Professional Documents
Culture Documents
Nursing Management 1
Effective Leadership and Management in Nursing
7th Edition
Sullivan & Decker
NCLEX® Review
Note: Some questions in this exercise may have more than one correct answer. To answer
such questions correctly, you must select all the correct answers. Also, some questions will
require you to type your answer in the space provided.
CHAPTER: 1
Introducing Nursing Management
2) Quality management and benchmarking are two approaches used to improve the
quality of care. The major difference between these two approaches is which of
the following?
a) Quality management is not useful in b) Benchmarking compares outcomes in
the outpatient setting. a variety of settings and disciplines.
c) Quality management is used only in d) Benchmarking looks only at outcomes
the primary care setting. specific to nursing.
Reason: The major difference between quality management and benchmarking is that
benchmarking compares outcomes in a variety of settings.
4) One of the most important driving forces behind health care policy changes is
which of the following?
a) New technology b) Outsourcing of services
c) Emerging role of nurse practitioners d) Ability to pay for health care
Reason: One of the most important driving forces behind health care policy changes is the
ability to pay for health care.
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8) The nurse manager is talking with the CNA about her time management. Which
of the following is an example of a nurse manager as coach?
a) "Your timely response to patients' b) "Your appearance is seldom
call lights is exemplary." professional."
c) "You must get the vital signs taken on d) "You never report AM blood sugar
time or you will be disciplined." levels on time."
Reason: Nurse managers must also be coaches, teachers, and facilitators.
9) Which of the following skills is essential for nurses in today's health care
environment?
a) Communication b) Supervision & Management
c) Delegation d) All of above
Reason: Management, supervision, delegation, and communication are all skills essential
for nurses in today's health care environment.
10) In our culturally diverse society, barriers to health care result from:
a) Prejudice. b) Different socioeconomic status.
c) Differences in language. d) All of above.
Reason: The main factors that constitute barriers to health care are differences in
language, different socioeconomic status, and prejudice. Telehealth is using
telecommunications technology to provide medical and nursing services from
afar.
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CHAPTER: 2
Designing Organizations
2) The Hawthorne effect explains that the relationship between people and
productivity is enhanced by which of the following?
a) Special attention b) Organizations
c) Creativity d) Groups
Reason: The Hawthorne effect explains that the relationship between people and
productivity is enhanced by special attention.
3) Which of the following theories best depicts current health care delivery systems?
a) Open system theory b) Closed system theory
c) Chaos theory d) Contingency theory
Reason: The contingency theory best depicts the current health care delivery systems.
Contingency theorists believe organizational performance can be enhanced by
matching an organization's structure to its environment. Closed systems are self-
contained and usually can be found only in the physical sciences. An open
system, in contrast, interacts both internally and with its environment.
5) Health care systems primarily have functional structures. Which of the following
would be an example of this?
a) Open communication exists between b) Medicine has authority over nursing.
Physical Therapy and Nursing.
c) Laboratory services have little d) All nursing tasks fall under nursing
authority. service.
Reason: In functional structures, employees are grouped in departments by specialty, with
similar tasks being performed by the same group.
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6) "Organizations are made up of intertwined links and diversified choices that
generate unanticipated consequences." This defines which of the following
theories?
a) Contingency theory b) Closed system theory
c) Open system theory d) Chaos system theory
Reason: The chaos theory is characterized by organizations that are made up of
intertwined links and diversified choices that generate unanticipated
consequences. The contingency theory best depicts the current health care
delivery systems. Contingency theorists believe organizational performance can
be enhanced by matching an organization's structure to its environment. Closed
systems are self-contained, and usually can be found only in the physical
sciences. An open system, in contrast, interacts both internally and with its
environment.
10) While interviewing for a position at City Hospital, the nurse asks about the
organizational structure of the institution. She is told that hospital is organized
into departments based on specialty (e.g., nursing, dietary, pharmacy, etc.).
Based on what you know about organizational structure, select the structure in
this example.
a) Parallel b) Functional
c) Service-integrated d) Matrix
Reason: In functional structures, employees are grouped in departments by specialty, with
similar tasks being performed by the same group, similar groups operating out of
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the same department, and similar departments reporting to the same manager.
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CHAPTER: 3
Delivering Nursing Care
3) Which of the following clients would most likely be selected for case management?
a) An adolescent with a gunshot wound b) A young adult with a fractured pelvis.
who is in the ER.
c) An elderly client awaiting a hip d) A 41-year-old client admitted for
replacement outpatient tonsillectomy.
Reason: This is a common surgical problem that is high volume for most hospitals so it
would be appropriate for case management.
4) Which of the following conditions would be well suited to use of a nursing critical
pathway?
a) Foreign object in ear b) Fever of unknown origin
c) Hip replacement surgery d) Bacterial infection acquired in a
foreign country
Reason: A critical pathway tracks the client's progress through assessment, interventions,
treatments, and outcomes for conditions across a time line. Hip replacement
surgery would have a specified time line, with specific interventions and
treatments to get the client back to optimal functioning.
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5) The nurse is developing a critical pathway for congestive heart failure (CHF).
Which components are essential to include? (Select all that apply.)
a) Expected length of stay b) Assigned staff nurse
c) Patient outcomes d) Medical diagnosis
Reason: Critical pathways are developed when there are usual expected outcomes for
client's with a particular medical diagnosis.
A critical pathway is developed with an expected length of stay that is appropriate
for the medical diagnosis and treatment plan.
A critical pathway can be developed for any medical diagnosis that has a usual set
of outcomes and length of stay.
6) A staff nurse is working with a patient who is on a critical pathway for education
in preparation for home care. Which one of the following responsibilities would
the nurse address first?
a) Taking vital signs b) Answering the client's questions
c) Evaluating client teaching d) Reviewing the information with the
client and family
Reason: Assessment is the first phase of the nursing process and history is part of client
assessment that precedes all others. The nurse should review pertinent
information with the client and family and establish goals for care.
8) The staff nurse is caring for the client with total accountability and is in continual
communication with the client, the family, the physicians, and other members of
the health care team. This type of nursing delivery system is known as:
a) Total patient care b) Qualified nurse case managers
c) Established critical pathways d) Quality management system
Reason: Total patient care is the original model of nursing care delivery, in which one RN
is responsible for all aspects of one or more patients' care.
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CHAPTER: 4
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Leading, Managing, Following
1) Which of the following is the major difference between managers and leaders?
a) Leaders usually have legitimate b) Leaders do not make good managers.
power.
c) Managers seldom are leaders. d) Managers always have legitimate power.
Reason: Managers will always have legitimate power; leaders do not have to have it.
2) A staff nurse describes the unit manager as "a born leader." The nurse ascribes to
which theory of leadership?
a) Trait theories b) Behavioral theories
c) Formal leadership theories d) Democratic leadership theories
Reason: Inborn characteristics are consistent with the trait theory of leadership. The
behavioral theory believes people learn new behaviors through direct experience,
or by observing other people performing the behaviors, which results in positive
and negative outcomes. Leadership is formal when practiced by a nurse with
legitimate authority conferred by the organization and described in a job
description. A democratic leadership style assumes individuals are motivated by
internal forces; the leader uses participation and majority rule to get work done.
3) The unit manager of a 32-bed medical-surgical unit allows the staff nurses to do
self-governance for scheduling, client care assignments, and committee work. The
manager would be considered which type of leader?
a) Autocratic b) Democratic
c) Bureaucratic d) Laissez-faire
Reason: The laissez-faire type of manager exerts very little control. Bureaucratic
leadership is a leadership style that assumes individuals are motivated by external
forces; the leader trusts neither followers nor self to make decisions, and therefore
relies on organizational policies and rules. Autocratic leadership is a leadership
style that assumes individuals are motivated by external forces; therefore, the
leader makes all the decisions and directs the followers' behavior. Democratic
leadership is a leadership style that assumes individuals are motivated by internal
forces; the leader uses participation and majority rule to get work done.
4) A multiple-car accident has occurred with multiple trauma clients being sent to an
Emergency Department. The unit manager is preparing the staff for the arrival of
the trauma victims. Which type of leadership would be most effective in this
situation?
a) Democratic b) Bureaucratic
c) Laissez-faire d) Autocratic
Reason: Different situations call for different types of managing style. An emergency is
best handled with one person in control, delegating activities. Laissez-faire
leaders exert little control; therefore this would not be appropriate in an
emergency. A democratic leader seeks consensus and there is insufficient time in
an emergency for this type of leadership. A leader who depends on bureaucratic
rules and policies will be ineffective in an emergency situation.
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6) Which of the following types of leadership behaviors would be most useful when
managing a staff of newly trained CNAs (Certified Nursing Assisstants)?
a) Achievement-oriented b) Supportive
c) Participative d) Directive
Reason: Directive leadership involves telling employees what is expected, giving specific
guidance, ensuring adherence to rules and procedures, and scheduling and
coordinating work efforts. Participative leadership is a leadership style that
involves consultation with subordinates in decision making. Supportive
leadership style focuses on the needs of employees. Achievement-oriented
leadership is a leadership style that includes goal setting and maintaining high
levels of performance in order to motivate employees.
8) The complexities of the current health care delivery systems require a variety of
leadership styles. Which of the following is one that has emerged in response to
these changes?
a) Quantum b) Servant
c) Autocratic d) Democratic
Reason: The quantum theory of leadership addresses complexity in organizations.
Autocratic leadership seeks to minimize complexity, while democratic leadership
looks to build consensus. Servant leadership is based on the premise that in
serving, one may be called to lead.
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CHAPTER: 5
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Initiating and Implementing Change
1) A new manager is implementing an initiative with the desired outcome to have the
unit run more "smoothly". What quality is the manager demonstrating?
a) Being unrealistic b) Being a change agent
c) Being democratic d) Being authoritarian
Reason: The nurse serves as a change agent when she acts to bring about change and
ensure the effectiveness of the unit atmosphere.
3) When trying to facilitate change in the staff, it is necessary to build trust and
recognize the need for change. This type of action is known as which of the
following, according to Lewin's Force-Field Model?
a) Moving the system to a new level b) Unfreeze of the system
c) Refreeze of the system d) Institutionalization
Reason: Unfreezing the existing equilibrium is the stage that motivates the participants
and builds trust/recognition. Refreezing reinforces the new patterns of behavior.
4) Lippitt's phases of change are important factors in the change process. The phase
that involves key people in data collection is known as:
a) Assess the motivation. b) Choose a change agent.
c) Diagnose the problem. d) Maintain the change.
Reason: There are seven steps in Lippitt's phases of change. The first is the diagnosis of
the problem, and it involves the key people in data collection and problem
solving. The second step is assessing the motivation. Choosing a change agent is
the fifth step. Maintaining the change is the sixth step.
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6) In determining a way to make shift change more effective for the nurse and the
client, a hospital implemented a course of action. After a week of implementation,
the decision was deemed inappropriate. What step of Roger's diffusion of
innovations is this?
a) Confirmation b) Implementation
c) Knowledge d) Persuasion
Reason: The stage of confirmation seeks reinforcement of the action taken. In the
implementation stage, the innovation is put to use, and reinvention or alterations
may occur. In persuasion stage, a favorable (or unfavorable) attitude toward the
innovation forms. In the knowledge stage, the decision-making unit is introduced
to the innovation and begins to understand it.
7) When is the time to make people think about the routines that have been
previously followed and to consider what might be a better plan of action?
a) Collection of data b) Planning
c) Analyzing data d) Identification
Reason: Planning is the time to make people uncomfortable with the norm.
8) The changes brought forth by the state boards of nursing are an example of which
type of change agent?
a) Resistance b) Empirical–rational
c) Normative–reeducative d) Power–coercive
Reason: Power–coercive strategies are based on the application of power by a legitimate
authority. In the empirical–rational model of change strategies, the power
ingredient is knowledge. The assumption is that people are rational, and will
follow their rational self-interest if that self-interest is made clear to them.
Normative–reeducative strategies of change rest on the assumption that people act
in accordance with social norms and values. Resistance is opposing the change.
9) Even though this is not easy, facilitating ____________ is a mandatory skill for all
nurse managers and is crucial in the success of the manager.
a) resistance b) change
c) planning d) collection of data
Reason: Successful change agents demonstrate certain characteristics that can be
cultivated and mastered with practice. Making change is a mandatory skill for
managers.
10) Change is a mandatory skill for managers. Successful change agents display
certain characteristics. Some of these characteristics are: (Select all that apply.)
a) Energy. b) Confidence.
c) Realistic thinking. d) Trustworthiness.
Reason: Energy, confidence, realistic thinking, and trustworthiness are among the
characteristics that successful change agents demonstrate.
CHAPTER: 6
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Managing and Improving Quality
2) A family member slips on the wet floor and hits her head. You understand that
completion of an incident report is necessary for which hospital process?
a) Risk management b) Outcome management
c) Quality management d) Peer review
Reason: Risk management deals with all incidents of error in the hospital.
3) A client experiences difficulty breathing after the change of shift. The nurse on
duty discovers that the IVFs were infusing at a rate 10 times the calculated
normal. After notifying the physician, and correcting the rate what should be the
next step in the client's care?
a) Notify family b) Discipline the previous nurse
c) Complete an incident report d) Obtain legal consult
Reason: Completion of an incident report is necessary after notification of the physician.
And legal consult may not be necessary.
5) A client complains every morning that the night shift nursing staff do not answer
his call light promptly to assist his elimination needs. His concerns are not shared
with the Nurse Manager, and he falls while trying to walk to the bathroom. This
fall could be attributed to which of the following?
a) Breakdown in communication b) Lack of staff
c) Lack of concern d) Breakdown in management
Reason: Communication with the staff allows a better understanding of safety concerns.
6) In order to best reduce the potential for risk, the development of which type of
atmosphere is needed?
a) Nurse-focused b) Physician-focused
c) Family-focused d) Patient-focused
Reason: The patients will believe that their best interest is at heart.
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7) What is the focus of a continuous quality improvement program?
a) Family b) Client
c) Nurse d) Physician
Reason: Continuous quality improvement is client-focused.
8) Monitoring the number of times a medication is given utilizing the "five rights" is
an example of which portion of the Six Sigma program?
a) Measure b) Management
c) Quantitative d) Goal
Reason: The goal of Six Sigma is monitoring.
9) A client experiences a major incident. The time frame for reporting the incident
would be:
a) 24 hours. b) 36 hours.
c) 48 hours. d) 72 hours.
Reason: The incident report needs to be submitted within 24 hours of the incident, which
is one of the steps in reporting.
10) A client discharges AMA (against medical advice). This is an example of the
_________ type of risk category?
a) nurse-focused b) physician-focused
c) medical-legal incident d) Patient-focused
Reason: Any refusal is considered a medical-legal incident.
CHAPTER: 7
Understanding Power and Politics
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4) A staff nurse tells other staff nurses that the manager is ineffective in order to move into
the manager position. Which of the following would describe the nurse's actions?
a) Using punishment power b) Using a power play
c) Using personal power d) Using information power
Reason: A power play is an attempt to diminish an opponent. Punishment, or coercive,
power is based on the penalties a manager might impose on an individual or a
group. Personal power refers to one's credibility, reputation, expertise, experience,
control of resources or information, and ability to build trust. Information power
is based on access to valued data.
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5) Which of the following are effective ways to apply power and politics in nursing?
(EXCEPT)
a) Picketing the employer b) Networking with other professionals
c) Writing letters to legislators d) Joining professional organizations
Reason: Networking with other professionals, campaigns, and joining professional
organizations are some of the effective ways to apply power and politics in
nursing.
7) A nurse who is planning to run for the local school board will find which of the
following sources of power important?
a) Connection b) Reward
c) Charisma d) Expert
Reason: Connection and information are two main sources of power important in political
action. The nurse will want to use relationships to build coalitions and get
information. The nurse does not have to be charismatic to use power effectively.
The nurse is not an expert on education and as a candidate does not have rewards
to grant.
8) A nurse manager needs to resolve a conflict between the staff nurses and the
physical therapy department. What type of power might the manager utilize?
(EXCEPT)
a) Connection and referent power b) Reward and punishment power
c) Legitimate power d) Information power
Reason: Referent power is based on admiration and respect for an individual. Connection
power is based on an individual's formal and informal links to influential or
prestigious persons within and outside an area or organization. Information power
is based on access to valued data. Reward power is based on the inducements the
manager can offer group members in exchange for cooperation and contributions
that advance the manager's objectives. Punishment, or coercive, power is based
on the penalties a manager might impose on an individual or a group. Legitimate
power stems from the manager's right to make a request because of the authority
associated with job and rank in an organizational hierarchy. This manager may
need to use several types of power to resolve an important issue that crosses
departmental lines.
9) Politics is a means for influencing events and the decision of others. The nurse
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manager who consistently reminds the staff that "there is no I in team" and
periodically brings treats for the staff is using:
a) Image enhancement b) Political skills.
c) Reward power. d) Expert power.
Reason: Politics involves interpersonal endeavors, collective activities, analysis and
planning, and image. The manager is skillfully building the team morale.
Occasional treats are not rewards, nor is the manager using expert knowledge
with the staff.
CHAPTER: 8
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Thinking Critically, Making Decisions, Solving Problems
3) A nurse manager has two out of six staff nurses call in sick for one shift.
Because of reduced availability of staff, the manager decides to manage the unit
with the three remaining nurses, which keeps the unit at minimal staffing
standards What type of decision-making strategy would this be?
a) Satisfycing b) Routine
c) Adaptive d) Rationalizing
Reason: Satisficing is a decision-making strategy whereby the person chooses an
alternative that is not ideal but good enough given the circumstances.
4) A nurse manager asks the staff to submit written suggestions for a change in
policy. The group would then vote on the different suggestions. What type of
decision-making technique did the nurse manager use?
a) Statistical aggregation b) Nominal group technique
c) Brainstorming d) Delphi
Reason: The nominal group technique primarily uses a written method for exchange of
ideas. In the Delphi technique, ideas are collected through a carefully designed
sequence of questionnaires interspersed with summaries of information and
opinions derived from previous questionnaires. In statistical aggregation,
individuals are polled regarding a specific problem, and their responses are
tallied. Brainstorming is a decision-making method in which group members
meet and generate diverse ideas about the nature, cause, definition, and/or
solution to a problem.
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solution after another until she solves the problem. This would be known as what
type of method?
a) Decision making b) Trial and error
c) Experimentation d) Analysis
Reason: Trial and error is usually used by people with little management experience.
Experimentation is a type of problem solving in which a theory is tested to
enhance knowledge, understanding, or prediction.
6) Scientific methods for problem solving are useful when time is not an issue. For
problems requiring immediate action, nurses can use an organized method that
involves seven specific steps. What is this method?
a) Nominal group technique b) Delphi method
c) Problem-solving process d) Brainstorming
Reason: The problem-solving method is an organized seven-step process useful for
problems that require immediate action.
7) Which of the following can cause negative effects on decision making among
groups?
a) Rationalization b) Groupthink
c) Risky shift d) Dialectical inquiry
Reason: Groupthink is a negative phenomenon occurring in highly cohesive, isolated
groups in which group members come to think alike, which interferes with critical
thinking. Dialectical inquiry is a technique used to minimize groupthink through
the use of a formal debate format. Risky shift is a phenomenon seen in groups in
which riskier, more controversial decisions are made.
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Schmieding? (EXCEPT)
a) Judgments on a particular topic are b) Ideas about the problem are validated
systematically gathered from or refuted based on empirical
participants. evidence through a serial rather than
a linear process.
c) Objective data are tested against one's d) Past experiences and knowledge are
thoughts and feelings. used to evaluate the situation.
Reason: The four characteristics of reflective inquiry are: objective data are tested against
one's thoughts and feelings; past experiences and knowledge are used to evaluate
the situation; ideas about the problem are validated or refuted based on empirical
evidence through a serial rather than a linear process; the facts and ideas
generated are verified through deliberate investigation.
CHAPTER: 9
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Communicating Effectively
1) A nurse manager who tells the staff to "come to me with any problem" but then
keeps the office door closed is using what type of communication?
a) Intrasender conflict b) Diagonal communication
c) Metacommunication d) Upward communication
Reason: When a verbal message is incongruent with the nonverbal message, it results in
intrasender conflict. Metacommunications are behaviors that include head or
facial agreement or disagreement. Upward communication occurs from staff to
management or from lower management to middle or upper management.
Diagonal communication involves individuals or departments at different
hierarchical levels.
2) The nurse manager can use several strategies to improve communication when
giving directions. Asking the subordinate to repeat the instructions would be
which of the following strategies?
a) Verifying through feedback b) Follow-up communication
c) Getting positive attention d) Knowing the context of the
instruction
Reason: Making sure the receiver has understood the request is verifying through
feedback.
3) A nurse manager finds herself in opposition to her immediate superior. The nurse
manager knows that an important strategy to use in a confrontation is using:
a) "I" language. b) Absolutes.
c) "Why" questions. d) Negative assertion.
Reason: Using "I" language and a low voice is important when a confrontation occurs.
Negative assertion, absolutes, and "why" questions do not promote professional
communication during conflict.
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9) A nurse needs to know how to increase her power base. Which of the following are
ways nurses can generate power as described by Umiker?
a) Using body language, standing when b) By listening for feelings
talking
c) With words, avoiding cliche's d) Through delivery, making one point
at a time
e) A & D f) All of above
Reason: Umiker describes four ways to generate power: Use words, through delivery, by
listening, and through body language.
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CHAPTER: 10
Delegating Successfully
1) The staff nurse delegates AM care for two patients to the UAP (Unlicensed
Assistive Person). What principle of delegation is the nurse following?
a) Delegation requires a situation with b) Delegation can only exist with a
clearly defined superiors. subordinate.
c) Delegation is a tool only used by d) You can delegate only those tasks
nurses. for which you are responsible.
Reason: You can delegate only those tasks for which you are responsible.
3) A staff nurse has delegated the ambulating of a new post-op patient to a new
staff nurse. Which of the following situations exhibits the final stage in the process
of delegation?
a) Supervising the performance of the b) Having the new nurse tell the
new nurse. physician the task has been
completed.
c) Telling the unit manager the task has d) Documenting that the task has been
been completed. completed.
Reason: Monitoring performance and providing feedback is the final stage of effective
delegation.
4) The staff nurse in a long-term care facility wants to delegate the passing of 9 AM
medications. The additional staff consists of two UAPs (Unlicensed Assistive
Persons). What type of barrier to delegation exists?
a) Trust versus control b) Approval versus affiliation
c) Poor communication d) Lack of resources
Reason: Lack of resources exists when there is no one to whom you can delegate.
5) A staff nurse delegates a task to a UAP (Unlicensed Assistive Person) and then
does half of the task herself, telling the UAP that she is too slow. This violates
which of the following principles of delegation?
a) In work allocation, no transfer of b) Transferring authority empowers
authority exists. the delegate to complete the task.
c) Poor communication is a barrier to d) To delegate effectively, the individual
delegation. should be matched to the task.
Reason: Transferring authority empowers the delegate to complete the task. Retaining
authority cripples the delegate's abilities to accomplish the task.
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6) When considering delegation of responsibility, the registered nurse should
consider which "rights" of delegation?
a) Right circumstance b) Right task & Right person
c) Right supervision d) All of above
Reason: The five rights of delegation include the right task, the right circumstances, the
right person, the right direction/communication, and the right
supervision/evaluation.
10) As a staff nurse you are asked to complete a task you feel you are not qualified to
do. What is the best response?
a) Ask for other tasks for which you feel b) Thank the delegator for the offer
prepared. and clearly explain why you must
decline.
c) Inform the supervisor that you are d) Try to do the task anyway.
being mistreated.
Reason: Thank the delegator for the offer and clearly explain why you must decline, this
is professional communication, keeps the nurse within the scope of practice, and
promotes professional relationships.
CHAPTER: 11
Building and Managing Teams
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3) A committee of nurses tries to determine who should be charged with the different
workloads of the committee. In what stage of group development is this
committee?
a) Norming b) Performing
c) Forming d) Storming
Reason: In the storming stage, the members wrestle with roles and relationships. In the
forming stage, individuals assemble into a well-defined cluster. In the norming
stage, the group defines its goals and rules of behavior. In the performing stage,
members agree on basic purposes and activities, and carry out the work.
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5) Productivity is influenced by groups. Which of the following aspects of group
behaviors would positively affect productivity?
a) Leadership b) Resources
c) Cohesiveness and collaboration d) Individual relationships
Reason: Work-group dynamics that are cohesive and collaborative positively affect
productivity.
7) A team of nurses needs to move the patients and equipment to a new unit while
remodeling is done. Each nurse has an assigned task within the group. This is an
example of what type of group task?
a) Divisible task b) Informal task
c) Disjunctive task d) Conjunctive task
Reason: With a divisible task, more people provide a greater opportunity for
interdependency in performing tasks. For a disjunctive task (the group succeeds if
one member succeeds), the greater the number of people, the higher the
probability that one group member will solve the problem. With a conjunctive
task (the group succeeds only if all members succeed), more people increase the
likelihood that one person can slow up the group's performance (e.g., a jury trial).
8) A nurse manager wants to call a meeting with the staff. What is the first and most
important step in the meeting process?
a) Determine which members will b) Determine the place and time.
contribute.
c) Thoroughly prepare for the meeting. d) Determine the members.
Reason: Preparation is the first key to a successful meeting.
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10) The nurse manager has had a lot of turnover on her unit recently, and decides
that team building is needed. An effective technique would be to:
a) Allow the team to progress through b) Identify those individuals who are not
the normal group developmental team players and recognize their poor
process until cohesiveness occurs. attitude in a team meeting.
c) Clarify team goals, roles, d) Pull the staff aside individually to
responsibilities, and boundaries. identify who is undermining the
team.
Reason: An effective technique for building a strong group would be clarifying goals,
roles, responsibilities, and boundaries within the group.
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CHAPTER: 12
Handling Conflict
2) In dealing with conflict, the nurse manager knows that feelings or perceptions
about the situation will have an effect. According to Filey, what is this effect
known as?
a) Conflict suppression b) Resolution aftermath
c) Antecedent conditions d) Manifest behavior
Reason: Feelings or perceptions about the situation initiate behavior, known as manifest
behavior. Antecedent conditions are preexisting conditions. Resolution aftermath
is the aftermath of the conflict. Conflict suppression is the next step, in which
conflict is suppressed but not resolved.
3) The babysitter calls the staff nurse to let him know that she will not be able to
take care of his children on the day the nurse is scheduled to work. The nurse is
presenting important material at a committee meeting that day. What type of
conflict is the staff nurse experiencing?
a) Intergroup conflict b) Perceived conflict
c) Role conflict d) Structural conflict
Reason: Role conflict exists when one has responsibilities that are overlapping.
Intergroup conflict occurs between two or more groups. Structured relationships
(superior to subordinate, peer to peer) provoke conflict because of poor
communication, competition for resources, opposing interests, or a lack of shared
perceptions or attitudes. Perceived conflict refers to each party's perception of the
other's position.
4) In dealing with a conflict on a unit, the nurse manager decides to ask one of the
staff nurses, who is not moving towards resolution, to transfer to another unit.
What tactic has the manager implemented?
a) Avoidance b) Withdrawal
c) Suppression d) Competition
Reason: The stage of conflict in which one of the conflicting parties is eliminated through
transfer or termination is called suppression technique.
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5) A nurse manager is interested in solving a serious conflict that exists among the
nursing staff. He uses a strategy that involves allowing the group to explore a
number of solutions and come to a consensus on a solution. What strategy for
conflict resolution has the manager used?
a) Integrative decision-making b) Win-win
c) Competing d) Confrontation
Reason: Allowing the group to explore a number of solutions and come to a consensus on
a solution is an integrative decision-making method.
6) The nurse manager has two employees with a longstanding conflict that is
affecting the group's productivity and cohesiveness. She decides to meet with the
employees in private and bring the conflict out into the open, and to attempt to
resolve it through knowledge and reason. Which conflict management strategies
did she employ?
a) Confrontation b) Suppression
c) Collaboration d) Intervention
Reason: Confrontation is the most effective means of resolving conflict. The conflict is
brought out in the open and attempts are made to resolve it through knowledge and
reason.
7) A group of physicians come into conflict with the nursing staff of a unit over when
AM vital signs are recorded. What type of technique might be used that respects
the professionalism of both parties?
a) Accommodating b) Collaboration
c) Avoiding d) Competing
Reason: Collaboration implies mutual attention to the problem, as the talents of all parties
are used.
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10) A resident on night call refuses to answer pages from the staff nurse on the night
shift and complains that she calls too often with minor problems. The nurse feels
offended and reacts with frequent, middle-of-the night phone calls to "get back"
at him. The behavior displayed by the resident and the nurse is an example of
what kind of conflict?
a) Perceived conflict b) Disruptive conflict
c) Competitive conflict d) Felt conflict
Reason: In disruptive conflict, the parties involved are engaged in activities to reduce,
defeat, or eliminate the opponent. Filey (1975) defines competitive conflict as a
victory for one side at a loss for the other side. Felt conflict refers to the feelings
of opposition within the relationship of two or more parties. Perceived conflict
refers to each party's perception of the other's position.
Nursing Management 32
CHAPTER: 13
Managing Time
1) A Nurse Manager has left the facility, and one of the remaining managers is given
that assignment in addition to her current load. She is told that the open position
will not be filled. This is an example of which of the following?
a) Job enlargement b) Proactive Management
c) Time log d) Prioritizing
Reason: Job enlargement occurs when positions are combined, and managers have more
employees to supervise.
2) A Staff Nurse submits a six week notice of resignation. The Nurse Manager
prepares a request to immediately post the position and begin interviews. This
action is best described as which of the following?
a) Delegation b) A time waster
c) Reactive management d) Proactive management
Reason: Proactive Management attempts to resolve problems over which you have
control. This manager is attempting to prevent short staffing. Reactive
Management wastes time on problems over which you have no control. Nothing
is delegated or considered a time waster in this example.
3) A Manager has a budget request deadline today at 3:00. He stops his work to
answer the phone, check e-mails as they arrive, and speak with staff who stop by
his office. As a result, he misses the deadline. What best describes the cause of
missing his deadline?
a) Goal setting b) Organization
c) Time wasters d) Assertiveness
Reason: This manager has allowed time wasters to interfere with his organization, goal
setting, and assertiveness.
4) A Manager decides that setting goals will assist her in better utilizing her time.
Which of the following are true regarding goal setting in the Manager role?
a) Goals need to be measurable, b) Writing goals will increase the stress
realistic, and achievable to be level of the Manager.
effective.
c) Goals should be vague, so they are d) Setting goals is a time waster in the
more likely to be met. Manager role.
Reason: Goals decrease stress by providing direction and saving time. They need to be
measurable, realistic, and achievable in order to be effective.
Nursing Management 33
6) A Manager has been given a deadline to complete an assignment by the end of the
day. It will take every minute left of the afternoon to complete. Which
interventions illustrate assertiveness to minimize interruptions in order to meet
the deadline? (Select all that apply.)
a) Allowing voice mail to answer all b) Delegating a discharge planning issue
incoming calls or Turning off e-mail for a patient to one of the staff nurses
notification
c) Placing a "Do Not Disturb for the d) All of above
Afternoon" sign on the office door
Reason: All of the interventions listed are appropriate ways to minimize interruptions.
7) A Nurse Manager completes an interruption log and identifies two staff members
who take inordinate amount of time with drop-in issues that are not urgent. What
are some methods to address this behavior in attempt to better manage time?
(Select all that apply.)
a) Designate time scheduled drop-in b) Turn desk chair so that it is not facing
time slots. the hall.
c) Discuss with staff using e-mail for d) When the staff members drop in, the
non-urgent issues to facilitate better manager should stand and remain
use of time. standing during the conversation.
e) A, B & C f) All of above
Reason: All of the interventions listed are appropriate ways to minimize interruptions.
Nursing Management 34
10) A Manager is prioritizing the following issues. Of the following issues, which
should be considered urgent and important?
The manager of physical therapy calls and A staff nurse reports a pattern of
complains about inappropriate behaviors of malfunctioning IV pumps on the unit
one of the staff nurses with one of his during her current shift, resulting in
therapists overdosing of medications.
One of the staff nurses, who would have A small group of staff nurses request a
been an extra nurse for the next shift, calls meeting to discuss initiating a scheduling
in sick. committee.
Reason: Patient safety issues should be considered urgent and important. The other issues
are important, but not urgent.
Nursing Management 35
CHAPTER: 14
Budgeting and Managing Fiscal Resources
1) A nurse manager is preparing the budget for the year. The budgeted amounts
have been set without regard to changes that may occur during the year. What
type of budget is the manager preparing?
a) Fixed budget b) Zero-based budget
c) Variable budget d) Operating budget
Reason: Budgets are considered fixed budgets when the budgeted amounts have been set
without regard to changes that may occur during the year. The zero-based budget
approach assumes the base for projecting next year's budget is zero. Variable
budgets are developed with the understanding that adjustments to the budget
may be made during the year. The operating budget, also known as the annual
budget, is the organization's statement of expected revenues and expenses for the
coming year.
2) The nurse manager needs to buy six new hospital beds for the unit. What type of
budget will be used for this expenditure?
a) Operating budget b) Capital budget
c) Salary budget d) Revenue budget
Reason: The capital budget identifies physical renovations, new construction, and new
equipment. The revenue budget represents the patient care income expected for
the budget period. The operating budget, also known as the annual budget, is the
organization's statement of expected revenues and expenses for the coming year.
The salary budget, also known as the personnel budget, projects the salary costs
that will be paid and charged to the cost center in the budget period.
3) The nurse manager compares the actual results of the budget with the projected
results of the budget. What budgeting process is this?
a) Variable budgeting b) Controlling
c) Revenue sharing d) Incremental budgeting
Reason: Controlling is the process of comparing actual results with the results projected
in the budget. Incremental budgeting utilizes separate categories for different
expense items Variable budgeting may require adjustments to the budget based
upon changes in revenues, Revenue sharing refers to sharing the profits and/or
losses with different identified groups.
4) When planning a budget, the nurse manager knows that costs depend on and
change in direct proportion to patient volume and activity. What type of costs are
these?
a) Variable costs b) Indirect costs
c) Fixed costs d) Direct costs
Reason: Variable costs depend on and change in direct proportion to patient volume and
activity. Fixed costs are expenses that remain the same for the budget period,
regardless of the activity level of the organization. Direct costs are expenses that
directly affect patient care. Indirect costs are necessary expenditures that do not
Nursing Management 36
affect patient care directly.
6) A typical budget takes time to prepare. What timetable should the nurse manager
plan on for the budgeting process?
a) 9-12 months b) 3-6 months
c) 1-2 months d) Over two years
Reason: The budgeting process takes 3-6 months.
7) A nurse manager is considering the variances of the budget. Fewer monies were
spent than expected. What type of variance is this?
a) Unfavorable variance b) Favorable variance
c) Dependent variance d) Independent variance
Reason: If less money was spent than expected, the variance is favorable
8) A nurse manager is working on the personnel budget for the year. The manager
anticipates she will need to replace 832 benefit hours for the year. How many
FTEs (Full Time Equivalents) will she need to budget for replacement?
a) 0.40 FTEs b) 17.0 FTEs
c) 0.05 FTEs d) 1.0 FTEs
Reason: 832 (Number of benefit hours) divided by 2,080 = 0.4 FTEs.
9) Which of the following are considered to be part of the operating expenses within
health care organizations? (EXCEPT)
a) Maintenance costs b) Rental fees
c) Renovation costs d) Supplies
Reason: Supplies, rental fees, maintenance costs, and equipment service contracts are all
part of the operating budget.
10) __________ is the difference between the amounts that were budgeted for specific
revenue or cost and the actual revenue or cost that resulted during the course of
activities.
a) Budget b) Variable
c) Variance d) Premiums
Reason: Variance is the difference between the amounts that were budgeted for specific
revenue or cost and the actual revenue or cost that resulted during the course of
activities.
Nursing Management 37
CHAPTER: 15
Recruiting and Selecting Staff
5) The regulatory body that requires that immunizations be given, particularly for
hepatitis B, is:
a) American Nurses Association (ANA). b) Occupational Safety and Health
Administration (OSHA).
c) Joint Commission on Accreditation d) State board of nursing.
of Healthcare Organizations
(JCAHO).
Reason: OSHA requires that the hepatitis immune series be offered to health care workers
who are not immune to hepatitis.
Nursing Management 38
8) There are several elements in recruiting strategies. Which of the following is one
of those elements?
a) Not selling b) How to sell
c) When to sell d) What to sell
Reason: Four elements in any recruiting strategy are where to look, how to look, when to
look, and how to sell.
9) The most important factor that nursing graduates look for when seeking their
first job is:
a) Location. b) Money.
c) Orientation. d) Vacation.
Reason: Nursing graduates report that the most critical factor they consider in seeking
their first nursing position is the orientation program.
Nursing Management 39
CHAPTER: 16
Staffing and Scheduling
1) The ANA recommends that nursing in the health care organization change its
focus. This requires a shift from a technical model to which of the following?
a) Professional b) Industrial
c) Random d) Organized
Reason: Focus should be on the level of nurse competence required to provide quality
care, which is the professional model.
2) Many patient classification systems have some type of shortcoming. Among these
are:
a) The client's condition changes before b) The staffing needs are predicted on a
the next shift. short term basis.
c) The potential admissions cannot be d) The staffing mix changes because of
accounted for. illness.
e) C & D f) All of above
Reason: Patient classification systems cannot easily account for changes in a client's
condition, changes in staffing due to illness, or the unexpected influx of new
admissions. Also, most classification systems only look at the short term staffing
needs, rather than utilizing demand management which takes into account client
outcomes helping to predict staffing needs over a period of time.
3) There are several things factored into the calculation of the amount of FTEs.
Which of following are NOT considered when calculating the FTEs? (EXCEPT)
a) Hours of care b) Ancillary staff
c) Procedures to be done d) Types of patient
Reason: One technique for determining the number of FTEs involves the hours of work
for the staff for two weeks, average daily census, and hours of care.
4) The nurse manager determines the staffing needs on a particular unit, and allows
only a certain number of nurses during that shift. This is known as which type of
staffing?
a) Flexible b) Mixed
c) Block d) Creative
Reason: Block staffing involves scheduling a certain number of people per day
consistently.
5) What are the advantages of using internal pools of nurses for staffing purposes?
a) Familiarity with the hospital & b) Centralization
Lower cost
c) Staffing mix d) Staff satisfaction
Reason: Internal float pools of nurses can provide supplemental staffing at a substantially
lower cost than using agency nurses while also being familiar with the hospital
and staff.
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6) When utilizing an internal float pool, which of the following pools is most
efficient?
a) Centralized b) Flexible
c) Mixed d) Decentralized
Reason: Centralization is most efficient because it allows for a pool of nurses to be used
anywhere in the hospital. In decentralized pools, a staff member usually works
for only one nurse manager or on only one unit.
7) During a staffing crisis, managers may need to use nurse extenders. These
individuals are better known as:
a) Float RNs. b) Unlicensed assistive personnel.
c) LPNs. d) Agency nurses.
Reason: Persons in the role of nonprofessionals, unlicensed assistive personnel (UAPs)
are used to free up some of the nurses' time, allowing for more client care time.
8) ___________ is the agency that reviews whether an organization meets its own
criteria for staffing.
a) American Nurses Association (ANA) b) Joint Commission on Accreditation
of Healthcare Organizations
(JCAHO).
c) Patient Classification Systems (PCSs) d) Nursing Care Hours (NCHs)
Reason: The Joint Commission specifies only that the right number of competent staff be
provided to meet client's needs.
9) Working on a schedule within the unit, involving only those who are working
within that unit, is called:
a) Flexible staffing. b) Self-staffing.
c) Internal pools. d) Management scheduling
Reason: Self-staffing is the model used when staff completely manage staffing and
scheduling themselves.
10) One way to determine staffing needs is to classify clients according to nursing
care required. Another name for this is a(n) __________.
a) self-scheduling b) supplementing staff system
c) patient classification system (PCSs) d) acuity system
Reason: An acuity system is when one familiarizes oneself with the current patient
classification system.
Nursing Management 41
CHAPTER: 17
Motivating and Developing Staff
2) What is an attribute observed among nurses who strive to find the best way to do
their job?
a) Punctual b) Strict
c) Honest d) Motivated
Reason: Motivation is the factor that initiates and directs behavior.
6) The type of theory that discusses how motivation works to direct a person's efforts
is:
a) Reinforcement. b) Operant.
c) Conditioning. d) Process.
Reason: Process theory emphasizes how the motivation process works to direct an
individual's effort into performance. Reinforcement theory, also known as
behavior modification, views motivation as learning. According to this theory,
behavior is learned through a process called operant conditioning, in which a
behavior becomes associated with a particular consequence. In operant
conditioning, the response--consequence connection is strengthened over time --
that is, it is learned.
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7) What theory views motivation as learning?
a) Reinforcement b) Process
c) Operant d) Conditioning
Reason: Process theory emphasizes how the motivation process works to direct an
individual's effort into performance. Reinforcement theory, also known as
behavior modification, views motivation as learning. According to this theory,
behavior is learned through a process called operant conditioning, in which a
behavior becomes associated with a particular consequence. In operant
conditioning, the response--consequence connection is strengthened over time --
that is, it is learned.
9) The thought that effort will lead to a specific performance level in an individual is
known as:
a) Rewards. b) Expectancy.
c) Valence. d) Instrumentality.
Reason: Expectancy is the perceived probability that effort will lead to a specific
performance level. Instrumentality is the belief that a given performance level or
behavior will lead to some outcome (reward or punishment). Valence is the
perceived value (attractiveness or unattractiveness) of an outcome.
10) The theory that emphasizes the long-range plan, not rewards, is known as:
a) Equity theory. b) Development.
c) Goal setting. d) Extinction.
Reason: Goal-setting theory suggests that it is not the rewards or outcomes of task
performance, but rather the goal that allows a person to expend effort. Equity
theory suggests that effort and job satisfaction depend on the degree of equity, or
perceived fairness, in the work situation. Extinction is a technique used to
eliminate negative behavior, in which a positive reinforcer is removed and the
undesired behavior is extinguished.
CHAPTER: 18
Nursing Management 43
Evaluating Staff Performance
2) There are many ways to ensure that your appraisal system is nondiscriminatory.
Which of the following is one way to ensure this?
a) Giving the appraisal once per year b) No appeal process
c) Withholding information from the d) Allowing no input from the employee
employee
Reason: There are several steps to ensure that your appraisal system is nondiscriminatory.
One is by giving the appraisal once per year to ensure ongoing evaluation.
4) Which of the following is the time period used in the traditional rating scale?
a) Twelve months b) Six months
c) Three months d) One month
Reason: In the traditional rating scale, the employee is rated over a 12-month period.
5) After her evaluation, a staff nurse exclaims: "I'm not sure if my manager knows
much about my performance, really. He only had three specific examples to give
me, two good performance examples and one to work on and they all happened in
the last month. I don't feel like he can see the whole picture." What kind of
performance appraisal rating does this statement exemplify?
a) Recency error b) Leniency error
c) Halo error d) Absolute judgment
Reason: Halo error is the process of assigning a rating on the basis of an overall
impression. Leniency error is the tendency of a manager to overrate staff
performance. Recency error is the tendency of a manager to rate an employee
based on recent events, rather than the entire evaluation period. Absolute
judgment is an evaluation method based on reasonable and acceptable standards
set by the organization.
Nursing Management 44
8) The process by which registered nurses assess and judge the performance of peers
against some predetermined standard is called:
a) Group evaluation. b) Peer review.
c) Forced distribution evaluation. d) Essay evaluation.
Reason: Peer review is conducted by professional peers. Essay evaluations represent an
evaluation method in which an employee's performance is described through a
detailed, written narrative. In a forced distribution evaluation, employees are
rated in a fixed method, similar to grading on a curve. Group evaluation is when
a group of managers compare individual and group performance to
organizational standards.
CHAPTER: 19
Nursing Management 45
Coaching, Disciplining, and Terminating Staff
3) One of the steps in coaching is often overlooked and taken for granted. What is
this step?
a) Stating the target b) Jumping to conclusions
c) Asking for suggestions d) Tying the problem to clients' care
Reason: Nurses need to understand the consequences of their actions that are related to
the clients' care.
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7) Which of the following is NOT the preferable alternative to firing an employee?
(EXCEPT)
a) Voluntary resignation b) Training
c) Confrontation d) Coaching
Reason: The preferable alternative to firing is voluntary resignation.
8) When a policy violation occurs, what are necessary steps for the nurse manager?
(EXCEPT)
a) Describing the staff nurse's behavior b) Terminating the staff immediately
that violated the policy
c) Confrontation d) Determining the employee's
awareness of the policy
Reason: When a policy has been violated, the necessary steps for the nurse managers are
confrontation, a communication technique used to address specific issues;
determining whether the employee is aware of the policy; and focusing on the
employee's behavior that violated the policy. Terminating the employee is not
always a necessary outcome of the policy violation.
10) If a staff member does not respond to discipline, the manager must __________
employment.
a) Terminate b) Confrontation
c) Describing the staff nurse's behavior d) Determining the employee's
that violated the policy awareness of the policy
Reason: Some employees do not respond to techniques to enhance performance, and
nurse managers will face the day when they must terminate, or fire, an
employee.
CHAPTER: 20
Nursing Management 47
Reducing Turnover, Retaining Staff
1) Which of the following is one of the sources used to determine the reason for
voluntary turnover?
a) Following up phone calls b) Employee questioning
c) Benchmarking d) Exit interviewing
Reason: Two sources for determining voluntary turnover are asking the supervisor and
exit interviewing.
2) One of the most useful tools to determine reasons for turnover is:
a) Questioning. b) Surveys.
c) Employee forums. d) Telephone calls.
Reason: Although all these tools may be useful to determine reasons for turnover, surveys
allow for the most truthful responses.
Nursing Management 48
a) After tenure b) After one month of employment
c) When the decision to hire a new d) After three months of employment
employee is made
Reason: The manager's first opportunity to reduce turnover is when the decision to hire is
made. An individual's length of stay at past employers is an indication of how
long the person can be expected to stay on a new job.
10) Which of the following is the term for higher starting pay of new nurses, or
rewarding those with fewer years of experience?
a) Salary compression b) Salary expectations
c) Salary range d) Salary inflation
Reason: Salary compression is compressing the salary of long-term employees.
CHAPTER: 21
Nursing Management 49
Managing Absenteeism and Other Staff Problems
4) A nurse is chronically late for work. When questioned about her attendance, she
states that she has unreliable transportation. This is known as which type of
barrier?
a) Attendance b) Voluntary
c) Motivation d) Involuntary
Reason: Attendance barriers can be personal illness, family responsibility, or
transportation issues.
Nursing Management 50
7) A nurse has a seriously ill parent and must take care of the parent at home. Which
of the following would NOT be a suitable solution to this problem? (EXCEPT)
a) Resignation b) FMLA
c) Termination d) LOA
Reason: FMLA provides up to 13 months of leave while securing an employees's job
status. Termination, resignation, and LOA are not good solutions, because they
do not secure job status.
9) A nurse who is determined to have a substance abuse problem most likely will
exhibit which of the following as a first sign that there is a problem?
a) Avoidance b) Bargaining
c) Denial d) Regression
Reason: Denial is the primary symptom.
10) Constant reports of inadequate pain control in clients indicate which of the
following?
a) Improper administration of drugs b) Potential substance abuse by the
employee
c) Poorly written orders d) Improper scheduling by MDs
Reason: Constant inadequate pain control may indicate that other substances are being
given in place of narcotics.
Nursing Management 51
CHAPTER: 22
Preventing Workplace Violence
1) Nurse Managers work with staff to educate them about ways to diffuse potentially
violent situations. Which of the following diagnoses can staff expect to be more
frequently associated with violence?
a) Alcohol or drug withdrawal b) Anxiety
c) Depression d) Confusion
Reason: Violence is associated with conditions that alter a person's inhibitions.
Gilmore (2006) reports that working with the public includes inherent risks and stressors.
In addition, individuals with head trauma, mental illnesses, and those
withdrawing from substances are more likely to respond with violence.
3) Factors that may contribute to workplace violence in a health care setting include:
a) Lack of armed security. b) Continuous loud noises and/or
poorly monitored entrances.
c) Poor staff interactions. d) Tense shoulders and clenched fits
Reason: Violence prevention includes self-awareness and awareness of the surroundings.
Nursing staff can maintain a safe environment if they identify potential problems
and report them to supervisors who will unsafe environments.
Nursing Management 52
5) A visitor who is loud and active arrives on the unit where you are in charge. You
notice that the visitor has a gun. You immediately:
a) Ask the visitor to leave. b) Talk quietly to calm the visitor.
c) Ask the visitor for the gun. d) Notify security with the details of the
situation.
Reason: Your responsibility as the professional is to protect patients and yourself. You are
in a position to enlist support from other staff to close doors and provide
protection to those for whom you care. Health care facilities employee trained
security guards or police to disarm a violent individual. Professionals who give
accurate, brief information to trained security guards so that they know what to
expect when they arrive on the scene can be assured that a well thought out plan
with minimal risk could be implemented.
6) After a violent incident, staff needs to discuss what occurred. Several actions need
to be taken following the incident:
a) Debrief the staff and complete b) Reassure the violent patient that
incident reports and Verify that all hurting staff when ill is not cause for
staffs are safe concern.
c) . Avoid any interactions. d)Standing close to the patient while talking.
Reason: Violence is a reality in organizations. Professionals who are trained to assess the
situation, develop and implement a planned intervention, and process the
situation following the intervention are more likely to be harmed or to have
others be harmed. Processing violent situations and interventions permits
learning to take place and helps professionals know how to handle future
incidents.
7) Staffs are sometimes injured when a patient or visitor becomes agitated. If a staff
member reports an injury, the following actions should take place: (EXCEPT)
a) Notify security. b) Complete incident report.
c) Notify the nursing supervisor. d) Make certain that staff has been
examined.
Reason: Staff need to handle the incident and be certain to enlist support from others,
follow appropriate protocols, and document the incident relative to patient care
as well as from a legal perspective. If staff or patients are injured, documentation
of the incident and what was observed is critical if there is an investigation.
Nursing Management 53
10) From a unit perspective, disruptive and violent patient behavior may be
distracting to patients and staff. As the nurse manager, you are concerned about:
(EXCEPT)
a) Patient and staff safety. b) Team tension.
c) Fear of disappointment. d) Stress levels.
Reason: Stressors on a unit create additional tension, which does not enhance relationship
based care with patients. In addition, if staff is distracted by agitated patients,
they are less likely to be able to focus on priorities, such as uninterrupted
medication administration, documentation of patient care, and ensuring positive
multi-professional team interactions.
Nursing Management 54
CHAPTER: 23
Handling Collective-Bargaining Issues
3) On a voting ballot, the persons who are to be elected during a vote are called:
a) Representatives. b) Employees.
c) Bargaining agents. d) Management authorities.
Reason: The bargaining agent is the one who is to be elected during a vote.
4) Which of the following describes the ability to enter into a contract with an
employer?
a) Certification to contract b) Certification to represent
c) Bargaining agreement d) Contract agreement
Reason: Certification to contract is the process by which a union, certified by the NLRB
as a bargaining agent, can enter into a contract with an employer that has been
voted on by the union membership.
Nursing Management 55
7) The ANA is a registered labor organization, but it does not engage in direct
__________ .
a) Empower union affiliation b) Reward union affiliation
c) Encourage union affiliation d) collective bargaining
Reason: The American Nurses Association is a registered labor organization, but it does
not engage in direct collective bargaining. The actual certification of units,
negotiation of contracts, and administration of contracts is conducted by the state
nurses associations (SNAs).
9) A nurse does not agree with the statements made by a physician about
performance. The nurse talks to the nurse manager. This is which step in the
grievance process?
a) First b) Second
c) Third d) Fourth
Reason: The first step in the process is to talk to the nurse manager. Step two involves a
written appeal to the director of nursing or designee. Step three involves a
meeting with the following: employee, agent, grievance chairperson, nursing
administrator, and director of human resources. The final step of the grievance
process is arbitration, which is invoked when none of the proposed solutions can
be agreed to by individuals involved.
10) The nurse and nurse manager did not resolve the situation related to the
physician's report about the nurse's performance. What is the length of time
allowed for the nurse to submit an appeal?
a) 10 days b) 15 days
c) 20 days d) 30 days
Reason: If informal discussion does not resolve the problem, a written appeal may be
submitted within 10 days, according to the health care facility policy.
Nursing Management 56
CHAPTER: 24
Managing Stress
1) Which of the following behaviors would be an early warning sign that you are not
handling job stress in a healthy way?
a) Focusing on patient outcomes b) Needing to spend more time with
staff
c) Juggling work, studies, and family d) Awakening in the morning, not
feeling rested
Reason: Equilibrium between stress and the ability to cope must exist for an individual.
Research by Selye (1978) reported evidence that the human body experiences
wear and tear in response to stress, with negative consequences when the amount
and intensity of the stress exceed the amount to which an individual can
accommodate.
2) Your nurse manager talks with you once per week to determine how you are
adjusting to your role as a new nurse. She asks if you feel that you are able to
provide good care to your patients, whether you are becoming familiar with the
electronic health record, and whether your preceptor is encouraging your
independence. This manager is demonstrating:
a) An intrusive style. b) An effort to understand if you are
coping with the demands.
c) An attempt to intimidate. d) An authoritarian style.
Reason: Effective professionals benefit from self-awareness, as well as feedback from
mentors and preceptors who have experience and insight about professional
growth and adjustment to stress.
3) Horizontal violence may be observed among staff interactions and causes stress
among staff. To minimize stress associated with such interactions, nurses can:
(Select all that apply.)
a) Encourage venting to as a way to b) Take control of the situation by
express feelings. being assertive.
c) Ignore staff who are volatile. d) Avoid interactions with angry staff.
Reason: Relationships in an organization can be the source of stress if they are not
respectful and professional. Nurses need to exert their professional power and
get support from managers to promote a healthy work environment that is free
from violence, bullying, and/or harassment.
4) Selye's stress theory explains that a person stressed for long periods of time will:
a) Face exhaustion and be more b) Become fatigued and become
susceptible to illnesses. stronger.
c) Become more assertive. d) Safety needs.
Reason: Individuals who have frequent, intense, hostile experiences will have a physical
response to these stressors. As result, an individual is more likely to become
physically and/or psychologically depleted, sometimes causing health problems.
Nursing Management 57
5) A high-volume, noisy emergency room in an urban area with a high incidence of
assault victims will affect staff in the following ways: (EXCEPT)
a) Feelings of extreme overload. b) Fear of failure.
c) A pessimistic sense about the world. d) Inability to separate intense work
situations from personal situations.
Reason: Constant noises and intense emotional situations create tension, stress, and
negative reactions. Managers who work with staff to assess the environment,
label situations, and debrief with staff can assist staff to be more aware of how
stressors influence their behaviors.
6) As a new nurse on a pediatric unit, you must work nights and you have minimal
time to spend with your children. Your colleague observes that you speak abruptly
with parents and you become easily annoyed when the patients cry or when they
are demanding. You realize you are becoming increasingly more distressed and
that you have no time with your children and, as a result you: (Select all that
apply.)
a) Express negative comments to b) Ask the nurse manager to have a
colleagues about patients and parents schedule with an equal number of
who annoy you. day and night shifts so that you can
be with your children.
c) Call off sick as frequently as you can d) Minimize your communication with
without violating policies so that you patients and parents so you do not
have more time with your children. offend them.
Reason: Minimize your communication with patients and parents so you do not offend
them.
7) A charge nurse role has negatively affected your relationship with your friends
and made you feel tense and isolated. You decide that you will delegate more time
consuming tasks to staff who are not your friends, who then complain to your
nurse manager about your perceived unfairness. You decide to:
a) Talk with your friends individually b) Not express your angry feelings.
to let them know that you will be
assigning patients to all staff in an
equitable manner.
c) Talk about staff who are annoying d) Ignore your feelings of uncertainty,
you with staff on other units. hoping they will diminish.
Reason: Being aware of how a professional reacts to managerial styles, interpersonal
relationships and to fairness influences a team's functioning and ultimately
affects patient care.
8) You believe that you are working harder than other nurses and that you take care
of patients that are more complex. You are angry that other staff nurses have less
complex and lower acuity patients, but you __________ .
a) Avoid discussing the situation b) Know that you need to discuss the
because you do not want to be inequity with the nurse manager
perceived as a complainer. because you are resenting the work
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and becoming more dissatisfied with
your job.
c) A & B d) None of the above
Reason: Professionals communicate their views in a respectful and direct manner. In
discussing the situation with the manager, professionals may gain insights about
their reactions to stress and how they can cope with the intense demands of the
health care environment.
9) As a staff nurse you know you are experiencing burnout because: (EXCEPT)
a) You are spending more time talking b) Staff is questioning your clinical
to staff on other units. judgment.
c) You sleep longer hours, sometimes d) You are drinking alcohol more
coming in late to work. frequently so that you can relax.
Reason: Professionals display behaviors that are on a continuum from healthy to
maladaptive. When behaviors indicate a change from professional standards,
quality patient care, or suggest that a professional is using substances to cope or
relax, these are indications that a professional is unable to cope with the
frequency or intensity of stressors. Managers need to intervene and provide
awareness with objective information about changes in the professional's
behavior.
Nursing Management 59
CHAPTER: 25
Advancing Your Career
1) The health care organization where you plan to work has a nurse residency
program. You identify that as a new nurse you would benefit most from:
a) Avoiding challenging patient b) Relying on your clinical preceptor,
assignments so that you can minimize similar to your relationship with your
the risk of making a mistake. nurse faculty.
c) Establishing professional goals d) Waiting to engage in evidence-based
based on your clinical knowledge. practice projects.
Reason: Your goals and your interests will influence your decision as you take your first
job. New graduates take into consideration learning opportunities, competency
development, and clinical precepting, knowing that realistic goals will include
prioritizing learning needs as a novice nurse.
2) What characteristics will you emphasize in a job interview that will positively
influence the meeting?
a) Patient diagnoses that are of b) Avoiding challenging patient
greatest interest. assignments so that you can minimize
the risk of making a mistake.
c) Number of times you inserted a d) Your grades on your scholarly papers
nasogastric tube. in nursing school.
Reason: Within the practice setting, interviewers recognize that new graduates mature
from novice to advanced beginner. Successes and recognition in nursing school
provides evidence of motivation and interest in achieving, which are typically
predictors of professional growth and success.
4) Strategies to advance your career and opportunities available in your first job can
coexist. Identify factors that will help you prioritize these opportunities to fulfill
your goals. (Select all that apply.)
a) Self-actualization OR Assess your b) Determine where can you make the
values and your lifestyle. highest salary.
c) Your ability to work as a team d) Ask friends what they believe will
member. make you most professionally
satisfied.
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Reason: Professional nurses who identify how they plan to accomplish goals and
determine the meaning of their career find that they are more successful. They
determine how they will become more knowledgeable clinically, apply evidence-
based practice, and participate in decision making within the organization.
5) Successful professional nurses benefit from working with mentors. What mutually
rewarding outcomes are realized in mentoring relationships? (EXCEPT)
a) Instilling a sense of accomplishing a b) Assuming each others'
meaningful effort characteristics
c) Fostering an interdependent d) Promoting self-esteem
relationship
Reason: Professional nurses who seek mentoring relationships work with their mentors to
gain objective feedback, guidance, and confidence. A mentoring relationship is
critical when making job decisions, establishing goals, discussing professional
judgment, considering ethical issues, and in determining challenges for growth.
6) You have been working at your job for 10 months and you decide that you can no
longer tolerate the tension and stress between staff nurses and the laissez faire
nurse manager who is not a leader. You decide to:
a) Submit a resignation and leave within b) Complain to staff about the nurse
30 days. manager.
c) Seek another position within the d) Inform the chief nursing officer that
health care organization and apply you are leaving and explain your
for a transfer. dissatisfaction with the lack of
leadership.
Reason: Professional decisions require thought and careful evaluation. Successful
professionals select jobs where they find that their values and the values of the
culture or unit are not the same. Careful consideration must be given to how and
why a position was accepted/selected. Seeking advice from a mentor or
counselor will provide insight and encourage a professional to consider different
viewpoints.
7) Your values do not coincide with your colleagues. When you report for your shift
on nights, staff is not responding to patient requests for pain medication. You are
interested in being promoted and as your goal you are the nurse responsible for
collecting data about patient quality of care, you:
a) Explain to the nurse manager that b) Issue a memo to staff to assess
quality problems are because of staff patients and document their response
apathy. to the pain medication.
c) Explain to staff that improving quality d) Schedule meetings to engage with
is one of your annual goals and you staff to monitor pain management.
expect them to follow through.
Reason: Professionals use facts to persuade others to share their goals, particularly related
to quality patient care. By enlisting support from staff, reviewing patient
satisfaction data, and reviewing quality reports about pain management, you will
be more likely to get support and change behaviors.
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8) Within the fast paced, changing healthcare environment, job satisfaction will
influence your success. What other characteristic is an asset?
a) Being friendly b) Humility
c) Ability to anticipate consequences d) Flexibility
Reason: Shaffer (2006) supports the notion that nurses benefit from the courage to
change. The ability to assess the environment and your reactions to changes will
contribute to professional growth.