Leadership Chapter 2

25) The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures. 4. Staffing has become less flexible as more nurses specialize in one aspect of care. 5. A recently updated organizational chart indicates the line authority for each position.

1,2,3

29) Reductive theory focuses on which factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Factors that occur in changing environments 2. The nature of the work 3. Structures to achieve work 4. Dividing work into parts 5. Desire for social relationships

2, 3, 4

24) As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Decrease the amount of time from client admission to the room to completion of the admission assessment." 2. "Increase client satisfaction survey scores regarding meals." 3. "Decrease the number of medication errors on the unit." 4. "Initiate intravenous therapy within 30 minutes of the order being taken." 5. "Use scanning mechanisms to record the numbers of supplies used."

4,5

26) Which situation is an example of a major weakness of service-integrated structure? 1. Two different units have purchased a demonstration model that could be used by both units. 2. The pharmacy has been asked to compromise on the times that medications are delivered to the units. 3. Nurse managers in several units are interviewing new graduates for staff positions. 4. The nurse manager of a unit is involved in a conflict between hospital management and the medical staff.

Answer: 1

4) During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage? 1. The nurse will have to choose a provider from within the HMO. 2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges. 3. For an additional premium, the nurse can choose any provider. 4. By joining this HMO, the nurse is entitled to unlimited treatment and services.

Answer: 1

5) A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy? 1. The nursing department is responsible for writing the client's comprehensive care plan. 2. The dietary department is responsible for nutritional assessment. 3. All nursing tasks fall under the nursing department. 4. Physical and occupational therapy departments coordinate and evaluate activities of daily living.

Answer: 1

3) During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement? 1. The nurse manager is not capable of performing all the duties expected of the role. 2. The nurse manager may have too many staff members to manage. 3. The nurse manager is burned out and needs time away from the unit. 4. The nurse manager is not educationally prepared for the role.

Answer: 2

1) The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory? 1. Span of control 2. Line authority 3. Hawthorne effect 4. Adhocracy

Answer: 3

2) A community-owned hospital has been purchased by a healthcare conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse? 1. "If our new bosses want a classical organization, we can expect a strong hierarchy." 2. "If we don't want to see lots of changes, we should hope our new bosses don't like chaos theory." 3. "If this new company is based on systems theory, there will be a lot of focus on how much work we can produce." 4. "If this new company is based on contingency theory, we will see lots of focus on how our environment impacts our work."

Answer: 3

17) The healthcare institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy? 1. "We will increase client satisfaction by 15 percent." 2. "We will increase productivity by 10 percent on the surgical floor." 3. "We believe in honest communication." 4. "We believe clients are most important."

Answer: 4

6) A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method? 1. Concentric diversification 2. Conglomerate diversification 3. Capitation 4. Joint venture

Answer: 4

8) A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory? 1. Contingency theory 2. Closed-systems theory 3. Classical theory 4. Chaos theory

Answer: 4

9) What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure? 1. Adaptation and innovation are encouraged. 2. The medical staff has become autonomous from the organization. 3. Two lines of authority have been created. 4. Organizational structure is becoming much clearer.

answer: 1

19) A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these healthcare providers should ensure which resources are available? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Electronic medical records (EMR) technology 2. A sufficient number of older adults who require long-term care 3. An understanding of the complexity of multiple-need clients 4. A robust marketing plan that describes the home's physical environment 5. A plan for compensation for the primary care provided

answer: 1,3,5

13) The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Functional 2. Shared governance 3. Service-line 4. Parallel 5. Matrix

answer: 1,4,5

10) Which structure is reflected by the statement, "Nursing practice is best determined by nurses"? 1. Hybrid 2. Shared governance 3. Matrix 4. Functional

answer: 2

12) What is the best example of a pediatric unit's organizational culture? 1. All client rooms are private. 2. Nurses wear colorful scrubs. 3. The nurse-to-client ratio is 4 to 1. 4. The primary nursing model is used for care.

answer: 2

18) The nurse works in a school clinic that is part of an integrated healthcare network. How would this nurse explain to parents and teachers the focus of care provided in the clinic? 1. Hospital focused 2. Primary care focused 3. Specialty care focused 4. Home care focused

answer: 2

27) Which situation reflects the primary service provided by home healthcare? 1. The physical therapy assistant performs range-of-motion exercises three times each week. 2. The nurse changes the client's abdominal dressing daily. 3. Oxygen is provided in the home and managed by a durable medical equipment company. 4. Diabetic testing supplies are delivered to the client's home each month.

answer: 2

22) The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Experts in hospital physical design 2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices

answer: 2,3,4,5

11) "We want to be the hospital of choice in the Midwest" is which type of statement? 1. Value statement 2. Mission statement 3. Vision statement 4. Philosophy statement

answer: 3

15) The nurse's friend says, "I've been thinking about going to that healthcare clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate? 1. "Most of those retail clinics are not very good. I'd go somewhere else." 2. "That would be okay, but you have to pay extra for the convenience." 3. "If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care." 4. "I would use the clinic for myself, but not for my children."

answer: 3

16) A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement? 1. The nurse is going to call the medical intern to assess the client. 2. The nurse is going to call the client's physician's on-call group. 3. The nurse is going to call a physician who cares for inpatients. 4. The nurse is going to call the emergency department and request that a physician see this client.

answer: 3

21) A healthcare organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Any changes to processes in the facility will be approved at the vice-president level. 2. Nurses who have made more than five medication errors in the last 12 months will be terminated. 3. Outcome data will be analyzed to identify successful interventions. 4. The primary focus will be on a few major initiatives. 5. Previous quality improvement efforts may or may not be discarded.

answer: 3,5

20) Which situation is an example of organizational culture? 1. Every Friday the administrator allows everyone to wear crazy hats while on the units. 2. The cafeteria opens at 7:00 a.m. for breakfast, 11:00 a.m. for lunch, and 5:00 p.m. for dinner. 3. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 4. ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift.

answer: 4

7) A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency? 1. Long-term care facility 2. Public health department 3. Temporary service agency 4. Home health agency

answer: 4

28) Which example of organizational structure depicts shared governance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. All the LPNs on the unit administer medications and complete dressing changes; all the RNs complete assessments and administer IV medications. 2. Clinical services are organized around clients with colostomies and colostomy teaching. 3. The nurse manager for the wound clinic reports to the vice-president of nursing and the vice-president of outpatient services. 4. Nursing councils address profession-wide issues linked to client care standards. 5. RNs are accountable for the latest standards and knowledge in the field.

answer: 4,5

23) The administration of a healthcare system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift. 5. The nurse executive communicates with managers mostly by email.

answer: 1,2,3,5

14) A nurse has accepted the position of vice-president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 3. There may be unrest because of the high proportion of management positions filled from outside the organization. 4. There is continual upheaval as the organization responds rapidly to changes in the external environment. 5. Managers have limited knowledge of general management techniques.

answer: 1,2,5