CH1 PRACTICE QUESTIONS- Leadership and Management roles in nursing:
12 Questions
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 for implementation of 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
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
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 the
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 for clarity issues.
c. Ask each party to examine their own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the
conflict.
ANS: C
4. At a second negotiation session, the unit manager and staff nurse are unable to
reach a resolution. What is the appropriate next step?
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Elevate the next negation session to the next manager, one level above.
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
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 ambulate patients.
The RNs on the staff have always practiced in a primary nursing-delivery system and
are very resistant to this idea. What would be the best initial strategy for
implementation of this change?
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
ANS: A
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
7. The nurse manager wants to increase motivation by providing motivating factors for
the nurse on the unit. What action would be appropriate to motivate the staff?
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.
ANS: C
8. 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 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
9. 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. What 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
10. The nurse manager has been asked to implement an evidence-based approach to
teach ostomy patients self-management skills postoperatively. The program is to be
implemented across the entire facility. What illustrates effective leadership in this
situation?
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. An RN who is already familiar with the new approach of volunteers to take the
lead in mentoring and teaching others how to implement it.
ANS: D
11. You overhear a new graduate RN telling a nurse colleague that leadership and
management belong to the unit manager, not to her. As a nursing colleague, what do
you know to be true in regard to the statement?
a. The statement is correct. Leadership is not the role of the staff nurse.
b. The new graduate 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. The new graduate has been influenced by nurse leaders and managers who leave
for other positions.
d. The general perception is that nurse leaders and managers are not satisfied in their
jobs.
ANS: B
12. The charge nurse walks into Mr. Smith’s room and finds him yelling at the LPN. He
is obviously very upset. The charge nurse determines that he has not slept for three
nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an
“ugly, old man.” The charge nurse acknowledges the LPN’s feelings and concerns and
then suggests that Mr. Smith’s behavior was aggressive but was related to lack of sleep
and to pain. The charge nurse asks, “Can you, together with Mr. Smith, determine
triggers for the pain and effective approaches to controlling his pain?” This situation is
an example of what?
a. Lack of empathy and understanding for Miss Jones
b. Concern with placating Mr. Smith
c. Leadership behavior
d. Management behavior
ANS: C
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. What is the most likely basis for the nurse manager’s request?
a. An established clinical pathway
b. Confirmatory scientific evidence
c. Unit protocol
d. Experience
ANS: D
14. Chart audits have revealed significant omissions of data that could have legal and
financial guideline ramifications. The unit manager meets with the staff to discuss
audit findings and to find approaches that will address the gaps in charting and
achieve desired goals. What is the manager demonstrating?
a. Leadership
b. Management
c. Decision making
d. Vision
ANS: B
15. A family is keeping vigil at a critically ill patient’s bedside. Distant family
members call the unit continuously asking for updates and expressing concern. The
nurse speaks with the distant family members and states she is referring them to the
hospital social worker, whose role is to work with family in this situation. What role is
the nurse assuming through this action?
a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
16. A family is keeping vigil at a critically ill patient’s bedside. The nurse approaches
the unit manager with concern over the family dynamics for the patient concerned
there are patient-family conflicts based on patient’s wishes. The nurse suggests that
the patient’s provider may need to discuss the treatment plan with the family. The
unit manager states he will arrange a discussion with the patient’s provider and ask
the nurse to support the provider’s decisions. What is the role of the nurse in this
situation?
a. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
17. The manager calls the 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, the manager
explains that the organization values patient-centered care and that evidence
supports that acting as an advocate and a listener is helpful to families. The manager
asks the staff for ideas and strategies that are effectively patient-centered in dealing
with families in similar situations. What is the role of the nurse manager in this
situation?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
18. The manager of a unit is finding it difficult to work with a new graduate nurse.
The new nurse has many ideas; however, his manner of presenting them irritates the
manager. After reflection and discussion with others, the manager recognizes that she
feels threatened by his behavior. She comes to understand that the new nurse is
trying to establish his own role on the unit; is not trying to challenge her; and needs
guidance, coaching, and affirmation. What is the nurse manager demonstrating in this
situation?
a. A positive self-concept
b. Deepening self-awareness
c. Leadership
d. Acquiescence
ANS: B
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. What is the
leadership you are employing?
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
20. As a leader on a rehab unit, the manager encourages all staff members to see
themselves as having a role in decision making and quality care. The manager sees
their role as involving particular responsibilities in decision making but not as a
hierarchal role. What is this view of the role consistent with in this situation?
a. Trait theories
b. Complexity theory
c. Situated theory
d. Emotional intelligence
ANS: B
21. A staff nurse has been recently promoted to unit manager. During the time on the
unit, the nurse formed a strong social network among staff, has promoted the
development of relationships between staff and workers in other areas of the
organization, and has formed relationships that generate ideas from patient
organizations and the local nursing education program. According to complexity
theory, what principle is being engaged?
a. Empowerment
b. Systematic thinking
c. Development of networks
d. Bottom-up interactions
ANS: C
22. According to the complexity theory, what would be the focus of measurement?
a. Cost per hospital day
b. Bed utilization
c. Infection rates
d. Staff morale and budgets
ANS: D
23. During a staff meeting held to discuss developing a mission statement for the unit,
the idea of placing patient needs first is discussed. What is considered when the
suggestion by the manager is for the unit mission to be derived from the organization
mission?
a. Empowering
b. A leadership tag
c. A symbol
d. A management task
ANS: B
24. A dispute arises between an RN and an LPN over a patient issue. The tension
continues between the two and begins to affect other staff members, who are drawn
into the conflict. Over time, the team becomes polarized toward either the RN or the
LPN. How might this situation be prevented?
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
ANS: A
25. The unit is shifting from primary nursing to a team model in an effort to contain
costs. Staff members are upset about the change and ask for a meeting to discuss the
new model. After hearing their concerns related to reduction in professional
autonomy, what is the initial response by the manager to address the concerns?
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
1. A new graduate nurse wonders about the directions that her preceptor has given
her regarding management of incontinent, confused patients. The new nurse brings
the preceptor evidence-based information she located regarding incontinence
interventions for confused patients and asks to talk about the guidance that given
after the preceptor reviews the information in the article. What is the new nurse
demonstrating in this situation? (Select all
that apply.)
a. Assertiveness
b. Followership
c. Management
d. Insubordination
ANS: A, B
CH 3 QUESTIONS- Chapter 03: Legal and Ethical Issues: 12 Questions
1. The manager in the coronary care unit believes an important ethical consideration
in performance evaluations is to include the employee’s good qualities and give
positive direction for professional growth. What ethical principle does this represent?
a. Justice
b. Fidelity
c. Beneficence
d. Nonmaleficence
ANS: D
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. What ethical principle is being reinforced?
a. Justice
b. Fidelity
c. Paternalism
d. Respect for others
ANS: C
3. A patient refuses a simple procedure that you believe is in the patient’s best
interest. What two ethical principles are in conflict in this situation?
a. Fidelity and justice
b. Veracity and fidelity
c. Autonomy and beneficence
d. Paternalism and respect for others
ANS: C
4. An individual in a wheelchair is applying for the position of receptionist in an
outpatient clinic. What does the nurse manager understand based on The Americans
with Disabilities Act of 1990 requirements for 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
5. A staff nurse, who was fired for reporting patient abuse to the appropriate state
agency, files a whistleblower lawsuit against the former employer. What reason would
the court provide to uphold a valid whistleblower suit claiming retaliation by the
nurse?
a. Previously reported the complaint, in writing, to hospital administration.
b. 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
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. What is the basis that binds employers to
statements in the employee handbook?
a. Under the doctrine of apparent agency
b. Under the doctrine of respondent 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
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
8. One means of ensuring that the nurses floated to other patient care areas in
healthcare organizations are qualified to work in the areas they are floated 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
9. A colleague asks you to give her your password access so that she can view her
partner’s healthcare record without using her login. This request violates the patient’s
right to:
a. privacy.
b. confidentiality.
c. undue authorization of treatment.
d. protection against slander.
ANS: A
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. one nursing practice act.
d. one nursing practice act and a medical act.
ANS: C
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. What conditions do not apply in this situation and do not
support malpractice?
a. Injury
b. Causation
c. Breach of duty
d. Breach of duty of care owed
ANS: A
12. As a charge nurse, you counsel your RN staff member that they have has their duty
of care by notifying a child’s physician regarding concerns about deterioration in the
child’s status at 0330 hours. The physician does not come in to assess the child and
does not provide additional orders. The child dies at 0630 hours. As the charge nurse,
you could be held liable for what?
a. Professional negligence
b. Assault
c. Avoidance
d. Murder
ANS: A
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. How is senior nurse executive 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
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
15. You volunteer at a free community clinic. A 13-year-old girl 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
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
17. Which ethical principle is primarily involved in informed consent?
a. Veracity
b. Autonomy
c. Beneficence
d. Nonmaleficence
ANS: B
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
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
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
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 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
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
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.
d. acknowledge the nurse’s role in ensuring that she does not fail in her duty of care
for the patient.
ANS: B
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
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
CH 13 QUESTIONS- Chapter 18: Leading Change- 12 Questions
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
2. 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 effective, staff will need to perceive this change agent as:
a. trusted, quiet.
b. flexible, informal.
c. credible, enthusiastic
d. communicative, personable.
ANS: C
3. 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 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
4. 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
5. 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.
d. operate between order and disorder.
ANS: A
6. 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
7. 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
8. The oncology clinical 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
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
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
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
ANS: A
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?
a. Linear
b. First-order
c. Facilitative
d. Integrative
ANS: A
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
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
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 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.” 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
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 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
17. Elizabeth is an example of a(n):
a. early adopter.
b. late majority.
c. laggard.
d. resister.
ANS: C
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.
b. linear thinking.
c. interprofessional collaboration.
d. first-order change.
ANS: A
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
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
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
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
23. You anticipate that your region will soon move toward 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 “e-health? 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.
c. deficits in education and experience.
d. lack of organizational support for change.
ANS: C
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
26. Which of the following are examples of application of the Leadership Rounding
Tool? (Select 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
QSEN initiative, Patient Safety: 12 Questions