Nursing Today Transition and Trends 8th Edition Zerwekh Test Bank

Nursing Today Transition and Trends
8th Edition Zerwekh Test Bank

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Chapter 10: Challenges of Nursing Management and Leadership
MULTIPLE CHOICE
1. What is the most consistent concern of the nurse as manager?

a. To develop long-range career goals
b. To coordinate patient care while meeting the agency goals
c. To maintain harmony within the agency
d. To organize the subordinates to meet agency goals
ANS: B
The role of the nurse as manager has evolved into a complex one that includes organizing
patient care, directing personnel to achieve agency goals, and allocating resources. The most
consistent concern of the nurse as manager is not to develop long-range career goals, maintain
harmony within the agency, or organize subordinates to meet agency goals. Although having
long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern.
Organizing subordinates in not a role of the nurse manager, but instead it is directing or
supervising them to achieve patient care needs.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208

OBJ: List characteristics of an effective manager and an influential leader.
TOP: Nursing definition
MSC: NCLEX®: Safe and effective care environment—management of care
2. What action would be an appropriate first step for the nurse to take toward becoming an
effective manager?
a. Learn how to effect and direct the change process.
b. Assess individuals’ sources of power.
c. Develop communication and interpersonal skills.
d. Implement effective nursing care plans.
ANS: C
Effective managers have a balanced mix of management skills and leadership qualities. There
are generally four functions the manager performs: planning (what is to be done), organizing
(how it is to be done), directing (who is to do it), and controlling (when and how it is done).
To be effective in performing these functions, a manager must develop communication and
interpersonal skills.
PTS: 1 DIF: Cognitive Level: Application REF: p. 212

TOP: Nursing management
3. What do the responsibilities of the nurse manager include?

a. Planning and organizing how nursing care can most effectively be delivered on the
nursing unit
b. Establishing the nursing care standards to be implemented on the unit
c. Developing educational programs to assist staff to meet licensure requirements
d. Assisting staff to adhere to organizational policies and procedures
ANS: A
Managers must be attentive to both dimensions of their job: the mission and goals of the
organization and planning with the staff to meet the nursing care goals of the unit within the
overall goals of the institution. Both levels must be addressed—the organization as well as the
needs of the individuals. Other options are not as comprehensive and could be included within
the first option.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210

TOP: Nursing management
4. The nursing staff on a busy unit enjoys autonomy and needs minimal direction for patient
care. Which leadership style would be most effective on this unit?
a. Democratic c. Laissez-faire
b. Authoritarian d. Bureaucratic
ANS: A
The democratic manager is people oriented and emphasizes effective group functioning. The
environment is open, communication is both ways, and staff members are encouraged to
participate in decision making. The manager is also willing to take responsibility to make
decisions when staff participation is not necessary. An authoritarian leader makes decisions
without the input of others. The laissez-faire manager maintains a permissive environment.
The bureaucratic leader follows a close set of standards to maintain order.

OBJ: Describe various types of management. TOP: Nursing management
5. Which statement best describes effective leadership by the nurse manager?

a. Directs a staff nurse to modify his or her communication skills
b. Fosters behavior changes in one staff member that have positive effects on the
nurse manager and his or her peers
c. Encourages behavior changes through the annual evaluation process
d. Uses the group process to determine what behavior is distressing to staff
ANS: B
Leadership in groups is democratic; the members feel positive about their participation and
the outcomes of the group process. The other options are not examples of effective leadership.
This person should be flexible enough to adapt to the changing roles of nursing staff. The
nurse manager/leader should be willing and able to share power with the same people that he
or she will supervise. It is important to understand that the most effective leadership style for
one situation is not necessarily the most effective for another. Research indicates that the
effectiveness of the leader is influenced by the situation itself. As leadership theories continue
to develop, emphasis is more on what the leader does rather than on the traits the leader
possesses. Effective leadership revolves around the leader focusing a group’s efforts on
identifying goals and carrying out the activities needed to reach those goals, not necessarily on
individual issues, such as an annual evaluation processes or working with a staff to change
communication skills.

TOP: Nursing management MSC: NCLEX®: Not applicable
6. The nurse manager is beginning the process of problem solving. Which action should be taken
first?
a. Define the problem. c. Analyze the information.
b. Gather information. d. Consider the alternatives.
ANS: A
The good manager will guide the process of defining or identifying the problem by asking the
what, when, and where of the problem. Before the manager can perform any of the other steps
of problem solving, the problem must be identified. Importance is placed on management’s
ability to differentiate between facts and opinions and to attempt to break down the
information to its simplest terms.

OBJ: Apply problem-solving strategies to clinical management situations.
7. A nurse is using the decision-making process. Which action should be taken first?
a. Evaluate the outcome. c. Set the objective.
b. Identify and evaluate options. d. Implement the options.
ANS: C
Decision making requires the definition of a clear objective to guide the process. The nurse
must set the objective before proceeding to the other steps in the decision-making process.
The second step is to identify and evaluate alternate decisions. The third step is to make the
decision and implement, and the last step is to evaluate the outcome.

OBJ: Use the decision-making process in clinical situations. TOP: Nursing management
MSC: NCLEX®: Not applicable
8. Which statement by the nurse shows understanding of the primary advantage in using the
group process in decision making? The process
a. “increases the time spent discussing alternatives.”
b. “eliminates opposition to decisions by administrators.”
c. “allows additional time for the planning process.”
d. “promotes acceptance of the decision by the group.”
ANS: D
When the group has input in the decision-making process, there is more acceptance of the
group’s decision. Groups can be beneficial to the decision-making process. Groups generally
offer the benefits of a broader knowledge base for defining objectives and more creativity in
identifying alternatives. The effectiveness of the group decision-making process is dependent
on the dynamics of the group. When a group is involved in the decision-making process, there
may be additional time spent discussing alternatives, and more time may be allowed for
planning; however, this is not a specific advantage. It may not necessarily eliminate
opposition to the decision by administration, but when the group makes a decision, it may be
easier to deal with administrative opposition.

OBJ: Identify characteristics of effective work groups. TOP: Nursing management
9. A nurse is interested in moving into a management position. Which action would assist with
accomplishing this?
a. Use of reward power c. Use of expert power
b. Use of coercive power d. Use of legitimate power
ANS: C
An expert refers to someone who is knowledgeable, experienced, and respected in his or her
area of nursing. This type of expert power would assist the nurse to advance to higher
positions in nursing. Reward power is closely linked with legitimate power in that it comes
about because the individual has the power to provide or withhold rewards. Legitimate power
is power connected to a position of authority. Coercive power is power derived from fear of
consequences.

OBJ: Differentiate between power and authority. TOP: Nursing management
10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The
nurse has studied diabetic patient educational needs and consults with several units. What type
of power does this nurse possess?
a. Informational c. Reward
b. Legitimate d. Expert
ANS: D
Expert power is based on specialized knowledge, skills, or abilities that are recognized and
respected by others. Those who have information that others need to perform their duties have
informational power. Legitimate power is based on the person’s position within an
organization. Reward power occurs when an individual has the power to give or withhold
rewards.

11. The nurse manager on a surgical unit receives notification that multiple victims of a plane
crash will arrive at the hospital momentarily. What is the most appropriate leadership style to
adopt in this situation?
a. Authoritarian c. Laissez-faire
b. Democratic d. Eclectic
ANS: A
The authoritarian style of management has its emphasis on the tasks, which would be
effective during an emergency or disaster situation; hence, the autocratic manager may be
most effective in a crisis situation. The laissez-faire manager maintains a permissive climate
with little direction or control exerted. This manager allows staff members to make and
implement decisions independently and relinquishes most of his or her power and
responsibility to them. The democratic manager is people oriented and emphasizes effective
group functioning. The environment is open, communication is both ways, and staff members
are encouraged to participate in decision making. Eclectic is not a specific leadership
management style.
12. The nurse manager tells the patient that he must eat his breakfast before getting out of bed.
What type of power is the nurse manager using?
a. Legitimate power c. Coercive power
b. Expert power d. Referent power
ANS: C
Coercive power is power derived from fear of consequences. Expert power is based on
specialized knowledge, skills, or abilities that are recognized and respected by others. Reward
power is closely linked with legitimate power in that it comes about because the individual
has the power to provide or withhold rewards. Legitimate power is power connected to a
position of authority. Referent power is power that a person has because others closely
identify with that person’s personal characteristics; the person is liked and admired by others.

13. Which statement by the staff nurse shows adequate understanding of the nurse manager role?
The nurse manager:
a. “is given information and power through an official position.”
b. “coordinates group activities toward a common goal.”
c. “is responsible for developing goals to be accomplished.”
d. “selects and assumes a role among a group of peers.”
ANS: B
The manager coordinates the activities of the group to maintain balance and direction. There
are generally four functions the manager performs: planning (what is to be done), organizing
(how it is to be done), directing (who is to do it), and controlling (when and how it is done).
Good leaders carefully balance job-centered and employee-centered behaviors to meet both
staff and patient needs effectively and often have information and power through an official
position. A good leader works toward developing goals and has a sense of purpose and
direction. A good leader must also be aware of how her or his behavior impacts the
workplace. Emotions, moods, and patterns of behavior displayed by the leader will create a
lasting impression on the behavior of the team involved. A team member is a person who
assumes a role among a group of peers.

14. The nurse manager is giving a presentation on the disadvantages of democratic leadership in
group functioning. Which statement shows an understanding of this type of leadership?
a. “Requires more time and effort to make decisions and accomplish goals”
b. “Discourages participation from quieter members of the group”
c. “Increases the possibility of “scapegoating” or argumentative behavior”
d. “Is difficult to control the outcomes and decisions of the group”
ANS: A
Because of the encouragement of participation in decision making and the democratic
leadership’s emphasis on group function, decision making becomes more involved with
consensus and is less timely. Democratic leadership encourages group participation and works
to reduce any type of scapegoating behavior among members because everyone has equal
voice. The group democratically makes decisions and determines outcomes that are not
controlled by management.

OBJ: Discuss theories of management and leadership. TOP: Nursing management
15. A nurse is unhappy about the way medications are being administered on the unit. What does
the nurse need to do first to facilitate a change in the process?
a. Initiate a new method starting with assigned patients.
b. Discuss concerns with fellow nurses.
c. Develop a better method to administer the medications.
d. Inform the charge nurse of how it can be done better.
ANS: C
The nurse needs to shift into the moving phase, which incorporates taking the lead by being
responsible and willing to implement change by sorting out what must be done and by
facilitating an appropriate and effective approach. Whenever one is not happy with a situation
or procedure, it is important that providing suggestions for change be incorporated into the
process. Discussing concerns with fellow nurses does not actively involve the change process.
For change to be effective, it must have “buy-in” from other staff and not merely inform the
staff or change nurse of how there is a better way to administer the medications on the unit.

OBJ: Discuss the change process. TOP: Nursing management
16. A nurse wants to implement a change in the work environment. Which of the following
actions would be the most important thing to do?
a. Ask for suggestions from peers working in other institutions.
b. Explain to coworkers how a different plan would work better.
c. Seek input from coworkers from the beginning.
d. Incorporate all suggestions into the plan before implementing.
ANS: C
Seeing the input from coworkers from the beginning is an important component of initiating
change in the work environment. In the unfreezing phase, all of the factors that may cause
resistance to change are considered. Others who may be affected by the change are sought out
to determine whether they recognize that a change is needed and to determine their interest in
participating in the process. It will be important to determine whether the environment of the
institution is receptive to change and then convince others to work with the group initiating
the change.

17. If many complaints arise about a newly developed procedure, what is the best way to handle
them?
a. Discontinue the change because it is not working.
b. Persuade a few friends to talk positively about it.
c. Consider the complaints as indications that change is being resisted.
d. Analyze the complaints and alter the plan as needed.
ANS: D
In handling complaints about a new procedure, consideration should be given to bringing in a
person with expert power and returning to the moving phase for analysis and adjustment of
the procedure if needed. Because a complaint occurs does not mean that the change is being
resisted. Until the complaint is investigated, the change should continue; it should not be
discontinued until the issue is fully determined and resolved about the newly developed
procedure
PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227

18. What types of changes in management can be anticipated with the introduction of generations
X and Y to the nursing work force?
a. More flexible work time and increased personal responsibility for work outcomes
b. Increased loyalty to the institution and the need for a well-defined work
environment
c. Increased interest in the goals and needs of the institution
d. Increased structure within the nursing environment to more effectively predict
outcomes
ANS: A
Members of generations X and Y are more independent and place higher value on personal
time. They are not characteristically team players, but they are very creative and want to be
responsible for their work outcomes. Baby Boomers are focused on building careers and are
invested in organizational loyalty. The silent or veteran generation places high value on
loyalty, discipline, teamwork, and respect for authority.

OBJ: Identify distinguishing generational characteristics of today’s workforce.
TOP: Generations X and Y MSC: NCLEX®: Not applicable
19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a
conference table) meeting takes less time to come to a decision based on which of the
following ideas?
a. Contingency-style leadership
b. Evidence-based management protocols and interventions
c. Autocratic management style
d. Presence of a clinical nurse leader (CNL)
ANS: B
Nurses are expected to practice using evidence-based protocols and interventions for clinical
decision making, and managers are expected to use those management practices that are not
simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that
stand-up meetings took 34% less time to make decisions (Pfeffer & Sutton, 2006). Using this
model could save an organization many hours a year that can be put to another productive use
or could be eliminated from the payroll. However, very few organizations use this model for
meetings even in the face of the clear evidence of the impact it would have on the
organization. The CNL is a highly prepared individual in the clinical setting whose role is to
positively impact patient safety issues by identifying and managing risk while meeting
standards of quality clinical care. Autocratic management style is authoritative. Contingency
leadership style is a style of leading that is flexible to adapt to the situation.

OBJ: Discuss the value of using evidence-based management actions.
20. A nurse manager has an adequate understanding of their nursing role when making which of
the following statements?
a. “A manager selects or assumes a role.”
b. “I have the same function as a floor nurse.”
c. “I have the same authority as the director of the hospital.”
d. “I was appointed to my role.”
ANS: D
Whereas a manager is assigned or appointed to a role, a leader selects or assume a role. The
nurse manager functions differently than a floor nurses, and although the nurse manager has
some authority, it is less than the director of the hospital.

OBJ: Differentiate between management and leadership.
TOP: Management versus leadership MSC: NCLEX®: Not applicable
21. Which of the following actions is consistent with a nurse leader?

a. A nurse who encourages staff to give excellent patient care
b. A nurse who performs chart audits on her staff
c. A nurse who writes yearly staff evaluations
d. A nurse who gives pain medication to an assigned patient
ANS: A
A nurse leader is someone who influences others, such as a nurse who encourages staff to give
excellent patient care. A nurse who performs chart audits and writes staff evaluations is
functioning as a nurse manager. Giving pain medications is a function of the staff or bedside
nurse.

22. A nurse manager has received a report that indicates the infection rate on the unit has gone up
by 25% in the past month. The control phase of management requires that the nurse manager
take action. What should the nurse manager do?
a. Post the report for staff to read.
b. Pull a couple of the nurses aside and discuss the issue with them.
c. Send an email out to the staff with information regarding upcoming infection
prevention conference.
d. Provide a mandatory handwashing in-service to all staff.
ANS: D
The nurse manager has a duty to implement and mandate interventions to reduce infection
rates for her unit. Providing a mandatory handwashing in-service to all staff is the best way to
do this and to ensure that every staff member is competent. The other options may be used in
the process for the nurse manager to set up or reinforce the handwashing in-service program.

TOP: Management versus leadership MSC: NCLEX®: Safe and effective care environment
23. Which of the following actions by the nurse manager would indicate an autocratic
management style?
a. Allows staff members to make most of the decisions
b. Makes most of the decisions without input from the staff members
c. Exerts little control over staff
d. Emphasizes effective group functioning
ANS: B
The autocratic manager uses an authoritarian approach to direct the activities of others. This
manager would make most of the decisions without input from the staff members. Allowing
staff members to make most of the decisions and exerting little control over staff is a
laissez-faire management style. Emphasizing effective group functioning is common for a
democratic management style.

OBJ: Differentiate the concepts of power and authority.
24. The nurse manager identifies which of the following as the most critical step in problem
solving?
a. Brainstorm all possible solutions. c. Evaluate possible solutions.
b. Identify the problem. d. Choose a solution.
ANS: B
The most critical step in the problem solving process is to identify the problem. Brainstorming
solutions, evaluating possible solutions, and choosing a solution occur after the problem has
been identified.

OBJ: Apply problem-solving strategies to clinical management situations.
TOP: Management problem solving MSC: NCLEX®: Not applicable
25. Which action by the nurse indicates placement in the unfreezing phase of Lewin’s Change
Theory?
a. The nurse reconsiders what has caused themself to be resistant to change.
b. The nurse begins the process of implementing change.
c. The change has become routine.
d. The change is permanent.
ANS: A
Lewin’s Change Theory consists of three phases: unfreezing, moving, and refreezing. In the
unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the
moving phase, the nurse begins the process of implementing change. In the refreezing phase,
the change has become a permanent, routine part of the nurse’s life.

OBJ: Discuss the change process. TOP: The challenge of change
MULTIPLE RESPONSE
1. Which of the following actions is consistent with a manager? (Select all that apply.)
a. Planning the agenda for a staff meeting
b. Directing nurse assistants in how to divide up patient care assignments
c. Organizing a group of nurses to present a topic at a staff meeting
d. Giving blood at the local hospital blood drive
e. Assume control of the guidelines for how hourly rounding will work on the unit
ANS: A, B, C, E
Managers plan, direct, organize. and control activities designated to their staff. Giving blood
at the local hospital would not be an action that is consistent with a nurse manager role.

2. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all
that apply.)
a. Developing goals that reflect the mission and vision of the organization
b. Defining strategies to meet the mission and vision of the organization
c. Providing direction for staff to perform the work of the organization
d. Retaining accountability for all work completed by the staff
e. Planning for contingencies which may interfere with the work of the organization
ANS: A, B, E
In the planning phase, the nurse manager will develop goals, define strategies, and plan for
contingencies that may interfere with the work. The next phase of management is providing
direction to staff and retaining accountability for all work completed by the staff.

OBJ: Management versus leadership. TOP: Differentiate between management and leadership
3. Which of the following statement by the nurse reflect transformational leaders? (Select all that
apply.)
a. Lifelong learners
b. Courageous change agents
c. Slow to change
d. Value-driven visionaries
e. Hesitant to follow
ANS: A, B, D
Transformational leaders are lifelong learners, courageous change agents, and value driven
visionaries. They are not slow to change or hesitant to follow.

OBJ: Describe theories of management and leadership.
4. Which of the following describes reward power used by the nurse manager? (Select all that
apply.)
a. A nurse manager who uses fear of consequences to motivate staff
b. A nurse manager who uses salary increases to motivate staff
c. A nurse manager who is perceived as an expert due to specialized knowledge
d. A nurse manager who is well liked by the majority of staff
e. A nurse manager who has information that others need to perform their jobs
ANS: A, B
Reward power occurs when nurse managers provide or withhold rewards. A nurse manager
who is perceived as an expert has expert power. A nurse manager who is well liked the
majority of staff has referent power. A nurse manager who has information needed by others
to perform their jobs has informative power.

OBJ: Differentiate the concepts of power and authority.
TOP: Power and authority in nursing management MSC: NCLEX®: Not applicable
MATCHING
Match the leadership theory with the appropriate description.

a. Development of trust in relationship; uses democratic concepts of management and
views the tasks to be accomplished from the standpoint of a team member
b. Holds power and control over followers by providing incentives when the
followers respond in a positive way to the leader’s vision and the actions needed to
reach that vision
c. Situation is analyzed and leadership style is selected that will best address issues
d. Process in which leader and followers work together in a way that changes or
transforms the organization, the employees or followers, and the leader
e. Leadership is flexible enough to address varying situations
f. Needs to look at systems, such as those in health care organizations, as patterns of
relationships and the interactions that occur among those in the system
1. Complexity theory
2. Transformational leadership
3. Contingency leadership
4. Transactional leadership
5. Situational leadership
6. Interactional leadership
1. ANS: F PTS: 1 DIF: Cognitive Level: Application

REF: p. 216 OBJ: Discuss theories of management and leadership.
2. ANS: D PTS: 1 DIF: Cognitive Level: Application
REF: pp. 214-215 OBJ: Discuss theories of management and leadership.
3. ANS: E PTS: 1 DIF: Cognitive Level: Application
4. ANS: B PTS: 1 DIF: Cognitive Level: Application
5. ANS: C PTS: 1 DIF: Cognitive Level: Application
6. ANS: A PTS: 1 DIF: Cognitive Level: Application

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Nursing Today Transition and Trends

8th Edition Zerwekh Test Bank

1. What is the most consistent concern of the nurse as manager?

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208

PTS: 1 DIF: Cognitive Level: Application REF: p. 212

3. What do the responsibilities of the nurse manager include?

PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 212

5. Which statement best describes effective leadership by the nurse manager?

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 216

PTS: 1 DIF: Cognitive Level: Application REF: p. 224

PTS: 1 DIF: Cognitive Level: Application REF: p. 226

PTS: 1 DIF: Cognitive Level: Application REF: p. 212

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222

PTS: 1 DIF: Cognitive Level: Application REF: p. 208

PTS: 1 DIF: Cognitive Level: Application REF: p. 212

PTS: 1 DIF: Cognitive Level: Application REF: p. 229

PTS: 1 DIF: Cognitive Level: Application REF: p. 229

PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 218

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 225

PTS: 1 DIF: Cognitive Level: Application REF: p. 208

21. Which of the following actions is consistent with a nurse leader?

PTS: 1 DIF: Cognitive Level: Application REF: p. 208

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208

PTS: 1 DIF: Cognitive Level: Application REF: p. 211

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 224

PTS: 1 DIF: Cognitive Level: Application REF: p. 230

PTS: 1 DIF: Cognitive Level: Application REF: p. 208

PTS: 1 DIF: Cognitive Level: Application REF: p. 208

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 214

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222

Match the leadership theory with the appropriate description.

1. ANS: F PTS: 1 DIF: Cognitive Level: Application

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