Marriner Tomey: Guide to Nursing Management and Leadership, 8th Edition

Chapter 1: Communications1. The nurse manager instructed the nursing assistant to “rinse her hands

after touching the patient.” The nurse manager meant for the nursing assistant to use universal precautions. Which part of the communication process was compromised?a. Ideationb. Encodingc. Transmissiond. Receiving

2. The client complains to the nurse about the noise at the nurse’s station at night. The nurse’s best response is:a. “I appreciate your reporting this to me.”b. “Thank you for contributing this information.”c. “What do you want me to do about this?”d. “Are you saying that you are unable to rest at night because of the

noise?”

3. During a unit meeting, the nurse manager discusses ways to deal with a hostile patient. The staff nurse suggests that more time be spent with the patient. How does the nurse manager enhance the value of the staff nurse’s suggestion?a. Identify the staff nurse’s meritsb. Dismiss what the staff nurse saidc. Enhance the value of the unitd. Accept others’ suggestions without regard to the staff nurse’s

suggestion

4. The nurse educator begins the presentation on group process by asking the participants to sit in a circle. The nurse educator’s use of this physical arrangement relates to which aspect of communication?a. Strategyb. Structurec. Supportd. Style

5. The school nurse wants to use a PowerPoint presentation to educate adolescents on sexually transmitted diseases. This method of presentation relates to which aspect of communication?a. Supplementb. Stylec. Structured. Strategy

6. For the nurse educator to prepare PowerPoint presentations, the nurse must be able to use which of the following?a. Palm Pilotb. Presentation softwarec. Spreadsheet softwared. Handheld computers

7. The nurse manager of a medical unit wants to assess how many clients develop urinary tract infections on the unit. The best way to collect and catalog this information is to use what type of software?a. Calendar and scheduling softwareb. Word-processing softwarec. Presentation softwared. Database software

8. A rural health nurse is evaluating the use of a telehealth system for the rural health clinic. Using this type of information technology can violate a client’s rights when personnel:a. Disseminate client information to a local physicianb. Disseminate client information to nearby hospitalsc. Disseminate the client's password for easier accessd. Disseminate client information to third-party reimbursers

9. The chief executive officer (CEO) of the institution asked the nurse manager to compile data on how many clients on the unit were considered to have a status of “critical.” Using upward communication, the nurse manager:a. Reviewed the charts and reported the data to the CEOb. Called a meeting of team leaders to discuss the status of clients

c. Called the business office for a list of medical diagnosesd. Assessed each client on the floor to find those whose status was

“critical”

10. A group of nursing assistants approached the nurse manager to discuss pay raises on another unit. This is a form of:a. Upward communicationb. Lateral communicationc. Diagonal communicationd. Informal communication

11. The staff nurse was providing discharge instructions to the client. After the nurse discussed the importance of making an appointment the following week for a follow-up visit with the physician, the client said, “I wonder if I can go visit my daughter who lives out of town next week.” The nurse determined that the client:a. Used selective perception to hear what she wanted to hearb. Decided not to see the physician for a follow-upc. Had poor cognitive abilitiesd. Mistrusted the nurse's instructions

12. A staff nurse was approached by a nursing assistant who wanted to give a report about a client’s condition. The nurse said, “I don't have time to listen right now.” This is an example of:a. Upward communicationb. Barrier to communicationc. Downward communicationd. Grapevine communication

13. Two nurses, one male and one female, were discussing client assignments. Which of the following best illustrates gender differences between these two colleagues?a. Male: “I think the client needs to have a nursing assistant assigned on

a one-to-one basis.”Female: “I agree with you.”

b. Male: “I think the client is experiencing a loss related to the fact that he is no longer the breadwinner of the family.”Female: “I think the client is grieving.”

c. Male: “I wonder if the client has expressed to his family his feelings of loss.”Female: “I think he is dealing with his feelings.”

d. Male: “I plan to care for the client as part of my assignment—he will confide in me because I am a male.”Female: “I am just as competent to care for the client as you are.”

14. Which of the following cultures views eye contact as indicating trustworthiness?a. Hispanic Americansb. Asian Americansc. White Americans of European origind. Native Americans

15. In assessment of cross-cultural communication, which nonverbal behavior is the most important?a. Placement of handsb. Facial expressionc. Use of wordsd. Eye contact

16. A nurse educator is developing a presentation for a group of senior citizens. The nurse has 10 typewritten pages of notes and 20 PowerPoint slides for a 30-minute presentation. Which method of communication will enhance learning?a. Continue lecturing for the 30 minutesb. Reduce the number of PowerPoint slides and use shorter sentences if

possiblec. Cover topics related to careers for the senior citizend. Provide copies of notes to the senior citizens

17. The best response for the nurse manager to use with an angry employee is:a. “What is wrong?”b. “You are really inappropriate with your anger.”c. “If you would like to talk, we can go into my office.”d. “I'm not sure why you are angry, but don’t take it out on me.”

18. In a unit meeting, a staff nurse exhibits what is commonly known as an adult tantrum. The nurse manager’s best response is to:a. Call the staff nurse by nameb. Discourage the staff nurse from talkingc. Allow the staff nurse to finish the outburst

d. Ask the staff nurse open-ended questions

19. During a performance evaluation, the staff nurse tells the nurse manager, “I'm not the only one who takes a long lunch break, so I shouldn't be penalized for doing that.” The nurse manager understands that the staff nurse’s behavior is that of:a. An exploderb. A sniperc. An unresponsive persond. A complainer

20. Which of the following is indicative of trashing other nurses?a. Nurses working together as a teamb. Nurses committing themselves to actions that they do not completec. Nurses identifying with their male colleaguesd. Nurses talking about other nurses behind their backs

21. A staff nurse exploded angrily at the charge nurse and said, “I don't have time to turn the client because I have to catch up on my charting.” The charge nurse replied, “I want to see you in my office right now!” This is an example of what type of transactional pattern?a. Adult to adultb. Child to childc. Parent to parentd. Parent to child

22. A staff nurse left the unit in anger. She told the nurse manager, “I would have gotten that promotion if it weren’t for you.” What type of game was the staff nurse playing?a. Blame othersb. Attackc. Self-pityd. The corner

23. The nurse manager was commenting to her staff about the overtime hours she was putting in because of a shortage of nurses. This is an example of what type of game?a. Blame othersb. “Poor me”c. The cornerd. The bear trapper

24. Which of the following people have a life position that indicates “I'm OK, you're not OK”?a. People who assume that they are less competent and less influential

than othersb. People who feel OK about themselves and othersc. People who supervise others closely because they feel others cannot

be trustedd. People who lack confidence in themselves and trust others

25. A staff nurse complained to the nurse manager that she was too tired to continue a schedule that required her to double back to work. The nurse manager responded, “I understand that you get tired when you double back.” The nurse manager was demonstrating which assertive technique?a. Broken recordb. Foggingc. Negative assertiond. Negative inquiry

Chapter 2: Stress Management

1. The nurse manager was orienting a new staff nurse to the unit. The nurse manager identified the staff nurse’s stress level when the staff nurse said:a. “I'm so excited about this new job!”b. “Is my license on the line if the equipment malfunctions?”c. “I realize I’m just out of school, but I’m willing to learn.”d. “How long is orientation?”

2. The nurse manager was reprimanding the nursing assistant for clocking in late 3 days in a row. Which statement indicates the greatest source of stress for the nursing assistant?a. “I’m sorry I am late. I have no excuse.”b. “I'm not the only one who clocks in late.”c. “I'm getting married this weekend.”d. “I need to get my cup of coffee.”

3. In teaching a stress management workshop, the nurse educator emphasizes that which of the following determines how one

responds to stress?a. State in life (e.g., single versus married)b. Agec. Job occupationd. Person’s perceptions

4. Which of the following people is more likely to experience burnout?a. A nurse who just celebrated her fifth year with the agencyb. A nurse manager who works 50 hours a weekc. A nursing assistant who just returned from vacationd. A unit secretary who would like to return to school

5. A nurse manager complains to another nurse about a new graduate who just began working on the unit. The nurse manager’s behavior can best be described as:a. Workaholismb. Chronic fatiguec. Burnoutd. Eustress

6. A staff nurse was promoted to unit manager. Which technique can the staff nurse use to manage the stress associated with this change?a. Become more authoritativeb. Request a pay raisec. Set aside time to observe respected leaders or managersd. Set aside time to inventory the unit’s weaknesses

7. A staff nurse felt anger about the poor care an elderly client received at a long-term care facility. The nurse probably used what technique to identify this anger?a. Time blockingb. Value clarificationc. Goal settingd. Feeling pause

8. A physician referred a client to the pain management clinic for biofeedback treatments to help with migraine headaches. The nurse teaches the client that biofeedback:a. Helps to get rid of negative thinkingb. Is the process of shouting “I feel …” inside one’s headc. Is a method of changing jobsd. Is a method of gaining self-regulation to control autonomic responses

9. An alcoholic client is being discharged. To help enhance the client’s self-esteem, it would be most appropriate for the staff nurse to provide information about:a. Taking a vacation aloneb. Self-help support groupsc. Referral sourcesd. Nutritional support

10. A confused, agitated client was placed in the seclusion room on the psychiatric unit. The client requested to see a doctor. Which of the following actions taken by the nurse manager would be most likely to prevent possible workplace violence?a. Having a nursing assistant stay with client in the seclusion roomb. Placing the client in a semiprivate roomc. Trying to orient the client to time and placed. Prohibiting employees from entering the seclusion room alone

11. The house supervisor is attempting to maximize his managerial time. Which of the following techniques can he use to maximize his time?a. Delegationb. Abdominal breathingc. Compartmentalizationd. Anchoring

12. What could a registered nurse (RN) delegate to a licensed practical nurse/vocational nurse (LPN/VN) that the RN could not delegate to a nursing assistant?a. Making bedsb. Ambulating the clientc. Administering oral medicationsd. Obtaining a urinary specimen

13. The charge nurse finished assessing the clients. In making assignments, which would be a priority?

a. Assign a nursing assistant to stay with a preoperative surgical client who was crying

b. Assign a licensed practical nurse/vocational nurse (LPN/VN) to start an intravenous line in a client who was bleeding rectally

c. Assign an LPN/VN to perform an initial assessment of a newly admitted client

d. Assign a nursing assistant to remove stitches from a postoperative client who is preparing to be discharged

14. The nurse manager delegated the task of making client assignments to the staff nurse. How would the nurse manager evaluate the results of the delegation?a. Ask other staff to supervise the nurse manager’s workb. Ask personnel if they are happy about the assignmentsc. Correct the staff nurse’s workd. Use performance standards to evaluate

15. After delegating to the staff nurse the task of scheduling, the nurse manager plans to provide support by:a. Sharing informationb. Criticizing how the staff nurse completes the taskc. Assuming authority over the projectd. Maintaining liability

16. Which of the following indicates that the nurse is culturally sensitive?a. Allowing a Hispanic-American client’s extended family into the roomb. Talking loudly to an Asian-American staff nursec. Firmly shaking hands with a Native American clientd. Standing face to face with an African-American staff nurse

17. The nurse manager stayed 2 hours late each night for a week developing new policies and procedures for the unit. This is an example of:a. Shared governanceb. Underdelegatingc. Overdelegatingd. Procrastination

18. A staff nurse complained that she was being a “gofer” for the nurse manager without any recognition for doing the extra work of developing policies. So the staff nurse decided not to continue working on the policies. This is an example of:a. Underdelegationb. Overdelegationc. Procrastinationd. Lack of self-confidence

19. Which of the following is one reason a staff nurse might not accept a delegated task?a. Lack of guidelines to complete the taskb. Lack of confidence in the nurse manager.c. Lack of understanding of organizational objectivesd. Lack of cooperation of other staff nurses

20. A staff nurse was ordering supplies for the unit. After several interruptions, the nurse put down the order form and walked away from the task. This is an example of:a. Underdelegatingb. Nonemotional procrastinationc. Emotional procrastinationd. Planning

21. A staff nurse put off charting until near the end of the shift change. To stop the procrastination, the nurse manager suggested that the staff nurse:a. Make a commitment to finishb. Needs to choose a pleasant taskc. Delegate the charting to other staff nursesd. Depend on the nurse manager to chart

22. To implement a new staffing schedule based on acuity levels, the nurse manager established time estimates for nursing duties. This is an example of maximizing organizational time by:a. Planningb. Organizingc. Staffingd. Directing

23. Organizational charts help clarify who is responsible to whom and for what. Which of the following is an example of the use of an organizational chart?a. Nurse’s aide giving a report to the physicianb. Nurse’s aide giving a report to the team leaderc. LPN/VN giving a report to the pharmacistd. LPN/VN giving a report to the house supervisor

24. A nurse manager wants to ensure appropriate delegation to a staff member. To do that, the manager should be familiar with all but which of the following?a. The job description for the staff memberb. The educational background of the staff memberc. The skills checklist or certifications of the staff memberd. The attitudes of other staff toward that staff member

25. An important way for nurse managers to maximize organizational time is to:a. Use passive-aggressive communication with othersb. Delegate all aspects of nursing care to nursing assistantsc. Teach others how to do the work instead of doing it themselvesd. Look the other way when conflict arises

Chapter 3: Decision-Making Process and Tools

1. A staff nurse was asked by the nurse manager to be the charge nurse because of the staff nurse’s long history of effective decision making. The staff nurse attributed her effective decision making to:a. Minimal knowledgeb. The nurse manager’s modeling of effective decision makingc. Good decision making by the physiciand. Supportive hospital personnel

2. In the decision-making process, the nurse identifies a problem by:a. Referring to the standards of practiceb. Using the nurse’s own experiencec. Drawing on his or her educationd. Analyzing available information

3. Which of the following is an example of effective decision making?a. Counseling an employee for taking off one sick dayb. Implementing changes before explaining them to the staffc. Including staff from one shift to help make a decisiond. Implementing the decision that has been made

4. Traditionally, a hospital cuts back on registered nurse staffing for budgetary reasons. The hospital chief executive officer (CEO) wanted to decrease the operating budget by reducing the number of travel nurses being used on the units. The nurse managers protested this decision loudly because they feared a resulting shortage of staff. The hospital CEO used what type of decision-making model?a. Rational modelb. Bureaucratic modelc. Political modeld. Collegial model

5. The nurse manager expected her staff to be able to log into evidence-based practice websites to update policies and procedures. This is an example of what element of reasoning?a. Purpose or goalb. Question at issuec. Frame of referenced. Empirical dimension

6. The staff nurse is assessing the need for further teaching for a preoperative surgical client. Based on the steps of critical thinking, what is the nurse’s first priority?a. Identifying the problemb. Developing a frame of referencec. Identifying implications and consequencesd. Implementing inferences and conclusions

7 The nurse manager of the labor and delivery room sees the need to develop a new policy that allows members of the extended family into the delivery room. This policy change would have to be presented to the medical staff. What type of structure would the nurses use to develop the new policy?

a. Task forceb. Ad hoc committeec. Formal committeed. Line committee

8. Three charge nurses were assigned by the nurse manager to develop a method for keeping the crash cart stocked after each shift. What type of structure would best accomplish this assignment?a. Task forceb. Ad hoc committeec. Informal committeed. Line committee

9. The hospital holds weekly meetings of a nurse manager council that discuss identified problem areas and makes recommendations to a central council or administration. This is a form of:a. Ad hoc committeeb. Informal committeec. Shared governance councild. Task force

10. The nurse manager wants to ensure that consensus has been reached at the monthly staff meeting. Consensus occurs when the committee members agree that they can live with the decision even if it is not the decision they would prefer. One way for the nurse manager to help build consensus among the committee members is to:a. Help them understand their responsibilitiesb. Evaluate their workc. Implement their decisionsd. Involve them in critical and creative thinking

11. An ad hoc committee was formed to collect data about the increase in absenteeism throughout the hospital. To ensure that this ad hoc committee functioned efficiently, the hospital limited the number of committee members to:a. 8b. 3c. 20d. 18

12. During a staff conference, the issue of mandatory in-service sessions was raised. The staff from the day shift wanted the in-service sessions to be held from 12:00 to 1:00 PM, so they could eat lunch together. Some of the newer staff members who worked nights remained silent. When it came time for the vote, the majority who worked days and evenings accepted the time for the in-service sessions. The night shift members did not promote this new schedule. This form of peer pressure is:a. Consensus buildingb. Groupthinkc. Ad hoc committeed. Task force

13. The nursing home staff members were brainstorming about ways to keep one of the residents from walking into other residents’ rooms uninvited. After they failed to agree on a solution, the nurse manager instructed the staff members to take a break for lunch. The nursing manager was practicing what phase of creative decision making?a. Preparationb. Incubationc. Illuminationd. Verification

14. A nurse manager asks the staff members, “What causes low morale?” This is an example of which of the following?a. Meditationb. Keeping an ideas diaryc. Reverse brainstormingd. Brainstorming

15. The nurse manager at a nursing home wanted to use creative thinking to solve the problem of residents’ borrowing each other’s cigarettes without permission. First, the nurse manager called two licensed staff members into her office to discuss the problem. Next, she called in the nursing assistant to join the group. Finally, she called in the social worker to join the group. The nurse manager employed which technique to solve the problem?a. Ladder of abstractionb. Think tanks

c. Stepladder techniqued. Delphi technique

16. After a brainstorming session on how to implement a new staffing policy, the nurse manager decided to have the staff rank the suggestions in order of most preferred solution after considering whether each suggestion is practical, cost effective, efficient, and effective. Next, the staff prioritized the list, eliminated items, and added others. This is a form of:a. Visual identification of relationshipsb. Checklist methodc. Modelingd. Self-interrogation checklist

17. A staff nurse ridiculed another staff nurse’s draft of the designs for new signs that were to be placed on the unit. The staff nurse who was ridiculing was demonstrating:a. Objectivityb. Ability to find problemsc. Negative attituded. Tolerance for complexity

18. A hospital planned to begin using a new computerized medication administration record. The hospital used an external consultant to act as a change agent and educate the staff. An advantage to using external consultants is that they:a. Will devote more time to the problemb. Are less costlyc. Have limited backgroundsd. Bring new ideas and different perspectives to the situation

19. The nurse manager put up a rotation schedule to ensure that the holidays would be covered. The manager scheduled a newly hired staff nurse for the same time slot as a nurse who had seniority. The nurse manager was demonstrating what ethical principle?a. Autonomyb. Fidelityc. Justiced. Utility

20. A staff nurse witnessed a hospital staff member who was finishing up the night shift stuff her pockets with extra rolls of tape. The hospital has a policy about unauthorized removal of supplies from the unit. The staff nurse reported the incident to the nurse manager. Instead of reporting the hospital staff member to the house supervisor, the nurse manager counseled the staff member in the nurse manager’s office. This is an example of what type of ethical position?a. Utilitarianismb. Formalismc. Egoismd. Rule ethics

21. The client’s bed linens were damp from excessive perspiration. The staff member helped the client take a bed bath, even though the client had requested that she not be bathed. The nurse’s action exemplified what model of ethical relationship?a. Priestly modelb. Engineering modelc. Contractual modeld. Collegial model

22. Staff nurses use individual justice to care for individual clients, but nursing leaders use what type of justice?a. Formal justiceb. Distributive justicec. Resourceful justiced. Merit justice

23. For nurses to function in a multicultural environment, they must be aware of global ethics. Which of the following is an example of global ethics?a. An African-American woman wants a midwife to deliver her baby.b. The nurse treats the clients on the unit impartially.c. Nurses and clients work interdependently to plan care.d. Clients depend on the nurses for all of their needs.

24. The nurse manager formed a task force of orthopedic staff nurses to develop cost-saving standard practices for the care of clients undergoing total hip replacement. The staff nurses used which type of decision-making model to reduce costs for clients undergoing total hip

replacement?a. Program Evaluation and Review Technique (PERT)b. Gantt chartc. Decision treesd. Critical path method (CPM)

25. Computers facilitate complex decision making. When nurses use computers to track clients who were discharged based on diagnosis-related groups (DRGs), they are using which type of computer system?a. Clinical systemb. Dietary systemc. Management information systemd. Educational system

Chapter 4: Motivation and Morale

1. The staff nurses enjoyed meeting in the break room to share lunches and have some down time. The nurse manager had the staff break room converted to a family waiting room. The nurse manager was interfering with which staff need, according to Maslow’s hierarchy of needs?a. Physiologicb. Safety/securityc. Social/belongingd. Self-actualization

2. A rural hospital was forced to close because of financial problems. The staff and personnel were laid off. Based on Alderfer’s modified need hierarchy, the hospital administration interfered with which need?a. Safety/securityb. Existencec. Relatednessd. Growth

3. Which of the following is an example of a motivation factor according to Frederick Herzberg’s motivation-hygiene (two-factor) theory?a. Nursing assistants’ working for a paycheck onlyb. Nurse manager’s interest in the prestige of the titlec. Administration’s interest in productivity onlyd. Hospital’s funding of graduate courses for staff nurses

4. Which of the following is an example of a hygiene factor in Herzberg’s two-factor theory?a. Staff members’ concern that the hospital will lay off workersb. Hospital’s sponsoring of an awards banquet for all personnelc. Performance evaluations that provide positive feedbackd. Staff nurses’ attendance at workshops to increase knowledge

5. The chief nursing officer evaluated an orthopedic floor because of complaints from staff about low morale. In the evaluation, the chief nursing officer found that the nurse manager was more interested in personal prestige than in achievement. According to McClelland’s basic needs theory, the nurse manager has what type of need?a. A need for advancementb. A need for achievementc. A need for powerd. A need for affiliation

6. The nurse manager received an award because the manager’s staff had taken fewer sick days than staff in other units in the hospital. The nurse manager felt that the unit demonstrated high morale and high productivity. According to McClelland’s basic needs theory, the nurse manager was demonstrating what type of need?a. A need for advancementb. A need for achievementc. A need for powerd. A need for affiliation

7. One of the staff nurses was attending graduate school to learn more about critical care. The nurse manager asked the staff nurse to develop policies and procedures for the new cardiac rehabilitation program that was to be opened the next year. According to Argyris’s psychological energy theory, the nurse manager was:a. Decreasing the staff nurse’s productivityb. Increasing the staff nurse’s moralec. Matching the staff nurse’s talents with the jobd. Increasing the staff nurse’s motivation

8. A staff nurse delegated to a nursing assistant the task of stocking the linen cart for the next shift. At the end of the shift, the staff nurse discovered that the linen cart was not stocked. According to Vroom’s expectancy theory, the nursing assistant was operating from:a. Negative valence and expectancy value of 1b. Positive valence and expectancy value of 0c. Positive valence and expectancy value of 1d. Negative valence and expectancy value of 0

9. According to Skinner’s positive reinforcement theory, a nurse manager needs to evaluate whether the desired results were obtained or not. If the desired results were not obtained, what is the nurse manager’s first action?a. Reassign tasks to different staff membersb. Assess the working environment for interferencec. Request staff to be reassigned to a different unitd. Reduce the number of hours staff members work

10. A staff nurse became upset with the hospital because newer nurses were being hired directly after graduation from nursing programs at a higher pay than the nurse’s. Based on the equity theory, what would be expected from the staff nurse?a. Pride in his performanceb. Feelings of being overrewardedc. Decrease in productivityd. Increase in productivity

11. The nurse manager recently embraced a participatory style of management. After doing so, the nurse manager found that morale and productivity were increased. Which of Douglas McGregor’s theories best describe this situation?a. Self-determination theoryb. Theory Xc. Theory Yd. Theory W

12. Likert’s participative management theory differs from McGregor’s theory Y in that Likert’s research found that:a. Only general supervision is adequateb. More supervision leads to greater productivityc. Employee-centered supervision is more productived. Job-centered supervision is more productive

13. The hospital changed its management technique to theory Z. Theory Z differs from other management theories in that theory Z:a. Focuses on productivityb. Focuses on institutional systemc. Calls for the formation of quality circles to make decisionsd. Calls for the development of strategic plans

14. A staff nurse made a medication error. The nurse immediately filled out an incident report, called the doctor, and notified the nurse manager. The staff nurse’s self-awareness and the ability to function responsibly is an example of:a. Productivityb. Emotional intelligencec. Empathyd. High morale

15. At the nurse managers’ council meeting, staff tardiness was discussed. After returning to the unit, the nurse manager developed a log to track how often tardiness occurred and who was coming into work late. The nurse manager was demonstrating:a. Accurate self-awarenessb. Service orientationc. Leveraging diversityd. Motivation

16. A nurse manager was having difficulty with the staff. Morale was low because of petty gossiping among the staff and intolerance of each other’s behaviors. The nurse manager decided that the best way to handle this situation was to develop self-competence by:a. Attending a conflict management courseb. Being politically awarec. Being conscientiousd. Attending a service orientation program

17. The charge nurses inform the nurse manager that the

newly hired nurses are having difficulty with decision making and delegating. The best way for the nurse manager to handle this situation is to send the charge nurses to:a. A conflict management courseb. A self-management coursec. A stress management coursed. Supervisory training

18. Newly hired nurses were having difficulty in delegating tasks to the nursing assistants. They approached the nurse manager about setting up a leadership laboratory. The nurse manager decided that the key component that needed to be taught was:a. How to take care of one’s bodyb. How to accept feelingsc. How to engage in responsible decision makingd. How to be successful

19. A staff nurse continually voiced complaints to the nurse manager about the workload. The staff nurse was exhibiting:a. High productivityb. High moralec. Low productivityd. Low morale

20. Which of the following is an example of high organizational morale?a. A staff nurse enjoys the quality of her work.b. A staff nurse shows decreased quality of work.c. A staff nurse is loyal to the profession.d. A staff nurse has a high rate of absenteeism.

21. A group of staff nurses met in the hospital cafeteria. They decided to write a letter to the nurse manager regarding the behavior of another staff member. In the letter, they planned to ask that the staff member be removed. This is an example of:a. High moraleb. Burnoutc. Vertical violenced. Horizontal violence

22. A senior registered nurse (RN) was assigned to serve as preceptor for a new RN for 6 months. By the end of the first month, the nurse manager observed the senior RN talking harshly to the new RN. The best action of the nurse manager to reduce horizontal violence would be to:a. Ignore the senior RN’s actionsb. Assign a senior licensed practical nurse to serve as preceptor for the

new RNc. Mentor the new RNd. Validate assumptions and perceptions before drawing conclusions

23. The nurse manager observed that the patients’ trash cans were not being emptied by the night shift personnel. The nurse manager decided to set up a rotation schedule so that all night shift personnel would be responsible for emptying the trash cans. This is an example of:a. Preventing workplace civilityb. Preventing burnoutc. Preventing horizontal violenced. Preventing vertical violence

24. The nurse manager compared the male and female registered nurses (RNs) on the unit. The nurse manager found that which of the following had the greatest influence on job satisfaction for male RNs?a. Social aspects of the jobb. Interpersonal relationshipsc. Company management and policiesd. Working conditions

25. Nursing administrators were concerned about the cost of replacing staff members. The reason for an increase of cost is:a. The work itselfb. The expense of the orientation periodc. Limited advancement potentiald. Increased recognition for achievement

Chapter 5: Power, Politics, and Labor Relations

1. A staff nurse admires the nurse manager’s leadership style. What type of power does the nurse manager have in this situation?

a. Informal powerb. Coercive powerc. Referent powerd. Information power

2. A cardiac rehabilitation clinic hired a nurse practitioner to manage the clinic. The nurse practitioner had recently obtained critical care certification. What type of power does the nurse practitioner have?a. Charismatic powerb. Informal powerc. Coercive powerd. Expert power

3. A staff nurse volunteered to serve on a newly formed task force charged with developing evidence-based practice protocols. This participation gave the staff nurse:a. Referent powerb. Interpersonal powerc. Reward powerd. Coercive power

4. One of the nurse manager’s roles is to evaluate staff performance. Because the nurse manager has this role, the nurse manager's positional power is increased by:a. Centralityb. Criticalityc. Flexibilityd. Relevance

5. A staff member has the authority to:a. Delegate to administrative staffb. Implement ideas without approval from administrationc. Assist managers in the performance of their dutiesd. Enjoy command privileges

6. The nurse educator planned an in-service program on empowerment. The nurse educator could include discussion of which of the following ways that a staff member can empower himself or herself?a. Be able to admit mistakesb. Withhold information from othersc. Decrease workloadd. Maintain a critical aloofness

7. The nurse manager’s vision was to empower the staff. The nurse manager used all of the following techniques to help empower

the staff except:a. Assigning big problems to the staffb. Sharing task-related informationc. Obtaining material resources so staff members can do their jobsd. Providing emotional support

8. A new staff member decided he wanted to work in an institution where he could have a voice in policy formation. What type of institution would be the best fit for the staff nurse?a. Home health agencyb. Magnet institutionc. Elementary schoold. Community-based clinic

9. A school nurse is following the legislative path of a bill that supports human papillomavirus immunization of high school girls. The school nurse’s most effective political strategy is to:a. Become emotionally involvedb. Educate area nurses about the immunization billc. Refrain from attending town hall meetingsd. Discourage neighborhood petitions

10. The nurse manager of a nursing home wants to address the legislature regarding the state’s position on the opening of new facilities. To be the most effective in communicating this concern, the nurse manager decides to:a. Call the legislative secretaryb. E-mail a letter to the legislative representativec. Have a petition signed and mailed to the legislative representatived. Have a face-to-face meeting with the legislative representative

11. A bill, HR 152, was originated by a group of nurses lobbying Congress for staffing based on nurse-patient ratio. After it was originated, this bill then went to:a. The president of the American Nurses Association

b. The primary sponsorc. A committee of the House of Representativesd. A committee of the Senate

12. A nurse manager was invited to attend a public hearing about whether the state needs to impose a moratorium on new for-profit health care agencies. The nurse understands that the bill addressing this issue is in what phase of the legislative process?a. The bill has been introduced in the Senate.b. The bill has been referred to a standing committee.c. The bill has been referred to a subcommittee.d. The bill has been introduced in the House of Representatives.

13. A staff nurse needs some time off to take care of her critically ill mother. She does not want to quit her job, nor does she have enough vacation time to take off. For the staff nurse to keep her job, she needs to be aware of which labor law?a. The National Labor Relations Actb. The Labor-Management Relations Actc. The Nonprofit Health Care Amendments to the Taft-Hartley Actd. The Family and Medical Leave Act

14. Hospital employees decided that they would support the union certified by the National Labor Relations Board and go out on strike. At what point in the unionization phase can striking occur?a. Organizing phaseb. Recognition phasec. Contract negotiation phased. Contract administration phase

15. A nurse manager was hired after the hospital employees unionized. After a few days on the job, an employee on the unit became angry at the staffing schedule the nurse manager had posted. The employee filed what type of grievance?a. Harassment grievanceb. Political grievancec. Imagined grievanced. Informal grievance

16. A nursing assistant complained to the nurse manager that a staff nurse was making sexually inappropriate statements. The nursing assistant felt that the nurse manager did not adequately counsel the staff nurse. After the nursing assistant filed a grievance, a hearing was held. It is the nursing assistant’s responsibility to:a. Hire an attorneyb. Obtain a witnessc. Leave the hospital because of conflict of interestd. Obtain the services of the American Nurses Association

17. Which of the following is an example of unfair labor practices by management?a. Contributing financial support to the unionb. Supporting employees to develop a unionc. Being unable to bargain with representativesd. Allowing the selection of a representative

18. Which of the following statements about union labor practices is untrue?a. Union representatives must be able to bargain with the employer.b. The union may take a strike action without notifying the employer.c. The union cannot boycott a hospital’s vendors.d. The union cannot cause the employer to pay for services not

performed.19. The hospital employees are proposing to form a

union. Which of the following persons do not have the right to vote on union issues?a. Nurse managersb. Housekeeping personnelc. Nursing assistantsd. Licensed personnel

20. After becoming unionized, hospital employees become satisfied with the hospital’s acceptance of their demands regarding staff-patient ratios. The employees then decide that they no longer want to be represented by the labor organization. The employees’ next step is to:a. Initiate a decertification election with a 10% show of interestb. Call a strike action toward the hospitalc. Initiate a decertification election with a 30% show of interestd. Initiate a certification election with a 30% show of interest

21. Certification of the employees’ bargaining unit was denied because of insufficient votes. The labor organization’s next step is to:a. Begin the decertification processb. Seek certification among the same employeesc. Allow a 12-month moratorium and then seek certification againd. Begin negotiations with the hospital’s management

22. Before an election is scheduled, the union’s responsibility is to:a. Get at least 10% of the nurses to sign individual authorization cardsb. Maximize the number of bargaining unitsc. Schedule a preliminary hearingd. Present solutions to the hospital management

23. The licensed staff members who belong to the union filed a grievance against the hospital related to the conditions of employment. According to the National Labor Relations Board, in this situation collective bargaining is:a. Petitionaryb. Illegalc. Voluntaryd. Mandatory

24. The union has a security clause that requires all new employees to join the union. The security clause states that all members must maintain their memberships during the duration of the contract. This is an example of:a. A closed shopb. A union shopc. A maintenance-of-membership claused. An agency shop

25. The nurse managers have been informed that employees have contacted a union and that the union is trying to solicit a show of interest from 30% of employees. The nurse managers suggest what method to help decrease the desire to form a union?a. Collective bargainingb. Information technologyc. Participative managementd. Bureaucratic management

Chapter 6: Conflict Management and Negotiatio

1. A nurse at a physician-run clinic tried to schedule an operating room for an early morning outpatient surgery. The nurse manager of the operating rooms did not have any available rooms until late afternoon, so the nurse manager refused the request. This resulted in what type of conflict?a. Cultural conflictb. Horizontal conflictc. Vertical conflictd. Intradepartmental conflict

2. Although the house supervisor demanded a high quality of care, the nurse manager’s request for more staffing because of increased patient acuity levels was denied. This action by the house supervisor produced what type of conflict?a. Intrasender conflictb. Person-role conflictc. Intragroup conflictd. Intergroup conflict

3. After working several years in the hospital setting, a master’s-prepared nurse was hired at a local university. As a new faculty member, the nurse began to feel overwhelmed with the responsibilities of teaching, professional development, and community service. The nurse was also expected to develop on-line courses using specific software. Which type of conflict did the faculty member experience?a. Intrasender conflictb. Intersender conflictc. Intragroup conflictd. Role overload

4. A staff member came to the in-service session upset because it was her day off. She was wearing tight, revealing clothes. The

nurse manager realized that the staff nurse was demonstrating what reaction to the conflict?a. Sublimationb. Attention gettingc. Identificationd. Rationalization

5. After a physician reprimanded a staff nurse for not reporting the patient’s vital signs, the staff nurse began experiencing a severe migraine headache. The staff nurse then asked the nurse manager if he could take a sick day and leave the unit. The staff nurse was coping with the physician’s reprimand by:a. Displacementb. Denialc. Somatizationd. Regression

6. A staff nurse disagreed with the nurse manager’s decision not to allow smoking breaks. The staff nurse then began discussing the decision with other members of the staff who smoked. The staff nurse escalated the conflict by:a. Competitionb. Bickeringc. Constriction of othersd. Coalition formation

7. A rural hospital was switching to computerized charting. Many of the senior nurses were feeling anxious about the changes because of the new technology involved. In what stage of conflict were the senior nurses?a. Latentb. Perceivedc. Feltd. Manifest

8. The nurse manager overheard a staff nurse say that she was sending out her résumé to other agencies. When the nurse manager tried to verify this information, the staff nurse denied that she was looking for another job. The staff nurse was demonstrating what type of conflict?a. Latentb. Perceivedc. Feltd. Manifest

9. A physician reprimanded a staff nurse in front of a patient about missing laboratory work in the chart. The staff nurse excused himself and left the room without answering the physician. The staff nurse managed the conflict by:a. Avoidingb. Accommodatingc. Compromisingd. Competing

10. Which of the following is the most effective way to manage conflict?a. Avoidingb. Compromisingc. Collaboratingd. Competing

11. Two staff nurses were unable to resolve their differences regarding the number of assigned days they had to float to another unit. The two staff nurses agreed to ask the nurse manager to help manage this conflict by:a. Mediatingb. Planningc. Collaboratingd. Competing

12. The union representative informed the hospital administrator that the staff members were planning to strike because of failed negotiations regarding an increase in benefits. The union representative is engaged in what type of bargaining?a. Principle negotiationb. Distributive bargainingc. Integrative bargainingd. Positional bargaining

13. The hospital administrator told the union representative that the hospital would rather close down the unit than give pay raises to the staff. The union representative knew that this was a calculated delay so that the staff nurses would not strike. This is an example of:a. Smoke screenb. Over the barrelc. Positional pressure tacticsd. Flattery

14. The hospital administrator began the bargaining process with the staff nurses by sarcastically saying, “I know that you are intelligent people.” The hospital administration was playing what dirty trick?a. Seducing the staff nursesb. Annoying the staff nursesc. Demeaning the staff nursesd. Using a smoke screen approach

15. During the breakthrough negotiation between the hospital's unlicensed workers and the nurse manager of a unit, the nurse manager reframed a personal attack by the unlicensed workers by saying:a. “I don't agree with you.”b. “I understand that you are angry.”c. “How would you deal with the situation?”d. “What do you think will happen if we reach agreement?”

16. The licensed personnel were told that they could no longer wear different-colored scrubs as their uniforms. They were told that they had to wear white uniforms. Because the licensed personnel were unionized, they refused to continue working until they could resume wearing different-colored scrubs. The best way for the nurse manager to handle this situation would be to:a. Express the shared value of choice with the licensed personnelb. Use the nurse manager’s authority and force them to complyc. Demonstrate acceptance of their requestd. Explore the reason for the resistance to wearing white uniforms

17. The hospital hired a consultant in the hopes of developing:a. An adversaryb. An opponentc. An allyd. A bedfellow

18. The hospital administrator insinuated that overtime hours would be cut from a certain staff member’s work schedule. This staff member had a history of complaining about the hospital’s policies. An essential rule that the staff member needs to remember when negotiating is to:a. Show no fearb. Be ready to be intimatedc. Complain to others about the problemd. Be ready for the conflict

19. Two staff members were experiencing an interpersonal conflict. They agreed to have the nurse manager present while discussing the problem. The nurse manager’s role would be that of:a. Compromiserb. Collaboratorc. Mediatord. Complainer

20. The nurse manager of a long-term care facility was mediating an interpersonal conflict between a staff nurse and a nurse’s aide who worked together on the night shift. One strategy that the nurse manager used was to:a. Allow each staff member to blame the otherb. Encourage the staff nurse to tell her side of the storyc. Allow the nurse’s aide to tell the staff nurse which of her personality

traits bothered himd. Encourage each staff member to listen to the other’s point of view

21. An equipment sales representative made frequent visits to a skilled nursing facility. During his visits, he continually asked one of the married staff nurses out to eat. The married staff nurse kept refusing his offer. One less direct way the staff nurse can deal with the equipment sales representative is to:a. Provide him with a copy of the sexual harassment policyb. Notify the medical directorc. Lodge a complaint with the equipment company

d. Ignore the sales representative when he comes to the unit

22. A nurse manager wanted to use the nominal group process as a team development technique to help resolve conflicts on the unit. The nurse manager asked each staff member to state his or her goal, which the manager then wrote on a chalkboard for all to see. What step of the nominal group process was the nurse manager using?a. Listing of ideasb. Round-robin sessionsc. Serial discussions for clarificationd. Preliminary vote

23. The nurse manager, using the nominal group process, made a list of ways to handle conflicts on the unit. The next step was to decide who should be involved in decision making and who would be responsible for implementing that decision. This is known as:a. A round-robin sessionb. A negotiating sessionc. Decision chartingd. Implementation charting

24. Because of low morale and a high level of territorialism, the unit personnel decided they wanted the administration to remove the new nurse manager. The unit personnel were exhibiting what type of behavior?a. Performance problemsb. Bullying behaviorc. Attendance problemsd. Healthy behavior

25. Because of an increased risk of workplace violence, an urban medical center instituted a workplace violence prevention training

program. All of the following are topics that need to be included except:a. Risk factors that contribute to assaultb. Information on multicultural diversityc. Approaches to dealing with individuals who have a stressful lifed. Ways of dealing with hostile persons

Chapter 7: Theories of Leadership and Management Development

1. A newly hired staff nurse observed the nurse manager’s leadership style. The nurse manager used rules and policies to guide the staff and expected compliance. The nurse manager’s leadership style was:a. Shared governanceb. Democraticc. Laissez-faired. Bureaucratic

2. The nurse manager sees herself as demonstrating leadership skills based on the situation. She can be a follower as well as a leader; she is aware of her behavior and the behavior of her followers. The nurse manager’s leadership style is:a. Transactional leadershipb. Integrative leadershipc. Transformational leadershipd. Situational leadership

3. Unit personnel have a great deal of respect for the nurse manager. Based on Fred Fielder’s contingency model of leadership, what situation helps the nurse manager to be effective?a. Unit environmentb. Staff-to-staff relationsc. Positional powerd. Staff empowerment

4. Hersey and Blanchard’s situational leadership theory predicts the most appropriate leadership style based on which of the following variables?a. Readiness of followersb. Readiness of physiciansc. Readiness of nursesd. Readiness of the organization

5. Transactional leadership focuses on management tasks and trade-offs in exchange for expected performance. In transformational leadership, the nurse manager:a. Sets goals for the employees

b. Uses management by exceptionc. Focuses on day-to-day operationsd. Encourages self-management

6. Which of the following management theorists established a work standard based on the effects of fatigue on work performance?a. Frederick Taylorb. Frank Gilbrethc. Henry Ganttd. Abraham Maslow

7. Which management theorist focused on the organization as a whole rather than concentrating solely on production?a. Frederick Taylorb. Frank Gilbrethc. Lillian Gilbrethd. Max Weber

8. The primary difference between the classical management theorists and the behavioral science theorists is that the latter:a. Focus on productivityb. Focus on social environmentc. Focus on having a positive attitude toward peopled. Focus on organizational structure

9. Which of the following management theorists favored a division of work through specialization?a. Elton Mayob. Kurt Lewinc. Jacob Morenod. Henri Fayol

10. What might one find in Likert’s consultative system that would be less likely in participative management systems?a. Staff members’ ideas are sought.b. Sometimes an informal organization resists the formal goals.c. Staff members feel free to discuss their jobs with the manager.d. Decision making is integrated throughout the organization.

11. Which theorist introduced the concept of management by objectives as a way to manage managers?a. Rensis Likertb. Kenneth Blanchardc. Peter Druckerd. Tom Peters

12. Which of the following theorists stresses leadership that serves people?a. Warren Bennisb. Robert Greenleafc. Larry Spearsd. Peter Senge

13. According to Peter Senge’s theory, all of the following

are disciplines for building a learning organization except:a. Systems thinkingb. Personal masteryc. Mental modelsd. Emotional competence

14. The nurse manager demonstrates self-confidence in his ability to lead. He also describes himself as a visionary with empathy. Daniel Goleman identifies this behavior as:a. A servant leaderb. A benchmark for excellencec. An emotional intelligence competencyd. Contingent reinforcement leadership

15. The staff developer prepared a presentation for the hospital regarding diversity. What is the single most important factor predicting successful implementation of a diversity program?a. Nurses’ supportb. Administrative supportc. Physicians' supportd. Stake holders’ support

16. The chief nursing officer (CNO) scheduled performance evaluations for one male nurse manager and one female

nurse manager. Which leadership skill would the CNO expect to find in the leadership styles of both genders?a. Autocratic management styleb. Aggressive communication skillsc. Skills in networking outside the organizationd. Nondirective management style

17. The nurse applicant revealed during a job interview that he had undergone a below-the-knee amputation. After the interview, the nurse manager thanked the nurse for coming in but said she was sorry that she would not be able to hire him (even though there were openings available). What law did the nurse manager violate?a. The Rehabilitation Actb. The Civil Rights Actc. The Americans with Disabilities Actd. The Equal Employment Opportunity Act

18. Which kind of followers believe they must please the boss?a. Effective followersb. Conformist followersc. Alienated followersd. Ineffective followers

19. A staff nurse did not agree with the nurse manager about the new staffing policy. What is the best way for the staff nurse to handle the situation effectively?a. Discuss the disagreement in a public forumb. Try to develop solutions to the problemc. Bring up the problem during a Joint Commission surveyd. Tell the nurse manager that the manager’s decision was

unprofessional

20. A school nurse planned a health promotion program on character development for a group of seventh-graders. Which behavior most likely prompted the school nurse to develop the program?a. Increased teacher involvementb. Manifestations of students’ trust of each otherc. Students’ increasing use of sexual language while walking down the

hallsd. Decrease in sexual activity among teens

21. Part of the performance evaluation for a staff nurse focused on ethics and character development. What kind of activity demonstrates to the nurse manager that a staff nurse has a healthy character?a. Declining civic responsibilityb. Attempt to create a caring workplacec. Promotion of exterior motivationd. Excessive drinking leading to increased absenteeism

22. Which professional statement makes it clear that a nurse’s responsibility is first to the patient and second to the institution?a. Nursing’s Social Policyb. Nursing’s Social Justice Policyc. The Code of Ethicsd. The bylaws of the American Organization of Nurse Executives

23. A staff nurse began a graduate program focusing on health systems management. To be prepared as an effective leader in a health care agency, the staff nurse would probably benefit the most from instruction in which area?a. Information systemsb. Computerized chartingc. Computerized medical recordsd. Self-regulation of nursing practice

24. The primary difference between leadership and management is that leadership is more outcomes oriented and management is more:a. Process orientedb. Solutions orientedc. Conflict resolution orientedd. Organization oriented

25. Which of the following trends is most important for the twenty-first-century leader and manager?a. Shortage of health care facilitiesb. Spread of Asian fluc. Shortage of medication

d. Globalization

Chapter 8: Strategic and Operational Planning

1. Nurse managers are more likely to be involved in what type of planning?a. Long-range planningb. Strategic planningc. Operational planningd. Short-term planning

2. The chief nursing officer was asked by the hospital administrator to assume the responsibility of determining how many nurses would be needed when the new surgical center opened in 2 years. This is what type of planning?a. Internal environmental analysisb. Planning for external opportunities and threatsc. Operational planningd. Strategic planning

3. Which of the following best describes operational planning?a. Planning that extends 3 to 5 years into the futureb. Planning that involves allocation of resourcesc. Planning that determines time framesd. Planning that is done in conjunction with budgeting

4. Strategic planning became prevalent in the health care industry as a result of:a. Shifting of payments to the federal governmentb. Reimbursement changes, which decreased competitionc. Increase in the use of high-cost technologyd. Construction of more hospitals

5. Which of the following contributed to increased health care spending?a. Aging of the populationb. Increased numbers of people with private insurancec. Decreased incidence of violenced. Decreased use of technology

6. Chief executive officers began using strategic planning to manage the rising cost of health care by:a. Focusing on pain management clinicsb. Seeking out partnershipsc. Increasing duplication of servicesd. Decreasing informal networking

7. The nurse manager of a unit uses strategic planning when the manager:a. Decreases staffingb. Increases duplication of effortsc. Sets unrealistic goalsd. Gives direction to the unit

8. The nurse manager participates in organizational planning by:a. Identifying competing health care agenciesb. Identifying goals and objectivesc. Identifying new physiciansd. Identifying health care vendors

9. A hospital was conducting an external assessment to ascertain whether it could set up a satellite clinic within a 75-mile radius of the larger hospital. An example of a threat to the hospital’s proposal is:a. New programsb. Diversificationc. Decrease in the number of insured patientsd. Population growth

10. The hospital’s business plans call for a market analysis. A market analysis includes:a. Definition of the nature of the organizationb. A resource analysisc. Determination of the developmental costs of projectsd. Formulation of alternative strategies

11. In a hospital setting, the lower-level managers carry out operational planning of daily, weekly, and monthly activities. An

example of a lower-level manager is:a. The chief nursing officerb. A unit supervisorc. A clinical nurse specialistd. A case manager

12. In a hospital, which of the following influences the philosophy, goals, and objectives of the organization?a. Mission statementb. Marketing analysisc. Visiond. Values

13. When developing or reevaluating a philosophy, the manager should consider theory, education, practice, research, and the role of nursing in the total organization. Which nursing theorist provided the most useful model for an acute care setting?a. Rogersb. Royc. Widenbachd. Levine

14. How does an institution organize to meet the institution’s goals?a. By defining the goalsb. By staffing to accomplish the goalsc. By stimulating personnel toward accomplishment of the objectivesd. By comparing the results with the objectives to evaluate

accomplishments

15. Which of the following individuals or groups influence how institutional goals are determined by the organization?a. Staff nursesb. Patient care coordinatorsc. Vice president for nursingd. Board of directors

16. A staff nurse participates in the determination of goals by establishing:a. Institutional goals and objectivesb. Goals and objectives for the nursing servicec. Unit goals and objectivesd. Outpatient service goals and objectives

17. The hospital educator established objectives for the education department. The following is an example of an objective:a. Develop and implement staff development programs to meet the need

for increased knowledgeb. Develop and implement at least 12 staff development programs by the

end of the fiscal yearc. Evaluate, revise, and implement the orientation program for new

personneld. Develop, implement, and evaluate in-service programs regarding new

products

18. Policies and procedures serve many purposes in an organization. Which of the following purposes of policies and procedures is the most important for the nurse manager?a. They serve as a basis for future decisions and actions.b. They serve as a means to plan the unit budget.c. They serve as a means to control performance.d. They serve as a means to increase consistency of action.

19. At a magnet hospital, the nurses’ council committee developed a new policy regarding the implementation of a computerized charting system. This policy can best be described as:a. Obsoleteb. Originatedc. Appealedd. Imposed

20. Procedure manuals provide:a. An abbreviated course of actionb. A basis for orientation and staff developmentc. A resource only for nurse managersd. A low degree of regularity

21. While writing a procedure for the administration of

chemotherapy, the staff nurse included all of the following except:

a. Materials needed and how to locate themb. Methods for recycling the materials usedc. The physician’s responsibilitiesd. Appropriate charting

22. The planning process is a critical element for nursing management. One consequence of planning is:a. Visionb. Valuesc. Mission statementd. External assessment

23. Evidence-based practice information is a most useful resource for the development of:a. The mission statementb. Policies and proceduresc. An evaluation processd. An environmental analysis

24. The Institute of Medicine defines evidence-based practice as the integration of:a. Patient values, clinical expertise, and the best research evidenceb. Organizational values, clinical expertise, and the best research

evidencec. Patient values, medical expertise, and the best research evidenced. Organizational values, medical expertise, and the best research

evidence

25. A staff nurse is transferred from the surgical unit to a medical intensive care unit. In the new unit, the staff nurse will most likely be at which level of competency as defined by Benner?a. Noviceb. Advanced beginnerc. Advancedd. Competent

Chapter 9: Financial Management, Cost Containment, and Marketing

1. Health care costs continue to increase. All of the

following contribute to rising health care costs except:a. Aging populationb. Increasing number of diseases requiring acute carec. Increased health care needsd. Increasing number of uninsured people

2. Which of the following reimburses according to the cost of treatment of specific diagnosis-related groups (DRGs)?a. Health promotion programsb. Managed care systemsc. Prospective reimbursement systemd. Health maintenance organizations

3. A system in which a fixed payment is given to a care provider per health plan participant per month for delivery of a specified amount of health care services is known as:a. Managed careb. Health maintenance organizationc. Individual provider arrangementsd. Capitation

4. What has been the impact of managed competition on nursing?a. Large differential in salary among nurses with an associate degree,

bachelor of science degree, and master of science degreeb. Increased registered nurse staffingc. Increased use of advanced practice nursesd. Use of licensed practical nurses/licensed vocational nurses as

utilization reviewers

5. How should nurse managers face the challenge of globalization?a. Participate in the World Health Organization to help prevent a

pandemicb. Assure that adequate disease testing equipment is in placec. Conduct research to develop new diagnostic testsd. Screen all patients to prevent an epidemic

6. A nurse manager acts as a fiscal manager on the unit.

The nurse manager’s most likely duty is to:a. Be proactive in the fiscal planningb. Guide the formulation of justification for requests for resourcesc. Coordinate the fiscal planningd. Analyze expenses

7. A nurse manager has to submit a proposal to the administration for the staffing needs of the intensive care unit. The nurse manager will be working with what type of budget?a. Operating budgetb. Revenue-and-expense budgetc. Personnel budgetd. Capital expenditure budget

8. The nurse manager assessed the need for a new flotation bed for patients with severe decubitus ulcers on the unit. The nurse manager reported this information to the chief nursing officer, who reviewed which budget to plan for replenishment of this equipment on the unit?a. Operating budgetb. Capital expenditure budgetc. Cash budgetd. Flexible budget

9. The nurse manager reviews the unit’s budget quarterly. One advantage of such a budget review is that:a. It is time consuming and expensiveb. Corrective measures can be takenc. The budget converts organizational performance into monetary valuesd. The budget supersedes the agency goals

10. The hospital established the financial responsibilities of the personnel who are part of the budgetary process. The function of the nurse managers and department heads during the budgetary process is to:a. Provide general planning expertiseb. Formulate and execute the budget by using guidelinesc. Establish a completion timetabled. Prepare and review goals and objectives, and compile the budgets for

their departments

11. The hospital is promoting a healthy living program for its employees. On what part of cost containment is the hospital focusing?a. Cost fairsb. Cost managementc. Cost avoidanced. Cost reduction

12. The nurse manager needs to determine the most economical level of inventory, because supplies represent a significant cost factor. To keep costs down, the nurse manager places small orders frequently. This is an example of reducing what kind of cost?a. Order costb. Carrying costc. Short costd. Stock-out cost

13. A nurse manager uses what technique to help control costs?a. Delegating appropriate tasks to unlicensed personnelb. Comparing costs with those of other departmentsc. Calculating the break-even points on an itemd. Conducting comparisons in monetary units

14. The chief nursing officer needed to make changes in the staffing budget because the hospital was opening an additional 10 beds to the emergency department. The nursing administrator had to look at what type of costs?a. Variable costsb. Sunk costsc. Semivariable costsd. Marginal costs

15. The nurse manager wanted to implement a new indirect cost savings strategy on the unit. An example of an indirect cost savings strategy is:a. Instituting a new 15-minute break policyb. Holding staff meetings on company timec. Charging for the coffee served to employeesd. Eliminating the nurses’ lounge area

16. The hospital implemented several cost-cutting

strategies to keep from closing. One strategy was the support of early retirement. What kind of strategy can the nurse manager use to keep up the morale of the unit?a. Initiate an across-the-board pay cut to be fair to everyoneb. Acknowledge the staff’s good workc. Encourage staff members to seek other positions for job securityd. Give a pay raise to the remaining employees

17. The nurse manager used the traditional model for costing out nursing services. In this model, the amount of nursing time per intensity level (NT) is calculated based on what?a. PPOsb. MHOsc. DRGsd. IPAs

18. One difference between the traditional model and the McCloskey model for costing out nursing services is that the McCloskey model uses:a. Average nursing hourly salary (ANHS)b. Benefits across the institution (BAI)c. Indirect cost amount (ICA)d. Nursing intervention (NI)

19. The hospital’s board of directors sent letters to wealthy community leaders seeking donations to help build an extension to the hospital. This target group is an example of:a. An exchange publicb. An internal publicc. A sought publicd. An unwelcome public

20. The hospital has established a wellness center that provides health education programs. To advertise this new service, the hospital conducts what type of marketing?a. Mass marketingb. Social marketingc. Product-variety marketingd. Exchange marketing

21. A marketing audit of a small rural town is performed to see if the community would be interested in having a clinic that specializes in women’s and children’s services. This is what type of market targeting?a. Differentiated marketingb. Comprehensive marketingc. Concentrated marketingd. Undifferentiated marketing

22. A wellness clinic was promoting a new weight loss capsule that was approved by the Food and Drug Administration. Over the last quarter, the clinic’s data revealed an increase in the sale of the product. This is an example of what stage of the product’s life cycle?a. Introduction stageb. Growth stagec. Maturity staged. Market decline stage

23. With very few Food and Drug Administration–approved nonprescription weight loss drugs on the market, the pharmaceutical companies that produce these over-the-counter medications can establish what kind of pricing goal?a. Cost-plus pricingb. Profit-maximizing pricingc. Sliding payment scaled. Price-discrimination pricing

24. The hospital used promotions that were not paid for by the hospital. What type of publicity tool did the hospital use?a. Public service announcementsb. Billboard advertisingc. Telephone stickersd. Fund raising

25. Marketing promotion informs potential customers of the existence and availability of products and services. Because consumers have become more knowledgeable about health care, hospitals have had to become very creative in their marketing promotions. Hospitals understand that marketing promotion leads to:a. Reutilization of servicesb. Underutilization of services

c. Narrowing of services to a select groupd. High bidding to get the business

Chapter 10: Organizational Concepts and Structures

1. The nurse manager resigned from an organization that had formal channels of communication to begin working at an organization with a flat structure. The nurse manager can expect to find which of the following?a. Division of labor with simplification of workb. Delimitation of responsibilitiesc. Performance of multiple work tasksd. Focus on product centricity

2. In response to the rising costs of health care, hospitals have developed population-based health programs that focus on a given disease or health condition and provide care to groups needing specialized health services. These programs, developed as managed care health plans, are termed:a. Disease management programsb. Coordination of carec. Modular cared. Consolidation of health plans

3. As a leader in the organization, the chief nursing officer should:a. Model the use of decentralized powerb. Model the use of centralized powerc. Follow the chain of commandd. Create a bureaucratic environment

4. The nurse manager of the unit is responsible for:a. Encouraging downward communicationb. Establishing a chain of commandc. Facilitating the formal groupd. Modeling the use of centralized power

5. The nurse manager develops an organizational chart

that includes all of the following except:a. Formal organizational relationshipsb. Informal organizational relationshipsc. Areas of responsibilityd. Channels of communication

6. In what is called a “new” organizational structure, versus a traditional structure, what is true of the chain of command?a. Communication flows from the top down.b. Authority and responsibility are aligned.c. Informal communication prevails.d. Authority and responsibility are delegated to the lowest operational

level.

7. A staff nurse was recently promoted to a case manager position. With this promotion, the staff nurse’s responsibilities now include:a. Making decisions for the organization as a wholeb. Long-term planning and policy makingc. Involvement in the specific unit’s workflowd. More bedside nursing involvement

8 A nurse manager has begun working in an organization with decentralized decision making. Decentralized decision making allows the nurse manager to:a. Make decisions effectivelyb. Make long-range plansc. Develop organizational goalsd. Initiate policy development

9. An urban hospital decided to sponsor a school-based clinic in a nearby ghetto area as part of the services of the hospital. The service is viewed as:a. Departmentalization by specialtyb. Departmentalization by functionc. Departmentalization by territoriesd. Departmentalization by client

10. A hospital recently hired a quality improvement director whose position can be viewed on the organizational chart. The

function of this position in the chain of command is to:a. Offer counsel on managerial problemsb. Restrain line authorityc. Perform the routine workd. Serve in an advisory capacity

11. The roles of the nurse manager throughout organizational redesign, restructuring, and reengineering include all of the

following except:a. Team buildingb. Change initiationc. Case managementd. Cost reduction

12. On the unit, the nurse manager assigned one staff member to pass medications and give treatments. In this case, span of control is defined in terms of:a. Functionb. Productc. Serviced. Region

13. In a large medical center, the chief nursing officer met with the vice president of information systems to schedule training for the nursing staff on the new information systems that were to be installed. What type of organizational structure does this medical center have?a. Shared governance structureb. Line and staff structurec. Dual management systemd. Organic structure

14. A staff nurse who recently graduated from a health systems management graduate program was relieved of her duties on the unit and given a temporary assignment along with other staff members who were working on their certifications. The staff members were participating in:a. Bureaucratic managementb. A task forcec. A line and staff modeld. An adhocracy

15. Which of the following is an important principle that maximizes the efficiency of the bureaucratic structure in an organization?a. Each staff member may have more than one boss.b. Verbal descriptions of the roles of staff members are sufficient.c. Authority and responsibilities of staff members should be defined in

writing.d. Role clarity guarantees effective delegation.

16. To increase performance effectiveness, the nurse manager must:a. Ensure increased productionb. Give employees informal authorityc. Decrease delegation of tasksd. Provide general supervision

17. An advanced practice nurse was hired to help establish a trauma unit. While working on the project, he found that he had to report to the chief nursing officer and the newly hired medical director of the trauma unit. This organizational design is known as:a. A functional lineb. A matrixc. A project lined. An adhocracy

18. A hospital decided to restructure the organization by changing from a bureaucratic model to European-style management. The primary difference between these two styles is that European-style management:a. Has a rigid line of authorityb. Uses a board to make policy decisionsc. Has inflexible boundaries separating jobs and divisionsd. Shifts personnel and disrupts training

19. The dean of the school of nursing decided to implement a shared governance model. The principal foundation of this model is:a. Self-governance

b. Autocratic leadershipc. Participatory managementd. European-style management

20. To survive the changes in the health care field, many nurses have become entrepreneurial and have established their own programs or agencies to hire others to provide care to the community. What type of organizational model would best fit this approach?a. Self-governanceb. Shared governancec. Corporate modeld. Mixed model

21. One way that nurse leaders who are employed by an organization can best fit into a corporate model instead of a traditional bureaucratic model is to:a. Meet every 3 months to approve by-lawsb. Increase autocratic leadershipc. Create a network instead of preserving a pyramidd. Establish vertical communications

22. A hospital established a professional partnership with a local nursing program. A joint practice agreement was signed between the two agencies. This is an example of what type of multiorganizational arrangement?a. Informal affiliationsb. Formal affiliationsc. Shared or cooperative servicesd. Consortia

23. In response to managed care, many hospitals have set up disease management programs. One benefit of such programs is:a. The focus primarily on acute illnessesb. The focus primarily on the elderly with acute illnessesc. The focus on coordination of care of people at riskd. The focus on tertiary prevention for all persons

24. A nurse manager was concerned about the employees of her unit when the hospital for which she was working merged with another health care system. She explained to her staff what was not going to change, what changes would take place, and the importance of the changes. The nurse manager was participating in what phase of this new integration of health care systems?a. Assessment phaseb. Planning and design phasec. Implementation phased. Development phase

25. Nurses need to be prepared for globalization and its implications for health care. Nurses would be most likely to focus on which of the following as the groundwork for the management of outcomes in global health care?a. Information technologyb. Case management and clinical pathwaysc. Complexity of connections leading to globalizationd. Amount of medicine required to treat diseases

Chapter 11: Organizational Culture, Change, and Innovatio1. The nurse manager assessed the culture of the unit

before instituting policy changes. The nurse manager found that the environmental culture fostered teamwork and consensus building. This best describes what type of culture?a. Individualistic cultureb. Collective culturec. Expert cultured. Transculturalism

2. The nurse manager attempted to help staff members adjust to the new organizational merger by explaining the need for changes and modeling tolerance of these changes. The nurse manager demonstrated what type of tolerance?a. Cognitive dissonanceb. Tolerance of othersc. Tolerance of ambiguityd. Tolerance of insolubility

3. With the new career ladder in place, the hospital expects nurse managers to attend budget meetings, prepare staffing schedules, and enroll in a health management systems graduate program. One nurse manager with three small children is at high risk for:

a. Role theoryb. Role structurec. Role learningd. Role stress

4. The hospital’s mission statement includes the phrase, “We are committed to providing multicultural services.” An example of carrying out this mission is:a. Supporting dialogue between individuals of different culturesb. Ensuring that patients of different cultures have translation services

availablec. Providing services only for English-speaking patientsd. Excluding different cultural practices

5. The hospital has planned a day of celebration called Cultural Diversity Day. At this celebration, employees of different cultures are allowed to bring their favorite foods to share with other employees. The hospital is demonstrating what stage of intercultural sensitivity?a. Denial of differencesb. Minimization of differencesc. Adaptation to differencesd. Integration of differences

6. A Hispanic nurse was interviewed for a position at a small rural hospital. The nurse was told that the hospital has written policies regarding the provision of equal support and career development resources to all employees. This hospital deals with cultural diversity through:a. Intercultural sensitivityb. Cultural awareness buildingc. Discrimination controld. Prejudice reduction

7. A nurse manager motivates her employees and serves on community service boards as a representative of the organization. The nurse is said to be:a. A herob. A legendc. A metaphord. An overachiever

8. Because the nurse manager has served the organization through two corporate buyouts, he has developed the skills of steward, inspirer, and promoter. This nurse manager is most likely to create what type of culture?a. Control cultureb. Collaborative culturec. Competence cultured. Cultivation culture

9. Student nurses joined a professional organization for student nurses while enrolled in a baccalaureate nursing program. This is an example of:a. A macrosystemb. A subculturec. Social cohesivenessd. A counterculture

10. The hospital was experiencing low staff morale and decreased productivity after it merged with another corporation. The staff from the hospital became territorial when staff members from the other corporation were scheduled to work with hospital staff. This is an indication that the change induced by the merger has been influenced by:a. Countercultureb. Internal forcesc. External forcesd. Microsystems

11. A nurse manager was asked to select nurses for a new geriatric unit and interviewed several nurses for the job of patient care coordinator. The nurse who was selected has a master’s degree in adult health with a focus on gerontologic nursing. This nurse manager used which kind of change strategy?a. Empirical-rational strategyb. Normative-reeducative strategyc. Power-coercive strategyd. Interactional change strategy

12. First-line managers can apply Lewin’s framework for planned change to nursing care. Which part of Lewin’s framework is comparable to the evaluation step of the nursing process?

a. Unfreezing phaseb. Moving phasec. Refreezing phased. Force-field analysis

13. A nurse manager requests in-service training about the new computerized system that is to be implemented once a planned merger between the nurse manager’s agency and another agency is completed. Based on Lewin’s force-field analysis, the nurse manager’s strategy is to:a. Increase the restraining forces and strengthen the driving forcesb. Increase the restraining forces and decrease the driving forcesc. Reduce the restraining forces and strengthen the driving forcesd. Reduce the restraining forces and decrease the driving forces

14. In a staff meeting, the staff complain that they would like to have more events that allow them to socialize with their co-workers. The nurse manager recognizes that there is a culture gap on the unit. The culture gap relates to which of the following?a. Task support normsb. Task innovation normsc. Social relationship normsd. Personal freedom norms

15. The hospital has approved the nurse manager’s suggestion to have more social activities for employees. The hospital will now implement the next track of Kilmann’s process for organizational planned change, which is:a. Management skillsb. Scheduling of the tracksc. Strategy structured. Reward system

16. The staff members question the nurse manager about the effects of the new computerized charting system on their workload. They are unsure if the computerized charting system will be easy to learn. The staff members are in which of the stages of the innovation process as defined by Rogers?a. Knowledgeb. Persuasionc. Decisiond. Confirmation

17. Several senior nurses have opposed the installation of the new computerized charting system. The nurse manager hears these senior nurses make negative comments to the novice nurses about the new system. According to Rogers, the senior nurses are which kind of adopters?a. Innovatorsb. Early adoptersc. Laggardsd. Rejecters

18. A hospital specializing in women’s and children’s services opened in a mid-sized town. As the organization grew, more staff members were needed to accommodate the new services added. The hospital developed job descriptions, policies, and procedures for the employees working in the new services. This hospital was going through which developmental stage?a. Birthb. Youthc. Maturityd. Termination

19. Within the organization, staff members continued to express negative comments about the changes that had occurred when a merger took place. The staff felt that after the merger, the new organization had lost its vision and mission. The members of this new organization were experiencing:a. An adaptive cultureb. A dysfunctional culturec. A cultural rutd. Culture shock

20. When the hospital merged with another institution, many workers decided to retire instead of remaining to work for the new organization. These employees are said to be:a. Disengaged

b. Disidentifiedc. Disorientedd. Disenchanted

21. Changes are disturbing to those affected, and resistance often develops. All of the following are causes of resistance to

change except:a. Threatened self-interestb. Complacencyc. Securityd. Previous long-term system stability

22. The nurse managers met with the chief nursing officer before the organization began downsizing. Some of the senior nurse managers complained about the downsizing after the meeting. In terms of their level of commitment to the change, these senior nurse managers could be categorized as:a. Championsb. Overt resistersc. Covert resistersd. Skeptics

23. One way that administration can handle incompetent executives is to:a. Hire new managersb. Move them from line to staff authorityc. Terminate their employmentd. Counsel them toward satisfactory performance

24. A year after the organization has completed a merger, patient surveys show that patient satisfaction has increased by 50%. The organization attributes this change to the hiring of a case manager. This organization is said to be:a. Moving backwardb. Advancingc. Oscillatingd. Restructuring

25. Two hospitals want to assess the organizational culture of each agency to predict the sources of resistance to change before they merge. What type of tool can they use?a. Value compassb. Organizational auditc. Competing Values Frameworkd. Organizational Culture Assessment Instrument