Chapter 8

1. What is required to successfully implement the chaos theory of

change? A) Most stakeholders accepting the need for change
B) Finding solutions to resistance to change
C) Changing attitudes more than increasing knowledge
D) Finding underlying order in random data
Ans: D
Feedback:
Chaos theory requires finding underlying order in apparent random
data.
2. It is appropriate to make a change for which reason? Select all that
apply.
1. A) To solve an existing problem
2. B) To increase staff efficiency
3. C) To reduce unnecessary workload
4. D) To improve staff productivity

Ans: A, B, C, D

Feedback:

Change should be implemented only for good reasons such as the solution of an
existing problem, increasing staff efficiency, eliminating unnecessary workload
and improving productivity. Boredom alone is not a sufficient reason to institute
change.

3. Which situation is associated with and aging organization?

1. A) Retired staff is replaced with new graduate nurses

2. B) State-of-the-art cardiac monitoring equipment is placed in the ICU
3. C) The unit functions with strict adheres to institutional rules and
policies
4. D) A suggestion committee composed of staff and management
meets monthly

Ans: C

Feedback:

The young organization is characterized by high energy, movement, and

virtually constant change and adaptation. Aged organizations have established
iturf boundaries,i function in an orderly and predictable fashion, and are focused
on rules and regulations. Change is limited.

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4. Distributing flyers that charge arbitrary action on the part of an employer in
an effort to garner interest in employee unionization would be a part of what
phase of planned change?

1. A) Unfreezing
2. B) Movement
3. C) Refreezing
4. D) Resistance

Ans: A

Feedback:

Unfreezing occurs when the change agent coerces members of the group to
change, or when guilt, anxiety, or concern can be elicited. This is not observed
in the other options.

5. Refusing to work with a staff member who dresses unprofessionally most

closely represents which change strategy?

1. A) Powerncoercive
2. B) Normativenreeducative
3. C) Rationalnempirical
4. D) Resistancenwithdrawal

Ans: A

Feedback:

The powerncoercive strategy assumes that people are often set in their ways
and will change only when faced by negative sanctions or some other method
that demonstrates power and/or coercion. This is not the principle guiding any
of the other options.

6. Which action represents a management function in planned change?

1. A) Inspiring group members to be involved in planned change

2. B) Visionary forecasting
3. C) Role modeling high-level interpersonal communication skills in
providing support
for individuals undergoing rapid or difficult change
4. D) Recognizing the need for planned change and identifying the
options and
resources available to implement change

Ans: D

Feedback:
Recognizing the need for planned change and identifying the options and
resources available to implement change are management functions; the other
choices are leadership functions.

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7. Which would be a normal and expected behavioral response during the

unfreezing phase of change?

1. A) Anger
2. B) Withdrawal and acceptance
3. C) Open acceptance
4. D) Active collaboration

Ans: A

Feedback:

During the unfreezing stage, people become discontented, and even angry, with
the status quo. Ironically, they may also become angry that change is needed,
because of the resistance that is a normal and expected part of the change
process. The other options are not usually associated with the unfreezing phase
of change.

8. What characteristic is associated with organizational groups assigned to

manage the change process?

1. A) Both formulate and implement the change

2. B) Have representation from all key stakeholders
3. C) Are made up of quality circles
4. D) Are teams of resistance breakers

Ans: B

Feedback:

In some large organizations today, multidisciplinary teams of individuals,

representing all key stakeholders in the organization, are assigned the
responsibility for managing the change process. In such organizations, this
team manages the communication between the people leading the change effort
and those who are expected to implement the new strategies.

9. Which behavior/attitude makes it likely that a planned change will be

unsuccessful?

1. A) The suggested change is brought forward after the plan has been
formalized
2. B) Individuals affected by the change are involved in planning for the
change
3. C) The change agent is aware of the organizations internal and
external environment
 4. D) An assessment of resources to carry out the plan is completed
before unfreezing

Ans: A

Feedback:

Employees should be involved in the change process. When information and

decision making are shared, subordinates will be more accepting of the change.
The other options support the change.

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10. Which activity does a change agent make a commitment to in order to best
assure a successful implementation of a change?

1. A) Helping followers arrive at total consensus regarding the change

2. B) Encouraging subgroup opposition to change so many viewpoints
can be heard
3. C) Using change by drift if the resistance to change is too strong
4. D) Being available to support those affected by a change until the
change is complete

Ans: D

Feedback:

The change agent needs to offer support to others so that the change occurs.
The other options are not as impactful on a successful transition to change.

11. Which description best describes the theory behind nonlinear change?

1. A) It occurs in organized steps

2. B) It must have a logical sequence
3. C) It results in equilibrium
4. D) It has unpredictable outcomes

Ans: D

Feedback:

Nonlinear change states that the dynamics and outcomes of change are always
unpredictable. Nonlinear change does not involve the other statements.

12. In planning strategies to prevent stagnation and promote renewal, which

action would most likely result in the desired outcome?

1. A) Developing a program for recruitment of young talent

2. B) Rewarding employees by promoting from within
3. C) Having set pay increases mandated annually
 4. D) Using longevity to determine committee selection

Ans: A

Feedback:

The constant influx of young talent brings new ideas to the organization. The
other options are not as relevant to the prevention of stagnation and promotion
of renewal.

13. Which statement is true regarding the philosophy of nonlinear change

theories?

1. A) Change occurs in sequential steps

2. B) Change is predictable
3. C) Change success relies on policies and hierarchies
4. D) Change is necessary because organizational stability is brief

Ans: D

Feedback:

Most twenty-first-century organizations experience fairly brief periods of

stability followed by intense transformation.

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14. Which statement is true regarding planned change? Select all that apply.

1. A) Resistance to change should be expected as a natural part of the

change process
2. B) Change should be viewed as a chance to do something innovative
3. C) Technical changes are more resisted by staff than social changes
are
4. D) Change affects the homeostasis of a group

Ans: A, B, D

Feedback:

Change should not be viewed as a threat but as a challenge and a chance to do

something new and innovative. Change should be implemented only for good
reason. Because change disrupts the homeostasis or balance of the group,
resistance should be expected as a natural part of the change process. The level
of resistance to change generally depends on the type of change proposed not
the age of the staff affected by the change. Technological changes encounter
less resistance than changes that are perceived as social or that are contrary to
established customs or norms.
15. Which activity is associated with the movement stage of the development of
a plan?

1. A) Gather data
2. B) Accurately diagnose the problem
3. C) Decide if change is needed
4. D) Develop a plan

Ans: D

Feedback:

A responsibility of the movement stage is to develop a plan. Responsibilities of

the change agent in the unfreezing stage are as follows: Gather data, accurately
diagnose the problem, and decide if change is needed.

16. What

1. A) Information supports change

2. B) Peer influence brings about change
3. C) Reward-based incentives influence change
4. D) Punishment supports the acceptance of change

Ans: A

Feedback:

The change agent using this set of strategies assumes that resistance to change
comes from a lack of knowledge and that humans are rational beings who will
change when given factual information documenting the need for change.
Normativenreeducative strategies use group norms and peer pressure to
socialize and influence people so that change will occur. Powerncoercive
strategies, features the application of power by legitimate authority, economic
sanctions or rewards, or political clout of the change agent.

is the basic argument for the use of rationalnempirical change strategies?

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17. Which change is easier to make?

1. A) Personal behavior
2. B) Group behavior
3. C) Group knowledge
4. D) Personal attitudes

Ans: A

Feedback:
It is much easier to change a persons behavior than it is to change an entire
groups behavior. It is easier to change knowledge levels than attitudes.

18. Which statement reflects an important factor to consider when

implementing a planned change?

1. A) Change should be implemented suddenly

2. B) Change should be implemented gradually
3. C) Change should be implemented arbitrarily
4. D) Change should be implemented sporadically

Ans: B

Feedback:

Change should be planned and thus implemented gradually, not sporadically or

suddenly and certainly not arbitrarily.

19. Which characteristics are associated with change by drift changes? Select all
that apply.

1. A) They are planned

2. B) They are accidental
3. C) They are unplanned
4. D) They are a result of a threat

Ans: B, C

Feedback:

Change by drift is unplanned or accidental. The other options are not

characteristics of changes that are a result of change by drift.

20. Historically, many of the changes that have occurred in nursing or have
affected the profession are the result of what type of change?

1. A) Planned
2. B) Change by drift
3. C) Rationalnempirical
4. D) Normativenreeducative

Ans: B

Feedback:

Historically, many of the changes that have occurred in nursing or have affected
the profession are the result of change by drift. While other types of changes
have occurred, change by drift accounts for most of them.

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21. Which force is driving change in todays health-care environment? Select all
that apply.

1. A) Increased cost of health-care services

2. B) Decrease in health-care professionals and providers
3. C) Decreased third-party reimburse of health-care services
4. D) Increased need to update health-carenrelated technologies

Ans: A, B, C, D

Feedback:

Many forces are driving change in contemporary health care, including rising
health- care costs, declining reimbursement, workforce shortages, increasing
technology, the dynamic nature of knowledge, and a growing elderly population.
Contemporary health- care agencies then must continually institute change to
upgrade their structure, promote greater quality, and keep their workers.
Wages for health-care professions and providers have not contributed
significantly to the changes in todays health-care environment.

22. Which action is reflective of the leadership role necessary for a successful
planned change to occur?

1. A) Demonstrates flexibility in goal setting

2. B) Recognizing the need for a planned change
3. C) Identifying the resources that are available to support a change
4. D) Support the staff during the implementation of a planned change

Ans: A

Feedback:

Leaders demonstrate flexibility in goal setting in a rapidly changing health-care

system. The other options are associated with management functions
associated with change.

23. Which statement is true concerning the refreezing phase of the change
process? Select all that apply.

A)

B)

C)

D)

Ans:

Feedback:
During the refreezing phase, the change agent assists in stabilizing the system
change so that it becomes integrated into the status quo. If refreezing is
incomplete, the change will be ineffective and the prechange behaviors will be
resumed. For refreezing to occur, the change agent must be supportive and
reinforce the individual adaptive efforts of those affected by the change.
Because change needs at least 3 to 6 months before it will be accepted as part
of the system, the change agent must be sure that he or she will remain
involved until the change is completed. The successfulness of the refreezing
stage is dependent about the acceptance of change by all staff.

The focus of this phase is to integrate the change into the status quo
Stabilization of change requires a 6- to 9-month period of time

If refreezing is incomplete, prechange behavior will be resumed

The change agent must remain involved until the refreeze stage is complete A,
C, D

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24. Which activity associated with the unfreezing state of change will have the
greatest impact on the success of the movement stage of the change process?

1. A) Accurate identification of the problem requiring change

2. B) Effective information gathering concerning the problem
3. C) Key personnel voicing their opinions regarding the need for
change
4. D) The need for change is perceived by all those affected by the
problem

Ans: D

Feedback:

The change agent should not proceed to the movement stage until the status
quo has been disrupted and the need for change is perceived by the others.
While the other options will affect the process, perception of the need to change
by all affected by the change is the most impactful of the options provided.

25. Which factor is the greatest contributor to the resistance encountered with
organizational change?

1. A) Poor organizational leadership

2. B) Presence of employee mistrust
3. C) Ineffective organizational management
4. D) Insufficient staff involvement in the process

Ans: B

Feedback:
Perhaps the greatest factor contributing to the resistance encountered with
change is a lack of trust between the employee and the manager or the
employee and the organization. While the other options may increase
resistance, employee distrust is the primary barrier to change.

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