.
d.
Lara asks Stacey to switch shifts with her because Lara wants to attend a concert.
Stacey would prefer not to but does to enable Lara, who is new in town, to be with
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her friends.
ANS: D
Avoidance and accommodation are the predominant conflict management styles of nurses.
Accommodating involves neglecting one’s own needs while trying to satisfy the needs of
another.
REF: Pages 438-440
TOP: AONE competency: Communication and Relationship-Building
24. In trying to achieve Magnet™ status, the chief nursing officer establishes a shared governance
model to help nurses experience job satisfaction. However, some nurses who have enjoyed
working with less autonomy resist this change and begin to criticize and make rude comments
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
about managers who embrace this model, as well as colleagues who support it. The comments
are largely ignored because those who are making them are well established nurses who are
often vocal about their displeasure with the organization. Organizational conflict is arising from
which of the following? a. Staffing practices
b. Increased participation in decision making
c. Allocation of resources
d. Tolerance of incivility
ANS: D
Organizational conflict arises from discord related to policies and procedures (such as staffing
policies and practices and allocation of resources), personnel codes or conduct or accepted
norms of behavior (such as incivility), and patterns of communication. A major source
conflict in organizations stems from strategies that promote more participation and autonomy
of staff nurses.
REF: Page 433 | Page 434
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. Nurses entering into the workforce today are faced with which of the following relationships that
could create organizational conflict? (Select all that apply.) a. Nurse-physician relationship
b. Nurse-nurse relationship
c. Nurse-patient relationship
d. Nurse-chief nursing officer relationship
e. Nurse-auxiliary personnel relationships
ANS: A, B, C, D, E
By nature, conflict is potentially present in all interpersonal situations. The nurse manager
should create an environment that recognizes and values differences in staff, physicians,
patients, and communities.
REF: Page 442
TOP: AONE competency: Communication and Relationship-Building
NURSINGTB.
Chapter 24: Managing Personal/Personnel Problems
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: C
Emotional difficulties are usually beyond the scope of skills that a nurse manager would
normally employ. A referral needs to be made to a professional who is specifically prepared to
deal with this kind of difficulty.
REF: Page 458
TOP: AONE competency: Communication and Relationship-Building
2. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is
that:
a.
b.
c.
d.
Using replacement personnel with new ideas may be beneficial.
Salary costs are lower because personnel are fewer, and outcome is favorable.
Absence on the part of the rest of the staff is decreased.
Unacceptable patient care may result.
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ANS: D
Reduced staffing adversely affects patient care. Employee morale suffers, care standards may
be lowered, and additional stress is placed on working staff.
REF: Page 451
3.
TOP: AONE competency: Knowledge of the Health Care Environment
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.
ANS: A
In documenting staff problems, it is important to identify the incident with an objective
statement of facts and record actions taken to correct/prevent future problems.
REF: Page 459 | Page 462
4.
TOP: AONE competency: Business Skills
Before terminating an employee, a nurse manager must:
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: B
It is important to know the policies of the organization to address disciplinary issues fairly and
equitably, as well as to know the model that is employed to address employee problems.
Human resource departments and legal departments are important sources for consultation,
advice, and support.
REF: Page 460
5.
TOP: AONE competency: Business Skills
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.
ANS: C
The progressive model of discipline advocates that the first step of the disciplinary process is
the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates
reminding the employee of the employment policies and procedures of the agency.
REF: Page 460
6.
TOP: AONE competency: Business Skills
The chief nursing officer understands that clinical incompetence is best prevented by a(n):
a. Flexible protocol for evaluating competency skills.
b.c. Standardized clinical skills checklist.NURSING TB.COM
Administration of personality tests and competency assessments at point of hire.
d. Formalized competency program with established standards for practice.
ANS: D
The competency program with established standards of practice outlines what the nurse must
do to achieve desired competencies in her current position. Competency assessment and goalsetting should help the nurse identify how to excel and which competencies the nurse wants to
achieve in the future.
REF: Pages 454-456
TOP: AONE competency: Business Skills
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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
ANS: B
In documenting staff problems, it is important to specifically indicate what rules were broken
or violated, consequences if behavior is not altered, employee’s explanation of the incidents,
and the plan of action to achieve and to reach new goals.
REF: Page 459 | Page 462
8.
TOP: AONE competency: Business Skills
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.
ANS: C
A chemically impaired nurse jeopardizes patient care through impaired skills and judgment.
She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in
work performance for their impaired team member.
REF: Page 457 | Page 458
9.
TOP: AONE competency: Business Skills
The chief nursing officer reviews the policy about “progressive discipline process.” The
progressive discipline process includes which of the following? The manager: a. Is 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.NURSINGTB.COM
d. Should terminate the employee if the problem persists.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Termination can be defined as the discharge of an employee who is performing at an
unsatisfactory level or who is not a good match for the organization. Termination is always
considered the last resort when dealing with poor performance.
REF: Page 460
TOP: AONE competency: Business Skills
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
ANS: C
All steps should be followed, including full appropriate detailed documentation and following
the procedures of the organization.
REF: Page 460
TOP: AONE competency: Business Skills
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
ANS: A
Many employees increase their absenteeism just before submitting their resignation. If the
healthcare worker is experiencing some form of role stress, it might be manifested through
absenteeism. Role strain may be reflected by (1) withdrawal from interaction; (2) reduced
involvement with colleagues and the organization; (3) decreased commitment to the mission
and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness
are associated with immaturity.
REF: Page 452
TOP: AONE competency: Business Skills
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.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
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.
ANS: A
Situations that may warrant immediate dismissal include theft, violence in the workplace,
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REF: Page 460
willful abuse of the patient, harassment, and chemical abuse.
TOP: AONE competency: Business Skills
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.
ANS: B
For the employee to change and grow, specific corrective measures need to be taken.
Consultation with the employee is necessary, and documentation is key to determining the
issues.
REF: Page 453 | Page 454
TOP: AONE competency: Business Skills
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
ANS: C
A manager needs to be alerted when suspicions of chemical dependency are raised by
behavioral changes in the employee. These include mood swings, changes in hygiene and
appearance, heightened interest in the pain control of patients, frequent changes in shifts,
increases in absenteeism, and increases in tardiness.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 457
TOP: AONE competency: Business Skills
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.
ANS: B
Effective management demands that the organization take an active role in helping employees
with special needs. Humanistic strategies that counsel and assist employees are cost-effective
and necessary.
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REF: Page 458
TOP: AONE competency: Business Skills
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
ANS: D
Dismissal does not enable the present organization to attempt remediation of the behavior and
is not consistent with first steps in progressive discipline.
REF: Page 458
TOP: AONE competency: Business Skills
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
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
The steps in progressive discipline are followed from the least severe (counseling the
employee) to the most severe (termination). Studies have shown that following this sequence
provides a fair and effective plan for discipline and remediation.
REF: Page 460
TOP: AONE competency: Business Skills
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.
ANS: D
Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious
to warrant immediate dismissal with the first incident.NURSINGTB.COM
REF: Page 460
TOP: AONE competency: Business Skills
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.
ANS: A
Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if
the behavior continues, then written documentation should be filed in Marg’s personnel file.
Monitoring and follow-up are your responsibility as the unit manager.
REF: Page 460
TOP: AONE competency: Business Skills
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?
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a.
b.
c.
d.
Ignore Ellen’s errors until she has more experience.
Instruct staff to avoid working with Ellen until she learns to how do things herself.
Ask Ellen to complete a self-assessment, using a standard skills checklist.
Encourage staff to report every behavior of Ellen’s that is different from theirs.
ANS: D
When other employees are engaged in enabling behavior by covering for the mistakes of one
of their peers, the nurse leader may be surprised to discover that the employee does not know
or cannot do what is expected of him or her. The nurse leader must remind employees that
part of professional responsibility is to maintain quality care and thus they are obligated to
report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring
violations of a safety rule or poor practice is unprofessional and cannot be tolerated. The
employee may be asked to do a self-assessment of the listed skills or competencies and then
have performance of the skills validated by a peer or co-worker. This is a very effective
method for the leader to assess the skill level of employees and to determine whether
additional education and training may be necessary.
REF: Pages 454-456
TOP: AONE competency: Communication and Relationship-Building
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.
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ANS: A
Not all absenteeism is voluntary or preventable, which means that absenteeism can never be
fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction,
and involuntary reasons such as jury duty.
REF: Page 452
TOP: AONE competency: Business Skills
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.”
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
As a manager, you need to be familiar with state and professional regulatory and reporting
requirements regarding chemical use and abuse, as well with Human Resource practices and
guidelines.
REF: Page 457 | Page 458
TOP: AONE competency: Business Skills
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.
ANS: B
Documentation of personnel problems is one of the most important aspects of the nursing
manager’s role. Through carefully detailed and timely documentation of the problem and
plan, the manager decreases the burdensome problems that can ensue from improper or
inadequate documentation.
REF: Page 459 | Page 462
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. 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? (Select all
that apply.)
a. Employee morale is at a high level.
b. Care will suffer and standards will be lowered.
c. Existing staff have experienced little effect from the absenteeism.
d.e. Replacement staff usually needs little supervision.Unit costs have increased because of staff
replacements and overtime.NURSINGTB.COM
ANS: B, E
Absenteeism puts a strain on staff, produces morale problems, can jeopardize patient safety,
and increases unit costs.
REF: Page 451
TOP: AONE competency: Business Skills
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
2. 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.”
ANS: A, B, C, D
The nurse leader must remind employees that professional responsibility is to maintain quality
care, and thus they are obligated to report instances of clinical incompetence, even when it
means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and
jeopardizes patient care.
REF: Pages 454-456
TOP: AONE competency: Professionalism
Chapter 25: Workplace Violence and Incivility
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
MULTIPLE CHOICE
1. Your healthcare organization places a high value on workplace safety and integrates this into all
aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse
this direction, and during the selection and hiring of new staff, you consistently: a. Refuse to hire
applicants who are pushy during interviews.
b. Thoroughly follow up with all references before offering a position.
c. Ask applicants during the interview if drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories.
ANS: B
Determining if current employees pose a danger in the workplace is a critical factor that is
often overlooked. In addition to personal and psychological factors, behaviors can be
observed in employees that may be related to violence or aggression in the workplace (Paludi,
Nydegger, & Paludi, 2006). The most obvious indicator is a previous history of aggression
and substance abuse. Screening potential employees through drug testing, background checks,
and references can help reduce the risk of hiring someone who may pose a danger in the
workplace.
REF: Page 469 | Page 470
TOP: AONE competency: Business Skills
2. You need to terminate Gregory, who has had a long-standing history of conflict with you and
the staff, and who recently was charged with theft of patient belongings. You consult Human
Resources, and together, you develop a plan, which includes:NURSINGTB.COM
a. A private meeting with Gregory, a Human Resources representative, and you to
deliver the news and deliver the termination notice and all other documents that are
related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired and that his paperwork will be sent
to him at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is available,
should he become upset or agitated.
ANS: A
Termination requires careful planning as to timing, privacy, safety, and how to preserve the
employee’s dignity and avoid humiliation. Choosing a private location where colleagues are
not present, and organizing all documentation that is required to be given to Gregory, achieves
these goals and prevents his having to come to the organization at a future date.
REF: Page 469
TOP: AONE competency: Business Skills
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
3. In which of the following situations would you, as the head nurse, be concerned about potential
safety issues?
a. Jordan comes to your office to complain about inadequate staffing on the unit. He
says that he is concerned because he attributes a recent incident to the staffing levels.
b. Henry, a long-standing RN on the unit, has begun to miss work regularly. He calls
in but is vague about his reasons for the absences.
c. Carla, RN, has just ended an abusive relationship with Jake, RN, and he will not
leave her alone. You are meeting with Jake today because colleagues on nights have
reported that Jake seems to have been intoxicated last night and the previous night.
d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been
much more animated since becoming friendly with a couple of other RNs on the
unit.
ANS: C
Jake seems at most risk for violence because of his alcohol use and history of aggression. In
the other situations, Jordan is expressing a legitimate concern and is behaving assertively;
Henry may have health concerns or other issues that are private and interfering with his work
life; and Sarah’s change in behavior is likely related to a higher level of comfort with work
and colleagues.
REF: Page 470
TOP: AONE competency: Business Skills
4. Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling
others that you are incompetent and do not know what you are doing in relation to patient care,
and that you lie to the staff about attempts to get more staffing. Delaney says that
Marjorie is derogatory towards her in front of others and tells her “that she better shape up.”
Through telephone calls and conversations during breaks, she is recruiting other staff to her
position. Delaney confides that most of the staff find you fair, honest, and knowledgeable.
Marjorie’s behavior can best be characterized as: a. Political action.
b.c. Bullying.Building alliances.
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d. Disgruntlement.
ANS: B
Workplace bullying involves aggressive and destructive behaviors such as running a smear
campaign, engaging in put-downs, and excluding team members from socialization
opportunities.
REF: Page 465 | Page 473
TOP: AONE competency: Business Skills
5. During coffee and other breaks, Rosalie, the new RN, is shut out of conversations with the other
staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the
other direction. The behavior of the staff is characteristic of: a. Dislike.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
b. Lack of trust in Rosalie’s abilities.
c. Horizontal violence.
d. Cultural incompetence.
ANS: C
Horizontal or lateral violence and bullying are terms used to describe destructive behaviors
towards co-workers, such as the “silent treatment” and shutting others out of socializing.
REF: Page 465 | Page 473
TOP: AONE competency: Business Skills
6. While working with an aggressive patient, it is important for the nurse to: a. Speak firmly.
b. Call the individual by name.
c. Place herself between the patient and the door.
d. Ignore threats against her.
ANS: C
In situations where a patient may become aggressive, it is important to ensure that you are not
trapped in the room.
REF: Page 479 | Page 480
TOP: AONE competency: Knowledge of the Health Care Environment
7. Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car
accident. The father screams at her and tells her that she has no right to ask his family to leave,
and that if she continues to do so, he will “throw her out of the room.” Caroline is shaken and
tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of
the head nurse:
a. Is reasonable. No physical violence was involved.
b. Is related to why statistics on violence in health care are likely underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse.
ANS: B
A common perception is that incidences such as these, which do not involve physical injury or
harm, but rather threats, are part of the job. Because of underreporting, data related to
violence and aggression in the workplace may not be reflective of its true incidence.
NURSINGTB.COM
REF: Page 465
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
8.
You are part of a multidisciplinary team that is charged with designing a workplace safety plan
for your healthcare organization. This team has been established in response to increases in
reports of violence and aggression. You begin by:
a. Surveying staff about levels of satisfaction with the workplace and management, collegial,
and patient relations.
b. Offering training sessions in self-defense.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviors with potential for violence.
ANS: A
Violence and aggression and a toxic workplace can lead to staff dissatisfaction and high staff
turnover rates. Surveying staff provides a useful starting place in identifying problems such as
employee dissatisfaction, bullying, and other forms of violence.
REF: Page 468 | Page 471
9.
TOP: AONE competency: Business Skills
In the Emergency Department waiting room, you notice a patient sitting, with his head in his
hands, who has been waiting for about 5 hours for relief of his headache. When you approach
him to ask him how he is doing, he says, “I can’t believe that I have to wait this long for help!
Do you know what it is like to be in pain for 10 hours?” Your response to him would be: a. “It
is frustrating to wait when you are in pain and when you are expecting to
receive relief right away.”
b. “Don’t talk to me. If you are going to be rude, then you will not receive treatment
here.”
c. “We are very busy and don’t have enough staff to deal with problems such as yours.”
d. “Perhaps you should go elsewhere. We do not have time for you here, as many more
sick patients are waiting.”
ANS: A
Empathizing helps the other person to know and feel that he has been understood and is
powerful in de-escalating a situation that has potential for aggression and violence.
REF: Page 479 | Page 480
TOP: AONE competency: Communication and Relationship-Building
10. At 3 AM, a man walks into your emergency department. He paces back and forth in the waiting
area before he approaches staff to ask if he can see his wife, who is a patient on another floor.
He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his
jacket pocket. A best initial response would be to: a. Assess your situation and your
surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are closed.
d. Remain calm as there is no potential for violence here.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: A
The behavior of the individual (flushed appearance, furtive glances, speed of speech) and the
hand in his pocket suggest the potential for violence or aggression. The first step is to quickly
assess your surroundings for others who might assist and for safety
aNURSINGTB.COM
larms.
REF: Pages 39-40 | Pages 81-82
TOP: AONE competency: Knowledge of the Health Care Environment
11. Linda, a staff nurse on nights, yells at Ali, another RN, and tells Ali that she is stupid and can’t
get anything right. In responding to this situation as head nurse, it is critical that you: a. Require
that Linda attend anger management classes.
b. Investigate to see if Ali did anything to aggravate Linda.
c. Call both immediately into the office to discuss the situation.
d. Respond to Linda in a way that is consistent with organizational processes and with
similar situations.
ANS: D
Erratic or arbitrary discipline, favoritism, or behavior that undermines the dignity of either
individual undermines efforts at curbing workplace violence. Disciplinary actions must be
proportionate, consistent, reasonable, and fair.
REF: Page 475
TOP: AONE competency: Business Skills
12. Residents in a new long-term care facility attend a large dining hall for meals. In reviewing
reports of aggression and violence, you note that behaviors such as hitting, or attempting, to hit
staff are increasing. Further investigation suggests that this behavior occurs most often at
mealtimes. A possible intervention would be to:
a. Seat residents with the highest potential for violence next to those with the lowest potential
for aggression.
b. Feed residents earlier in the day.
c. Restrain residents who are violent or aggressive during mealtimes.
d. Establish a smaller dining area that is away from the main area that is for residents who
have potential for aggression/violence.
ANS: D
Violence and aggression are more likely during times of increased activity, such as mealtimes.
Reducing activity levels through interventions such as a separate dining area may reduce
incidents of violence and aggression.
REF: Pages 468-469
TOP: AONE competency: Knowledge of the Health Care Environment
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
13. You note that Unit 64 has had a high turnover rate of staff during the past year. In investigating
this situation, an important source of data might include: a. Employee evaluations.
b. Level of experience of staff.
c. Exit interviews with staff.
d. Selection processes and decisions.
ANS: C
Exit interviews may assist in identifying issues such as workplace violence, bullying, and
intimidation by managers.
REF: Page 471 | Page 472
TOP: AONE competency: Business Skills
N
14. You note that Unit 64 has had a high turnover rate of staff during the past year. In selecting
URSINGTB.COM
the appropriate action, it is important that: a. All documentation is
reviewed.
b. Usual processes for discipline are followed.
c. Confidentiality is assured.
d. An incident report is filed.
ANS: C
Confidentiality is important if an employee fears intimidation or retribution from a manager.
REF: Page 471
TOP: AONE competency: Communication and Relationship-Building
15. You note that Unit 64 has had a high turnover rate of staff during the past year. In addressing
the staff turnover rate, you are:
a. Confirming the high correlation between managerial incompetence and violence.
b. Demonstrating awareness that workplace violence, if present, has significant costs.
c. Aware that staff and manager experiences contribute to high turnover.
d. Aware that violence is a rare but present factor in the workplace.
ANS: B
Workplace violence and aggression contribute to staff turnover and toxic work environments.
Loss of the organizational investment required to train new staff and departure of experienced
staff can increase operating costs and reduce the quality of care.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 468
TOP: AONE competency: Business Skills
16. A patient who has a history of involvement with drugs and weapons comes up to you in the
hallway and asks you a question regarding directions in treatment. When you respond, he
moves closer in to you and puts both hands up on either side of your neck. No one else is in
the hallway. Your best response at this point is to: a. Yell at him to stop.
b. Calmly ask the patient to remove his hands.
c. Hit the patient in the midsection.
d. Use pepper spray.
ANS: B
In a potentially violent situation, it is important to look and behave in a calm and confident
manner, even if you do not feel calm or confident. The person that you are de-escalating will
notice and take his cues from you.
REF: Page 478
TOP: AONE competency: Communication and Relationship-Building
17. Jenny tells you that she is always able to tell when others are about to become violent because
they yell. Your response to Jenny is based on your understanding that: a. Her perception is
accurate.
b. Yelling is more likely associated with aggression.
c. Violence is signaled by a variety of behaviors.
d. She is mostly accurate in her thinking.
ANS: C
The STAMP Assessment Components and Cues outline a wide variety of verbal and
nonverbal cues that might signal the potential for violence.NURSINGTB.COM
REF: Page 476 | Page 478
TOP: AONE competency: Business Skills
18. Joe and Carol, two of the RNs on Unit 22, are discussing recent incidents on the unit that have
involved patients and visitors uttering threats or making demeaning remarks to staff during
evening hours. Joe observes that unless someone shoots at him, he is not concerned because
“words can’t hurt you.” Joe’s remarks:
a. Illustrate common misperceptions about the nature of violence.
b. Accurately depict the difference between violence and aggression.
c. Are partially correct because verbal remarks do not cause injury.
d. Reveal possible issues that Joe relates to violence in his personal life.
ANS: A
a.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
Violence and aggression involve verbal and nonverbal and covert and overt behaviors, and all
forms are capable of producing short- and long-term injury that may have an impact on
productivity, work performance, work attendance, and patient care.
REF: Page 464 | Page 465
TOP: AONE competency: Business Skills
19. Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in
Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics.
Which of these four is most at risk for violence and aggression?
Becky
b. Sarah
c. Sharon
d. Donna
ANS: A
Healthcare workers, especially nurses, experience a disproportionately high rate of violence,
compared to personnel in other industries. Nurses are the primary target of violence in
healthcare settings, especially those who work in emergency room, mental health, and
geriatrics. Hader (2008) found that nurses experienced their colleagues as primary targets of
violence 79.7% of the time.
REF: Page 465 | Page 468 | Page 469
TOP: AONE competency: Business Skills
20. Which of the following healthcare employees is MOST at risk for violence?
a. Becky, working in a well-lit area with stable psychiatric patients and other staff members
nearby.
b. Sarah, who works in a busy emergency room. Access to the emergency patient units is
allowed by security staff and alarm systems are in place in patient units.
c. Sharon, who works evening shifts. Workstation is behind a shatterproof glass, and an
alarm can be reached easily from her computer.
d. Donna, who works the evening shift, cleans rooms each night in the administrative wing
and business offices, which are largely empty. The wing is near an outside access door.
ANS: D
Staff who work in isolated, poorly lit areas are at higher risk of violence, which would
describe Donna’s work conditions. In addition, if the business office contains money, this
could make it a desirable target for criminals. While Becky and Sarah work
iNURSINGTB.COM
n high-risk areas (mental health and the emergency room),
the nearby presence of colleagues, the availability of alarms, and good lighting help to reduce
the risk.
b.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
REF: Page 468
TOP: AONE competency: Business Skills
21. A safety and security plan is important to a healthcare organization because it:
a. Lays out preventive measures in relation to violence.
b. Provides direction as to changes in facilities that protect staff.
c. Establishes expectations in relation to behavior and tolerance of violence.
d. Establishes policies and practices that guide prevention of violence and expectations in
the workplace.
ANS: D
A safety plan provides overall direction in relation to what is expected, how violence is
prevented, and what will occur when violence happens.
REF: Page 471 | Page 472
TOP: AONE competency: Business Skills
22. Sarah is involved in intervening when a patient attempts to harm herself on the unit. During
the interaction, the patient slaps Sarah across the face. As a head nurse, it is important that
you:
a. Offer Sarah immediate education and training in self-defense.
Assist with follow-up documentation and offer access to counseling.
c. Provide access to a lawyer.
d. Encourage Sarah to see the incident as a normal part of care.
ANS: B
Training should be conducted on a regular basis and cover a variety of topics, including
policies and procedures for reporting, record-keeping, and for obtaining medical care,
counseling, workers’ compensation, or legal assistance after a violent episode or injury.
REF: Page 477
TOP: AONE competency: Business Skills
23. Which of the following is NOT a factor in patient- and/or family-generated violence in
healthcare settings?
a. Feelings of vulnerability
b. Anxiety about treatments or diagnoses
c. Feelings of powerlessness or loss of control
d. Staff rudeness
ANS: D
Unlike in other settings, hospital violence differs in that it is usually the result of patients or
their family members feeling frustration or anger. This is usually related to feelings of
c.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
vulnerability, stress, and loss of control that accompany illness. Other factors such as the
location, size of the facility, and type of care provided also increase the risk for violence.
REF: Page 468 | Page 469
TOP: AONE competency: Business Skills
24. As a nurse manager, you realize that your unit has become a toxic environment in which
horizontal violence and incivility has become common. In addressing the problem, you decide
to implement which of the following?NURSI NGTB.COM a. Increased education in
clinical skills
b. Follow-up of all reports of violence
c. Training in conflict resolution and team-building
d. Posting of the institutional policy on violence at the nursing station
ANS: C
Encouragement to report violence in all its forms is crucial to understanding the root of the
problem and implementing plans to eradicate it. Acts of good faith by organizational
management in supporting staff include a policy of non-retaliation for reporting. Making sure
that reporting is easier and doing an impartial investigation are critical. Addressing a toxic
culture also requires training in conflict management, leadership, communication, and
team-building.
REF: Page 471 | Page 473
TOP: AONE competency: Business Skills
25. As a senior manager, you notice that there have been several resignations on a unit where a
new charge nurse has been hired. You suspect that the new charge nurse may be
demonstrating bullying behaviors, but staff say little about their relationship with the charge
nurse. Your decisions about intervention would be based on which assumptions?
a. The staff nurses would tell you if the charge nurse was engaging in relational violence.
b. It would be unusual for leaders to engage in violence and bullying behavior.
Bullying is primarily related to feelings of marginalization and jealousy among
d.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
peers.
d. Initiating confidential exit interviews will assist in determining if leader violence
or bullying is occurring.
ANS: D
To understand if violence or intimidation is a reason for leaving, organizations should
conduct exit interviews with the assurance that the information will remain confidential if
an employee fears retaliation. This is an important step in gauging if the problem is
bullying or intimidation by managers. Johnson (2009) found that 50% of respondents
indicated that they were bullied by their manager or director. The researcher suggested
that when management is part of the problem, victims have a harder time feeling they
have adequate support to end the negative cycle of violence. Lack of support leads many
victims of bullying to decide that the best alternative is to leave the organization and to
give this advice to others who find themselves in similar situations (Johnson, 2009).
REF: Page 471 | Page 472
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. In designing a new healthcare facility, it is particularly important to pay close attention
to safety elements related to violence and aggression in which of the following settings?
(Select all that apply.)
a. Emergency
b. Psychiatry
c. Gerontology
d. Maternal-child
ANS: A, B, C
NURSINGTB.COM
Although the potential for violence and aggression exists in all healthcare settings,
emergency, psychiatric, and geriatric settings are at particular risk for violence.
REF: Page 468
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 26: Delegation: An Art of Professional Nursing Practice
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
5.
NURSINGTB.COM
Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
MULTIPLE CHOICE
1.
You are a member of a team assigned to care for 15 general medical/surgical clients. You
have all worked well together in the past in this same type of care. If you are assigned to
coordinate this team’s work, your best strategy, based on the Hersey and Blanchard model,
would be to:
a. Have a list of tasks to be accomplished and tell each member of the team what he or
she must do.
b. Encourage people to discuss their frustrations in providing this care.
c. Ignore them—they’ve done it before.
d. Provide minimal direction and let them come to you with questions.
ANS: D
According to the Hersey and Blanchard model, when ability (skills, job knowledge) and
willingness are strong, the role of the delegator is less (“delegating behavior”).
REF: Page 493
2.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse manager is setting up the room assignments for the unit. She has one critical
patient on the unit, who is going to require more care than the others. Before delegating a
task, a nurse manager should:
a. Delegate the admission assessment to the LPN.
b.c. Review the employee’s performance assessment for the most recent period.Assess the
amount of guidance and support needed in a particular situation.NURSINGTB.COM
d. Create a task analysis of critical behaviors for the individual.
ANS: C
To delegate effectively, the nurse manager must assess the abilities required in the
situation and the abilities that staff have to anticipate the amount of direction, monitoring,
explanation, and independence that can be assumed.
REF: Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
3.
A key advantage that a nurse manager has in terms of delegating is that:
a. Clients receive less attention because too many staff make it difficult to coordinate
care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.
ANS: D
The use of multilevel healthcare providers enables healthcare organizations and nursing to
provide patient-centered care, with a focus on abilities and skills that can be employed to
perform “what is needed now.” As tasks become more complicated, delegating skills to
others enables the nurse to effectively deliver a complex level of care.
REF: Page 496
4.
TOP: AONE competency: Knowledge of the Health Care Environment
The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing
personnel (UNP) employee. The night nurse should remain: a. Accountable.
b. Responsible.
c. Authoritative and liable.
d. Responsible and task-oriented.
ANS: A
When a registered nurse delegates care to a UNP, responsibility is transferred; however,
accountability for patient care is not transferred. Thus, “accountability rests within the
decision to delegate while responsibility rests within the performance of the task”
(Anthony and Vidal, 2010, p. 3).
REF: Page 496
5.
TOP: AONE competency: Professionalism
The night nurse understands that certain factors need to be considered before delegating
tasks to others. These factors include the:
a. Complexity of the task and the age of the delegatee.
b. Potential for benefit and the complexity of the task.
c. Potential for benefit and the number of staff.
d. Complexity of the task and the potential for harm.
7.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
In delegating tasks to others, the nurse considers factors such as stability of the patient,
safety of the situation and of the patient, time and intensity involved, and level of critical
thinking required to achieve desired outcomes.
NURSINGTB.COM
REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
6.
During a fire drill, the nurse manager becomes very assertive and directive in her
communications with staff. This type of situational leadership depends on: a. Supportive
behavior by the leader and immature followers.
b. The development level of the followers and the type of behavior of the leader.
c. Well-developed followers combined with a strong leader who acts quickly.
d. The leader’s ability to evaluate personnel and communicate that evaluation.
ANS: B
When abilities, relationships, and/or time is limited (as in a crisis situation), the leader
assumes a bigger role in guiding and in making decisions (Hersey and Blanchard and
“telling” behavior).
REF: Page 493
7.
TOP: AONE competency: Leadership
The unit manager is working in a large metropolitan facility and is told that two UNPs are to
be assigned to work with her. Delegation begins with:
a. Acknowledging the arrival of the second UNP on the unit.
b. Providing clear directions to both UNPs.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.
ANS: C
In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as
the factors of safety, time, critical thinking, and stability of patients.
REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
8.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
8.
During staff development programs, staff nurses verbalize their frustration about their
workloads and having to delegate so many tasks to others. One of the main reasons that
delegation has emerged as an issue is because of:
a. The amount of paperwork required to complete care.
b. The complexity of client care.
c. Earlier discharge practices.
d. The numbers of other disciplines present on a given unit.
ANS: B
Complexity of client care, a multilevel nursing model (registered nurses, mixed with
LPNs/LVNs, and UNPs), and community-based care provide many challenges in
determining the care required and outcomes desired and/or mandated, and in matching
needs with various abilities and authority of regulated and unregulated healthcare
providers. The nurse manager should ensure that staff is clinically competent and trained
in their roles in patient safety.
REF: Page 486
9.
TOP: AONE competency: Knowledge of the Health Care Environment
The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day
shift nurse is engaging in what function? a. Delegating
b. Assigning
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c. Sharing
d. Authorizing
ANS: B
Delegation refers to transfer of responsibility for work; the day shift nurse retains
accountability for the outcomes of patient care.
REF: Pages 494-496
TOP: AONE competency: Knowledge of the Health Care Environment
10. You are working in a home health service and have three unlicensed nursing personnel
(UNPs) assigned to your team. You have worked with two of them for 2 years; the third is
new. The two experienced UNPs have patients with complex illnesses for whom they
provide basic care. The third member of the team has been assigned to patients with less
complex illnesses. Your best approach to supervising their care is to:
9.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. Remain in the office and ask each UNP to check in with you upon arrival at their
first patient care site.
b. Ask another RN to supervise the two experienced assistants so you can be with the
new person full time.
c. Meet the new staff member at the first patient care site and ask the others to call if
anything is unusual.
d. Meet the new staff member at the first patient care site and call the others with
questions to determine whether anything is unusual.
ANS: D
When ability and willingness are strong, the involvement of the delegator is less (Hersey
and Blanchard).
REF: Page 493 | Page 494
TOP: AONE competency: Knowledge of the Health Care Environment
11. With delegation, responsibility and accountability remain with the:
a. Physician.
b. Professional who delegates.
c. Individual who receives the delegation.
d. Individual who previously performed the task.
ANS: B
Even though the delegatee (the one who receives the delegation) receives direction from
the professional who delegates a task and must have the authority to complete it, the
delegator retains accountability for the overall outcome and completion of the activity.
The delegatee has responsibility (obligation to engage in the task) and authority for the
task.
REF: Page 488
TOP: AONE competency: Professionalism
12. Which of the following exemplifies accountability? Karen, the nurse manager on 5E:
a. Consistently submits her budgets on time.
b. Gets along well with her staff and with other managers.
c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice
Committee after serious patient injury.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
d. Actively solicits ideas regarding scheduling from her staff.NURSINGTB.COM
ANS: C
Reliability, dependability, and obligation to fulfill the roles and responsibilities of the
nurse manager are consistent with responsibility. Accountability refers to being
answerable for actions and results.
REF: Page 488
TOP: AONE competency: Professionalism
13. Which of the following indicates safe delegation?
a. The nurse supervisor for a large urban acute care department asks the unit
manager to accept two new acutely ill patients, which the manager does. The unit
is short two staff, and the replacement is inexperienced.
b. A unit manager agrees to release a staff from her unit to Unit B. The staff
member she agrees to release is experienced on Unit B and is agreeable to the
change. The unit manager’s unit is fully staffed and patients are stable.
c. The nurse supervisor asks the head nurse for Unit A to make do without a
replacement for an ill staff member because Unit A was originally overstaffed
anyway. Patient acuity levels are very high on Unit A and two staff are
orientating.
d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is
two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit
B is an experienced manager but has no experience with the nursing care required
on Unit F.
ANS: B
When span of control (number of individuals for whom a manager is responsible) is
compromised by geographic factors such as lack of proximity, instability in patients’
conditions, or lack of experience, the span of control that is being delegated may lead to
unsafe care.
REF: Page 492
TOP: AONE competency: Knowledge of the Health Care Environment
14. Which of the following would be most in line with Hersey and Blanchard’s concepts?
a. The team of caregivers on day shift are familiar with their roles and with the
patients. The nurse manager decides to work on the unit budget in her office.
b. After a year of working on the unit, Shari, an LPN, is still hesitant about many
policies and procedures. The charge nurse decides to challenge Shari with more
difficult patients.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
c. The nursing supervisor asks one of her charge nurses to lead a technology
integration project. The supervisor continuously demands involvement in
decisions that the charge nurse is making in the project.
d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses
assignments that are complex or difficult. The charge nurse suggests that Alysha
is relatively new and that she needs time to adjust.
ANS: A
The Hersey and Blanchard framework suggests that when ability (skills, job knowledge)
and willingness are strong, the involvement of the delegator is less.
REF: Page 493
TOP: AONE competency: Business Skills
15. In delegating to a UNP in a home health setting, which of the following represents the most
appropriate delegation communication?NURSIN GTB.COM
a. “You will be taking care of Mrs. S., who needs assistance with her bath.”
b. “You will need to help Mrs. S. get into and out of her shower. Ensure that you
check the condition of her feet, and let me know if you have any concerns when
you check in.”
c. “I am not sure that you know how to do this, but I am giving you Mrs. S. She is
quite obese and needs skin care.”
d. “Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be
completed by 10:00. When you are helping her to dry, please check between her
toes and toenails, and phone me by 10:30 if you notice nail discoloration or
redness.”
ANS: D
Delegation communication includes what is being delegated (and what is not), outcomes,
specific deadlines (if applicable), specific reporting guidelines (what, when), and who may
be consulted. Communication also includes conveying recognition of the authority to do
what is expected.
REF: Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
16. An RN colleague, who is a long-standing and collaborative member of your team, is
performing a complex and novel dressing for the first time for the patient to whom she has
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
been assigned. Which of the following would be the most appropriate communication with
her?
a. “How do you usually do this kind of dressing?”
b. “The dressing needs to be done today and tomorrow with the supplies on this cart.”
c. “Here is what you need for the dressing, and I will show you what needs to be done.”
d. “I know you know what you are doing. Let me know if you have any problems.”
ANS: C
If a situation involves a new task and the relationship is ongoing (two individuals who will
usually continue to work together), the delegator explains what to do and how to do it.
Hersey described the leader’s behavior as explaining or persuading, which, is
characterized as “selling.” The RN who is assigned to the patient is an experienced nurse
and team member, but is new to this specific situation. In situations where the nurse is
experienced but the task is new, explain (and demonstrate) what needs to be done.
REF: Page 493
TOP: AONE competency: Knowledge of the Health Care Environment
17. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She
is assigned David, a patient who has been admitted with a severe head injury. In
communicating with Sally, you would:
a. Provide a detailed explanation of what she needs to do with ICP monitoring.
b. Tell her when she needs to provide an update about David’s status.
c. Ask her to tell you what she knows about ICP monitoring and share expectations about
reporting.
d. Advise her that you are available if she needs you.
ANS: D
You and Sally have a well-established relationship and Sally has the expertise to work
effectively with David; therefore, you would need to provide little guidance but would
need to NURSINGTB.COM communicate that you are available if needed. Hersey
refers to this leader behavior as
“delegating.”
REF: Page 493
TOP: AONE competency: Knowledge of the Health Care Environment
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
18. You ask Evelyn, a new UNP, to check what is left in Mrs. N.’s inhaler when Evelyn makes
visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the
medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is
enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is
admitted to the hospital in severe respiratory distress. When she is admitted, she tells the
physician that she has not been using the inhaler for 4 weeks. This incident is an example
of: a. Incompetence of the UNP.
b. Failure to follow through.
c. Skills but no motivation.
d. Lack of accountability.
ANS: B
The nurse should maintain open lines of communication and seek information, and the
UNP should know how, when, and what to report. Communication of delegation of tasks
includes specific information about what is being delegated, expected outcomes, and
deviations (which includes what immediate action needs to be taken). This two-way
communication and follow-through allows patient care to be altered, if necessary, in a
timely manner.
REF: Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.’s inhaler when Evelyn makes
visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the
medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is
enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is
admitted to the hospital in severe respiratory distress. When she is admitted, she tells the
physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to
Mrs. N.’s care, the most appropriate action of the care coordinator would have been to:
a. Determine Evelyn’s educational background and preparation for this role.
b. Ask Evelyn if she has worked with inhalers before and to describe what she knows
about them.
c. Advise that if Evelyn has any questions about what to do with the inhaler, she
should come to the coordinator.
d. Advise Evelyn that working the inhaler is not really complicated and that she
should ask the patient how to check medication levels in the inhaler.
ANS: B
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
When delegating tasks, in addition to specifying the task to be completed, outcomes,
priorities, timelines, deviations, report time frames, monitoring, and resources, asking the
delegatee to give examples of each is helpful in ensuring that communication is clear and
has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice
is to determine the knowledge and skill level of the UNP in relation to the skill and the
patient before delegating.
REF: Page 492
TOP: AONE competency: Knowledge of the Health Care Environment
20. You ask Evelyn, a new UNP, to check what is left in Mrs. N.’s inhaler when Evelyn makes
NURSINGTB.COM
visits to Mrs. N. and also to check whether Mrs. N. is receiving
any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the
inhaler and that there is enough medication left in the device. The day of her last visit to
Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is
admitted, she tells the physician that she has not been using the inhaler for 4 weeks.
Determination of Evelyn’s educational preparation and certification is related to the concept
of: a. Accountability.
b. Authority.
c. Role performance.
d. Assignment.
ANS: B
Authority refers to the right to do and may be designated by law, educational preparation,
or job description.
REF: Page 488
TOP: AONE competency: Business Skills
21. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a
team leader on the rehab unit, assesses the needs of the patients in her area, assesses the
skills and backgrounds of each of the individuals on her team, and then assigns and
delegates the appropriate care provider to each patient and task. Sarah’s activity in the
example described is termed:
a. Passive delegation.
b. Passive accountability.
c. Active delegation.
d. Active responsibility.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
When a position description contains functions that are considered to be the normal
practice of the person in that role, then it is considered a passive delegation act. When
Sarah decides what is best for the patients in her care in terms of who should perform the
care and then holds the person accountable, she is engaging in active delegation.
REF: Page 492
TOP: AONE competency: Knowledge of the Health Care Environment
22. Functions such as “delegates tasks to assistive personnel” that are outlined in a position
description for an RN Team Leader would be considered: a. Active delegation.
b. Passive delegation.
c. Passive accountability.
d. Active responsibility.
ANS: B
Delegation of functions that are normally considered part of or an essential part of the
practice of a licensed person through a position description is considered passive
delegation.
REF: Page 492
TOP: AONE competency: Knowledge of the Health Care Environment
23. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a
team leader on the rehab unit, assesses the needs of the patients in her area, assesses the
skills and backgrounds of each of the individuals on her teNURSINGTB.COMam, and
then assigns and delegates the appropriate care provider to each patient and task. Sarah
provides Colleen, her RN colleague with details regarding the patients to whom Colleen has
been assigned on the day shift. This is an example of:
a. Accountability.
b. Responsibility.
c. Assignment.
d. Delegation.
ANS: C
When an RN assigns care to another RN, it is termed an assignment and not delegation,
because both accountability and responsibility are transferred.
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REF: Pages 494-496
TOP: AONE competency: Knowledge of the Health Care Environment
24. Leslie, a UNP, transfers a patient while using improper technique. The patient is injured,
and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the
delegatee) are named. Sarah is named in the suit because she:
a. Retains accountability for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.
ANS: D
Whenever care is provided by someone other than a registered nurse, accountability for
care remains with the manager/delegator even though others provide aspects of care.
REF: Page 496
TOP: AONE competency: Knowledge of the Health Care Environment
25. Ali, an RN on your unit, is consistently late to work and makes remarks such as “Do you
really want me to do that?” when patients and care are assigned to her. You have spoken
with her frequently about her: a. Ability.
b. Skills.
c. Attitude.
d. Personal issues.
ANS: C
Hersey and Blanchard explained followership in terms of ability and willingness. Attitude
refers to willingness or reluctance to perform work.
REF: Page 493
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. An example of a care activity that would likely not be delegated by an RN to a UNP is
(select all that apply):
a. Teaching self-catheterization to a patient with paraplegia who has limited English.
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b. Basic care for a patient with a head injury who is rapidly deteriorating.
c. One-to-one observation with a suicidal patient.
d.e. Assessment of patients being admitted through the Emergency Department.Basic hygienic
care for a patient who is post MI and stable.NURSINGTB.COM
ANS: A, B, D
Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In
addition, stability, critical thinking, time, and safety are factors that are considered in
assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a
patient with limited English requires critical thinking; basic care for a patient who is
rapidly deteriorating exemplifies concern with stability; and assessment of patients
through Emergency is related to the factor of time. An exception to safety and stability in
which patients may be delegated to UNPs is when patients are placed on suicide
precautions.
REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 27: Role Transition
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1.
The unit leader on an inpatient psychiatric unit of a large hospital has been in the position
for 3 months. The unit leader is frustrated by how little time is available to work with
clients and how few changes have been implemented in that time. The phase of role
transition being experienced is the role of: a. Acceptance.
b. Negotiation.
c. Discrepancy.
d. Internalization.
ANS: C
Role discrepancy is an experience that includes a gap between what is expected and what
is occurring and can lead to disillusionment, discomfort, and frustration. If the unit
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manager values the relationship and sees the differences between performance and
expectations as correctable, then the manager is likely to stay in the role.
REF: Page 510
2.
TOP: AONE competency: Leadership
An interviewee for a nurse manager position asks for a copy of the organizational chart.
Organizational charts provide information about the role component
of: a. Expectations.
b.c. Opportunities.Responsibilities.
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d. Lines of communication.
ANS: D
No matter what role an individual is in, multiple relationships exist with individuals
including supervisors and peers. Roles incorporate patterns of structured interactions
between the manager and people in these groups. Organizational charts provide
information about relationships and lines of communication in the organization.
REF: Page 507 | Page 508
TOP: AONE competency: Knowledge of the Health Care Environment
3.
During an employment interview for the manager’s position in a home health agency, the
applicant asks questions about the medical director and about retention of staff. The nurse
executive assures the applicant that the agency has few personnel problems and receives
excellent support from the medical director. The applicant knows that the agency has a 50%
turnover rate and has had three medical directors in the past year. The nurse executive is: a.
Unaware of the turnover rate and difficulties with the medical director.
b. Lying about the problems and hoping to resolve them by hiring the applicant.
c. Denying that the agency has a turnover problem with staff or medical directors.
d. Minimizing the challenges of the position to make a positive impression on the
applicant.
ANS: D
During the dating phase or preview period in the role transition process, the potential
employer attempts to make a favorable impression, which may result in minimizing the
challenges of the position.
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REF: Page 510
4.
TOP: AONE competency: Business Skills
The new head nurse on telemetry has been in the position for 3 months. The head nurse and
the administrator disagree on how much time the head nurse should allot to various aspects
of the role. Staff members on the unit complain that the head nurse is unavailable for
clinical concerns because of being off the unit while attending meetings. To facilitate the
process of role transition, the head nurse should:
a. Develop policies consistent with the head nurse’s prior workplace.
b. Attend a workshop on how to deal with difficult people.
c. Decide to give the position 3 more months and then leave if things do not improve.
d. Schedule a series of meetings with staff and the administrator to clarify expectations.
ANS: D
During role transition, it is important for the manager to negotiate the role by writing
down the manager’s expectations of the role and determining the expectations of others
(staff, supervisors) in order to clarify expectations and reduce or ameliorate role
ambiguity and role strain. Weinstock (2011) suggests that it takes up to a year to
understand the role, system, and boundaries in a new position.
REF: Page 512 | Page 513
TOP: AONE competency: Communication and Relationship-Building
5.
A nurse manager in one hospital values a colleague who is a few years older and has more
NURSINGTB.COM
experience in nursing management. The colleague works in
another hospital, but they meet for lunch once a month. In these meetings, they share their
feelings about nursing management and their lives. The function of a mentor that is missing
in the relationship is: a. Sponsorship.
b. Role modeling.
c. Social interaction.
d. Mutual positive regard.
ANS: A
Sponsorship involves building the competency of the mentee through exposure or by
creating opportunities for achievement in order for the mentee to develop a reputation of
competence.
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REF: Page 514
6.
TOP: AONE competency: Leadership
The new nurse manager feels pulled between the expectations of staff, the demands of
hospital administrators, and family obligations. According to Hardy (1978), unrelieved role
stress and strain will lead to: a. Frustration and anger.
b. Alienation of family and friends.
c. Low productivity and performance.
d. Physical symptoms and acute illness.
ANS: C
Unrelieved role stress and strain leads to focusing energy into negative thoughts and
feelings, which can leave the manager fatigued and therefore less likely to be productive
or to perform well.
REF: Page 509
7.
TOP: AONE competency: Leadership
The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being
near retirement, the former nurse manager wanted to be employed at the hospital and was
offered a position on the same unit. The former nurse manager complains often about how
infrequently the current nurse manager is available on the unit and argues with physicians
and co-workers. Clients have complained about the attitude of the nurse. The behavior of
the former nurse manager can be best explained as being caused by: a. Overwork in the staff
nurse position.
b. Inadequate mentoring in the new role.
c. Anger as a stage of the grieving process.
d. Demotion as a threat to personal identity.
ANS: C
When an employment relationship ends or changes unexpectedly, grieving occurs. One of
the phases in grieving is anger.
REF: Page 510 | Page 511
8.
TOP: AONE competency: Leadership
A nurse is interviewing for a manager’s position. Which of the following actions is
considered a role preview?
a. Formal commitment of the employment contract
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b. Improving role performance
c. Touring the unit
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d. Disillusionment about the expectations of the job
ANS: C
Touring the unit enables the candidate to assess further whether this organization will
assist in growth and also to make a positive impression on the potential employer.
REF: Page 510
9.
TOP: AONE competency: Business Skills
The chief nursing officer develops a mentoring program to help new staff members adjust
to their new jobs. The main purpose of mentoring is: a. Promoting staff retention.
b. Promoting staff attrition.
c. Developing new role expectations.
d. Promoting staff supervision.
ANS: A
Mentoring has been identified as important to staff retention.
REF: Page 513
TOP: AONE competency: Business Skills
10. A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3
years, has a particular interest in technology and seems to be very enthused about working
with software and hardware at home. She speaks with Nathan and asks him if he would lead
investigation of software applications on the unit. This is an example of:
a. Opportunity.
b. Delegation.
c. Role negotiation.
d. Role transition.
ANS: A
Nathan’s nurse manager recognizes Nathan’s interest in technology as an opportunity for
the unit and as an untapped resource that can be used to meet unit goals.
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REF: Page 508
TOP: AONE competency: Business Skills
11. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
the unit that she has been hired to manage. Sarah’s actions are important in avoiding role: a.
Ambiguity.
b. Transition.
c. Development.
d. Negotiation.
ANS: A
Clarification of implicit and explicit expectations regarding the role assists in avoiding
role ambiguity and role strain.
REF: Page 509
TOP: AONE competency: Leadership
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12. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
the unit that she has been hired to manage. After beginning her new position, Sarah finds
that she spends a great deal of time in direct patient care. Her staff begins to complain that
they are never able to find her when they need her, and that some aspects of her
responsibilities fall behind, such as scheduling. Sarah is most likely:
a. Lacking an understanding of the nurse management role.
b. Attempting to prove her clinical skills to the nursing staff.
c. Experiencing difficulty in unlearning old roles.
d. Lacking enjoyment in her new role.
ANS: C
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Role transition involves transforming one’s identity. Although any of the answers listed
might be correct, as a new manager, her confidence in her clinical skills suggests that she
is having difficulty in the transformation process and in unlearning her role as a clinician.
REF: Page 510 | Page 511
TOP: AONE competency: Leadership
13. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
the unit that she has been hired to manage. A strategy that may help to make the transition
to her management role and to respond to relationships and situations in her new position is:
a. Avoiding discussion of her personal beliefs with staff until she is ready to do so.
b. Finding a network of clinicians with interests similar to her own.
c. Researching clinical literature to maintain her clinical assessment skills for the unit.
d. Recognizing her strong commitment to care in the management process through
journaling.
ANS: D
During the transition period, it is important to recognize, use, and strengthen values and
beliefs, translate these for staff, and adapt behaviors to the situation. Understanding
personal and professional beliefs and values assists in helping the manager respond to
situations and relationships.
REF: Page 512
TOP: AONE competency: Leadership
14. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends
time with her nurse executive to clarify the executishe has been hired to manage. Sarah
finds that she has begun to think negatively about the NURSINGTB.COve’s
expectations of her and of the unit that M
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
way nursing care is delivered on her nursing unit. She often wishes that she was back on
her old unit and in her familiar staff nurse role. This behavior: a. Is natural when
assuming a new position.
b. Diverts energy from internalization of Sarah’s new role.
c. Is justified if practices are deficient on the new unit.
d. Reflects Sarah’s astuteness as a clinician.
ANS: B
By focusing on the weaknesses of the unit, Sarah may lack the energy to internalize the
new role—a step that is critical to being an effective leader. As a new manager, Sarah
must learn how to access resources in the organization. Approaching the organization as a
foreign culture, Sarah can keenly observe the rituals, accepted practices, and patterns of
communication within the organization. This ongoing assessment promotes a speedier
transition into the role of manager.
REF: Page 510 | Page 511
TOP: AONE competency: Leadership
15. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the
role of unit manager for 3 years and has a similar interest in clinical excellence. During their
frequent meetings, Amy provides assistance with learning aspects of the manager’s role,
including technical aspects, such as how to interpret budget printouts and to achieve budget
outcomes. The success of Amy’s coaching depends on: a. Clarity of Amy’s information.
b. Organizational support for the mentor relationship.
c. The congruence of Amy’s beliefs with Sarah’s beliefs.
d. Willingness of Sarah to receive feedback.
ANS: D
Coaching provides information about how to improve performance and learning aspects of
the role. Coaching requires willingness on the part of the mentee to accept feedback.
REF: Page 514
TOP: AONE competency: Leadership
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16. In addition to providing coaching, a nurse mentor may provide counseling to the mentee.
For counseling to be successful, the mentor must:
a. Provide a quiet environment away from the unit.
b. Keep the focus on technical and management responsibilities.
c. Assure confidentiality.
d. Present assignments that stretch the intellectual and technical ability of the
mentee.NURSINGTB.COM
ANS: C
Counseling provides opportunity for the mentee to share personal concerns. For
counseling to be successful, confidentiality must be assured.
REF: Page 514 | Page 515
TOP: AONE competency: Leadership
17. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
the unit that she has been hired to manage. After a year, Sarah successfully transitions into
the nurse manager role and considers taking the examination to become a certified nurse
executive.
Amy advises her that this is not possible because Sarah will
need: a. A graduate degree.
b. At least a nursing diploma.
c. 24 months of experience.
d. 5 years of successful experience.
ANS: C
Nurses with baccalaureate preparation and holding a nurse executive position with at least
24 months of experience can take the examination to become a certified nurse executive.
REF: Page 515
TOP: AONE competency: Leadership
18. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has
taken some certificate courses in leadership and management and has considered beginning
a graduate degree with this focus. She is excited about being able to use her knowledge and
interest by being hired as a nurse manager. Before beginning her new position, Sarah
spends time with her nurse executive to clarify the executive’s expectations of her and of
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
the unit that she has been hired to manage. Sarah finds that she is comfortable with the
expectations of staff and her supervisor regarding her management role and responsibilities
and has been able to effect a strong commitment to quality clinical care on the unit. At this
point, Sarah has likely attained this role: a. Development.
b. Acceptance.
c. Symmetry.
d. Internalization.
ANS: D
Role internalization is achieved when the manager experiences performance of the role as
being congruent with his or her own beliefs. Role acceptance refers to accepting the
contract and making a public announcement of the acceptance.
REF: Page 510 | Page 511
TOP: AONE competency: Leadership
19. As a new manager, you reflect on what professional development would be most valuable
to assist you in taking on this role. Which of the following would you most likely identify?
a. Opportunities to hone clinical skills that are used most often on the unit that you will
manage.
b. A workshop on conflict management and communication sNURSINGTB.COM
kills.
c. Attendance at a conference on global health care economics.
d. Attendance at a workshop on survey tool development and statistical measurement.
ANS: B
Patrician et al. (2012), in a qualitative descriptive study that explored the professional
development needs of nursing leaders, developed a number of recommendations that were
based on what charge nurses indicated about their needs. The recommendations included
education and orientation to the role, managing performance and development of staff,
and communication skills. Additional education should be focused on unit finances and
patient relations. Leadership support was found to be pivotal for charge nurses to feel
successful or hinder their work.
REF: Page 515
TOP: AONE competency: Leadership
20. John, a new nurse manager, complains to his colleague that he feels very uncomfortable
with the conflict between what he thinks he should be doing as the manager and what his
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
supervisor thinks he should be doing. According to Hardy’s role theory, John is
experiencing: a. Stress.
b. Role stress.
c. Role strain.
d. Role exploration.
ANS: C
According to Hardy, role strain is the subjective feeling of distress that occurs when role
stress or a social condition of conflicting demands or difficult conditions is present.
REF: Page 507 | Page 509
TOP: AONE competency: Leadership
21. Seth is hired as the nurse manager for a surgical unit. After a year, the hospital reorganizes,
and his position is lost. In leaving the unit, it is important for Seth to:
a. Engage in clarifying why the hospital did not state its expectations for the unit at the
time of hiring.
b. Hire a lawyer to represent his interests during this unexpected role transition.
c. Seek counseling to deal with his shock and anger.
d. Negotiate a reasonable settlement.
ANS: D
When role transition occurs as a result of restructuring, the unit manager should request
and negotiate reasonable compensation and assistance, even if it is not offered initially by
the employer.
REF: Page 511
TOP: AONE competency: Business Skills
22. After several months in the role of manager of a dialysis unit, Maryanne finds herself still
questioning the gap in expectations between her and her staff and management and is also
questioning if she can reconcile her concerns about quality care with the strong cost
containment orientation of the facility. At this point, Maryanne is in which stage of role
transition?
a. Internalization
b. Acceptance
c. Development
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d. Discrepancy
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
At this point, Maryanne is still experiencing discomfort and disillusionment with the gap
between what she expected and what others expect of her in the performance of her role
as manager. She is considering the significance and fit of the relationship for her, which is
consistent with role discrepancy.
REF: Page 510
TOP: AONE competency: Leadership
23. In assisting new graduates to make the role transition to graduate nurse, Ted, the unit
manager initiates which of the following?
a. Self-check list to assess competencies that have been strengthened
b. Discussions that focus on what the new graduates have yet to learn
c. Fixed target dates for acquisition of competency and transition to RN role
d. Frequent formal meetings to provide feedback on performance and areas to be
strengthened
ANS: A
Transition to the new role is facilitated through reflection and ongoing development of
awareness of strengths (as compared with a focus on weaknesses) and of weaknesses. The
value of the employee may not depend on quickness in making the role transition.
REF: Page 508
TOP: AONE competency: Leadership
24. Who of the following might be the BEST mentor for Becky, a new nurse manager on the
cardiac unit who has 4 years of previous clinical experience?
a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed
role of head nurse in an interim capacity because of the incumbent’s illness.
b. Leslie, who has been a clinical educator at the institution for a number of years.
She has tired of her role and aspires to become a nurse manager. She looks at
mentorship as an opportunity to understand the role better.
c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor
value her skills and her leadership acumen and championship of innovation.
d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role
because he was uncomfortable with the expectations and has been a team leader
on surgery for 15 years.
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ANS: C
A mentor needs to have sufficient professional experience and organizational authority so
that he or she can mentor the career of the mentee. Mentors need competencies that
include interpersonal and communication effectiveness, risk taking and creativity, and
ability to inspire change.
REF: Page 514
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. As a result of Amy’s coaching, Sarah, a nursing graduate of 5 years, completes a ROLES
assessment. This assessment is helpful in (select all that
apply):NURSINGTB.COM
a. Identifying her
clinical knowledge.
b. Role development.
c. Areas of conflict in expectations.
d. Expected work time commitments.
ANS: B, C, D
A ROLES assessment is useful in identifying, confirming, and visualizing responsibilities,
opportunities, lines of communication, expectations of self and others for the position, and
support. This is particularly useful in identifying areas of conflict in expectations,
including conflict between the manager’s own expectations and those of staff and
supervisors and in negotiating role expectations.
REF: Pages 508-510
TOP: AO
Chapter 28: Self-Management: Stress and Time
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. As a nurse manager, you observe a staff nurse who over the past few weeks has become
withdrawn and has had several absences due to minor ailments. Your best action would be
to: a. Ask the nurse if she is okay during report.
b. Refer the nurse to the employee assistance program.
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c. Ask the nurse to meet with you for a few minutes before she leaves for the day.
d. Write a note to the nurse advising her that her work attendance must improve.
ANS: C
Stress can lead to emotional symptoms such as depression and a variety of ailments.
Meeting with the nurse privately may assist in identifying stress and possible solutions.
REF: Page 526 | Page 527
TOP: AONE competency: Business Skills
2. The nurse manager of a unit has lost many staff members, and the unit is now staffed with a
large number of agency and traveling nurses. She knows that the agency and traveling nurses
are all contracted to stay on the unit for the next 3 months. One way to improve morale and
decrease stress in the unit would be to:
a. Plan a social event and include the agency and traveling nurse staff members.
b. Plan unit-based social events for your remaining permanent staff members.
c. Request hospital-based “floating” nurses to substitute for the temporary staff.
d. Implement team nursing.N URSINGTB.COM
ANS: A
Social support, in the form of positive work relationships, can be an important way to
buffer the effects of a stressful work environment. Including all staff in the social event
enables those who are not normally part of the team to experience this support and
provides an opportunity for the staff as a whole to develop supportive relationships.
REF: Page 528
TOP: AONE competency: Communication and Relationship-Building
3. As a nurse manager, the one activity you should not overlook is:
a. Posting the yearly rotation schedule.
b. Reviewing vacation requests.
c. Scheduling staffing for holidays 6 months in advance.
d. Anticipating staff sick days.
ANS: B
Free time and vacation time are needed for individuals to recharge. If time for work is
more than 60% of wake time, or when self-time is less than 10% of wake time, stress
levels increase.
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REF: Page 527
TOP: AONE competency: Business Skills
4. A nurse manager has decided that she must institute some personal time management steps to
survive work and home life. Her first step should be to:
a. Determine what takes up so much of her time and energy.
b. Organize her personal and work spaces.
c. Purchase a handheld personal digital assistant to help remind her of important
meetings.
d. Determine her personal and professional goals.
ANS: D
Personal time management refers, in part, to “the knowing of self.” Self-awareness is a
critical leadership skill, and being self-aware and setting goals helps managers determine
how their time is best spent.
REF: Page 533
TOP: AONE competency: Leadership
5. A hospice nurse has been feeling very stressed at work because of both the physical strain
and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles
three times a week and to talk regularly with her husband about her work-related feelings.
One reasonable stress management strategy would be to: a. Start taking yoga lessons.
b. Make an appointment to meet with a psychiatrist.
c. Start jogging 5 to 6 miles every day.
d. Plan to go out for a drink with fellow nurses after work every day.
ANS: A
Stress relief techniques include 30 minutes of exercise five times a week, as well as
techniques such as yoga that relieve mental stress.
REF: Page 530
TOP: AONE competency: Leadership
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6.
The nurse manager is implementing a shared governance model to help with
communication and decision making. Although staff members like the concept, change is
difficult. Staff nurses feel:
a. More empowered.
b. More communicative.
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c. Less stressed.
d. More powerless and devalued.
ANS: D
Change can lead to feelings of being overwhelmed and powerless, especially if
complexity compression or rapid, intense changes have been involved.
REF: Page 521 | Page 526
7.
TOP: AONE competency: Business Skills
The chief nursing officer listens to nurse managers verbalize their feelings of internal stress.
One common source of internal stress seems to
be: a. The death of a loved one.
b. Perfectionism.
c. Getting married.
d. Losing a job.
ANS: B
Losing a job, the death of a loved one, and getting married are examples of external stress.
REF: Page 523 | Page 524
8.
TOP: AONE competency: Business Skills
The staff development educator presents a series of programs on stress management to the
nurse managers. Research has indicated that an individual’s ability to deal with stress is
moderated by psychological hardiness. Psychological hardiness is a composite of: a.
Commitment, control, and challenge.
b. Commitment, powerlessness, and passivity.
c. Commitment, control, and passivity.
d. Decreased isolation, challenge, and passivity.
ANS: A
Some people have the capacity to accept changes in life with good humor and resilience,
which, in turn, influences behavior that prevents illness. Hardiness involves the capacity
to manage time and stress, to reframe situations positively, and to commit.
REF: Page 523 | Page 524
TOP: AONE competency: Leadership
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9.
The chief nursing officer understands that a nurse manager can exhibit stress that is related
to trying to keep up with the number of electronic messages that arrive, as well as trying to
remain accessible to staff. What is a strategy that would assist the manager to manage the
information overload effectively?
a. Ignore messages unless they are labeled as important.
b. Determine who is most likely to send useful or important information or requests.
c. Check e-mail messages once a day.
d. Encourage face-to-face meetings rather than e-mail.
ANS: B
Reduction of stress related to information overload requires the development of
NURSINGTB.COM information-receiving and information-sending skills.
Information-sending skills include determining most common sources of useful data,
labeling files and folders to which e-mail messages can be directed, deletion of e-mails,
and focusing on the most important pieces. Information-sending skills include keeping email messages short (and calling if the message needs to be long) and considering the
most appropriate medium for messages (telephone, fax, face-to-face).
REF: Page 537 | Page 538
TOP: AONE competency: Professionalism
10. In helping nurse managers to manage their time, the chief nursing officer suggests that they:
a. Maintain a perfectionistic attitude.
b. Set up a complaint list.
c. Have good negotiation skills.
d. Have good information literacy skills.
ANS: D
Time can be saved by using information technology effectively, as it assists with effective
data retrieval and information gathering and with communication related to a variety of
needs in the management setting.
REF: Page 535
TOP: AONE competency: Business Skills
11. Which of the following statements would best define stress? Stress is:
a. The comfortable gap between how we like our life to be and how it actually is.
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b. Everyday life, both the highs and the lows.
c. A consequence or response to an event or stimulus that can be positive or negative. d.
Identical to distress.
ANS: C
Stress is defined as a gap between how we would like our lives to be and how they
actually are and as a consequence or response to an event or stimulus. It is not inherently
bad (distress), and whether highs and lows are seen as distress or eustress is dependent on
each individual’s interpretation of the event.
REF: Page 520
TOP: AONE competency: Business Skills
12. In a job interview for a nursing position, Marley can be assured that which of the following
will occur?
a. Both eustress and distress
b. Only eustress
c. Only distress
d. Neither eustress nor distress
ANS: A
Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an
unpleasant nature. One can assume that every interview has both of these stresses.
REF: Page 520
TOP: AONE competency: Business Skills
13. Which one of the following statements has been proven to be true?
a. Recent research has found that women do not have a unique physiologic response
NURSINGTB.COM
to stress.
b. Both men and women interpret the same stressor in the same manner without regard to
past experiences.
c. Stress influences the immune system in one complex manner.
d. Stressors that are identical do not necessarily have similar effects on each individual.
ANS: D
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Stressors may be unique to certain environments, situations, and persons or groups, and
individuals may respond to the same stressor in different ways.
REF: Page 524
TOP: AONE competency: Business Skills
14. An example of role stress occurs when:
a. The director of the ICU and the manager of the surgical unit wish to hire the same new
employee.
b. Two part-time staff members are hired to work in a unit, but the job expectations for
them are not clear, and the head nurse expresses disappointment in their performance.
c. The nurse manager for the ICU wants to advocate for more staff and finds it difficult
to find data to substantiate his proposal.
d. Line managers believe that support staff use their technical knowledge to intrude on
their authority.
ANS: B
Role stress is an additional stressor for nurses. Viewed as the incongruence between
perceived role expectations and achievement, role stress is particularly acute for new
graduates. Failure to comply with expectations can lead to role conflict. Role conflict and
role ambiguity are major sources of conflict for nurses.
REF: Page 522
TOP: AONE competency: Business Skills
15. A staff nurse approaches the unit manager and indicates to her that because of her father’s
death in the previous month, she is now finding it very difficult to do her work effectively.
This would be considered a(n) ________ stress. a. Internal source
b. Familial
c. Burnout
d. External
ANS: D
External stress is outside and removed from the work setting, but it is considered workrelated stress because of the impact it has on the worker.
REF: Page 521
TOP: AONE competency: Business Skills
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16. Sources of occupational stress in nursing include all except which of the following? a.
Authoritarian leadership
b. Concern about moral wrongdoing by colleagues
c. Multiple changes in a short time
d. Rotating shifts
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ANS: A
Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts,
and workload are all sources of work-related stress for nurses.
REF: Page 520
TOP: AONE competency: Business Skills
17. Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge.
Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views
this as abandonment by his family and is worried that the care will be inadequate. Each
senior perceives the situation differently. This is a good example of stress that is: a. Both a
positive stressor and a negative stressor.
b. Occurring only because of age.
c. Positive in both cases.
d. Harmful in both cases.
ANS: A
Some researchers have determined that stress is a person-environment process in which
the person appraises the situation as taxing or not. Appraisal is an important concept that
explains why two people react in different ways to the same situation. Stress can be
viewed as positive (eustress) or negative (distress).
REF: Page 520 | Page 524
TOP: AONE competency: Business Skills
18. Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6
months’ severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and
is asked to take early retirement with a buyout. How will the two men react to the
emotional and physical influences and the sequence of stress? a. The younger man will feel
more stress.
b. The two men may or may not feel the same amount of stress.
c. The older man will feel more stress.
d. Neither man will experience any stress.
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ANS: B
The response to similar stressors does not always result in a similar experience of stress in
individuals. Responses are mediated by the appraisal of the event as well as by factors
such as gender, personality, lifestyle, and age.
REF: Page 524 | Page 525
TOP: AONE competency: Business Skills
19. Social stressors are considered a major factor in the stress nurses experience in the
healthcare system. Which of the following is not considered to be a social stressor? a. High
amounts of stress in the nursing home environment
b. Changes in the current healthcare system such as nursing strategies
c. Disruptive behavior coming from physicians and other healthcare workers
d. Stress triggers such as self-criticism and overanalyzing
ANS: D
Personal stress triggers such as self-criticism are considered intrapersonal stressors;
environmental factors such as change, work environment, and interactions with others are
considered social stressors.
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REF: Page 521
TOP: AONE competency: Business Skills
20. After several months of heavy patient loads in the Emergency Department and inability to
secure sufficient and experienced staff, the department is especially taxed by a train
accident that brings in many seriously injured individuals. You observe that Rama ignores
the requests of several of the injured, even when time is available to care for them and is
rude to two elderly patients. You are concerned that Rama is evidencing which state? a.
Hardiness
b. Depression
c. Role ambiguity
d. Depersonalization
ANS: D
A characteristic of burnout is depersonalization, a state characterized by distancing
oneself from the work itself and developing negative attitudes toward work in general
(Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being
outside one’s body, feeling as if one is a machine or robot, an “unreal” feeling that one is
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in a dream or that one “is on automatic pilot.” Generally, subjective symptoms of
unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little
time may distance themselves from patients as a means of dealing with emotional
exhaustion.
REF: Page 529
TOP: AONE competency: Business Skills
21. “Stress-buffering” behaviors can be elicited to reduce stress. All of the following
behavioral coping responses can be used by nurse managers to reduce and manage stress
except: a. Distancing oneself from work.
b. Using cognitive reframing to change irrational thoughts.
c. Refusing a request to sit on a committee to evaluate scheduling software.
d. Exercising regularly.
ANS: A
Achieving balance between work and leisure is a useful strategy for stress reduction.
Distancing, however, can be a sign of depersonalization that includes negative attitudes as
well and is a characteristic of burnout.
REF: Pages 526-529
TOP: AONE competency: Business Skills
22. The education consultant at St. Joseph’s Hospital is giving a workshop on cognitive
reframing. The consultant explains that cognitive reframing reduces stress by: a. Aiding
individuals in identifying positive stressors.
b. Helping people realize that negative thinking causes emotional distress.
c. Eliminating negative stressors.
d. Replacing positive self-statements with negative irrational beliefs.
ANS: B
Cognitive reframing is a therapy that aids individuals in discovering that their irrational
thoughts can be replaced with responses that are more rational. It enables individuals to
gain a sense of control over the situation and can change “I’ll never ...” to “I can ...” or
“She always ...” to “Sometimes she ... .” It is an approach that allows individuals to
replace negative thoughts and statements with others that are more realistic and helpful.
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REF: Page 526 | Page 527
TOP: AONE competency: Business Skills
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23. Time management is very essential for the nurse manager. Which of the following is not a
good time-management technique? a. Decide what not to do.
b. Learn to say “No.”
c. Learn to delegate.
d. Break down your workload into large manageable tasks.
ANS: D
To manage time successfully, it is important to break down your workload into smaller,
manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger,
complex projects. Both charts can be used to outline how an individual will approach a
large project.
REF: Page 533 | Page 534
TOP: AONE competency: Leadership
24. As a unit manager, you chair the unit meetings. For each meeting, you consider and
establish the purpose of the meeting. Second, you prepare an agenda. Arrange the
following steps in an order that would make the meetings productive and successful.
1. Distribute an agenda.
2. Distribute minutes.
3. Select team members.
4. Start on time.
5. Keep the meeting focused and directed toward accomplishing the set objectives. Select
the correct order from the following options: a. 1, 2, 4, 5, 3
b. 4, 1, 2, 5, 3
c. 3, 1, 4, 5, 2
d. 3, 4, 2, 1, 5
ANS: C
Planning, organizing, and keeping the group on task are critical in ensuring that meetings
are productive and that time is managed well.
REF: Page 541
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
1. High levels of work-related stress affect all but which of the following? (Select all that
apply.) a. Job satisfaction
b. Absenteeism and turnover
c. Nurses’ health
d. Client welfare
ANS: A, B, C, D
Many writers and researchers have found that these work-related areas are adversely
affected by stress.
REF: Page 519 | Page 525
TOP: AONE competency: Business Skills
NURSINGTB.COM
Chapter 29: Managing Your Career
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A new graduate is seeking a new position in nursing and wants to “sell” herself effectively.
The best strategy is to: a
Create a résumé.
b. Practice interviewing.
c. Call the personnel offices.
d. Create a curriculum vitae.
ANS: A
A résumé provides a customized overview of details of your professional background that
relates specifically to a position for which you are applying. Résumés advertise your skills
to a prospective employer.
REF: Page 550 | Page 551
TOP: AONE competency: Communication and Relationship-Building
2. A nurse manager has been employed in the same facility for 20 years and has held the same
position. This career style is known as: a. Linear.
b. Spiral.
c. Steady state.
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d. Entrepreneurial/transient.
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ANS: C
Career styles that are marked by selecting and staying in a role throughout a career are
characterized as steady state.
REF: Page 547
TOP: AONE competency: Leadership
3. The nurse executive at the local hospital began working there 20 years ago and has risen to
the highest designation in nursing. This career style is known as: a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.
ANS: A
The linear career style, as described by Friss (1989), refers to vertical advancement in an
organization and is of interest to those with a desire to gain organizational knowledge and
different perspectives on nursing.
REF: Page 547
TOP: AONE competency: Leadership
4. Before beginning her own nursing agency, a nurse worked with other temporary nursing
agencies in nine states. This career style is known as: a. Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.
ANS: D
The entrepreneurial/transient career style, as described by Friss (1989), is appealing to
nurses who enjoy variety in experiences.
REF: Page 547
TOP: AONE competency: Leadership
5. A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to
a home healthcare agency. After 2 years, he was promoted to a managerial position and now
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has returned to another hospital as a new director of nursing. This career style is known as: a.
Linear.
b. Spiral.
c. Steady state.
d. Entrepreneurial/transient.
ANS: B
The spiral career style, as described by Friss (1989), involves an in-and-out and up-anddown approach to opportunities.
REF: Page 547
TOP: AONE competency: Leadership
6. A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology.
She applied to take a certification exam. Certification is designed to
recognize: a. Basic knowledge in a specified area.
b. Advanced practice in functional roles.
c. Special knowledge beyond basic licensure.
d. Continued competence as a registered nurse.
ANS: C
Certification is an expectation in some settings for career advancement in advanced
practice or in specialized areas and goes beyond basic preparation.
REF: Page 559
TOP: AONE competency: Leadership
7. Which of the following situations is most likely to result in a productive, whole work
situation?
a. Amy, RN, 5 years of experience in the emergency department. Amy accepts a
position working with older clients in a home health agency because she has
relocated and this is the only full-time position available.
b. Adam, RN, 8 years of experience in various nursing positions, including that of a
nurse manager. Adam accepts a new nurse manager position because he has a
family and wants more regular hours. He is most comfortable working in direct
client care.
c. Louise, RN, 10 years of experience in an emergency department. She accepts a
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position as a case manager in home health care, working with older clients. She
especially enjoys working with older adults and wants to take on leadership and
management challenges.
d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering
nursing care as an RN. She is offered a position on surgery as a permanent team
leader. The unit has had a great deal of turnover recently, and only limited
mentorship is available.
ANS: C
The whole of any work situation is composed of two elements: person and position. A
productive, whole work situation results when a person’s talents and strengths are
successfully blended with expectations of the position. Of the situations described
previously, the one most likely to result in a productive, whole work situation is that of
Louise, who, although her experience has not been in home health, is interested in both the
roles and the responsibilities of the position, as well as the target group being served. She
also considers the group being served as an area in which she demonstrates strength.
REF: Page 545
TOP: AONE competency: Business Skills
8. A nurse is applying for a new position. This position is one in which she will serve as a
liaison between a hospital and a school of nursing. The nurse has to update her résumé to
include her teaching experience. The goal of creating a curriculum vitae is to: a. Have a
listing of facts about your professional life.
b. Provide potential employers with information about where you are in your career.
c. Respond quickly whenever a position becomes available.
d. Be certain you can recall facts for a prospective position.
ANS: B
A curriculum vitae provides an all-inclusive but not detailed listing of your professional
life. This approach allows a prospective employer to find the most recent information
quickly and gain a sense of where you are in your career.
NURSINGTB.COM
REF: Page 550
9.
TOP: AONE competency: Business Skills
To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The
goal of a personal data file is to:
a. Create an opportunity to be interviewed.
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b. Have a listing of facts about your professional life.
c. Have a tool in place for marketing yourself.
d. Create a document that lists your skills.
ANS: B
A personal data file enables storage and recall of career-specific details that can be
retrieved and shaped for a specific purpose using cut-and-paste approaches rather than
creating whole new documents.
REF: Page 549 | Page 550
TOP: AONE competency: Business Skills
10. An experienced staff nurse applies for a distinct position of patient advocate at a new clinic.
Based on the various tools available to her, which of the following should she bring to her
interview to best present her skills? a. Résumé
b. Annual evaluations
c. Portfolio
d. Patient advocacy project
ANS: C
A portfolio enables prospective employers to view evidence of significant achievements
and responsibilities that would be pertinent to the position.
REF: Page 553 | Page 554
TOP: AONE competency: Professionalism
11. During performance appraisal interviews, Joanne’s nurse manager notices Joanne’s
excitement when she talks about how she has helped patients on a rehab unit understand the
complexities of their regimens. When Joanne’s nurse manager asks her about her career path
plans, Joanne says that she wants to become a nurse administrator. The best response to
Joanne would be:
a. “Nursing administration is rewarding. What experiences would help you along this
path?”
b. “You do not appear excited about nursing administration. Unless you are excited by
that career path, I wouldn’t advise going in that direction.”
c. “You seem to find teaching others very rewarding. Have you considered that as a
possible career path?”
d. “You are too inexperienced to consider administration. Work for a few years, and then
consider administration.”
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ANS: C
Joanne evidences excitement about teaching patients, and although administration could
be a rewarding path for her, education might be a better option for her to consider.
Looking at job aspects that are rewarding is helpful in determining which career direction
to pursue.
REF: Page 545
TOP: AONE competency: Professionalism
12. Knowing your professional strengths is important to:
a.
b.
c.
d.
NURSINGTB.COM
Finding your fit in positions and a career path.
Maintain a professional status.
Act in a manner that is legal and ethical.
Understand the role expectations of a position.
ANS: A
Being aware of your strengths is critical in determining what you will bring to a position
and can be used to find your fit and possible career path. Knowledge and experience are
important in maintaining the privilege of belonging to a profession and of behaving
ethically and legally.
REF: Page 545
TOP: AONE competency: Professionalism
13. You are offered an opportunity to take a temporary leave from your position as a nurse
manager to lead a technology implementation project. Which of the following reasons for
accepting the opportunity is most consistent with developing a solid career path? a. You are
pressured to do so by your supervisor.
b. The organization has no other suitable candidate for the position.
c. You have limited knowledge of information technology and no real interest, but this
will increase your knowledge.
d. Accepting a position outside of your established skill set may establish you
organizationally as an innovative, adaptable leader.
ANS: D
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Although giving into organizational or supervisory pressure may bring an enhanced
learning and organizational profile, what is to be gained needs to be assessed against your
career goals, interest, and aspirations. Increasing and expanding your skill set within
defined career interests is a valid reason to consider a chance opportunity.
REF: Page 561
TOP: AONE competency: Professionalism
14. Steady state styles would be most likely in which of the following situations?
a. Small hospital, in an isolated rural setting, with limited hierarchy
b. Large urban teaching hospital
c. Health network with several organizations
d. Travel nurse agency
ANS: A
Steady state career styles (career-long commitment to a particular position) are more likely
in rural settings, where commitment to the community is high and alternative career
opportunities are limited.
REF: Page 547
TOP: AONE competency: Professionalism
15. On your curriculum vitae, which of the following is the recommended approach for listing
employment and educational history information? a. 1979 RN Diploma
1985 BScN
2002 MN
b. 2002 Mount Rush Health Center Staff Nurse
1997 Cedar Falls Clinic Staff Nurse
2007 Kilkarney Rehab Center Case ManagerNURSINGTB.COM
c. 2007 MN
2005 BScN
d. 1997 Sturgeon County Hospital Head Nurse
2002 Sturgeon County Supervisor
2007 Sturgeon County Director
ANS: C
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Information that is included in the body of the curriculum vitae should always be in
reverse chronological order so that the most recent and, presumably, most relevant job
information appears first.
REF: Page 550
TOP: AONE competency: Business Skills
16. Which of the following needs revision on a résumé or CV?
a. John Jones
87 Highway Drive
City, MI 79110
jjones@gmail.com
b. M. Howes
Anyway Highway
City, MO 77700
(H) 777-777-0000
e-mail:
mh@gmail.com
c. Dr. L. Jones
99 Carway Drive
City, NY 84003
(H) 999-999-0000
(Cell) 999-000-9999
d. Tanya Jones
67 Honeywell Drive
City, MO 66907
beerhog@hotmail.co
m
ANS: D
When including Web or e-mail addresses, it is important to use addresses that are not
overly casual or that communicate personal information.
REF: Page 550
TOP: AONE competency: Business Skills
17. The primary difference between a résumé and a CV is that a résumé:
a. Reflects your skills, knowledge, and background in relation to a specific position.
b. Offers a detailed listing of positions held and where positions were held.
c. Includes a long and detailed explanation of academic and work experience.
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d. Provides contact information and focuses on your background, in general.
ANS: A
A résumé is a short, customized overview of your professional life that relates to the
qualifications of specific positions and how you are able to match your background to the
qualifications that are desired. Provision of contact information is common to both the
résumé and the CV. Résumés are more effective if details of particular positions that have
been held are highlighted as compared with a detailed listing of positions
held.NURSINGTB.COM
REF: Page 550
TOP: AONE competency: Business Skills
18. A functional résumé focuses on:
a. Experience and skills gained in positions.
b. Positions held and specific roles in the positions.
c. Academic qualifications and achievements.
d. Relating skills and experience to qualifications in a specific position.
ANS: A
Functional résumés highlight skills and experience gained rather the details of specific
positions. As with résumés in general, skills and experiences are customized to create an
image of an individual in a particular position.
REF: Page 551
TOP: AONE competency: Business Skills
19. A cover letter and a résumé together should be no longer than ________ page(s). a. Two
b. One
c. Four
d. Three
ANS: D
Two pages is recommended for a résumé and one for a cover letter.
REF: Page 551
TOP: AONE competency: Business Skills
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20. During an interview for a manager’s position, you find the supervisor and staff unfriendly.
Responses to questions are met with vague responses. After the interview, you decide not to
pursue the position. What follow-up, if any, is most appropriate?
a. There is no need for you to do anything further. You likely will not be offered the
position anyway.
b. You should file a complaint with Human Resources about the supervisor’s lack of
interviewing skills.
c. You should send a thank-you note to the interviewer, indicating appreciation for her
time.
d. You should call and leave a voicemail, indicating your disinterest in the position.
ANS: C
Even if you are disinterested in the position or think that the interview has gone badly, an
appropriate follow-up is a thank-you note to the interviewer. This recommended follow-up
creates a positive impression and may leave open the possibility of future interactions.
REF: Page 552
TOP: AONE competency: Communication and Relationship-Building
21. A well-written letter of resignation is critical to:
a. First announce your intent to resign.
b. Formally signal discontent in your current position.
c. Maintain a positive relationship with your former organization and colleagues.
d. Fulfill your legal obligations as a departing employee.
ANS: C
NURSINGTB.COM
A well-written resignation letter outlines your intent to leave the organization and your
appreciation of the organization but should follow an initial meeting with your manager to
first discuss your intention. A well-written letter maintains a positive relationship with the
organization.
REF: Page 552 | Page 553
TOP: AONE competency: Communication and Relationship-Building
22. In preparing for a fair interview process as a hiring manager, you should:
a. Put water out for the candidates.
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b. Ensure that you know the names of all candidates.
c. Dress comfortably and professionally.
d. Prepare a schedule of questions to be asked of all candidates.
ANS: D
Although providing water, knowing names, and dressing appropriately sets a professional
and respectful tone for the interview, developing a schedule of questions to be asked of all
candidates is important for gathering comparative data and ensuring equitable treatment.
REF: Page 554
TOP: AONE competency: Business Skills
23. To enhance team leadership skills for your team leaders, you arrange opportunities for: a.
Certification.
b. Continuing education.
c. Graduate courses.
d. Volunteerism.
ANS: B
Continuing education provides systematic learning opportunities that augment existing
skills and knowledge for delivery of quality care and advancement of career goals.
Graduate and certification courses provide advanced knowledge and skills.
REF: Page 558
TOP: AONE competency: Professionalism Skills
24. Professional associations:
a. Set regulatory requirements and establish entry requirements for nursing.
b. Offer graduate programs for clinical and career advancement.
c. Provide opportunities for career networking and support.
d. Are open to all individuals who meet the criteria for membership.
ANS: C
Professional associations are frequently, although not always, voluntary groups whose
members provide leadership in issues and policies of interest to nurses. Professional
associations also offer networks of nurses with similar interests.
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REF: Page 548
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
1. Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas’ professional
development, you would focus on (select all that apply): a. Certification for the ICU
environment.
NURSINGT B.COM
b. Discussions about how Thomas can fit with role expectations and relationships.
c. Possible specializations within the ICU environment.
d. Encouraging him to lead changes that leave long-term impacts after his retirement.
ANS: C, D
Thomas is a mid career professional. As such, you would expect him to be interested in
honing areas of expertise (such as leadership or developing a deeper expertise in a
particular area of ICU nursing) as opposed to gaining skills necessary for his work
environment such as certification or becoming comfortable with his role and relationships
in ICU, which would be critical to an early career nurse. Legacy building is characteristic
of mid career professionals.
REF: Page 546
TOP: AONE competency: Business Skills
2. An example of a career is (select all that apply):
a. Employment in short-term contract jobs in business, nursing, and whatever is
available.
b. Involvement in an area of practice that is regulated.
c. Continuous employment in the same position and the same arrangement for 20
years.
d. Moving into and out of nursing positions in various cities while pursuing travel
and education that develop understanding of global health.
ANS: C, D
Career refers to progression of skills, consistency, knowledge, and/or status. This
movement through nursing life is predicated on having a vision of a career as opposed to a
series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or
spiral. Deepening skills in one area is an example of a steady state career style, whereas
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moving into and out of positions in various cities can characterize an entrepreneurial style.
Involvement in a regulated field defines a professional interest but not necessarily a career.
REF: Pages 545-547
TOP: AONE competency: Professionalism
Chapter 30: Thriving for the Future
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. Nursing professionals in the twenty-first century will accomplish most of their work:
a. Through teams of internationally prepared professionals.
b. In teams and through group work.
c. Through long-term, secure jobs.
d. In competitive environments and work groups.
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ANS: B
The future is about teams and group work. Competition will be out and collaboration will
be in. Job security will be out and career options will be in. Our brightest and best may
leave more often than they do at present to pursue career options internationally.
REF: Page 567 | Page 572
TOP: AONE competency: Knowledge of the Health Care Environment
2. Based on studies of workplace environments for nurses and future projections, the workplace
of the future will be:
a. Less intense because of more technology.
b. About the same as it is now.
c. More intense because of more technology.
d. Fluctuating between intense periods and less intense periods.
ANS: C
NURSINGTB.COM
Technology will continue to revolutionize health care and contribute to complexity
compression. In addition to access to knowledge, electronic records, and current
applications of technology, technology will include robotics, which will change how
chronic disease can be managed, and bioengineering will make possible interventions that
do not yet exist.
REF: Page 572
3.
TOP: AONE competency: Business Skills
Which of the following actions is most representative of how health care of the future might
be delivered? As a nurse leader, you:
a. Refer families who require immediate help to a local food bank. You also work
with local agencies and families to establish a mothers collective in which
mothers learn about nutrition and prepare low-cost, nutritious meals that are
shared with the mothers in the collective.
b. Work together with a local agency to set up a free clinic in which addicts and
the homeless can receive free health care and prescriptions for immediate needs.
c. Ensure that individuals who are admitted to your unit are asked about their
smoking history and that preoperative and postoperative planning takes into
account how smoking will affect status during and after surgery.
d. Address the health of those who are overweight and obese on your unit by
ensuring that hospital meals offer nutritious, healthy food choices that are
satisfying.
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ANS: A
Referral to a food bank addresses the needs of a specific population, while exemplifying
an important leadership strength: thinking long-term, acting short-term. The project that
involves mothers will teach mothers about nutrition and engage them in preparation of
low-cost, healthy meals while promoting longer-term changes in healthy eating.
REF: Page 567 | Page 568 | Page 572
4.
TOP: AONE competency: Leadership
You notice that wait times in your Emergency Department are growing longer, because of
factors such as increases in the numbers of persons with chronic disorders, discharge of
patients into the community at a higher level of acuity, and limited resources for transfer of
inpatients. You begin to think about an application that would use your knowledge of the
Emergency Department but also software and business applications and wonder if this
would reduce wait times. You have not encountered anything similar to this idea. According
to the Wise Forecast Model©, you are in what phase? a. Wild thinking
b. Act widely
c. Think wildly
d. Learn widely
ANS: C
The second step in the Wise Forecast Model© is to think wildly. Step two is designed to create
connections among disparate thoughts. This thinking might be seen as the start of innovations.
REF: Page 570
5.
TOP: AONE competency: Knowledge of the Health Care Environment
Your organization is in the middle of re-designing patient care units, with decisions based
on best practices and various other sources of evidence. In the middle of the transition, there
is a temporary halt called to the transition because of a reNURSINGTB.COM-design
of the health care system and greater emphasis on primary care. What would be a healthy
response to this situation? a. Salvage as much of the original planning as possible so as to
reduce expenditures.
b. Engage in consultation to create innovative solutions that bridge the existing plans and
the new directions.
c. Abandon the current planning in favor of addressing the new trends.
d. Continue with the current planning because trends come and go.
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ANS: B
Stability and total chaos are the ends of a continuum. Moving in some way between those
two ends suggests that we live in a constant state of disequilibrium in which we strive
toward stability while recognizing we experience chaos. As we continue to move from
“traditional” practices to evidence-based ones and from a heavy focus on tertiary care to
one that values primary care, we can assume that we might experience more chaos. Chaos
can lead to new learning and new, innovative solutions. As nurses, it is important to be
able to function in an evolving environment.
REF: Page 571
6.
TOP: AONE competency: Leadership
Your organization is in the middle of re-designing patient care units, with decisions based
on best practices and various other sources of evidence. In the middle of the transition, there
is a temporary halt called to the transition because of a re-design of the health care system
and greater emphasis on primary care. As a manager in this situation, your staff experience
a gap between what they expected (the original re-design of the units) and what is actually
happening (a need to integrate primary care in some way). According to Selye, the nurses on
your nursing team are likely experiencing what? a. Eustress
b. Distress
c. Stress
d. Compression
ANS: C
Selye described stress as being on a continuum between stress that is positive (eustress)
and stress that is negative (distress). Because individuals perceive the same event
differently, from the information that is given, it is not possible to determine whether the
nurses experience the events as eustress or distress; what is most likely is that the nurses
are experiencing stress, which is what occurs when there is a gap between expectations
and what is actually occurring.
REF: Page 571
7.
TOP: AONE competency: Leadership
As a nurse manager, it is important to become a “future thinker.” Which is an example of a
“future thinker”?
a. Keeping traditional practices
b. Moving toward evidence-based practices
c. Finding less need for more knowledge
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d. Believing that macromarketing will be a necessityNURSINGTB.COM
ANS: B
Future forecasts include evolutions in power, structure, and knowledge; rapid change in
the healthcare system; the demise of macromarketing; and increased evidence-based
practice.
REF: Page 571
8.
TOP: AONE competency: Leadership
As a team, you and the staff have determined that there is a need to reduce medication errors
on your unit. Together, you developed the questions that you would like addressed and
searched the literature for relevant research studies. Based on the evidence, you suggested a
change to your practices and now are involved in implementation of these changes. Today,
there was a major study released that would significantly change what you have decided to
do. What are you and your staff experiencing? a. Compression complexity
b. Distress
c. Information lag
d. Technology advancement
ANS: A
This situation exemplifies complexity compression, a term that means many changes are
happening almost simultaneously and before one practice can be firmly implanted in our
minds, we are already addressing some other new change. This compression can be
distracting or useful.
REF: Page 572
9.
TOP: AONE competency: Leadership
Nursing research has indicated that the foundation for becoming a nursing leader is the
ability to:
a. Write effectively.
b. Speak two or three languages.
c. Focus on day-to-day priorities.
d. Think futuristically.
ANS: D
Whether you are a leader, a follower, or a manager, being able to visualize in your mind
what the ideal future is becomes a critical strategy. A vision can range from that of an
individual to that of a group or to a whole organization.
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REF: Page 569
TOP: AONE competency: Leadership
10. The chief nursing officer has been developing her portfolio for years. What is the chief
nursing officer modeling? a. Her clinical expertise
b. Affection for tradition
c. Her employability
d. Her busy professional life
ANS: C
Being employed is no longer sufficient; we must be employable. A portfolio outlines
achievements and experiences that communicate employability.
REF: Page 569 TOP: AONE competency: LeadershipNURSINGTB.COM
11. Your unit has a number of patients who have undergone limb amputation. In working with
the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery
and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral
therapies as possibilities in working with these clients. You begin to amass information in a
number of areas with which you previously had little familiarity. According to the Wise
Forecast Model©, you are a. Acting wildly.
b. Learning wildly.
c. Engaging in interprofessional care.
d. Increasing your complexity compression.
ANS: B
The first step, learn widely, means that we must extend our sources of knowledge beyond
our role and clinical areas of interest. In fact we must extend our learning beyond nursing
and health care. Widely might encompass another discipline such as architecture or
engineering.
REF: Page 570
TOP: AONE competency: Leadership
12. The starfish analogy is exemplified in which of the following?
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a. A unit manager resigns after continued tension between the administration and her
regarding implementation of primary nursing. The primary nursing project dies.
b. Nurses try to establish a clinic that provides ambulatory care to parents and young
children in an impoverished neighborhood. Community members advocate for
funding from political leaders and insurers.
c. Alana, a new graduate, promotes continence care based on evidence. When she
presents her ideas, senior staff refuses to consider it.
d. The head of a community health service moves on to another position. Programs are
disbanded.
ANS: B
The starfish analogy points to the connectivity that we have with one another and how we
influence and are influenced by others all the time. This affords many opportunities for
leadership that are dependent not on formal titles but on opportunities to shape the work at
hand.
REF: Page 568
TOP: AONE competency: Leadership
13. Which of the following will require greater attention in the future?
a. Chronic disorders
b. Obstetrical outcomes
c. Prevention of hospital-based errors
d. Team conflict resolution strategies
ANS: A
Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on
prevention, personal accountability, and innovations such as robotics in the management
of chronic illnesses.
REF: Page 572
TOP: AONE competency: Knowledge of the Health Care Environment
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14. Which of the following strategies is most important in developing a strong vision?
a. Seeking out evidence to support trends and out-of-the-box thinking
b. Spending time with others with whom we discuss ideas
c. Setting up focus groups to provide information on current realities
d. Being honest and open about what we think for the future
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: D
Regardless of how we go about developing our vision (gathering evidence, testing ideas
with others), honesty and openness are foundational to a strong vision.
REF: Page 569
TOP: AONE competency: Leadership
15. To move beyond stereotypical thinking and toward thinking about the future, which of the
following would be most consistent with thinking wildly in the Wise Forecast Model©? a.
Listing everything that we know about our current situation
b. Defining which practices will remain unchanged and which will change
c. Asking someone with a great deal of experience to share ideas about best practice
d. Challenging current and future practices with questions of “what if?”
ANS: D
Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild
idea.
REF: Page 570
TOP: AONE competency: Leadership
16. Which aspect of our tradition and history in nursing may impede our movement towards
future-oriented thinking? a. Lack of confidence
b. Focus on the discipline of nursing
c. Focus on details in the everyday practice
d. Mistrust of trends and new evidence
ANS: C
Because of our history of attention to details, we may need to challenge ourselves in
developing our ability for leadership. Moving from micromanaging to focusing on setting
expectations for those for whom we are accountable may feel uncomfortable. However,
that movement reinforces our ability to deal with longer-term issues.
REF: Page 569
TOP: AONE competency: Knowledge of the Health Care Environment
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17. A stroke unit experiences numerous changes related to implementation of new
technology, a changed nursing care delivery model, and staff turnover within a period of 6
months. Staff members begin to show signs of reluctance to implement any more changes.
This exemplifies: a. A poor relationship between leaders and staff.
b. Lack of knowledge regarding the importance of changes.
c. Striving to achieve stability in the midst of great disequilibrium.
d. The importance of chaos in promoting adherence with established practices.
ANS: C
Stability and chaos are at opposite ends of a continuum. When chaos is present, change
occurs but life may seem uncontrollable. Resisting further change is a move toward
establishment of
equilibrium.
REF: Page 571
NURSINGTB.COM
TOP: AONE competency: Leadership
18. A stroke unit experiences numerous changes related to implementation of new technology, a
changed nursing care delivery model, and staff turnover within a period of 6 months. Staff
members begin to show signs of reluctance to implement any more changes. The
phenomenon experienced by the staff is termed: a. Eustress.
b. Care process.
c. Stereotypical thinking.
d. Complexity compression.
ANS: D
Complexity compression refers to many changes occurring simultaneously before time is
sufficient to assimilate the change.
REF: Page 572
TOP: AONE competency: Leadership
19. A business condition that may assist forecasting but add to the complexity of change is:
a. Consulting with professional groups about change.
b. Researching about trends on futuristic sites.
c. Asking patients to examine options for change.
d. Building profit projects and sustainability into planning.
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
ANS: C
Stalk and Butman suggests that asking the customer for feedback on options may assist
with forecasting. Adopting this strategy runs counter to current practice and would
increase the complexity of healthcare planning and forecasting.
REF: Page 572
TOP: AONE competency: Knowledge of the Health Care Environment
20. A number of changes are introduced to a unit, including changes to familiar clinical
procedures and the use of PDAs to enable bedside documentation. You, as unit manager,
anticipate which of the following will contribute most to complexity compression? a.
Meaning of the change
b. Pace of changes
c. Previous experiences with change
d. Confidence of the leader in the value of the change
ANS: B
Complexity compression is a term that means that many changes are happening almost
simultaneously and before one practice can be firmly implanted in our minds, we are
already addressing some other change
REF: Page 572
TOP: AONE competency: Leadership
21. In order to plan long term, you consider what the client of the future will look like. Which
of the following client profiles would best capture shifting demographics and trends in
health care?
a. Younger, knowledgeable about health options
b. Female, uses emergency care services for parents and children
c. Older, one or more chronic disorders, diverse background
NURSINGTB.COM
d. Male, various occupationally generated disorders, diverse ethnic background
ANS: C
The client base is aging and more people will be living with chronic disorders. Persons
will travel more and there will be increased need to speak two or more languages to
address the needs of a mobile global population.
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REF: Page 572
TOP: AONE competency: Leadership
22. You have just hired a recent graduate. The graduate is thrilled with the opportunity that she
has been given, as well as with the idea that “working means no more essays, tests, or
assignments!” She indicates that she has no intention of touching a book, journal, or health
information Website for a “long time.” Which of the following would be your best
response? a. The expectations and design of educational programs means that new graduates
are better prepared for the workforce.
b. The new graduate will still have to learn, but it will be job-specific learning.
c. An ideal learning plan for nurses emphasizes followership.
d. The amount and intensity of knowledge demands lifelong learning that includes
assessment of relevancy of knowledge for practice.
ANS: D
Knowledge will change dramatically, requiring that we all be dedicated learners. With or
without state law, continuing education will be mandatory and essential.
Knowledge will evolve from the intensity of the current information evolution so that we
will access content with meaning and applicability for our work.
REF: Page 572
TOP: AONE competency: Professionalism
23. A necessary leadership strength for nurses of the future is:
a. Inspiring others to work their best to create the future.
b. Understanding the nuances of fundraising to make up funding shortfall.
c. Guarding the tendency of other professions to encroach on nursing roles.
d. Adapting work life to an aging nursing workforce.
ANS: A
Senge said that all leadership is really about is people working at their best to create the
future. Predictions of the future highlight the importance of interprofessional teams and of
a shift towards understanding the importance of health care.
REF: Page 569 | Page 572
TOP: AONE competency: Leadership
24. Nathan tells you that he has selected nursing as a career because many jobs are available and
he will have job security. Your best response to Nathan is:
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Leading and Managing in Nursing 6th Edition Yoder-Wise Test Bank
a. “With many young people going overseas, many jobs and options will be available.
Stable jobs and job security will be part of the nursing employment market.”
b. “The job market for nurses will be diminished with funding cuts to hospitals.”
c. “The employment prospects for nurses are positive with many options to choose from.
Flexibility and adaptability are essential to income security.”
d. “It is unlikely that nursing will survive in the long term with funding cuts and a
declining population of seniors.”NURSI NGTB.COM
ANS: C
Employment for nurses continues to be positive, although roles will change in a rapidly
changing environment, which will increase options. With the number of options available
and sporadic work opportunities, nurses will need to be flexible and able to adapt rapidly.
Job security will be out; career options will be in.
REF: Page 572
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. In developing curricula that will address needs based on forecasts for the future, nursing
educators need to contemplate (select all that apply): a. Prevention strategies.
b. Leadership skills and knowledge.
c. Violence de-escalation strategies.
d. Strategies for job security.
ANS: A, B, C
Future forecasts suggest that health factors such as obesity that are implicated in the
development of chronic disorders will increase, as will chronic disease. Leadership skills
have been identified as a key competence for nurses of tomorrow, and competence with
technology will be needed as technology continues to revolutionize health care. Rather
than emphasizing job security, nurses will need to be prepared to be in an environment
with many options and episodic employment.
REF: Page 571 | Page 572
TOP: AONE competency: Knowledge of the Health Care Environment
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