Leading and Managing in Nursing 7th Edition Yoder-Wise Test Bank

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Leading and Managing in Nursing 7th Edition

Yoder-Wise Test Bank
Chapter01:Leading,Managing,andFollowing
Yoder-Wise:LeadingandManaginginNursing,7th Edition
MULTIPLECHOICE
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults.
Sheisaskedto assessand adapttheunitto bettermeet theunique needsof the
olderadultpatient.Using complexity principles, what would be the best approach to take for
implementation ofthischange?
a. Leveragethehierarchical
managementpositiontogetunitstaffinvolvedinassessmentand planning.
b. Engageinvolvedstaffatalllevelsinthedecision-makingprocess.
c. Focus the assessment on the unit and omit the hospital and
communityenvironment.
d. Hireageriatricspecialist tooversee and controltheproject.
ANS:B
Complexity theory suggests that systems interact and adapt and that decision making
occursthroughoutthesystems,asopposedtobeingheldinahierarchy.Incomplexitytheory,everyv
oicecounts, and therefore,all levels of staffwould beinvolved indecision making.
TOP:AONEcompetency:CommunicationandRelationship-Building
2. Aunitmanagerofa25-bedmedical/surgicalarea receivesaphone callfromanursewhohascalled in

sick five times in the past month. He tells the manager that he very much wants tocometo
workwhenscheduled butmust oftencare forhis wife,who isundergoing treatment
NRIGB.CM
forbreastcancer. According toUMaS N’sTneed hiO
slow erarchy theory, what wouldbe thebest
approachtosatisfyingtheneedsof thisnurse,otherstaff, andpatients?
a. Lineupagency nurseswho canbecalledinto workonshortnotice.
b. Placethenurseon unpaidleavefortheremainder ofhiswife’s treatment.
c. Sympathizewiththenurse’sdilemmaand letthe chargenurseknow thatthis
nursemaybecalling in frequently in thefuture.
d. Workwiththenurse,staffingoffice,andothernursestoarrangehisscheduleddaysof
faroundhis wife’streatments.
ANS:D
Placingthenurseonunpaidleavemaythreatenthenurse’s capacity tomeetphysiologic
needsanddemotivatethenurse.Unsatisfactorycoverageofshiftsonshortnoticecouldaffectpatientc
areandthreaten theneedsofstafftofeelcompetent.Arrangingtheschedule around
thewife’sneedsmeetstheneedsofthestaffandofpatientswhilesatisfyingthenurse’sneedforaffiliat
ion.
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the
firstmediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and
theunitmanagercontinuestoreiteratethereasonsfor
theactions.Whatwouldbethebestcourseofaction at this time?

a. Sendthetwo disputantsaway toreachtheirown resolution.
b. Involve anotherstaffnursein thediscussion forclarity issues.
c. Askeach partyto examinetheirown motivesand issues intheconflict.

d. Continuetolistenasthepartiesrepeat
theirthoughtsandfeelingsabouttheconflict.
ANS:C
For resolution of conflict, one should address the interests and involvement of participants
intheconflict by examining the real issues of all parties.
4. Atasecond negotiationsession, theunit manager and staffnurseareunableto

reacharesolution.What is the appropriate next step?
a. Arrangeanothermeetinginaweek’s timesoas toallowacooling-offperiod.
b. Elevatethenext negationsessionto thenextmanager, onelevelabove.
c. Insistthatparticipantscontinuetotalkuntilaresolutionhasbeenreached.
d. Backtheunit manager’sactions andend thedispute.
ANS:B
Partofleadershipis understandingconflictresolution andabilityto
negotiateandmanageforresolution of issues and concerns. This situation has failed a second
negotiation session,elevation to a manager with additional training to facilitate conflict
resolution is important atthis point.
5. The manager of a surgical area has a vision for the future that requires the addition of
RNassistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the
staffhave always practiced inaprN
imaR
rynIursiG
ng-B
de.
liC
USNT OveryMsystem and arevery resistant to this
idea.
Whatwouldbe thebestinitial strategyforimplementation ofthischange?
a. ExploringthevaluesandfeelingsoftheRNgroupinrelationshipto thischange
b. Leaving the RNs alone for a time so they can think about the change before it
isimplemented
c. Dropping the idea and trying for the change in a year or so when some of
thepresentRNs haveretired
d. Hiringtheassistants andallowing theRNsto seewhat goodadditions theyare
ANS:A
Influencing others requires emotional intelligence in domains such as empathy,
handlingrelationships, deepening self-awareness in self and others, motivating others, and
managingemotions. Motivating others recognizes that values are powerful forces that
influenceacceptanceofchange.Leaving theRNsalone for aperiodoftimebeforeimplementation
doesnot provide opportunity to explore different perspectives and values. Avoiding
discussionuntil the team changes may not promote adoption of the change until there is
opportunity toexplore perspectives and values related to the change. Hiring of the assistants
demonstrateslackof empathyforthe perspectives of theRN staff.
TOP:AONEcompetency:KnowledgeoftheHealthCareEnvironment
6. AstheRN chargenurse onthe nightshift inasmalllong-term carefacility,you’vefoundthatthere is

little turnover among your LPN and nursing assistant (NA) staff members, but theyare not
very motivated to go beyond their job descriptions in their work. Which of
thefollowingstrategies mightmotivate thestaffand lead togreater job satisfaction?
a. Askthedirectorof nursingtoofferhigher wagesandbonuses
forextraworkforthenight LPNs and NAs.
b. AllowtheLPNsandNAs greaterdecision-makingpowerwithin thescope
oftheirpositionsin the institution.
c. Hireadditionalstaffsothat
therearemorestaffavailableforenhancedcare,andindividualworkloads are
lessened.
d. Ask the director of nursing to increase job security for night staff by having
themsigncontracts that guaranteework.
ANS:B
Hygiene factors such as salary, working conditions, and security are consistent
withHerzberg’s two-factor theory of motivation; meeting these needs avoids job
dissatisfaction.Motivator factors such as recognition and satisfaction with work promote a
satisfying andenriched work environment. Transformational leaders use motivator factors
liberally to inspireworkperformanceand increasejob satisfaction.
7. The nurse manager wants to increase motivation by providing motivating factors for the
nurseonthe unit. What actionwouldbe appropriate tomotivatethe staff?
a. Collaborate with the human resource/personnel department to develop on-
sitedaycareservices.
b. Provideahierarchical organizational structure.
N R I G B.C M
c. Implementamodel ofsharU edgS
oveNrnanTce. O
d. Promotethedevelopment ofaflexiblebenefitspackage.
ANS:C
Complexitytheorysuggeststhatsystemsinteractandadaptandthatdecisionmakingoccursthroug
hout systems, as opposed to being held in a hierarchy. In complexity theory, everyvoice
counts, and therefore all levels of staff would be involved in decision making.
Thisprincipleis thefoundation of shared governance.
8. A chargenurseonabusy40-bed medical/surgicalunit is approached byafamily memberwho

begins to complain loudly about the quality of care his mother is receiving. His behaviorisso
disruptivethat it isoverheard bystaff,physicians, and othervisitors.Thefamilymemberleaves the
unit abruptly, and the nurse is left feeling frustrated. Which behavior by the
chargenursebestillustrates refinedleadership skillsin anemotionallyintelligentpractitioner?
a. Reflect to gain insight into how the situation could be handled differently in
thefuture.
b. Trytocatchupwiththe angryfamilymembertoresolvetheconcern.
c. Discusstheconcernwiththepatientafterthefamilymemberhasleft.
d. Notifynursingadministration ofthesituation.
ANS:A
Goleman suggests that emotional intelligence involves insight and being able to step
outsideof the situation to envision the context of what is happening as well as being able to
manageemotionssuch as frustration effectively.
TOP:AONEcompetency: Leadership
9. The chief nursing officer has asked the staff development coordinator to facilitate
thedevelopment of a clinical competency program for the facility. While making rounds on
theunits, the staff development coordinator overhears RN staff complaining that they feel it
isinsulting to be required to participate in a competency program. What behavior by the
staffdevelopmentcoordinatoris most appropriate in this situation?
a. Disregardstaffconcernsandcontinuewithdevelopmentoftheprogram.
b. Informthenursesthatthis programis arequirement forJCAHO accreditation.
c. Scheduleameetingwith thechiefnurseexecutivetoapprise her ofthesituation.
d. Facilitate a meeting so nurses can articulate their values and concerns about
acompetencyprogram.
ANS:D
The manager role involves guiding others through a set of derived practices that
areevidence-based and known to satisfy preestablished outcomes such as participation in
acompetency program. This involves engagement of staff through sharing of concerns
andideas.Acloseanalysisof the IOMreportand thesummaryofthePPACAsuggests thatno
healthreformcanunfoldwithoutactivenursingengagement.Eachdocumentemphasizesthatnurses
must lead, manage, and behave as active collaborators with other members of thehealthteam
and with thosebeing served.
TOP: AONE competency:Communication and Relationship-Building
N R I G B.C M
USNT O
10. The nurse manager has been asked to implement an evidence-based approach to teach
ostomypatients self-management skills postoperatively. The program is to be implemented
across theentirefacility. What illustrates effectiveleadershipin this situation?
a. Thetraining modulesareleftin the staffroom for times when staffareavailable.
b. The current approach is continued because it is also evidence-based and is
morefamiliarto staff.
c. You decide to implement the approach at a later date because of feedback from
theRNsthat thenew approach takes too much time.
d. AnRNwhoisalreadyfamiliarwiththenewapproachofvolunteerstotaketheleadin
mentoring and teaching othershowto implement it.
ANS:D
Followership occurs when there is acquiescence to a peer who is leading in a setting where
ateamhasgatheredtoensurethebestclinicaldecisionmaking, andactionsaretakento
achieveclinical or organizational outcomes. Followership promotes good clinical decisions
and use ofclinicalresources.
11. You overhear a new graduate RN telling a nurse colleague that leadership and
managementbelong to the unit manager, not to her. As a nursing colleague, what do you
know to be true inregardto the statement?
a. Thestatementis correct.Leadershipis nottheroleofthestaffnurse.
b. Thenewgraduate wouldbenefitfrom furtherunderstandingofher roleas

aprofessional, whose influence may affect the decision making of
patients,colleagues,and other professionals.
c. Thenewgraduatehasbeen influencedbynurseleaders
andmanagerswholeaveforotherpositions.
d. Thegeneralperceptionisthatnurseleaders andmanagers arenotsatisfiedintheirjobs.
ANS:B
Care coordination that involves the intersection of individual, family, and community-
basedneeds requires that nurses have self-confidence, knowledge of organizations and
healthsystems, and an inner desire to lead and manage. There is often a view that leadership
isisolated to those holding managerial positions, and that a direct care nurse is subject
tofollowing by adhering to the direction of others. Such views fail to acknowledge that to
be anurse requires each licensed individual to lead, manage, and follow when practicing at
thepoint-of-careand beyond.
12. The charge nurse walks into Mr. Smith’s room and finds him yelling at the LPN. He
isobviously very upset. The charge nurse determines that he has not slept for three
nightsbecauseofunrelievedpain levels.TheLPNis very upsetandcallsMr.Smithan“ugly, old
man.” The charge nurse acknowledges the LPN’s feelings and concerns and then suggests
thatMr. Smith’s behavior was aggressive but was related to lack of sleep and to pain. The
chargenurse asks, “Can you, together with Mr. Smith, determine triggers for the pain and
effectiveapproachesto controlling his pain?”This situation is an exampleof what?
a. Lack ofempathy and understanding for MissJones
N R I G B.C M
b. Concern with placating MrU . SmSithNT O
c. Leadershipbehavior
d. Managementbehavior
ANS:C
ThesituationbetweenMr.SmithandMissJonesisacomplexsituationinvolvingunrelievedpatient
symptoms and aggressiveness toward a staff member. Providing engaged,collaborative
guidance and decision making in a complex situation where there is nostandardizedsolution
reflects leadership.
13. Afterassessinganolderadultpatientinlong-termcarewhohasbeenslowlydeterioratingforweeks,
the nurse manager calls the family and asks them to come in, as the patient is
dying.Whatisthe most likely basisforthe nursemanager’srequest?
a. Anestablishedclinicalpathway
b. Confirmatoryscientificevidence
c. Unitprotocol
d. Experience
ANS:D
Thenursemanager isemploying knowledgeand experiencein determiningthat thepatient
isdying, because the course of dying is not standardized and cannot be determined by
clinicalpathways.
14. Chart audits have revealed significant omissions of data that could have legal and
financialguideline ramifications. The unit manager meets with the staff to discuss audit
findings and tofind approaches that will address the gaps in charting and achieve desired
goals. What is themanagerdemonstrating?
a. Leadership
b. Management
c. Decisionmaking
d. Vision
ANS:B
The process of guiding others to meet established goals, outcomes, and procedures
ismanagement.Thiscanrequirecollaborativedecisionmakingto determine howbestto
reachpredeterminedgoals andfollow established practices.
15. Afamilyiskeepingvigilatacriticallyillpatient’sbedside.Distantfamilymemberscalltheunit
continuously asking for updates and expressing concern. The nurse speaks with thedistant
family members and states she is referring them to the hospital social worker, whoserole is
to work with family in this situation. What role is the nurse assuming through thisaction?
a. Manager
b. Leader
c. Follower
d. Laissez-faire NURSINGTB.COM
ANS:A
Asamanager,youareconcernedwithmanagingandcoordinatingresourcesto
achieveoutcomes in accordance with established clinical processes. Referral to a social
workeralleviatesdemand on stafftimeand isconsistent with hospital procedures.
16. A family is keeping vigil at a critically ill patient’s bedside. The nurse approaches the
unitmanager with concern over the family dynamics for the patient concerned there
arepatient-familyconflictsbasedonpatient’swishes.Thenursesuggeststhatthepatient’s
providermayneedtodiscussthetreatmentplanwiththefamily.Theunitmanagerstateshewill
arrange a discussion with the patient’s provider and ask the nurse to support
theprovider’sdecisions. What isthe role ofthe nursein thissituation?
a. Leadership
b. Management
c. Follower
d. Evidence-based
ANS:C
In the followership role, you bring to the manager your concerns about concerns for
patientsandtheoutcomesandacceptthedirectiongivenbythemanagerin responsetoyour concerns.
17. Themanagercalls thestaff togetherto assessa situationin whichthefamily ofaseriouslyillpatient

is anxious and is absorbing a great deal of staff time in consultation, discussion,
andquestioningoftreatmentdecisions.Staffmembersarebecomingdistancedfromthefamily.
After inviting the concerns of staff, the manager explains that the organization
valuespatient-
centeredcareandthatevidencesupportsthatactingasanadvocateandalistenerishelpful to
families. The manager asks the staff for ideas and strategies that are effectivelypatient-
centered in dealing with families in similar situations. What is the role of the
nursemanagerin this situation?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS:A
As a leader, the manager is providing and communicating vision and direction based
onevidence andexperience.Themanagerisengagingothersindecisionmakingthatmoves
themtowardthevision with areasonablelevel ofrisk taking.
18. The manager of a unit is finding it difficult to work with a new graduate nurse. The new
nursehasmanyideas;however,hismannerofpresentingthemirritatesthemanager.Afterreflection
and discussion with others, the manager recognizes that she feels threatened by hisbehavior.
She comes to understand that the new nurse is trying to establish his own role on theunit; is
not trying to challengeher;andneeds guidance,coaching,and affirmation. What is the
N R I G SB.NC TM
nursemanager demonstrating iU n thissituation? O
a. Apositiveself-concept
b. Deepeningself-awareness
c. Leadership
d. Acquiescence
ANS:B
Stepping outside oneself to envision the situation while assuming ownership is a
componentof emotional intelligence. This is an example of self-awareness to identify the
resolve toself-conflictin this situation.
TOP:AONEcompetency:Professionalism
19. As the head of a nursing program, you consistently invite the ideas of your team
aboutinnovations in teaching, community partnerships, and curriculum design and
inviteparticipationindecisions. Manyoftheseideashavebeenimplemented
successfully,andyourstaffmembersarekeento try onotherideas. Whatis the leadershipyou
areemploying?
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS:D
Transformationalleadershipinvolvesattendingtotheneedsandmotivesof
followers,whichresultsin creativity, improvement, andemployeedevelopment.
TOP:AONEcompetency:Professionalism
20. As a leader on a rehab unit, the manager encourages all staff members to see themselves
ashaving a role in decision making and quality care. The manager sees their role as
involvingparticular responsibilities in decision making but not as a hierarchal role. What is
this view oftherole consistent with in this situation?
a. Traittheories
b. Complexitytheory
c. Situatedtheory
d. Emotionalintelligence
ANS:B
Complexity theory involves envisioning each member of the team involved in
decisionmaking,management,and leadership,withtheleadernot seenina
hierarchalrelationship tootherteam members.
21. A staff nurse has been recently promoted to unit manager. During the time on the unit,
thenurse formed a strong social network among staff, has promoted the development
ofrelationships between staff and workers in other areas of the organization, and has
formedrelationshipsthatgenerateideasfrompatientorganizationsandthelocalnursingeducatio
nprogram.According to complexity theory,what principleis being engaged?
a. Empowerment NRI GB.CM
b. Systematicthinking U SNT O
c. Developmentofnetworks
d. Bottom-upinteractions
ANS:C
Accordingtocomplexity theory,socialnetworksevolvearound
areasofcommoninterestandareableto respond to problems in creativeand novel ways.
22. Accordingtothecomplexitytheory,what wouldbethefocusofmeasurement?

a. Costperhospital day
b. Bedutilization
c. Infectionrates
d. Staffmoraleandbudgets
ANS:D
According to complexity theory and the principle “Think systematically,” one cannot
ignoreobjectivedata ornonmeasurable data,as bothinform decisions.
TOP:AONEcompetency:Business Skills
23. During a staff meeting held to discuss developing a mission statement for the unit, the idea
ofplacing patient needs first is discussed. What is considered when the suggestion by
themanageris for theunit mission tobe derived fromthe organizationmission?
a. Empowering
b. Aleadershiptag
c. Asymbol
d. Amanagementtask
ANS:B
According to complexity theory, leadership tags, which are similar to values, reflect
thepatient-centeredphilosophiesandvalues-
drivencharacteristicsthatdefineanorganizationandgiveit personality.
24. A dispute arises between an RN and an LPN over a patient issue. The tension
continuesbetweenthetwoandbeginsto affectother staffmembers,who aredrawn
intotheconflict.Over time, the team becomes polarized toward either the RN or the LPN.
How might thissituationbeprevented?
a. Expediency in responding to the initial dispute, once it became apparent that
itcouldnot beresolved bythe two parties themselves
b. Askingother staffmemberswhat therealissues werein thedisputebetween
theRNand the LPN
c. Reassigning one of the parties to another unit when it became apparent that the
twoindividualscould not resolve thedispute themselves
d. Callingastaffmeeting attheonset ofthedisputeto allowtheteam andthe RNandLPNto
discuss theinitialdispute
ANS:A
Theinitialstepinconflict resolutionshouldhaveinvolvedan expedientresponsetotheissuesand
putting a focus on theissN
ueUsR
inSvI veGdT
olN inBt.
heCdO
isM
putebetween the LPNand RN through
negotiationinvolving thetwo parties, beforethe disputeinvolved others.
25. Theunitis shiftingfromprimary nursingtoa teammodelin aneffortto

containcosts.Staffmembers are upset about the change and ask for a meeting to discuss the
new model. Afterhearing their concerns related to reduction in professional autonomy,
what is the initialresponseby themanagerto address theconcerns?
a. Acknowledgetheloss.
b. Explainthereasonsforchange,emphasizing theneedtoreducecosts.
c. Repeattheinformationseveraltimes,givingdetailedbudgetoverviews.
d. Adjournthemeetingandprovideexplanationthroughe-mail.
ANS:A
Visioning involves engaging with others to assess the current reality, specify the end
point,andthenstrategizetoreducedifferences.Thisrequirestrustingrelationshipsthatacknowledget
he differences in values and ideas. When done well, the nurse manager and the nurses
withinaunit experiencecreativetension that inspiresworking in concertto achievedesiredgoals.
MULTIPLERESPONSE
1. Anewgraduatenursewondersaboutthedirectionsthatherpreceptorhasgivenherregardingmanage
mentofincontinent, confusedpatients. Thenewnursebrings thepreceptor
evidence-based information she located regarding incontinence interventions for
confusedpatients and asks to talk about the guidance that given after the preceptor reviews
theinformation in the article. What is the new nurse demonstrating in this situation? (Select
allthat apply.)
a. Assertiveness
b. Followership
c. Management
d. Insubordination
ANS:A,B
This is an example of followership in which a staff nurse is demonstrating assertive
behaviorand presenting evidence that may influence the decision making of her nurse leader
andmanager.
NURSINGTB.COM

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Leading and Managing in Nursing 7th Edition

2. Aunitmanagerofa25-bedmedical/surgicalarea receivesaphone callfromanursewhohascalled in

theactions.Whatwouldbethebestcourseofaction at this time?

c. Askeach partyto examinetheirown motivesand issues intheconflict.

4. Atasecond negotiationsession, theunit manager and staffnurseareunableto

6. AstheRN chargenurse onthe nightshift inasmalllong-term carefacility,you’vefoundthatthere is

8. A chargenurseonabusy40-bed medical/surgicalunit is approached byafamily memberwho

b. Thenewgraduate wouldbenefitfrom furtherunderstandingofher roleas

17. Themanagercalls thestaff togetherto assessa situationin whichthefamily ofaseriouslyillpatient

22. Accordingtothecomplexitytheory,what wouldbethefocusofmeasurement?

25. Theunitis shiftingfromprimary nursingtoa teammodelin aneffortto

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