Exam 1 - Unit 10

Which organization provides federal funding for research? a. National Institute of Nursing Research b. Robert Wood Johnson Foundation c. W. K. Kellogg Foundation d. Sigma Theta Tau International

ANS: A Correct: The National Institute of Nursing Research is a federal agency that provides federal funding for health care research. Incorrect: b. Robert Wood Johnson is a private foundation. c. W. K. Kellogg Foundation is also a private foundation. d. Sigma Theta Tau International is a nursing organization.

A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary

ANS: A Correct: The transactional leader is concerned with the day-to-day operations of the facility. Incorrect: b. Situational theory has attempted to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables. c. The transformational leader is committed to organizational goals, has a vision, and is able to empower others with that vision. d. The contemporary theories attempt to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables.

The illustration below identifies which type of chart? a. Productivity b. Organizational c. Resource d. Staffing

ANS: B Correct: An organizational chart is a visual picture of an organization that identifies lines of communication and authority. Incorrect: a. Productivity is the amount of output or work that is produced with a specific quantity of input or resources. c. Resources include personnel, time, and supplies needed to accomplish the goals of an organization. d. Staffing is the manpower needed to complete the work.

A nursing unit's census consists primarily of long-term residents with a high risk for falls. To meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with new beds equipped with Fall Watch electronic sensors that will detect when patients get out of bed. The manager will be involved in which type of budgeting to replace the beds? a. Fiscal b. Labor c. Operational d. Capital

ANS: D Correct: Capital budgets are concerned with major purchases such as equipment paid for over several years. Incorrect: a. A fiscal budget is projected over 12 months, whereas capital budgets involve long-term financial planning. b. Labor budgets are concerned with salaries, wages, and employee benefits. c. Operational budgets are composed of expenses needed to operate on a daily basis and revenue received for services rendered.

A nurse manager is preparing a budget that does not base annual budgets on the revenue and expenditures of the prior year and has the advantage that outdated information is not integrated into the budget. The manager is using which budget method? a. Zero-based b. Incremental c. Labor d. Operational

ANS: A Correct: The zero-based method is based on the assumption of no volume and no resources assigned; it essentially starts each new budget period at zero rather than building from past budgets. Incorrect: b. The incremental method uses the current budget with an incremental increase in consideration of future growth. c. Labor budgets represent a type of budget, rather than a method of budgeting. d. Operational is a type of budget rather than a method of budgeting.

A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? a. Expert b. Legitimate c. Connection d. Reward

ANS: C Correct: Connection power results from knowing or associating with power people such as the upper administration. Incorrect: a. Expert power comes from expertise in skills and knowledge. b. Legitimate power comes from an official position within an agency; the nurse is a staff nurse. d. Reward power comes from the ability to compensate others with money, time off, or acknowledgement of a job well done

A nurse on the unit is heard saying, "I am not going to document that I used four catheters to start that IV; it doesn't matter anyway." What action can help the staff nurse understand the financial budget goals of the unit? a. Have the nurse work in payroll for a week. b. Enroll the staff in continuing education units (CEU) for personal finance. c. Ask the nurse to represent the unit on the budget planning committee. d. Make the nurse responsible for monitoring all disposable equipment and supplies.

ANS: C Correct: Participating on the committee will give the nurse ownership of the unit's budget and will provide insight into the unit's budgetary goals. Incorrect: a. Having the nurse work in payroll would not help the nurse understand the intricacies of budgeting. b. A personal budget may have some aspects of a unit budget but will not help the nurse understand the unit budgetary goals. d. Keeping a log will not help the nurse integrate the concept of accountability in budgeting.

An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? a. Rewards b. Coercion c. Expert d. Legitimate

ANS: C Correct: Seven primary sources of power are known. Expert power is based on knowledge, skills, and information. Incorrect: a. Rewards power comes from the ability to reward others for complying; it may include such rewards as money, desired assignments, or recognition. b. Coercive power is based on fear of punishment or failure to comply. d. Legitimate power is based on holding an official position within an organization.

The financial plan required for the distribution of resources and expenses is a _________.

ANS: budget A budget is an organization's financial plan that expresses expected expenses (such as personnel and supplies) and anticipated revenues for products and services over a defined period, usually 12 months.

Place the following steps of the budget development process in the correct order in which they are performed. a. Project expected expenses on the basis of units of service. b. Gather information about past budget results and combine with budget assumptions to set reasonable expectations about future performance. c. Predict the units of service that will be provided during the budget period. d. Identify the strategic goals and objectives of the organization. e. Set budget assumptions on which to base budgeting decisions.

ANS: d, e, b, c, a By determining the organization's goals and objectives, the budget can be developed to support those identified goals and objectives. Assumptions address issues that can affect the future performance of the organization and provide important considerations for budget development. Gathering information allows for setting of reasonable expectations about future performance that are based on past performance and budget assumptions. Patient days or visits are the usual units of service, and the number predicted to be provided will affect operational expenses; managers also must have information about budget assumptions before they can predict future units of service. Before expenses for staff, supplies, and so forth can be projected, information about the projected volume of service (units of service) must be known.

1. Development and validation of the body of knowledge and foundation on which practice is based is called ____________.

ANS: research Research refines and enhances new and existing knowledge and provides accountability for nursing practice.

In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the _____ approach. a. top-down b. participatory c. iterative d. incremental

ANS: A Correct: Budget goals are established by administrators; unit managers do not contribute to goal setting, which is the primary principle of the top-down approach. Incorrect: b. Managers had no input into setting the budgetary goals; in the participatory approach to budgeting, the people responsible for achieving budgetary goals are included in goal setting. c. The managers did not participate in setting budgetary goals; in the iterative budget approach, upper management defines strategic goals, then unit leaders develop their operating budgets to incorporate individual unit goals in conjunction with strategic goals of the organization. d. Incremental is not a budgeting approach but rather a budgeting method in which the new budget is developed on the basis of an incremental increase from the prior budgeting period.

A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were analyzed to arrive at a description of the culture including rituals. The nurse is practicing which type of research? a. Qualitative, Ethnography b. Qualitative, Phenomenology c. Quantitative, Quasi-experimental d. Quantitative, Secondary data analysis

ANS: A Correct: Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experience. Incorrect: b. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. c. Quasi-experimental is a type of quantitative research study design that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. d. Secondary data analysis is a research design in which data previously collected in another study are analyzed.

A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: "To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes." The nurse knows generalizability refers to the: a. conclusion that findings can be generalized from the sample to the entire population. b. fact that the group of steroids used are from the same organic compounds. c. possibility the subjects were carefully selected and that outside influence is thus suspected. d. fact that the type of bacteria carried by ticks is universal.

ANS: A Correct: Generalizability is the deduction that findings from one study can be applied to other populations not involved in the actual research. Incorrect: b. The type of steroid used or not used does not pertain to generalizability. c. Homogeneous or selected subjects would not allow generalizability to the entire population. d. The type of bacteria is one variable but does not pertain to generalizability.

Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational

ANS: A Correct: Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. Incorrect: b. Chaos is an organizational theory that attempts to account for complexity and randomness in organizations. c. Bureaucracy is part of the organizational theory that provides an understanding of authority within organizations. d. Organizational theory provides the framework for an understanding of leadership and management, and for an understanding of complex organizations.

A new nurse researcher is interested in tracing the history of nursing research. The researcher learns that nursing research began with: a. the work of Florence Nightingale during the Crimean War. b. studies between 1900 and 1940 following Nightingale's work. c. studies to improve patient care by doctorally prepared nurses. d. studies based on the naturalistic paradigm.

ANS: A Correct: Nursing research began with the Nightingale during the Crimean War—more can be read in Chapter 1: Evolution of Nursing. Incorrect: b. As nurses received formalized training, research focused on who entered nursing and nursing satisfaction. c. Doctorally prepared nurses began clinical studies to improve patient care. d. Studies based on the naturalistic paradigm were the focus of research in the 1980s. This was often qualitative research.

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection

ANS: A Correct: Referent power comes from the followers' identification with the leader Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her. Incorrect: b. Legitimate power is based on an official position with an organization such as the nurse manager or Chief Nursing Officer. c. Information power is based on data or information needed by others. d. Connection power is related to the powerful people a person knows.

An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent

ANS: A Correct: The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. Incorrect: b. A democratic leadership style would not be effective in an emergency situation. c. A laissez-faire leadership style that not be effective in an emergency situation. d. Referent refers to a type of power that comes from followers' identification with the leader and is not a leadership style.

The nurse managers of an organization are meeting with administration to plan the budget. The above graph shows last year's 2011 expenditures, and the team will trend the upcoming budget knowing that, with the slowdown in the economy, patient census will be lower. Which budget approach is being used? a. Incremental b. Zero-based c. Productivity metrics d. Capital

ANS: A Correct: The incremental approach is simply a forward trend of current or recent performance with adjustments for future growth or decline in revenues or expenses. Incorrect: b. A zero-based approach does not trend data from the previous year; rather it is developed as though the budget were being prepared for the first time. c. Productivity metrics represents the amount of work produced with a specific quantity of input or resources. d. Capital budgets are concerned with major purchases such as equipment paid for over several years.

The nurse manager meets with upper administration and learns that the strategic plan for nursing is to have 80% BSN staff within the next 3 years. The nurse manager then built her budget to meet the organization's strategic goal by providing tuition reimbursement and flexible work hours, which required some agency staffing. Which approach to budgeting is used? a. Iterative b. Top-down c. Participatory d. Zero-based

ANS: A Correct: The iterative approach is a combination of the top-down and the participatory approach, with upper management defining strategic goals and then unit leaders developing their operating budgets to incorporate their individual goals in conjunction with the organization's strategic goals. Incorrect: b. In top-down approach, upper management sets budget goals and imposes those goals on the rest of the organization. c. In the participatory approach, the people responsible for achieving the budget goals are included in goal setting. d. Zero-based budgeting is a type of budget rather than process in which a budget is built from the assumption of no volume and no resources allocated.

A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? a. Transformational b. Transactional c. Laissez-faire d. Authoritative

ANS: A Correct: Transformational leaders mentor followers through a vision and are admired and emulated. Incorrect: b. Transactional leaders are concerned with day-to-day activities rather than visionary leadership. c. Laissez-faire leadership lack vision, provide little guidance and feedback. d. Authoritative leadership accepts little or no input from staff, makes decisions alone.

In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance

ANS: A Correct: Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change. Incorrect: b. Move is incorrect because at this stage the change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan. c. Refreeze is incorrect because at this stage the change is being integrated into the organization so that it becomes recognized as the status quo. The change agent must facilitate change by monitoring adherence to the new requirements. d. Acceptance is incorrect because acceptance and integration represent the final aspect of any change.

According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Bureaucracy b. Closed systems c. Open systems d. Trait

ANS: A Correct: Weber's concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization. Incorrect: b. There are two views: open and closed. Closed systems theory views the system as being totally independent of outside influence. c. There are two views: open and closed. Open systems theory suggests that the organization is affected not only by internal change but also by external environmental changes that can have a direct or an indirect influence on the organization. d. Trait theory, which describes intrinsic traits of leaders, is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.

Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (Select all that apply.) a. serving on interdisciplinary care teams. b. being competent to work in several areas independently when dictated by patient census. c. attending a meeting to plan advanced training for unlicensed assistive personnel. d. evaluating outcomes of care that are reported to a standing committee. e. managing units with higher acuity, shorter length of stay, and more diverse patients and staff.

ANS: A, C, D, E Correct: a. The new nurses will be placed in many situations that require leadership and management skills: for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and require complex interventions delivered during shorter stays with an ever-increasing diverse staff. c. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. d. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. e. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Incorrect: b. For RNs who are entering the workforce, being competent to work in several areas independently is not a realistic expectation.

The informed consent documents must include: (Select all that apply.) a. an explanation of potential risks and benefits to participants in the study. b. medical terminology rather than lay terms to prevent misunderstanding of the study. c. a statement on how the anonymity and confidentiality of participants are protected. d. explanation of the cost of the study. e. details on how to contact the investigator.

ANS: A, C, E Correct: a. Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. c. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment. e. The informed consent must include specific information on how to contact the investigator. Incorrect: b. Informed consent is always written in lay terminology so that participants can clearly understand. d. The actual cost of the study is not included on the informed consent form.

A nurse has recently been appointed to the position of nurse manager. To become successful in managing the unit's budget, the new nurse manager should: (Select all that apply.) a. read the financial policy manual to learn more about the organization's budgeting process. b. allow the nursing administration office to manage the unit's budget until he or she is able to complete an online financial management course. c. communicate regularly with a person in the hospital's finance office about interpreting budget reports. d. pay attention to only the bottom line numbers in budget reports rather than trying to understand each line in these reports. e. discuss the process of developing budgets with other members of the management team.

ANS: A, C, E Correct: a. Knowing the organization's financial policies is an important step toward understanding the organization's budget process. c. Building a relationship with the finance office is fundamental to learning about the budgeting. e. As one participates more in the budget process, one's understanding of the process and related responsibilities is enhanced. Incorrect: b. Managing the budget requires more than an online course; it requires participation in the budgeting process as well as personal study, working with mentors, attending classes, reading books and journals, and joining professional organizations that promote health care finance and budget knowledge. d. A manager needs to know what each line in the budget means to understand how the bottom line numbers are derived.

A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which of the following study designs? (Select all that apply.) a. Survey b. Grounded theory c. Phenomenology d. Needs assessment e. Experimental

ANS: A, D, E Correct: a. Surveys collect demographics, social characteristics, behavioral patterns, and information bases. d. Needs assessments are used to determine what is most beneficial to aggregates. e. The experimental method establishes cause-and-effect relationships while also testing relationships Incorrect: b. Grounded theory explores and describes a social process such as adjusting to a chronic illness. c. Phenomenology describes the "lived experience" of abstract experiences.

A nurse manager is working with the financial officer to develop the budget of the nursing unit for the next fiscal year. The nurse manager tells the financial officer that which of the following pieces of information will affect budget assumptions? a. The capital budget request for new emergency department equipment has been turned in for consideration by the hospital's administrative team. b. The patient census likely will increase during the next fiscal year because two large physician groups have transferred their admission privileges to this hospital. c. The participatory budgeting approach instituted last year has been helpful in controlling supply costs. d. Zero-based budgeting will help the managers to be more efficient in establishing next year's budget.

ANS: B Correct: Budget assumptions are future predictors of performance and include the stability of the price of supplies, the salary range needed to recruit and retain quality employees, new services offered by competitors, and the variability of the patient census. Incorrect: a. Capital budget requests that are awaiting approval do not affect budget assumptions that should be addressed in the next fiscal year. c. The participatory budgeting approach involves front-line managers in the budgeting process, but it is not necessarily related to future budget assumptions. d. Zero-based budgeting is prepared as if for the first time and is actually more time consuming and less efficient than incremental budgeting; also, zero-based budgeting is a method of budgeting and does not affect budget assumptions.

A primary function of the budgeting process is to provide managers with an opportunity to: a. insist that salary increases for all nurses are included in the annual budget. b. discuss concerns about resource allocation with leaders of the organization who are capable of resolving issues. c. develop a mechanism for changing from zero-based budgeting to incremental budgeting. d. develop for all staff an educational program related to supply usage.

ANS: B Correct: Coordination and communication are very important functions of budgeting that require many different groups within an organization to come together with organizational leaders to discuss the resources necessary to accomplish the goals of a business unit. Incorrect: a. Although salary increases to remain competitive are important and should be discussed, providing a mechanism for insisting on salary increases is not the primary function of the budget process. c. Changing from zero-based to incremental budgeting is not a primary budget function but is related to a method of budgeting. d. Developing educational programs is not a primary budget function, although the program suggested may serve as a means of teaching staff about supply management.

A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation

ANS: B Correct: Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. Incorrect: a. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. c. Case study design is a type of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or social unit. d. Hypothesis generation is the first step in the basic research process.

The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a(n) _________ design. a. experimental b. quasi-experimental c. survey d. meta-analysis

ANS: B Correct: In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Incorrect: a. An experimental design must have a control group. c. The purpose of a survey design is to collect information, not to compare groups. d. A meta-analysis is a process whereby multiple research studies are reviewed.

Which component of budgeting might normally be addressed in the annual performance evaluation for a nurse manager? a. Including in the labor budget costs for overtime and benefits b. Managing variances in nursing overtime costs and supply usage c. Accurately predicting revenues on the basis of unit of service d. Providing qualitative analysis for variances in the capital budget

ANS: B Correct: Nurse managers are often evaluated according to their success in managing nursing overtime costs and supply usage as reflected in the unit's budget. Incorrect: a. The labor budget is best controlled and budgeted at the departmental level. c. The unit of service may vary depending on the organization, setting, and financial policies. d. Variances in the capital budget are not typically addressed in the manager's annual performance evaluation.

Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study? a. Ethnography b. Pilot c. Secondary data analysis d. Phenomenology

ANS: B Correct: Pilot studies are small-scale studies often referred to as feasibility studies to determine if a larger more sophisticated research study is needed. Incorrect: a. Ethnography is the study of cultures where the research is immersed in the culture. c. Secondary data analysis is using data already collected to answer another research question. d. Phenomenology is qualitative research studying the "lived experience."

A researcher is interested in learning if elderly persons perceive their health to be satisfactory even with comorbidities and chronic illness. A large multisite assistive living facility will be the site. The researcher lists residents in alphabetical order and chooses every third person on the list. To ensure improved generalizability, the researcher is using: a. triangulation. b. randomization. c. informed consent. d. a meta-analysis approach.

ANS: B Correct: Randomization is a method of choosing subjects based on chance alone. Incorrect: a. Triangulation is the use of two or more research methods in the same study to add richness and depth to the data. c. Informed consent involves explaining the study to participants and assuring them of their rights, including their right to refuse to participate or to withdraw from the study. d. Meta-analysis is the quantitative merging of findings from several studies to determine what is known about a phenomenon.

A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is: a. quasi-experimental. b. survey. c. case study. d. ethnography.

ANS: B Correct: Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Incorrect: a. Quasi-experimental research design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. c. Case study designs are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled, broader studies. d. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection and description and analysis of data for the purpose of developing a theory of cultural behavior.

The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions.

ANS: B Correct: The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision-making and problem-solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation. Incorrect: a. Identifying the problem is a later step in the nursing and problem-solving processes. c. Considering the consequences is a later step in the nursing and problem-solving processes. d. Implementing interventions is a later step in the nursing and problem-solving processes.

A nurse researcher who is seeking funding for a study should identify _____ of funding agencies. a. board members b. priorities c. budgets d. accreditation

ANS: B Correct: The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. Incorrect: a. Identifying the board members of funding agencies would give you information about the agencies, but would not be helpful in the preparation of a study proposal. c. Learning the budgets of funding agencies would provide descriptive information about the agencies but would not be helpful in the preparation of a study proposal. d. Identifying the accreditation of funding agencies would give you descriptive information about the agencies but would not be helpful in the preparation of a study proposal.

A researcher conducts a survey to determine the perceived health status of elderly persons living independently at home. The same subjects participate in a phone call in which they describe the lived experience of living with chronic illness. When writing up the research study, the nurse would describe using: a. a control group. b. triangulation. c. a pilot study. d. secondary data analysis.

ANS: B Correct: Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. Incorrect: a. A control group is a set of subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. c. Pilot studies are small-scale studies, often referred to as feasibility studies, to determine if a larger, more sophisticated research study is needed. d. Secondary data analysis use preexisting data to answer a research question.

A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts with a patient census of 6 in the short-stay observation room. The nurse manager reviews the budget report 3 months later and notes that the salary expenses are higher than was budgeted because of higher-than-planned RN staff salaries. This additional RN staff is necessary to meet patient care needs because the census has remained constant at 10 patients rather than the 6 projected when the budget was developed. The difference between the planned budget and the actual cost is known as: a. revenue. b. variance. c. monitoring. d. capital expenditures.

ANS: B Correct: Variance is the difference between the planned budget and actual results; it can be a positive or a negative discrepancy. Incorrect: a. Revenue is the income, but it is not analyzed to detect variations between predicted and actual expenses. c. Monitoring is the process by which variances are identified. d. Capital expenditures, which are long-term investments such as bedside computers, are part of the budget but are included in comparison with projected results.

A nurse manager has calculated that providing 75 hours of direct nursing care per day requires that 120 hours must actually be worked by nursing staff. The manager is involved in: (Select all that apply.) a. developing the capital budget. b. applying productivity metric. c. monitoring the labor budget. d. incremental budgeting processes. e. addressing budget assumptions.

ANS: B, C Correct: b. The nurse manager is determining the amount of work produced by calculating the actual number of nursing hours worked, which is productivity metric. c. Budgets use productivity metrics. Incorrect: a. The manager is not evaluating long-term major expenses, which are the components of the capital budget. d. The nurse is not planning a new budget by using an incremental increase from the prior budgeting period; this activity is part of the incremental budgeting process. e. The manager is not addressing issues such as the stability of prices, projected patient census, and recruitment efforts for the next year, all of which would be considerations in budget assumptions.

The nursing executive team met to review last year's productivity metric to strategize for the upcoming year's metric. The team wants to be certain the productivity metric shows productivity was: a. high. b. low. c. balanced. d. iterative.

ANS: C Correct: A balanced productivity is desired because it encourages quality and safety while providing financial efficiency. Incorrect: a. High productivity (high patient census with low nursing hours) means that there are fewer staff to take care of more patients, and they may not be able to provide safe, high-quality patient care. b. Low productivity (high nursing hours worked with low patient census) is not desirable because it means higher staff salaries combined with lower revenues for patient care services. d. Iterative is a budget approach with upper management defining strategic goals and then unit leaders developing their operating budgets to incorporate their individual goals in conjunction with the organization's strategic goals.

A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is: a. a survey. b. quasi-experimental. c. a needs assessment method. d. a pilot study.

ANS: C Correct: A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; the method is commonly used to prioritize the needs of an organization or community. Incorrect: a. A survey is a research design that is used to collect demographic information, social characteristics, behavioral patterns, and other information. b. Quasi-experimental research is a type of quantitative research that lacks one of the components of an experimental design. d. A pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study.

The nurse manager meets with upper management to share strategic goals agreed upon by her staff for their individual nursing unit as the first step to begin budget negotiations. One strategic goal is that staff will have access to technology that will allow them to incorporate point-of-care devices for all RNs.The second goal is to improve RNs' ability to recognize critical indicators that a patient's health status is deteriorating through advanced health assessment skills. During the meeting the manager discusses the strategy options and selecting the one that works for the unit. Which type of budget development is used? a. Iterative b. Top-down c. Participatory d. Zero-based

ANS: C Correct: In the participatory approach, the people responsible for achieving the budget goals are included in goal setting. Incorrect: a. The iterative approach is a combination of the top-down and the participatory approach with upper management defining strategic goals and then unit leaders developing their operating budgets to incorporate their individual goals in conjunction with the organization's strategic goals. b. In top-down approach, upper management sets budget goals and imposes those goals on the rest of the organization. d. Zero-based budgeting is a type of budget rather than process in which a budget is built from the assumption of no volume and no resources allocated.

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin's change is: a. unfreeze. b. moving. c. refreeze. d. resistance.

ANS: C Correct: In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation. Incorrect: a. In the unfreeze stage leaders gathers data while making others aware of the need for change. b. In the moving state the change is implemented with goals established. d. Resistance is the refusal to cooperate with the plan for change and is an expected part of change. The effective change agent recognizes that resistance is a natural response to change.

A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey

ANS: C Correct: Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. Incorrect: a. The quasi-experimental method is research involving one study. b. Secondary analysis is the use of data from a previous study in which new questions are asked. d. A survey collects data from populations and is a single study.

A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the "lived experience." These characteristics are consistent with the qualitative research method known as: a. grounded theory. b. ethnography. c. phenomenology. d. case study.

ANS: C Correct: Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Incorrect: a. Grounded theory is a qualitative research design that is used to collect and analyze data with the aim of developing theories grounded in real world observations. This method is used to study a social process. b. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection, description, and analysis of data to develop a theory of cultural behavior. d. Case study is a method of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or other social unit.

Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative

ANS: C Correct: Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. Incorrect: a. Descriptive statistics consist of numerical data. b. Inferential statistics consist of numerical data. d. Quantitative research is a formal, objective, systematic process in which numerical data are used.

Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward

ANS: C Correct: Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished. Incorrect: a. Informal power is not one of the seven primary sources of power; however, informal leaders may distribute a considerable amount of power among the workers, can influence the attitude of the group, and significantly affect the efficiency and effectiveness associated with workflow, goal setting, and problem-solving. b. Expert power is based on knowledge, skills, and information. d. Rewards power results from the ability to reward others for complying and may include such rewards as money, desired assignments, or recognition.

Institutional review boards determine whether research studies involving human subjects will: a. be published. b. add to the body of nursing knowledge. c. cause harm. d. receive funding.

ANS: C Correct: The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. Incorrect: a. Research publication is not controlled by institutional review boards. b. Institutional review boards do not review the merit or significance of research to nursing knowledge. d. Institutional review boards do not award grants or allocate funds.

A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic

ANS: C Correct: The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement. Incorrect: a. Transactional leaders are involved in day-to-day operations rather than having a vision. b. The nurses are not looking to the leader as a resource for clinical advice. d. Autocratic managers do not seek input from staff.

One difference between a leader and a manager is that a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization.

ANS: C Correct: The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes. Incorrect: a. Authority is the legitimate right to direct others that is given to a person by the organization through assignment to an authorized position such as a nurse manager. b. It is the nurse leader who has the ability to guide or influence, as well as to motivate and inspire, others on the team. d. Managers are assigned responsibility for accomplishing the goals of an organization.

A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (Select all that apply.) a. Survey b. Triangulation c. Meta-analysis d. State of the science summary e. Quasi-experimental design

ANS: C, D Correct: c. Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. d. State of the science summary is a merging of findings from several studies that explored the same topic. Incorrect: a. Survey research design is used to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population. b. Triangulation is defined as the use of a variety of methods to collect data on the same concept. e. Quasi-experimental design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design.

A nurse asks, "What is meant by 'internal' customers?" The correct response is: (Select all that apply.) a. Insurance companies b. Accreditors such as The Joint Commission c. X-ray technicians d. Clinical pharmacist e. Chief financial officer

ANS: C, D, E Correct: c. Internal customers are employees of an organization at all levels. An x-ray technician is an example of an internal customer. d. Internal customers are employees of an organization at all levels. A clinical pharmacist is an example of an internal customer. e. Internal customers are employees of an organization at all levels. A chief financial officer is an example of an internal customer. Incorrect: a. External customers are not employees of an organization. An insurance company is an external customer. b. External customers are not employees of an organization. An accreditor such as The Joint Commission is an external customer.

Nurses on a unit met with the nurse manager as part of participatory budgeting. They ask, "What exactly is the difference between fixed and variable costs? Understanding this will help us better understand the budgeting process." The manager provides a definition and asks the staff to list types of direct and indirect cost. Which example would indicate a need for further teaching? a. Fixed costs would include accreditation fees. b. Fixed cost would include the cost for the automated medication-dispensing system. c. Variable cost would include the nurse manager's salary. d. Variable cost would include the salary expense for registered nurses.

ANS: D Correct: Variable costs would include the salary expense for registered nurses because their number can change. Incorrect: a. The salary line for RNs would increase with high census and decrease with low census. b. Fixed costs are costs that do not change as the unit-of-service volume changes. For example, administrative salaries do not change regardless of the patient census on the nursing units such as accreditation fees and the automated medication dispensing system. c. Variable costs would not include the nurse manager's salary since it does not change with patient census.

A nurse is interested in learning how reminiscence therapy can improve memory in cognitively intact persons over the age of 65 years. Findings from three groups are compared. Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not receive therapy, but data are collected from all three groups and compared. Group 3 is known as the: a. pilot study. b. survey. c. needs assessment. d. control group.

ANS: D Correct: A control group is a set subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. Incorrect: a. A pilot study is a small feasibility study. b. A survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. c. Needs assessment is a study in which the researcher collects data for estimating the needs of a group, usually for resource allocation. DIF: Application REF: p. 87

Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

ANS: D Correct: A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future. Incorrect: a. Determining that all nurses on the unit understand the current organizational philosophy is a form of current evaluation and analysis, and does not look toward the future. b. Evaluating the communication process between the pharmacy and the nursing departments is a form of current evaluation and analysis, and does not look toward the future. c. Monitoring data from the quality management initiative related to the last three orientation programs is a form of current evaluation and analysis, and does not look toward the future.

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling

ANS: D Correct: Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality. Incorrect: a. Directing involves communicating, delegating, motivating, and managing conflict. b. Planning involves developing policies and procedures, determining resource allocation, and developing evaluation methods. c. Organizing involves identifying the management structure to accomplish work, determining communication processes, and coordinating people, time, and work.

When the nurse manager conducts a qualitative analysis of budget variances, he or she is: a. determining the percentage increase of supply usage from the last quarter to the current quarter. b. identifying the overall increase in the dollar amount of salaries paid for overtime. c. comparing productivity metrics across all nursing units in the facility. d. reconciling with current conditions the underlying assumptions on which the budget was based.

ANS: D Correct: Qualitative analysis of the budget explains why current conditions are different than they were when the budget was developed; new conditions might include greater patient acuity or additional physicians with increased admissions. Incorrect: a. The percentage of supply increase from last quarter is quantitative. b. Identifying the degree of salary increase is quantitative; however, explaining why salaries increased would be qualitative. c. Productivity metrics is a quantitative analysis.

Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.

ANS: D Correct: Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. Incorrect: a. Qualitative research is time consuming and costly. One-on-one interviewing takes time, and the interviews must be recorded, typed, transcribed, and analyzed. b. Qualitative studies use small sample sizes that are not randomly selected. c. The small sample sizes used in qualitative research do not allow results to be generalizable to the whole population.

A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

ANS: D Correct: The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members. Incorrect: a. The nurse manager would not gain the respect or trust of other nurses on the unit by excluding one of their peers from an activity. b. The nurse manager must make a sincere attempt to work with the nurse, whose clinical experience is valuable to the unit. A transfer request would be the last option after all other efforts to develop a working relationship with the staff nurse have been exhausted. c. The best way to work with this employee and gain the respect of other nurses on the unit is through open and direct communication.

A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate

ANS: D Correct: The coordinator of the committee has an official position within the organizational committee. Incorrect: a. The CNL is not being threatened with punishment. b. Transformational is not a type of power. c. Laissez-fair is a type of management style, not a type of power.

A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

ANS: D Correct: To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment. Incorrect: a. Thanking each employee for doing an excellent job lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. b. Establishing an "employee recognition award" lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. c. Waiting until the annual performance review to recognize accomplishments lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment.

Organizations measure the effectiveness of their budgets by examining actual revenues and expenditures versus: a. planned variances. b. incremental budgets. c. productivity metrics. d. expected performance.

ANS: D Correct: Variance analysis is the process by which deviations from budgeted amounts are examined by comparing actual performance results against expected, or budgeted, performance. Incorrect: a. Actual rather than planned variances are used. b. Incremental budgets are developed through the use of current or recent budget performance information, and adjustments are made for future growth or decline in revenue or expenses. c. Productivity metrics represent the amount of work produced with a specific quantity of input or resources.

The use of research to guide nursing practice is called: a. utilization. b. dissemination. c. generalizability. d. analysis.

ANS: A Correct: Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. Incorrect: b. Dissemination is defined as the spreading of information, generally through published reports or by word of mouth. c. Generalizability is when findings true for the sample are found to be true for the entire population. d. Analysis is the second step or phase of the nursing process.