6th Leadership

A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet multiple service needs of clients and families is known as: a. case management. b. total client care. c. private duty nursing. d. managed care.

a

A model of population care coordination would include: a. data analysis of population, population needs assessment, identification and selection of health services, multidisciplinary planning, implementation of wellness and prevention interventions, and monitoring/evaluation of care management. b. population needs assessment, prioritization of needs, community wellness resources, provider prevention services, and health education services. c. population needs surveys, community funding, emergency medical services, medical home clinic services, school health programs, and occupational health for workers. d. population needs surveys, community engagement, community planning, emergency medical services, medical home clinic services, school health programs, and occupational health education services.

a

All nurses must know how to be effective team players, which includes a variety of skills such as technical and functional expertise, problem-solving and decision-making skills, and interpersonal skills. Which of the following statements best reflects this? a. Leaders and managers must be able to function both independently and interdependently with others. b. The formation of a well-functioning group or team is often the work of the leader. c. Nursing staff members must be able to function interdependently with others. d. Members need skills to give input, participate in decision making, share responsibility, and hold the manager accountable for the outcomes of the group.

a

Conflict is a natural and inevitable outcome in any group or organization. Select the correct statement from the following statements. a. A defensive framework for conflict resolution includes winning some resources and losing others. b. To build effective interdisciplinary teams, conflict must be present, and managers must not interfere with conflict resolution. c. Conflict can be a positive force in a group, but conflict should be avoided most of the time in a group to get work done. d. Conflict arises when job descriptions are clear, policies and procedures are written, and uniform behaviors are fostered in an organization.

a

Effective delegation skills are important for leaders and managers whose function is to get work done through the efforts of others. The individual who accepts this work is called the: a. delegate. b. adaptor. c. supervisor. d. delegator.

a

Health care quality and safety principles and practices form the foundation of any accessible, reliable care services. In establishing this foundation, which of the following statements helps guide it? a. The importance is on outcomes rather than process and structure. b. Risk management programs are designed to ensure a high level of quality. c. Three areas in which quality can be measured are structure, process, and cost. d. When an incident report is filled out, it absolves the person from responsibility for the occurrence.

a

Identify the elements of organizational structure that address patient safety. What structural changes do you recommend for further improving safety in an organization using organizational design principles? a. Empowering employees to report problems or potential problems, encouraging innovations and improvements in processes, and rewarding continual learning and exploration b. Keeping administrators out of the way of staff and allowing staff to improve the environment in their organization c. Safety teams, who evaluate near-misses and report errors to know who risk managers should discipline, direct educational offerings d. Root cause analysis when a problem is reported so that all aspects of an error situation can be avoided

a

In nursing, group process theory relates to how to work as an employee within an organization that is often large and complex. Which statement best reflects the need for teams and groups? a. Interdisciplinary work teams are necessary for complex situations. b. The major reason for individuals to join groups is to gain information. c. In all groups, decision making is a joint process, with all members participating. d. Group decision making is cost-effective in all situations.

a

Resolving conflict requires interventions. One type of intervention requires preparation and planning, ground rules, clarification and justification, bargaining and a closure with implementation. Which of the following is this type of conflict management? a. Negotiation b. Win-win strategy with problem solving c. Restrict or isolate the conflict d. Compromise

a

Shared governance requires slow, gradual development, role modeling, and mentoring by nurse leaders, and continual coaching, nurturing, and education for nursing staff and management. Select the statement that is an accurate statement about shared governance. a. Shared governance models empower nurses to provide quality care and efficient point-of-service expertise. b. All clinical nurses are in favor of a shared governance system in which accountability and decision making are encouraged. c. Implementation of shared governance systems is costly and requires considerable time and effort. d. Shared governance remains out of reach to some and a simple process to others.

a

Team dynamics will need to be addressed to form an effective team. Select the best strategy to help address the challenges in forming effective teamwork. a. Set group norms on how team members treat each other, how support is demonstrated, how conflict is handled, and the decision-making process to help team members operate with disruptive behaviors. b. Lead group members through "just in time" training to work together to overcome lack of trust and commitment to the team. c. Organize appropriate representation and delegation of authority to the group to help team members avoid confusion about the team's work, accountability, and inattention to results. d. Keep the number of members in groups between 10 and 14, build a structural team, and coach the team to avoid conflict.

a

The advantages of group problem solving over individual problem solving are best described by which of the following? a. Obtaining a wider range of knowledge and information from group members stimulates thinking. Strength in diversity, more individual perspectives, and member's commitment to the decision save time. b. Groups can be positive and constructive, and costs are more because more ideas are generated over an individual effort to solve the problem. c. People with the expertise get together in a group to talk about issues and resolutions, so alternative approaches or options can be planned, and consequences discussed. d. Groups that include ideas from both inside and outside the unit will understand the different aspects of the problem, plan a series of tasks with options to resolve the problem, and together implement the solution faster with role assignment.

a

The critical care nurses' specialty organization identified five factors that should be considered to make the best decisions. Which of the following identifies all five factors? a. Care is complex and requires attention, adaptation, or innovation in approach, with some risk that the activity may cause potential harm, and the level of patient interaction and the patient's response to the activity are unpredictable. b. The complexity of the intervention or task, the skill of the registered nurse's (RN's) delegation, the competencies of unskilled assistive caregivers, the risk of harm to patients, and the criticality of the outcome. c. The care requires special attention, adaptation, or an innovative approach, the skill of the RN's delegation, and the competencies of unskilled assistive caregivers. d. A patient's risk for potential harm, the skill of the RN's delegation, the competencies of assistive caregivers, the difficulty of the intervention, and the fact that a patient's response to the activity is unknown or unpredictable.

a

The integration and coordination of health services to a specified population of individual patients has been described as case management. Select the best statement to describe this approach. a. A comprehensive process to identify individuals who would benefit from activities of assessment, problem identification, care planning, care delivery, advocacy, monitoring, and evaluation of care provided for relevance to client and caregiver and health care team's ability to meet desired outcomes and established goals b. A systematic integration and organized way to finance and deliver health care to achieve specific client outcomes, given fiscal and other resource constraints c. A comprehensive integrated approach to care and reimbursement based on the natural course of a disease d. A comprehensive process of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation of resident care activities and rehab services that will promote quality of life and activities of daily living.

a

The organization and individuals engaged in scientific investigation using methods and variables that influence the rate and extent of adoption of practices to improve clinical services is known as: a. translation research. b. evidence-based practice. c. research utilization. d. best practice.

a

What is the administrative and systematic process to be responsive to environment-related and future-oriented changes that are sensitive to the correct positioning of the organization known as? a. Strategic management b. Tactics c. Strategy d. Performance effectiveness

a

When nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment, what model is likely being used? a. Shared governance model b. Administrative model c. Councilor model d. Congressional model

a

Nurse leaders who encourage transformation through their commitment to the journey will find roles changing. Which of the following statements best describe the role of nurse managers? (Select all that apply.) a. Staff members in decentralized organizations are more accountable because fewer people provide functional supervision, quality monitoring, or unit-specific responsibilities. b. Nurse managers are accountable for transactional processes such as budgets, productivity, and quality monitoring, on top of their roles as coaches, mentors, and leaders to staff nurses. c. Nurses have an opportunity to take leader roles in integrated care networks with shared governance, and the nurse manager's role shifts to one of facilitating, enabling, and supporting the staff personnel. d. Nurses have depth of experience in attending and conducting committee meetings, setting agendas, developing consensus, and dealing with conflict. e. A nurse's individual performance and activities can reduce errors and promote patient-centered care.

a,b,c

Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines. c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills.

a,b,c

Nurses involved in the selection or development of a nursing care delivery system should consider which of the following as important? (Select all that apply.) a. Fiscal accountability, client characteristics, staffing composition, case mix severity, and clinical service intensity b. Practice guidelines and new medication information and technology c. Role of the RN, practice expectations, accountability of nurses, decision making about care, and provider competencies and experience d. Direct and indirect client nursing care interventions, end of shift reporting, physician-prescribed care, and communication e. Reimbursement models within the Affordable Care Act and American Health Care Act that cover preexisting diseases and other illness across a larger insured population

a,b,c,d

Which of the following are the building blocks that nurses should use to develop the organizational structures to support an evidence-based practice environment? (Select all that apply.) a. Incorporate evidence-based practice terminology into mission, vision, strategic plan, and performance appraisals. b. Establish explicit expectations about evidence-based practice for nursing leaders with a culture that values clinical inquiry. c. Demonstrate the value of evidence-based practice through administrative behaviors of the chief nurse executive. d. Educate nurse executives, nurse managers, nurses, physicians, and other health care professionals about the value of evidence-based practices. e. Integrate evidence-based practice into the governance structure of nursing departments and the health care system.

a,b,c,e

Multiple unique goals are achieved with case management services that are different from the goals of managed care. Nurses as case managers contribute to which of these goals? (Select all that apply.) a. Coordinating client-focused care by planning and arranging access to appropriate services and interventions b. Providing nursing interventions to meet diagnosed client needs in the most cost-effective manner c. Seeking to reduce costs, conserve resources, and maximize the value of services d. Tracking outcomes and guiding services across time and settings through ongoing evaluation of assessments e. Measuring access, satisfaction, health care costs, resources and service processes available, and goals of entity

a,b,d

Research has shown which two of these statements are correct? (Select all that apply.) a. Nurses need to be responsible for beliefs, values, meanings, goals, and relationships. b. Experienced leaders feel comfortable with the star pattern communication style. c. In crisis situations, members work in a team that capitalizes on the skills and strengths of each team member. d. Less experienced leaders feel most comfortable with the circle pattern communication style. e. Scripting is not useful for communication with physicians and patients.

a,c

Disadvantages of group decision making over individual decision making would include: (Select all that apply.) a. premature decisions. b. delayed decisions. c. individual domination. d. disruptive conflicts. e. timely tracking of outcomes

a,c,d

Which of the following describe the four tenets embraced by members of the IOM Committee on Quality of Health Care in America and how these tenets incorporate into nursing practice? (Select all that apply.) a. Nurses use standardization of processes when using nursing diagnoses to identify issues with clients and using nursing interventions to identify best practice to improve client's status. b. Nurses are members of multidisciplinary teams, and people are the problem, not the processes and systems. c. Nurses use assessments to collect patient data to diagnose problems and risk and to identify the state of optimal health care across the continuum. d. Using the methodology of PDCA (plan-do-check-act) is like the nursing process. e. Nurses depend on quality department to get data to evaluate quality and cost-effectiveness for complying with accreditation and regulatory compliance with reporting.

a,c,d

Chief nursing officers (CNOs) are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements related to delegation, for both RNs and delegates. Which statements are correct? (Select all that apply.) a. A key element in delegation is to assess the competency level of the staff. b. When an RN delegates a task, he or she is responsible for supervision but is not accountable for the outcome. c. A state's nurse practice act consists of rules that govern how RNs delegate to competent staff. d. The National Council of State Boards of Nursing is opposed to delegation to unlicensed assistive personnel (UAP). e. Any traveling nurse unaware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons.

a,c,e

New policies, programs, projects, and services are developed to meet the needs of patients. Which statements are descriptions of when nurses take steps to use these items? (Select all that apply.) a. Strategic management is the processing of an organization's vision or mission. b. Strategic planning is a process of developing an action plan for actualizing the mission. c. Strategic management is nurses making decisions about the delivery of care. d. Nurses use strategic planning to help them meet personal and professional goals. e. Nurses use the principles of strategic planning with other stakeholders to explore programs, projects or services to promote population health, patient satisfaction, and decreased health care costs.

a,c,e

Quality can be defined in which of the following ways? (Select all that apply.) a. When outcomes compare favorably with standards b. When activities and interventions are examined c. The measurement of effectiveness, efficiency, benefits, and appropriateness of care services d. The existence of a program or actions to show effort in the pursuit of excellence e. When higher volume of procedures is associated with lower mortality

a,c,e

A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. "I don't blame you. I don't like lime Jell-O either." b. "Tell me about your cultural beliefs to best help you." c. "Why don't you want to eat the lime Jell-O?" d. "It is important for you to eat so that you will heal."

b

A complex combination of a hierarchical structure with project teams is the definition of which type of organization structure? a. Decentralized b. Matrix c. Centralized d. Divisionalized

b

A number of industry-based models for quality management and measurement have been adopted by the health care industry over the past two decades. The model that provides a holistic approach to enterprise transformation and focuses on stakeholder's value propositions and interdependencies to determine effective processes before achieving efficiency in work flow across the enterprise would be: a. Six Sigma. b. Lean Enterprise. c. High-Reliability Organization. d. Baldrige National Quality Award (BNQA).

b

Although all clients need coordinated care, population health management best serves the needs of targeted, high-risk populations for: a. coordinating the care of the individual client in relation to one or more diseases or health conditions after hospitalization. b. building personal relationship to identify knowledge deficits, counseling needs, facilitate monitoring, treatment adherence, and stabilization. c. a specific disease or health condition of a population group, with subsequent application to individuals over time. d. managing services for patients using beyond what is typically expected in order to reduce cost and focus on only necessary medical services.

b

Cultural differences are characteristics that define individuals beyond unique numbers and names. Which statement is true? a. Each generation possesses unique characteristics that are associated with race and ethnicity values, behaviors, and practices. b. Cultural differences in ways of doing things and in beliefs about health and illness are learned and transmitted via cultural environments. c. Cultural differences do not include eye contact norms, gender issues, touching and physical contact, and food practices. d. Cultural differences do not generally impact communication, so standard safety and quality of care practices can be sustained.

b

Effective communication can best be described by which one of the following statements? a. The major part of any communication is the words that we say to others. b. Conversation that is clear, direct, straightforward, and offers frequent message transmission is most effective. c. To respond effectively to communication, place responsibility on others. d. Feedback should be used carefully and only when absolutely necessary, because it inhibits effective communication.

b

Managers and executives in practice will struggle to make decisions regarding staffing and practice to achieve best outcomes. Staffing levels have often but not always been associated with a number of unfavorable outcomes, including increased surgical mortality, failure to rescue, and rates of complications due to errors in care such as urinary tract infections, intravenous line infections, decubitus ulcers, and patient falls. Managers and executives can take steps to: a. review the literature in nursing outcomes research to find a valuable point of reference for managers that lowering staffing levels and skill mix in hospitals associates with decreased risk of negative outcomes. b. identify and use data systems that are comprehensive for outcomes management in order to support the monitoring of nursing-sensitive outcomes and establish continuous monitoring of outcomes against internal and external benchmarks using a national database of quality indicators. c. use a wealth of information available to them and hire data analysts and others to determine what data indicate a need for action. d. contribute unit-specific data on nursing-sensitive indicators to a national nursing database registry and use balanced scorecard for administrative discharge data evaluation.

b

The accountable care organization (ACO) will need to measure progress toward optimized population health. The measures for the ACO would include: a. benchmarks that provide frames of reference against which an organization can compare itself relative to others. b. population health measures on clinical process and outcome indicators, patient satisfaction, functional status, quality of life, economic and utilization indicators, and changes in health disparities. c. structured care methodologies, such as critical pathways or streamlined interdisciplinary tools, identification of best practices, facilitated standardization of care, quality enhancement, and outcomes measurement. d. variances identifying positive and negative differences between what was expected from a standard and what actually occurred with client- and family-related, systems-related, or provider-related factors.

b

The degree to which a client or population with common personal or environmental characteristics continues a negotiated treatment is a parameter. To measure this indicator in a community or interdependent organizations, such as ACOs, would be: a. compliance. b. adherence. c. maintenance. d. noncompliance.

b

The determinant for the decision to delegate is the legal scope of delegation rules described within: a. an institutional policy. b. a nurse practice act. c. the American Nurses Association (ANA) Code of Ethics. d. The Joint Commission (TJC) Patient Care Standards.

b

The type of power exhibited when providing the opportunity for others to take responsibility and accountability for their work is: a. referent power. b. empowerment. c. expert power. d. legitimate power.

b

Valid, reliable, and operationally defined measures that are important, feasible, and have clinical logic and measurement properties are known as: a. end results. b. indicators. c. outcomes. d. findings.

b

Variables that influence nursing practice and client care delivery include: a. client-centered versus task-focused versus provider-focused perspective. b. skill mix for client condition severity, nurse-to-client ratio, use of temporary staff, workload, nursing education and experience, and technology level. c. medical home structure for more integrated or coordinated between acute and primary care. d. RN preparation, critical thinking, and delegation skills.

b

Which of the following describes ways in which nurse managers can create an environment devoted to health care safety? a. Developing a punitive work environment to remove staff who lack behaviors for safety b. Establishing a culture of safe, effective, patient-centered, timely, efficient, and equitable care c. Examining processes and systems issues regarding people, providing feedback, and rewarding achievement of safety goals d. Mentoring others toward the goals of excellence and finding external data for comparison

b

Leaders and managers should know the many aspects of case management. Identify the two correct statements. (Select all that apply.) a. Case management focuses on continuity of the plan. b. Case management entails providing holistic care, conservation of resources, and care across episodes and settings. c. A current trend is the push for accountability and accreditation for case management organizations. d. Case management frequently is associated with health maintenance organizations and preferred provider organizations. e. Case management is focused on stabilization of costs and clinical care for chronic disease and recovery from debilitating injury and accomplished by frequent phone communication.

b,c

Changing the operational process of an organization is often necessary when adding or updating patient care and health information technologies. Three key dimensions of the organization design to engage in making this change are: (Select all that apply.) a. linear process. b. centralization. c. coordination. d. formalization. e. position specialization.

b,c,d

When communicating health information with diverse populations, miscommunication and misunderstanding can lead to: (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost.

b,c,d,e

Placing someone from a high-context workplace culture into a setting dominated by leaders from a low-context culture will increase the likelihood of perceptions of inequity and workplace conflicts. What are the differences between low-context and high-context cultures? Select the two statements that are correct. (Select all that apply.) a. In high-context cultures, often found in the Western world, that which is written or stated rarely carries the meaning, because the meaning of the message is understood by reading between the lines for what is not written or stated, whereas low-context cultures require extensive detailed explanations and information because they are making up for what is missing in a situation. b. In high-context cultures, often found in the non-Western world, that which is written or stated rarely carries the meaning, because the meaning of the message is understood by reading between the lines for what is not written or stated, whereas the low-context cultures in the Western world require extensive detailed explanations and information because they are making up for what is missing in a situation or the context. c. The cultural context of the Western world is low context, and in low-context cultures the meaning is assumed to exist by the nature of the situation that is the context, while in high-context cultures most of the explicit verbal or written message carries the meaning. d. The cultural context of the Western world is low context, and in low-context cultures the explicit verbal or written message carries the meaning, while in high-context cultures, most of the meaning is assumed to exist by the nature of the situation that is the context. e. The cultural context of the non-Western world that which is low context does not use the written or verbal message as meaning but has an expectation for those in authority to guide the meaning and direct the decision, which the high-context culture use the written and verbal message as having adequate meaning to allow the communication to direct the decision using rules to guide the understanding.

b,d

What are two health care trends that can affect the use for measuring and managing outcomes? (Select all that apply.) a. The lack of documentation of effectiveness of client services and the variations in practice have triggered the demand for outcomes measurement. b. Management decision making should be evidence based wherever possible in order to optimize quality of care. c. Pay-for-performance reimbursement systems provide for direct payment of services if within a medical home model. d. Cost-containment strategies often involve a focus on decreasing staff coverage or reducing the proportions of registered nurses in staff mixes without forethought to the potential consequences. e. Measuring nursing-sensitive patient outcomes and nursing interventions within health care's Big Data systems will require skilled data analysts and less effort by nurses.

b,d

A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict.

c

A health care organization plans to integrate an electronic health record (EHR), health information network, and clinical data analysis into all clinical areas. Using the five theories of organization as a social system would put forward to manage the challenge, which approach is best for nursing? a. Scientific management school where leaders choose a single best technology and implementation process for the organization with EHR implementation in all units and settings b. Classic management theory where a top-down approach is used, and administration selects the system and determines the implementation process c. Open systems theory where the leaders emphasize the dynamic interaction and interdependence of the organization with its external environment and internal subsystem d. Bureaucratic theory where leaders aim toward mass production and technical efficiency in implementing an EHR system

c

A strategy of demonstrating an opportunity for improvement at baseline, outlining current practice related to specific care process indicators is: a. outreach or academic detailing. b. change champions. c. performance gap assessment. d. audit and feedback.

c

An overarching organizational strategy to ensure accountability of all employees, to incorporate evidence-based health care quality indicators, and to improve care delivered to various populations is best known as: a. the accreditation and certification process. b. continuous quality improvement. c. a performance improvement program. d. lean value-stream strategy.

c

Arms and Stalter (2016) described six competencies needed by nurses who are serving on boards and/or policy committees so that they can contribute in a productive manner. Which of the following best describes how nurses engaged in this approach? a. Verify the information associated with the intense/conflict situations; investigate what others think; decide how to prevent future situations. b. Advocate the views for both sides; stimulate creativity and innovation; value each side disclosed; encourage others interest and curiosity; obtain information and decide. c. Professional commitment to serve, knowledge about bylaws and position descriptions, and standard business protocols; manage intense/uncivil situations. d. Assist others who are difficult to deal with by managing discontent and infighting among board members, group cohesiveness and effectiveness, and communication; view the ideas as having potential; identify outside resources; discuss options.

c

Diversity assists with team effectiveness, improves retention of the best people, capitalizes on out-of-the-box thinking, lays the groundwork for future business growth, and provides more supportive work environments. Which of these are benefits to the nursing workforce? a. Each generation possesses unique characteristics, and often the values and behaviors of an older cohort of nurses help younger colleagues. b. Communication style, work style, organizational role/level, economic status, and geographic origin are uniform factors helping team effectiveness among nurses. c. A diverse workplace allows synergy of diverse viewpoints to improve nursing's knowledge base and care strategies. d. In the health care setting, diversity among employees helps the awareness of diverse patient and family values, beliefs, and practices.

c

Implementation of a strategic plan can be accomplished when a priority order for achieving the strategic objectives or outcomes exists, responsibility for achieving these objectives has been determined, and some available financial support is provided within an expected timetable. The role of nurses would include: a. finding out who is responsible for the implementation. b. waiting to implement until administration develops an action plan that breaks the plan into manageable parts. c. integrating the strategy into daily activities and keeping the strategy a major agenda item for their nursing department or service. d. waiting until the workable action plan is presented by nurse leaders.

c

Management must understand and address aspects of generational workforce diversity. Which of the following statements best describes aspects of the generations? a. Nexters matured in a world with manipulation of people and limited ethical code to reign. X'ers found the need to be resourceful at an older age. Boomers thrived with efficiency, teamwork, quality, and service. The Silent Generation prefers limited government. b. Nexters are shallow on advanced skills because technology takes care of every step. X'ers share with boomers the need to push authority aside. Boomers blur gender roles and attempt to push systems toward their conveniences. The Silent Generation likes individualism. c. Nexters can create solutions that other generations could not have imagined. X'ers prefer a balanced life and protect themselves from the capriciousness of business challenges, constraints, and rules. Boomers ignore or break rules and will still be successful. The Silent Generation treasures and exhibits conformity. d. Nexters are problem solvers who grew up in a flourishing economy. X'ers desire traditional practices and beliefs. Boomers prefer a participative and more authoritarian workplace. The Silent Generation respects authority.

c

Outcomes management is a process that can be described accurately by which of these statements? a. Outcomes management provides relatively little data for internal use in health care organizations. b. Effects of outcome management are used as measures of all three of Donabedian's (1985) aspects of quality: structure, process, and outcomes. c. Outcomes management is an interdisciplinary process designed to provide quality care, decrease fragmentation, and constrain costs. d. Variances with outcome management are complex, interactive, and only occur at a single level, such as that of organization level.

c

Similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase. Strategic management involves: a. assessing the nursing mission, diagnosing outcomes for needed services, developing a plan to achieve the outcomes, implementing the strategies, and evaluating the changes toward the outcome. b. identifying the organization's needs, establishing the purpose for new services, planning the action steps, and evaluating the outcomes for the new services. c. developing a strategic mission or vision, setting objectives, developing strategies to achieve the objectives, implementing the strategies, and evaluating the results. d. assessing the service needs, planning goals and objectives, implementing the action plan, and evaluating the goals and objectives.

c

The individual in a clinical nurse specialist role would be known as holding the: a. analyst position. b. line position. c. staff position. d. support staff position.

c

The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: a. miles in which the network resides. b. ancillary staff accountable to her. c. nurses and non-nurses reporting to her. d. inpatients that the facilities service.

c

The roles of sender and receiver must be assumed in interpersonal communication. This is reflected within which description of communication? a. Communicating with diagnosing and adapting is one of the basic competencies of influencing, effectiveness in engaging and motivating people, and in getting work done through others. b. When humanistic or democratic values are upheld in an organization, then trusting, authentic relationships become the norm in a nurturing, productive work environment. With humanistic values, intergroup cooperation, flexibility, and organizational effectiveness tend to improve. c. Interpersonal communication is a two-way level of communication involving face-to-face interactions between people who are consistently aware of each other. d. Skillful, positive questioning by a leader or manager can persuade people to willingly commit themselves to see personal benefits and accept change.

c

When clients are grouped together and cared for by one nurse, this is known as: a. functional nursing. b. team nursing. c. group nursing. d. primary nursing.

c

Which is a perceived antagonistic process at the individual-organization level of interaction that affects productivity, morale, and teamwork in organizations? a. Interpersonal conflict b. Organizational conflict c. Job conflict d. Social conflict

c

Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion.

c

Leadership is necessary across all organizational levels, and different roles can support implementing evidence-based changes. Which of the following roles are important to the success of this transformation of practice? (Select all that apply.) a. Senior leaders b. Medical staff directors c. Chief nurse executives d. Opinion leaders e. Project director

c,d

Criteria can be used to assess co-workers competency for delegation. Which of the following methods can be used to assess the competency of nursing assistive personnel? (Select all that apply.) a. Micro-managing and being able to step in and take over tasks b. Educating and training for the required role function c. Supervising with periodic review and performance feedback d. Orienting to the job description and evaluating tasks within a designated time frame e. Checking with unlicensed assistant when completing the task to obtain feedback about the patient

c,d,e

Implementation of a shared governance model is best accomplished when which of the following steps are considered within the organization? (Select all that apply.) a. Administrators must justify the initial cost in terms of personnel time, effort, and financial commitment. b. The cost of shared governance is not operationalized into the budget, because the philosophy of accountability must be implemented by someone. c. Organizational executives, managers, and point-of-care staff receive education and support. d. Establish an organizational purpose is to share the work through developing the culture that supports, encourages, and maintains it. e. Offer opportunities for formal empowerment to advance practice and time for nurses' involvement in leading practice.

c,e

A 17-year-old male has presented to the emergency department with appendicitis. He speaks English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctor proceeds without obtaining consent, he may face: a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims.

d

A business approach that ensures a competitive advantage over similar enterprises involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Which of the following statements is correct? a. The best strategic planning is from the top down. b. The strategic planning process is threatening to employees and creates decreased job satisfaction. c. A basic form of strategic planning is a detailed written business plan with a comprehensive market analysis. d. Strategic management involves strategic planning and implementation.

d

A deliberate and cognitive process of becoming responsive and sensitive to the client's culture, values, and learning to avoid imposing on them is: a. cultural knowledge. b. cultural diversity. c. cultural skill. d. cultural awareness.

d

A rigorous scientific process used to combine findings from research into a powerful and clinically useful report to guide practice is: a. performance appraisal. b. practice guideline. c. implementation science. d. systematic review.

d

Case managers were deployed to decrease fragmentation; reduce expense by streamlining care; and control costs by linking, advocating, coordinating, negotiating, educating, and monitoring. Today the model that guides hospitals and clinics to case manage is best described in which of the following statements? a. Social services, rehabilitation, and public health have addressed coordination of care for the ill and the poor to manage catastrophic injury or illness. b. Traditional public health nursing has addressed the coordination of client-centered care within the community setting. c. Tertiary care has addressed the treatment of acute, episodic health care conditions. d. Public health guides the health care organization to coordinate and integrate services across the continuum from hospital to community to reduce costs and eliminate redundancy of services.

d

Centralization and decentralization are organizational philosophies about where decision-making authority resides in the institution. What is the best description of centralization and decentralization? a. Confident administrators will decentralize during crisis and centralize during stable times. b. An organization may use selective decentralization for decision making in the functional areas of staffing and operations, while centralizing the decisions of purchasing at very low dollar limits. c. Centralization is the concentration of decision-making authority at the service lines of the organization. d. Decentralization is dispersing decision-making authority throughout the organization.

d

Given the interdisciplinary nature of case management, who would be best in the case manager role? a. Associate degree nurses are skilled in the coordination of client care. b. Geriatric advanced practice nurses are skilled in the coordination of client care for specialized services. c. Registered nurses after 5 years possess expert knowledge, experience, and education and are qualified to be case managers. d. Advanced practice nurses draw on a wealth of knowledge to lead and coordinate the health care team.

d

Leaders who give and take exchanges aimed at resolving issues are doing which of the following? a. Bargaining b. Effective communication c. Persuasion d. Negotiation

d

Nurse managers, in collaboration with nursing leadership, design nursing systems for the provision of client care and the betterment of the organization. Nurse managers should consider which of the following as important? a. Two factors that nurse managers must consider when designing a care delivery system are the type of nursing skilled staff and turnover. b. Mixed model approaches offer a confusing type of nursing care delivery system, with trying to balance nurse's needs with those of clients, physicians, and organizations. c. Models that promote professional practice have implications for job satisfaction, the character of professional practice, and the amount of control staffing leading to turnover. d. They should include staff nurses in the development and selection process of the professional practice model.

d

Nurses may communicate using humanizing and dehumanizing attitudes which affect the outcome of communication. Select the most humanizing option below. a. In a small group session, there were varying opinions, with two individuals quite vocal about their viewpoints on how to proceed with a project. b. The manager handled the nurses on the unit with tolerance, judgment, and role-playing. c. In a unit-based group session, there was disregard for conversation offered by 10 group members with steps to change the agenda item to another topic. d. The manager engaged nurses to share their concerns and ideas openly along with their fears about the developing project.

d

Personal conflict can arise when trying to ingratiate another person because there is the use of: a. influencing an individual or group to gain a scarce resource. b. providing a pay raise, promotion, or advancement. c. threats, discipline, or negative consequences. d. lavishing praise on another to make him or her feel important to gain favor.

d

Professional nurses develop performance and quality improvement programs and conduct evidence-based improvement studies and research. Which statement is true about standards? a. Structure standards measure whether the services provided by the organization make any difference. b. A standard of care is outcome-oriented and focuses on the nurse as a provider. c. Standards can be set only by professional organizations. d. Standards essentially define quality, against which performance and outcomes are measured.

d

Select the best statement for why communication processes are important to organizations. a. Horizontally decentralized organizations are more efficient than centralized organizations. b. Positive communication techniques include agreeing uncritically and reassuringly. c. Individual communication is more complex than group communication because it is so intensive. d. Human interaction issues are the general area in which leaders and managers spend most of their time.

d

The process for determining better scientific evidence on the effect of different treatments on client-centered health outcomes is: a. research using risk adjustment. b. health services research. c. outcomes research. d. comparative effectiveness research.

d

When the group decision-making procedure is that the entire group decides, whether by a two-thirds vote, simple majority, consensus, or some other process, this is known as: a. delegated decision procedure. b. autocratic decision procedure. c. consultative decision procedure. d. joint decision making.

d

When the leader engages in dialogue with the nurse to share ideas and help in making decisions, what style of Situational Leadership® communication is being used? a. Selling b. Delegating c. Telling d. Participating

d

Which of the following statements correctly describes case management? a. Primary therapists have therapeutic relationships with the clients and provide primary case management functions. b. Physicians must document the effects of interventions on client outcomes to demonstrate that they can provide cost-effective services. c. Social workers can coordinate care for all patients and provide case manager functions to coordinate health care services for high-risk populations across community, acute, and long-term care settings. d. Registered nurses (RNs) have emerged as the large majority of case managers, especially in hospitals, because of their specialized expertise for the function of determining medical necessity for health care payment and because of care coordination for complex medical discharge planning needs.

d

Within nursing practice, the use of advanced practice roles is an example of: a. cross-training. b. departmentalization. c. fragmentation. d. specialization.

d