Exam 1 Leadership

What would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

"At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most creative conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating

Collaborating

Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice is based? a. Licensure status b. Experience in the agency c. Leadership capabilities d. Education and expertise

Education and expertise

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the most likely basis for the nurse manager's request? a. An established clinical pathway b. Confirmatory scientific evidence c. Unit protocol d. Experience

Experience

Jane has transferred from the ICU to the CCU. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates which type of conflict? a. Organizational b. Intrapersonal c. Interpersonal d. Disruptive

Interpersonal

Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Sarah is experiencing which type of conflict? a. Intrapersonal b. Interpersonal c. Organizational d. Professional

Intrapersonal

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares she has incorporated her core values and beliefs into her role and responsibilities as a nurse manager. What type of leadership has she described? a. Positional leadership b. Personal leadership c. Formal leadership d. Information leadership

Personal leadership

The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try. The manager decides to journal her feelings regarding the new nurse and her feelings. What is the nurse manager practicing in this situation? a. Leadership b. Reflection c. Knowledge d. Action

Reflection

According to the complexity theory, what would be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

Staff morale and budgets

As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, what would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.

The facility is an older house that is more than 30 minutes away from the acute care center.

You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement? a. The statement is correct. Leadership is not the role of the staff nurse. b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. The new graduate has been influenced by nurse leaders and managers who leave for other positions. d. The general perception is that nurse leaders and managers are not satisfied in their jobs.

The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

The staff nurse who persuades other staff members to practice by making evidence-based decisions

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

Transactional

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. direct responsibility for patient care. b. direct accountability for patient outcomes. c. an authority relationship to staff. d. an influence over patient outcomes.

an influence over patient outcomes.

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. breakdown in function and communication across specialties. b. lack of congruence in culture and organizational values. c. highly centralized decision making and authority. d. wide span of control.

breakdown in function and communication across specialties.

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: a. cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. b. plan for the smooth transition of patients from the emergency services department to other units in the hospital. c. ensure that funding follows the patient from acute care to long-term care services. d. bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

The head nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new procedure based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with: a. lateral violence. b. horizontal violence. c. confrontation. d. bullying.

bullying.

With revenue reductions and cost-saving measures, the number of managers has been reduced, this has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. decreased patient satisfaction. b. increased efficiency in costs. c. a more positive perception of managers. d. little change to manager-staff relationships.

decreased patient satisfaction.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. function through influence. b. take complete responsibility for the care of clients. c. interview and hire staff nurses for designated nursing units. d. be granted functional authority to determine standards of nursing care and enforce them.

function through influence.

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. differentiated practice. b. team nursing. c. functional nursing. d. case management.

functional nursing.

In matrix organizational structures, a nurse manager understands that this type of structure: a. is a simplified organizational structure. b. has both a functional manager and a service or product-line manager. c. arranges departments strictly according to function. d. promotes harmony in organizational decision making.

has both a functional manager and a service or product-line manager.

After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. observe to make sure the conflict has been resolved. b. fire both staff nurses. c. reassign both staff nurses. d. reassign the nurse manager.

observe to make sure the conflict has been resolved.

In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on healthcare delivery systems of the future is: a. changes in staffing patterns. b. increasing reports of violence in the workplace. c. the increasing percentage of the population that will be over age 65. d. escalations in the cost of health care.

the increasing percentage of the population that will be over age 65.

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. What would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

"At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be

A group of your staff members goes to the administration to propose closing of a different unit.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed. What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission? a. Empowering b. A leadership tag c. A symbol d. A management task

A leadership tag

Recruiting among the emerging work force (18 to 35 year olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging work force? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

A nurturing and receptive environment

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: (Select all that apply.) a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education. d. potential damage to reputation through learner error.

A, B, C

Organizational culture includes: (Select all that apply.) a. norms. b. traditions. c. behaviors. d. values.

A, B, C, D

Nurses entering the work force today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.) a. Nurse-physician relationship b. Nurse-nurse relationship c. Nurse-patient relationship d. Nurse-chief nursing officer relationship e. Nurse-auxiliary personnel relationships

A, B, C, D, E

Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

A, B, E

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.) a. Attending professional conferences b. Reading books on leadership c. Joining professional organizations d. Connecting with other leaders in the organization e. Experiences from new nurses

ANS: A, B, C, D

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns? a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

Acknowledge the loss.

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care, and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.

The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation? The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? a. A formal leader b. A positional leader c. An official leader d. An informal leader

An informal leader

Which of the following exemplifies the predominant conflict management style of nurse managers? a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit. b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs. c. During management meetings, George, the head nurse on nephrology, dominates meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to miss the management meetings. d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion for clarity issues. c. Ask each party to examine their own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

Ask each party to examine their own motives and issues in the conflict.

A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent, confused patients. The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article. What is the new nurse demonstrating in this situation? (Select all that apply.) a. Assertiveness b. Followership c. Management d. Insubordination

Assertiveness Followership

Factors that influence the ease with which conflict is resolved include all except which of the following? a. Level of interdependence of the parties b. Interprofessional collaboration c. Expression of one's own needs and ideas d. Avoidance of the issue or concern

Avoidance of the issue or concern

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to: (Select all that apply.) a. retain funding from third-party payers. b. develop leaders. c. maintain and/or improve quality of care. d. stay abreast of new knowledge and evidence.

B, C, D

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LPN/LVN

Baccalaureate

As a new nurse manager, you are aware of leadership, management, and followership principles. What is the first step to becoming an effective leader? a. Being an effective follower b. Taking a class on leadership c. Taking a class on management d. Getting an advanced degree

Being an effective follower

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

Case management method

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

Case method

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

Competent

As a leader in nursing, one must seek new insights and establish personal tools to improve their lifelong learning. Which behavior by manager would be a concern for a chief nursing executive? a. Journaling for self-reflection b. Authentic relationships c. Complacent behavior d. Improved knowledge of staff

Complacent behavior

As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care. The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role. What is this view of the role consistent with in this situation? a. Trait theories b. Complexity theory c. Situated theory d. Emotional intelligence

Complexity theory

John is a circulating nurse in the operating room. He is usually assigned to general surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies the doctor's preference cards before each patient. The fourth patient comes into the room and John prepares a site for a biopsy using a Betadine solution. The surgeon prefers another solution. He notices what John has done and immediately corrects him by rudely insulting John. What is the appropriate approach to conflict resolution in this example? a. Collaboration b. Compromising c. Avoiding d. Withdraw

Compromising

Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas' stages of conflict? a. Frustration b. Conceptualization c. Action d. Outcomes

Conceptualization

What patients would most likely be covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

Dan, who is 68 years of age and in good health

The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation? a. A positive self-concept b. Deepening self-awareness c. Leadership d. Acquiescence

Deepening self-awareness

A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, what principle is being engaged? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

Development of networks

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step? a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Elevate the next negation session to the next manager, one level above. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

Elevate the next negation session to the next manager, one level above.

At the end of a shift, the charge nurse shares with the new nurse she had done an excellent job with a difficult patient that day. The new nurse was upset by the way the family of the patient had treated her. She shared her feeling with the charge nurse. The charge nurse offered to change the assignment the following day. What is the charge nurse displaying? a. Emotional intelligence b. Comportment c. Compassion d. Management of conflict

Emotional intelligence

Excellent leaders need to have or develop the skills of empathy and expressiveness when dealing with others in the workplace. This is also known as understanding and managing own feelings and emotions as well as discerning the emotions of others. What is this an example of required by good leaders? a. Social awareness b. Self-awareness c. Emotional intelligence d. Intellectual ability

Emotional intelligence

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

Engage involved staff at all levels in the decision-making process.

As a nurse manager, you are a leader in health care and on the unit you manage. Looking at the larger picture of health care and patient environment on the unit, what is your primary role when evaluating the care provided on your nursing unit? a. Focus on cost outcomes. b. Assess staff for contentment on unit. c. Ensure quality patient care on unit. d. Provide education to the staff of the unit.

Ensure quality patient care on unit.

A dispute arises between an RN and an LPN over a patient issue. The tension continues between the two and begins to affect other staff members, who are drawn into the conflict. Over time, the team becomes polarized toward either the RN or the LPN. How might this situation be prevented? a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves b. Asking other staff members what the real issues were in the dispute between the RN and the LPN c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute

Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change? a. Exploring the values and feelings of the RN group in relationship to this change b. Leaving the RNs alone for a time so they can think about the change before it is implemented c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired d. Hiring the assistants and allowing the RNs to see what good additions they are

Exploring the values and feelings of the RN group in relationship to this change

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. What behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level

Fifth level

A family is keeping vigil at a critically ill patient's bedside. The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes. The nurse suggests that the patient's provider may need to discuss the treatment plan with the family. The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions. What is the role of the nurse in this situation? a. Leadership b. Management c. Follower d. Evidence-based

Follower

The charge nurse of a unit is asking the staff what patients they had the day before to make assignments for the day. A new nurse complains about having the same patients every day. The charge nurse considers the new nurse request at an assigned to different patient for today. What type of leadership is the charge nurse displaying? a. Informal leadership b. Formal leadership c. Favoritism d. No leadership displayed

Formal leadership

The chief nursing officer (CNO) is appointed for the local hospital in a rural area. The nursing committee agreed with the appointment of the new CNO offered the position. What is this type of leadership position considered? a. Formal leadership b. Informal leadership c. Director leadership d. Personal leadership

Formal leadership

In developing leadership skills, one should focus on authentic leadership. The theory of authentic leadership focuses on various factors. What is the top priority in development of authentic leadership? a. Honest relationships b. Organizational task c. Accomplishment of goals d. Exploring others

Honest relationships

The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

Implement a model of shared governance.

Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to provide quality patient care, and they express their concerns to senior management. The CEO of Valley Hospital makes the following statement: "We need to contain costs because our funding has been decreased." This is a good example of which of the following conditions that propel a situation toward conflict? a. Incompatible goals b. Role conflicts c. Structural conflict d. Competition for resources

Incompatible goals

A staff nurse is the person on the unit everyone seeks for input and asks questions. What type of leadership position is the staff nurse displaying? a. Position leadership b. Informal leadership c. Personal leadership d. Formal leadership

Informal leadership

A nurse manager when in the formal leadership position attempts to translate the picture or vision of her facility across for the staff nurses. The manager is faced with a staff who is resistant to the vision of the facility. What is the theory the manger needs to incorporate to be effective? a. Model the Way b. Inspire a Shared Vision c. Challenge the Process d. The Four Agreements

Inspire a Shared Vision

A staff nurse wants to become a charge nurse. What is one of the most effective methods for the staff nurse to incorporate to effectively transition to charge nurse? a. Read a book on charge position. b. Integrate prior experience to new role. c. Do things the way always done. d. Change units to be a charge on different unit.

Integrate prior experience to new role.

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious.

What exemplifies the predominant style of conflict management for staff nurses? a. Sarah and Jonas, two RNs, disagree about the best approach to assisting a family that has complex needs. They decide that they will consult with family and together will decide what is best. b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with Nancy, who wants a day off next to a 3-day break. c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating that she has already helped out for 2 days by staying late for Lindsay. d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends. ANS: D

Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation? a. Leadership b. Management c. Follower d. Visionary

Leadership

The charge nurse walks into Mr. Smith's room and finds him yelling at the LPN. He is obviously very upset. The charge nurse determines that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr. Smith's behavior was aggressive but was related to lack of sleep and to pain. The charge nurse asks, "Can you, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what? a. Lack of empathy and understanding for Miss Jones b. Concern with placating Mr. Smith c. Leadership behavior d. Management behavior

Leadership behavior

Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications. The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. What is the manager demonstrating? a. Leadership b. Management c. Decision making d. Vision

Management

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

Management can be taught; leadership depends on abilities.

A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire

Manager

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? a. Collaborating b. Avoiding c. Negotiating d. Accommodating

Negotiating

The manager is using self-reflection to gain insight into improving the leadership skills. By using self-awareness what does a leader develop? a. New knowledge b. Personal growth c. Improved self esteem d. Management skills

New knowledge

What would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors

Pain management for patients with low back pain

What is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

Pediatric intensive care unit that heavily involves families as well as patients

The core of nursing leadership incorporates integration of unique qualities to include us as individuals. Which is not considered part of leadership integration? a. Person b. Leader c. Nurse d. Position

Position

A new nurse leader wants to be the best leader she can. The nurse takes classes, finds and leadership mentor, seeks input from her unit, and employs other strategies for leadership development. What is another strategy for the leader to develop and improve leadership skills? a. Proactive learning b. Ignoring feedback c. Being in charge d. Authoritative position

Proactive learning

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

RN and medication assistants

In what situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

Reflect to gain insight into how the situation could be handled differently in the future.

A staff nurse is taking leadership classes in an advanced degree program as the nurse wants to become a manager. The instructor requires the students to create a journal and make notes of their feelings when they experience conflicts at work over the next few weeks. The assignment calls for the use of reflection. What is the purpose of this assignment? a. Log of conflicts which occur b. Reflection for self-awareness in conflict situations c. Assess the students conflict management skills d. Analysis of student lead conflicts

Reflection for self-awareness in conflict situations

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. What is this position considered? a. Hierarchical position b. Ancillary c. Line position d. Staff position

Staff position

The core of leadership is awareness. The text by Don Miguel, The Four Agreements, presents a set of agreements to enhance personal growth and awareness. What is not one of the four agreements? a. Be impeccable with your word. b. Take things personally. c. Do not make assumptions. d. Always do your best.

Take things personally.

As a nurse manager in a hospital, you would expect what to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield

The federal government

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment.

The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. What factor can increase stress and escalate conflict? a. The use of avoidance b. An enhanced nursing work force c. Accepting that some conflict is normal d. Managing the effects of fatigue and error

The use of avoidance

A group of patients with early Alzheimer disease and their spouses approach you regarding help with the establishment of a local Alzheimer Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group? a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic. b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group.

In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following? a. Staffing practices b. Increased participation in decision making c. Allocation of resources d. Tolerance of incivility

Tolerance of incivility

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing? a. Situational b. Trait-based c. Contingency-based d. Transformational

Transformational

Which of the following is an example of a formal leadership position on a nursing unit? a. Staff nurse b. Unit secretary c. Unit manager d. Nursing assistant

Unit manager

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. a healthcare network. b. a tertiary care institution. c. rehabilitative. d. long-term care.

a healthcare network.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that Veterans hospitals provide: a. primary care and are privately funded. b. a range of services and are responsible to government and taxpayers. c. secondary care only and are publicly administered and funded. d. services to Veterans under an HMO.

a range of services and are responsible to government and taxpayers.

Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. According to Thomas' four stages of conflict, in which stage could the nurse have been more effective?

a. Frustration b. Conceptualizing c. Action d. Outcomes

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. primary care, specialized. b. tertiary care, long-term. c. acute care, specialized. d. public care, specialized.

acute care, specialized.

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. the possibility of violence. b. an increase in prescription drugs available for abuse. c. decisions of the public board. d. an increase in uncompensated care events.

an increase in uncompensated care events.

Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian's relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian's relationships can be more satisfying for Jillian and her team members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation, Lee and Jillian are demonstrating: a. similar conflict management strategies. b. escalation of conflict. c. avoidance and compromise strategies. d. competing and compromise strategies.

avoidance and compromise strategies.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. be able to effectively communicate with patients. b. build relationships with physicians. c. be able to adapt to daily changes in staffing. d. adapt in communicating information to her supervisor.

be able to adapt to daily changes in staffing.

A hospital is working toward becoming a Magnet® hospital. The chief nursing officer is aware that professional nursing departments in Magnet® hospitals will: a. not be directed by nurses. b. be virtual organizations. c. be designed to maintain nursing standards of practice. d. be entitled to have client care departments.

be designed to maintain nursing standards of practice.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. be represented by a high number of Baby Boomers. b. be presenting different generational values and attitudes than the head nurse. c. be unresponsive to her transactional leadership style. d. want a leader rather than a manager.

be presenting different generational values and attitudes than the head nurse.

In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. transformational leadership. b. transactional leadership. c. bureaucratic organization. d. Chaos theory.

bureaucratic organization.

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. can be effective in recognizing individual strengths and backgrounds of staff. b. promotes autonomy and independence for the RN. c. avoids conflict because of role clarity. d. is efficient in delivering care to a large group of patients, utilizing a staffing mix.

can be effective in recognizing individual strengths and backgrounds of staff.

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. clinical expertise. b. leadership ability. c. communication style. d. conflict-resolution skills.

clinical expertise.

A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. b. horizontal violence involves those with similar status but little power in the larger context. c. interprofessional collaboration reduces unresolved conflicts. d. all conflicts involve some level of disagreement.

conflict can decrease creativity, thus acting as a deterrent for the development of new ideas.

A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. creating more jobs in the community for registered nurses. b. resulting in an overall loss of jobs for registered nurses. c. controlled by the federal and state governments. d. controlled by the insurance agency.

creating more jobs in the community for registered nurses.

A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will generate: a. creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers. b. creativity, a staid atmosphere, a weak team spirit, and motivation of its workers. c. creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. d. a bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. nursing care plan. b. physician's orders. c. critical pathway. d. clinical practice guidelines.

critical pathway.

Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in: a. decreased frustration between the maintenance worker and her. b. a good relationship with the maintenance department. c. eventual resolution of the problem without further intervention. d. decreased productivity on her part.

decreased productivity on her part.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. breadth of nursing knowledge and expertise required. b. intention to provide holistic nursing. c. degree of task orientation. d. levels and types of assessment.

degree of task orientation.

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. bureaucratic. b. decentralized. c. delegated authority and responsibility. d. delegated responsibility but no authority.

delegated responsibility but no authority.

Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. The outcome as depicted by Thomas' conflict stages can be considered to be: a. compromising. b. confronting. c. constructive. d. destructive.

destructive.

John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

In considering whether or not to accept a job offer as a nurse manager at a Magnet® hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. find it difficult to recruit new staff. b. see rapid turnover of staff on your unit. c. find nurses who exemplify interest in quality care. d. find limited interest in excellence in the nursing environment.

find nurses who exemplify interest in quality care.

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. rehabilitative or long-term care. b. disease-restorative care. c. first access to care. d. only outpatient services.

first access to care.

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. care for the specific needs of individual families in the community. b. focus on the treatment of community-wide problems rather than on individual health problems. c. do not include services provided by public health departments. d. provide personal health follow-up for all acute care hospitalizations.

focus on the treatment of community-wide problems rather than on individual health problems.

The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: a. frustration, competition, negotiation, and action. b. frustration, conceptualization, action, and outcomes. c. frustration, cooperation, collaboration, and action outcomes. d. frustration, conceptualization, negotiation, and action outcomes.

frustration, conceptualization, action, and outcomes.

When interviewing an applicant for an RN position, the nurse manager describes the unit's care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks and the RNs complete all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. the case method. b. functional nursing. c. primary nursing. d. nurse case management.

functional nursing.

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. provides more expensive care than other types of insurance plans. b. has a centralized administration that directs and compensates physician services. c. pays physicians on a fee-for-service basis. d. does not pay as much for acute care as other practice plans.

has a centralized administration that directs and compensates physician services.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. has many divisions of labor. b. best fits long-term care units. c. has a mixture of the characteristics of various organizational types. d. places the authority for decision making closest to the places where workers perform.

has a mixture of the characteristics of various organizational types.

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. cannot accept mental health patients who are Medicare beneficiaries. b. can care for only Medicaid and not Medicare beneficiaries. c. has not met the standards set by the CMS as determined by an external review panel. d. has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: a. identify the conflicting facts. b. be determined to resolve the conflict. c. schedule a meeting time for resolution. d. have a clear understanding of the differences between the parties in conflict.

have a clear understanding of the differences between the parties in conflict.

When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. registered nurse with a master's degree. b. physiotherapist with a background in stroke rehabilitation. c. social worker with a background in counseling. d. health professional with advanced background who is client and outcome focused.

health professional with advanced background who is client and outcome focused.

The nurse manager is comparing functional nursing and primary nursing for potential adoption. The nurse manager determines that patient and nurse satisfaction in primary nursing are: a. similar to those in functional nursing. b. not of significance in either model. c. low by comparison with functional nursing. d. high when compared with functional nursing.

high when compared with functional nursing.

With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. increasingly seen as primary care sites for children. b. providing only health education programs for children and their parents. c. capable only of providing referrals for health problems to primary care providers. d. funded exclusively by local authorities.

increasingly seen as primary care sites for children.

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. is increased. b. is decreased. c. is relinquished. d. remains the same.

is decreased.

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. it is the role of the primary nurse to make alterations based on assessment data and input. b. the associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. neither the primary nor the associate should make changes without first consulting you as the manager. d. it really does not matter who alters the nursing care plan as it depends on situation and time to do so.

it is the role of the primary nurse to make alterations based on assessment data and input.

The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. know that this challenge is their issue and that it has nothing to do with your unit. b. understand that such events are localized and do not have an impact on the organizational culture. c. know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. anticipate that your prior experiences with facilities have no effect on the current situation.

know that the nature of challenges and reorganization in facilities will have an impact on other areas.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. is fearful of losing her job. b. lacks understanding of Kari's leadership style. c. is not intimidated by Kari's leadership style. d. knows how to "play the game."

knows how to "play the game."

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. been in the same position and can relate to the new supervisor's problems. b. had vast leadership opportunities and likes to talk about his or her past experiences. c. leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. people who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

leadership experience and time to spend communicating with the new supervisor about his or her experiences.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. look directly at speakers and acknowledge their comments. b. promise to implement each suggestion that is made. c. implement the idea that receives the most discussion. d. listen but implement the plan that she had in mind before the discussion began.

look directly at speakers and acknowledge their comments.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. lower salary compensation for staff. b. rising expectations of impoverished and indigent individuals for services. c. poor orientation and retention practices for staff. d. an overwhelming emphasis on accepting learners from health disciplines.

lower salary compensation for staff.

A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. critical pathways. b. healthcare networks. c. health maintenance organizations. d. managed care.

managed care.

Case managed care may enhance profit in a for-profit health organization by: a. minimizing costs in high resource consumption areas. b. combining licensed and non-licensed care providers in delivering patient care. c. increasing reimbursement from third-party payers. d. reducing the amount of technology used to support clinical decision making.

minimizing costs in high resource consumption areas.

"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. vision statement. b. mission statement. c. goal statement. d. statement of philosophy.

mission statement.

Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracy's responsibilities most likely would include: a. managing physician-led research. b. monitoring physician documentation of the need for medical care. c. determining which services are designated fee-for-service. d. identifying errors in physician diagnoses.

monitoring physician documentation of the need for medical care.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. is a designated role. b. must be earned. c. is more likely to be taken by someone who is more talkative. d. rarely is taken over by someone with less experience.

must be earned.

The chief nursing officer and the dean of the School of Nursing create a partnership based on belief that by establishing rules and regulations and controlling the environment, this partnership will: a. promote professional medical authority, autonomy, and responsibility. b. need a degree of flexibility to engender success. c. be essential for self-governance. d. provide for the establishment of medical committees.

need a degree of flexibility to engender success.

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place 10 years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. organizational redesign. c. organizational reengineering. d. restructuring.

organizational reengineering.

The Sunny long-term care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. well managed and well led. b. overly managed and not well led. c. poorly managed and well led. d. overly led and overly managed.

overly managed and not well led.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. department. b. unit. c. staff. d. patient.

patient.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. pay dividends to stockholders. b. can refuse clients who are unable to pay. c. have no paid employees. d. pay no taxes.

pay no taxes.

Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a. risk taking seems to be unavoidable. b. people see events differently. c. personal and professional priorities do not match. d. the ways in which people should act do not match the ways in which they do act.

people see events differently.

A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: a. group decision-making options. b. perceptions of incompatibility. c. increases in group cohesiveness. d. debates, negotiations, and compromises.

perceptions of incompatibility.

A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. mission b. goal c. vision d. philosophy

philosophy

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. points out the impact that the changes he has initiated have had on the unit. c. advises the senior executive that the mission statement and goals are important to him. d. points out the contributions of his staff to the outcomes and shares the praise with his staff.

points out the contributions of his staff to the outcomes and shares the praise with his staff.

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization for this patient is to: a. implement the care pathway on admission. b. provide direct nursing care throughout the hospitalization. c. supervise the nursing staff members who implement the care map. d. prevent additional hospitalizations resulting from complications of the client's disease.

prevent additional hospitalizations resulting from complications of the client's disease.

In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. reflect the culture of the unit and its values. b. be developed by the nursing manager on the unit. c. identify the clients that will be served on the unit. d. replicate the organization's philosophy.

reflect the culture of the unit and its values.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would: a. explain in detail how well the new idea will work. b. reinforce how this change will respond to the ideas and solutions generated by staff members. c. reason with staff members that the new idea will save money and allow more free time. d. imply that raises will be smaller than anticipated if the new idea is not accepted.

reinforce how this change will respond to the ideas and solutions generated by staff members.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. rotation of task assignments. b. frequent opportunities for in-service education. c. orientation to job responsibilities and performance expectations. d. team social events in off hours.

rotation of task assignments.

A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. hierarchical. b. bureaucratic. c. service-line. d. matrix

service-line.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. telling the assistant clinical director and asking her to share the bad news with the other staff members. b. posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. meeting with a small group of seasoned staff members and asking them how to break the news.

showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. implementation of an all-RN staff complement. b. significant changes in the physical structure of units. c. orientation of staff to new roles and responsibilities. d. testing and piloting technology at the bedside.

significant changes in the physical structure of units.

The style of leadership that Kari is exhibiting is likely to: a. ensure that the organization is financially stable. b. stifle innovative thinking about ways to move out of financial jeopardy. c. lead to apathy and disinterest in the organizational goals. d. lead to decreased attrition of staff on her unit.

stifle innovative thinking about ways to move out of financial jeopardy.

Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.

The chief nursing officer is given the task of reviewing and proposing revision of the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. the organizational structure. b. line and staff responsibilities. c. the policies and procedures. d. government regulations.

the organizational structure.

While explaining the importance of developing leadership skills among nurses to a group of first- year nursing students, Natalie, a nursing unit manager, emphasizes that: a. most nurses are not expected to assume leadership roles. b. the role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. only individuals in formal leadership roles are expected to be leaders. d. the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

At Hospital XYZ, staff members on Y3 Unit have dealt with the third charge nurse in 3 years. Donna, the current charge nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. staff members will resolve the conflict on their own. b. the situation will lead to ongoing disgruntlement and attrition. c. no further discussion or concerns will come out of the situation. d. the head nurse will be able to resolve the conflict on her own.

the situation will lead to ongoing disgruntlement and attrition.

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self- appraisal and to know her strengths. This observation is based on an understanding that: a. self-confidence comes automatically out of leading. b. self-confidence requires constant self-affirmation of strengths. c. there is little external motivation and affirmation in leadership. d. supervisors of leaders rarely provide feedback.

there is little external motivation and affirmation in leadership.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging work force of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. they feel more comfortable in a group. b. they find that the journey to the solution is as important as the solution itself. c. they were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

they find that the journey to the solution is as important as the solution itself.

In the Unity Healthcare organization, communication flows: a. laterally. b. bottom to top. c. top to bottom. d. intermittently.

top to bottom.

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a time line for achieving those plans. The new leader is: a. not expecting that novice leaders will have a vision. b. demonstrating mistrust of the abilities of her staff to implement the plans. c. instituting deadlines against which the performance of staff will be evaluated. d. translating a global document into realistic plans for nursing.

translating a global document into realistic plans for nursing.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. units that provide only primary care services. b. owned by the institutions. c. a feature of all public institutions. d. units that serve large populations.

units that serve large populations.

"Georgia Hospital will provide care that is a national example of consumer service" is a: a. vision statement. b. statement of philosophy. c. mission statement. d. rationale for care.

vision statement.

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. within. b. through a relationship with a mentor. c. with the job description. d. with the chief nursing officer of the organization.

within.