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Test Bank Leading Managing Nursing 6th Edition, Patricia
Chapter 01: Leading, Managing, and Following
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.
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 Maslows 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 wifes treatment.
c. Sympathize with the nurses 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 wifes treatments.
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 managers 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.
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 weeks 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 managers actions and end the dispute.
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 nursingdelivery 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.
6. As the RN charge nurse on the night shift in a small long-term care facility, youve 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.
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.
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 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.
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. 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.
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.
Chapter 02: Safe Care: The Core of Leading and Managing
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.
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. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
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.
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.
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.
6. 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.
d. Preference is given to increasing staff numbers rather than staff credentials.
7. 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.
8. In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
a. Evidence-based practice.
d. The patient.
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.
c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
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%
Chapter 03: Developing the Role of Leader
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.
2. After a newly hired director of nursing has reviewed the hospitals strategic plans, she develops a timeline for achieving those plans. The new leader is:
a. Not expecting that novice leaders will have a vision.
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.
3. A nurse executive is hired to restore a units 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.
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 everyones 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
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:
b. Through a relationship with a mentor.
c. With the job description.
d. With the chief nursing officer of the organization.
6. 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.
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 supervisors 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.
8. 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
9. 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.
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.
Chapter 04: Developing the Role of Manager
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?
2. A nurse manager has worked rapidly to bring the staff to accept changes in the units 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. Determining accurately the direction of change in the institution.
d. Requiring all staff members to review and reinforce their technological skills.
3. The nurse manager, as the leader of the units 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:
b. Shared leadership.
c. A common purpose.
d. Independence in the nursing managers role.
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.
5. A nurse managers 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).
6. 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.
7. 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.
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
9. 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.
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.
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 managers goals may be:
d. Too low.
Chapter 05: Legal and Ethical Issues
1. The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employees good qualities and that they give positive direction for professional growth. This belief is an example of:
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:
d. Respect for others.
3. A patient refuses a simple procedure that you believe is in the patients 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.
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.
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.
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 employees or the employers expectations.
d. Based on the theory that the handbook creates an explicit contract.
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.
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.
9. A colleague asks you to give her your password access so that she can view her partners healthcare record. This request violates the patients right to:
c. Undue authorization of treatment.
d. Protection against slander.
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.
Chapter 06: Making Decisions and Solving Problems
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.
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.
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.
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.
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.
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.
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.
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 RNs 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.
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.
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.
Chapter 07: Healthcare Organizations
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.
2. 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.
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 childrens 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.
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.
5. 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.
6. 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 organizations 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.
7. 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
8. 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.
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.
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.
Chapter 08: Understanding and Designing Organizational Structures
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.
c. Line position.
d. Staff position.
2. 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.
3. 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.
b. Need a degree of flexibility to engender success.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.
4. 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.
5. 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.
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 organizations philosophy.
7. 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.
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:
c. Delegated authority and responsibility
d. Delegated responsibility but no authority
9. The chief nursing officer is given the task of reviewing and revising the organizations 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.
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.
Chapter 09: Cultural Diversity in Health Care
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:
b. Wound management.
c. Blood transfusion.
d. Advance directives.
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 Years 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.
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.
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 together in giving patients care, he jokes about my being a little fat Mexican? The nurse managers 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?
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 patients eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to:
c. Cultural diversity.
d. Cultural sensitivity.
6. 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?
7. 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.
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?
b. Love for people
c. Shared vision
d. Genetic predisposition
9. The nurse manager for a units 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.
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:
b. Cardiovascular disease.
Chapter 10: Power, Politics, and Influence
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 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.
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.
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 nurses district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing?
d. Political astuteness
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
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 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.
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
7. Two nurses approach their manager about a conflict regarding the next months 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.
8. 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?
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
9. 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.
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.
d. They are closest to the front line of health care and see how it affects clients and families.
Chapter 11: Caring, Communicating, and Managing with Technology
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.
2. 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:
b. Cost-effective care.
c. Meeting standards.
d. Evidence-based practice.
3. 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 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.
4. 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.
5. The clinic nurse has just accessed a clients chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that clients chart. She should say:
a. No problem. Just log me off when youre done.
b. Ill put the note in for you. What do you want to say?
c. Just make sure that you sign your note because its under my password.
d. Im sorry, but you will have to enter the information using your own password.
6. 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.
d. Biomedical technology.
7. 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. Central data repository.
c. Nurse expert system.
d. Handheld device.
8. 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.
9. 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.
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.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.
Chapter 12: Managing Costs and Budgets
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.
2. The difference between a nurse practitioners charge of $45 for an office visit and the insurance companys payment of $34 is:
a. A contractual allowance.
b. A profit.
c. A flat rate.
3. 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.
c. Using high-technology treatments.
d. Requiring second opinions.
4. 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:
c. Fixed costs.
d. Medication costs.
5. 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-to-day plan for operations.
b. Unit of service.
c. Statement of revenues and services.
d. Financial plan.
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
7. 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?
8. 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.
9. An example of an initiative that may reduce total healthcare costs would be:
a. Offering nurse practitionerled 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.
c. Lowering copayments for prescription drugs for seniors.
d. Advocating for more readily available MRI services to ensure early diagnosis.
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
Chapter 13: Care Delivery Strategies
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.
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 nurses:
a. Clinical expertise.
b. Leadership ability.
c. Communication style.
d. Conflict-resolution skills.
3. When interviewing an applicant for a position, the nurse manager describes the units 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.
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. Physicians orders.
c. Critical pathway.
d. Clinical practice guidelines.
5. The nurse case manager is working with a client admitted for end-stage renal disease. The case managers 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.
d. Prevent additional hospitalizations resulting from complications of the clients disease.
6. 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
7. In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse managers main responsibility is the needs of the:
8. 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?
9. 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
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
Chapter 14: Staffing and Scheduling
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.
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:
3. 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.
4. 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.
5. A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the units 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.
6. A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is:
a. Organizational staffing policies.
b. State licensing standards.
c. American Nurses Association.
d. Consumer expectations.
7. A nurse manager uses many sources of data when planning the units 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
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.
9. 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
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