Book Review Leadership

Chapter 01: Decision Making, Problem Solving, Critical Thinking, and Clinical
Reasoning: Requisites for Successful Leadership and Management
1. The nurse is applying a decision-making process to a clinical challenge. When applying this
process, the nurse must:
a. analyze the root causes of a situation.
b. begin by solving the underlying problem.
c. choose between different courses of action.
d. prioritize the maximum good for the maximum number of people.
ANS: C
Feedback: Decision making is a complex, cognitive process often defined as choosing a
particular course of action. Problem solving is part of decision making and is a systematic
process that focuses on analyzing a difficult situation. It is not always realistic for the nurse
to solve each of the problems contributing to a larger challenge, especially at the beginning
of the decision-making process. The nurse often lacks the time, information, or resources to
analyze the root causes of a situation. Many times, the nurse makes a decision that benefits
the largest number of people, but this is not always feasible or desirable.
PTS: 1 DIF: Moderate REF: Page: 3 OBJ: 1

NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter Number: 01: Title: Decision Making, Problem Solving, Critical Thinking,
and Clinical Reasoning KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
2. The nurse is applying the traditional problem-solving model when mediating in a conflict
between two colleagues. When applying this model, the nurse should prioritize what task?
a. Identifying the root cause of the conflict
b. Implementing a solution as quickly as possible
c. Eliciting input from other nurses
d. Encouraging each nurse to reflect on his or her actions
ANS: A
Feedback: The traditional problem-solving model attempts to identify the root problem in
situations, a task that can require much time and energy. Efficiency is desirable, but trying
to implement a solution as quickly as possible can result in a hasty and incorrect solution.
Reflective thinking is always beneficial, but this is not a specific component of the
traditional problem-solving model. Outside input may or may not be necessary; this varies
with each individual problem.

TOP: Chapter Number: 01: Title: Traditional Problem-Solving Process
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
3. Which statement is true regarding decision making?

a. Scientific methods provide identical decisions by different individuals for the same
problems.
b. Decisions are greatly influenced by each person’s value system.
c. Personal beliefs can be adjusted for when the scientific approach to problem
solving is used.
d. Past experience has little to do with the quality of the decision.
ANS: B
Feedback: Values, life experience, individual preference, and individual ways of thinking
will influence a person’s decision making. No matter how objective the criteria will be,
value judgments will always play a part in a person’s decision making, either consciously or
subconsciously. It is not possible for a nurse to fully “set aside” personal beliefs when
making a decision, even if the nurse applies the principles of self-reflection.

TOP: Chapter Number: 01: Title: Values KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. The nurse-manager of a short-staffed unit needs to make a decision about a nurse’s request
for an unpaid leave of absence. In order to increase the chance of making a good decision,
the manager should:
a. involve as many people in the decision-making process as possible.
b. begin the decision-making process by presuming the status quo to be the best
option.
c. generate as many different alternatives as possible.
d. prioritize the option that is most innovative.
ANS: C
Feedback: The greater the number of alternatives that can be generated by the decision
maker, the better the final decision will be. Generating multiple alternatives may require
involving more people in the decision-making process, but the process can easily become
unwieldy if too many people are involved. The manager should always consider the status
quo as a possible option, but this is not always considered to be the default option.
Innovation is often a desirable characteristic, but it would be inappropriate to choose an
option solely because it is innovative; many other values must be considered.

TOP: Chapter Number: 01: Title: Generate Numerous Alternatives
5. An experienced nurse-manager has been described as being a “right-brain thinker.” This

manager’s decision-making process likely prioritizes what characteristic?
a. Linear analysis
b. Intuition
c. Transparency
d. Efficiency
ANS: B
Feedback: Right-brained thinkers have traditionally been characterized as being creative and
intuitive. Linear analysis is more closely aligned with left-brained thinking. Transparency
and efficiency are desirable qualities that are not particularly aligned with either of these
two paradigms.
PTS: 1 DIF: Easy REF: Page: 18 OBJ: 3 | 4

TOP: Chapter Number: 01: Title: Brain Hemisphere Dominance and Thinking Styles
6. The nurse-manager is applying an evidence-based approach to a clinical question around

client mobilization. When using a PICO format to search for evidence, the nurse should
identify what?
a. The role of intuition in the decision-making process
b. The preferences of clients and their families
c. The clients for whom the intervention would be relevant
d. Costs associated with a potential change in practice
ANS: C
Feedback: The PICO (patient or population, intervention, comparison, and outcome) format
is used in evidence-based practice to guide the search for the current best evidence to
address a problem. Client and family preferences and cost are included in evidence-based
practice but are not explicit components of the PICO format. Intuition is a component of
decision making but is not specifically included in the PICO format.
PTS: 1 DIF: Moderate REF: Page: 14 OBJ: 5 | 6

TOP: Chapter Number: 01: Title: Use an Evidence-Based Approach
7. The nurse-manager is applying the decision-making process when addressing a nurse’s high
rate of absenteeism. This process should result in:
a. an outcome that is desired by all.
b. a chosen course of action.
c. an action that guarantees success.
d. a new understanding of the problem.
ANS: B
Feedback: A decision is made when a course of action has been chosen. A decision may not
always be pleasing to everyone involved in the situation, and success can never be fully
guaranteed. The manager should seek to fully understand the problem, but this is a phase in
decision making, not the result of the process.
PTS: 1 DIF: Easy REF: Page: 3 OBJ: 1

8. The nurse-manager is faced with a difficult decision in a situation that involves the
manager’s values. What is the manager’s best action?
a. Try to base a decision on intuition rather than values.
b. Set aside his or her values and make a rationale decision.
c. Defer the decision to a colleague with different values.
d. Identify and reflect on his or her own values.
ANS: D
Feedback: Every person has a value system, and this cannot be simply “set aside.”
Awareness and reflection are necessary to make good decisions in the context of one’s own
values. Intuition and values are not counterpoints, and prioritizing intuition does not negate
the importance of values. Values influence every decision to varying degrees, and it is
impractical to defer every value-laden decision to someone else.

9. Which statement is true concerning critical thinking?

a. It is a simple approach to decision making.
b. It is narrower in scope than decision making.
c. It requires reasoning and creative analysis.
d. It is a synonym for the problem-solving process.
ANS: C
Feedback: Critical thinking has a broader scope and is more complex than decision making
and problem solving. It is sometimes referred to as reflective thinking. Critical thinking also
involves reflecting on the meaning of statements, examining the offered evidence and
reasoning, and forming judgments about facts.

10. A nurse-manager has realized that the data gathering process before a recent decision may
have been influenced by confirmation bias. How can the manager best prevent this in the
future?
a. Delegate data gathering to a trusted colleague who has different values.
b. Make sure not to prioritize information that supports the manager’s beliefs.
c. Consider all of the implications of an alternative before making a decision.
d. Collect only the minimum quantity of data before making a decision.
ANS: B
Feedback: Confirmation bias refers to our tendency to search for and favor information that
confirms our beliefs while simultaneously ignoring or devaluing information that contradicts
our beliefs. Self-awareness and reflection can reduce this tendency. Delegating the
data-gathering process may be beneficial in some situations, but every person is prone to
confirmation bias, although in differing ways. Considering the implications of a decision is
an important part of decision making but does not address the issue of confirmation bias.
Minimizing data collection may reduce confirmation bias but could compromise the quality
of a decision.
PTS: 1 DIF: Difficult REF: Page: 13 OBJ: 8 | 9 | 10

TOP: Chapter Number: 01: Title: Gather Data Carefully
11. A nurse-manager has made a decision and is now preparing to evaluate the decision. What
question should best guide the nurse’s evaluation process?
a. Is evaluation necessary when using a good decision-making model?
b. Can evaluation be eliminated if the problem is resolved?
c. Is every party happy with the outcomes of the decision?
d. Did the outcomes align with the original objectives?
ANS: D
Feedback: The evaluation phase is necessary to find out more about one’s ability as a
decision maker and to find out where the decision making was faulty. This step cannot be
eliminated from the decision-making process because it provides the means for determining
whether a good decision was made. Happiness is not the criterion by which decisions are
usually evaluated. Rather, evaluation is done by comparing actual outcomes to desired
outcomes.

TOP: Chapter Number: 01: Title: Managerial Decision-Making Models
12. Which statement concerning the role of the most powerful individuals in organizational
decision making is true?
a. They exert less influence on decisions than was previously thought.
b. They often make decisions that are in congruence with their own values.
c. They tend to delegate decision making rather than making decisions themselves.
d. They usually make the important decisions with consideration of effect on others.
ANS: B
Feedback: Not only does the preference of the powerful influence decisions of others in the
organization but the powerful are also able to inhibit the preferences of the less powerful.
Powerful people in organizations are more likely to have decisions made that are congruent
with their own preferences and values. Powerful people tend to make decisions on their own
rather than delegating them. Often, the effect on others is not prioritized as highly as it
should be.
TOP: Chapter Number: 01: Title: Effect of Organizational Power
13. One of the nurses on the unit said, “My Vietnamese patient won’t look me in the eye, but I
know that Asian patients avoid making eye contact as a way of showing respect.” This nurse
is demonstrating what type of illogical thinking?
a. Affirming the consequences
b. Arguing from analogy
c. Deductive reasoning
d. Overgeneralizing
ANS: D
Feedback: This type of “crooked” thinking occurs when one believes that because one
person has a particular characteristic, every other person in the same category also has the
same characteristic. It is an overgeneralization to assign one meaning to an action to every
person from an entire continent. This kind of oversimplified deduction is exemplified when
stereotypical statements are used to justify arguments and decisions. When affirming the
consequences, one decides that if B is good and he or she is doing A, then A must not be
good. When arguing from analogy, the nurse applies a component that is present in two
separate concepts and then states that because A is present in B, then A and B are alike in all
respects.

TOP: Chapter Number: 01: Title: Think Logically
14. The nurse has accepted a job in a workplace where organizational power has a pronounced
effect. This characteristic may have what effect on the nurse and the workplace?
a. Many decisions will be delegated to the nurse by supervisors.
b. There will be high levels of mistrust and suspicion at the workplace.
c. Communication will be compromised in the workplace.
d. The nurse may have to accept decisions contrary to his or her own values.
ANS: D
Feedback: The ability of the powerful to influence individual decision making in an
organization often requires adopting a private personality and an organizational personality.
The nurse will often have to accept decisions that solely reflect the values of more powerful
individuals. This may lead to a feeling of powerlessness but not necessarily mistrust and
lack of communication. Delegation of decision making is likely to be rare, not common,
because it is concentrated with those in power.

TOP: Chapter Number: 01: Title: Effect of Organizational Power
15. The unit manager has created a decision grid in order to assist with a difficult staffing
decision that will affect many nurses. The decision grid will allow the manager to:
a. examine alternatives visually and compare each against the same criteria.
b. ensure that the decision is made objectively rather than subjectively.
c. plot the outcomes of a decision over time and evaluate the decision-making
process.
d. predict when events must take place to complete a project on time.
ANS: A
Feedback: A decision grid allows one to visually examine the alternatives and compare each
against the same criteria. This assists with the decision-making process, but it cannot
guarantee that the decision will be completely objective. A decision grid is not a tool for
tracking the outcomes of a decision. Decision grids are not synonymous with project
planning tables.

TOP: Chapter Number: 01: Title: Decision Grids
16. A nurse-manager is planning to apply a decision-making model to a clinical challenge.

When using a decision-making tool, what should the manager do?
a. Be aware that the tool cannot eliminate the risk of human error.
b. Have an impartial colleague apply the tool, if possible.
c. Apply the tool as quickly as possible.
d. Recognize that the tool will negate the effect of the manager’s values.
ANS: A
Feedback: Management decision-making aids are subject to human error and do not remove
the effects of individual values, which always affect decision making. There is no particular
reason that a tool would have to be applied by another person. Making the correct decision
can take time; moving too quickly can compromise the quality of the process.
PTS: 1 DIF: Difficult REF: Page: 22 OBJ: 14

TOP: Chapter Number: 01: Title: Decision-Making Tools
17. A nurse-manager had to intervene in a conflict between a client and a staff member. The
manager chose to make a decision “in the moment” rather than applying a methodical or
deliberate decision-making tool. How should this manager’s actions be best interpreted?
a. The manager applied heuristics to a problem that required a quick solution.
b. The manager should have used a decision-making tool before responding.
c. The manager’s decision was likely made on the basis of emotion.
d. The manager demonstrated an autocratic leadership style.
ANS: A
Feedback: Most individuals rely on discrete, often unconscious processes known as
heuristics, which allows them to solve problems more quickly and to build on experiences
they have gained in their lives. This manager’s prompt decision making exemplifies this
rapid approach. This does not necessarily lead to worse outcomes than a slower, more
methodical approach. Heuristics can be based on experience and knowledge and are not
simply expressions of emotion. Heuristics and rapid decision making are not synonymous
with an autocratic leadership style that downplays input from others.

TOP: Chapter Number: 01: Title: Theoretical Approaches to Problem Solving and
Decision Making KEY: Integrated Process: Nursing Process
18. Which statement is true regarding an economic man style manager?

a. The manager may lack complete knowledge and generate few alternatives.
b. The manager makes decisions that may not be ideal but result in solutions that
have an adequate outcome.
c. The manager is primarily motivated by his or her own financial gain.
d. The manager gathers as much information as possible and produces many
alternatives.
ANS: D
Feedback: Economic managers gather as much information as possible and generate many
alternatives. However, most management decisions are made by using the administrative
man model of decision making, in which the manager never has complete knowledge and
generates fewer alternatives. The term economic man does not suggest that the manager is
motivated by personal financial gain. The administrative man carries out decisions that are
only satisficing, a term used to describe decisions that may not be ideal but result in
solutions that have adequate outcomes.

TOP: Chapter Number: 01: Title: Rational and Administrative Decision Making
19. What characteristic of a nurse-manager best demonstrates left-brained thinking?

a. The manager highly values innovation and intuition when making decisions.
b. The manager’s relationships with peers are prioritized when evaluating decisions.
c. The manager applies a linear, analytical model when making a decision.
d. The manager is open to feedback from staff when making a decision.
ANS: C
Feedback: Analytical, linear, left-brain thinkers process information differently from
creative, intuitive, right-brain thinkers. Placing a value on relationships and being open to
feedback are not specifically associated with one or the other sides of the brain.
TOP: Chapter Number: 01: Title: Brain Hemisphere Dominance and Thinking Styles
20. The nurse-manager is preparing to use the PERT tool when making a staffing decision. This
tool will primarily address what component of the decision-making process?
a. Values
b. Consequences
c. Timing
d. Ethics
ANS: C
Feedback: PERT is a popular tool to determine the timing of decisions. This tool does not
explicitly address some of the other relevant considerations when making decisions,
including values and ethics. This tool does not focus on the evaluation (consequences)
component of decision making.

TOP: Chapter Number: 01: Title: Program Evaluation and Review Technique
21. The nurse is working with a group of students who are learning a high-risk procedure. How
should the nurse best ensure learning while protecting the safety of clients?
a. Create an unfolding case study featuring the procedure.
b. Use simulation for the students to learn and practice the skill.
c. Help the students use a decision-making model to choose the safest technique.
d. Teach the students about the traditional problem-solving process before they
practice the procedure.
ANS: B
Feedback: Simulation provides learners opportunities for problem solving that have little or
no risk to clients or to organizational performance while providing models, either
mechanical or live, to provide experiences for the learner. Simulation is generally
considered to be more realistic (and conducive to learning) than a case study and no less
safe. A decision-making or problem-solving model is not normally implemented when
learning new skills or procedures.

TOP: Chapter Number: 01: Title: Case Studies, Simulation, and Problem-Based Learning
22. Which statements demonstrate a characteristic of a critical thinker? Select all that apply.
a. “Since that didn’t work effectively, let’s try something different.”
b. “The solution has to be something the client is willing to do.”
c. “I’ll talk to the client’s primary care giver about the problem.”
d. “Maybe there is no new solution to this particular problem.”
e. “It’s important that we not give up; our clients deserve it.”
ANS: A, B, C, E
Feedback: A critical thinker displays persistence, empathy, and assertiveness. Trying a new
approach shows persistence. Considering the client’s participation shows empathy.
Speaking to the care provider on the client’s behalf shows assertiveness. Concluding that
there is no solution to a problem reflects an inability to think outside the box. Stating “It’s
important that we not give up; our clients deserve it” shows persistence and empathy.

BLM: Cognitive Level: Analyze NOT: Multiple Selection
23. What is the value of using a structured approach to problem solving for the novice nurse?
a. Facilitates effective time management
b. Supports the acquisition of clinical reasoning
c. Supplements the orientation process
d. Encourages professional autonomy
ANS: B
Feedback: A structured approach to problem solving and decision making increases clinical
reasoning and is the best way to learn how to make quality decisions because it eliminates
trial and error and focuses the learning on a proven process. This is particularly helpful to
the novice nurse with limited clinical experience and intuition. The other options are
outcomes of the possession of critical thinking skills and clinical reasoning.

TOP: Chapter Number: 01: Title: Theoretical Approaches to Problem Solving and
Decision Making KEY: Integrated Process: Nursing Process
24. A novice nurse has been trying to apply the nursing process to each client interaction. What
should the nurse do to enhance the effectiveness of this process for making decisions and
solving problems?
a. Ensure that specific goals are identified during the planning process.
b. Conduct assessment and diagnosis simultaneously whenever possible.
c. Prioritize ethics during each phase of the nursing process.
d. Avoid evaluating the process until every outcome has been met.
ANS: A
Feedback: The weakness of the nursing process, like the traditional problem-solving model,
is in not requiring clearly stated objectives. Goals should be clearly stated in the planning
phase of the process, but this step is frequently omitted or obscured. Assessment and
diagnosis often cannot be performed at the same time. Ethics should always be considered,
of course, but this variable is not identified as enhancing the overall effectiveness of the
nursing process. Evaluation is recommended as an ongoing, iterative process that is not
reserved for when all outcomes have been met. Indeed, it is impossible to determine whether
outcomes have been met without performing evaluation.

TOP: Chapter Number: 01: Title: The Nursing Process
25. A team of nurse-managers is considering the purchase of pressure-reducing mattresses to

reduce the incidence of pressure ulcers among long-term care residents. In order to use a
payoff table to assist with the decision making, what must the managers know? Select all
that apply.
a. The cost for each new mattress
b. Clients’ expectations for how a mattress should feel
c. The prognosis for recovery from a pressure ulcer
d. The cost of treating pressure ulcers
e. The amount of time between ordering the mattresses and their delivery
ANS: A, D
Feedback: Payoff tables can be used to make decisions involving cost, profit, and volume.
To make a decision, the team would need to know how much it costs to introduce a mattress
and how much it costs to treat a pressure ulcer. Other variables such as client expectations,
timing, and prognosis would be considered when making a decision, but these variables
would not be quantified into a payoff table.

TOP: Chapter Number: 01: Title: Payoff Tables
BLM: Cognitive Level: Apply NOT: Multiple Selection
26. A nurse is considering applying for a management job that will require the nurse to make
many difficult decisions. What question should the nurse ask when considering his or her
ability to make difficult decisions?
a. “How comfortable am I with taking risks?”
b. “Am I able to apply the nursing processes in varied circumstances?”
c. “Am I usually able to please my coworkers?”
d. “How quickly do I think?”
ANS: A
Feedback: An individual’s comfort level with risk has a major bearing on that person’s
ability and willingness to make difficult decisions. It also affects the outcomes of decisions.
The nursing process can have application in the decision-making process, but it is not
among the most common decision-making models in management situations. A focus on
pleasing other people may make it difficult to arrive at a decision when there are not ideal
options available. Quick thinking can be beneficial when making some decisions, but people
who are more methodical thinkers are not necessarily at a disadvantage. Quick thinking does
not always lead to wise decisions.

TOP: Chapter Number: 01: Title: Individual Preference
27. A nurse-manager has to make some difficult decisions around the allocation of vacation
time during the holiday season. When making a decision, what should the manager do first?
a. Elicit ideas from as many staff members as possible.
b. Consider how the issues has been addressed in the past.
c. Think of as many alternatives as possible.
d. Clearly identify each of the desired objectives in the situation.
ANS: D
Feedback: Regardless of what decision-making or problem-solving tool a manager is going
to use, the process must necessarily begin with clear identification of the objectives. Once
these are determined, subsequent steps like engaging stakeholders, creating alternatives, and
considering previous approaches can be performed.

TOP: Chapter Number: 01: Title: Define Objectives Clearly
28. The nurses on a medical unit are using several different techniques for performing wound
care and the manager recognizes a need to implement evidence-based practice (EBP). What
should the manager do first when applying the principles of EBP?
a. Identify the main peer-reviewed journals in field of wound care.
b. Formulate a specific, searchable clinical question about wound care.
c. Perform a review of the literature about wound care.
d. Identify how expert nurses typically perform wound care.
ANS: B
Feedback: The implementation of EBP usually follows a linear approach that begins with
formulating a specific question that can be used to guide a literature search. This should be
done before starting a literature review or consulting experts in the field.

TOP: Chapter Number: 01: Title: Use an Evidence-Based Approach
29. A nurse has accepted a management position in a busy ambulatory clinic and recognizes that
the day-to-day operations of the clinic will require many decisions. What is the nurse’s best
initial action when preparing for this new role?
a. Identify staff who are likely to be allies.
b. Determine where organizational power exists in the clinic.
c. Clarify and reflect on his or her own values.
d. Collaborate with the previous manager of the clinic.
ANS: C
Feedback: Values clarification is an imperative first step when preparing for a role that
requires decision making and problem solving. This form of internal examination must
precede strategic interactions with others or an analysis of where power lies in the
organization. Internal examination should come before external examination.

30. A sales representative is describing the benefits of a new brand of incontinence brief to a
manager. The representative states, “These are a superior product. With what you’re
currently using, you’re actually causing harm to your clients.” How should the manager best
interpret this statement?
a. The representative is analogy.
b. The representative is overgeneralizing about the new briefs.
c. The representative is overgeneralizing about the briefs the unit currently uses.
d. The representative is affirming the consequences.
ANS: D
Feedback: Affirming the consequences is a logical fallacy where a person decides that if B
(i.e., the new brief) is good and he or she is doing A (i.e., using the old brief), then A must
not be good. The fact that the new brief is good does not mean the old brief is bad.
Overgeneralizing involves extending characteristics of an individual to a group. Arguing
from analogy is illogical thinking that applies a component that is present in two separate
concepts and then states that because A is present in B, then A and B are alike in all
respects. The representative is not suggesting that the two types of briefs are alike.

TOP: Chapter Number: 01: Title: Think Logically
Chapter 02: Classical Views of Leadership and Management
1. Which represents the management functions that are incorporated into the management
process?
a. Planning, directing, organizing, staffing, and transforming
b. Planning, organizing, staffing, directing, and controlling
c. Inspiring, planning, staffing, directing, and evaluating
d. Organizing, staffing, planning, empowering, and controlling
ANS: B
Feedback: Management functions include planning, organizing, staffing, directing, and
controlling. These are incorporated into what is known as the management process.
Inspiring, empowering, and transforming are more often associated with a leadership role.

TOP: Chapter Number: 02: Title: Key Concepts
BLM: Cognitive Level: Remember NOT: Multiple Choice
2. The manager of a care facility advocates traditional management science. What is this
manager most likely to prioritize?
a. Ensuring that workers are satisfied in their roles
b. Identifying and addressing barriers to efficiency
c. Empowering workers to make decisions independently
d. Providing rewards for exceptional caring
ANS: B
Feedback: Classical, or traditional, management science focuses on production in the
workplace and on delineating organizational barriers to productivity and efficiency. Little
attention was given to worker job satisfaction, and workers were assumed to be motivated
solely by economic rewards. This management style tends to be more authoritarian than
empowering. Rewards are more likely to be conferred on workers who increase efficiency
rather than those who exemplify psychosocial concepts, such as caring.

3. Caregivers at a public health center believe that their manager adheres to Theory X. What
action by the manager best confirms this suspicion?
a. The manager collaborates with senior staff to set quarterly goals for the center.
b. The manager insists on accompanying nurses to community events and observes
them closely.
c. The manager is difficult to access when there is a problem or crisis in the center.
d. The manager allocates rewards based on the outcomes of nurses’ work.
ANS: B
Feedback: Theory X managers believe that their employees are basically lazy, need constant
supervision and direction, and are indifferent to organizational needs. Close scrutiny of
nurses’ performance would suggest this perspective. Being inaccessible during a crisis is an
undesirable trait in a manager, but this does not directly suggest a Theory X perspective.
Collaboration and the distribution of rewards would be more closely associated with a
Theory Y approach, which is more optimistic.

TOP: Chapter Number: 02: Title: Human Relations Management (1930 to 1970)
4. Accreditors are scheduled to visit a hospital site, and staff members have been made aware
of what they will be assessing. What staff behavior would most clearly suggest the presence
of the Hawthorne effect?
a. The nurses consciously improve their performance because they know it is being
scrutinized.
b. The nurses avoid contact with the accreditors because they fear criticism.
c. The manager blames individual nurses for deficits identified in the accreditation
report.
d. The manager temporarily adopts a leadership role.
ANS: A
Feedback: The Hawthorne effect indicated that people respond to the fact that they are being
studied, attempting to increase whatever behavior they feel will continue to warrant the
attention. Avoiding scrutiny does not demonstrate this effect, which involves improving
one’s performance, knowing that it is being observed. Blame shifting does not reflect this
deliberate improvement in performance, or does adopting a leadership role on a temporary
basis, which may or may not be seen as beneficial.

5. The manager at a long-term care facility has intervened in a conflict between two staff
members about the timing and length of lunch and coffee breaks. What management
function is this manager demonstrating?
a. Planning
b. Organizing
c. Directing
d. Evaluating
ANS: C
Feedback: Directing entails human resource management responsibilities, such as
motivating, managing conflict, delegating, communicating, and facilitating collaboration.
Planning encompasses determining philosophy, goals, objectives, policies, procedures, and
rules; carrying out long- and short-range projections; determining a fiscal course of action;
and managing planned change. Organizing includes establishing the structure to carry out
plans, determining the most appropriate type of patient care delivery, and grouping activities
to meet unit goals. Evaluation is not one of the five specific functions in the management
process.

TOP: Chapter Number: 02: Title: Management Functions Identified
6. A manager demonstrates one of the four principles of scientific management when he or

she:
a. shows an interest in employees’ personal lives and emotional health.
b. engages in lifelong learning and expects employees to do the same.
c. allows employees to do their jobs independently, with minimal oversight.
d. hires and promotes employees on the basis of their competence and skills.
ANS: D
Feedback: Frederick W. Taylor, the “father of scientific management,” had the idea that
workers should be hired, trained, and promoted based on their competence and abilities.
Scientific management did not emphasize relationships between managers and employees,
lifelong learning, or high levels of independence for workers.
PTS: 1 DIF: Difficult REF: Page: 40 OBJ: 1 | 2

TOP: Chapter Number: 02: Title: Scientific Management (1900 to 1930)
7. What aspect of the way that work is organized on a nursing unit best reflects the
management theories of Max Weber?
a. A committee that includes employees and managers has been established to plan
the work on the unit.
b. The hierarchy of authority and the policies and procedures on the unit are clearly
posted.
c. Quarterly awards are granted to employees who have demonstrated exceptional
service.
d. Employees are allowed to self-schedule their vacation time and must work out any
conflicts on their own.
ANS: B
Feedback: Weber saw the need for legalized, formal authority and consistent rules and
regulations for personnel in different positions. Clear expectations around authority and
processes reflect Weber’s beliefs. Weber did not emphasize collaborative decision making,
using awards to incentivize work, or autonomy in workers’ decision making.
PTS: 1 DIF: Difficult REF: Page: 41 OBJ: 1 | 2 | 6
TOP: Chapter Number: 02: Title: Scientific Management (1900 to 1930)
8. The clinic leader tends to make decisions independently and closely supervises and controls
the practice of the nurses at the clinic. What type of leadership is being exemplified?
a. Authoritarian
b. Democratic
c. Laissez-faire
d. A contingency approach
ANS: A
Feedback: Authoritarianism is associated with decision making that does not involve others
and strong control. Democratic leadership emphasizes broad participation in decision
making, and a laissez-faire approach highly permissive with low control. A contingency
approach emphasizes the need for flexibility in leadership, not high control and centralized
decision making.

TOP: Chapter Number: 02: Title: Behavioral Theories (1940 to 1980)
9. How can a manager best implement the principles of situational or contingency leadership
theory?
a. By establishing rules and norms that can be applied in all conditions in the
organization
b. By avoiding punitive consequences when addressing workers’ lack of performance
c. By deferring to employees for day-to-day management decisions
d. By adapting his or her leadership style to a particular circumstance
ANS: D
Feedback: The idea that leadership style should vary according to the situation or the
individuals involved was first suggested almost 100 years ago by Mary Parker Follett and is
central to contingency (situational) leadership. This model of leadership does not emphasize
workers’ autonomy in decision making, rigid rules and norms, or the avoidance of
consequences.

TOP: Chapter Number: 02: Title: Situational and Contingency Leadership Theories (1950
to 1980) KEY: Integrated Process: Nursing Process
10. Which statement best depicts leadership?

a. Strong leaders can coerce people into following them.
b. A leadership position has a narrower scope than a management position.
c. People will follow a person in a leadership position only by choice.
d. Leadership requires meeting organizational goals.
ANS: C
Feedback: Those individuals who choose to follow a leader do so by choice, not because
they have to; “followership” cannot be coerced. Leadership is a much broader concept than
management, which implies a more specific and finite role. Leadership is not necessarily
dependent on meeting organizational goals.

TOP: Chapter Number: 02: Title: Leaders
11. What characteristic of a nurse-manager suggests that he or she is acting in the role of a
traditional manager rather than an integrated leader-manager?
a. The manager is conscious of the important role of politics and is politically astute.
b. The manager has an outward view, extending to the larger organization.
c. The manager’s influence is limited to his or her group.
d. The manager emphasizes the importance of vision and values.
ANS: C
Feedback: Traditional managers influence those in their own groups, whereas integrated
leaders influence others beyond their own group. Political astuteness, an outward view, and
an emphasis on vision and values are all characteristics of the integrated leader-manager.

TOP: Chapter Number: 02: Title: Integrating Leadership Roles and Management
Functions
12. What statement by a leader most clearly demonstrates the Great Man theory of leadership?
a. “Leadership is grounded in close, supportive relationships.”
b. “Leadership and management are two different manifestations of one skill set.”
c. “Some people are born to lead, and some are born to be led.”
d. “Leadership can’t exist without earning people’s respect.”
ANS: C
Feedback: The Great Man theory purports that some people are born to lead and some are
born to follow. This early theory of leadership did not emphasize the role of relationships or
earning the respect of others. This theory did not state that leadership and management were
a synonymous skill set.

TOP: Chapter Number: 02: Title: The Great Man Theory/Trait Theories (1900 to 1940)
13. A nurse-manager has recently been accused of assigning work unequally. The manager has
recognized the need to revise the process for assigning work to nurses. How can the
manager best apply the principles of Theory Z?
a. Making a decision independently and imposing it on the nurses
b. Gathering input from employees in order to reach a consensus
c. Making a decision based on the pros and cons of each option
d. Identifying as many different alternatives as possible
ANS: B
Feedback: The characteristics of Theory Z include consensus decision making. Autocratic
decision making, formal analysis of pros and cons, and maximizing the number of
alternatives are not major characteristics of this leadership theory.

TOP: Chapter Number: 02: Title: Interactional Leadership Theories (1970 to Present)
14. The nurse who manages an ambulatory clinic is well known as being a visionary leader who
is skilled at empowering others with this vision. What type of leader is this nurse?
a. Transactional
b. Transformational
c. Interactional
d. Bureaucratic
ANS: B
Feedback: Transformational leadership is characterized by the presence of a vision.
Transformational leaders impart this to others, creating a collective purpose. The traditional
manager, concerned with the day-to-day operations, was termed a transactional leader.
Transactional leaders are not typically known as being visionaries. Bureaucratic leaders are
focused on functions and processes, not vision. The basic premise of interactional theory is
that leadership behavior is generally determined by the relationship between the leader’s
personality and the specific situation; vision is not a central focus.

TOP: Chapter Number: 02: Title: Transactional and Transformational Leadership
15. A nurse-leader has set a goal of becoming a more transformational leader. What outcome
will best indicate progress toward achieving this goal?
a. The nurse maximizes efficiency when allocating scarce resources.
b. The nurse’s subordinates demonstrate respect and loyalty.
c. The nurse empowers others to reach their full potential.
d. The nurse provides praise for good work performances.
ANS: C
Feedback: Transformational leadership is characterized by empowering others and instilling
them with vision. Transactional leadership is more management-oriented and includes
functions around rewarding performance and allocating resources. Transactional and
transformational leadership can both result in loyalty and respect.

TOP: Chapter Number: 02: Title: Table 2.2 Transactional and Transformational Leaders
16. What management activity characterizes the priorities that existed during the human
relations era of management?
a. Collaborative decision making
b. Punishing workers who were unproductive
c. Granting equal rights to men and women
d. Application of laissez-faire leadership
ANS: A
Feedback: The human relations era of management science emphasized concepts of
participatory and humanistic management in which participative management was espoused.
This included workers in decision making, which was innovative at the time. This did not
mean that men and women gained equal rights. Leadership became more democratic but
was not characterized as laissez-faire. Punitive actions were not central to human relations
management.

17. A nurse oversees the care on a hospital unit in the role of an integrated leader-manager.
What characteristics should this nurse exhibit? Select all that apply.
a. The nurse describes herself has an “inward thinker.”
b. The nurse’s thinking includes long-term issues.
c. The nurse consciously attempts to motivate the employees.
d. The nurse has influence that goes beyond her own group.
e. The nurse is always conscious of political realities.
ANS: B, C, D, E
Feedback: Gardner asserted that integrated leader-managers possess six distinguishing traits:
They influence others beyond their own group; they emphasize vision, values, and
motivation; they think longer term; they look outward, toward the larger organization; they
are politically astute; and they think in terms of change and renewal.

Functions
18. The nurse-manager of a community clinic is applying the principles of interactional

leadership when addressing a challenging situation. What variables should the nurse
prioritize when applying this model of leadership? Select all that apply.
a. The characteristics of the nurse’s personality
b. The financial resources available to the nurse
c. The consequences of failure
d. The factors that motivate the employees of the clinic
e. The specifics of the clinical challenge that the nurse is addressing
ANS: A, E
Feedback: The basic premise of interactional theory is that leadership behavior is generally
determined by the relationship between the leader’s personality and the specific situation.
The nurse would not ignore other variables, such as finances, employee motivation, and the
risks for failure, but these are not the central considerations in the model of interactional
leadership.

19. The nurse-manager of the perioperative department is attempting to apply the full-range
leadership model (FRLM) when overseeing the department. The nurse should attempt to
integrate what types of leadership? Select all that apply.
a. Laissez-faire
b. Scientific
c. Autocratic
d. Transactional
e. Transformational
ANS: A, D, E
Feedback: The FRLM integrates the principles of laissez-faire, transactional, and
transformational leadership. This model does not emphasize practices associated with
autocratic leadership. Scientific management is an antiquated model of management that
was influential in the early 20th century, not in contemporary models of leadership such as
FRLM.

TOP: Chapter Number: 02: Title: Full-Range Leadership Model/Theory
20. The manager of a busy emergency department is primarily concerned with the practical,
day-to-day operations of the department. This manager is most clearly demonstrating what
type of leadership?
a. Transactional
b. Transformational
c. Interactional
d. Bureaucratic
ANS: A
Feedback: The traditional manager, concerned with the day-to-day operations, is termed a
transactional leader. Transformational leadership prioritizes longer term vision and
empowerment. Bureaucratic leadership emphasizes rules and regulations, whereas
interactional leadership focuses on the link between personality and situations.

21. What statement by a manager best reflects the principles of interactional leadership?
a. “People’s motives are important, and motives change over time.”
b. “People perform to their fullest potential and then they’re under pressure.”
c. “A person can’t simultaneously act as a manager and a leader.”
d. “Organizations run best when there is no formal, centralized authority.”
ANS: A
Feedback: Interactional leadership emphasizes the fact that people’s motives are very
important and that these are constantly changing. Interactional leadership does not prioritize
pressure as a form of incentive or motivation, and it does not deny a role for authority or for
the integration of leadership and management principles.

22. Which activities are associated with a leadership role? Select all that apply.
a. Mentoring two new managers
b. Establishing goals for the coming year
c. Advocating for nurses to receive more professional development opportunities
d. Providing a motivational speech at the new employee orientation
e. Finding a nurse to cover another nurse’s shift
ANS: A, B, C, D
Feedback: Leadership roles include mentoring, decision making, advocating, and
energizing. Risk taking is also considered a leadership role. Day-to-day functions such as
staff scheduling are more closely associated with a management role.
TOP: Chapter Number: 02: Title: Display 2.3 Common Leadership Roles
23. The failure to engage in which activities are considered a fatal flaw of leadership? Select all
that apply.
a. Collaboration with colleagues
b. Communication with employees
c. Self-improvement
d. Staff development
e. Determining salary scales for employees
ANS: A, B, C, D
Feedback: Leadership is flawed and likely ineffective when the leader does not collaborate
and communicate effectively with others in the organization. The improvement and
development of both others and oneself is vital to the effectiveness of a leader. Clear
forward thinking is associated with good leadership. Variables related to pay scales are more
suggestive of a management role; this particular activity is not identified as a fatal flaw of
leadership.

TOP: Chapter Number: 02: Title: Display 2.2 Ten Fatal Leadership Flaws
BLM: Cognitive Level: Understand NOT: Multiple Selection
24. Which statement by a subordinate demonstrates the greatest challenge for the leader?
a. “Your plans for the change can’t realistically be implemented.”
b. “I don’t think you heard what the rest of us had to say.”
c. “Do you have an idea what direction we need to go?”
d. “Can you tell me why my suggestion will not work?”
ANS: A
Feedback: The statement is a clear indication that the subordinate feels the leader is not
listening and collaborating; this is a fatal flaw. The subordinate is not making a statement
that leads to dialogue and solutions. The other statements express openness to explanation
by and with the subordinate and leader.

TOP: Chapter Number: 02: Title: Display 2.2 Ten Fatal Leadership Flaws
25. Which function of the management process involves the performance evaluation of
employees?
a. Planning
b. Organizing
c. Staffing
d. Controlling
ANS: D
Feedback: Controlling is the function that includes performance appraisals, fiscal
accountability, quality control, legal and ethical control, and professional and collegial
control. Planning encompasses determining philosophy, goals, objectives, policies,
procedures, and rules; carrying out long- and short-range projections; determining a fiscal
course of action; and managing planned change. Organizing includes establishing the
structure to carry out plans, determining the most appropriate type of patient care delivery,
and grouping activities to meet unit goals. Staffing functions consist of recruiting,
interviewing, hiring, and orienting staff.

26. A nurse has been hired to oversee the operations of a series of ambulatory clinics. The nurse
can best promote the success of the organization by:
a. promoting management skills among all employees.
b. integrating leadership skills and management skills.
c. clearly communicating to employees that they will be required to follow.
d. advocating for the organization to hire a leader for each site.
ANS: B
Feedback: Success and high achievement are best promoted when leadership and
management functions are integrated by individuals. Promoting certain management skills
among employees can be beneficial, but this cannot replace the importance of the
leader-manager’s own skill set. Followership cannot be mandated; it must be earned. The
presence of multiple leaders can make it more difficult to effect change because of diverse
visions.

Functions
27. What action by the nurse-manager in a health organization best demonstrates

transformational leadership?
a. The manager readily takes responsibility after making a scheduling error.
b. The manager’s employees are reminded that they must submit evidence of
renewing their license.
c. The manager informs each employee about the new criteria that will be the basis of
the performance reviews.
d. The manager holds a workshop to outline a new vision for patient-centered care.
ANS: D
Feedback: Transformational leadership often involves the communication of a vision and
empowering employees to share in it. Functions involving performance review, scheduling,
and licensure are more consistent with a transactional role. Taking responsibility is a trait of
effective transformational and transactional leadership.

28. A nurse was 20 minutes late returning from a scheduled lunch break and a colleague’s break
was consequently cut short. What response by the manager best demonstrates a laissez-faire
leadership approach?
a. Ask each of the nurses to speak with the manager separately to discuss the
implications of this event.
b. Ask the nurses to attend a short meeting together in the manager’s office.
c. Allow the two nurses to dialogue about this event and observe for evidence of a
satisfactory resolution.
d. Impose a meaningful consequence on the first nurse and have the nurse apologize
to the colleague.
ANS: C
Feedback: Laissez-faire leadership is generally understood to be a “hands-off” approach.
The manager using this approach would likely allow the two nurses to self-manage this
event and reach a solution independently. Requiring a meeting would be a more
authoritarian or autocratic approach. Punishing the nurse and requiring an apology would be
a strongly autocratic approach.

29. The nurse-manager is addressing a nurse’s suspected breach of client confidentiality in a

social media posting. What function of the management process is this nurse-manager
demonstrating?
a. Organizing
b. Staffing
c. Directing
d. Controlling
ANS: D
Feedback: Legal and ethical issues, such as violations of confidentiality, are categorized
within the controlling function. Organizing includes establishing the structure to carry out
plans, determining the most appropriate type of patient care delivery, and grouping activities
to meet unit goals. Staffing functions consist of recruiting, interviewing, hiring, and
orienting staff. Directing entails human resource management responsibilities, such as
motivating, managing conflict, delegating, communicating, and facilitating collaboration.

30. The nurse-manager has been approached by three different families in recent weeks, all of
whom have described a particular nurse as giving exceptional care. The manager has relayed
this feedback to the nurse and nominated the nurse for an organization-wide award. How
should the manager’s actions be best interpreted?
a. The manager is giving an example of democratic leadership.
b. The manager’s actions are likely to cause accusations of favoritism.
c. The manager is following the Great Man theory of leadership.
d. The manager’s actions may inadvertently discourage the other nurses.
ANS: A
Feedback: Democratic leadership involves the use of awards and feedback. The Great Man
theory posits that leadership is an inherent trait, not a learned trait; the manager’s actions do
not point to this. There is no reason to believe that a commendation may discourage the
nurse’s peers. Accusations of favoritism are unlikely, provided the manager’s
commendation is evidence-based.

Chapter 03: Twenty-First-Century Thinking About Leadership and
Management
1. What action by a nurse-manager best demonstrates servant leadership?

a. Prioritizing the interests of others over the manager’s own interests
b. Cultivating a personal relationship with each subordinate
c. Making decisions on the basis of customer service
d. Communicating a clear vision for the future and asking subordinates to share it
ANS: A
Feedback: Managers who are servant leaders put serving others, including employees,
customers, and the community, as the number one priority. This attitude is not dependent,
however, on having a personal relationship with every subordinate. Customer service is
valued, but the servant leader also emphasizes the needs of employees and the community.
Servant leadership has a place for vision, but this is not a specific characteristic of this type
of leadership.

TOP: Chapter Number: 03: Title: Servant Leadership
2. The nurse-manager who seeks to exemplify emotional intelligence should:

a. attempt to remove emotion from decision making.
b. prioritize emotion over reason when making decisions.
c. regulate his or her own emotions and those of others.
d. effectively manipulate the emotions of others to achieve goals.
ANS: C
Feedback: Theorists studying emotional intelligence posit that the ability to regulate the
emotions of self and others is key to effective leadership. Emotional intelligence does not
involve removing emotion from decision making; conversely, it does not claim that emotion
should trump reason. Management of emotions is not the same as manipulating the emotions
of others, which is unethical.

TOP: Chapter Number: 03: Title: Emotional Intelligence
3. The leader-manager provides oversight on a busy medical–surgical unit. There has recently
been an incident where two nurses were not honest about neglecting a controversial new
protocol and misled the leader. How can the leader-manager best prevent similar episodes?
a. Support employees’ right to disagree with proposed changes.
b. Ensure that employees know the consequences of misleading the manager.
c. Avoid making decisions that displease large numbers of employees.
d. Identify allies who can be trusted to report employees who may mislead the
manager.
ANS: A
Feedback: There is no guarantee that followers will not mislead leaders, but adhering to
certain principles, such as making sure that followers are allowed to disagree, will guard
against this happening. The manager can often not avoid making unpopular decisions.
Enacting punitive measures (consequences) has not been shown to encourage honesty. The
use of “informants” is likely to cultivate mistrust and is likely to increase dishonesty.

TOP: Chapter Number: 03: Title: New Thinking About Leadership and Management
4. Which statement regarding the characteristics of a good leader is true?

a. They are brave in all situations.
b. They may have character flaws.
c. They are by nature good-intentioned.
d. Charisma is their strongest attribute.
ANS: B
Feedback: Leaders may be deceitful and trustworthy, greedy and generous, and cowardly
and brave. To assume that all good leaders are good people is foolhardy and makes us blind
to the human condition. It is only when we recognize and manage our failings that leaders
achieve greatness. No one can be brave in each and every situation. Many good leaders have
strong charisma, but this is not always the case.

TOP: Chapter Number: 03: Title: Authentic Leadership
5. To decrease overtime, the manager of a surgical unit offers nurses who get their work
finished on time for an entire 2-month period an extra day off with pay at regular time. The
nurse is enacting what model of leadership?
a. Favoritism
b. Quantum leadership
c. Principal agent theory
d. Servant leadership
ANS: C
Feedback: Principal agent theory suggests that followers may have an informational
(expertise or knowledge) advantage over the leader as well as their own preferences, which
may deviate from that of the principal. This may lead to a misalignment of goals. To
influence the agent, the principal offers an incentive that corrects excessive overtime. This
action is performance-based, so it would be difficult to characterize it as favoritism. Servant
leadership prioritizes the interests of others; creating incentives to address the misalignment
of goals is not central to servant leadership. Quantum leadership is a holistic theory of
leadership that does not mainly focus on the alignment of disparate goals.

TOP: Chapter Number: 03: Title: Principal Agent Theory
6. A nurse has been hired to oversee a day surgery clinic. What action will best ensure good
outcomes for this nurse, the clients, and the employees of the clinic?
a. Implement the principles of authoritative leadership.
b. Teach all employees about the financial considerations at the clinic.
c. Consciously develop the ability to be charismatic.
d. Integrate nursing management and nursing leadership roles and practices.
ANS: D
Feedback: For managers and leaders to function at their greatest potential, the two roles
must be integrated. This helps ensure positive outcomes for all. Authoritative leadership is
generally not preferred in the 21st century because it has poorer results than more
contemporary models. Charisma can be beneficial in a leadership position, but it is not
among the major traits of successful leadership and management. A focus on finances with
all employees is not normally necessary and is not linked to high-level outcomes.

Functions in the 21st Century KEY: Integrated Process: Nursing Process
7. A new leader-manager is planning to implement the principles of strengths-based leadership

after being hired for a new position. What action will best facilitate this plan?
a. Creating a team with diverse abilities and talents
b. Identifying his or her personal strengths and utilizing them
c. Appraising team members on a scale that runs from “weaker” to “stronger”
d. Organizing the flow of work to match his or her strengths
ANS: A
Feedback: Strengths-based leadership posits that effective leaders surround themselves with
people who have different strengths than they do. The leader should focus on addressing
areas where he or she is weaker, not relying solely on existing strengths. This model does
not rank people on a two-dimensional scale because there are diverse ways of being strong.

TOP: Chapter Number: 03: Title: Strengths-Based Leadership and the Positive Psychology
Movement KEY: Integrated Process: Nursing Process
8. A leader is applying the principles of emotional intelligence? What outcome indicates

successful application of these principles?
a. Emotions are held in check.
b. Emotions are used effectively.
c. Emotions dominate decision making.
d. Expression of emotion indicates success.
ANS: B
Feedback: Emotional intelligence (EI) refers to the ability to use emotions effectively and is
required by leader-managers in order to enhance their success. Holding one’s emotions in
check can be unhealthy; EI does not demand this. EI does not require that emotions
dominate decision making or that the expression of emotion is the marker of success.

9. A manager has proposed to the hospital board that it hire someone to teach management and
leadership classes and that head nurses are paid to attend the classes. What is this an
example of?
a. Using emotional intelligence
b. Transformational leadership
c. Building human capital
d. Using quantum leadership
ANS: C
Feedback: By providing classes in leadership, the manager is investing in the potential of
the head nurse staff to become better leaders and managers. Human capital refers to the
attributes of a person that are productive in some economic context, although it is normally
measured and conceived of as a private return to the individual as well as a social return.
There is no mention of the role of emotions or emotional intelligence. Quantum leadership
focuses on the dynamic and multifactorial nature of leadership, but this is not evident in the
scenario. Transformational leadership focuses on influencing and promoting vision; these
are not evident in the scenario.

TOP: Chapter Number: 03: Title: Human and Social Capital Theory
10. An organization has hired six RNs who are recent immigrants. The manager has noticed
they interact very little with other staff, often speaking in their own language during their
breaks, although they speak English while on duty. Which intervention would be the most
helpful action for the manager to help these new RNs better assimilate?
a. Explain to the new nurses the problem that their isolating is causing.
b. Arrange to send them to an English language course at the local adult school.
c. Ask the established RNs to make an effort to include the new nurses in after-work
activities.
d. Hold a sharing session so all RNs can share information about their cultures and
differences in client care.
ANS: D
Feedback: This situation has varied nuances that require the manager to address many
factors. Providing an opportunity for both groups of nurses to share their cultural heritage
and differences in nursing care is an opportunity to promote acceptance among all members
of the staff. It has been established that speaking the language is not a problem because they
do so while on duty. Including them in after-work activities may demonstrate willingness on
the staff’s part but will not address work-related isolation. Merely presenting the problem to
the new nurses does not show managing initiative.

TOP: Chapter Number: 03: Title: New Thinking About Leadership and Management
11. A nurse-manager will soon be introducing a significant change in the way that overtime
shifts are allocated on a hospital floor. What action by the manager will best demonstrate the
principles of thought leadership?
a. Convincing employees that the change will be beneficial and innovative
b. Relating the change to the fact that the floor has been required to cut costs
c. Delegating the implementation of the change to the nurses themselves
d. Describing clear expectations for nurses’ adherence to the new policy
ANS: A
Feedback: Thought leadership refers to any situation in which one individual convinces
another to consider a new idea, product, or way of looking at things. Thought leadership
does not emphasize financial realities, delegation, or the need for rigid adherence.

TOP: Chapter Number: 03: Title: Thought Leadership and Rebel Leadership
12. When applying the principles of quantum leadership, the nurse-manager should prioritize:
a. careful management of emotions.
b. his or her own values, beliefs, and moral character.
c. the difference between personal goals and organizational goals.
d. the fact that workplaces are complex and dynamic.
ANS: D
Feedback: Quantum leadership suggests that the environment and context in which people
work is complex and dynamic and that this has a direct impact on organizational
productivity required by leader-managers in order to enhance their success. Authentic
leadership suggests that in order to lead, leaders must be true to themselves and their values
and act accordingly. Quantum leadership does not prioritize the difference between personal
and organizational goals or the management of emotions.

TOP: Chapter Number: 03: Title: Quantum Leadership
13. Twenty-first-century leadership models generally emphasize the importance of:

a. relationships.
b. incentives.
c. motivation.
d. consequences.
ANS: A
Feedback: A transition has occurred in the 21st century from industrial age leadership to
relationship age leadership. Most of the contemporary models of leadership have some form
of emphasis on relationships. Incentives, consequences, and motivation are not ignored, but
relationships are highly prioritized.

Functions in the 21st Century KEY: Integrated Process: Nursing Process
14. There are current and future paradigm shifts in health care that affect the leadership skills
needed by nurses in the 21st century. What issue at the organizational and unit levels are
nurse-leaders being directed to address?
a. Active involvement in greatly needed health-care reform
b. Persistent and growing international nursing shortage
c. Increasing disparities between health outcomes for wealthy clients and poorer
clients
d. High turnover rates by staff nurses
ANS: D
Feedback: At the organizational and unit levels, nurse-leaders are being directed to address
high turnover rates by staff, an emerging shortage of qualified top-level nursing
administrators, growing trends toward unionization, and intensified efforts to legislate
minimum staffing ratios and eliminate mandatory overtime while maintaining cohesive and
productive work environments. At the national level, nurse-leaders and nurse-managers are
actively involved in greatly needed health-care reform and in addressing a persistent, and
likely growing, international nursing shortage. Healthy disparities exist at regional and
national levels, not organizational levels.

TOP: Chapter Number: 03: Title: Introduction
15. A nurse-manager demonstrates Level 5 leadership by performing what action?

a. Keeping emotions in check
b. Accepting nothing less than perfection from subordinates
c. Taking responsibility for errors that he or she makes
d. Avoiding conflict unless absolutely necessary
ANS: C
Feedback: Level 5 leaders know when to ask for help, accept responsibility for the errors
they or their team make, and are incredibly disciplined in their work. This model does not
have a particular emphasis on avoiding conflict or keeping emotions in check. Rejecting
anything short of perfection is unrealistic and is not cited as a characteristic of a Level 5
leader.

TOP: Chapter Number: 03: Title: Level 5 Leadership
16. A subordinate has accused a manager of favoritism after the manager created the work
assignment for the day. How should the manager best apply the principles of emotional
intelligence?
a. Identify and reflect on the feelings that she experiences after being accused.
b. Recognize that the subordinate’s statement was likely based on emotion rather than
evidence.
c. Involve a colleague in the situation who has no emotional investment in the
situation.
d. Choose a response that will diffuse the subordinate’s emotions.
ANS: A
Feedback: Self-awareness is a key component of emotional intelligence that involves the
ability to recognize and understand one’s moods, emotions, and drives as well as their
effects on others. The manager should apply this aspect of emotional intelligence by
self-reflection. This self-awareness can often help the manager address a challenging
situation without having to involve an impartial third party. Emotional intelligence requires
a manager to empathize with others’ emotions, but this does not mean that decisions should
be made with the sole goal of diffusing people’s emotions. The manager must acknowledge
the role of emotion but should not assume that a subordinate’s complaint is exclusively
emotional and lacking a rational basis.

TOP: Chapter Number: 03: Title: Display 3.4 Five Components of Emotional Intelligence
17. A nurse-manager has been attending several conferences and workshops in order to network
with colleagues and build relationships with people outside the organization. How should a
nurse best interpret this manager’s actions?
a. The manager is building on his or her strengths.
b. The manager’s self-regulation is likely to grow because of this activity.
c. The manager is demonstrating servant leadership, which will ultimately benefit the
whole organization.
d. The manager is applying the social skills necessary for emotional intelligence.
ANS: D
Feedback: Social skills are a component of emotional intelligence and involve proficiency in
handling relationships and building networks in an effort to find common ground. Servant
leadership is characterized by selfless acts, which are not in evidence in this scenario.
Similarly, there is no obvious evidence of the manager building on his or her strengths.
Self-regulation is a component of emotional intelligence, but it involves controlling or
redirecting disruptive impulses or moods; there is no indication that the manager is doing
this.

TOP: Chapter Number: 03: Title: Display 3.4 Five Components of Emotional Intelligence
18. Two nurses have approached the manager and have asked the manager to speak to a nurse
on the unit who has a reputation for being difficult to get along with. How can the manager
best implement authentic leadership?
a. Meet with the “difficult” nurse to assess emotions.
b. Analyze the facts of the situation before making a decision.
c. Encourage all three nurse to meet without the manager present.
d. Encourage all three nurses to disregard their emotions.
ANS: B
Feedback: Four factors cover the components of authentic leadership. One of these is
balanced processing, which involves analyzing data rationally before making decisions. This
model acknowledges the salience of emotions, and it would not be appropriate or realistic to
ask people to ignore them. Authentic leadership focuses on affective ways of being and does
not prescribe specific actions like arranging meeting.

19. A new nurse-manager has set a goal of implementing authentic leadership. What is the
manager’s best initial action?
a. Identify and reflect on her own principles.
b. Examine the source of her power in the organization.
c. Differentiate colleagues who are allies from those who are potential threats.
d. Delegate management activities so she can focus on leadership.
ANS: A
Feedback: In authentic leadership, the leader’s principles and values are paramount.
Identifying these is a logical starting point for implementing authentic leadership.
Separating people into allies and enemies is likely to result in conflict and authoritarianism.
Authentic leadership does not require that all management activities must be delegated;
authentic leadership can occur in a blended leadership–management role. Examining
sources of power may be a necessary practical concern, but this is not a focus of authentic
leadership and its focus on principles and values.

20. An organization is facing budget cuts and the manager has openly shared the details,
rationale, and implications of the cuts with staff. The manager has also expressed feelings of
disappointment about the cuts. What component of authentic leadership has the manager
demonstrated?
a. Balanced processing
b. Internalized moral perspective
c. Relational transparency
d. Self-awareness
ANS: C
Feedback: Relational transparency refers to openly sharing feelings and information
appropriate to a situation, as this manager has done. Balanced processing refers to analyzing
data rationally before making decisions. Internalized moral perspective suggests that the
authentic leader is guided by internal moral standards, which then guide his or her behavior,
and self-awareness alludes to a knowing of self so as to make sense of the world.
21. What actions by the nurse-manager are consistent with relationship age leadership? Select
all that apply.
a. Communicating regularly and openly with employees
b. Encouraging teamwork to solve problems and address issues
c. Including committee representatives from all areas that will be affected by a
change
d. Recognizing staff members who have contributed to the organization’s goals
e. Encouraging competition between staff members to increase overall efficiency
ANS: A, B, C, D
Feedback: People skills, transparent communication, cooperation, and valuing staff
knowledge are all characteristics of the relationship age leader. Promoting competition is
characteristic of an industrial age leader.

TOP: Chapter Number: 03: Title: Table 3.1 A Shift in Paradigms: The Context for the
New Leadership KEY: Integrated Process: Nursing Process
22. The leadership of a health-care organization has chosen to implement human capital theory.
What actions should the organization promote in order to meet this goal? Select all that
apply.
a. Giving subsidies to nurses who want to advance their education
b. Increasing the frequency of performance appraisals for managers
c. Providing in-services and workshops for nurses and other care providers
d. Increasing opportunities for families to participate in care planning
e. Providing salary increases of 2% for all nonmanagement staff
ANS: A, C
Feedback: Human capital theory emphasizes the benefits of investing in education and
professional development. Making performance appraisals more frequent for managers is
inconsistent with this focus on education and professional development. Salary increases are
invariably popular but do not build capacity by increasing knowledge and skills. Similarly,
including families is beneficial to the quality of care but is not a direct example of human
capital theory.

23. Which activity best supports the principles of strengths-based leadership in a health-care
organization?
a. Funding for staff to become educated in areas where they are naturally talented
b. Providing remedial services to staff who have committed a medication error
c. Mental health counseling for staff who have depression or anxiety
d. Smoking cessation support classes
ANS: A
Feedback: Strengths-based leadership, which grew out of the positive psychology
movement (began in the late 1990s), focuses on the development or empowerment of
workers’ strengths as opposed to identifying problems, improving underperformance, and
addressing weaknesses and obstacles. Investing in staff to develop areas where they are
naturally talented is an example of this. Remedial learning, counselling, and treatment
address problems or vulnerabilities, not strengths.

24. Which characteristics are associated with a Highly Capable Individual in Collin’s Level 5
Leadership model? Select all that apply.
a. Possesses useful knowledge
b. Builds effective interdisciplinary teams
c. Galvanizes members to achieve goals
d. Has the talent and skills needed to do a good job
e. Works effectively to help a team succeed
ANS: A, D
Feedback: In Level 1 of this model, a highly capable individual makes high-quality
contributions with their work, possesses useful levels of knowledge, and has the talent and
skills needed to do a good job. Team building and teamwork are Level 2 characteristics,
whereas galvanizing members to achieve goals is demonstrated by Level 4 leaders.

TOP: Chapter Number: 03: Title: Display 3.2 Jim Collins's Level 5 Leadership
25. Which response is most characteristic of a servant leader?

a. “I don’t think you have the skills necessary to be effective.”
b. “Let me think about that request for 24 hours and get back to you.”
c. “Do whatever it takes to get it done fast.”
d. “I’ll personally handle this situation.”
ANS: B
Feedback: A servant leader always thinks before reacting. This leader also chooses words
carefully so as to not damage those being led, provides directions toward goal achievement,
and finds asking for input more important than personally providing solutions. Speed is not
a priority within servant leadership.

TOP: Chapter Number: 03: Title: Display 3.3 Defining Qualities of Servant Leaders
26. A nurse has recently begun a leadership–management role and is most likely to face
challenges in:
a. resolving tensions between baccalaureate-educated nurses and nurses without a
degree.
b. promoting best outcomes for clients while reducing costs.
c. educating nurses about their legal scope of practice.
d. marketing the organization to members of the community.
ANS: B
Feedback: The fiscal realities of nursing and health care are known to make great demands
on managers and leaders, regardless of their setting. For this reason, this challenge is more
likely than intraprofessional tensions, which are more likely to be isolated. Marketing is not
normally the responsibility of the nurse manager-leader. Scope of practice affects what
nurse can and cannot do, but it is not the manager’s responsibility to educate them about
this; most professionals have a grasp of this before beginning a job.

27. The leaders of a health-care organization ascribe to human capital theory and are planning
the budget for the next year. What activity should the team prioritize in the budget to
promote the goals of this theory?
a. Signing bonuses for nurses who are hired from outside the region
b. Incentives for staff members who provide exemplary care and who make no errors
c. Community outreach activities that will increase engagement between staff and
residents
d. Reimbursement of tuition to nurses who are upgrading their education
ANS: D
Feedback: Human capital theory prioritizes the long-term benefits of investing in training
and education. Incentives, signing bonuses, and community outreach do not run contrary to
this theory, but these actions are not direct examples of prioritizing skills acquisition and
educational development.

28. The chief nursing officer is assembling a leadership team. The nurse is ensuring that the
team is made up of people who have a diverse range of natural talents and skills. This leader
is most clearly exemplifying what theory of leadership?
a. Level 5 Leadership
b. Emotional intelligence
c. Strengths-based leadership
d. Authentic leadership
ANS: C
Feedback: Strengths-based leadership emphasizes the need to not only identify one’s own
strengths but also to surround oneself with people who have different strengths. Emotional
intelligence prioritizes the importance of values, emotions, and feelings. Level 5 Leadership
focuses on the affective traits of strong leaders. Authentic leadership is a holistic model that
encompasses many more variables than just strengths.

29. A nurse manager-leader is experiencing many challenges overseeing the care in a

health-care organization. What statement most clearly indicates a need to apply quantum
leadership principles?
a. “There’s a lot of conflict, not just between nurses but also between members of
other disciplines.”
b. “Our workplace is in a constant state of change. Each part of our work is
unpredictable and always shifting.”
c. “Historically, many decisions seem to have been made on the basis of emotion,
and I’d really like to change that.”
d. “There’s a rift between management and employees and it affects
communication.”
ANS: B
Feedback: Quantum leadership posits that today’s workplace is a highly fluid, flexible, and
mobile environment, and this calls for an entirely innovative form of leadership. Quantum
leadership encompasses varied aspects of this uncertainty, such as conflict and emotion, but
these are not the central focuses of this theory.

TOP: Chapter Number: 03: Title: Quantum Leadership
30. A nurse-manager has proposed a change in the skills mix on a hospital unit, with fewer
registered nurses and more nursing assistants. What outcome best demonstrates that the
nurse is applying the principles of thought leadership?
a. Skeptics of the plan have begun to see it as innovative and beneficial.
b. Individuals who oppose the plan have become isolated by their peers.
c. Nurses and nursing assistants will both participate in the operations planning.
d. The ultimate decision on the matter will be based on rational ideas rather than
emotions.
ANS: A
Feedback: Thought leadership refers to any situation in which one individual convinces
another to consider a new idea, product, or way of looking at things. The theory does not
advocate achieving this through ostracizing dissenters. Inclusive leadership groups are
beneficial, but this is not a particular characteristic of thought leadership. Thought
leadership does not imply a rejection of emotion.

TOP: Chapter Number: 03: Title: Thought Leadership and Rebel Leadership
Chapter 04: Ethical Issues
1. Which statement best describes ethics?

a. How our lives and relationships are led in day-to-day circumstances
b. How people make decisions they see as legally and morally appropriate
c. The conflict, power, and interdependency associated with the way we live
d. What our conduct and actions should be regarding what is right and good
ANS: D
Feedback: Ethics is the systematic study of what a person’s conduct and actions should be
with regard to self, other human beings, and the environment; it is the justification of what is
right or good and the study of what a person’s life and relationships should be, not
necessarily what they are. It is not the study of what people actually do in their daily lives or
how they live but rather what they should do. Ethics is related to legality and morality, but it
is not synonymous with these concepts.

2. A nurse is facing an ethical dilemma about whether to report a colleague’s offensive

comment, an action which is likely to jeopardize their relationship. What is a characteristic
of this nurse’s ethical dilemma?
a. The dilemma can be solved by applying empirical data.
b. The situation involves a breach of the law.
c. The dilemma has no realistic solution.
d. The situation involves two or more undesirable alternatives.
ANS: D
Feedback: Ethical dilemmas involve being forced to choose between two or more
undesirable alternatives. Ethical dilemmas are often not amenable to being solved with
empirical data; they involve values and beliefs, not only facts. Most ethical dilemmas do not
involve a breach of the law; legal issues often have a more clear and unambiguous response.
Even though ethical dilemmas are difficult to manage, this does not mean that there is no
possibility of a realistic solution.

TOP: Chapter Number: 04: Title: Moral Issues Faced by Nurses
3. The A nurse is applying the ethical principle of justice when providing care for clients.
What action best exemplifies this principle?
a. Meeting continuing education requirements for license renewal
b. Prioritizing actions that will benefit the largest number of clients
c. Respecting clients’ rights to make decisions about their care
d. Ensuring that time and resources are distributed equitably to clients
ANS: D
Feedback: The principle of justice states that equals should be treated equally and that
unequals should be treated according to their differences; this is the principle of equity.
Justice is frequently applied when there are scarcities or competition for resources or
benefits. Meeting requirements for licensure is a legal issue, not a principle of ethics. The
principle of utility involves prioritizing actions that will benefit the largest number of
clients. Respecting clients’ rights to make decisions demonstrates autonomy.

TOP: Chapter Number: 04: Title: Justice (Treating People Fairly)
4. The only treatment alternative left for a client diagnosed with advanced cancer is a rare,
highly experimental bone marrow transfusion with a 10% success rate. Some individuals are
arguing that the high cost of the procedure could be better spent providing well-baby
screening for 2,000 residents in the service area. What ethical principle is most directly
involved in this situation?
a. Unethical conduct
b. Maleficence
c. Paternalism
d. Utility
ANS: D
Feedback: The principle of utility states that what is best for the common good outweighs
what is best for the individual. There is no indication of unethical or maleficent (harmful)
behavior. Paternalism would be characterized by decisions being made without the client
having input.

TOP: Chapter Number: 04: Title: Utility KEY: Integrated Process: Nursing Process
5. A nurse is applying the MORAL decision-making model to a dilemma involving a

colleague’s possible dishonesty in documentation. What is the nurse’s initial action?
a. Perform a critical self-reflection of the nurse’s own morals and values.
b. Think of as many alternatives as possible.
c. Gather as much information about the situation as possible.
d. Engage the colleague in the decision-making process.
ANS: C
Feedback: The first step of the MORAL decision-making model is to “massage the
dilemma.” This involves collecting data about the ethical problem and who should be
involved in the decision-making process. However, this does not necessarily mean that the
nurse must engage the colleague who is the object of the decision. Outlining options
(alternatives) is the second step in the model. It is presumed that a nurse will engage in
self-reflection when addressing dilemmas, but this is not an explicit component of the
MORAL model.

TOP: Chapter Number: 04: Title: Display 4.5 The MORAL Decision-Making Model
6. A nurse has been asked to stay after a shift and work overtime because three nurses have
called in sick. The nurse is reluctant to work the overtime because of a social commitment.
Duty-based reasoning would dictate that the nurse:
a. carefully weigh the effect of the decision on workplace relationships.
b. work overtime because of the responsibility owed to clients.
c. base the decision on recent precedents in the health-care organization.
d. contact the three nurses to remind them of their obligations.
ANS: B
Feedback: Duty-based reasoning is an ethical framework stating that some decisions must
be made because there is a duty to do something or to refrain from doing something. In this
case, it could be construed that the nurse has a duty to care for clients that supersedes social
activities. Duty-based reasoning would not prioritize the effect on relationships over the
nurse’s moral duty. Precedents would not necessarily indicate what the nurse’s duty is.
Duty-based reasoning emphasizes the nurse’s own duty, not that of colleagues.

TOP: Chapter Number: 04: Title: Ethical Frameworks for Decision Making
7. A nurse is integrating the code of ethics when making a decision about the best response to
a challenging situation. What information will the nurse be able to obtain from this
document?
a. Legal guidelines to help the nurse make an ethical decision
b. The principles that are most valued in nursing practice
c. A model that will guide the nurse to make an ethical decision
d. Guidelines that will help the nurse clarify his or her own values
ANS: B
Feedback: A professional code of ethics is a set of principles, established by a profession, to
guide the individual practitioner. It is not, however, a decision-making model or a tool for
clarifying one’s own values. Codes of ethics are not legally binding documents.

TOP: Chapter Number: 04: Title: Codes of Ethics and Professional Standards
8. The nurse is faced with a situation that requires ethical decision making. What statement
should guide the nurse’s action?
a. Outcomes are the main criterion for evaluating ethical decision making.
b. Only desirable alternatives should be identified when solving ethical dilemmas.
c. Critical ethical decisions should be made quickly so the situation does not worsen.
d. Accepting some ambiguity and uncertainty is a part of ethical decision making.
ANS: D
Feedback: Ethical decision makers choose between two or more undesirable alternatives,
and because they can use only the information and resources available at the time, they must
live with some ambiguity and uncertainty. Processes must be considered during ethical
decision making, not only outcomes. The nurse should identify as many alternatives as
possible during the early stages of decision making, not only desirable alternatives. Ethical
decisions often require a careful and methodical approach rather than a quick decision.

Functions in Ethics KEY: Integrated Process: Nursing Process
9. Which statement by a nurse most clearly demonstrates an intuitionist framework for ethical
decision making?
a. “I’ll make the best decision if I choose the option that comes to mind first rather
than overanalyzing the situation.”
b. “I’m trying to think of as many different options as I can rather than focusing on
those that look most attractive.”
c. “It’s important that I consider the effect of my decision on the organization, not
just the people who are directly involved.”
d. “I’ve got to look at this situation on the basis of its unique characteristics, not by
comparing it to other situations.”
ANS: D
Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine
relative goals, duties, and rights. Consequently, there is a focus on the specific
characteristics of a situation, not its commonalities with other situations. Thinking of as
many options as possible is a good practice for ethical decision making, but it is not
specifically aligned with an intuitionist framework. Similarly, considering the effects on the
organization is not a particular characteristic of this framework. Intuition does not entail
choosing the option that first comes to mind, without any further analysis or consideration.

TOP: Chapter Number: 04: Title: Table 4.1 Ethical Frameworks
10. The principle of autonomy would have the greatest bearing on what clinical situation?
a. A client is discussing a do-not-resuscitate order with the care team.
b. A client is unable to afford the treatment that carries the best chance for a cure.
c. A nurse is considering whether to report a colleague’s rough treatment of a client.
d. The nurse is caring for two clients in pain and must choose which to treat first.
ANS: A
Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and
accepting the responsibility for one’s choice. Deciding on resuscitation options involves this
principle because the client’s preference is the final determinant on the matter. Situations
involving scarce resources or time are more closely aligned with issues of justice. The
nurse’s ethical decision making around reporting bad practice align most closely with
duty-based reasoning and beneficence for clients.

TOP: Chapter Number: 04: Title: Autonomy (Self-Determination)
11. The care team is working with a client who has mental illness and who has been deemed a
threat to self and others. It may be justified to take away the client’s right to:
a. justice.
b. confidentiality.
c. self-determination.
d. beneficence.
ANS: C
Feedback: When an individual’s impaired decision making poses a threat to self or others, it
may be in the interests of the client and other people to temporarily remove the client’s right
to self-determination. That is, to remove the client’s right to reject treatment. This is
ultimately an act of beneficence, even though the client may perceive otherwise. Justice is
more closely aligned with the distribution of benefits between people. Confidentiality is
maintained whether or not the client’s right to self-determination remains in place.

12. The interdisciplinary team is considering whether to apply the principle of paternalism in
the care of a client. What question should guide the team’s decision?
a. Does the client have strong social or family support?
b. What is the client’s most likely prognosis?
c. Is the client competent to make decisions?
d. What interventions are in the client’s best interest?
ANS: C
Feedback: Paternalism can be invoked when a client is unable to make sound decisions for
himself or herself. Consequently, the client’s ability to make decisions underlies the
question of whether acting paternalistic is justified or not? The presence or absence of social
and family support does not justify or rule out paternalism. Likewise, the particulars of the
client’s prognosis do not determine whether it is appropriate to be paternalistic. The client’s
competence decides whether the care team is justified in stepping in to act in the client’s
“best interest.”

TOP: Chapter Number: 04: Title: Paternalism
13. The nurse has navigating a difficult situation that involved an ethical dilemma. Which
factors should be considered when assessing the quality of the nurse’s ethical
problem-solving process? Select all that apply.
a. The outcomes of the process
b. The process that was used to arrive at a decision
c. The number of alternatives that the nurse initially generated
d. The process the nurse used for data gathering
e. Precedents in the organization involving similar situations
ANS: A, B, C
Feedback: Outcomes should never be used as the sole criterion for assessing the quality of
ethical problem solving because many variables affect outcomes that have no reflection on
whether the problem solving was appropriate. Quality, instead, should be evaluated both by
the outcome and the process used to make the decision. Rigorous data gathering enhances
the decision-making process, but this is not the criteria by which the overall process is
gauged. Similarly, precedents can be used to inform decision making but do not constitute
the basis for evaluating the overall process. Generating multiple alternatives aids the
problem-solving process by identifying as many options as possible.

14. The nurse has applied the MORAL decision-making model to a situation that involved an
ethical dilemma. The nurse should complete the process by:
a. evaluating the effectiveness of the decision-making process.
b. reaffirming the nurse’s relationships with stakeholders.
c. disseminating the results of the process to other nurses.
d. leading the implementation plan.
ANS: A
Feedback: The final phase of the MORAL decision-making model involves “looking back.”
That is, evaluating the decision-making process. This model does not explicitly involve
reaffirming relationships or disseminating the results, even though the model does not
preclude these actions. Implementing the decision precedes the evaluation phase.

15. Which statement is correct regarding the distinction between legal and ethical obligations in
decision making?
a. Ethical controls are clearer and philosophically impartial.
b. Ethical controls are much clearer and individualized.
c. Legal controls are clearer and philosophically impartial.
d. Legal controls are much less clear and individualized.
ANS: C
Feedback: In general, legal controls are clearer and philosophically impartial; ethical
controls are much less clear and individualized.

TOP: Chapter Number: 04: Title: Separate Legal and Ethical Issues
16. The nurse-manager has learned there is conflict between a nonresponsive client’s family
members about the best plan of care. The manager recognizes the complex ethics of this
situation. What is the manager’s best action?
a. Base a decision on the most recent precedent in the organization.
b. Make contact with the hospital’s ethics committee.
c. Refer the family to the hospital’s spiritual care service.
d. Ask an impartial staff member to mediate.
ANS: B
Feedback: An ethics committee can bring needed experience, perspective, and insight to
challenging ethical situations. Precedent cannot always be used as a guide because each
situation is unique even if they appear superficially similar. Clients and families often
benefit from spiritual care, but this does not help the manager make a good decision.
Mediation can sometimes be beneficial, but this does not release the nurse-manager from
addressing the situation as best as he or she can.

TOP: Chapter Number: 04: Title: Collaborate Through Interprofessional Ethics
Committees KEY: Integrated Process: Nursing Process
17. In which situation would the nurse be justified in overriding a client’s right to
confidentiality?
a. An older adult client discloses to the nurse that her son occasionally hits her.
b. A client states that he does not want to know the results of his recent diagnostic
test.
c. A client does not want her husband to know that she is a client on the unit.
d. A teenage client asks the nurse not to tell her parents that she is pregnant.
ANS: A
Feedback: Health-care managers are required by law to report certain cases, such as drug
abuse in employees, elder abuse, and child abuse. This is considered a justifiable violation
of confidentiality. The manager is obliged to respect client confidentiality around disclosing
pregnancy, acknowledging a hospital admission, or not wanting to know diagnostic results.

TOP: Chapter Number: 04: Title: Confidentiality (Respecting Privileged Information)
18. The new nurse-manager has committed to modeling the leadership roles associated with
applying ethics in the workplace. What is the manager’s best action?
a. Demonstrate self-awareness about his or her own beliefs, morals, and values.
b. Ensure that individual rights are always prioritized over collective rights.
c. Delegate ethical decision making to staff nurses whenever possible.
d. Ensure nurses are responsible for scrutinizing each other’s behavior to monitor for
ethical violations.
ANS: A
Feedback: A core competency for ethical leadership is evaluating one’s own values and
beliefs. This form of self-reflection is foundational for providing ethical care and promoting
in others. The balance between individual and collective rights is situation-specific;
individual rights are not always priorities over group interests. The manager must show
leadership in ethical decision making and cannot always delegate this important function to
staff. Ethical nurses are observant for violations, but this should not result in an environment
where each nurse is “scrutinizing” colleagues’ practice.

TOP: Chapter Number: 04: Title: Display 4.1 Leadership Roles and Management
Functions Associated With Ethics KEY: Integrated Process: Nursing Process
19. Which nurse is experiencing moral distress?

a. A nurse witnesses a colleague using a racial slur in a conversation with another
nurse.
b. The children of a terminally ill client do not want the client’s prognosis
communicated to the client.
c. A nurse knows that a colleague called in sick to work because the colleague had a
social engagement.
d. A heavy workload prevents a nurse from providing the care that each client
requires.
ANS: D
Feedback: Each of the listed situations has an ethical element. However, moral distress
occurs when the individual knows the right thing to do but organizational constraints make
it difficult to take the right course of action. A nurse who lacks the time and energy to give
clients what they need is likely to experience moral distress. Issues of respect, honesty, and
confidentiality require ethical decision making, but they do not directly involve a disconnect
between the desire and the ability to do the right thing.

20. The nurse is practicing in a challenging environment where ethical and moral issues must
often be dealt with. Which statement describes how moral uncertainty occurs?
a. An individual is unsure which moral principles or values apply and may even
include uncertainty as to what the moral problem is.
b. An individual knows the right thing to do, but organizational constraints make it
difficult to take the right course of action.
c. An individual witnesses the immoral act of another but feels powerless to stop it.
d. An individual is forced to choose between two or more undesirable alternatives.
ANS: A
Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or
values apply and may even include uncertainty as to what the moral problem is. Moral
distress occurs when the individual knows the right thing to do but organizational
constraints make it difficult to take the right course of action. Moral outrage occurs when an
individual witnesses the immoral act of another but feels powerless to stop it. Ethical
dilemma is being forced to choose between two or more undesirable alternatives.

21. The nurse-manager is applying the MORAL decision-making model to a decision around a
client’s plan of care. The manager has engaged all the necessary stakeholders and collected
as much data about the situation as possible. What should the manager do next?
a. Assess the client’s values and beliefs.
b. Identify as many alternatives as possible.
c. Choose the option that best aligns with ethical principles.
d. Arrange to meet with the institution’s ethics board.
ANS: B
Feedback: The initial step in the MORAL decision-making model involves collecting data
and determining who should be involved in the decision-making process. After this, the
nurse identifies alternatives and then chooses the best option. Engaging with an ethics
committee should take place in the first step when the manager decides who to involve.
Assessing the client’s values should take place early in the decision-making process.

22. Which ethical principle is demonstrated when an adult child is legally given the right to
make medical decisions for a cognitively impaired parent?
a. Justice
b. Fidelity
c. Paternalism
d. Beneficence
ANS: C
Feedback: Paternalism is when one individual assumes the right to make decisions for
another. Justice requires that a person seek fairness, treat “equals” equally, and treat
“unequals” according to their differences. Fidelity involves the need to keep promises.
Beneficence involves actions that are taken in an effort to promote good.

TOP: Chapter Number: 04: Title: Display 4.2 Ethical Principles
23. A nurse has repeatedly witnessed a physician being dismissive of clients’ reports of pain and
anxiety. The nurse recognizes that the best action would be to address this behavior with the
physician, but the nurse strongly suspects that these concerns would be dismissed. What
phenomenon is this nurse experiencing?
a. Moral conflict
b. Moral outrage
c. Ethical relativism
d. Ethical universalism
ANS: B
Feedback: Moral outrage occurs when an individual witnesses the immoral act of another
but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual
is unsure which moral principles or values apply and may even include uncertainty as to
what the moral problem is. Ethical relativism suggests that individuals make decisions based
only on what seems right or reasonable according to their value system or culture. Ethical
universalism holds that ethical principles are universal and constant and that ethical decision
making should not vary as a result of individual circumstances or cultural differences.

24. Which statements concerning autonomy are true? Select all that apply.
a. It is a form of personal liberty.
b. Its legal equivalent is self-determination.
c. It is based on a person’s right to make a choice.
d. It supports the process of progressive employee discipline.
e. It overrides paternalism but not beneficence.
ANS: A, B, C, D
Feedback: A form of personal liberty, autonomy is also called freedom of choice or
accepting the responsibility for one’s choice. The legal right of self-determination supports
this moral principle. The use of progressive discipline recognizes the autonomy of the
employee. The employee, in essence, has the choice to meet organizational expectations or
to be disciplined further. If the employee’s continued behavior warrants termination, the
principle of autonomy says that the employee has made the choice to be terminated by
virtue of his or her actions, not by that of the manager. Ethical situations always differ, so it
is impossible to state that one particular principle always overrides another.

25. Which activity best demonstrates a nursing unit manager’s attention to ANA standards for
ethics required of that position?
a. Refers complex dilemmas to the institution’s ethics board
b. Terminates a staff member for absenteeism
c. Assures staff and patients that unit decisions are ethically sound
d. Maintains current licensure
ANS: A
Feedback: ANA standards for ethics related to nurse administrators identifies participants on
multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and
outcomes as a criteria measurement. The remaining options, although addressing ethical
behaviors on the administrator’s part, are not as directly identified by the ANA.

TOP: Chapter Number: 04: Title: Display 4.4 Standards of Professional Performance for
Nurse Administrators KEY: Integrated Process: Nursing Process
26. A nurse has applied for a management position in a new organization. How can the manager
best prevent intrapersonal conflict related to ethical issues in this role?
a. Determine whether nurses in the organization are required to follow a code of
ethics
b. Identify a mentor in the organization who maintains high ethical standards
c. Clarify his or her own values and beliefs and compare to those of the organization
d. Become familiar with the nurse practice act in the jurisdiction where the
organization is located
ANS: C
Feedback: The likelihood of intrapersonal conflict resulting from disagreement between a
manager’s values and those of the organization is reduced if the manager clarifies his or her
own values and those of the organization. A mentor cannot necessarily help a manager do
this because values are personal. All nurses must follow a code of ethics, so this is not a
variable. Becoming familiar with the nurse practice act is beneficial, but this legislation does
not address ethical issues and values.

TOP: Chapter Number: 04: Title: The Moral Decision-Making Model
27. The managers of a hospital unit have been approached by a nurse educator who wants to
conduct research into a particular nursing intervention. In order to ensure that the rights of
clients who may participate are protected, the managers should:
a. ask the hospital ethics committee to approve or deny the application.
b. discuss the educator’s values, beliefs, and ethics.
c. compare the study methodology to the code of ethics.
d. refer the educator to the institutional review board.
ANS: D
Feedback: Institutional review boards (IRBs) are primarily formed to protect the rights and
welfare of research subjects. They are the main gatekeepers for research that takes place in
the institution. Ethics committees more often deal with specific situations involved in client
care. Discussing the educator’s values and beliefs is insufficient to protect the rights of
participants. There may be some benefit in comparing the research proposal to the code of
ethics, but ultimately, this is within the jurisdiction of the IRB.

TOP: Chapter Number: 04: Title: Use Institutional Review Boards Appropriately
28. The policies in a long-term care facility specify that immobile residents should be
repositioned at least every 2 hours. Despite this, it is well known that many residents endure
long periods without being repositioned. How should the nurse best interpret this situation?
a. It is necessary for the nurses at the facility to review the code of ethics.
b. There is a need for actions to address this theory–practice–ethics gap.
c. The nurses at the facility are experiencing intrapersonal conflict that affects their
practice.
d. The nurses at the facility should apply the MORAL decision-making model to
address this.
ANS: B
Feedback: Theory–practice–ethics gaps exist when there is incongruence between what
nurses know they should or must do and what they actually do. Intrapersonal conflict is
internal discontent resulting from inconsistency between what should be done and what a
nurse can realistically do. However, there is no evidence that this is the case. Reviewing a
code of ethics is unlikely to bring about meaningful change without the addition of other
incentives. The MORAL decision-making model guides ethical decision making but does
not address these gaps between what should be done and what is actually done.

TOP: Chapter Number: 04: Title: Ethical Problem Solving and Decision Making
29. A nurse has recognized that many older adult clients on the unit do not receive enough
nutrition because they are unable to feed themselves independently. What action by a
manager would be most likely to resolve the nurse’s moral distress?
a. Acknowledging and validating the nurse’s observation
b. Hiring more nursing assistants to help feed these clients
c. Arranging to have the clients’ diets changed so they are more nutrient-dense
d. Providing a reference so the nurse can seek new employment
ANS: B
Feedback: Moral distress occurs when the individual knows the right thing to do but
organizational constraints make it difficult to take the right course of action. In this case, the
nurse knows what needs to be done (the clients need assistance with feeding) and arranging
for more employees to do this function would remove the organizational constraint.
Validation is of no value if it is not followed up by action. Changing the clients’ diets is not
helpful if they cannot be fed the new diet. Helping the nurse seek employment elsewhere
does not benefit the clients and may not relieve the nurse’s moral distress.

30. A nurse-manager is discussing a proposed change in practice the interdisciplinary team.

What question by the manager best reflects a utilitarian perspective?
a. “Have we asked clients and families what they think?”
b. “Does our code of ethics address this?”
c. “Are the benefits greater than the risks?”
d. “How many people will this benefit?”
ANS: D
Feedback: Utilitarianism prioritizes the greatest good for the largest number of people. For
this reason, a question about how many individuals would benefit would be more indicative
of utilitarianism than issues related to consulting clients, weighing risks and benefits, and
consulting the code of ethics.

TOP: Chapter Number: 04: Title: Ethical Frameworks for Decision Making
Chapter 05: Legal and Legislative Issues
1. Two registered nurses have disagreed about their scope of practice regarding medication
administration. What resource should the nurse consult?
a. The attorney general’s office
b. The Nurse Practice Act
c. The nursing standards of practice
d. The code of ethics
ANS: B
Feedback: Nurse Practice Acts define and limit the practice of nursing, stating what
constitutes authorized practice as well as what exceeds the scope of authority. An attorney
general’s office cannot supersede the provisions of a Nurse Practice Act. Ethical guidelines
do not establish a nurse’s scope of practice. Standards of practice describe the quality of a
nurse’s care but not the legal scope.

TOP: Chapter Number: 05: Title: Sources of Law
2. A nurse is facing a malpractice suit after a client was injured in a fall. When establishing
whether the nurse committed a breach of duty, the court will consult with:
a. other nurses who practice in similar settings and specialties.
b. members of public who have been treated in similar care settings.
c. the administrators of the health facility where the fall occurred.
d. medical experts from the same area of specialty.
ANS: A
Feedback: The testimony of other nurses in the same specialty as the defendant may be used
to prove breach of duty. These people are considered a reliable and valid source of
information by the court, more so than members of the public, administrators, or medical
experts.

TOP: Chapter Number: 05: Title: Elements of Malpractice
3. A health-care provider prescribes a medical procedure that the staff nurse has reason to
believe will harm the client. Which principle should guide the nurse’s choice of action?
a. The staff nurse cannot be held legally liable for any harm to the client if the
procedure is carried out with due care.
b. The nurse may lose his or her license by refusing to carry out the procedure.
c. The nurse can be held legally liable for any harm if the procedure is carried out
without questioning it.
d. Liability rests with the health-care provider, not the nurse.
ANS: C
Feedback: The rule of personal liability says that every person is liable for his or her own
conduct, even if someone else prescribed the intervention. The law does not permit a
wrongdoer to avoid legal liability for his or her own wrongdoing, even though someone else
also may be sued and held legally liable. “Due care” does not negate the consequences of
the nurse’s actions or release the nurse from liability if he or she knowingly committed an
unsafe act. Refusal to carry out the procedure would not be a basis for losing a nursing
license.

TOP: Chapter Number: 05: Title: Extending the Liability
4. The preoperative admitting nurse witnessed a client sign an operative consent form. The
nurse then cosigned the same document as a witness. The client suffered an injury during
surgery and names the nurse in the suit because the nurse witnessed the consent form. What
is the most likely outcome?
a. The nurse is not likely liable because the signature only specifies that the nurse
witnessed the client signing the consent form.
b. The nurse is likely not liable because surgery is beyond the nurse’s scope of
practice.
c. The nurse may be liable because cosigning the consent form makes the nurse an
equal member of the surgical team.
d. The nurse is liable because cosigning the consent form confirms that the client
fully understood the risks of surgery.
ANS: A
Feedback: Informed consent is obtained by a physician; therefore, in most cases, a nurse is
not legally responsible for informed consent but is confirming that the client signed the
consent form. If the nurse acts solely in the role of a witness, there are not likely to be legal
consequences for the nurse. The nurse would not be considered to be a full member of the
surgical team if his or her role was limited to admitting the client. Surgery is beyond the
nurse’s scope of practice, but this does not form the basis for the nurse’s likely exemption
from liability.

TOP: Chapter Number: 05: Title: Informed Consent
5. A client is preparing to be discharged from the health-care facility and has told the nurse
that he would like to read his medical record. What is the nurse’s best initial action?
a. Arrange for the medical record to be provided to the client.
b. Inform the client that this request will be communicated to the facility’s ethics
committee.
c. Confirm the facility’s policy around providing medical records to clients.
d. Check whether this provision is included in the jurisdiction’s Nurse Practice Act.
ANS: C
Feedback: Clients possess a right to view their medical records, but the protocols for
facilitating this vary. Consequently, the nurse should check this facility’s policy before
acting. It would likely be premature for the nurse to provide the medical record to the client
before communicating with other members of the care team or administrators to ensure
policy is followed. This matter is outside the purview of ethics committees because it does
not involve a dilemma. The Nurse Practice Act focuses on scope of practice and other
regulatory issues, not client rights.

TOP: Chapter Number: 05: Title: Medical Records
6. A charge nurse has discovered that a medication error was made on the previous shift. What
is the nurse’s best action?
a. Share that information with the charge nurse on the previous shift.
b. Document the incident and follow it up as per hospital policy.
c. Write a memo to the nurse who made the error requesting an incident report be
written.
d. Document in the client’s chart that an incident report will be completed.
ANS: B
Feedback: It is the responsibility as manager to immediately document the error according
to hospital policy. Because policies concerning such situations vary, it is vital to know and
follow established policies. It is not generally appropriate to make such a note on the client’s
chart. Speaking to another nurse or manager is not a sufficient response, although this may
be one part of the follow-up process.

TOP: Chapter Number: 05: Title: Avoiding Malpractice Claims
7. What is the best reason that nurse-managers have an ongoing responsibility to be aware of
legislation affecting nursing practice?
a. Laws are created by people who are not nurses.
b. Laws are fluid and subject to change.
c. Awareness will help ensure ethical practice.
d. Awareness is included in nursing standards of practice.
ANS: B
Feedback: When using doctrines as a guide for nursing practice, the nurse must remember
that all laws are fluid and subject to change. Laws are not static. It is the responsibility of
each manager to keep abreast of legislation and laws affecting both nursing practice and
management practice. It is true that laws are made by people who are not nurses, but this
does not necessarily create a need for managers to stay abreast of laws. Standards of practice
do not explicitly guide nurses to remain aware of changes in legislation. Awareness is
unlikely to have a direct effect on ethical practice, which is rooted in values and beliefs
about what is good.

TOP: Chapter Number: 05: Title: Legal Doctrines and the Practice of Nursing
8. The novice nurse can reduce the likelihood of being sued for malpractice by:
a. beginning his or her career in a lower acuity setting.
b. avoiding performing interventions without a witness present.
c. establishing positive, therapeutic relationships with clients and families.
d. engaging in lifelong learning.
ANS: C
Feedback: It has been shown that despite technical competence, nurses who have difficulty
establishing positive interpersonal relationships with patients and their families are at
greater risk for being sued. Relationship building is a skill that consequently has the
potential to reduce a nurse’s risk of a lawsuit. Many malpractice suits originate in lower
acuity settings, such as long-term care, so practicing in such an environment may not
necessarily reduce the nurse’s risk of a lawsuit. It is unrealistic and unnecessary to perform
all interventions with a witness, and there is no evidence that this would reduce the risk of a
lawsuit. Lifelong learning is beneficial but is not noted to reduce the nurse’s risk of a
lawsuit.

9. A state Nurse Practice Act is an example of which source of law?

a. Statutes
b. Constitution
c. Administrative
d. Judicial
ANS: A
Feedback: Statutes are the only laws made by official enactment by the legislative body. A
Nurse Practice Act is an example of a “law that governs.” As a statute, a Nurse Practice Act
is not a form of constitutional, administrative, or judicial law.

TOP: Chapter Number: 05: Title: Sources of Law
10. A nurse failed to supervise a confused client, and the client fell while transferring to the
bathroom. The client was unharmed, but the client’s family has launched a malpractice suit,
citing the nurse’s breach of duty. What is the most likely outcome of this case?
a. The outcome will depend on the extent to which the client was responsible for the
incident.
b. It will likely be successful, provided the family can prove the event was reasonably
foreseeable.
c. It will likely be unsuccessful because the client was not injured.
d. The outcome will depend on how the nurse’s actions compare to the established
standard of care.
ANS: C
Feedback: A malpractice suit requires evidence of actual injury to the offended party. The
fact that this client was unharmed would likely jeopardize the suit, regardless of the client’s
role or the standard of care. Even if the event was foreseeable, the absence of injury
removes a key criterion of malpractice.

11. A nurse is facing a malpractice suit after an incident where a client received the wrong dose
of medication. Which elements must be present to prove malpractice? Select all that apply.
a. Breach of duty
b. Presence of injury
c. Ability to foresee harm
d. Causal relationship between inadequate care and injury
e. Intent to cause harm
ANS: A, B, C, D
Feedback: A lawsuit pertaining to malpractice must include a standard of care, breach of
duty, injury, a causal relationship between breach of duty and injury, and a foreseeability of
harm. Malicious intent does not need to be present or proven. The presence of malice would
be more suggestive of a criminal act than professional malpractice.

12. A nurse is being sued for malpractice after a client completed suicide on the
medical–surgical unit. The nurse’s attorney has pointed out that the client had no history of
suicide attempts, had no history of mental illness, and denied suicidality on the standard
intake assessment. This argument calls into question what component of a malpractice suit?
a. Breach of duty
b. Failure to meet standard of care
c. Foreseeability of harm
d. A causal relationship
ANS: C
Feedback: This argument suggests that there is no obvious reason why the nurse should
have predicted a suicide attempt. This may negate the criterion of foreseeability. There is no
evidence that the attorney is addressing the nurse’s standards of care or the nurse’s ability to
perform his or her duties. The attorney is not questioning the relationship between the
nurse’s actions and the outcomes.

13. The nurse made a medication error that injured a hospital client. The nurse’s attorney has
cited the concept of respondeat superior during the trial. This argument would focus on:
a. the resources that were available to the nurse.
b. the intent of the nurse’s actions.
c. the hospital’s responsibility for the injury.
d. the provisions of the nurse’s malpractice insurance.
ANS: C
Feedback: The legal concept of respondeat superior states that an employer should be held
legally liable for the conduct of employees whose actions he or she has a right to direct or
control. Consequently, there is no direct reference to the nurse’s resources, intent, or
insurance coverage.

14. A client has provided informed consent for surgery and is being assessed by the nurse. What
statement by the client should prompt the nurse to contact the surgeon?
a. “Why am I not allowed to eat and drink before the surgery?”
b. “How long do you think I’ll stay in the recovery room?”
c. “Do you think this surgery is actually safe and necessary?”
d. “What is the difference between the surgeon and the anesthesiologist?”
ANS: C
Feedback: Nurses are obligated to provide teaching and to clarify information given to
patients by their physicians. This could include such topics as the different roles of the OR
team, typical recovery times, and the rationale for fasting. However, nurses must be careful
not to give new information or to go outside the scope of practice. Addressing the safety and
relative risks of a surgery, or the necessity for surgery, would be beyond the nurse’s scope.

TOP: Chapter Number: 05: Title: Informed Consent
15. In which situations does the nurse-manager have a legal responsibility for reporting? Select
all that apply.
a. A nurse had to work 2 hours of overtime because another nurse failed to report for
a shift.
b. A nursing assistant has reported a suspected incident of elder abuse.
c. A nurse is suspected of providing substandard medical care.
d. A pediatric client reports physical abuse in the home.
e. There is a confirmed case of a reportable infectious disease.
ANS: B, C, D, E
Feedback: The manager, like all professional nurses, is responsible for reporting improper or
substandard medical care, child and elder abuse, and communicable diseases, as specified by
the Centers for Disease Control and Prevention. Staffing issues are not mandated reportable
situations.

TOP: Chapter Number: 05: Title: Other Legal Responsibilities of the Manager
16. What initiative is most likely to promote open communication between clients and
practitioners?
a. Involving health-care consumers as active members of the health-care team
b. Promoting the creation of cultures of client safety in health-care organizations
c. Establishing a federal leadership locus for advocacy of client safety and
health-care quality
d. Building an evidence-based information and technology system that impacts client
safety
ANS: A
Feedback: One way to promote open communication between clients and practitioners is
involving health-care consumers as active members of the health-care team. Pursuing client
safety initiatives prevent medical injury by promoting the creation of cultures of client
safety in health-care organizations, establishing a federal leadership locus for advocacy of
client safety and health-care quality, and building an evidence-based information and
technology system impacts client safety.
TOP: Chapter Number: 05: Title: Display 5.2 Summary of Recommendations from the
Executive Summary of Health Care in the Crossroads: Strategies for Improving the Medical
Liability System and Preventing Patient Injury
17. A registered nurse has admitted to the manager that she obtained her license on false
pretenses and that she never actually graduated from a nursing education program. What is
most likely to take place next?
a. An investigation by the board of nursing
b. A civil lawsuit by the health-care facility
c. Criminal charges
d. A fine levied by the jurisdiction where the event took place
ANS: A
Feedback: Following a complaint, the board of nursing completes an investigation. The
facility may or may not pursue a lawsuit and is more likely to focus solely on dismissal.
This would be more likely to be handled administratively by the board of nursing than
criminally, by the court system. A ban from the profession would be more likely than a fine.

TOP: Chapter Number: 05: Title: Professional Versus Institutional Licensure
18. The nurse-manager is working with colleagues to update the policies and procedures at a
health-care facility. To ensure that the policies align with the provisions of Title VII, the
team should focus on what aspect of care?
a. Falls prevention
b. Timely and accurate documentation
c. Relationships between practical and registered nurses
d. Avoiding discrimination against clients
ANS: D
Feedback: Title VII is the Civil Rights Act which covers many different manifestations of
diversity. The major focus of Title VII is civil rights and the avoidance of discrimination.
Topics such as injury prevention, documentation, and interprofessional relationships are not
normally within the scope of civil rights.

TOP: Chapter Number: 05: Title: Legal Considerations of Managing a Diverse Workforce
KEY: Integrated Process: Communication and Documentation
19. Which nurse could face discipline for committing an intentional tort? Select all that apply.
a. A nurse who slapped a client when the client became verbally abusive
b. A nurse who applied restraints to a client as a punitive measure
c. A nurse who increased a client’s analgesia dosage without a prescription
d. A nurse who neglected to supervise a client, leading to a fall
e. A nurse who threatened an elderly client when the client did not participate in care
ANS: A, B, E
Feedback: Whereas professional negligence is considered to be an unintentional tort,
assault, battery, false imprisonment, invasion of privacy, defamation, and slander are
intentional torts. Failing to supervise a client or practicing outside the scope of practice
(changing a medication dose) would be classified as unintentional torts. Slapping a client is
battery. Threatening a client is assault, and applying restraints inappropriately is a form of
false imprisonment.

TOP: Chapter Number: 05: Title: Intentional Torts
20. The nurse at a long-term care facility became frustrated with a client who has dementia and
is unable to be redirected from wandering. The nurse applied restraints to keep the client in
bed during a night shift despite there being no order to do so. How should this nurse’s
actions be best interpreted?
a. The nurse is guilty of malpractice.
b. The nurse’s action is permissible if it was in the client’s best interest.
c. The nurse could face charges of false imprisonment.
d. The nurse’s action may be grounds for an assault charge.
ANS: C
Feedback: Inappropriate use of restraints constitutes false imprisonment. Assault, however,
is characterized by a verbal threat of harm. Malpractice is an unintentional tort, but this
nurse’s action is an intentional tort. Even if the nurse’s felt that he or she was acting in the
client’s best interests, there are still grounds for false imprisonment charges.

TOP: Chapter Number: 05: Title: Intentional Torts
21. Which statement is true regarding criminal law cases in the context of nursing? Select all
that apply.
a. Incarceration is a likely consequence of being found guilty of a criminal offense.
b. Intentionally giving an overdose of a potent narcotic is a criminal offense.
c. A guilty verdict requires evidence beyond a reasonable doubt.
d. Most malpractice cases are tried in criminal court.
e. A serious, inadvertent drug error is likely to bring criminal charges.
ANS: A, B, C
Feedback: In criminal cases, the individual faces charges generally filed by the state or
federal attorney general for crimes committed against an individual or society. In criminal
cases, the individual is always presumed to be innocent unless the state can prove his or her
guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for
being found guilty in criminal matters. Nurses found guilty of intentionally administering
fatal doses of drugs to clients would be charged in a criminal court. Most malpractice cases
are tried in civil court. In most cases, unintentional errors do not result in criminal charges.

TOP: Chapter Number: 05: Title: Types of Laws and Courts
22. Which action should the nurse prioritize when trying to prevent malpractice claims?
a. Always carrying a personal liability insurance policy
b. Always functioning with the scope of the nursing practice act
c. Asking for assistance when engaged in complicated procedures
d. Devoting time to establishing an effective nurse–client relationship
ANS: B
Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope
of the Nurse Practice Act. Nurses should purchase their own liability insurance and
understand the limits of their policies. Although this will not prevent a malpractice suit, it
should help to protect a nurse from financial ruin should there be a malpractice claim.
Asking for assistance when needed is prudent nursing practice, but staying within the scope
of practice is a more important guideline. Similarly, good nurse–client relationship has been
shown to reduce the likelihood of malpractice, but this is a less significant guideline than
staying in the scope of practice, which is paramount.

23. Which statements accurately describe the implications of a Good Samaritan law for a
registered nurse? Select all that apply.
a. A nurse has a legal responsibility to provide emergency services.
b. Such laws are universally worded so as to minimize differences between
jurisdictions.
c. To be protected, nurses must provide care that is within their legal scope of
practice.
d. A nurse who provided out-of-scope care is not protected by the Good Samaritan
law.
e. A nurse can be held responsible for a person’s injuries if he or she does not
intervene.
ANS: C, D
Feedback: Nurses are not required to stop and provide emergency services as a matter of
law, although most health-care workers feel ethically compelled to do so. Good Samaritan
laws suggest that health-care providers are typically protected from potential liability if they
volunteer their nursing skills away from the workplace (generally limited to emergencies),
provided that actions taken are not grossly negligent and if the health-care worker does not
exceed his or her training or scope of practice in performing the emergency services. Good
Samaritan laws vary between jurisdictions.

TOP: Chapter Number: 05: Title: Good Samaritan Laws
24. A nurse has been hired to manage a busy medical–surgical unit. What actions should the
nurse-manager perform to ensure compliance with legal issues? Select all that apply.
a. Develop a vision for the organization’s future and communicates this vision.
b. Remain current on all institutional policies and procedures.
c. Delegate with consideration to appropriate scopes of practice.
d. Require physical proof of appropriate professional licensure.
e. Ensure client–nurse ratios do not exceed 3:1.
ANS: B, C, D
Feedback: Sound management functions regarding legal issues include understanding and
adhering to institutional policies and procedures; delegating to subordinates wisely; and
monitoring subordinates to ensure they have a valid, current, and appropriate license to
practice nursing. Some jurisdictions have legal requirements around client–nurse ratios, but
these ratios vary according to the care setting; in many cases, a ratio of greater than 3:1 is
permitted. Developing and communicating a vision is an essential leadership function, but
this does not apply to management of legal matters.

Functions In Legal and Legislative Issues KEY: Integrated Process: Nursing Process
25. Which statement best describes the impact that the concept of respondeat superior has on the
issue of nursing liability?
a. It allows for equal liability among physicians, nurses, and health-care
organizations.
b. It supports the sharing of blame among all involved sources of health-care
services.
c. It encourages legal intervention when health care is thought to be substandard.
d. It implies that the institution is responsible for errors, not the employee.
ANS: B
Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the
burden of blame from the employee to the organization but rather to share the blame,
increasing the possibility of larger financial compensation to the injured party. Liability is
not always apportioned equally in every situation, and it does not wholly release employees
from liability.

26. The nurse is admitting a client to the health-care facility who is in the late stages of
pancreatic cancer. In order to comply with the terms of the Patient Self-Determination Act
(PSDA), the nurse should:
a. ensure the client clearly understands each treatment option.
b. determine whether the client has established an advance directive.
c. document that the client’s family has been included in care planning.
d. assess the client’s expectations for recovery.
ANS: B
Feedback: The PSDA requires acute care facilities to document on the medical record
whether a patient has an AD and to provide written information to patients who do not. This
legislation does not directly address such matters as ensuring the client’s understanding of
treatment options, including the family in care planning, and determining the client’s
expectations, even though each of the actions is necessary for providing quality care.

TOP: Chapter Number: 05: Title: The Patient Self-Determination Act
27. For which client are the provisions of the Patient Self-Determination Act (PSDA) most
likely to be significant?
a. A client who has recently been diagnosed with HIV
b. A client whose neonate has just died of sudden infant death syndrome (SIDS)
c. A client whose reduced ability to perform activities of daily living (ADLs) has
required an admission to long-term care
d. A client who has just experienced an ischemic stroke and whose prognosis is poor
ANS: D
Feedback: The PSDA applies to all clients, but it is especially relevant to clients and
families who are facing decisions around end-of-life care. A client whose infant has died, a
client with a new HIV diagnosis, and a client whose ADLs are compromised are not facing
imminent decisions about end-of-life care. However, this is not the case for a client with a
fresh stroke and poor prognosis.

TOP: Chapter Number: 05: Title: The Patient Self-Determination Act
28. The nurse-manager oversees the care of several dozen nurses. With which nurse should the
manager review the provisions of the Health Insurance Portability and Accountability Act
(HIPAA)?
a. A nurse who has discussed a client’s status with a physician over the telephone
b. A nurse who confirmed a new client’s admission to the unit to a relative who
telephoned
c. A nurse who completed a client’s documentation outside of the client’s room
d. A nurse who has initiated contact with the social worker to discuss a client’s
discharge planning
ANS: B
Feedback: HIPAA states that a client’s privacy and confidentiality must be maintained.
Confirming a new client’s presence on a unit can be problematic because the identity of the
person speaking cannot be confirmed. Communicating by telephone with other members of
the care team is acceptable, provided efforts are taken to protect the client’s privacy from
others who may overhear. Documentation can be completed in any setting, provided it is
guarded from view of unauthorized persons. There is no prohibition against initiating
contact for referrals.

TOP: Chapter Number: 05: Title: Health Insurance Portability and Accountability Act of
1996 KEY: Integrated Process: Nursing Process
29. A nurse is off-duty, in the community, and witnesses an adult suddenly collapse. The
individual appears to be unconscious. How should the nurse apply Good Samaritan laws to
this situation?
a. The nurse should intervene because of the legal obligation to do so.
b. The nurse is not required to intervene, even though intervening is an ethical act.
c. The nurse should attempt to contact emergency services before intervening.
d. The nurse attempt to determine if the individual has an advance directive before
intervening.
ANS: B
Feedback: Good Samaritan laws vary by jurisdiction, but they generally do not create a legal
requirement for a nurse to intervene, although the ethical obligations for beneficence still
apply to nurses. A nurse is not obliged to contact emergency services before acting. It is
rarely possible or practical to determine a stranger’s end-of-life wishes in a situation like
this.

TOP: Chapter Number: 05: Title: Good Samaritan Laws
30. The nurse has been caring for a medical client for several shifts and the client has expressed
frustration with his slow recovery. At the beginning of the shift, the client states to the
nurse, “That’s it. I want to read what they’ve written in my chart.” What is the nurse’s best
response?
a. “Certainly. I’ll go and get it for you.”
b. “You’ll have to get permission to do so, but I’ll definitely pass on your request to
the care team.”
c. “It sounds like you might have some questions about your health and your care.
Can we talk about that?”
d. “That’s definitely within your rights, but you’ll likely find that it’s difficult to
understand because of medical jargon.”
ANS: C
Feedback: Clients’ requests to read their health records are often motivated by confusion or
dissatisfaction with care. The nurse should offer to address the clients concerns. Doing so is
not a refusal of the client’s right to view his or her health records. Protocol must be followed
when a client requests access, so it would be inappropriate for the nurse to immediately
provide the client with the record. Even though protocol must be followed, clients still have
the right to view their records and do not require permission under normal circumstances.
The nurse should not attempt to dissuade the client by warning him or her about medical
jargon, even though this is likely to be a barrier to understanding.

TOP: Chapter Number: 05: Title: Medical Records
Chapter 06: Patient, Subordinate, Workplace, and Professional Advocacy
1. When applying the principles of advocacy, a nurse-manager should:

a. defer to a leader whenever possible because advocacy is primarily a leadership
function.
b. prioritize the needs of subordinates over the needs of the organization.
c. balance the need to advocate for several different individuals, groups, and
organizations.
d. recognize that advocacy can only be provided for individuals, not groups or
organizations.
ANS: C
Feedback: Advocacy is helping others to grow and self-actualize. The manager must be an
advocate for clients, subordinates, and the nursing profession. Advocacy is not limited to
leaders. It is simplistic to claim that the needs of subordinates always trump those of the
organization; every situation is different.

2. The nurse-manager is overseeing the care of a client who is taking a passive role in his care.
How should the nurse begin to act in the role of an advocate?
a. Inform the client of his rights and help him to understand them
b. Teach the client the benefits of taking an active and assertive role in his care
c. Assess the size and quality of the client’s social support network
d. Role-play with the client in order to teach him assertiveness skills
ANS: A
Feedback: The advocate informs others of their rights and makes certain they have sufficient
information to make decisions. This contextualizes any further teaching or dialogue, such as
role modeling or educating him about the benefits of being more assertive. As well, not
every client has the desire or skills necessary to be assertive and an active participant in
care. It is important to assess clients’ social support networks, but this is not directly related
to advocacy.

3. Even after a lengthy discussion concerning the ramifications, a client wants to leave the
hospital against medical advice (AMA). What should the nurse do in the role of client
advocate?
a. Instruct the client to wait until morning to leave the hospital.
b. Ask family members to help talk the client out of the decision.
c. Encourage the client to leave and assist with the transition.
d. Make sure the client has appropriate follow-up appointments.
ANS: D
Feedback: As advocate for this client, it is important to make sure the client is informed of
the ramifications of leaving AMA; however, it is a client’s right to refuse treatment.
However, this does not mean that the nurse is obliged to actively encourage the client to
leave, which would be inappropriate. The nurse should dialogue with the client about the
risks of leaving but avoid making the decision for the client or coercing the client to stay.

TOP: Chapter Number: 06: Title: Patient Rights
4. A nurse-manager is reviewing the provisions of the Consumer Bill of Rights and

Responsibilities (Patient’s Bill of Rights) with a group of new nurses. The manager should
address what goals of this legislation? Select all that apply.
a. Ensuring every client has access to quality, affordable health care
b. Promoting strong relationships between clients and health-care providers
c. Promoting clear communication between members of the health-care team
d. Helping clients feel confident in the health-care system
e. Assisting clients with understanding the provisions of their health insurance
ANS: B, D
Feedback: The provisions of the Patient’s Bill of Rights are threefold: (a) to help patients
feel more confident in the US health-care system, (b) to stress the importance of a strong
relationship between patients and their health-care providers, and (c) to stress the key role
patients play in staying healthy by laying out rights and responsibilities for all patients and
health-care providers. This legislation does not explicitly address access to health care,
communication in the health-care team, or teaching clients about their insurance.

5. The nurse-manager can implement workplace advocacy and subordinate advocacy by

performing what actions? Select all that apply.
a. Creating an atmosphere that is free of violence or the threat of violence
b. Providing education about injury prevention and safety
c. Making efforts to ensure that nurses have reasonable and predictable work
schedules
d. Including nurses in the decisions that must be made at the facility
e. Encouraging clients to provide feedback about the care they provide when they are
discharged
ANS: A, B, C, D
Feedback: Workplace and subordinate advocacy includes such actions as preventing
violence, promoting safety, creating workable schedules, and including nurses in the
decision-making process. Asking clients to provide feedback about their care may be helpful
in promoting good practice, but this does not directly relate to subordinate advocacy or
workplace advocacy.

TOP: Chapter Number: 06: Title: Subordinate and Workplace Advocacy
6. A nurse has become dismayed at repeated instances of false documentation in the

health-care organization. The nurse has become aware that documentation has been altered
so that acts of negligence appear to be accidents. When preparing to blow the whistle on this
behavior, the nurse should:
a. attempt to edit the false documentation so that it is more accurate.
b. resign from the health-care facility to reduce the risk of retaliation.
c. seek permission from the nurse’s immediate supervisor and head of the
organization.
d. carefully document any prior attempts to address the issue with supervisors.
ANS: D
Feedback: Before whistleblowing, the nurse should carefully document any prior attempts to
resolve the situation. It is unrealistic to expect supervisors to support whistleblowing, which
is only necessary when the normal chain of authority has failed to respond to an issue. The
nurse may eventually be forced to resign, but this is not a precondition for whistleblowing in
every situation. Attempting to edit documentation may set the nurse up for legal
consequences.

TOP: Chapter Number: 06: Title: Whistleblowing as Advocacy
7. Which statement is true regarding political action committees (PACs)?

a. They attempt to persuade legislators to vote in a particular way.
b. They are composed of volunteers who are interested in politics.
c. Their focus is usually on defeating specific pieces of legislature.
d. They appear to have less influence on lawmakers than in the past.
ANS: A
Feedback: PACs attempt to persuade legislators to vote in a particular way. Lobbyists of the
PAC may be members of a group interested in a particular law or paid agents of the group
that wants a specific bill passed or defeated. Currently, PACs appear to have a significant
amount of influence on lawmakers and the legislative process. There is no evidence that
their influence is waning.

TOP: Chapter Number: 06: Title: Nursing's Advocacy Role in Legislation and Public
Policy KEY: Integrated Process: Nursing Process
8. A nurse is deeply concerned about a proposed piece of legislation. Which action will best
influence a local legislator who will be voting on the legislation?
a. Signing an online petition
b. Phoning the legislator’s office repeatedly
c. Writing a succinct, personalized letter to the legislator
d. Forwarding the legislator online articles that related to the legislation
ANS: C
Feedback: Personalized letters can have a significant influence on a legislator, likely more
so than telephone calls. It is not normally possible to outline one’s ideas in a telephone
message and a nurse cannot provide any detail by signing a petition. E-mail forward is very
likely to be ignored and not opened.

Policy KEY: Integrated Process: Communication and Documentation
9. A nurse is preparing for a television interview to address an aspect of health care. What
actions should the nurse perform? Select all that apply.
a. Being focused on key points
b. Introducing statistics that support the key points
c. Repeating key points several times during the interview
d. Providing background material related to the key points
e. Using technical vocabulary to ensure precise communication
ANS: A, B, C, D
Feedback: The best strategies for a television interview are to be prepared and to stick to
three or four key points that will drive home your message and repeat them during the
interview. Concentrating on popular points is not necessarily where the focus should be
directed. It is best to avoid technical jargon because it will be not be understood by most
people.

TOP: Chapter Number: 06: Title: Nursing and the Media
10. Which statement is true concerning political action of nurses?

a. Political action is often contrary to codes of ethics.
b. Political action mainly takes place through the American Nurses Association
(ANA).
c. Nurses’ primary focus is to speak out on consumer health-related issues.
d. Nurses have not yet recognized the full potential of political activity.
ANS: D
Feedback: As a whole, the nursing profession has not yet recognized the full potential of
collective political activity. Political action is not contrary to ethical practice and may in fact
support it. The ANA is not the main venue for political action among nurses, which can take
many forms. Nurses can speak to many aspects of health care and the nursing profession,
not only consumer issues.

11. Which leadership role is most closely associated with advocacy?

a. Creating a climate where advocacy and its associated risk taking are valued
b. Giving subordinates and clients adequate information to make informed decisions
c. Ensuring that the workplace environment is safe
d. Seeking appropriate consultation when advocacy results in intrapersonal or
interpersonal conflict
ANS: A
Feedback: A leadership role associated with advocacy is to create a climate where advocacy
and its associated risk taking are valued. Management functions include giving subordinates
and clients adequate information to make informed decisions and seeking appropriate
consultation when advocacy results in intrapersonal or interpersonal conflict. Workplace
safety is more closely aligned with a management role than a leadership role.

Functions Associated With Advocacy KEY: Integrated Process: Nursing Process
12. The manager of a community health center is committed to acting as an advocate. What
action by the manager best promotes this goal?
a. Taking prompt action when working conditions appear unsafe
b. Seeking formal and informal interactions with the media
c. Communicating a vision that advocacy is something highly valued in the
organization
d. Pushing for the creation of a binding, national Bill of Rights for Patients
ANS: A
Feedback: A management function associated with advocacy is taking prompt action when
there is a lack of safety in the workplace. Leaders generally interact with the media more
than managers do, and communicating vision is more closely aligned with a leadership role.
Similarly, advocating for a national Bill of Rights for Patients is more closely aligned with
leadership than management.
Functions Associated With Advocacy KEY: Integrated Process: Nursing Process
13. The nurse is working with a client who has a terminal diagnosis and who is facing difficult
decisions around end-of-life care? How can the nurse best advocate for this client?
a. Teach the client how to make an effective decision.
b. Offer to facilitate a referral to social work or spiritual care.
c. Arrange for the client to meet an individual who has faced the same decision.
d. Ensure the client receives all the necessary information to make an informed
choice.
ANS: D
Feedback: The main advocacy role for nurses involves giving clients all they need to make
informed decisions. Teaching the client how to make a decision is likely to be perceived as
paternalistic. Referrals may be helpful for the client, but this does not advocate for the
client’s need to make a decision. Introducing a client to another client in similar
circumstances can be ethically challenging and may or may not be perceived as helpful.

TOP: Chapter Number: 06: Title: The Right to Die Movement and Physician-Assisted
SuicideKEY: Integrated Process: Nursing Process
14. Which characteristics associated with being a client of the health-care system increase the
need for advocacy? Select all that apply.
a. Loss of physical freedom as a result of extended hospitalizations
b. Decreased independence due to physical or psychosocial limitations
c. Loss of legal rights due to being a client in a health-care facility
d. Physical or psychosocial limitations negatively impacting autonomy
e. Increased vulnerability due to impaired communication
ANS: A, B, D, E
Feedback: Patient advocacy is necessary because disease almost always results in decreased
independence, loss of freedom, and interference with the ability to make choices
autonomously. In addition, aging, as well as physical, mental, or social disability, may make
individuals more vulnerable and in need of advocacy. Admission to a health-care facility
does not result in a loss of legal rights.

TOP: Chapter Number: 06: Title: Patient Advocacy
15. Which are common areas requiring nurse–client advocacy? Select all that apply.
a. Maintaining current licensure
b. Securing client informed consents
c. Preventing medication errors
d. Facilitating access to health-care services
e. Promoting respect for client dignity and cultural values
ANS: B, C, D, E
Feedback: Common areas requiring nurse–client advocacy include inadequate client
consents, medical errors, access to health care, and respect for client dignity and cultural
values. Although nurses must maintain current licensure, this does not involve client
advocacy.

TOP: Chapter Number: 06: Title: Display 6.4 Common Areas Requiring Nurse–Patient
Advocacy KEY: Integrated Process: Nursing Process
16. The nurse-manager of a hospital unit has set a goal of increasing client advocacy. What
activities are likely to help the manager attain this goal? Select all that apply.
a. Staffing the unit with a sufficient number of care providers
b. Orienting staff on the safe use of a new mechanical lift
c. Providing an in-service on culturally meeting clients’ end-of-life needs
d. Arranging for a client to have a meeting with a member of the financial office
e. Organizing an equitable system for distributing vacation time to staff
ANS: A, B, C, D
Feedback: Common areas for managers to advocate for clients include distribution of
resources, use of technology, end-of-life decisions, and health-care reimbursement. Issues
around scheduling and vacation are areas where the manager could advocate for
subordinates, but this matter has little direct impact on clients.

TOP: Chapter Number: 06: Title: Display 6.4 Common Areas Requiring Nurse–Patient
Advocacy KEY: Integrated Process: Nursing Process
17. The nurse is reviewing the provisions of legislation that relates to nursing practice in the
jurisdiction where the nurse provides care. The nurse should identify what primary purpose
of this legislation?
a. Protecting clients’ rights and safety
b. Organizing the overall structure of the health-care system
c. Promoting a unique role for nursing in promoting wellness
d. Ensuring nurses provide care that is ethical and moral
ANS: A
Feedback: The legislative controls of nursing practice primarily protect the rights of clients.
Legislation is not primarily aimed at organizing the health system, which is an
administrative role, not a legislative function. Legislation is not aimed at promoting the role
of nursing. Ethical practice is addressed primarily by codes of ethics, not binding legislation.
18. A nurse feels strongly that a proposed piece of legislation would be contrary to the interests
of clients. How can the nurse most effectively oppose this legislation?
a. Address the issue on social media sites as often as possible.
b. Send e-mails to legislators’ offices expressing concerns.
c. Collaborate with a group of professionals who feel the same way.
d. Contact media outlets and ask to be interviewed.
ANS: C
Feedback: Collective action is generally considered to be more effective than individual
action. E-mails are easy to ignore and are less effective than personalized letters. Addressing
the issue on social media may make more people aware of the issue, but it may or may not
result in action change. Media outlets normally initiate interest in news interviews; they
rarely respond to people’s requests to be interviewed.

19. The Genetic Information Nondiscrimination Act (GINA) protects which individual from
discrimination?
a. A client who has chosen genetic testing for her child
b. A client who has received gene therapy
c. A client who has been diagnosed with a health disorder that has a genetic
component
d. A client who is known to have a genetic predisposition to a disease
ANS: D
Feedback: Some legally binding legislation has been passed to safeguard vulnerable
populations. One such legislation, the Genetic Information Nondiscrimination Act (GINA),
is a federal law passed in 2008, making it illegal for health insurers or employers to
discriminate against individuals based on their genetic information.

20. A nurse is involved in a challenging clinical situation which requires the nurse to consider
many people’s interests. How can the nurse best implement Standard VII of the American
Nurses Association (ANA) Scope and Standards of Practice?
a. Allow the client to read the documentation about the situation.
b. Seek legal advice promptly.
c. Advocate for the organization’s interests above those of individuals.
d. Carefully consider the ethical aspects of the situation.
ANS: D
Feedback: Standard VII of the American Nurses Association (ANA) Scope and Standards of
Practice (2015) states that the registered nurse practices ethically. Consequently, this
standard is more closely related to issues around ethics than issues around documentation or
legality. It is simplistic and inaccurate to presume that the organization’s interests always
supersede the individual’s interests.

TOP: Chapter Number: 06: Title: Patient Advocacy
21. Which nursing intervention demonstrates attention to the nursing values central to client
advocacy? Select all that apply.
a. Assuring clients that their wishes will be respected regarding the care they receive
b. Reassuring the client that he or she will always make the right decision
c. Identifying the client’s religious dietary practices when discussing a prescribed
diet
d. Answering the client’s questions regarding the alternatives to a proposed
procedure
e. Suggesting to a client that a social services consult would help with discharge
needs
ANS: A, C, D, E
Feedback: The nursing values central to advocacy emphasize caring, autonomy, respect, and
empowerment. Telling a client that she will certainly make the right decision is false
reassurance, which is not a valid form of advocacy.

TOP: Chapter Number: 06: Title: Display 6.2 Nursing Values Central to Advocacy
22. Which strategy best demonstrates an understanding of the managers role as an advocate for
his or her subordinates?
a. Posting a copy of the code of ethics in the staff room
b. Addressing an employee’s high rate of absenteeism
c. Establishing friendships with as many of the nurses as possible
d. Working with primary care providers to expand standing nursing orders
ANS: D
Feedback: Promoting nurse autonomy in the form of increased standing orders is an
example of advocating for subordinates. Publicizing the code of ethics may be beneficial for
nurses but does not advocate on their behalf. In the same way, a manager is being
responsible by addressing absenteeism, but this is unlikely to entail an advocacy role. The
manager should seek professional relationships, not friendships.

23. What action by the manager of a community health center best demonstrates workplace
advocacy?
a. Phoning the home of a nurse who has called in sick to confirm that the nurse is
genuinely ill
b. Asking clients to provide feedback on the care that they have received in their
homes
c. Ensuring nurses have all the personal protective equipment they need to perform
home visits
d. Assigning a different nurse to a client who had personality differences with his
original nurse
ANS: C
Feedback: Ensuring the safety or workers is one of the major demonstrations of workplace
advocacy. Checking on a nurse who states that he or she is sick is likely to be perceived as
an act of mistrust, not of advocacy. Asking for clients’ feedback and assigning a client a
new nurse are suggestive of client advocacy, not workplace advocacy.

24. A nurse is concerned about the implications of a new piece of legislation that is being
debated by lawmakers. The nurse has decided to draft a letter to a legislator and should do
what actions? Select all that apply.
a. Self-identify as a constituent in the first paragraph.
b. State the reason for writing in the second paragraph.
c. Sign the letter and include contact information.
d. Address the legislator by his or her title.
e. Hand deliver the letter to the legislator’s office, if possible.
ANS: A, C, D
Feedback: The nurse should be sure to address the legislator properly by title and establish
credibility early in the letter as both a constituent and a health-care expert. It is best to state
your reason for writing the letter in the first paragraph and refer to the specific bill that you
are writing about. Then, state your position on the issue and give personal examples as
necessary to support your position. Personal letters are more effective than other formats,
but there is no reason to hand delivery the letter to the legislator’s office.

25. A nurse-manager has been asked to write an article for the newspaper addressing a
health-care issue of local concern. Which statement demonstrates the nurse’s understandings
of the appropriate way to respond to such a request? Select all that apply.
a. “I’ll include the latest data on the subject.”
b. “When will you need to have the final draft of my article?”
c. “Are you comfortable with me focusing on three key points related to this topic?”
d. “That isn’t my field of expertise but I will contact a peer with that knowledge.”
e. “Working with the media is outside my scope of practice, but I’ll recommend you
to someone else.”
ANS: A, B, C, D
Feedback: Tips for effective interaction with the media include respecting and meeting their
deadlines, having key facts ready to include, limiting key points to two or three, and not
being afraid to say you lack that specific expertise. Working with the media is not
something that is beyond the nursing scope or practice.

TOP: Chapter Number: 06: Title: Display 6.8 Sample: A Letter to a Legislator
26. The nurse is admitting a new client who is facing a serious health problem. The nurse can
best apply the skills of advocacy when working with this client by:
a. seeking opportunities to demonstrate professionalism.
b. engaging closely and genuinely with the client and family.
c. making decisions for the client and family in order to lessen their responsibilities.
d. providing evidence-based care.
ANS: B
Feedback: Engagement has been identified as a key factor in advocating for clients and
families when they are in the health-care system. Demonstrating professionalism and
providing evidence-based care support good outcomes and may put the client and family at
ease, but these actions do not necessarily demonstrate or promote advocacy. The nurse
should always support the family’s decision-making process rather than taking on this role.

TOP: Chapter Number: 06: Title: Patient and Family Engagement
27. A client has been diagnosed with a degenerative neurologic disease and has expressed
interest in physician-assisted suicide. How should the nurse best advocate in this situation?
a. Document the client’s statements verbatim in the medical record as a resource for
the care team.
b. Clearly explain the moral and ethical implications of physician-assisted suicide.
c. Implement interventions that directly address the client’s fear and anxiety.
d. Ask the client and family questions that help them identify and explore their values
and beliefs.
ANS: D
Feedback: Providing the client and family with the tools necessary to make an informed
decision is the best demonstration of client advocacy. Documentation is important in this
situation, but this action does not necessarily demonstrate advocacy. The moral implications
of physician-assisted suicide must be identified by the family rather than provided by the
nurse; these are subjective and this will be part of the family’s decision-making process. The
nurse should avoid presuming that the client is fearful and anxious. This may not necessarily
be the motivation behind the client’s request.

28. For which client would right to die laws most likely apply?
a. An adult client with major depression
b. An adult client who has a terminal diagnosis
c. A client who lives with intractable pain
d. A client who has expressed suicidal ideation
ANS: B
Feedback: Typically, right to die laws apply only to patients who are at least 18 years old,
with the capacity to make medical decisions, with a terminal disease expected to result in
death within 6 months. Depression and pain are not normally considered to be terminal
diseases, and suicidal ideation in and of itself does not mean that this legislation would
apply.

29. A nurse has accepted a new position as the manager at an ambulatory clinic. The nurse can
best model subordinate advocacy in this new position by:
a. abolishing formal performance reviews.
b. increasing the number of part-time employees and reducing the number of
full-time employees.
c. adopting a laissez-faire leadership style.
d. encouraging employees to participate in decision making.
ANS: D
Feedback: Collaborative decision making is associated with subordinate advocacy.
However, the manager does not need to abolish rigorous practices (such as performance
reviews) or adopt a laissez-faire style of leadership in order to promote subordinate
advocacy. Doing away with full-time positions in favor of part-time positions is unlikely to
be accepted as an example of advocacy; this will likely be perceived as threatening.

30. A nurse is distressed by some of the examples of substandard care in the workplace and is
considering whistleblowing. What is the nurse’s best initial action?
a. Seek contacts in the local media.
b. Inform the manager of the nurse’s intent.
c. Carefully consider the possible ramifications of whistleblowing.
d. Hire an attorney to assist with the whistleblowing process.
ANS: C
Feedback: Before taking action, it is important for the nurse to consider the possible
ramifications of whistleblowing, which could be serious. This must precede efforts such as
hiring a lawyer or contacting the media. Depending on the circumstances, it may be
inadvisable to dialogue with the manager before whistleblowing.

TOP: Chapter Number: 06: Title: Whistleblowing as Advocacy
Chapter 07: Organizational Planning
1. A nurse is considering applying for employment at a new health-care facility. How should
the nurse best identify the aims and priorities of the organization?
a. Review the organization’s mission statement.
b. Speak with as many front-line workers as possible.
c. Ask interviewers about recent responses to consumer satisfaction surveys.
d. Review the organization’s policy and procedures documents.
ANS: A
Feedback: The purpose or mission statement is a brief statement identifying the reason that
an organization exists. The mission statement identifies the organization’s position
regarding ethics, principles, and standards of practice. The nurse should be able to infer the
organization’s aims and priorities from this statement. Consumer feedback will not
necessarily reveal the organization’s aims and priorities. Similarly, workers are often unable
to identify these priorities. Policies and procedures identify the preferred ways of
completing tasks but not the organization’s aims and priorities.

TOP: Chapter Number: 07: Title: Vision and Mission Statements
2. The nurse is participating in a planning process in a large health-care organization. The

nurse and the other members of the team should:
a. avoid specifics so that the plan can be applied in any health-care setting.
b. ensure that long-term priorities are always prioritized over short-term priorities.
c. ensure that evaluation occurs at several points during the process.
d. begin to engage employees in the process after the plan has been implemented.
ANS: C
Feedback: Planning can be short term or long term but should always include built-in
evaluation checkpoints so there can be a midcourse correction if unexpected events occur.
Excessive generalization (vagueness) can make a plan difficult to implement because of the
lack of specifics. Employee engagement should occur early in the process. Short-term and
long-term interests must be balanced; long-term priorities do not always supersede
short-term priorities.

TOP: Chapter Number: 07: Title: Overcoming Barriers to Planning
3. Which is a true statement about planning?

a. All plans should be defined at the outset so that changes are not necessary.
b. Long- and short-range plans should be kept separate so priorities do not become
confused.
c. Objectives and goals must be established before the philosophy is written.
d. All plans should be flexible to accommodate changing circumstances.
ANS: D
Feedback: Every plan should be flexible because unexpected events are inevitable. It is
impossible to identify every aspect of the plan at the outset because circumstances are
always changing. Short- and long-range plans should be complementary and integrated, not
separate. The philosophy should form the foundation of objectives and goals.

4. A nurse is participating in the process of values clarification. What are the characteristics of
a true value? Select all that apply.
a. It is freely chosen from among alternatives.
b. It aligns with the dominant values of society.
c. It is prized and cherished.
d. It is positively affirmed.
e. It is acted upon.
ANS: A, C, D, E
Feedback: McNally identified the fact that a value is prized and cherished, positively
affirmed and acted on, and chosen freely from among alternatives. It is possible for a value
to be true while not aligning with the dominant values of the society.

TOP: Chapter Number: 07: Title: Individual Philosophies and Values
5. Which statement is an example of a process objective?

a. “Every nurse will screen newly admitted clients for alcohol abuse.”
b. “The falls rate on the unit will decrease by 50% compared with 2016 rates.”
c. “The health-care facility will achieve accreditation within the next 24 months.”
d. “The new bowel care protocol will be fully implemented by the end of the calendar
year.”
ANS: A
Feedback: Objectives can focus on either the desired process or the desired result. Process
objectives are written in terms of the method to be used, whereas result-focused objectives
specify the desired outcome. The statement “Every nurse will screen newly admitted clients
for alcohol abuse” states how (i.e., the process) each client will be screened. Each of the
other listed statements focuses on results or outcomes.

TOP: Chapter Number: 07: Title: Goals and Objectives
6. A leader has launched an organizational planning process that requires the development of
new policies. How should the leader utilize subordinates during this process?
a. Delegate the evaluation phase of organizational planning to subordinates.
b. Ask subordinates to brainstorm alternatives and then have industry experts
evaluate each alternative.
c. Limit the involvement of subordinates to developing unit-level policies and
procedures.
d. Include subordinates early in the process and include them in all aspects of policy
formation.
ANS: D
Feedback: The leader should encourage subordinates to be involved in policy formation,
including developing, implementing, and reviewing unit philosophy, goals, objectives,
policies, procedures, and rules. The leader should work alongside the subordinates, not just
delegate to them. Subordinates should contribute to evaluation rather than this role limited
to experts. The role of subordinates should not be limited to policies and procedures at a unit
level.

Functions Associated With Organizational Planning
7. The manager is leading a team to develop a unit-level philosophy statement. What guideline
should the team use during this process?
a. The unit philosophy should align with the larger organization’s philosophy.
b. The unit’s philosophy should include a mission statement and vision statement.
c. The statement should reflect the values and priorities of the specific unit manager.
d. The statement should be consistent with that of other similar health-care agencies.
ANS: A
Feedback: The unit philosophy will be congruent with the organizational philosophy. Vision
and mission are distinct from philosophy statements. The statement should transcend any
one particular manager and does not necessarily have to align with other organizations.

Functions Associated With Organizational Planning
8. A new nurse on the unit has been criticized for deviated from the accepted model of
end-of-shift report, even though there is no written policy about the content or format for
report. Which term is used for this type of policy?
a. Implied policies
b. Expressed policies
c. Understood precedents
d. The organizational culture
ANS: A
Feedback: Implied policies are neither written nor stated verbally and have developed over
time. The other options fail to meet this description.

TOP: Chapter Number: 07: Title: Policies and Procedures
9. A health-care organization has adopted a new philosophy statement. What observation best
shows that the philosophy is being implemented?
a. The philosophy is displayed prominently in client care areas and staff areas.
b. The philosophy aligns with the organization’s vision and mission.
c. The philosophy is reflected in the care that clients and families receive.
d. The philosophy was created by an interdisciplinary group that included nurses.
ANS: C
Feedback: A philosophy is being implemented if it is evident in the care that clients and
families receive. Displaying the philosophy prominently, aligning it with vision and
mission, and collaboratively creating the philosophy do not guarantee that the philosophy is
actually being implemented.

TOP: Chapter Number: 07: Title: Organizational Philosophy
10. A recent nursing graduate has not performed a dressing change on a central catheter for
several months and is unsure of how to correctly perform this. The nurse should refer to the:
a. documentation.
b. practice rules.
c. organization policy.
d. procedure manual.
ANS: D
Feedback: Procedures delineate a series of specific steps of a required action, such as
performing a specific type of dressing change. Policies are plans reduced to statements or
instructions that direct organizations in their decision making, not specific nursing actions.
Procedures are not synonymous with documentation of “practice rules.”
TOP: Chapter Number: 07: Title: Policies and Procedures
11. A nurse-manager recognizes the role that individual values play on decision making. How
should the manager best address this fact during a period of organizational planning?
a. The manager should carefully reflect on his or her most important values.
b. The manager should make every attempt to set aside his or her values when
making decisions.
c. The manager should seek individuals who have similar values when creating a
decision-making team.
d. The manager should seek individuals who claim to have flexible values when
creating a decision-making team.
ANS: A
Feedback: All people should carefully examine their value system and recognize the role
that it plays in how they make decisions and resolve conflicts and even how they perceive
things. Therefore, the nurse-leader must be self-aware and provide subordinates with
learning opportunities or experiences that foster increased self-awareness. In most cases,
teams are not chosen on the basis of their personal values. It is unrealistic for a person to
expect that he or she can set aside values or alter them when making decision.

12. A nurse has been asked to join the health-care organization’s strategic planning committee.
What actions should the committee perform in order to create an efficient and
evidence-based planning process? Select all that apply.
a. Enlist members with expertise in health-care economics.
b. Carefully consider political issues related to health care.
c. Prioritize the role of intuition in the planning process.
d. Identify and implement a planning theory.
e. Include as many stakeholders as possible in the planning process.
ANS: A, B, D, E
Feedback: Strategic planning requires managerial expertise in health-care economics,
human resource management, and political and legislative issues affecting health care, as
well as planning theory. Stakeholders should be engaged in the process. Intuition is not
assigned a high value in organizational planning processes and is not normally prioritized
over other decision-making processes.

Functions in Planning KEY: Integrated Process: Nursing Process
13. Which statement best describes an emerging paradigm that is likely to influence strategic
planning for health care in the 21st century?
a. Reduced emphasis on cost containment
b. Reduced regulatory oversight of health-care organizations
c. A shift from interdependence of health-care professionals to greater autonomy
d. Continued increases in the cost of pharmaceuticals
ANS: D
Feedback: The rising cost of pharmaceuticals and ongoing drug shortages will continue to
be a problem for US hospitals for at least the next 3 years. Cost containment, regulatory
oversight, and interdependence of health-care providers are predicted to continue.

TOP: Chapter Number: 07: Title: Visioning: Looking to the Future
14. Which element should influence the nurse executive most heavily when assessing the
organization’s philosophy of nursing services for possible revision?
a. Consumer surveys
b. Input from other health disciplines
c. The organization’s mission statement
d. Policy statements
ANS: C
Feedback: The philosophy flows from the mission statement, the highest priority in the
planning hierarchy. Each of the other sources may be considered, but none should be as
influential as the mission statement of the organization.

TOP: Chapter Number: 07: Title: Vision and Mission Statements
15. A nurse-manager can implement the principles of preactive planning by:

a. responding quickly to emergent problems.
b. using new technologies to accelerate change.
c. preferring the status quo as a stable environment.
d. directing planning in response to a crisis.
ANS: B
Feedback: Preactive planners utilize technology to accelerate change and are future oriented.
Unsatisfied with the past or present, preactivists do not value experience and believe that the
future is always preferable to the present. Their focus is not necessarily crisis response.

TOP: Chapter Number: 07: Title: Proactive Planning
16. A manager has been experiencing challenges during a planning process and must implement
strategies to overcome barriers that impede planning. What is the manager’s best action?
a. Reevaluate whether the goals and objectives are appropriate and achievable.
b. Establish a fixed goal that is unaffected by changes in the organization.
c. Limit membership in the planning team to administrators, leaders, and executives.
d. Make the goals of the plan more general so that they can be more easily achieved.
ANS: A
Feedback: The organization can be more effective if movement within it is directed at
specified goals and objectives. Because a plan is a guide to reach a goal, it must be flexible
and allow for readjustment as unexpected events occur. Reevaluation is often necessary to
ensure this happens. The manager should include in the planning process all people and
units that could be affected by a plan, not just administrators and executives. A plan that is
too global or unrealistic discourages rather than motivates employees because attainment of
the goals can never be clearly determined.

17. A nurse-manager is creating an organizational plan. What characteristic of the plan is more
likely to promote success?
a. A midterm evaluation of the planning process
b. Several predefined evaluation checkpoints
c. The rejection of any earlier plans that did not succeed
d. Overplanning to accommodate predicted lapses in the planning process
ANS: B
Feedback: Good plans have several built-in evaluation checkpoints so that there can be a
midcourse correction if unexpected events occur. A single midterm evaluation is likely
insufficient. If goals were not met, the plan should be examined to determine why it failed.
However, this does not necessarily mean that similar plans cannot be reattempted.
Overplanning can result in an excessive and inefficient commitment to minor details.

18. At the unit level, what time frame may be considered long-range planning?
a. 3 months
b. 6 months
c. 12 months
d. 18 months
ANS: B, C, D
Feedback: At the unit level, any planning that is at least 6 months in the future may be
considered long-range planning.

TOP: Chapter Number: 07: Title: Strategic Planning at the Organizational Level
BLM: Cognitive Level: Remember NOT: Multiple Selection
19. The nurse-manager is on a team that is performing a SWOT analysis of the staffing system
at a community clinic. What should the manager do when addressing the “S” component of
the SWOT analysis?
a. Identify stakeholders in the current staffing system.
b. Examine the factors indicating that a change in the staffing system is necessary.
c. Identify any characteristics of the staffing system that currently help the clinic
meet its goals.
d. Strategize about ways that the staffing system could possibly be improved.
ANS: C
Feedback: After identifying the issue, SWOT analysis begins with identifying strengths,
which are the internal attributes that help an organization achieve its objectives. The “S”
does not denote stakeholders or strategizing. It is important to identify the rationale for a
change, but this is not a component of the SWOT model of analysis.

TOP: Chapter Number: 07: Title: Display 7.3 SWOT Definitions
20. One of the most commonly used tools in health-care organizations is SWOT analysis. What
is the definition of the “O” component of this model?
a. Internal attributes that help an organization achieve its objectives
b. Internal attributes that challenge an organization in achieving its objectives
c. External conditions that promote achievement of organizational objectives
d. External conditions that challenge or threaten the achievement of organizational
objectives
ANS: C
Feedback: Opportunities are external conditions that promote achievement of organizational
objectives. Strengths are internal attributes that help an organization achieve its objectives.
Weaknesses are internal attributes that challenge an organization in achieving its objectives.
Threats are external conditions that challenge or threaten the achievement of organizational
objectives.

21. The nurse-manager is participating in organizational planning. Which factors should the
team consider when identifying variables that may complicate the planning process? Select
all that apply.
a. Government regulations
b. Rapidly changing technologies
c. Decreased acknowledgement of the importance of planning
d. Changing population demographics
e. Public mistrust of the nursing profession
ANS: A, B, D
Feedback: Because of the rapidly changing technology, increasing government regulatory
involvement in health care, changing population demographics, and reduced provider
autonomy, health-care organizations are finding it increasingly difficult to appropriately
identify long-term needs and plan accordingly. Nurses are generally well trusted by the
public, and there is acknowledgment that planning is important in health-care organizations.

22. An organization is considering a revision to its philosophy. What characteristic of the

current philosophy would most clearly indicate a need for revision?
a. The philosophy is more than 5 years old.
b. Staff claim the stated unit philosophy is in contrast to the care that is being given.
c. The philosophy was appropriated from a different health-care facility.
d. The philosophy was created after the organization’s vision and mission were
determined.
ANS: B
Feedback: An organizational philosophy that is not or cannot be implemented is useless. An
old philosophy is not necessarily obsolete, and it is possible to adopt a philosophy from
another facility if it is appropriate in a different setting. It is acceptable for an organization’s
philosophy to flow from the vision and mission statements.

23. Which statement regarding nursing policies and procedures is most important to their
successful application in achieving goals?
a. The policies and procedures are created by staff representatives.
b. All policies and practices are based on current evidence related to practice.
c. Policies and procedures are reviewed at fixed times, every 5 years.
d. One hundred percent of the staff adheres to established policies and procedures
100% of the time.
ANS: B
Feedback: Policies and procedures should be evidence-based. It is unrealistic to expect
100% compliance, 100% of the time. A policy that is created by staff representatives but
which is not evidence-based is not appropriate because it may be unsafe. Ongoing, cyclical
review should be implemented.

24. The nurse-manager is reviewing the rules that the previous manager had put into place.
When reviewing these rules, what principles should guide the manager’s actions? Select all
that apply.
a. Rules should be flexible.
b. The number of rules should be kept to a minimum.
c. Rules should be changed on a regular basis.
d. Enforcement of the rules supports staff morale.
e. Consistent rule enforcement supports organizational structure.
ANS: A, B, D, E
Feedback: Rules are fairly inflexible, so the fewer rules, the better. Existing rules, however,
should be enforced to keep morale from breaking down and to allow organizational
structure. It is neither reasonable nor necessary for all involved parties to agree with the
rules but all must follow them. Rules require regular evaluation, but change may not be
warranted.

25. Which statements concerning the role of the leader-manager in organizational planning are
true? Select all that apply.
a. The leader-manager must be future-oriented.
b. The leader-manager has to be willing to take risks.
c. The leader-manager should possess human resource management skills.
d. The leader-manager must evaluate the social climate that affects the organization.
e. The leader-manager must be the most experienced clinician in the organization.
ANS: A, B, C, D
Feedback: Planning requires managerial expertise in health-care economics, human resource
management, political and legislative issues affecting health care, and planning theory.
Planning also requires the leadership skills of being sensitive to the environment, being able
to appraise accurately the social and political climate, and being willing to take risks. A
leader-manager can give effective oversight without being the most experienced clinician on
the unit.

Functions in Planning KEY: Integrated Process: Nursing Process
26. The manager of a clinic is considering a change in the scheduling of vacation time in which
nurses would self-schedule their vacation rather than having the manager respond to their
submitted requests. A nurse has pointed out that it is possible that newer nurses may feel
intimidated by more experienced nurses on the unit when scheduling their vacation. This
observation constitutes what component of a SWOT analysis?
a. S
b. W
c. O
d. T
ANS: B
Feedback: Weaknesses are those internal attributes that challenge an organization in
achieving its objectives. In this case, possible intimidation within the culture of the unit
would be considered an internal attribute that could complicate the proposed system.
Threats are also potential confounding factors, but these are external, not internal, factors.
Strengths and opportunities are positive attributes.

27. A nurse-manager is on a strategic planning team that is applying the balanced scorecard
while strategic planning. The team should specifically consider what variables when
creating the scorecard? Select all that apply.
a. Legislation that governs the organization’s operations
b. The health-care organization’s budget
c. Goals identified by similar organizations
d. The existing processes that are in place
e. Opportunities for learning and growth
f. Feedback that clients and families have provided
ANS: B, D, E, F
Feedback: Strategic planners using a balanced scorecard develop metrics, collect data, and
analyze that data from four organizational perspectives: financial, customers, internal
business processes (or simply processes), and learning and growth. This particular model
does not explicitly include other organizations’ goals or legislation as major components of
planning.
PTS: 1 DIF: Difficult REF: Page: 173–174

OBJ: 3
TOP: Chapter Number: 07: Title: Balanced Scorecard
28. A nurse-manager has been asked for the first time to join the health-care facility’s strategic
planning committee. What action should the manager take first?
a. Approach potential mentors on the committee.
b. Perform a SWOT analysis of the issues facing the committee.
c. Identify and examine his or her own planning style.
d. Review the committee’s most recent Balanced Scorecard.
ANS: C
Feedback: Self-reflection is a necessary first step when a nurse is becoming involved in
strategic planning. This should precede efforts such as finding mentors. Performing SWOT
analysis and creating balanced scorecards constitute the work of the committee.

29. A society that highly values social equity and equality is likely to support a health-care
system which:
a. prioritizes the role of the free market in providing health-care services.
b. entitles all citizens to similar levels of health-care services.
c. relies on the private sector to organize and provide health care.
d. is cost-effective and efficient.
ANS: B
Feedback: Values strongly influence the formation of health-care policy. A society that
values equality of access and social equity is likely to create a health-care system in which
each citizen has similar access to services. In many cases, the roles of the free market and
the private sector are eclipsed by government, which provides or coordinates services
accessible to all. This type of system may or may not be cost-effective, depending on
numerous variables.

TOP: Chapter Number: 07: Title: Societal Philosophies and Values Related to Health Care
30. A nurse-manager has identified the following objective for the care on the unit: “At least
95% of new clients’ health records will contain a completed assessment for intimate partner
violence.” How should the manager improve this objective?
a. Increase the objective to 100% of health records.
b. Include the rationale for the objective.
c. Focus on client actions rather than documentation.
d. Include a time frame in the statement.
ANS: D
Feedback: For objectives to be measurable, they should have certain criteria. There should
be a specific time frame in which the objectives are to be completed, and the objectives
should be stated in behavioral terms, be objectively evaluated, and identify positive
outcomes rather than negative outcomes. It is appropriate for an objective to include
references to documentation and it may or may not be appropriate to expect 100%
compliance, depending on many factors. The rationale is not normally included in an
objective statement.

TOP: Chapter Number: 07: Title: Goals and Objectives
Chapter 08: Planned Change
1. A nurse-manager is applying chaos theory to a proposed change in the structure of care at a

clinic. What skills will best facilitate the manager’s application of this theory?
a. Creating “buy-in” from the stakeholders
b. Finding solutions to resistance to change
c. Changing attitudes more than increasing knowledge
d. Finding underlying order in seemingly random data
ANS: D
Feedback: Chaos theory requires finding underlying order in apparently random data. This
particular theory of change does not explicitly focus on creating buy-in, addressing
resistance, or changing attitudes, although none of these activities is contrary to the theory.

TOP: Chapter Number: 08: Title: Chaos Theory
2. The nurse-manager would be justified in making a change for which reasons? Select all that
apply.
a. To solve an existing problem
b. To test workers’ abilities to adapt
c. To increase staff efficiency
d. To reduce unnecessary workload
e. To improve staff productivity
ANS: A, C, D, E
Feedback: Change should be implemented only for good reasons such as the solution of an
existing problem, increasing staff efficiency, eliminating unnecessary workload, and
improving productivity. Introducing change for the sole purpose of testing workers’ abilities
to adapt would be unnecessary, disruptive, and likely unethical.

3. What characteristic of a health-care organization most clearly suggests that is an aged

organization?
a. The organization was established more than 75 years ago.
b. The organization used to be the largest in the region but is now smaller than
several similar organizations.
c. The organization has a history of stifling innovation.
d. The organization is having difficulty attracting new graduates.
ANS: C
Feedback: A history of suppressing innovation is a hallmark of aged organizations. Age
alone does not constitute an aged organization; well-established organizations can stay
“fresh” and avoid becoming aged by promoting positive change and innovation. Many
factors can contribute to being overtaken in size or in attractiveness to new graduates. These
phenomena do not necessarily mean that it has become an aged organization.

TOP: Chapter Number: 08: Title: Organizational Aging: Change as a Means of Renewal
4. The manager on a hospital unit has highlighted some of the large gaps between desired
client outcomes and actual client outcomes. What component of Lewin’s change theory is
the manager demonstrating?
a. Unfreezing
b. Movement
c. Refreezing
d. Resistance
ANS: A
Feedback: Unfreezing occurs when the change agent coerces members of the group to
change, or when guilt, anxiety, or concern can be elicited. This impetus for change must
precede the other phases, such as movement and refreezing. There is no indication that the
manager’s information has caused resistance.

TOP: Chapter Number: 08: Title: Unfreezing
5. A nurse is ostracizing a staff member who dresses “unprofessionally” and is encouraging

other nurses to treat the staff member in the same way. This most closely represents which
change strategy?
a. Power–coercive
b. Normative–reeducative
c. Rational–empirical
d. Resistance–withdrawal
ANS: B
Feedback: Normative–reeducative strategies use group norms and peer pressure to socialize
and influence people so that change will occur and do not require the change agent to have a
legitimate power base. This exercise of power is not the principle guiding any of the other
options.

TOP: Chapter Number: 08: Title: Classic Change Strategies
6. Which action represents a management function in planned change?

a. Inspiring group members to be involved in planned change
b. Visionary forecasting
c. Role modeling high-level interpersonal communication skills in providing support
for individuals undergoing rapid or difficult change
d. Identifying the options and resources available to implement change
ANS: D
Feedback: Recognizing the need for planned change and identifying the options and
resources available to implement change are management functions. Inspiration, role
modeling, and exercising vision are more closely aligned with leadership functions.

Functions in Planned Change KEY: Integrated Process: Nursing Process
7. Many nurses at an ambulatory clinic have expressed frustration about the low quality of care
that clients have been receiving. How should a manager best interpret this situation?
a. The nurses may be in the unfreezing phase of change.
b. The clinic is likely an aged organization.
c. The movement phase of change will be difficult to initiate.
d. There is a need for the manager to demonstrate power–coercive strategies.
ANS: A
Feedback: During the unfreezing stage, people become discontented, and even angry, with
the status quo. This is a necessary precursor to the movement phase of change. This is a
positive development and does not indicate a need for power–coercive strategies. Similarly,
this does not demonstrate that this is an aged organization.

8. A multidisciplinary team has been assigned responsibility for managing the change process
in a large health-care organization. What goal should this team set for their activities?
a. Resistors will face workplace discipline.
b. Employees will not sabotage the change process.
c. Change will happen as quickly as possible.
d. Change will become a constant state in the organization.
ANS: B
Feedback: In some organizations, a team manages the communication between the people
leading the change effort and those who are expected to implement the new strategies.
Ultimately, this increases the chances of successful change and decreases the chance of
sabotage. This is not achieved in a coercive way, such as punishing resistors. Rapid or
constant changes are not typical goals; efficiency does not necessarily depend on speed.

9. Which characteristic of a planned change is most likely to threaten its success?

a. The suggested change is introduced to staff after the plan has been formalized.
b. Individuals affected by the change are involved in planning for the change.
c. The change agent is aware of the organization’s internal and external environment.
d. An assessment of resources to carry out the plan is completed before unfreezing.
ANS: A
Feedback: Employees should be involved in the change process. When information and
decision making are shared early in the process, subordinates will be more accepting of the
change. Awareness of the environment and assessment of resources support successful
change.

TOP: Chapter Number: 08: Title: Planned Change as a Collaborative Process
10. Which activity should a change agent perform in order to best assure a successful
implementation of a change?
a. Helping followers arrive at total consensus regarding the change
b. Encouraging subgroup opposition to change so many viewpoints can be heard
c. Using change by drift if the resistance to change is too strong
d. Being available to support those affected by a change until the change is complete
ANS: D
Feedback: The change agent needs to offer support to others so that the change occurs. Total
consensus is not normally a realistic goal. The change agent should encourage a diversity of
views, but not by fostering opposition by subgroups. Resistance should be expected and
does not indicate that planned change should not occur.

TOP: Chapter Number: 08: Title: Resistance: The Expected Response to Change
11. When applying the principles of complex adaptive systems (CAS) theory, the
nurse-manager should consider what principle?
a. Change must occur by organized, linear steps.
b. Change should be guided by intuition instead of being constrained by planning.
c. Change is easier in small organizations than large organizations.
d. Small variations in the change process can have major effects.
ANS: D
Feedback: CAS theory emphasizes the fact that even small variations can dramatically alter
choice of action. It recognizes that change is often nonlinear and that it requires careful
planning. Change is not necessarily easier in smaller organizations.

TOP: Chapter Number: 08: Title: Complexity and Complex Adaptive Systems Change
Theory KEY: Integrated Process: Nursing Process
12. In planning strategies to prevent stagnation and promote renewal, which action would most
likely result in the desired outcome?
a. Developing a program for recruitment of young talent
b. Rewarding employees by promoting from within
c. Having set pay increases mandated annually
d. Using length-of-service to determine committee selection
ANS: A
Feedback: The constant influx of young talent brings new ideas to the organization. Each of
the other listed strategies may promote stagnation and inhibit the promotion of renewal.

TOP: Chapter Number: 08: Title: Organizational Aging: Change as a Means of Renewal
13. Which statement best describes the philosophy of nonlinear change theories?
a. Change occurs in sequential steps of varying speed.
b. Change is predictable with proper analysis.
c. Change success relies on clear policies and hierarchies.
d. Change is necessary because organizational stability is brief.
ANS: D
Feedback: Most 21st-century organizations experience fairly brief periods of stability
followed by intense transformation. Change is rarely sequential or linear, and it is usually
difficult to predict, even with careful analysis. Policies and hierarchies are often not
adaptable enough to accommodate nonlinear change.

TOP: Chapter Number: 08: Title: Organizational Change Associated With Nonlinear
Dynamics KEY: Integrated Process: Nursing Process
14. Which statements are true regarding planned change? Select all that apply.
a. Resistance to change should be expected as a natural part of the change process.
b. Change should be viewed as a chance to do something innovative.
c. Technical changes are more resisted by staff than social changes are.
d. Change affects the homeostasis of a group.
e. Careful planning can guarantee the success of a change initiative.
ANS: A, B, D
Feedback: Change should not be viewed as a threat but as a challenge and a chance to do
something new and innovative. Change should be implemented only for good reason.
Because change disrupts the homeostasis or balance of the group, resistance should be
expected as a natural part of the change process. The level of resistance to change generally
depends on the type of change proposed not the age of the staff affected by the change.
Technological changes encounter less resistance than changes that are perceived as social or
that are contrary to established customs or norms. Planning increases the chance of success,
but it can never be guaranteed.

15. The nurse-manager has begun the movement stage of a proposed change. What is the
manager’s most appropriate activity?
a. Gather data about the need for change.
b. Accurately diagnose the problem.
c. Decide whether change is needed.
d. Collaborate with stakeholders to develop a plan.
ANS: D
Feedback: A responsibility during the movement stage is to develop a plan. Responsibilities
of the change agent in the unfreezing stage include gathering data, accurately diagnosing the
problem, and deciding if change is needed.

16. A change in the skills mix has been proposed at a care facility. What action by the
nurse-manager would best support a rational–empirical change strategy?
a. Presenting the research evidence that supports the change
b. Publicizing the change to generate enthusiasm
c. Appointing “champions” to ensure communication throughout the change process
d. Ensuring that employees know the consequences of resisting
ANS: A
Feedback: Rational–empirical change strategies assume that resistance to change comes
from a lack of knowledge and that humans are rational beings who will change when given
factual information documenting the need for change. Actions to create awareness and
enthusiasm are more consistent with normative–reeducative strategies. A punitive approach
would be more consistent with a power–coercive strategy.
PTS: 1 DIF: Moderate REF: Page: 196–197

OBJ: 5
17. A nurse-manager has introduced a proposed change to the operations of an ambulatory

clinic and has been met with resistance. How should the manager best interpret this
resistance?
a. Resistance is an expected component of a proposed change.
b. Resistance confirms that the proposed change is necessary.
c. The presence of resistance suggests that the change may be unsuccessful.
d. The presence of resistance indicates a need to implement power–coercive
strategies.
ANS: A
Feedback: Resistance is an expected component of a change process and it does not suggest
that change will be unsuccessful. However, the presence of resistance does not necessarily
validate that the change was necessary. A manager should interpret the presence of
resistance as indicated a need to implement power–coercive change strategies.

18. A team has been formed to consider a change in medication delivery. How can the team
leaders best promote a successful change?
a. Implement the change as rapidly as possible in order to diffuse resistance.
b. When planning, involve as many people who will be affected by the change as
possible.
c. Bring in outside experts to implement the change.
d. Enforce compliance with the change fairly and consistently.
ANS: B
Feedback: Whenever possible, all those who may be affected by a change should be
involved in planning for that change. Making a change too quickly can result in poor
outcomes because rigor is compromised. Outsiders are often resisted more than internal
change agents. A collaborative approach is preferred to “enforcement,” even though fairness
and consistency are appropriate goals during a change process.
TOP: Chapter Number: 08: Title: Planned Change as a Collaborative Process
19. Frequent turnover in leadership at a health-care organization has meant that change has
often occurred by drift. What are characteristics of this mode of change? Select all that
apply.
a. Changes are planned by teams.
b. Changes occur accidentally.
c. Changes take place even though they are unplanned.
d. Changes take place only as the result of threats.
e. Change takes place democratically.
ANS: B, C
Feedback: Change by drift is unplanned or accidental. Change by drift is not necessarily the
result of a threat. Even though change by drift happens “organically,” this does not mean
that it is necessarily a democratic process.

BLM: Cognitive Level: Remember NOT: Multiple Selection
20. A planned change has been imposed by upper management at a large hospital and will
greatly affect the delivery of care on inpatient units. What is an appropriate role for the
leader-manager in this time of change?
a. Mobilizing resistance in a respectful but assertive way
b. Demonstrating a positive attitude toward the prospect of change
c. Implementing the change as rapidly as possible
d. Dialoguing with staff about the benefits of maintaining the status quo
ANS: B
Feedback: Even when a change process has not been collaborative, the leader-manager still
has a responsibility to demonstrate a positive outlook on change. Mobilizing resistance
would be a subversive act that would be reserved for only the most harmful of proposed
changes. Rapid change can sometimes cause chaos rather than efficiency. Dialoguing with
staff about keeping the status quo would have the effect of increasing resistance.

TOP: Chapter Number: 08: Title: The Leader-Manager as a Role Model During Planned
Change KEY: Integrated Process: Nursing Process
21. The nurse-manager is describing the forces that are driving change in today’s health-care
environment. What phenomena should the nurse describe? Select all that apply.
a. Increased cost of health-care services
b. Shortages of health-care professionals and providers
c. Decreased third-party reimbursement for health-care services
d. Decreased use of technology due to high cost of implementation
e. Increased need to update health-care–related technologies
ANS: A, B, C, E
Feedback: Many forces are driving change in contemporary health care, including rising
health-care costs, declining reimbursement, workforce shortages, increasing technology, the
dynamic nature of knowledge, and a growing elderly population. Even though technology is
expensive, its use is increasing.

22. The leader-manager has successfully implemented a change and is now entering the
refreezing stage of the change process. During this stage, the leader-manager should
prioritize:
a. restoring stability to the workplace.
b. rewarding the employees who embraced the change early.
c. communicating the specific benefits of the change.
d. addressing the concerns of resistors.
ANS: A
Feedback: During the refreezing phase, the change agent assists in stabilizing the system
change so that it becomes integrated into the status quo. The distribution of rewards is not a
high priority in this phase, although this may help reinforce the change. Communicating the
benefits and addressing concerns should take place in the early stages of the change process.

TOP: Chapter Number: 08: Title: Refreezing
23. Which statement is true concerning the refreezing phase of the change process? Select all
that apply.
a. The focus of this phase is to integrate the change into the status quo.
b. Stabilization of change requires a 6- to 9-month period of time.
c. If refreezing is incomplete, prechange behavior will be resumed.
d. The change agent must remain involved until the refreeze stage is complete.
e. The priority in this phase is to identify resistance.
ANS: A, C, D
Feedback: During the refreezing phase, the change agent assists in stabilizing the system
change so that it becomes integrated into the status quo. If refreezing is incomplete, the
change will be ineffective and the prechange behaviors will be resumed. For refreezing to
occur, the change agent must be supportive and reinforce the individual adaptive efforts of
those affected by the change. Because change needs at least 3 to 6 months before it will be
accepted as part of the system, the change agent must be sure that he or she will remain
involved until the change is completed. The successfulness of the refreezing stage is
dependent on the acceptance of change by all staff. Identifying resistance and addressing it
is performed during the unfreezing and movement stages.

TOP: Chapter Number: 08: Title: Refreezing
24. Which activity associated with the unfreezing state of change will have the greatest impact
on the success of the movement stage of the change process?
a. Accurate identification of the problem requiring change
b. Effective information gathering concerning the problem
c. Key personnel voicing their opinions regarding the need for change
d. The need for change is perceived by those affected by the problem
ANS: D
Feedback: The change agent should not proceed to the movement stage until the status quo
has been disrupted and the need for change is perceived by the others. Although the other
options will affect the process, perception of the need to change by all affected by the
change is the most impactful of the options provided.

TOP: Chapter Number: 08: Title: Display 8.3 Stages of Change and Responsibilities of the
Change Agent KEY: Integrated Process: Nursing Process
25. Which factor is the greatest contributor to the resistance encountered with organizational
change?
a. Poor organizational leadership
b. Presence of employee mistrust
c. Ineffective organizational management
d. Insufficient staff involvement in the process
ANS: B
Feedback: Perhaps the greatest factor contributing to the resistance encountered with change
is a lack of trust between the employee and the manager or the employee and the
organization. Although the other options may increase resistance, employee distrust is the
primary barrier to change.

26. Nurses on a hospital unit have been informed that a change to the documentation system is
being proposed. What factor surrounding this change is most likely to cause unfreezing?
a. The proposed documentation system has been introduced in many hospitals in the
region.
b. The leader-manager supports a change in the documentation system.
c. An influential nurse has extensive experience with different documentation
systems.
d. The nurses find the current documentation system unwieldy and inefficient.
ANS: D
Feedback: Unfreezing occurs when the change agent convinces members of the group to
change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent
and aware of a need to change. In this case, dissatisfaction with the current documentation
system creates a powerful impetus for change. This factor is likely more significant than the
support of the leader-manager and influential nurse or the fact that similar institutions have
made a change.

27. A nurse intends to enroll in graduate school and has informed a colleague of this intention.
What response suggests that the colleague is in the precontemplation stage of change?
a. “I haven’t decided, but I might start looking into doing that as well.”
b. “That’s a good idea for you, but I’m just thankful that I’m done with school.”
c. “I suppose that will open up some new opportunities for you.”
d. “That’s my plan as well. When will you start?”
ANS: B
Feedback: In the precontemplation stage, the individual has no intention of changing in the
foreseeable future. Exploring the possibility of making a change would suggest the
contemplation stage, and transitioning to movement characterizes the preparation stage.

TOP: Chapter Number: 08: Title: A Contemporary Adaptation of Lewin's Model
28. A workplace health initiative has been launched in which subsidies are being offered for
gym memberships and exercise equipment. This initiative is most likely to affect individuals
who are in which phase of the stages of change model?
a. Precontemplation
b. Contemplation
c. Action
d. Maintenance
ANS: B
Feedback: Motivations and incentives are particularly effective among individuals who are
in the contemplation stage of change. In this case, this may be staff who would like to begin
exercising but who have not yet done so. Staff who are in the precontemplation stage would
not likely be affected because they have no desire to change their lifestyle. People in the
action and maintenance stages are already engaging in change and likely need no further
motivation.

TOP: Chapter Number: 08: Title: A Contemporary Adaptation of Lewin's Model
29. A leader-manager plans to implement normative–reeducative strategies to facilitate change

in a community health clinic. What action will the leader-manager most likely choose?
a. Addressing likely points of resistance before they can be stated by nurses who are
reluctant to change
b. Communicating the fact that the majority of nurses are enthusiastic supporters of
the change
c. Publicizing the benefits of the proposed change and the research that supports it
d. Providing incentives to nurses who are willing to adopt the change early
ANS: B
Feedback: Normative–reeducative strategies use group norms and peer pressure to socialize
and influence people so that change will occur. The change agent assumes that humans are
social creatures, more easily influenced by others than by facts. Communicating the fact that
most nurses support the change is an example of this form of pressure or persuasion. This
does not necessarily involve a proactive approach to resistance. A focus on evidence is more
consistent with the rational–empirical strategy. Incentives may be beneficial, but these do
not necessarily create peer pressure.

30. The nurse who provides oversight to a large health-care organization can best demonstrate
leadership during a time of change by:
a. clearly and assertively reminding nurses of their responsibilities to accept change.
b. asking permission of nurses before proposing a change process.
c. acknowledging that there is going to be resistance during the change process.
d. communicating a vision that change is an opportunity to be embraced.
ANS: D
Feedback: The leader should be open and receptive to change and views change as a
challenge and an opportunity for growth. A focus on responsibilities may create a backlash
and increase resistance. Collaboration is necessary, but this is not synonymous with asking
permission for change. Resistance should be expected, but stating this fact does not
demonstrate leadership.

Functions in Planned Change KEY: Integrated Process: Nursing Process
Chapter 09: Time Management
1. A nurse-manager is having difficulty finishing the necessary tasks for each day. When
implementing the time management process, what should the manager do first?
a. Complete the highest priority task.
b. Allow enough time for sufficient daily planning.
c. Reprioritize based on new information received.
d. Delegate work that cannot be accomplished in a day.
ANS: B
Feedback: Daily planning is essential if the manager is to manage by efficiency rather than
by crisis. Delegation, completion of tasks, and reprioritizing on the basis of new information
are steps that occur after planning.

TOP: Chapter Number: 09: Title: Three Basic Steps to Time Management
2. What is the reason that first- and middle-level managers experience more interruptions than
higher level managers?
a. They generally interact directly with a greater number of individuals in daily
planning.
b. They seldom have the clerical and secretarial help assigned to higher level
managers.
c. They often lack the time management skills that more experienced managers
possess.
d. They generally have heavier workloads than higher level managers.
ANS: A
Feedback: Frequent interruptions are common for first- and middle-level managers, who
have a larger number of direct reports than do higher level managers. Clerical support does
not necessarily prevent interruptions. Time management skills increase efficiency, but these
do not prevent interruptions for coworkers and subordinates. Workloads vary widely, and
lower level managers do not always have heavier workloads than upper level managers.

TOP: Chapter Number: 09: Title: Dealing With Interruptions
3. A nurse-manager has set a goal of addressing external time wasters. What phenomenon
should the manager address?
a. Difficulty in setting clear, achievable objectives
b. The manager’s inability to say no to coworkers’ and subordinates’ requests
c. The fact that the manager has a tendency to procrastinate
d. The large quantity of paperwork that the manager must complete
ANS: D
Feedback: Excessive paperwork is an external time waster; the other characteristics are
internal time wasters created by the manager himself or herself.

TOP: Chapter Number: 09: Title: Time Wasters
4. A manager is trying to get in the habit of creating a daily list of tasks. The manager should:
a. avoid changing the list once initial planning is completed.
b. include flexibility in the implementation of the list.
c. include all relevant short-term, intermediate, and long-term goals.
d. keep the list highly structured, thus decreasing the possibility of procrastination.
ANS: B
Feedback: The daily list should be flexible, changeable, leave some time for the unexpected,
and include appropriate short-term goals.

TOP: Chapter Number: 09: Title: Making Lists
5. A nurse-manager has recognized that unproductive socialization is making it difficult to

complete each day’s tasks. What action should the manager take to prevent this cause of
inefficiency?
a. Maintain an open-door policy so employees can have more rapid interactions with
the manager.
b. Schedule appointments so that interactions can be predicted and controlled.
c. Request a transfer to a site where the manager knows fewer coworkers and
employees.
d. Ban socialization on the unit during working hours.
ANS: B
Feedback: Appointments will discourage unproductive socialization since time will be
allotted and a schedule maintained. Open-door policies and impromptu meetings encourage
socialization. Requesting a transfer would be an extreme measure that should be reserved
for more entrenched or unsolvable problems. An outright ban on socialization is excessive
and likely to cause resentment.

6. A nurse-manager is responsible for implementing a large and complex plan that will require
much time and effort. How should the manager address this large task?
a. Work on the task with few breaks in order to finish as quickly as possible.
b. Delegate as much of the task as possible to employees and focus on evaluation.
c. Break the task into smaller, less intimidating units.
d. Delay beginning the task until it has the manager’s undivided attention.
ANS: C
Feedback: Breaking down a task, or chunking, prevents the person from becoming
overwhelmed by the size of the task. Working with few breaks may lead to exhaustion and
compromise the quality of outcomes. Delegation is appropriate, but it is not usually
appropriate to delegate all of a large task and to focus solely on evaluation instead of
execution. Managers often need to work on several tasks simultaneously and cannot always
wait until they can devote their undivided attention.

7. Which statement about time management is true?

a. Most people have an accurate perception of the time they spend on a particular
task or the total amount of time they are productive during the day.
b. Nurses with clearly identified personal goals and priorities have greater control
over how they spend their time.
c. Writing goals down is not usually necessary if the goals are limited to fewer than
five in number.
d. Keeping a time inventory for a day will allow the manager to identify a time
management pattern.
ANS: B
Feedback: Nurses who are self-aware and have clearly identified personal goals and
priorities have greater control over how they spend their time. Most people have
misperceptions about how they spend their time. Writing down goals is always necessary
and creating an accurate time inventory requires more than 1 day.

TOP: Chapter Number: 09: Title: Personal Time Management
8. Which task should the team leader perform first when planning care for a group of clients?
a. Plan so that each client on the team receives equal amounts of nursing care.
b. Prioritize the amount and type of nursing care each client requires.
c. Identify the staff who will comprise the individual care teams.
d. Assign clients to the specific nursing teams.
ANS: B
Feedback: Prioritizing the care each client will require is the initial step in care planning.
The other options are considered, but implementation will happen after the prioritizing.

9. The nurse-manager is frustrated by the quantity of paper clutter. How should the manager
best deal with this time waster?
a. Require face-to-face communication between staff members rather than written
documentation.
b. Set aside a block of time once per week to process documents.
c. Deal with paper correspondence as soon as possible after it arrives.
d. Place additional recycling and trash receptacles throughout the unit.
ANS: C
Feedback: Whenever possible, incoming correspondence should be handled the day it
arrives. It should either be thrown away or filed according to the date to be completed.
Letting it accumulate for a week at a time may make the problem worse, not better. Many
forms of written documentation cannot be replaced by face-to-face conversation. Providing
more waste receptacles will not help the manager process paperwork, which cannot
normally be discarded without being addressed.

10. A nurse-manager is prioritizing tasks. Which tasks should the manager put into the “do
now” category?
a. Adding follow-up comments to an incident report from the previous day
b. Covering sick calls for the upcoming shift to ensure there are enough nurses
c. Conducting a new employee’s initial performance review
d. Meeting with the chairperson of the hospital’s strategic planning committee
ANS: B
Feedback: Short-term staffing needs are a priority because this has direct implications for
client safety. Following up an incident report, meeting with a committee, and providing
performance reviews are actions that are necessary but less time-dependent and with less
direct implications for safety.

TOP: Chapter Number: 09: Title: Priority Setting and Procrastination
11. The nurse-manager is creating a list in order to promote efficiency and productivity. What is
the manager’s best action?
a. Use long-term goals as the framework for creating the list.
b. Include slightly more activities than can be completed in a day, in order to
motivate.
c. Begin by ranking the priority of tasks that need to be accomplished.
d. Keep each day’s list as similar as possible to each other day’s lists.
ANS: C
Feedback: Lists must be based on the relative priority of tasks. Lists generally focus on
short-term priorities more than longer term goals. The list should not be longer than what
can be realistically accomplished in 1 day; otherwise, it demotivates instead of assists. There
is no particular benefit to keeping each day’s list similar to every other days.

12. Which activity is associated with a leadership role in time management?

a. Assisting followers in working cooperatively to maximize time use
b. Prioritizing day-to-day planning to meet short-term and long-term unit goals
c. Building time for time management planning into the work schedule
d. Utilizing technology to facilitate timely communication and documentation
ANS: A
Feedback: A leadership role is to assist followers in working cooperatively to maximize
time use. Management functions include prioritizing day-to-day planning to meet short-term
and long-term unit goals, building time for planning into the work schedule, and utilizing
technology to facilitate timely communication and documentation.

Functions in Time Management KEY: Integrated Process: Nursing Process
13. How can subordinates be discouraged from taking up a nursing manager’s time
unproductively? Select all that apply.
a. Having the manager be accessible in the nursing station
b. Instituting an open-door policy
c. Having limited office seating available
d. Refocusing conversations as needed
e. Work in a public area
ANS: C, D
Feedback: Productivity can be enhanced by refocusing conversations that are taking too
long and limiting the amount of office seating so that subordinates do not “settle in.”
Working in a public area is likely to invite interruptions. An open-door policy promotes
collaboration but can harm productivity.

14. What is the best response for a nurse-manager to handle someone who has a pattern of
lengthy chatter?
a. “We’ll need to make it brief since my schedule is tight today.”
b. “I can’t speak with you now, but I’m going to have free time at 11 AM.”
c. “Stop by and we can talk during your lunch break.”
d. “I am sorry but I do not have anytime today to talk with you.”
ANS: B
Feedback: If someone has a pattern of lengthy chatter and manages to corner you on rounds
or at the nurse’s station, say, “I can’t speak with you now, but I’m going to have some free
time at 11 AM. Why don’t you see me then?” Unless the meeting is important, the person
who just wishes to chat will not bother to make a formal appointment. If you would like to
chat and have the time to do so, use coffee breaks and lunch hours for socializing.

15. Time management can be reduced to cyclic steps that include which of the following? Select
all that apply.
a. Allow time for planning and establish priorities.
b. Complete tasks according to their difficulty, from easiest to most difficult.
c. Complete the highest priority task, and whenever possible, finish one task before
beginning another.
d. Reprioritize based on remaining tasks and new information that may have been
received.
e. Divide each day into 1-hour blocks.
ANS: A, C, D
Feedback: Time management can be reduced to three cyclic steps: (a) allow time for
planning and establish priorities; (b) complete the highest priority task, and whenever
possible, finish one task before beginning another; and (c) reprioritize based on remaining
tasks and new information that may have been received. It is often necessary to divide days
into blocks that are much smaller than 1 hour. Sequencing is based on priority, not ease or
difficulty of completion.

16. A manager has identified the need to spend more time planning in order to accomplished
each day’s tasks. When should the manager do this planning?
a. Whenever a block of time is available
b. At the beginning of each day
c. In the middle of the day, after high-priority tasks have been completed
d. At the end of the day, in preparation for the next day
ANS: B
Feedback: Setting aside time at the beginning of each day to plan the day allows the
manager to spend appropriate time on high-priority tasks. This proactive approach is
preferable to planning in the middle of the day. Taking an ad hoc approach will not likely
result in consistent planning. The manager may be too fatigued to plan the next day’s work
at the end of a busy work day.

17. A leader-manager has recognized the need to be more consistent with time management?
What skill should the nurse develop in order to facilitate time management?
a. Enlisting the help of an administrative assistant
b. Recognizing the need for goal setting
c. Prioritizing tasks accurately
d. Handling emergency situations quickly
ANS: C
Feedback: Priority setting is perhaps the most critical skill in time management because all
actions taken are some type of relative importance. It is very possible for a manager to set
goals but then fail to manage his or her time. A person’s ability to handle emergencies does
not necessarily indicate his or her ability to manage time on a day-to-day basis. An
administrative assistant can be a valuable asset but does not facilitate the manager’s own
time management skills.

18. A nurse-manager is reviewing a backlog of correspondence and reads an e-mail asking for
feedback from a manufacturer about a piece of equipment that is used at the facility. The
manager reads that the sender asked for all feedback to be submitted by the end of last week.
In what category of prioritizing should this task be placed?
a. Squeaky wheel
b. Don’t do
c. Do later
d. Do now
ANS: B
Feedback: One simple means of prioritizing what needs to be accomplished is to divide all
requests into three categories: “don’t do,” “do later,” and “do now.” The “don’t do” items
reflect problems that will take care of themselves, are already outdated, or are better
accomplished by someone else. In this case, this is a task that is outdated because the
deadline for feedback has passed. Doing it now (or later) is ultimately a waste of time at this
point.

19. The nurse-manager of a hospital unit has categorized some tasks in the “do now” category.
The tasks most likely reflect:
a. the unit’s day-to-day operational needs.
b. issues related to long-term goals.
c. large, time-consuming tasks.
d. problems that cannot be safely delegated.
ANS: A
Feedback: The “do now” requests most commonly reflect a unit’s day-to-day operational
needs. These “do now” requests may or may not be related to long-term goals or require
large amounts of time. The fact that a task can be safely delegated, or not delegated, has
little to do with its priority.

20. A nurse-manager set a goal early in the year take better control of time management. Upon
achieving this goal, the manager is likely to experience what benefits? Select all that apply.
a. Increased learning
b. Increased influence on coworkers
c. Increased knowledge
d. Enhanced productivity
e. Decreased stress
ANS: D, E
Feedback: Managing time appropriately reduces stress and increases productivity. However,
a manager is unlikely see a direct relationship between time management and increased
knowledge, influence, and learning.
Functions in Time Management KEY: Integrated
Process: Nursing Process
21. Which statement identifies a common mistake made related to daily planning?
a. “Crises always come up so my plan is always changing.”
b. “I always handle each client’s needs as they arise.”
c. “Sometimes it’s difficult to reserve time for daily planning.”
d. “Client care requires a lot of reassessment by nursing.”
ANS: B
Feedback: If a nurse is sequencing his or her work solely on the basis of when issues
emerge, this suggests that the nurse is not taking time to prioritize tasks in terms of their
importance. Essentially, tasks are completed in a random sequence based only on when the
nurse became aware of the client need. The other listed statements reflect thoughtful
planning and flexibility, which are important skills.

TOP: Chapter Number: 09: Title: Taking Time to Plan and Establishing Priorities
22. How should the nurse-manager most effectively deal with the ever-changing nature of the
nursing work environment?
a. Evaluating the management skills of the nursing team leaders
b. Providing time management classes for staff members
c. Frequently reassessing personally established priorities
d. Encouraging staff to engage in daily planning
ANS: C
Feedback: Setting new priorities or adjusting priorities to reflect ever-changing work
situations is an ongoing reality for the unit manager. Although the other options are
appropriate, they are not directed to the management role in dealing with the ever-changing
nature of the environment of nursing.

TOP: Chapter Number: 09: Title: The Time-Efficient Work Environment
23. Which statements demonstrate adherence to habits that supports good personal time
management skills? Select all that apply.
a. “It’s important to me to be professional.”
b. “I’m learning to trust the members of my team.”
c. “I’ve learned that I’m most energetic in the morning.”
d. “I’ll adjust my sleep schedule now that I’m on night shift.”
e. “I never quit a task that I’ve decided to do.”
ANS: B, C, D
Feedback: Habits that foster good time management include favoring trusting relationships
and listening to biorhythms. Professionalism is an important attribute of good managers, but
this does not related directly to personal time management. Having the wisdom to quit tasks
that are unimportant or futile is important to time management.

TOP: Chapter Number: 09: Title: Display 9.6 Brans's 12 Habits to Master for Personal
Time Management KEY: Integrated Process: Nursing Process
24. What is the primary reason for documenting nursing interventions as soon as possible after
an activity is completed?
a. Decreasing the risk of inaccurate documentation
b. Implementing effective time management skills
c. Demonstrating professional nursing behavior
d. Observing an established nursing principle
ANS: A
Feedback: It is important to document nursing interventions as soon as possible after an
activity is completed. Waiting until the end of the workday to complete necessary
documentation increases the risk of inaccuracies and incomplete documentation. It is true
that this is an established nursing principle and that it shows professionalism and good time
management, but the primary rationale is client safety.

25. A novice nurse-manager is frequently late for appointments. This manager’s colleagues are
likely to have what perception of the manager?
a. The manager is overworked with too many responsibilities.
b. The manager needs additional management training.
c. The manager does not value other people’s time.
d. The manager lacks the skill necessary for the job.
ANS: C
Feedback: A lack of punctuality suggests that one does not value other people’s time.
Chronic lateness is likely to cause resentment among colleagues, not a recognition of the
manager’s needs for more support.

26. A nurse-manager admits to feeling frustrated and confused by the fact that each day “just
slips away,” leaving many important tasks undone. How should this manager begin develop
better time management skills?
a. Identify a mentor who can plan the manager’s schedule.
b. Complete a time inventory to identify how time is used.
c. Experiment with adjustments to the daily schedule.
d. Request a temporary reduction in workload.
ANS: B
Feedback: A time inventory provides objective data that can be used to inform changes in
the manager’s behavior. It is unrealistic to expect a mentor to plan the manager’s schedule,
and this action would not improve the manager’s ability to self-manage time. Adjustments
should not be made without the necessary data from a time inventory. A reduction in
workload will not improve the manager’s time management skills.

TOP: Chapter Number: 09: Title: Using a Time Inventory
27. A unit manager has been instructed to complete a comprehensive audit of the unit’s use of
resources. The manager is daunted by the size of the task, which will likely take several
weeks to complete. The manager should:
a. set aside low- and medium-priority tasks until the project is complete.
b. delegate the project to subordinates and ask for weekly updates.
c. divide the project into smaller components that can be more easily completed.
d. request clerical or secretarial assistance.
ANS: C
Feedback: Breaking up large projects into smaller pieces makes them much easier to
accomplish and prevents procrastination. Delegation is often appropriate and efficient, but it
would normally be inappropriate to delegate the entirety of a large project to subordinates.
The manager must not neglect other tasks, even when there is a major project at hand.
Secretarial support may provide some assistance with a larger project, but it is not likely to
be the major determinant of success.

28. A nurse-manager makes lists of tasks for each day. What should the manager do in order to
ensure that lists accurately reflect changes in priorities?
a. Reevaluate the lists on a regular basis and adjust them as needed.
b. Ensure that each day’s list is significantly different from the previous day’s list.
c. Make lists as detailed as possible in terms of the time allocated and the specifics of
each task.
d. Have the lists reviewed by a trusted colleague on a regular basis.
ANS: A
Feedback: Evaluating and reprioritizing are vital aspects of time management. There is no
obvious benefit in aiming to make lists different from other days’ lists. Increased detail can
help with time management, but this does not help the manager adjust time and tasks as
needed. Similarly, review by a colleague does not mean that the manager’s planning will
respond to short-term changes.

TOP: Chapter Number: 09: Title: Reprioritizing
29. A nurse-manager is beginning a day and is responsible for completing numerous tasks,
including one high-priority task, three medium-priority tasks, and several lower priority
tasks. How should the manager plan the day?
a. Complete some low-priority tasks first to make room for focusing on the
high-priority task.
b. Complete the high-priority task as early in the day as possible.
c. Arrange the tasks according to the amount of time that they will require.
d. Complete the low-priority tasks first, then a medium-priority task, and then focus
exclusively on the high-priority task.
ANS: B
Feedback: Finishing high-priority tasks first is an essential step in personal time
management. Any option that does not focus first on the high-priority task is inaccurate.

TOP: Chapter Number: 09: Title: Three Basic Steps to Time Management
30. A nurse-manager is having an exceptionally busy day and tells a colleague, “There’s no way
I can take a lunch break today. I’ve got too much to do.” What is the colleague’s best
response?
a. “It’s important to take breaks, so there’s never any valid reason for skipping
lunch.”
b. “I know that happens sometimes. Let me know if you need help with organizing
your day.”
c. “You probably just need to reorganize your day. Do you need help with that?”
d. “Let’s take a quick break and get something to eat, even if we have to come back a
bit early.”
ANS: D
Feedback: Whenever possible, the manager should take breaks in order to recharge and be
more focused and efficient. Even so, there may be days where it is an impossibility. The
colleague should encourage the manager to take a break, if possible, and even if it is shorter
than usual. Often a day is exceptionally busy, no matter how well it is organized.

Chapter 10: Fiscal Planning
1. The nurse-manager at a long-term care facility is participating in fiscal planning for the first
time. What is fiscal planning?
a. A learned skill that improves with practice
b. A job role of the facility business manager
c. Part of the organizing phase of the management process
d. Reactive, based on political, social, and economic forces
ANS: A
Feedback: Fiscal planning is a learned skill and must include nursing management input. It
should be proactive, not reactive, and it is part of the planning process of management.

2. What is an implication of responsibility accounting for a nurse who manages a hospital unit?
a. The manager is accountable for the way that resources on used on the unit.
b. The manager has a responsibility to submit the unit budget on time each year.
c. The organization’s financial officer works with manager regarding budget
approval.
d. The budgeting process must be transparent and data must be made publicly
available.
ANS: A
Feedback: Responsibility accounting requires that someone must be responsible for all
revenue, expenses, assets, and liabilities. As a result, the leader-manager may be held
accountable for the financial results of the operating unit. Collaboration and timeliness are
characteristics of prudent budgeting, but these are not implications of the principle of
responsibility accounting. For most organizations, the budgeting processing is not revealed
to the public.

TOP: Chapter Number: 10: Title: Responsibility Accounting
3. The leader-manager of several inpatient units is participating in fiscal planning. During this
process, the leader-manager should:
a. assume primary responsibility for the organization’s budgetary planning goals.
b. monitor and evaluate all aspects of the unit’s budget control.
c. encourage broad participation of subordinates in the budgetary process.
d. control unpredictable census variations that may undermine the personnel budget.
ANS: B
Feedback: The manager’s responsibility is to monitor all aspects of the unit’s budget in the
unit under his or her leadership. However, the leader-manager does not have primary
responsibility for budgeting, which usually lies with a chief financial officer. There is often
minimal participation by subordinates in fiscal planning, and it is often not possible to
control variations in the census.

TOP: Chapter Number: 10: Title: Responsibility Accounting
4. When participating in fiscal planning, a leader should perform what role?

a. Monitoring aspects of budget control
b. Accurately assessing personnel needs using agreed-on standards or an established
client classification system
c. Documenting the need for resources on a unit
d. Being visionary in identifying short- and long-term unit fiscal needs
ANS: D
Feedback: Leaders are visionary; the other roles of assessing needs, monitoring budget
control, and documenting needs are management-related.

Functions in Fiscal Planning KEY: Integrated Process: Nursing Process
5. A nurse-manager has been required to justify each item of the following year’s proposed
budget. The manager has been instructed that referring to the previous year’s expenditures is
not a sufficient justification. What type of budgeting is being used in this facility?
a. Incremental budgeting
b. Perpetual budgeting
c. Zero-based budgeting
d. Managed care
ANS: C
Feedback: Zero-based budgeting begins each year with zero and requires rejustification.
This is not true of the other options.

TOP: Chapter Number: 10: Title: Zero-Based Budgeting
6. A disease outbreak in the local community caused an unprecedented increase in staffing

costs. In what category of expenses should the nurse-manager place these costs?
a. Controllable
b. Fixed
c. Capital budget
d. Noncontrollable
ANS: D
Feedback: Noncontrollable costs include equipment depreciation, the number and type of
supplies needed by clients, or overtime that occurs in response to an emergency. This would
not be a fixed cost. Personnel costs are not capital expenditures.

TOP: Chapter Number: 10: Title: Budget Basics
7. A recent switch to a new laundry provider at a long-term care facility has been described as
“cost-effective.” What does this imply about the change in laundry service?
a. It is the least expensive service available.
b. It is worth the cost.
c. It is reimbursable.
d. The cost was anticipated.
ANS: B
Feedback: Cost-effective does not necessarily imply the cheapest, but it requires that the
expenditure be worth the cost. The other options are not characteristic of the term
cost-effective.

TOP: Chapter Number: 10: Title: Balancing Cost and Quality
8. The nurse-manager of a community health clinic is participating in budget planning for the
next year. The manager will most likely assign the most money to what expenditure
category.
a. The personnel budget
b. Short-term capital acquisitions
c. The operating budget
d. Supplies and equipment
ANS: A
Feedback: Health care is labor-intensive; therefore, the personnel budget makes up the
largest expense. In most circumstances, the other options represent lower expenditures.

TOP: Chapter Number: 10: Title: The Personnel Budget
9. Determine the nursing care hours per client day (NCH/PPD) if the following staffing existed
for a 24-hour period (unit census = 10):
12 midnight to 12 noon, 1 registered nurse, 1 licensed vocational nurse
12 noon to 12 midnight, 1 registered nurse, 1 licensed vocational nurse, 1 unit clerk (8 hours
only)
a. 5.6 NCH/PPD
b. 4.8 NCH/PPD
c. 5.0 NCH/PPD
d. 6.2 NCH/PPD
ANS: A
Feedback: A total of 56 hours of nursing was worked in 24 hours (unit clerks are counted in
NCH/PPD) and the census was 10 clients. Dividing the total number of nursing care hours
by the census (56 divided by 10) yields an NCH/PPD calculation of 5.6 NCH/PPD.

10. The unit manager is calculating the NCH/PPD for a 24-hour period. The manager will need
what data to calculate this? Select all that apply.
a. The acuity level of the clients on the unit
b. The total number of hours worked by nursing personnel
c. The average hourly wage of the nurses on the unit
d. The complexity of nursing care that was provided on a particular unit in a 24-hour
time span
e. The unit census
ANS: B, E
Feedback: NCH/PPD by dividing the number of nursing care hours worked in 24 hours by
the client census. It is not necessary to know the acuity level, the nurses’ wages or the
complexity of care provided, even though these variables affect budgeting.

11. What is the name for a provision of health care in an organized system to subscribing
members in a geographical area with an agreed-on set of basic and preventive supplemental
health maintenance and treatment services for a fixed, prepaid charge?
a. Preferred provider organizations (PPOs)
b. A traditional third-party payer indemnity plan
c. A health maintenance organization (HMO)
d. Diagnosis-related groupings (DRGs)
ANS: C
Feedback: HMOs provide health care in an organized system to subscribing members in a
geographical area with an agreed-on set of basic and preventive supplemental health
maintenance and treatment services for a fixed, prepaid charge. That definition does not
apply to the other options.

TOP: Chapter Number: 10: Title: Types of Managed Care Organizations
12. What was the primary reason for the development of the prospective payment system?
a. Skyrocketing health-care costs following the advent of Medicare and Medicaid
b. The passage of the Health Maintenance Act of 1973
c. The introduction of the Health Security Act to Congress
d. A coalition held by the three largest private insurers in 1975
ANS: A
Feedback: Prospective payment systems were the result of skyrocketing medical costs in the
United States. They are not generally attributed to the Health Maintenance Act, the Health
Security Act, or a coalition of insurers.

TOP: Chapter Number: 10: Title: The Prospective Payment System
13. A client has a managed care program that is organized on the basis of capitation. What is a
characteristic of this client’s health care?
a. Health-care providers earn a bonus if the client remains free of disease for a
predetermined length of time.
b. The client pays a fixed percentage of the cost of any health care, usually between
10% and 20%.
c. The program uses a “gatekeeper” to ensure appropriate utilization of services.
d. The client’s providers are paid the same amount each month, regardless of the
client’s use of services.
ANS: D
Feedback: Capitation is a predetermined, negotiated payment to providers, per client,
regardless of whether services are used. Providers earn more if clients use fewer services,
but this is not characterized in the form of a “bonus.” Capitation does not denote the
payment of a fixed percentage of health-care costs. Many forms of managed care involve a
gatekeeper of sorts, but this is not particular to capitation.

TOP: Chapter Number: 10: Title: Managed Care
14. Which client would be most likely to qualify for Medicaid?

a. An adult client who earns $750.00 per month
b. A veteran who sustained injuries in combat
c. A Native American client who lives on a reservation
d. A child who requires physical therapy to recover from traumatic injuries
ANS: A
Feedback: Low income is the primary criterion for Medicaid. Veterans do not automatically
qualify, nor do Native American clients. Some individuals with long-term disabilities
qualify, but recovery from acute injuries would not normally cause an individual to qualify.

TOP: Chapter Number: 10: Title: Medicare and Medicaid
15. An older adult client has been admitted to the hospital with pneumonia and has been placed
on a critical pathway. This tool will allow the care team to:
a. minimize the client’s out-of-pocket expenses for care.
b. decrease the amount of paperwork required for reimbursement.
c. minimize administrative costs.
d. standardize the client’s care.
ANS: D
Feedback: Critical pathways are one means of standardizing care for clients with similar
diagnoses. Pathways do not necessarily reduce the client’s costs. Care is standardized, but
this does not mean that administrative costs and documentation are always reduced.

TOP: Chapter Number: 10: Title: Critical Pathways and Variance Analysis
16. The manager is using a decision package to set funding priorities for a hospital unit. What
type of budgeting is the manager most likely using?
a. Flexible
b. Operating
c. Capital
d. Zero based
ANS: D
Feedback: Managers must rejustify their program or needs every budgeting cycle in
zero-based budgeting. Using a decision package to set funding priorities is a key feature of
only zero-based budgeting, not flexible, operating, or capital budgets.

TOP: Chapter Number: 10: Title: Zero-Based Budgeting
17. The nurse is caring for a client who has health insurance that is a form of managed care.
What are likely characteristics of this client’s health-care plan? Select all that apply.
a. Clients as gatekeepers of their health-care services
b. A focus on prevention of illness
c. Decreased emphasis on inpatient hospital care
d. Capitation
e. Unlimited choice of health-care providers
ANS: B, C, D
Feedback: Key principles of managed care include the use of primary care providers as
gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use
of clinical practice guidelines for providers, selective contracting, capitation, utilization
review, the use of formularies to manage pharmacy care, and continuous quality monitoring
and improvement. The client’s choice of health-care providers is often limited.

18. What aspect of a client’s care is most likely to be influenced by the Patient Protection and
Affordable Care Act (PPACA)?
a. The number of health insurance plans that the client can choose between
b. The likelihood that the client will have to seek out-of-state treatment
c. The client’s ability to act as the “gatekeeper” of his or her own care
d. The client’s ability to qualify for Medicaid
ANS: A
Feedback: The Affordable Care Act was aimed at increasing consumers’ options for
obtaining health insurance. It did not alter the criteria for Medicaid. In most forms of
managed care, the client does not act as the “gatekeeper” for his or her own care.
Out-of-state treatment was not a focus of the PPACA.

TOP: Chapter Number: 10: Title: Health-Care Reform Efforts: The Patient Protection and
Affordable Care Act. What Comes Next? KEY: Integrated Process: Nursing Process
19. A client belongs to an HMO that is a preferred provider organization (PPO). When requiring
health care, this client will most likely:
a. prove that he or she has received preventive care from a provider at some point.
b. pay out of pocket for care and then submit for reimbursement.
c. be assessed by a nurse before being referred to a physician.
d. choose between the health-care providers that are in the PPO.
ANS: D
Feedback: A PPO provides financial incentives to consumers to use a select group of
preferred providers and pay less for services. Clients do not normally have to pay out of
pocket, and there is no obligation to demonstrate preventative care or to be assessed by a
nurse before seeing a physician.

TOP: Chapter Number: 10: Title: Types of Managed Care Organizations
20. What changed the structure of Medicare payments from a retrospectively adjusted cost
reimbursement system to a prospective, risk-based one?
a. Zero-based budgets
b. Diagnosis-related groupings
c. Prospective payment system
d. Incremental budgets
ANS: B
Feedback: The impetus of diagnosis-related groupings changed the structure of Medicare
payments from a retrospectively adjusted cost reimbursement system to a prospective,
risk-based one. None of the other options were involved in the change.

21. Which statement concerning a budget is true?

a. A budget’s reliability decreases if it is prepared significantly in advance of the
funding period.
b. Budgets should be created as far in advance is possible.
c. A budget is revised every 3 months during a fiscal year.
d. Budgets are reliable only when expenses are fixed.
ANS: A
Feedback: A budget that is predicted too far in advance has greater probability for error. For
this reason, it is not desirable to create a budget too far in advance.

22. Which statements regarding fiscal planning are true? Select all that apply.
a. Social influences affect fiscal planning.
b. A successful fiscal planner must be creative.
c. An understanding of economic forces is necessary to perform fiscal planning.
d. Practical experience is a key to being a good fiscal planner.
e. Subordinates should be excluded from fiscal planning.
ANS: A, B, C, D
Feedback: Fiscal planning is not intuitive; it is a learned skill that improves with practice.
Fiscal planning also requires vision, creativity, and a thorough knowledge of the political,
social, and economic forces that shape health care. Subordinates should be included in the
process.

23. Which statement about American health-care budget spending is correct?

a. A large health-care budget equals quality health-care outcomes.
b. America spends less than any other industrialized country on health care.
c. Outcomes related to low–birth-weight infants are worse than many other
industrialized countries.
d. The scarcity of resources is the biggest factor in the failure to reach outcomes.
ANS: C
Feedback: Spending more does not always equate to higher quality health outcomes. The
United States spends more per capita on health care than does any other industrialized
country, and yet outcomes in terms of teenage pregnancy rates, low–birth-weight infants,
and access to care are worse than many countries that spend significantly less.

TOP: Chapter Number: 10: Title: Balancing Cost and Quality
24. A nurse-manager is participating in the budgeting process. What task should the manager
perform first?
a. Creating a spending plan
b. Determining what needs to be covered in the budget
c. Identifying the organization’s strengths and weaknesses
d. Determining how to maximize cost-effectiveness
ANS: B
Feedback: The first step in the budgetary process involves assessment. That is, the manager
must assess what needs to be covered in the budget. Creating a plan and maximizing
cost-effectiveness occur after the assessment. Identifying the organization’s larger strengths
and weaknesses is not an explicit part of the budgetary assessment.
TOP: Chapter Number: 10: Title: Steps in the Budgetary Process
25. Which statements regarding a budget are true? Select all that apply.
a. Personnel costs are normally considered to be an uncontrollable expense.
b. A budget contains an estimate of both expenses and income for a fixed period.
c. It allows for an institution to plan for the effective use of its resources.
d. The cost of supplies is an example of a variable expense.
e. A mortgage is an example of a fixed expense.
ANS: B, C, D, E
Feedback: A budget is a financial plan that includes estimated expenses as well as income
for a period of time. Accuracy dictates the worth of a budget; the more accurate the budget
blueprint, the better the institution can plan the most efficient use of its resources. Examples
of fixed expenses might be a building’s mortgage payment or a manager’s salary; variable
expenses might include the payroll of hourly wage employees and the cost of supplies.
Personnel costs are usually considered to be a controllable expense, not an uncontrollable
expense.

26. During the budgetary process, a nurse-manager and the other members of the fiscal planning
team are considering factors that may affect the accuracy of the budget. What factor should
the team prioritize?
a. Legislation regarding client safety
b. Possible changes in reimbursement policies
c. Depreciation of capital equipment
d. Establishment of new HMOs in the region
ANS: B
Feedback: Historically, there have been significant changes in reimbursement policies that
have happened quickly. These changes threaten the accuracy of budgeting. Depreciation is
more predictable and changes in client safety regulations usually do not have such
significant effects on the budget process. The emergence of an HMO would not be expected
to affect an organization’s budget.

TOP: Chapter Number: 10: Title: The Future of Managed Care
27. An organization is considering the adoption of flexible budgeting. What advantage will this
type of budgeting provide to the organization?
a. Increased ability to adapt to changing circumstances throughout the year
b. Increased reimbursement from state and federal agencies
c. Longer budget cycles
d. Increased opportunities for staff to participate in the budget process
ANS: A
Feedback: Flexible budgeting allows for adjustments throughout the year based on volume.
Flexible budgets do not necessarily involve longer budget cycles or more participation by
staff. Flexible budgeting has no effect on reimbursement policies.

TOP: Chapter Number: 10: Title: Flexible Budgeting
28. A client is a member of an HMO and has chronic shoulder pain from an old injury. The
client has decided to pursue shoulder surgery and the HMO has required a utilization
review. What will this review focus on?
a. The circumstances surrounding the client’s original injury
b. The client’s baseline level of functioning
c. The costs and benefits of the proposed surgery
d. The profit to be made from the surgery
ANS: C
Feedback: Utilization review is a process used by insurance companies to assess the need
for medical care and to assure that payment will be provided for the care. Utilization review
typically includes precertification or preauthorization for elective treatments, concurrent
review, and, if necessary, retrospective review for emergency cases. Profits are always a
relevant consideration, but many other variables would be considered. The client’s baseline
functioning and the circumstances of the original injury are not the primary focuses of a
utilization review.

29. The managers of an HMO have argued against a proposed decrease in deductibles, citing a
risk of moral hazard. What phenomenon would show that the managers’ concerns were
justified?
a. Members of the HMO adopt high-risk behaviors because they know that treatment
is available.
b. Members of the HMO use more health-care services because of the reduced cost.
c. Members are reluctant to comply with the HMO regulations.
d. Members leave the HMO for other HMOs that have more favorable terms.
ANS: B
Feedback: Moral hazard is the risk that the insured will overuse services just because the
insurance will pay the costs. This does not denote an increase in high-risk behavior,
noncompliance with regulations, or abandonment of the HMO by consumers.

TOP: Chapter Number: 10: Title: Proponents and Critics of Managed Care Speak Up
30. A nurse-manager is working in the context of an accountable care organization (ACO).

What task will this manager most likely perform?
a. Coordinating care for Medicare clients
b. Providing community-based illness prevention
c. Health promotion
d. Determining whether clients’ care plans are justified
ANS: A
Feedback: ACOs exist to better coordinate care for Medicare patients across care settings.
Health promotion and illness prevention would be lesser concerns. In this particular context,
justifying clients’ care plans would not be the nurse’s major task.

TOP: Chapter Number: 10: Title: Accountable Care Organizations
Chapter 11: Career Planning and Development in Nursing
1. A nurse is currently in the “promise” phase of career development. What goal should the
nurse prioritize during this stage?
a. Acting as a role model to recent graduates
b. Gaining exposure to a variety of experiences
c. Avoiding obsolescence
d. Graduating from nursing school
ANS: B
Feedback: Promise is the earliest of the career phases and typically reflects the first 10 years
of nursing employment. Milestones to be attained include socialization to the nursing role
(becoming an insider); building knowledge, skills, abilities, credentials, and an education
base; and gaining exposure to a variety of experiences. This stage begins after graduation,
not before. Role modeling becomes more of a priority in the subsequent stages of the
nurse’s career. Obsolescence (or the perception of it) becomes an increasing concern during
the harvest stage.

TOP: Chapter Number: 11: Title: Career Stages
2. An experienced nurse-manager describes a recently hired nurse as “very promising.” The

manager can best promote this nurse’s career development by:
a. asking other nurses to model their behavior on the new nurse’s behavior.
b. providing the nurse with increasingly challenging work assignments.
c. removing the nurse from client care responsibilities and assigning management
tasks.
d. providing the nurse with positive feedback.
ANS: B
Feedback: Providing challenging assignments is one way that the nurse’s skills and
knowledge can be enhanced, benefiting career development. Identifying the recent hire as a
role model may place undue stress on the nurse and may create resentment from other
nurses who have more experience. Giving the nurse positive feedback may validate the
nurse’s performance but will not necessarily promote career development. Removing the
nurse from client care would be premature at this early stage.

TOP: Chapter Number: 11: Title: The Organization's Role in Employee Career
Development KEY: Integrated Process: Nursing Process
3. A nurse-manager is arguing for the establishment of a formal career development program

in the health-care facility. What potential benefits should the manager describe? Select all
that apply.
a. Employee attrition can be reduced.
b. Personnel can be used more effectively.
c. Employees can increase earning power.
d. Employment benefits are increased.
e. New skills are brought into the organization.
ANS: A, B, E
Feedback: Organizational justification for career development programs includes attrition
reduction, improved productivity, and general improved quality of life. Career development
programs cause a steady influx of new skills into an organization. Although employees may
earn more money and additional benefits as a result of career development, they are not the
reason that organizations undertake career development programs.

TOP: Chapter Number: 11: Title: Justifications for Career Development
4. A recent graduate’s mentor is explaining the importance of career planning. What should the
mentor teach the recent graduate about career planning?
a. It is ultimately the employer’s responsibility.
b. It should begin once the nurse has at least 12 months of client care experience.
c. It requires development and implementation of a long-term plan.
d. It functions best when the planning is episodic in nature.
ANS: C
Feedback: Effective career planning requires long-term planning; it is the responsibility of
the individual and requires constant attention to function properly. Career planning should
begin as soon as possible in the nurse’s career; there is no need to delay it until accruing 12
months of experience.

TOP: Chapter Number: 11: Title: Career Planning and the New Graduate Nurse
KEY: Integrated Process: Teaching/Learning
5. A nurse is constructing a resumé before beginning to search for a new job. When creating a
resumé, the nurse should:
a. give equal weight to strong and weak points.
b. aim for at least four to five pages in length.
c. use complex, scholarly language to demonstrate competence.
d. ensure that the document is concise and easy to read.
ANS: D
Feedback: The content of a resumé should be able to be grasped quickly by the individual
doing the hiring, so conciseness and readability are of key importance. Weaknesses are not
emphasized, and one to two pages is an ideal length.
TOP: Chapter Number: 11: Title: Display 11.6 General Guidelines for Resumé Preparation
6. A nurse has recently graduated from nursing school and is transitioning into a nursing
career. Which activity is the nurse’s personal responsibility for career management?
a. Developing career ladders
b. Establishing career paths
c. Providing challenging assignments
d. Developing career goals
ANS: D
Feedback: Only the development of a career plan is the responsibility of the individual. The
development of career ladders and career paths and the provision of challenging
assignments are management responsibilities.

TOP: Chapter Number: 11: Title: Table 11.1 Roles and Responsibilities for Career
Development KEY: Integrated Process: Nursing Process
7. A nurse is interviewing for a position in a health-care facility. The interviewer identifies a

long-term coaching program for career development as one of the benefits in the
organization. The nurse should identify what characteristic of this program?
a. It occurs annually at performance appraisal reviews.
b. It focuses on employee performance deficits.
c. It requires the same intensity as a mentoring relationship.
d. It occurs over the entire employment tenure of an employee.
ANS: D
Feedback: Long-term coaching should occur over the entire employment of the employee.
Ideally, it is not something that happens solely at performance reviews, and it is generally
not as interpersonally intense as a mentoring relationship. Coaching focuses on enabling
strengths, not identifying deficits.

TOP: Chapter Number: 11: Title: Career Coaching
8. A nurse who has transferred to a new workplace setting self-identifies as “competent” on

Benner’s continuum from novice to expert. What characteristic does this nurse most likely
possess?
a. A Bachelor of Science in Nursing degree
b. Two to 3 years of clinical experience
c. Basic health-care management skills
d. A well-defined career plan
ANS: B
Feedback: Nurses who are at the “competent” stage of their career typically have around 2
or 3 years of experience. The possession of a degree is not a necessary characteristic.
Similarly, it is unlikely that the nurse has firsthand experience at management. The nurse
may or may not have a career plan; the absence of a career plan does not necessarily prevent
ascension in nursing experience.

TOP: Chapter Number: 11: Title: Display 11.2 Benner's Levels of Nursing Experience
9. An experienced nurse-manager is organizing management development classes for some of

the nurses in the organization. What principle should the manager follow when planning the
classes?
a. They should be offered to every employee in the organization.
b. They should be limited to employees with university degrees.
c. The classes should include social learning activities.
d. The classes should be offered in an online format.
ANS: C
Feedback: The inclusion of social learning activities in management development increases
the possibility for employee retention. Management classes are not normally offered to
every employee, but they should also not be limited to just employees with university
degrees. There is no reason why they must be offered in an online format, and doing so may
make it more difficult to apply social learning principles.

TOP: Chapter Number: 11: Title: Management Development
10. The nurse-manager of a clinic has launched a career development program for nurses. The
manager should anticipate what benefits? Select all that apply.
a. Increased retention of staff
b. Decreased staff turnover
c. Increased skill level of nurses
d. Enhanced quality of work life for nurses
e. Increased interdisciplinary cooperation
ANS: A, B, C, D
Feedback: Research has shown that career development programs increase retention,
decrease attrition, increase nursing skill level, and improve the quality of work life for
nurses. Career development is less likely to have a direct effect on interdisciplinary
collaboration because this is not a direct result of career planning.
TOP: Chapter Number: 11: Title: Justifications for Career Development
11. A nurse-manager is launching career coaching program in the workplace. What is the
a. Observe employees to see who would most benefit from coaching.
b. Publicize the program to elicit as many participants as possible.
c. Arrange a meeting to present the learning objectives for the program.
d. Link participation in the program to employees’ performance appraisals.
ANS: A
Feedback: The first step in career coaching is to observe employees and gather data. This
should be performed before selecting participants or meeting with interested employees. It
would be manipulative and counterproductive to link participation in a coaching program
with an employee’s performance appraisal. Coaching that is based on coercion is unlikely to
be beneficial.

12. A nurse is selecting areas to focus on for continuing education and personal growth over the
next year. During this process, the nurse should:
a. prioritize learning that can take place in a college or university setting.
b. ask the manager to perform this task, if possible.
c. prioritize areas of study that are new to the nurse.
d. engage in reflective practice.
ANS: D
Feedback: Reflective practice has been suggested as a strategy for promoting personal
growth and continued competence in nursing. This does not always point to a need for
learning in a college or university setting, and it is unrealistic to delegate this task to a
manager. Reflection may indicate a need to enhance knowledge and skills in areas that are
familiar, not always new areas.

TOP: Chapter Number: 11: Title: Reflective Practice and the Professional Portfolio
13. A nurse has asked a colleague for assistance with a complex wound dressing change. What
response suggests that the colleague is at a novice level of nursing experience?
a. “Sure. Can you give me directions and then I’ll do what you say?”
b. “I’m really busy right now. Can we do it sometime this afternoon?”
c. “I can do it for you later, if that helps.”
d. “Definitely. I’ll go and get the supplies and meet you at the bedside.”
ANS: A
Feedback: A novice typically requires clear directions and is oriented on following
instructions and is less focused on thinking innovatively or independently. Deferring the
other nurse’s request or taking initiative would be less typical of a novice nurse.

14. A nurse is applying for a job and is now writing a cover letter. The nurse should integrate
what characteristics of a cover letter? Select all that apply.
a. Introduce the applicant.
b. Briefly highlight key points of the resume.
c. List the contact information for the nurse’s references.
d. Make a positive first impression.
e. Always used when submitting a resume.
ANS: A, B, D, E
Feedback: Cover letters should always be used when submitting a resumé. Their purpose is
to introduce the applicant, briefly highlight key points of the resume, and make a positive
first impression. The specific contact information for the nurse’s references is not normally
included in the cover letter.

TOP: Chapter Number: 11: Title: Display 11.6 General Guidelines for Resumé Preparation
15. How can a nursing professional best demonstrate advanced achievement of competencies?
a. Participating in career planning
b. Achieving a new specialty certification
c. Transfer to a new department
d. Maintaining ethical standards of practice
ANS: B
Feedback: Professional specialty certification is one way that an employee can demonstrate
advanced achievement of competencies. The transfer, when used appropriately, may be an
effective way to provide career. Career planning and ethical practice are minimum
indicators of nursing practice, not indicators of advanced achievement. Requesting a transfer
does not necessarily indicate that the nurse possesses advanced achievement.

16. A nurse is considering certification in an area of specialty. What potential benefits of

certification should the nurse consider? Select all that apply.
a. A personal sense of accomplishment
b. Exemption from continuing education requirements
c. Increased career options
d. Increased potential for advancement and promotions
e. Higher salaries
ANS: A, C, D, E
Feedback: The certified nurse often finds many personal benefits related to the attainment of
such status, including more rapid promotions on career ladders, advancement opportunities,
and feelings of accomplishment. In addition, they often earn more than their noncertified
counterparts. All nurses must complete continuing education requirements, regardless of
certification.

TOP: Chapter Number: 11: Title: Professional Specialty Certification
17. The manager of a clinic is creating a system for career development for all employees. What
should be included in this program? Select all that apply.
a. Quarterly performance reviews for employees
b. Appropriate use of transfers between work locations
c. Policies and processes for handling promotions
d. Long-term coaching
e. Mandatory specialty certifications for all staff
ANS: B, C, D
Feedback: The manager should have a well-developed, planned system for career
development for all employees; this system should include the appropriate use of transfers,
how promotions are to be handled, and long-term coaching. These policies should be fair
and communicated effectively to all employees. Performance reviews are a necessity, but
performing these quarterly is excessive and onerous. Specialty certifications are beneficial,
but these are not normally required for all staff members. They are usually pursued by
nurses who choose to pursue them rather than being a mandatory requirement for
employment.

Functions in Career Planning and Development KEY: Integrated Process:
Nursing Process
18. What characteristic of a nurse best indicates the attainment of an “expert” level of nursing
experience?
a. The nurse has more than 3 years of clinical experience.
b. The nurse is learning from experience how best to react in clinical situations.
c. The nurse identifies long-term goals for career advancement.
d. The nurse possesses an intuitive grasp of complex clinical situations.
ANS: D
Feedback: Benner identifies the fact that the expert nurse has an intuitive grasp of complex
situations. This normally requires more than 3 years of experience. Learning from
experience and setting goals are characteristics of the earlier stages in Benner’s continuum.

19. A nurse is currently in the “momentum” career phase. What activity is most appropriate
during this stage of the nurse’s career?
a. Adjusting from the student role to the professional role
b. Avoiding obsolescence
c. Beginning to participate in continuing education
d. Being a role model to other nurses
ANS: D
Feedback: During the momentum stage, the individual often achieves a high enough level of
expertise to be a role model to others. Adjusting from a student role and beginning to
participate in continuing education are characteristic of the promise phase. During the
harvest stage, the nurse must avoid obsolescence.

OBJ: 2
20. A nurse is described by peers and colleagues as having expert knowledge, skills, abilities,
credentials, and education base. What career stage is this nurse most likely in?
a. Promise
b. Momentum
c. Harvest
d. Legacy
ANS: B
Feedback: Momentum is the middle career phase and typically reflects the nurse with 11 to
29 years of experience. Nurses in this phase are experienced clinicians with expert
knowledge, skills, abilities, credentials, and education base. “Promise” precedes this stage,
and “harvest” follows it. Nurses in the harvest stage are often described as legacy clinicians.
PTS: 1 DIF: Easy REF: Page: 272–273
OBJ: 2
21. A nurse has applied for a new position and has presented a nursing portfolio to the human
resources department. This portfolio will allow the nurse to:
a. present his or her specific career goals.
b. justify salary expectations.
c. give examples of professional growth.
d. showcase his or her academic credentials.
ANS: C
Feedback: All nurses should maintain a professional portfolio to reflect their professional
growth over their career. Normally, a professional portfolio is not used for presenting career
goals, academic credentials, or justifying a desired salary.

22. A nurse-manager is appraising employees’ competency levels during performance reviews.

What goal should the manager set when performing competency assessments?
a. Helping nurses identify ways to exceed minimal licensing requirements
b. Fulfilling state requirements for minimal nursing practice
c. Facilitating each nurse’s advancement up the facility’s career ladder
d. Satisfying institutional employment requirements
ANS: A
Feedback: Competency assessment and goal setting in career planning should help the
employee identify how to exceed the minimum levels of competency required by federal,
state, or organizational standards. Consequently, goals should go beyond just meeting
minimum requirements or fulfilling regulations.

TOP: Chapter Number: 11: Title: Continued Competency as Part of Career Development
23. A nurse had made a renewed commitment to career planning. What activities should the
nurse perform in order to meet this goal? Select all that apply.
a. Accepting more overtime shifts
b. Introducing evidence-based practice changes regarding wound dressings
c. Discussing the health needs of the homeless with local politicians
d. Earning a bachelor’s degree in nursing
e. Working with a seasoned mentor
ANS: B, C, D, E
Feedback: Career planning should include, at minimum, a commitment to the use of
evidence-based practice, learning new skills or bettering practice through the use of role
models and mentors, staying aware of and being involved in professional issues, and
furthering one’s education. Working more hours in the form of overtime will not necessarily
advance the nurse’s career plan.

24. The nurse-manager is designing a transition program for new nursing graduates. When
planning this program, the manager should aim to address what issues? Select all that apply.
a. Supporting practice autonomy
b. Strengthening new clinical skills
c. Introducing time management skills
d. Socializing nurses to the clinical environment
e. Enforcing adherence to institutional policies and procedures
ANS: A, B, C, D
Feedback: A well-designed transition-to-practice program strengthens new graduates’ skills
and competencies and prepares the new nurse for the demands of caring for clients. As well,
it socializes nurses to the professional role. These programs are designed to empower new
graduates, not enforce policies and procedures.

TOP: Chapter Number: 11: Title: Transition-to-Practice Programs/Residencies for New
Graduate Nurses KEY: Integrated Process: Nursing Process
25. A recent nursing graduate has begun working full-time and is committed to career planning.
What action will be most likely to advance the nurse’s career?
a. Changing jobs every 12 to 18 months
b. Obtaining professional certification
c. Adhering to standards of ethical practice
d. Participating actively in performance appraisals
ANS: B
Feedback: Advanced certifications have many benefits for a new nurse’s career plan.
Changing jobs too often may create the impression that the nurse is unreliable. Ethical
practice is an imperative part of nursing but is not considered a career planning activity.
Similarly, active participation in career planning will not necessarily advance the nurse’s
career.
TOP: Chapter Number: 11: Title: Career Planning and the New Graduate Nurse
26. A manager is conducting career coaching for an employee who is new to the organization.
When coaching this employee, the manager should:
a. conduct the coaching in a group of no more than six to eight nurses.
b. encourage the nurse to share his or her plans with the other nurses in the
organization.
c. help the nurse establish goals and make the attainment of the goals a condition of
employment.
d. make sure not to intimidate the employee during questioning.
ANS: D
Feedback: In order to make coaching a productive activity, it is important that the manager
not intimidate the nurse. Coaching is usually performed one-on-one, not in a group setting.
In most cases, the nurse is not obliged or expected to describe these private and personal
communications to the other nurses. Coaching should not normally become a precursor to
binding expectations for performance.

27. What activity is most likely to promote a nurse’s continued competence?

a. Working in a variety of clinical settings
b. Meeting minimal standards for relicensing
c. Acquiring new knowledge and skills on a regular basis
d. Submitting to regular performance reviews
ANS: C
Feedback: Continued competence requires a conscious plan for the nurse to increase his or
her knowledge and skills on an ongoing basis. This goes beyond meeting the minimum
requirements for licensure. Regular performance reviews will not necessarily cause a nurse
to promote continued competence. Similarly, a variety of clinical settings will not expose
the nurse to new experiences but may not be accompanied by an increase in knowledge and
skills.

TOP: Chapter Number: 11: Title: Continued Competency as Part of Career Development
28. The manager of a busy medical–surgical wants to establish a transition-to-practice program.
The manager should cite what benefit of the proposed program to the hospital’s
administrators?
a. More experienced nurses will be likely to apply for jobs.
b. Nurses on the unit will be more motivated.
c. Staffing costs will be reduced.
d. Turnover of new staff will likely be reduced.
ANS: D
Feedback: Transition-to-practice programs reduce staff turnover and attrition. Their
existence is less likely to be an issue for more experienced nurses. These programs can be
expensive and may not cause a reduction in overall staffing costs. This program is unlikely
to affect overall motivation on the unit.

TOP: Chapter Number: 11: Title: Transition-to-Practice Programs/Residencies for New
Graduate Nurses KEY: Integrated Process: Nursing Process
29. A nurse will soon be creating a plan for continuing competence. What activity should the
nurse prioritize when making this plan?
a. Reflecting on his or her own practice
b. Eliciting input from trusted nursing colleagues
c. Eliciting input from members of other health disciplines
d. Setting 3-year and 5-year career goals
ANS: A
Feedback: Reflection is a critical step in the development of a continued competence plan,
and it must precede the development of goals. Eliciting input from others can be beneficial,
but it is not a substitute for self-reflection.

30. A nurse has more than four decades of experience. In order to ensure that the nurse is not
seen as obsolete by peers and colleagues, the nurse should:
a. seek a leadership position.
b. offer to mentor newly graduated nurses.
c. change jobs as frequently as possible.
d. continually seek new knowledge and experience.
ANS: D
Feedback: Nurses in the later stages of their career must aim to “reinvent” themselves in
order to avoid being seen as obsolete. This normally entails the acquisition of new
knowledge and experience. Holding a leadership position does not guarantee that the nurse
will acquire new knowledge and skills nor does mentoring a new graduate. Changing jobs
exposes the nurse to new settings and experiences but does not necessarily cause the nurse
to gain new knowledge and skills.

Chapter 12: Organizational Structure
1. After starting a new job, a nurse-manager has been surprised at the amount of grapevine
communication that happens. The manager should recognize what characteristic of this type
of communication?
a. It is difficult to control or stop.
b. It always involves verbal, face-to-face communication.
c. It consists of negative and subversive messages.
d. Strong organizations have policies that prohibit it.
ANS: A
Feedback: “Grapevine” communication is informal and is difficult to control or stop.
Consequently, policies that aim to ban it are unrealistic. This type of communication can
involve all types of content, not just negative messages. The spread of easy, instant
electronic communication means that it is not always verbal.

TOP: Chapter Number: 12: Title: Formal and Informal Organizational Structure
2. Max Weber, as part of the scientific management era, contributed immensely to the
development of organizational theory. Which statements are representative of his beliefs?
Select all that apply.
a. Bureaucracy could provide a rational basis for administrative decisions.
b. Worker satisfaction was integral to productivity.
c. Organization charts could depict the hierarchy of authority.
d. Impersonality of relationships should exist in organizations.
e. Advancement and placement should be based on relationships.
ANS: A, C, D
Feedback: Weber emphasized the impersonality of work relationships, the ability of
bureaucracy to provide rational decisions, and the role of organizational charts. Max
Weber’s theories did not address worker satisfaction. Weber advocated promotions based on
competence, not relationships.

TOP: Chapter Number: 12: Title: Organizational Theory and Bureaucracy
3. A nurse has begun working in a new health-care facility and is beginning to understand the
organizational culture. When seeking to understand the organizational culture, the nurse
should:
a. carefully examine the demographic characteristics of the workforce.
b. ask the middle- and upper level managers about the potential for advancement.
c. ask coworkers at various levels to interpret the organizational chart.
d. try to perceive the dominant values, traditions, and beliefs in the organization.
ANS: D
Feedback: Organizational culture is the symbols and beliefs, values, history, and
communication patterns of the organization. It differs from organizational climate, which is
how the employees perceive the organization. Employees may not be able to articulate the
organizational culture due to their proximity to it. Culture does not determine the potential
for advancement and is not solely a reflection of demographics.

TOP: Chapter Number: 12: Title: Organizational Culture
4. A clinical nurse specialist (CNS) is included on a hospital department’s organizational chart.

However, there are no solid lines leading to or from the nurse’s position on the chart. What
does this imply?
a. The CNS lacks productive relationships with colleagues.
b. Any member of staff may exercise authority over the CNS.
c. The CNS is not accountable for his or her practice.
d. The CNS does not have formal authority over other staff members.
ANS: D
Feedback: The absence of a “line position” denotes an absence of formal decision-making
authority. This is often the case for an advisory (staff) position such as CNS. However, this
does not suggest that every other staff member holds authority over the CNS or that the
CNS is not accountable for his or her safe practice and adherence to standards. Line
positions do not represent personal relationships.

TOP: Chapter Number: 12: Title: Relationships and Chain of Command
5. There is one vertical, solid line connecting a middle manager and a top-level manager on a
clinic’s organizational chart. What should a nurse conclude from this aspect of the
organizational chart?
a. The middle- and top-level manager share equal authority.
b. The middle manager is in a permanent position.
c. The middle manager has only one boss.
d. The top-level manager was originally promoted from being a middle-manager.
ANS: C
Feedback: Unity of command means one immediate boss per employee and is denoted by a
single vertical line. This does not suggest equal authority among the two managers or that
the top-level manager was promoted from the position below him or her. This portion of the
chart does not indicate that the middle manager’s position is permanent.
TOP: Chapter Number: 12: Title: Relationships and Chain of Command
6. Which employee of a health-care organization would likely be considered a middle-level

manager?
a. An experienced primary care nurse who mentors other nurses
b. The team leader of the hospital’s wound care specialists
c. The charge nurse who oversees day shifts on a medical unit
d. The hospital’s nursing supervisor
ANS: D
Feedback: Nursing supervisors are middle-level managers. All the other listed nurses are
first-level managers.

TOP: Chapter Number: 12: Title: Managerial Levels
7. A health-care organization utilizes decentralized decision making. What will most likely
happen when there is need for decisions to be made in the organization?
a. A decision can be made at the lowest practical managerial level.
b. The decision will be made by top-level managers.
c. There is a potential that the decision will be made too quickly.
d. It will be unclear who is ultimately accountable for the decision.
ANS: A
Feedback: Decentralized organizational structure allows decision making to be made at the
level at which problems occur. Decision making by top managers is more likely when
decision making is centralized. Decentralized decision making does not necessarily lead to
rash decisions or unclear accountability.

TOP: Chapter Number: 12: Title: Decision Making Within the Organizational Hierarchy
8. A middle-manager who oversees the operations of several nursing units has a high degree of
organizational centrality. What is most likely true about this manager?
a. The manager is isolated from top-level managers.
b. The manager interacts with a comparatively small number of coworkers.
c. The manager receives much communication from varied directions.
d. There are more middle-level managers than first-level managers in the
organization.
ANS: C
Feedback: Centrality is a position on an organizational chart where it is possible to have
many different types of communication (upward, downward, lateral, and diagonal). This
does not suggest that there are more middle-level managers than lower level managers or
that this manager is isolated from his or her superiors.

TOP: Chapter Number: 12: Title: Centrality
9. A nurse-manager has established a new committee and will be chairing the committee. The
committee consists of six representatives from various departments, at various levels within
the organization. What goal should the committee members set?
a. Creating a new organizational chart
b. Adding four to six new members
c. Emphasizing formal communication
d. Implementing shared decision making
ANS: D
Feedback: A shared decision making is a desirable goal in most committees. This
maximizes productivity and input. Communication does not necessarily need to be formal
and a committee does not necessarily have to consist of 10 to 12 members. It would unusual
for a committee to be charged with creating an entirely new organizational chart.

TOP: Chapter Number: 12: Title: Responsibilities and Opportunities of Committee Work
10. The nurse-manager is chairing a committee, most of whose members are subordinates.
When communicating with the members during meetings, the manager should:
a. ensure their contributions are recorded for performance appraisal purposes.
b. avoid overt demonstrations of power or authority.
c. reserve the right to impose decisions on the committee.
d. avoid informality in speech or writing.
ANS: B
Feedback: During committee work, encouraging interaction that is free of status and power
is important. Recording for performance appraisal purposes is likely to be intimidating for
committee members. There is no reason for all communication to be formal in a committee
setting.

11. A manager has accepted a new position and there are more than 20 people who directly
report to the manager. What description of this manager’s role is most accurate?
a. The manager’s workload is unrealistic.
b. The manager has a large span of control.
c. The manager has a top-level management position.
d. The manager is working in a poorly designed organization.
ANS: B
Feedback: The number of people directly reporting to any one manager represents that
manager’s span of control and determines the number of interactions expected of him or her.
Without knowing more about the manager’s role, there is no way of knowing if the
workload is unrealistic or if this is a top-level position. This manager’s large span of control
is not necessarily a marker of a poorly designed organization.

TOP: Chapter Number: 12: Title: Span of Control
12. A nurse-manager is working with a committee that is showing evidence of groupthink. What
characteristic of the committee would show evidence of this phenomenon?
a. Members of the committee are unwilling to take risks with new ideas.
b. The committee prefers to make decisions by consensus.
c. The committee members want to take turns chairing the meetings.
d. Membership in the committee is frequently changing.
ANS: A
Feedback: Groupthink occurs when group members fail to take adequate risks by
disagreeing, being challenged, or assessing discussion carefully. A preference for a rotating
meeting chair does not necessarily indicate groupthink, nor does a preference for working
by consensus. Unstable membership is not a desirable characteristic of a committee, but this
does not directly indicate groupthink.

13. The nurse is working on a unit whose culture has become firmly entrenched? What solution
should the nurses on the unit best propose?
a. New leadership
b. A decrease in workload
c. Collaboration with a unit that is not entrenched
d. Increased administration support
ANS: A
Feedback: It is extremely difficult to change a unit culture without new leadership. A
change in administrative support or even a reduction in workload will not necessarily
challenge the established culture. Collaboration with a unit that is not entrenched may be
beneficial, but new leadership is likely the most effective solution.

TOP: Chapter Number: 12: Title: Organizational Culture
14. Which characteristic of an organization would suggest that flattening is occurring?

a. There is a collective spirit.
b. There is reduction in the administration levels.
c. There are shared work goals across units.
d. There are formal and informal systems are in place to address conflicts.
ANS: B
Feedback: Reducing the numbers of administration levels is called flattening the
organization. A collective spirit, shared work goals, and adequate structures for conflict
resolution are not related to organizational flattening.

TOP: Chapter Number: 12: Title: Flat Designs
15. A manager is participating in introducing a shared governance model to a health-care

organization. What is the manager’s best action?
a. Remove lines of authority.
b. Form joint practice committees.
c. Eliminate performance appraisals.
d. Increase the number of first-level managers.
ANS: B
Feedback: In shared governance, the organization’s governance is shared among board
members, nurses, physicians, and management. Joint practice committees are developed to
assume the power and accountability for decision making, and professional communication
is egalitarian rather than hierarchical. Shared governance does not require a complete
removal of lines of authority or the elimination of performance appraisals. Shared
governance would not require more first-level managers.

TOP: Chapter Number: 12: Title: Shared Governance: Organizational Design for the 21st
Century KEY: Integrated Process: Nursing Process
16. A nurse-manager is chairing a workplace committee. What should the manager prioritize in
this role?
a. Keeping members on task and promoting productivity
b. Promoting members’ career development
c. Resolving interpersonal conflicts and preventing groupthink
d. Providing information on each agenda item
ANS: A
Feedback: Although all the items may be something the chairperson does, the primary
responsibility is to keep members on task so that committee work gets completed. This is
prioritized because it best reflects the main purpose of a committee, which is to collectively
address specific tasks and challenges in the workplace.

17. A nurse-manager has been commissioned to create a new workplace committee that will
focus on client safety issues. When forming this committee, the manager should:
a. meet at least twice per week for the first month to create momentum.
b. aim for diversity of genders and cultures among the membership.
c. ensure that half of the members are the manager’s subordinates and half are the
manager’s superiors.
d. give members permission to attend meetings as often or as rarely as they wish in
order to accommodate their schedules.
ANS: B
Feedback: When assigning members to committees, cultural and gender diversity should
always be a goal. The manager should make efforts to accommodate members’ schedules,
but giving members’ permission to attend as rarely as they wish will compromise the
group’s cohesion and effectiveness. Momentum must be created after the committee is
formed, but this does not necessarily require twice-weekly meetings. It is unnecessary and
unrealistic to split the membership between the manager’s subordinates and superiors.

18. What should the leader remember when forming committees?

a. Committees work best when there is an adequate supply of workers, with 10
members being the minimum.
b. Willingness to work hard is the most important criterion for appointment.
c. Written agendas provide excessive structure and stifle committee creativity.
d. There should be sufficient expertise among committee members to accomplish the
assigned task.
ANS: D
Feedback: The most important criterion for committee selection is overall adequate
expertise to accomplish the agenda. Effort is an important criterion for membership, but this
quality is not productive unless it is accompanied by expertise. There is no absolute
minimum of 10 members. Written agendas provide structure and focus for committee
meetings and the manager should provide these.

TOP: Chapter Number: 12: Title: Committee Structure in an Organization
19. During a strategic planning committee meeting to develop technology goals, several unit
managers spend a considerable amount of time discussing current staffing problems. What
is the primary action of the chairperson of this committee?
a. Take the remainder of the meeting time to discuss staffing with all members.
b. Adjourn the meeting and reschedule at a time when there are no staffing problems.
c. Request that committee members return to discussing items on the agenda.
d. Excuse those discussing staffing from the remainder of the meeting.
ANS: C
Feedback: Committee time is wasted when agendas are not adhered to. The chairperson
should avoid facilitating discussion of peripheral issues. It is unrealistic to put the
committee’s work “on hold” pending resolution of this problem. Dismissing the members
who are discussing irrelevant issues is a heavy-handed approach that is unnecessary and
which would be disruptive.

20. The nurse-manager works in a health-care facility that has applied for Magnet status. What
characteristics of the organization will support the application? Select all that apply.
a. Centralized decision-making environment
b. Open, participatory management
c. Improved patient outcomes
d. High staff nurse satisfaction
e. Large number of registered nurses and an absence of practical nurses
ANS: B, C, D
Feedback: Magnet designation is conferred by the ANCC to health-care organizations
exemplifying well-qualified nurse executives in a decentralized environment, with
organizational structures that emphasize open, participatory management.
Magnet-designated organizations demonstrate improved patient outcomes and higher staff
nurse satisfaction than organizations that do not have Magnet status. Magnet status is not
dependent of registered nurses performing roles that are otherwise performed by practical
nurses.
TOP: Chapter Number: 12: Title: Magnet Designation and Pathway to Excellence
21. Which components are considered a part of an organizational structure? Select all that
apply.
a. The individuals included in the group
b. Lines of communication
c. Decision-making process
d. Channels of legitimate authority
e. Organizational culture
ANS: A, B, C, D
Feedback: Organizational structure refers to the way in which a group is formed
(membership), its lines of communication, and its means for channeling authority and
making decisions. Organizational culture is an important aspect of every organization but
this is not conveyed in the organizational structure.

TOP: Chapter Number: 12: Title: Formal and Informal Organizational Structure
22. The leadership of a large health-care organization has arranged a series of meetings with
stakeholders. What individuals or groups would be included in this category? Select all that
apply.
a. A community group that advocates for the rights of people addicted to drugs
b. Representatives from the labor union that represents many staff members, an
external organization, or individual
c. A community group that promotes client safety in health care
d. Members of the local media
e. The surgeons and anesthetists who work in the operating room
ANS: A, B, C, E
Feedback: Stakeholders are those entities in an organization’s environment that play a role
in the organization’s health and performance or that are affected by the organization.
Stakeholders may be both internal and external, they may include groups. As a result,
groups that focus on client safety or a particular vulnerable population would be considered
stakeholders. As well, staff members or the organizations representing their interests would
be considered stakeholders. The media would not normally play a role in the organization’s
health and performance or be affected by the organization.

TOP: Chapter Number: 12: Title: Stakeholders
23. A health-care organization has undergone an organizational restructure that increases

nurses’ autonomy and empowerment. What effect is most likely?
a. Increased interdisciplinary collaboration
b. Increased communication
c. Increased effectiveness of client care
d. Increased client autonomy
ANS: C
Feedback: Current research suggests that changing an organization’s structure in a manner
that increases autonomy and work empowerment for nurses will lead to more effective
client care. There is no evidence that increasing the autonomy of nurses causes enhanced
communication or collaboration, or that it has an effect on client autonomy.

24. The organization of work in a large health-care facility reflects Weber’s theories around
bureaucracies. What characteristic is most likely to exist in this facility?
a. High flexibility in the way that work is structured
b. Promotion and advancement on the basis of relationships
c. Absolute autonomy of each employee
d. A clear division of labor among employees
ANS: D
Feedback: Weber emphasized the need for a clear division of labor. Advancement was to be
based on competence, not relationships. A high degree of accountability was to exist rather
than absolute autonomy. The flow of work is more structured than flexible.

25. Which statements are true concerning a bureaucratic organization? Select all that apply.
a. It is commonly referred to as a line organization.
b. It is typically found in large health-care organizations.
c. It is rooted in individual personalities.
d. They resemble Weber’s original design of organization.
e. Its authority is represented by its staff organizational chart.
ANS: A, B, D, E
Feedback: Bureaucratic organizational designs are commonly called line structures or line
organizations. Their structure is illustrated by an organizational chart. These designs are
common in large health-care organizations and are based on Weber’s original
conceptualization. Policies and rules govern the organization rather than individual
personalities.

TOP: Chapter Number: 12: Title: Line Structures
26. A nursing supervisor has been given the responsibility for increasing the frequency and
thoroughness of nursing assessments on a hospital unit. However, the supervisor does not
have the authority to enforce new guidelines for assessment or assign consequences for
noncompliance. What is the most likely outcome of this scenario?
a. The desired outcome will not be achieved.
b. The assessments will improve, but the nurses will be resentful.
c. The supervisor will need to use unauthorized enforcement.
d. The assessments will improve as a result of collaboration.
ANS: A
Feedback: Responsibility without authority often causes role confusion and makes it
difficult for a manager to enforce a necessary change. This is likely to cause the failure of
the initiative. Without binding incentives and disincentives, it is unlikely that change will
occur. Spontaneous collaboration is possible, but role confusion is more likely. The use of
unauthorized enforcement could be problematic for the manager and would be most likely
avoided due to the associated risk.

TOP: Chapter Number: 12: Title: Limitations of Organization Charts
27. An organization has proposed a policy stating that no more than five people should report to
any single manager in the organization. What is the most likely outcome of this change in
organizational structure?
a. Decision making will become unpredictable.
b. Workplace satisfaction will increase.
c. Efficiency will decrease in the organization.
d. Worker autonomy and empowerment will increase.
ANS: C
Feedback: Having too few people report to a manager creates an inefficient and top-heavy
organization. Decision making is likely to become similarly inefficient, although it may not
become more unpredictable. This change in structure will not necessarily increase the
autonomy or satisfaction of employees who may be under closer scrutiny.

TOP: Chapter Number: 12: Title: Span of Control
28. A nurse-manager is reviewing the organizational chart of a health-care facility before

accepting a job offer. When reviewing the organizational chart, the nurse should:
a. be aware that the informal structure of the organization cannot be discerned from
the chart.
b. confirm the accuracy of the chart with the human resources department.
c. try to meet with the people at the top of the chart, if possible.
d. review the qualifications of each person on the chart.
ANS: A
Feedback: Organizational charts convey the formal structure of an organization, but they do
not include informal structures. It is impractical and unnecessary to review every
individual’s qualifications. Unless there are reasons to doubt the accuracy of the chart, it is
unnecessary to confirm with the human resources department. Unless the manager is
applying for a top-level position, it is often unnecessary and impossible to meet with the
people at the top of the chart.

TOP: Chapter Number: 12: Title: Limitations of Organization Charts
29. A rural hospital is considering a sharp reduction in the range and availability of the services
it provides. Before making this change, the hospital’s leadership should:
a. decentralize its decision-making model.
b. implement shared governance.
c. review its organizational chart.
d. consult with local stakeholders.
ANS: D
Feedback: The stakeholders are all the internal and external individuals and groups that have
an interest in an organization’s operations. In a rural community where few options for
health care exist, it would be prudent to consult with local stakeholders before a major
change in service. There is no obvious need for this organization to decentralize, implement
shared governance, or review its organizational chart.

TOP: Chapter Number: 12: Title: Stakeholders
30. The top-level managers of a hospital have chosen to apply for magnet designation. The
decision to grant this designation will be largely based on what factor?
a. Input from local nursing educators and academics
b. The findings from an onsite visit by assessors
c. The results of a local public opinion survey
d. Review of the organizational chart
ANS: B
Feedback: A detailed onsite visit is a major component of the magnet accreditation process.
Nurse educators from outside the organization would not normally be consulted, and a
public opinion survey is not normally taken. Accreditors would review the organizational
chart, but this is a lesser piece of data compared with the results of a site visit.

TOP: Chapter Number: 12: Title: Magnet Designation and Pathway to Excellence
Chapter 13: Organizational, Political, and Personal Power
1. Which of the following nurses would be considered to have expert power?

a. A nurse-manager who dispenses favors to nurses who are willing to work overtime
b. A nurse with extensive experience and specialized training in perioperative nursing
c. A nurse whose dynamic and engaging personality makes it easy to create alliances
d. A nurse who is positioned high on the hospital’s organizational chart
ANS: B
Feedback: Expert power is gained through knowledge, expertise, or experience, as
exemplified by a nurse with advanced education and experience in perioperative nursing.
Dispensing rewards is associated with reward power; a dynamic and engaging personality is
associated with charismatic power; high position on the organizational chart is associated
with legitimate power.

TOP: Chapter Number: 13: Title: Types of Power
2. Which statement about power is correct?

a. It is a finite quality and, once gained, is very difficult to lose.
b. It is destructively manipulative but is necessary for effective management.
c. Women generally view power more positively than do men.
d. Having power generally results in the gain of additional power.
ANS: D
Feedback: Power is likely to bring more power in an ascending cycle, whereas
powerlessness often generates more powerlessness. Power is not difficult to lose and it is
often viewed more positively by men than women. Power does not have to be a “necessary
evil” and can be used for the betterment of many.

TOP: Chapter Number: 13: Title: Power and Powerlessness
3. A nurse-manager is aiming to project a powerful image of a team leader who empowers

subordinates. What statement is most appropriate to this goal?
a. “I’m in charge here, and so all requests need to come to me. Please let me know if
you have any questions.”
b. “I’m too tired to deal with Dr. Jones today. When he gets here, tell him I’ve gone
to lunch.”
c. “Is it okay with the rest of you if I do all the charting and you do the direct patient
care?”
d. “We have a great deal to accomplish today, but I am confident that we can do it by
working together.”
ANS: D
Feedback: The empowerment of staff is a hallmark of transformational leadership. To
empower means to enable, develop, or allow. The manager’s statement about working
together exemplifies this principle. Insisting that “I’m in charge” asking an employee to be
dishonest or tentatively asking permission from subordinates does not demonstrate
empowerment or team leadership.

TOP: Chapter Number: 13: Title: Empowering Subordinates
4. A new employee is attempting to implement appropriate power-building strategies. What

actions should this employee perform? Select all that apply.
a. Maintaining a sense of humor
b. Gaining additional nursing certifications
c. Suggesting major changes to the unit’s workflow
d. Learning the institution’s organizational culture
e. Attending a training seminar on a new piece of unit equipment
ANS: A, B, D, E
Feedback: Trying to induce change when one is a new employee is not an appropriate
power-building strategy while the other options are all appropriate for a new employee to
engage in.

TOP: Chapter Number: 13: Title: Strategies for Building a Personal Power Base
5. What determines the size of the authority–power gap between a manager and an employee?
a. The organizational philosophy
b. The degree of rigidity in the organizational chart
c. How credible the manager is perceived to be
d. How much informal power the manager possesses
ANS: C
Feedback: When a manager loses credibility, the authority–power gap widens. The
authority–power gap is not determined by the philosophy, rigidity of the organizational
chart, or the degree of informal power possessed by the manager.

TOP: Chapter Number: 13: Title: Bridging the Authority–Power Gap
6. A nurse-manager is implementing proactive political strategies. What activity by the nurse
is most consistent with this type of strategy?
a. Assuming authority to do something if it is not expressly prohibited
b. Using competitive approaches to the decision-making process
c. Attempting to appear as a victim so future gains can be made
d. Verbalizing discontent with the politics of an organization
ANS: A
Feedback: Assuming authority to do something that is not prohibited allows the individual
to accomplish goals for the organization, which will lead to greater empowerment. Proactive
strategies do not include overt competition, adopting a position of victimhood or explicitly
verbalizing discontent.

TOP: Chapter Number: 13: Title: The Politics of Power
7. Which strategy should the manager adopt when attempting to empower staff?
a. Role model the characteristics of an empowered nurse.
b. Follow a rigid but consistent rule enforcement policy.
c. Arrange for all employees to get an annual cost-of-living raise.
d. Encourage staff to establish a strong unit culture.
ANS: A
Feedback: By serving as a role model of an empowered nurse, the manager encourages
others to become empowered. Rule enforcement produces order but may not foster
empowerment. Similarly, increased salaries would be welcomed but may not cause
empowerment. Encouraging a strong unit culture may not give staff the empowerment to
accomplish this task.

8. A female manager has worked hard in her career to reach a high position in the organization.
What action by the manager will directly prevent her from developing the queen bee
syndrome?
a. Emphasizing formal demonstrations of power rather than informal demonstrations
b. Aiming for an equal number of male and female subordinates
c. Working with other women to help them achieve similar success
d. Increasing accountability to subordinates
ANS: C
Feedback: Female-dominated professions such as nursing often exemplify the queen bee
syndrome. The queen bee is a woman who has struggled to become successful, but once
successful, she refuses to help other women reach the same success. Conscious effort to help
other women succeed will prevent this phenomenon. Hiring more men will not prevent this
and there is no direct benefit in increasing accountability or emphasizing formal power.

TOP: Chapter Number: 13: Title: An Action Plan for Increasing Professional Power in
Nursing KEY: Integrated Process: Nursing Process
9. What is one of the most politically serious errors one can make?
a. Dispensing untrue information
b. Promoting the advancement of subordinates
c. Withholding or refusing to divulge information
d. Delaying decision making until there is additional information
ANS: A
Feedback: Lying to others is a serious political error. The other options represent
appropriate behaviors.

10. An experienced nurse has been assigned to a management position. What task will this new
manager most likely have to accomplish in order to address a common reluctance among
women to hold positions of power?
a. Seeking frequent counsel from other women who are leaders
b. Limiting the influence of men on the unit whenever possible
c. Organizing an educational inservice about gender in the workplace
d. Challenging any negative preconceptions of power that she may have learned
while growing up
ANS: D
Feedback: Some of the reluctance of women to embrace power in relationships can be
explained by their socialization to the female role. Some women, in particular, may hold
negative connotations of power and never learn to use power constructively. It may be
necessary for the new manager to consciously confront such views. Other women may or
may not be able to help the manager confront this issue. Limiting the role of men is unlikely
to be beneficial or ethical.

TOP: Chapter Number: 13: Title: Gender and Power
11. A nursing administrator believes that the organization supports an inadequate distribution of
power. What is an appropriate action to combat this situation?
a. Bring the issue to the state board of nursing.
b. Propose a plan to the CEO for organizational restructuring.
c. Seek entry into an informal power group.
d. Seek employment in a new setting.
ANS: C
Feedback: To gain power, one needs entry into informal lines of communication provided
by informal power groups. Going directly to the CEO would likely be premature and the
nurse should first try to work within his or her sphere of influence. A state board of nursing
would not become involved in this type of issue. The nurse should attempt to resolve the
situation before resorting to a new job.

12. The nurse-manager has held an educational workshop about the need for nurses to be more
comprehensive with their client assessments. What outcome would suggest that there is a
wide authority–power gap?
a. The nurses respond by improving their assessments because of the respect they
hold for the manager.
b. The nurses do not make significant changes to the way that they assess clients.
c. The nurses improve their assessments out of fear for the consequences of not doing
so.
d. The nurses seek an extended dialogue about the issue.
ANS: B
Feedback: If there is a wide authority–power gap, employees will tend to question or
disobey orders. Seeking more dialogue does not necessarily suggest that the employees are
reluctant or unwilling to comply.

TOP: Chapter Number: 13: Title: The Authority–Power Gap
13. The nurse-manager is working in a facility where two of the organizational goals are to
increase physician satisfaction and reduce costs. A unit goal is to increase professional RN
staffing. Which statement best supports all the stated goals?
a. Increasing the RN staff will cut down on nursing errors, prevent burn out, and
decrease the cost associated with staff turnover.
b. Increasing the use of unlicensed assistive personnel will result in increased patient
safety and quality care, and thus improve physician satisfaction.
c. Increasing the RN staff will free more nurses to be available to address doctors’
concerns during their rounds and will reduce our costly use of overtime.
d. Increasing the RN staff will lead to improved patient education and a reduction in
costly patient stays.
ANS: C
Feedback: Politically wise requests should always be made using the goals of the
organization; therefore, stating that increasing the staff would meet the organization’s goals
is most appropriate. This option meets the organizational goals and the unit goal. None of
the other listed options addresses each of these goals. Increased use of UAPs is unlikely to
increase safety.

14. A nurse-manager can best expand political resources by:

a. networking with individuals who are politically influential.
b. making decisions proactively.
c. initiating discussions about political power while at work.
d. delegating decisions as much as possible.
ANS: A
Feedback: Nurses often can increase their power and influence by forming coalitions and
alliances (networking) with other groups, be they peers, sponsors, or subordinates,
especially when these alliances are with peers outside the organization. Proactive decision
making is beneficial but does not necessarily expand the manager’s political influence. In
the same way, delegating and talking about political realities at work will not necessarily
expand the manager’s influence.

15. What is the primary influence that shapes a person’s response to authority?
a. Power figures in the family unit
b. Work experiences in each job held
c. Administrative figures in the workplace
d. Experiences in the spiritual dimension of life
ANS: A
Feedback: A person’s response to authority is conditioned early through authority figures
and experiences in the family unit. Although the other options may influence an individual,
none are the primary influence.

16. A manager has issued a directive to nursing staff about improving the timeliness of their
documentation. Most nurses have failed to make a change in their practice, however. The
manager should consider what potential cause of this failure to act?
a. Leadership–subordinate conflict
b. Manager–subordinate gap
c. Administrator–power differential
d. Authority–power gap
ANS: D
Feedback: The gap that sometimes exists between a position of authority and subordinate
response is called the authority–power gap. None of other options is the term used to
identify the described power gap.

TOP: Chapter Number: 13: Title: The Authority–Power Gap
17. A new manager is confused why nurses are not heeding her directions in the workplace.
What strategy is most appropriate when attempting to resolve this problem?
a. Assure the nurses that she has their best interests in mind.
b. Ignore the issue and reintroduce the directions in 6 to 8 weeks.
c. Hold a meeting to remind staff that they are under the manager’s authority.
d. Bring in an outside consultant to have one-on-one conversations with staff.
ANS: A
Feedback: One effective strategy for bridging the authority–power gap is to assure
subordinates that the manager cares about them and has their best interests in mind. It would
be inappropriate to ignore this issue, and overt displays of authority should be avoided
whenever possible. Bringing in an outside consultant would be considered an action of last
resort and is not a usual response to the authority–power gap.

18. A new nurse-manager has set a goal of building a personal power base. What strategy
should the manager choose?
a. Exercise overt displays of power to subordinates whenever possible.
b. Seek to become highly visible in the organization.
c. Take every opportunity to collaborate with physicians.
d. Initiate dialogues with colleagues about the relationship between gender and
power.
ANS: B
Feedback: Increasing visibility and voice is a key strategy for managers who wish to expand
their power base. Overt displays of power should be avoided whenever possible.
Collaboration at all levels is beneficial, but there is no reason to prioritize collaboration with
physicians in particular. Talking about gender and power with colleagues is not likely to
cause an increase in the manager’s power base.

TOP: Chapter Number: 13: Title: Develop Visibility and a Voice in the Organization
19. The manager has been experiencing challenges working with a nurse who has a history of
making unsympathetic comments about clients to other nurses. The manager has tried
various strategies for changing the nurse’s behavior with little effect. The manager feels that
an application of coercive power is now appropriate. What action will the manager most
likely take?
a. Change the nurse’s client care assignment.
b. Implement disciplinary action.
c. Offer sensitivity training to the nurse.
d. Dialogue with the nurse about the effects of these comments.
ANS: B
Feedback: Coercive power is based on fear and punishment. Workplace discipline could be
an example of this type of power. Coercive power foregoes more collaborative and indirect
methods of changing behavior, such as training, dialoguing, or changing the nurse’s work
assignment.

20. A group of nurses have formed an action group that has the goal of increasing professional
power of the nursing profession. What strategy should the group adopt?
a. Seek formal positions where members can influence public policy.
b. Make a formal commitment to providing family-centered care.
c. Increase interactions with recent nursing students and recent nursing graduates.
d. Ask clients and families to publicize the high-quality care they have received.
ANS: A
Feedback: Increasing professional power in nursing requires the placement of more nurses
in influential positions of public policy. Family-centered care ensures good outcomes for
clients but does not necessarily translate into enhanced professional power. Similarly,
engagement with students and recent graduates reduces attrition but does not necessarily
increase the profession’s power. It is ethically questionable to ask clients to publicize the
care they receive, and this obligation should not be placed on clients and families.
21. In order to minimize the potentially negative effects of organizational politics in the
workplace, the nurse-manager should:
a. limit interpersonal interactions to people the manager can trust.
b. role model being an empowered nurse to subordinates.
c. develop skills in handling information and communication.
d. ensure that overt displays of power are visible to colleagues.
ANS: C
Feedback: In order to mitigate the possible threats of organizational politics, the
nurse-manager should seek to become an expert in handling communication and
information. Overt displays of power should be used only as a last resort, not as a tool for
managing politics. It is unrealistic to limit interactions to only those people that the manager
can trust. Role modeling what an empowered nurse looks like is beneficial to subordinates
but does not necessarily prevent political conflict.

22. A nurse at a community health clinic has no formal position of authority but exercises great
influence over staff because many of them perceive the nurse as being powerful. What type
of power does this nurse possess?
a. Referent power
b. Legitimate power
c. Personality power
d. Coercive power
ANS: A
Feedback: Referent power exists because others perceive a person as powerful, even if that
person does not possess formal authority. Coercive power is based on the threat of
punishment. This nurse lacks legitimate (position) power and there is not a category of
“personality power.”

23. A nurse-manager has begun in a new position and has quickly perceived that the nurses in
the organization need to be empowered. How can the nurse empower the nurses? Select all
that apply.
a. Role model the way that an empowered nurse behaves.
b. Delegate as many management tasks as possible.
c. Minimize the amount of scrutiny and supervision that the manager provides.
d. Teach nurses strategies for increasing their personal power.
e. Seek nurses’ input into proposed changes.
ANS: A, D, E
Feedback: Strategies for empowering employees include teaching them about building their
personal power, seeking their input in decision making, and role modeling what
empowerment looks like. Empowerment does not entail excessive delegation or failing to
give sufficient oversight to the care that nurses provide.

24. A staff member asks the manager for a particular day off on the next schedule. Which
response demonstrates the concept of underpromising and help the manager retain the staff’s
trust?
a. “I’d like to, but that would be unfair to the other nurses.”
b. “Be sure to get the written request in early.”
c. “I can’t guarantee it right now but I will try to find a solution for you.”
d. “If you don’t take any sick time before then, I’ll give it to you.”
ANS: C
Feedback: Underpromising helps preserve trust by making it less likely that a manager will
have to go back on his or her word. This can be done by not promising to honor a request at
the time it is made but then making efforts to meet the request. Underpromising does not
involve outright refusal or requiring a favor in return.

25. Which statements support the manager’s commitment to staff empowerment? Select all that
apply.
a. “I need you to know that I won’t accept any substandard nursing care.”
b. “A staff committee will be formed to address that unit issue.”
c. “We can arrange for you to spend 2 months working on another unit to expand
your skills.”
d. “I’ve got funding to support staff who are interested in earning certifications.”
e. “There’s talk of acquiring new mechanical lifts, but I’d like to get your input.”
ANS: B, C, D, E
Feedback: Empowerment occurs when leaders communicate their vision; employees are
given the opportunity to make the most of their talents; and learning, creativity, and
exploration are encouraged. Rejecting substandard practice may be necessary, but this action
does not necessarily empower nurses.

26. A nurse-manager has been overseeing the care at a clinic for several weeks and has noted
that staff members are reluctant to follow instructions. How should the manager attempt to
resolve this problem?
a. Consult with the person who previously managed the clinic.
b. Make more of an effort to get to know each of the employees individually.
c. Reduce expectations on the employees in order to improve compliance.
d. Remind the nurse about their obligation to follow standards of practice.
ANS: B
Feedback: One way for a leader to bridge the authority–power gap is to make a genuine
effort to know and care about each subordinate as a unique individual. It is unlikely that the
ex-manager will be able to solve this problem for the new manager. Reducing expectations
sets a dangerous precedent of acquiescing to the employees’ reluctance to follow. Standards
of practice do not address specific areas of followership.

27. The nurse-manager has just begun a new assignment in a new health-care organization.
What action should the manager prioritize in order to be seen as credible by subordinates?
a. Share her doubts about her abilities with the employees.
b. Maintain an open-door office policy.
c. Ask for input from staff on decision making.
d. Avoid any and all forms of dishonesty.
ANS: D
Feedback: Dishonesty is absolutely fatal to the manager’s credibility and must be avoided at
all costs. Having an open-door policy may enhance rapport but will not necessarily affect
the manager’s credibility. Seeking staff input on decisions can empower staff but would
have less of an effect on credibility. Although the manager should be honest with staff,
sharing internal doubts about her abilities may harm the perception of competence that
employees have.

28. A nurse has joined a group that has a goal of increasing the power base of the nursing
profession. What is the nurse’s best initial action to help achieve the group’s goals?
a. Recruit nursing students to join the group as auxiliary members.
b. Present a powerful picture to others in the group.
c. Recruit among the nurse’s peers and colleagues.
d. Become familiarized with relevant public policy issues.
ANS: D
Feedback: Increasing the professional power of nursing must begin with becoming
knowledgeable and familiar with the issues that are relevant to the profession. This baseline
knowledge should precede recruitment efforts. Presenting a powerful image may build the
nurse’s power base within the group but does little to accomplish the group’s goals.

29. An experienced nurse has been hired to manage an inpatient unit at a hospital in a different
city. What is an appropriate activity for building the manager’s personal power base when
beginning this new job?
a. Take every opportunity to describe personal accomplishments.
b. Offer to lead a high-visibility committee within the hospital.
c. Determine which people are most powerful in the hospital.
d. Seek to openly display authority when colleagues are present.
ANS: C
Feedback: The nurse can build his or her personal power base by first determining which
people in the organization possess power. This is especially important when beginning in a
new organization. Although the manager is new, it is best to avoid vying for high-level
leadership. Overt displays of authority should be minimized and used as a last resort, not
used as a means of building power. Talking about accomplishments could be interpreted as
prideful by colleagues and could potentially harm the nurse’s transition.

TOP: Chapter Number: 13: Title: Determine the Powerful in the Organization
30. Which nurse is experiencing the effects of coercive power?

a. A nurse who has been granted an extra vacation day after willingly working
overtime for several days
b. A nurse who has completed a master’s degree in nursing
c. A nurse who has great influence from being “well-connected”
d. A nurse who was terminated after assaulting a client
ANS: D
Feedback: Punishment and discipline are examples of the effects of coercive power. Getting
an extra vacation day is an example of reward power. Completing a graduate degree
enhances expert power. Personal connections build referent power.

Chapter 14: Organizing Patient Care
1. Which aspect of care at a long-term care facility most clearly suggests that a functional
model of care delivery is being used?
a. One nurse is assigned to provide all of a resident’s care during a shift.
b. Unlicensed assistive personnels (UAPs) coordinate each resident’s care and
occasionally delegate to practical nurses.
c. Registered nurses perform all assessments while UAPs provide all feeding and
hygiene.
d. A pairing of one registered nurse and one practical nurse provides all the care for a
designated pool of residents.
ANS: C
Feedback: Functional nursing is task focused with specific tasks assigned to specific
members of the care team. Having one nurse provide all of a resident’s care is indicative of
total patient care. No model of care ascribes a coordination role for UAP. Pairings suggest
team or modular nursing.

TOP: Chapter Number: 14: Title: Functional Method
2. The nurse is assigned to administer medications to all patients throughout the shift. What is
this an example of?
a. Team nursing
b. Case method nursing
c. Primary care delivery
d. Functional nursing care
ANS: D
Feedback: Being assigned a specific task to do is part of functional nursing. None of the
other options identify that connection.

3. A nurse has accepted a position as a staff nurse and will practice primary care nursing. The
nurse will be the only RN on the team. What is an appropriate role expectation for role
fulfillment?
a. Planning nursing care independently of others
b. Assigning work according to the expertise of group members
c. Being responsible for care planning only during the shift when he or she works
d. Carrying out the majority of personal care for assigned patients
ANS: B
Feedback: In the primary nursing, during work hours, the primary nurse provides total direct
care for that client. When the primary nurse is not on duty, associate nurses, who follow the
care plan established by the primary nurse, provide care. In primary nursing, the sole RN
would not plan the care without others’ input. The nurse is responsible for care planning for
24 hours per day. The RN leads the planning of care but may not carry out the majority of
personal care.

TOP: Chapter Number: 14: Title: Primary Nursing in the Inpatient Setting
4. A registered nurse is providing care in a setting that uses modular nursing. What task should
the nurse perform during a shift?
a. Providing every aspect of care to one half to one third of the mini-team’s assigned
patients
b. Collaborating with another registered nurse to plan the care of all the mini-team’s
assigned patients
c. Confirming that each member of the mini-team is completing his or her assigned
tasks
d. Providing total patient care to the most acutely ill patients that the mini-team is
assigned
ANS: C
Feedback: The modular team leader should check the work of team members. Care is
divided among the mini-team members, so the RN does not provide every aspect of care to
some of the patients, even those who are acutely ill. Modular nursing does not usually
involve collaboration between two RNs; it is more common for each team to have only one
RN.

TOP: Chapter Number: 14: Title: Modular Nursing
5. A nurse-manager is advocating for a switch from team nursing to primary nursing care.
What characteristic of primary nursing care should the manager describe to decision
makers?
a. It requires minimal RN staffing.
b. It is comparatively easy to implement.
c. Many nurses find it stimulating and challenging.
d. It eliminates the need for UAP or practical nurses.
ANS: C
Feedback: Primary care provides challenging work for nurses; however, it is not easy to
implement and it can succeed with a diverse skills mix (i.e., not all RNs). It requires a
comparatively large cohort of RNs.
6. A nurse-manager has recently learned that the health-care facility will be moving toward a
case management approach. What factor is most likely driving this change?
a. The need to address cost-effective options for care
b. The need to provide challenging work for nurses and other members of the care
team
c. The need to enhance professionalism throughout the organization
d. The need to obtain magnet designation
ANS: A
Feedback: Case management addresses each client individually, identifying the most
cost-effective providers, treatments, and care settings possible. It is not an explicit
requirement of magnet designation and it is not primarily motivated by a need to stimulate
nurses or increase professionalism.

TOP: Chapter Number: 14: Title: Case Management
7. A change in the patient care delivery system has been mandated on a hospital unit. The
manager can best ensure the successful introduction of a new delivery system by:
a. assigning a senior registered nurse to lead the implementation.
b. explaining the implications of the proposed change to patients and families.
c. carefully studying the best method for implementing the planned change.
d. hiring nurses who have experience in providing the new delivery system.
ANS: C
Feedback: Thorough preparation is essential to the successful implementation of a new
patient care delivery system. This does not necessarily require hiring new nurses who have
experience with the new system; existing staff can be adequately prepared if there are
sufficient time and resources. The manager should collaborate with staff but it would be an
inappropriate delegation if the manager assigned a nurse to lead the transition. Explaining
internal changes to patients and families is not normally necessary and would not
significantly increase the chances of success.

TOP: Chapter Number: 14: Title: Selecting the Optimum Mode of Organizing Patient Care
8. What is the primary focus of case management in prioritizing client care?

a. Assessing each client’s needs individually
b. Minimizing costs to the organization
c. Minimizing costs to the patient
d. Applying the principles of team nursing
ANS: A
Feedback: Case management is largely dependent on individualized assessments of each
patient’s specific needs. The patient’s needs supersede costs, even though cost containment
is an important consideration. Case nursing does not necessarily entail a team nursing care
delivery model.

9. A nurse is practicing in a case management context and a patient has been following a
multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the
patient’s health status is not improving as quickly as expected and the patient is deviating
from the MAP. What is the nurse’s best action?
a. Cancel the patient’s current MAP and call a meeting to select a new one.
b. Document the presence of a variance in the MAP.
c. Collaborate with the care team to arrange a transfer to a new setting.
d. Cancel the current MAP and adopt customized, rather than standardized care.
ANS: B
Feedback: In care MAPs, it is necessary to provide variances when there are patient
deviations, because this is a major component to case management. Deviations do not
warrant a wholesale rejection of the existing MAP or case management principles. A
transfer to another site may or may not be necessary, and this does not address the need to
change the patient’s MAP.

10. The nurse is providing care in a setting that uses a team nursing approach. What should be
integrated into the routines in the health-care facility?
a. Inclusion of the patient and family as members of the team
b. Opportunities for UAP and practical nurses to increase their education level
c. Frequent communication between team members
d. Use of multidisciplinary action plans (MAPs)
ANS: C
Feedback: Team nursing is wholly dependent on close, frequent communication between the
team members. Through extensive team communication, comprehensive care can be
provided for clients despite a relatively high proportion of ancillary staff. The client’s and
family’s input is vital, and frequently sought, but they are not formal members of the care
team. MAPs are associated with case management, which may or may not utilize team
nursing. Educational opportunities for practical nurses or UAPs are not the drivers behind
team nursing.

TOP: Chapter Number: 14: Title: Team Nursing
11. The majority of patients whose care is organized by case management have contact with the
health-care system in what acute care setting?
a. Emergency department
b. Ambulatory clinics
c. Primary care provider offices
d. Perioperative settings
ANS: A
Feedback: Because 50% to 80% of admissions in most hospitals enter via the emergency
department, case management often begins there in the acute care setting.

12. Which patient would be most likely to benefit from a disease management approach within
the context of case management?
a. A client who is being treated for a ruptured tympanic membrane
b. A client who has chronic obstructive pulmonary disease (COPD)
c. A client who has been diagnosed with a postpartum hemorrhage (PPH)
d. A client being treated for a transfusion reaction after receiving packed red blood
cells
ANS: B
Feedback: Disease management is most often focused on the management of long-term,
chronic diseases rather than acute health problems.

TOP: Chapter Number: 14: Title: Case Management of Disease Management Programs
13. What is one of the most important differences between case management and disease
management?
a. Disease management referrals begin in the hospital inpatient setting.
b. Disease management is a collaborative process to meet patient needs.
c. High-cost population groups are specifically targeted in disease management.
d. Disease management treatment is episodic.
ANS: C
Feedback: Although there are many similarities between disease management and case
management, the primary goal of disease management is to target high-cost disease
populations. Disease management referrals may originate in the community rather than from
inpatient settings. Both models are collaborative. Disease management is designed to be
ongoing rather than episodic.

TOP: Chapter Number: 14: Title: Case Management of Disease Management Programs
14. A large health-care organization is reconsidering the model of patient care delivery. What
factor should be prioritized in this decision?
a. Patient needs
b. Staff expertise
c. Cost
d. Physical layout of the facility
ANS: A
Feedback: Many factors need to be considered when a change in care delivery is being
selected. Central among these, however, is the interests of patients. Costs, staffing, and
facilities must be considered, but the needs of patients are paramount.

15. A registered nurse is paired with a practical nurse and the two nurses are working together
to provide all the needs for a group of patients. What type of nursing care delivery are these
nurses demonstrating?
a. Total patient care
b. Functional nursing
c. Modular nursing
d. Primary care nursing
ANS: C
Feedback: Modular nursing uses mini-teams, typically an RN and unlicensed health-care
worker(s), to provide care to a small group of patients, centralized geographically. None of
the other options provide this particular staffing format.
TOP: Chapter Number: 14: Title: Modular Nursing
16. Primary care nursing is organized so that the patient is at the center of the structure. How
many nurses have 24-hour responsibility for care planning and coordination for the patient?
a. One
b. Two
c. Three
d. Four
ANS: A
Feedback: Primary care nursing is organized so that the patient is at the center of the
structure. One nurse has 24-hour responsibility for care planning and coordination.

TOP: Chapter Number: 14: Title: Figure 14.4 Primary Nursing Structure
17. A nurse can directly address one of the Institute of Medicine’s recommendations to improve
practice environment by:
a. facilitating open communication and shared decision making.
b. advocating for caps on the maximum allowable nurse–patient ratio.
c. adopting a functional nursing model whenever the setting allows.
d. becoming a nurse navigator who is centered on patients’ needs.
ANS: A
Feedback: Interdisciplinary teamwork is accomplished through interdependent
collaboration, open communication, and shared decision making. The Institutes of Medicine
future of nursing has expand opportunities for nurses to lead and diffuse collaborative
improvement efforts with physicians and other members of the health-care team to improve
practice environments.

TOP: Chapter Number: 14: Title: Interprofessional/Multidisciplinary Health-Care Teams
18. A nurse is following a multidisciplinary action plan (MAP) when caring for a new patient.
The nurse should identify what components within the MAP? Select all that apply.
a. Cost analysis of major interventions
b. Identity of the nurse navigator
c. Critical path
d. Nursing care plan
e. Indication of times when nursing interventions occur
ANS: C, D, E
Feedback: The care MAP is a combination of a critical path and a nursing care plan that
shows times when nursing interventions should occur as well as variances. All health-care
providers follow the care MAP to facilitate expected outcomes. It does not include cost
analysis and does not necessarily involve a role for a nurse navigator.

19. A patient who has just been diagnosed with lung cancer has been assigned a nurse navigator.
What task should the nurse prioritize in this role?
a. Providing evidence-based guidance on treatment options and treatment decisions
b. Providing clinical leadership and ensuring quality for the patient’s care
c. Guiding the patient in an effort to provide high-quality managed care
d. Guiding the patient and family through their various interactions with the
health-care system
ANS: D
Feedback: The primary role of a nurse navigator is to help the patient and the family
navigate the complex health-care system by providing information and support. The
navigator would not provide direct guidance on choosing treatment options, which are
normally beyond the nurse’s scope of practice. Clinical leadership is the role of the clinical
nurse-leader. The role of the nurse navigator is not synonymous with managed care.

TOP: Chapter Number: 14: Title: Nurse Navigators
20. An experienced registered nurse has begun a position as a clinical nurse-leader (CNL). In
this role, what tasks should the nurse perform? Select all that apply.
a. Collaborating with the interdisciplinary team
b. Guiding patients and families through the health-care system at various sites
c. Coaching nurses to provide evidence-based care
d. Introducing quality improvement initiatives
e. Preceptoring senior nursing students
ANS: A, C, D
Feedback: The CNL role involves close collaboration with the interdisciplinary care team,
leading nurses on the unit to ensure high-quality care and introducing quality improvement
measures. Guiding patients and families through the health-care system at various sites is
more congruent with a nurse navigator role. A CNL focuses on high-level leadership at the
clinical site and would be less likely to be a preceptor because that role focuses on direct
patient care.
TOP: Chapter Number: 14: Title: The Clinical Nurse-Leader
21. A clinical site has a diverse skill mix that includes registered nurses, practical nurses, and
UAPs. Senior management is proposing a shift from team nursing to primary nursing. What
effect will the skills mix have on this transition?
a. Implementation of primary nursing will likely require hiring more UAPs and
laying off some RNs.
b. Implementation of primary nursing will likely require hiring more RNs, and laying
off some UAPs.
c. With adequate resources, primary nursing can be successfully implemented with
the existing skills mix.
d. Primary nursing is most successful if every member of the team providing direct
patient care is an RN.
ANS: B
Feedback: Shifting from a team approach to a primary care nursing approach would
typically necessitate an increased number of licensed RNs and a reduction in UAP.

22. Which statement demonstrates an intervention focused on the primary disadvantage of team
nursing?
a. “We are working with one fewer team member today.”
b. “The team will be meeting for a care report update in 5 minutes.”
c. “Our patient assignment is comprised of both males and females.”
d. “We will be having a member of the float pool on our team today.”
ANS: B
Feedback: Disadvantages to team nursing are associated primarily with improper
implementation rather than with the philosophy itself. Frequently, insufficient time is
allowed for team care planning and communication. This can lead to blurred lines of
responsibility, errors, and fragmented patient care. None of the other options address a
known disadvantage of team nursing.

TOP: Chapter Number: 14: Title: Team Nursing
23. Which statements demonstrate an understanding of the factors that should be considered
when a change in the care delivery system is being proposed? Select all that apply.
a. “We have determined that our level of care would improve if we provided it
differently.”
b. “It’s questionable whether our current nursing staff is large enough to support the
proposed change.”
c. “We will discuss our proposed change with the multidisciplinary team members.”
d. “Administration has been supportive of the planned change in our care delivery
system.”
e. “We’re going to make our decision based on which option is newest in the
literature.”
ANS: A, B, C, D
Feedback: If evaluation of the present system reveals deficiencies, leaders and managers
need to examine available resources and compare those with resources needed for the
change. Therefore, openness to change and a willingness to examine available resources are
necessary. Interdisciplinary collaboration is essential and support from high-level
administration is needed as well. Decisions should not be based simply on which model is
newest or most innovative.

24. Which historical event is known that have had a major effect on the delivery model of
nursing care?
a. Emergence of antibiotic-resistant microorganisms in the 1990s
b. Increases in patient empowerment during the 1970s and 1980s
c. High rates of infection, death, and disability during the Civil War
d. Shifts from home-based care to hospital-based care during the 1930s
ANS: D
Feedback: Major shifts in the location of care from the home to the hospital underlie many
of the shifts in care delivery in the early decades of the 20th century. Patient empowerment,
antibiotic resistance and the Civil War are not identified as having such sweeping effects on
the delivery of nursing care.

TOP: Chapter Number: 14: Title: Total Patient Care Nursing or Case Method Nursing
25. A nurse-manager is part of a committee that has been commissioned to change the care
delivery model at a health-care facility. When planning this change, the nurse and the other
committee members should be aware that this process will:
a. be difficult to implement without hiring staff who have experience with the new
model.
b. affect social relationships and group functioning in the workforce.
c. require equal input from every staff member during the planning stage.
d. be best conducted by objective consultants from outside the organization.
ANS: B
Feedback: The nurse-leader-manager needs to be aware that redesigning work that disrupts
group cohesiveness may result in increased levels of job dissatisfaction. Reorganizing care
does not necessarily require individuals from outside the organization. Often, the existing
staff and skills mix can be used to implement a change; hiring may not be necessary. Input
from staff and other stakeholders should be sought, but it is unrealistic to expect equal input
from everyone.

26. The emergency room nurse is assessing a patient who has presented with an exacerbation of
recently diagnosed irritable bowel syndrome. The patient states that he is “overwhelmed”
and “bewildered” by the mix of diagnostic tests, appointments, and consultations since he
was diagnosed. What is the nurse’s best action?
a. Acknowledge the difficulty of the patient’s circumstances and arrange for a nurse
navigator.
b. Validate the patient’s concerns and liaise with the clinical nurse-leader (CNL).
c. Offer to mediate between the patient and the case manager.
d. Offer to accompany the patient to any upcoming appointments.
ANS: A
Feedback: Nurse navigators help patients and families navigate the complex health-care
system by providing information and support. It would not be possible for the ED nurse to
perform this role on an ad hoc basis. A CNL focuses on quality of care in a specific setting
and less on helping patients navigate the larger health-care system. Offering to mediate
between the patient and the case manager does not address the patient’s expressed concern.

TOP: Chapter Number: 14: Title: Nurse Navigators
27. An experienced nurse is applying for a position as a clinical nurse-leader (CNL). In addition
to the nurse’s clinical experience, what characteristic best qualifies the nurse for this
position?
a. The nurse currently sits on the hospital’s ethics board.
b. The nurse has consistently adhered to the standards of practice.
c. Specialty certification in a specific area of practice.
d. The nurse has a master of science in nursing degree.
ANS: D
Feedback: The CNL, as an advanced generalist with a master’s degree in nursing, is
expected to provide clinical leadership at the point of care. CNLs have advanced knowledge
and education in general practice as opposed to specialization in one primary discipline, like
clinical nurse specialists. Adherence to standards of practice is a minimum requirement for
nursing practice, not a specific qualifier for a CNL role. Similarly, sitting on an ethics board
is a useful aspect of experience but not a specific qualifier for a CNL role.

TOP: Chapter Number: 14: Title: The Clinical Nurse-Leader
28. A nurse-manager sits on the hospital’s board of directors and there has been repeated
discussion about the possibility of changing the care delivery model. What action should be
performed first?
a. Elicit support from internal and external stakeholders.
b. Perform a cost–benefit analysis of the major alternatives for care delivery.
c. Assess the strengths and weaknesses of the current delivery model.
d. Plan a pilot project where the delivery model will be changed on one subacute unit.
ANS: C
Feedback: Assessment of the current delivery system must precede any decision to change
the delivery model. Consequently, it would be premature to start building support from
stakeholders, introducing a pilot project or doing cost–benefit analysis of alternatives.

29. A primary health-care teams (PHCT) has been established to coordinate the care of a patient
with complex health-care needs. What should be the nurse’s primary role in this team?
a. Communicate the wishes of the patient to the other team members.
b. Weigh the benefits of suggested interventions with their costs.
c. Provide the patient’s direct bedside care, whenever possible.
d. Emphasize improved quality of life and patient-centered care.
ANS: D
Feedback: The nurse can perform several tasks in the context of a PHCT, but advocating for
the patient and promoting patient-centered care is a priority role that encompasses many
smaller tasks (such as communicating the patient’s wishes, when necessary). The nurse does
not focus on financial concerns in this setting, and it is not necessary for the nurse on the
PHCT to be the one to provide the majority of the patient’s actual care.

TOP: Chapter Number: 14: Title: Interprofessional/Multidisciplinary Health-Care Teams
Chapter 15: Employee Recruitment, Selection, Placement, and Indoctrination
1. A nurse-manager is implementing strategies to maintain adequate staff in the health-care

organization. What action by the manager will best achieve this goal?
a. Proactively plan to hire two RNs for each unit each year.
b. Use knowledge of turnover rates on their units for planning and hiring.
c. Look at staff-to-client ratios at other health-care organizations in the area.
d. Hire consultants to study national turnover rates to determine recruitment needs.
ANS: B
Feedback: Staffing needs are unique to each institution and should be determined by looking
at client census, client health-care needs, the type of client care management used, and
budget. Specifying the number of new hires each year does not respond to changing needs.
The manager should focus on the organization where he or she works, not in other
organizations. Local and regional needs may not be reflected in larger, national trends.

TOP: Chapter Number: 15: Title: Predicting Staffing Needs
2. Which statement about the role of unit managers in recruitment and selection is accurate?
a. The more centralized nursing management is and the more complex the personnel
department, the greater the involvement of the unit manager.
b. Unit managers should always leave such decisions to a centralized personnel
department so consistency can be maintained.
c. Regardless of the extent of their involvement, all managers must be aware of
recruitment and selection constraints within their organization.
d. Unit managers should assume total responsibility for recruitment and selection of
personnel on their units.
ANS: C
Feedback: Although some institutions have personnel departments and nurse recruiters to
carry out most of the hiring responsibilities, the nurse-manager must understand how
recruitment and selection are accomplished within the organization. Generally speaking, the
more decentralized nursing management and the less complex the personnel department is,
the greater the involvement of lower level managers in selecting personnel for individual
units or departments. Nurse-manager may not have the ability to defer decision making to a
personnel department. In most cases, the manager collaborates with other staff in the
organization and does not hold total responsibility for personnel matters.

TOP: Chapter Number: 15: Title: The Nurse-Recruiter
3. What is the relationship between the national and local economy and an organization’s
ability to maintain an adequate workforce?
a. When the economy is on an upswing, many unemployed nurses return to work and
recruitment becomes easier.
b. When a recession occurs, it causes many part-time nurses to return to full-time
employment and others to delay their retirement.
c. Although the economy tends to affect the size of the blue-collar workforce,
professions such as nursing remain fairly stable regardless of economic changes.
d. When there is an economic downturn, many nurses reduce their work hours from
full time to part time.
ANS: B
Feedback: Nursing shortages occur when the economy is on the upswing and decline when
the economy recedes because many unemployed nurses return to the workforce and
part-time employees return to full-time employment. The nurse workforce is highly variable
and is subject to changes in the economy.

4. Interviews at a large health-care organization are conducted by various individuals and

groups, due to the high number of positions and applicants. What action will best ensure
interrater reliability when different individuals are conducting interviews?
a. Use a semistructured format and have interviewers practice with one another.
b. Create a structured interview format and adhere to it closely.
c. Have at least two, but not more than four, interviewers conduct each interview.
d. Use yes-no questions whenever possible, rather than open-ended questions.
ANS: B
Feedback: Interrater reliability is better if the interview is structured and the same format is
used by different interviewers. Unstructured and semistructured interviews are more
subjective and less reliable. A team approach enhances validity but cannot guarantee
reliability among interviewers who work independently of one another. Open-ended
questions yield more meaningful information than yes or no questions and are always
preferred.

TOP: Chapter Number: 15: Title: Limitations of Interviews
5. What should a nurse-manager do to reduce the potential for bias when interviewing
candidates?
a. Conduct single, rather than multiple, interviews.
b. Trust his or her first impressions of an applicant.
c. Avoid taking notes during the interview.
d. Have at least one other colleague join in the interview.
ANS: D
Feedback: Having more than one person interview the job applicant reduces individual bias.
Multiple interviews are recommended, and limiting the process to one interview does not
reduce bias. First impressions should be recognized but reflected upon and appraised
critically. Note taking enhances the interviewer’s recall of the interviewee’s statements;
avoiding it does not reduce bias.

TOP: Chapter Number: 15: Title: Use a Team Approach
6. A nurse-manager is preparing to interview an applicant for a position. What is the most

appropriate strategy for planning, conducting, and controlling the interview?
a. If the applicant clearly lacks qualifications for the position, the manager should
promptly and tactfully tell this to the applicant.
b. Personal questions should be asked early the interview so rapport can be
established between the manager and the applicant.
c. The manager should develop questions that can be answered with a yes or no
answer.
d. The manager should assess an applicant’s perceptive skills by sending nonverbal
cues to the applicant during his or her responses.
ANS: A
Feedback: In situations in which the interviewee is not qualified for the position, the
interviewer must inform the interviewee of this early and tactfully. The manager should
include job-related questions only, not personal questions. Open-ended questions elicit more
information than yes-no questions. Nonverbal communications is highly subjective and is
not included as reliable and valid interview data.

TOP: Chapter Number: 15: Title: Planning, Conducting, and Controlling the Interview
7. Which interview questions would be considered illegal? Select all that apply.
a. “What is your current marital status?”
b. “Which languages are you able to speak or write?”
c. “What university did you attend?”
d. “What city do you live in?”
e. “In what year were you born?”
ANS: A, E
Feedback: Asking applicants about their marital status or age is unlawful. None of the other
options are considered illegal areas of questioning.
TOP: Chapter Number: 15: Title: Table 15.1 Acceptable and Unacceptable Interview
Inquiries KEY: Integrated Process: Nursing Process
8. What should selectors do when processing employment applications?

a. Reject applicants who have a criminal record.
b. Require a physical examination before making a hiring decision.
c. Always follow up on references and verify employment history.
d. Use unsolicited personal information about an applicant in the decision-making
process.
ANS: C
Feedback: Some managers prefer to verify credentials and references before the interview;
others do it after the interview. Either way, doing a comprehensive check of credentials and
references is of absolute importance. A physical examination (if required) should be
performed after a hiring decision is made. Categorical rejection of all applicants with a
criminal record is unnecessary and refusing to hire someone with a criminal record could
constitute illegal discrimination in some circumstances. Unsolicited information should not
be used to make hiring decisions because this could constitute discrimination.

TOP: Chapter Number: 15: Title: Reference Checks and Background Screening
9. A nurse-manager is required to make decisions about the proper placement of employees

within the organization. What practice should the manager follow?
a. Attempting to place employees in units where they have the greatest chance of
success
b. Avoiding overemphasizing the match between the employee and the unit in order
to prevent discrimination suits
c. Placing new employees on units that have the greatest need for new staff
d. Helping employees modify their personal values and beliefs to coincide with that
of the unit on which they are placed
ANS: A
Feedback: If employees are placed where they have the greatest chance of success,
employee morale and retention will be positively affected. It is unrealistic to expect
employees to fundamentally change their beliefs and values. A match between the employee
and the unit should be sought; this practice is not grounds for a discrimination suit. The
employees’ strengths and skills should be considered in placement, not solely the needs of
the unit.

TOP: Chapter Number: 15: Title: Placement
10. Which statement describes the induction phase of employee indoctrination?

a. It occurs after hiring but before performing the role.
b. It includes the activities performed by the personnel department.
c. It relates to the information included in the employee’s handbook.
d. It is the responsibility of the staff development department.
ANS: A
Feedback: Induction, the first phase of indoctrination, includes all activities that educate the
new employee about the organization and personnel policies and procedures before actually
assuming nursing responsibilities. It does not denote the roles of the personnel department.
The manager has partial responsibility for induction and it is not the exclusive responsibility
of a staff development department. An employee is often provided with a handbook during
induction, but the process is not limited to information in a handbook.

TOP: Chapter Number: 15: Title: Induction
11. Which question asked during an interview is acceptable?

a. “Are you married?”
b. “Have you ever been arrested?”
c. “What is your religious preference?”
d. “What professional organizations do you belong to?”
ANS: D
Feedback: It is lawful for an interviewer to ask about professional organizations, but the
interviewer cannot ask the interviewee to produce a list of all memberships. It is not
permissible to ask about an applicant’s marital status, religion, or arrest record.

TOP: Chapter Number: 15: Title: Table 15.1 Acceptable and Unacceptable Interview
Inquiries KEY: Integrated Process: Nursing Process
12. A health-care organization has advertised a position that requires a doctoral degree and
several years of experience. These high standards for education and experience may have
what unintended consequence?
a. The position may remain unfilled for longer than desired.
b. Applicants may lack applicable skills.
c. Applicants’ credentials may be difficult to verify.
d. Applicants may find it difficult to collaborate with subordinates.
ANS: A
Feedback: If requirements for a position are too rigid, the job may remain unfilled for some
time. There is no reason why these high standards would be associated with a lack of skills
or difficulty verifying credentials. High standards do not correlate with an inability to
collaborate.

TOP: Chapter Number: 15: Title: Educational and Credential Requirements
13. When do nursing shortages historically occur?

a. When the economy is on an upswing
b. When the economy is in recession
c. When nursing salaries decline
d. When client acuity increases
ANS: A
Feedback: Historically, nursing shortages occur when the economy is on the upswing and
decline when the economy recedes. Historically, salaries were not a causative factor in
existing nursing shortages. Client acuity is not identified as a factor that directly contributes
to nursing shortages.

14. When evaluating the risk of a nursing shortage, the nurse-manager should prioritize which
of the following variables?
a. The economy
b. Infectious disease prevalence
c. Continuing education offerings
d. Political climate
ANS: A
Feedback: Nursing shortages are multifactorial. However, it is generally agreed that the state
of the economy is among the most salient variables.

15. What action most directly addresses the projected nursing shortage?
a. Increasing the number of unlicensed assistive personnel
b. Increasing the number of nursing internships for recent graduates
c. Expanding the nursing scope of practice
d. Creating incentives for nurses to enter faculty roles
ANS: D
Feedback: A shortage of nursing faculty is known to contribute significantly to the pending
nursing shortage. Because so many qualified applicants are being turned away from schools
of nursing, there is a pressing need to increase numbers of nursing educators. Internships
and scope of practice have a significant effect on the nursing profession, but a faculty
shortage is seen as even more significant. Increasing the numbers of UAPs does not
necessarily relieve a nursing shortage.

TOP: Chapter Number: 15: Title: Supply KEY: Integrated Process: Nursing Process
16. The manager may be greatly or minimally involved with recruiting, interviewing, and
selecting personnel. What factors can determine to the extent of the manager’s involvement?
a. Size of the institution
b. Existence of a separate personnel department
c. Presence of a nurse recruiter within the organization
d. Centralization or decentralization of nursing management in the organization
e. The preferences of subordinates
ANS: A, B, C, D
Feedback: The manager may be greatly or minimally involved with recruiting, interviewing,
and selecting personnel depending on (a) the size of the institution, (b) the existence of a
separate personnel department, (c) the presence of a nurse recruiter within the organization,
and (d) the use of centralized or decentralized nursing management. The preferences of
subordinates would not normally determine the extent of the manager’s involvement in
personnel decisions.

TOP: Chapter Number: 15: Title: The Nurse-Recruiter
17. What type of interview is the best predictor of job performance and overall effectiveness?
a. Unstructured
b. Semistructured
c. Structured
d. Informal
ANS: C
Feedback: As a predictor of job performance and overall effectiveness, the structured
interview is much more reliable than the unstructured, semistructured, or informal
interviews.

TOP: Chapter Number: 15: Title: Limitations of Interviews
18. A nurse is preparing for a job interview. The nurse should prepare responses to what types
of interview questions because they are difficult to respond to without advance thought?
a. Personal philosophy of nursing
b. Professional organizations membership
c. Individual strengths and weaknesses
d. Career goals
e. Days and times of availability
ANS: A, C, D
Feedback: It is difficult to spontaneously answer interview questions about a personal
philosophy of nursing, individual strengths and weaknesses, and career goals without giving
them advance thought. Question about availability and professional organizations are less
open-ended and likely require less forethought and preparation.

TOP: Chapter Number: 15: Title: Tips for the Interviewee
19. A team of nurse-managers have finished interviewing qualified candidates for a position and
have now begun the selection process. During this process, the managers should:
a. review the results of the applicants’ physical examinations.
b. schedule times for induction and orientation.
c. carefully verifying the chosen applicant’s references and credentials.
d. reflect on the overall efficiency of the hiring process.
ANS: C
Feedback: Positions should never be offered until information on the application has been
verified and references have been checked. Physical examinations should be performed after
a position has been offered to a particular applicant. It would normally be impractical to
schedule induction and orientation until an applicant has been offered the position.
Evaluation is normally focused at the end of the hiring process.

20. An applicant has accepted a position in the health-care organization and has begun the
indoctrination process. This process should include what activities? Select all that apply.
a. Educating the employee about the policies and procedures
b. Orienting the employee to the specifics of the job role
c. Socializing the employee to the workplace culture
d. Scheduling the employee’s continuing education activities
e. Verifying the employee’s references and credentials
ANS: A, B, C
Feedback: Indoctrination includes orientation and socialization of employees. During
orientation, the employee is informed of the organization’s policies and procedures.
Normally, continuing education offerings are addressed after the employee has completed
orientation and indoctrination. The employee’s credentials and references should be verified
before an offer of employment is made.

TOP: Chapter Number: 15: Title: Indoctrination
21. Health disparities in the client care population are likely to occur when the health-care
workforce lacks diversity in which areas? Select all that apply.
a. Age
b. Gender
c. Ethnicity
d. Education
e. Personality type
ANS: A, B, C
Feedback: The workforce should also reflect the gender, culture, ethnicity, age, and
language diversity of the communities that the organization serves. The lack of ethnic,
gender, and generational diversity in the workforce has been linked to health disparities in
the populations served. Heterogeneity of educational levels and types will exist in every
health-care organization and issues related to a lack of diversity in this area are rare. It is
normally impractical to make hiring decisions on the basis of personality type, and a lack of
diversity in this area has not been identified as being problematic.

22. A team of nurse-managers are attempting to make accurate predictions about variables that
will impact future staffing decisions. What pieces of data should the team seek to identify?
a. Client satisfaction levels
b. When staff resignations historically occur
c. How long new hires usually stay employed
d. Education of current nursing staff members
e. Third-party insurer reimbursement levels
ANS: B, C, D, E
Feedback: Accurately predicting staffing needs is a crucial management skill because it
enables the manager to avoid staffing crises. Managers should know the usual length of
employment of newly hired staff and peak staff resignation periods. In addition, managers
must consider the education and knowledge level of needed staff and have a fairly
sophisticated understanding of third-party insurer reimbursement because this has a
significant impact on staffing in contemporary health-care organizations. It is important to
assess and review client satisfaction levels, but this factor does not normally have a direct
effect on staffing needs unless low satisfaction is directly linked to staffing issues.

23. What factor contributed significantly to the beginning of the acute RN shortage that
originated in the late 1990s?
a. Closing of nursing programs
b. Lack of interest in nursing
c. Hospital downsizing
d. Poor nursing salaries
ANS: C
Feedback: Hospital downsizing and shortsightedness regarding recruitment and retention
contributed to the beginning of an acute shortage of RNs in many health-care settings by the
late 1990s. None of the other options were significant contributors to the nursing shortage
that began in the late 1990s.

24. Which of the following factors is most likely to benefit a health-care organization’s
recruitment and retention efforts?
a. Being located in a rural area distant from major urban centers
b. Dedicating several weeks to induction for new employees
c. Offering incentives to employees with more than 10 years of service
d. Ensuring high levels of employee engagement and satisfaction
ANS: D
Feedback: One of the best ways to maintain an adequate employee pool is by word of
mouth; the recommendation of the organization’s own satisfied and happy staff. Work
groups with high employee engagement have a far lower turnover rate than those with low
engagement. In general, rural areas have historically had more difficulty recruiting
employees. Prolonged induction is likely to be attractive to applicants but will not normally
have as large an effect as a satisfied work force. Incentives that take a decade to accrue may
not have an appreciable effect on newer employees or potential applicants.
TOP: Chapter Number: 15: Title: The Relationship Between Recruitment and Retention
25. A small health-care organization has had a static group of employees for almost 2 years. The
manager should identify what potential advantage of having some staff turnover in the
organization?
a. Fresh ideas
b. Younger staff
c. Cost containment
d. Increased groupthink
ANS: A
Feedback: Some turnover is normal and, in fact, desirable. Turnover infuses the
organization with fresh ideas. It also reduces the probability of groupthink, in which
everyone shares similar thought processes, values, and goals. Staff turnover is not
guaranteed to result in a younger staff; as well, this may or may not be a desirable goal.
Turnover nearly always comes with a cost because recruitment and indoctrination are
expensive.

TOP: Chapter Number: 15: Title: The Relationship Between Recruitment and Retention
26. The nurse-manager responsible for personnel is checking the references of an applicant. The
reference offers unsolicited information about the applicant’s personal history. What should
the nurse-manager do with this information?
a. Contact the applicant to disclose this violation of confidentiality.
b. Disregard the information unless it has a direct bearing on the applicant’s ability to
do the job.
c. Document the information and note the fact that it was offered unsolicited.
d. Corroborate the information with the applicant without mentioning the source of
the information.
ANS: B
Feedback: Occasionally, reference calls will reveal unsolicited information about the
applicant. Information obtained by any method may not be used to reject an applicant unless
a justifiable reason for disqualification exists. There is not normally an obligation for the
manager to contact the applicant to disclose this, and corroborating it would constitute an
inappropriate interview question. Unless the personal information has a direct bearing on the
applicant’s ability to do the job, the information should not be entered into the personnel
record.

27. An applicant has disclosed a criminal record during an interview. When considering the
implications of this disclosure on the hiring decision, the manager should consider what
factors? Select all that apply.
a. The time that has elapsed since the offense
b. The geographic location where the offense occurred
c. The severity or gravity of the criminal offense
d. The relationship of the offense to the job duties
e. The applicant’s collaboration with other persons during the offense
ANS: A, C, D
Feedback: Any decision not to hire on the basis of criminal history must be job related and
consistent with business necessity and must take into account factors such as the nature and
gravity of the criminal offense, the amount of time since the conviction, and the relevance of
the offense to the job being sought. In most cases, the location of the offense and applicant’s
collaboration with other criminals are not central considerations and are unlikely to affect
the applicant’s ability to perform the job role.

28. The personnel department at a health-care organization has recently mandated

preemployment personality testing for all applicants. How should a nurse-manager best
interpret the results of this testing when making hiring decisions?
a. Testing results should be disregarded until their legal status becomes more clear.
b. Testing results should be prioritized over subjective data such as interviews and
references.
c. Testing results should be considered alongside interview results and reference
checking.
d. The applicant should be invited to review the results of the testing with the
interviewers.
ANS: C
Feedback: Preemployment testing is not a stand-alone selection tool, but it can, when
coupled with interviewing and reference checking, provide additional information about
candidates to make a selection decision. There have been legal challenges (lawsuits)
regarding this testing but this does not necessarily mean that results should be disregarded if
they are in fact mandated in an organization. It is atypical for applicants to have the
opportunity to discuss the results of these tests with interviewers.

TOP: Chapter Number: 15: Title: Preemployment Testing
29. A nurse-manager has made a selection to fill a staff opening. When finalizing this selection,
the manager should:
a. identify the successful applicant’s long-term career goals.
b. inform the unsuccessful applicants that the position has been filled.
c. negotiate the successful applicant’s salary.
d. inform the successful applicant about when he or she will be given promotions.
ANS: B
Feedback: Candidates not offered a position should be notified of this as soon as possible.
The applicant’s career goals and salary expectations should be ascertained well before a
selection is made. It would be premature to tell the successful applicant when he or she may
expect promotions.

TOP: Chapter Number: 15: Title: Finalizing the Selection
30. A nurse-manager has proposed an expansion of the organization’s indoctrination program to

the organization’s board of directors. What potential advantage of expanding the
indoctrination program should the manager describe?
a. Enhanced retention rates
b. More efficient recruitment
c. Higher proportion of internal applicants
d. Reduced burden on unit managers
ANS: A
Feedback: An extensive and effective indoctrination program has the potential to reduce
staff turnover of new employees and increase retention. The program may have an effect on
recruitment but its effects are more likely to be experienced by new employees in the
organization. Such programs will likely have a lesser effect on internal employees who are
already familiar with the organization. Despite being beneficial, indoctrination does have
the potential to be burdensome for managers because of the time and effort it requires.

TOP: Chapter Number: 15: Title: Indoctrination
Chapter 16: Socializing and Educating Staff in a Learning Organization
1. Which statement best describes a characteristic of mentorship?

a. The intensity and duration of relationships are similar in mentorship and
preceptorship.
b. Staff cannot be assigned to become mentors. It is a role voluntarily chosen by the
mentor.
c. Mentees must be willing to put aside their personal goals and beliefs in an effort to
identify more closely with their mentor.
d. Most nurses will have the opportunity for many mentor relationships during their
careers.
ANS: B
Feedback: The mentor makes a conscious decision to assist the protégé in career
development, with the relationship usually lasting several years. Mentorship and
preceptorship differ in purpose and duration. Mentorship does not necessitate putting aside
one’s personal goals and beliefs. Mentorship relationships are intended to have a longer
duration; most nurses do not have several mentors during their career.

TOP: Chapter Number: 16: Title: Mentors
2. A nurse-manager is helping a newly graduated RN adjust to the professional nursing role.

What is the manager’s most appropriate action?
a. Advise the new RN to avoid confrontations with health-care providers whenever
possible.
b. Advise the new RN that the “real world” of nursing is fundamentally different
from the one described in textbooks.
c. Be alert to signs and symptoms of the shock phase of the nurse’s role transition.
d. Be alert to signs that the new RN has not shed nursing school values.
ANS: C
Feedback: Managers should be alert to signs and symptoms of the shock phase of role
transition. Managers should also ensure that some of the new nurse’s values are supported
and encouraged so that work and academic values can blend, rather than being rejected. The
nurse should learn to manage conflict appropriately, not avoid it at all costs.

TOP: Chapter Number: 16: Title: Socialization of the New Nurse: Overcoming Reality
Shock KEY: Integrated Process: Nursing Process
3. Which statement best describes the manager’s main role in socialization of a new nurse?
a. Providing the employee with organizational rules and regulations
b. Providing the new employee with a good preceptor
c. Ensuring that there are sufficient numbers of good role models
d. Sharing organizational values, expected attitudes, and behaviors
ANS: D
Feedback: New group members must be socialized into the group, and these socialization
efforts should be led and modeled by the manager.

4. The manager overheard an experienced nurse say to a new nurse, “Sorry you won’t be able
to join us for our weekly get-together at the yogurt shop. I see you are going to be here
charting for a while yet.” How should the manager best interpret this nurse’s statement?
a. The experienced nurse’s positive sanction has the ability to affect the new nurse’s
behavior.
b. The experienced nurse has applied a negative sanction regarding group norms.
c. The experienced nurse is giving constructive feedback about expected group
norms.
d. Desired behavior is being role modeled for the new nurse.
ANS: B
Feedback: Negative sanctions provide cues that enable people to evaluate their performance
and modify behavior when needed. In this case, the experienced nurse is letting the new
nurse know that the group’s weekly outing is important, and on that day the staff makes sure
they finish their work on time. Missing out on the social event is a form of negative, not
positive, sanction. The experienced nurse is not overtly providing feedback or modeling a
different behavior.

TOP: Chapter Number: 16: Title: Negative Sanctions
5. The nurse-manager is attempting to promote closer adherence to the principles of

evidence-based practice. What is the manager’s best action?
a. Stress the need to base practice on research findings during orientation of new
graduates.
b. Include a statement of the need for evidence-based practice in the unit vision
statement.
c. Impose sanctions on nurses who do not use research during the annual evaluations.
d. Arrange for easy online access to academic databases.
ANS: D
Feedback: Providing available research for the staff is the most concrete action an
organization could take to encourage nurses to incorporate research in practice. None of the
remaining options provides the staff with the tools to actually implement evidence-based
practice.

TOP: Chapter Number: 16: Title: Shared Responsibility for Implementing Evidence-Based
Practice KEY: Integrated Process: Nursing Process
6. An experienced nurse has accepted a half-time management position on the unit. As well,
the nurse works half-time providing direct client care on the unit. This nurse’s immediate
supervisor should identify the nurse’s risk of:
a. exhaustion.
b. negative sanctions.
c. role overload.
d. role ambiguity.
ANS: D
Feedback: A nurse who provides client care half of the time and who is in a management
role half of the time will have a high risk for role ambiguity. These simultaneous and dual
roles may or may not lead to exhaustion and role overload, depending on the number of
responsibilities. Role ambiguity does not necessarily lead to negative sanctions.

TOP: Chapter Number: 16: Title: The Socialization and Orientation of New Managers
7. The unit supervisor is working with an RN who has just been promoted to charge nurse.
What action by the supervisor will best help the RN adjust to this new role?
a. Take the RN out to lunch to congratulate the nurse on the promotion.
b. Arrange for the RN to meet with staff peers in the organization.
c. Explain to the RN on the need for underling respect.
d. Inform the RN of the past performance of employees that he or she will manage.
ANS: B
Feedback: There should be a management group in the organization with which the new
manager can consult. The new manager should be encouraged to use the group as a
resource. Congratulating the nurse will not help the adjustment to the new role. Similarly,
emphasizing the need for respect and telling the nurse about subordinates’ performance does
not facilitate role adjustment.

TOP: Chapter Number: 16: Title: The Socialization and Orientation of New Managers
8. The manager is organizing a class to prepare nurses to function in the neonatal ICU. What is
the manager’s initial action?
a. Identify available learning resources that will assist with role transition.
b. Evaluate the professional attributes of the nurses who already work on the unit.
c. Evaluate the educational background and credentials of the new nurses.
d. Identify the learning needs of the new nurses.
ANS: D
Feedback: Developing a training program starts with identifying the knowledge or skill
needed. There may or may not be a correlation between these learning needs and the
educational background of the nurses. The attributes of the existing nurses and the available
resources are not priorities over the orientees’ learning needs.

TOP: Chapter Number: 16: Title: Assessing Staff Development Needs
9. A nurse-manager has organized a 1-day workshop that is open to all the staff members on
the unit. What characteristic of the workshop would most clearly suggest that it is an
educational workshop rather than a training workshop?
a. The workshop is focused on the broad intellectual development of the participants.
b. Participants will be able to apply the material from the workshop immediately after
completing it.
c. The workshop provides skills for performing a specific task.
d. The workshop specifically addresses a common deficiency in the work
performance of participants.
ANS: A
Feedback: Although training has an immediate use for a specific task or function, education
is designed to develop the person in a broader sense. The results of training can often be
applied more immediately.

TOP: Chapter Number: 16: Title: Training Versus Education
10. The nurse-manager is applying the principles of andragogy during an educational offering.
What is the manager’s most appropriate action?
a. Competition is prioritized over collaboration during learning activities.
b. The manager seeks to establish a highly structured learning environment.
c. The manager openly values participants’ life experiences.
d. The manager leads the majority of learning activities.
ANS: C
Feedback: Andragogy works well with those who have had life experiences because they
are mature and can take part in their own learning experiences. In this type of learning, the
learner is self-directed rather than dependent. Collaboration, student-directedness, and a
less-structured learning environment are also associated with adult learning.

TOP: Chapter Number: 16: Title: Table 16.1 Characteristics and Learning Environment of
Pedagogy and Andragogy KEY: Integrated Process: Nursing Process
11. Before starting an educational session, the nurse-manager has determined that participants
possess readiness to learn. What does this imply about the participants?
a. They have acquired the skills necessary for what is to be learned.
b. They are motivated to learn the necessary material.
c. The participants are contributing to a positive atmosphere.
d. The participants are mature individuals with much experience.
ANS: A
Feedback: Readiness means that the individual has the prerequisites to move to the next
stage of learning. The prerequisites could be behavior or prior learning. This is not
synonymous with motivation to learn, which involves “buy in” to the benefits of learning. A
positive atmosphere does not necessarily mean that there is readiness to learn. Maturity and
experience are components of adult learning theory but not necessarily a readiness to learn.

TOP: Chapter Number: 16: Title: Other Learning Concepts
12. The staff at a community health clinic will require training on the use of the new electronic
health record system. How should the nurse-manager organize the necessary education in
order to enhance learning?
a. Schedule a long, uninterrupted session.
b. Explain the most complicated part of the system first.
c. Use a dynamic lecture technique.
d. Teach in several short, frequent sessions.
ANS: D
Feedback: When learning motor skills, spaced practice is more effective than massed
practice. Simpler concepts should precede more complex concepts. Lectures are generally
less effective than more interactive learning techniques.

13. New intravenous pumps are being introduced in a health-care organization. How can
educators best implement social learning theory into the necessary education and training?
a. Encouraging each learner to give feedback about other learners’ performance
b. Demonstrating the use of the pump to groups of learners and then letting them
practice
c. Organizing an informal teaching session that allows learners to socialize with each
other
d. Maximizing the size of the group that attends each teaching session
ANS: B
Feedback: Demonstration and practice in a group setting is central to social learning theory.
This may or may not involve extensive feedback between participants. This theory does not
imply casual learning and an emphasis on socialization. Social learning theory does not
mandate a large size for the group.

TOP: Chapter Number: 16: Title: Social Learning Theory
14. What is the emphasis for the manager in the coaching role?
a. Solving problems for the employee
b. Showing employees how to work within the system
c. Helping employees reach an optimum level of performance
d. Redirecting employees to meet organizational goals
ANS: C
Feedback: In coaching, the emphasis is on assisting the employee to recognize greater
options, to clarify statements, and to grow. The other options are focused on doing for the
learner rather than encouraging the learner to do for themselves.

TOP: Chapter Number: 16: Title: Coaching as a Teaching Strategy
15. The nurse-manager is developing an educational program for an organization. What action
should the manager perform first?
a. Identifying the facilities available to meet the needs
b. Identifying the desired skills or knowledge the staff should have
c. Explaining to the team the benefits that will result from the program
d. Assessing the staff who is willing to learn new skills
ANS: B
Feedback: Identifying the desired skills or knowledge the staff should have is the first step
in developing an educational program. Although the other options are relevant, they should
be done after the requisite skills and knowledge are identified.
TOP: Chapter Number: 16: Title: Assessing Staff Development Needs
16. The nurse-manager needs to determine the effectiveness of a staff workshop on establishing
IV access. What is the manager’s best method for determining this?
a. Having class participants evaluate the instructor and the class
b. Giving participants an examination or test at the conclusion of the course
c. Having a documented decrease in the unit’s IV site infections
d. Observing staff perform and document the practice
ANS: D
Feedback: Instructor evaluation supports effective teaching but not learning of the new
skills. Testing someone at the end of educational training does not confirm that the learning
changed behavior, which is the primary goal of staff development. There needs to be some
method of follow-up to observe whether a behavior change occurred, showing that the
education was effective. Observation of the staff will fulfill this need. Having a decrease in
IV site infections may or may not be the result of the staff implementing the educational
program.

TOP: Chapter Number: 16: Title: Evaluation of Staff Development Activities
17. The nurses and managers of a clinic have agreed on a commitment to becoming a learning
organization. What change in practice would suggest progress toward this goal?
a. Recognizing that mistakes are an inevitable part of the learning process
b. Exclusively hiring RNs with baccalaureate degrees
c. Encouraging a variety of individual visions among the nursing staff
d. Stressing the need for individual learning
ANS: A
Feedback: Learning organizations have a shared vision and promote team learning. A
common feature of learning organizations is their tolerance for mistakes as an inevitable part
of the learning process. An organization does not need to limit itself to baccalaureate
educated nurses in order to be a learning organization.

TOP: Chapter Number: 16: Title: Display 16.2 Senge's Five Disciplines of a Learning
Organization KEY: Integrated Process: Nursing Process
18. What goal is most congruent with being a learning organization?

a. Staff development is the main priority in the organization.
b. The organization employs a dedicated staff member for providing in-house
education.
c. There is dedicated time on each shift for staff to pursue education.
d. Continuing education for staff exceeds the requirements for licensure.
ANS: D
Feedback: In a learning organization, staff members’ educational activities exceed the
minimum standards that are needed for licensure. Being an LO does not necessarily require
dedicated staff members whose exclusive role is to provide education. Client care, not staff
development, should be the main priority in any health-care organization. Opportunities for
education should be provided regularly, but it is not realistic or necessary to provide
opportunities during every shift for every staff member.

TOP: Chapter Number: 16: Title: The Learning Organization
19. A nurse-manager’s interactions with a staff member suggest that the person is experiencing
difficulties with resocialization. What potential causes should the manager consider? Select
all that apply.
a. Role ambiguity
b. Lack of a dedicated coach, mentor, and preceptor simultaneously
c. Inability to meet job demands
d. Role overload
e. Lack of motivation
ANS: A, C, D, E
Feedback: Difficulties with resocialization usually center on unclear role expectations (role
ambiguity), an inability to meet job demands, or deficiencies in motivation. Role strain and
role overload contribute to the problem. Individuals do not normally have an assigned
mentor, coach, and preceptor at the same time.

20. Training and education are important parts of staff development. Responsibility for these
activities lies with:
a. preceptors.
b. the education department.
c. the manager and preceptor.
d. the manager and the education department.
ANS: D
Feedback: Managers and education department staff have a shared responsibility for the
education and training of staff. It is not the responsibility of the other options.
21. Which action by the nurse-leader best demonstrates the leadership role to the socialization
and education of new nursing staff during their orientation?
a. Discusses organizational values and unit culture
b. Addresses all questions regarding the responsibilities of the RN
c. Schedules orientation sessions at times when client acuity is at its lowest
d. Applies sanctions appropriately so new staff become socialized
ANS: A
Feedback: Discussing organizational values and unit culture is primarily a leadership
responsibility; the remaining options are appropriate management responsibilities.

Functions Associated With Education and Socializing Staff in a Learning Organization
22. The responsibilities for staff development have recently been decentralized in a large
health-care organization. The nurse-manager should take action to prevent what possible
consequence of this change?
a. Poor staff retention
b. Deficient nursing care
c. Increased role ambiguity
d. Decreased nursing autonomy
ANS: C
Feedback: Some difficulties associated with decentralized staff development include the
conflict created by role ambiguity whenever two people share responsibility. Role ambiguity
is sometimes reduced when staff development personnel and managers delineate the
difference between training and education. Decentralization of staff development is less
likely to have a direct impact on retention, nursing care, or the autonomy of nurses.

TOP: Chapter Number: 16: Title: Responsibilities of the Education Department
23. The nurse-manager can begin to promote the needs of a culturally diverse staff by:
a. viewing diversity as an opportunity rather than a threat.
b. clustering staff members according to their culture whenever possible.
c. focusing educational activities on the needs of staff from minority groups.
d. adopting a neutral teaching style that is equally accessible to all cultures.
ANS: A
Feedback: The nurse-manager should aim to see diversity as an opportunity that can be
leveraged rather than a problem that must be managed. There is no such thing as “neutral”
practice that is devoid of cultural content. Clustering staff by culture likely reinforces
differences and separation. The manager should aim to meet the needs of all staff, not only
those from minority backgrounds.

TOP: Chapter Number: 16: Title: Meeting the Educational Needs of a Culturally Diverse
Staff KEY: Integrated Process: Nursing Process
24. Which statement best demonstrates understanding of the concept of knowledge of results?
a. “These are the goals for today’s lecture.”
b. “Today you clearly demonstrated an understanding of client focused care.”
c. “As RNs on this unit, you will need to be proficient in assessing for depression.”
d. “There will be a short quiz on today’s material at the end of the session.”
ANS: B
Feedback: Research has demonstrated that people learn faster when they are informed of
their progress. The knowledge of results must be automatic, immediate, and meaningful to
the task at hand. People need to experience a feeling of progress, and they need to know
how they are doing when measured against expected outcomes. The other options failed to
demonstrate an understanding of that need.

25. The nurse-manager stresses the benefits of learning a new skill to achieving the unit’s goal
of client satisfaction. The manager will break the skill down into its component parts and
teach the subskills in sequence. This demonstrates understanding of which concept of
education?
a. Readiness
b. Motivation
c. Task learning
d. Transfer of learning
ANS: C
Feedback: Task learning usually entails taking a big task and breaking it down into smaller
components. None of the other options demonstrates association with this concept of
learning.

26. The leadership of a health-care organization has declared their intention to make the facility
a learning organization (LO). What action is most likely to achieve this goal?
a. Assigning mentors to each new employee and to employees who have relocated in
the organization
b. Requiring each employee to prove that he or she has met the continuing education
requirements for license renewal
c. Offering the facility to university researchers as a site for conducting health-care
research
d. Acknowledging and rewarding employees who participate in continuous learning
ANS: D
Feedback: Recognizing and incentivizing education is one step that an organization can
make toward become a true LO. Mentorship is an important tool for new and relocated
employees, but it does not directly promote the establishment of a learning organization.
Establishing an LO requires more than just the minimum requirements for licensure. Having
researchers present on the unit may or may not promote the development of an LO, because
there is no guarantee that there would be close collaboration between researchers and staff
members.

TOP: Chapter Number: 16: Title: The Learning Organization
27. New mechanical lifts for client transfers are being introduced at a health-care facility. The
manager plans to implement the principles of social learning theory in the necessary
training. What actions should the manager facilitate? Select all that apply.
a. Having an expert demonstrate the correct use of the mechanical lift
b. Uploading a video for staff to watch on their own time
c. Providing opportunities for hands-on practice
d. Distributing an information packet to staff 1 week before education sessions
e. Encouraging staff to work in groups during education sessions
ANS: A, C, E
Feedback: Key components of social learning theory include group work, demonstration
(modeling), and hands-on practice. Written information and online materials that learners
complete on their own would be less indicative of social learning theory, even though they
may benefit some learners.

TOP: Chapter Number: 16: Title: Social Learning Theory
28. The integrated leader-manager has recognized a need to promote evidence-based practice on
the unit. What action is most appropriate?
a. Requiring staff to research the evidence base for each of their nursing actions
b. Supporting staff who are trying to change old practices that are not evidence-based
c. Implementing the principles of andragogy whenever possible
d. Expanding the role of mentors within the organization
ANS: B
Feedback: Organizational cultures often do not support the nurse who seeks out and uses
research to change long-standing practices rooted in tradition. The leader-manager must
support efforts to change practices. It is impractical and unrealistic to expect nurses to
research every action they perform. Mentorship and andragogy affect socialization and
education on a unit, but are not directly related to implementation of EBP.

TOP: Chapter Number: 16: Title: Shared Responsibility for Implementing Evidence-Based
Practice KEY: Integrated Process: Nursing Process
29. One year ago, a hospital implemented a 6-month internship program for new hires who are
recent graduates. When evaluating the success of this transition to practice program, what
piece of data should leaders and managers prioritize?
a. Rates of absenteeism in participants compared with more experienced staff
b. The incidence of sentinel events (safety violations) in periods before and after the
program
c. Retention rates among participants of the program compared with nonparticipants
d. Response rates to the personnel department’s recruitment campaigns
ANS: C
Feedback: Transition-to-practice (TTP) programs can improve outcomes for new nurses in
their first year of practice and increase their retention. This is one of the ultimate goals of
TTP programs, so data related to absenteeism, safety violations and recruitment would be
secondary, even though these data are relevant.

30. A nurse with more than 15 years of experience in an adult medical setting has just
transitioned to a job in the day surgery department. What should the manager of this
department do to aid the resocialization of this experienced nurse?
a. Avoid making assumptions about the nurse’s ability to perform the job roles.
b. Encourage the nurse to mentor new graduates as a gesture of respect for the
nurse’s experience.
c. Emphasize the importance of evidence-based practice in the culture of the unit.
d. Arrange for a nurse residency to help the nurse transition to a new site.
ANS: A
Feedback: Managers must avoid making assumptions about an experienced nurse’s ability
to transition to a new location with new roles. It would be premature to assign a mentorship
role to the nurse while he or she is in this transition period. Emphasizing EBP is important,
but this action does not ease the nurse’s resocialization. Nurse residencies are normally
provided to new graduates, not experienced nurses who are changing sites.

TOP: Chapter Number: 16: Title: Resocialization of the Experienced Nurse
Chapter 17: Staffing Needs and Scheduling Policies
1. What is the most fiscally responsible method for determining staffing needs for a hospital
unit?
a. Maximum patient load capacity of the unit
b. Numbers of patients present for an upcoming shift
c. An agreed-upon staffing formula based on client acuity
d. Total beds on the unit
ANS: C
Feedback: A staffing formula is the best way to determine staffing needs, provided it is
based on an accurate patient classification system (PCS). A robust formula considers the
other variables listed, none of which can be used in isolation to determine staffing needs
accurately.

TOP: Chapter Number: 17: Title: The Relationship Between Nursing Care Hours, Staffing
Mix, and Quality of Care KEY: Integrated Process: Nursing Process
2. Which statement about patient classification systems is accurate?

a. Classification systems are able to solve staffing problems if applied consistently.
b. Nursing care hours assigned to a classification system should remain constant.
c. A good classification system can resolve all staffing challenges.
d. Internal and external forces may affect classification systems.
ANS: D
Feedback: Examples of internal and external forces that may affect a PCS are a sudden
increase in nursing or medical students using the unit, a lower skill level of new graduates,
or cultural or language difficulties of recently hired foreign nurses. PCSs are not able to
independently solve staffing challenges and cannot resolve every staffing challenge. Care
hours will be constantly changing due to the interplay of numerous variables.

TOP: Chapter Number: 17: Title: Workload Measurement Tools
3. A self-scheduling system has been proposed at a health-care facility. What potential benefit
of this system should the manager recognize?
a. Self-scheduling increases employees’ autonomy over their work lives.
b. The manager no longer has to participate directly in staff scheduling.
c. Self-scheduling ensures an equitable distribution of benefits to employees who
participate.
d. Self-scheduling can be more easily implemented and sustained than other
alternative systems.
ANS: A
Feedback: Self-scheduling can increase worker satisfaction by giving employees more
control over their work life. This form of scheduling does not absolve the manager from
participation, and there is a possibility that the advantages and disadvantages may be
distributed unequally. This system is challenging to implement effectively and fairly.

TOP: Chapter Number: 17: Title: Staffing and Scheduling Options
4. A health-care organization is transitioning from a centralized staffing system to a

decentralized staffing system. A nurse-manager should anticipate what outcome of this
change?
a. Increased fairness to employees through consistent, objective, and impartial
application
b. Increased cost-effectiveness through better use of resources
c. Greater manager autonomy, resulting in an increase in self-esteem and teamwork
d. Increased availability of data for monitoring the effect of staffing size and
composition, quality of care, and costs
ANS: C
Feedback: In an institution that has no human resources department and no nurse recruiters,
the unit manager does the hiring and has greater autonomy in personnel matters. Centralized
staffing is more closely associated with increased impartiality, cost-effectiveness, and
availability of data.

TOP: Chapter Number: 17: Title: Table 17.1 Strengths and Limitations of Decentralized
and Centralized Staffing KEY: Integrated Process: Nursing Process
5. It is 2 PM and the nurse-manager is calculating the nursing care hours for the 3 to 11 PM
shift. There are three RNs, three nursing assistants, and one ward clerk scheduled and there
are 22 clients with the following acuity and nursing care hours allotted for the evening shift:
Category I, 4 clients at 2.0 hours
Category II, 2 clients at 2.3 hours
Category III, 10 clients at 2.8 hours
Category IV, 6 clients at 3.4 hours
What are the needed hours of nursing care?
a. 61 hours
b. 52.6 hours
c. 68.4 hours
d. 48.4 hours
ANS: A
Feedback: Four category I clients require 8 hours of care; 2 category II clients require 4.6
hours of care; 10 category III clients require 28 hours; 6 category IV clients require 20.4
hours; total nursing care hours equal 61.
TOP: Chapter Number: 17: Title: Table 17.2 Patient Care Classification Using Four Levels
of Nursing Care Intensity KEY: Integrated Process: Nursing Process
6. What goal should the nurse-manager prioritize when organizing staffing and scheduling?
a. Schedule staff so there is a minimum of overtime.
b. Ensure that there is adequate staff to meet the needs of each client.
c. Develop trust in staff by seeing that staffing is carried out in a fair manner.
d. Ensure that staff members achieve a healthy work-life balance.
ANS: B
Feedback: The manager is tasked with seeing that client care needs are met first and
foremost. Although the other options are relevant and appropriate, they are not the priority
goal of the manager.

TOP: Chapter Number: 17: Title: Fiscal and Ethical Accountability for Staffing
7. A nurse-manager is working with a team of colleagues to update the organization’s staffing

and scheduling policies. What principle should the manager follow during this process?
a. It is more important to communicate policies verbally than in writing.
b. Policies should be written in a way that allows some flexibility.
c. Each employee should be given the right to opt into the type of system that he or
she wishes.
d. Each unit manager should be granted full control over scheduling and staffing.
ANS: B
Feedback: To retain employees, the staffing policies must allow some flexibility, which
could include job sharing, flextime, a part-time staffing pool for weekends, or allowing
employees to exchange hours of work among themselves. Policies must be written, not only
verbal. Having individual employees adopt different systems would result in chaos. Even in
a decentralized system, individual managers do not have absolute autonomy of staffing
issues.

8. A community health unit is transitioning from centralized staffing to decentralized staffing.

The manager should recognize what possible consequence of this change?
a. It carries risks that employees may be treated unequally or inconsistently.
b. One individual or a computer will perform the staffing functions.
c. The manager’s role is that of making minor adjustments or providing input.
d. The change will increase control over personnel by the organization.
ANS: A
Feedback: A manager being perceived as granting special treatment to some employees is a
risk of decentralized staffing. A single individual or department is responsible in a
centralized, not decentralized, system. Similarly, a manager plays a lesser role in a
centralized system and the organization possesses more control.

TOP: Chapter Number: 17: Title: Centralized and Decentralized Staffing
9. A nurse-manager is applying the facility’s patient classification system (PCS) to the unit’s
staffing needs before the beginning of a shift. What task should the manager perform first?
a. Identify the number of staff members scheduled for the shift.
b. Create a preliminary work assignment based on the unit norms.
c. Appraise the care needs of each client.
d. Assign three clients to each nurse and then adjust according to client needs.
ANS: C
Feedback: Regardless of the specifics of a PCS, the starting point is the needs of each client.
Other variables such as the mix and number of staff are accommodated to this priority
consideration. It is simplistic to presume a baseline of three clients per nurse across all care
settings.

10. A health-care organization is changing from a functional nursing model to a team nursing
model. How should the nurse-manager best address the impact on staffing and scheduling?
a. More unlicensed assistive personnel will need to be hired.
b. A self-scheduling system will need to be adopted.
c. No changes in scheduling policies will likely be necessary.
d. The client assignment method will need to be adjusted.
ANS: D
Feedback: As new practice models are introduced, there must be a simultaneous
examination of the existing staff mix and patient care assessments to ensure that appropriate
changes are made to the staffing and scheduling policies. This change does not necessarily
create a need for self-scheduling or more UAPs.

TOP: Chapter Number: 17: Title: Establishing and Maintaining Effective Staffing Policies
11. What term identifies a system that allows employees to select among variations in work
start-time and end-time schedules to meet their personal needs?
a. Self-scheduling
b. Flextime
c. Decentralized staffing
d. Cyclical staffing
ANS: B
Feedback: When a hospital uses flextime, employees arrive at the unit and leave at many
different times. The other options are not associated with the system described.

12. A busy medical unit has been increasing the use of agency nurses. The nurse-manager
should anticipate what consequence of this staffing alternative?
a. Increased reliance on unlicensed assistive personnel by nurses
b. A need for 8-hour rather than 12-hour shifts
c. Short-term cost savings
d. Decreased continuity of nursing care
ANS: D
Feedback: The use of agency nurses can increase costs and decrease continuity of care.
There is no obvious need to change the length of shifts or for nurses to become more reliant
on UAPs with the use of agency nurses.

13. Which statement is true regarding legislated minimum staffing ratios?

a. They are mandated by federal law.
b. They are required by 28 states.
c. They are proposed to improve client care.
d. They are necessary to reduce costs.
ANS: C
Feedback: The intent of mandatory staffing ratios for the purpose of improving patient care,
although there is no guarantee improved care will result from such legislation. Legislation is
at the state, not federal, level. California is the only state that has legislated minimum
staffing ratios. Their focus is quality of care and working conditions, not cost.
TOP: Chapter Number: 17: Title: Should Minimum Registered Nurse to Patient Staffing
Ratios Be Mandated? KEY: Integrated Process: Nursing Process
14. A health-care facility is considering whether to move from 8-hour shifts to 12-hour shifts.
What potential consequences of this change should be considered? Select all that apply.
a. Increased overtime pay
b. Increased nurse satisfaction
c. Decreased cost
d. Increased judgment errors
e. Increased need for continuing education
ANS: A, B, D
Feedback: Twelve-hour shifts have become commonplace in acute care hospitals even
though there continues to be debate about whether extending the length of shifts results in
increased judgment errors related to fatigue. Because extending the workday with 10- or
12-hour shifts may require overtime pay, the resultant nurse satisfaction must be weighed
against the increased costs. There is no notable increase in the need for continuing education
with 12-hour shifts.

15. A health-care organization has achieved a decrease in RN hours in the total nursing care
hours per patient-day (NCH/PPD). What is a potential outcome of this change?
a. Increased interprofessional collaboration
b. Decreased numbers of errors
c. Decreased client fall rate
d. Decreased client satisfaction
ANS: D
Feedback: A review of current literature suggests that as RN hours decrease in NCH/PPD,
adverse patient outcomes generally increase, including increased errors and patient falls as
well as decreased patient satisfaction. There is no evidence that such a change increases
interprofessional collaboration.

TOP: Chapter Number: 17: Title: The Relationship Between Nursing Care Hours, Staffing
Mix, and Quality of Care KEY: Integrated Process: Nursing Process
16. A nurse-manager’s immediate supervisor is a member of the veteran generation. What

generational characteristic is the supervisor most likely to possess?
a. Strong loyalty to the employer
b. A high value on workplace flexibility
c. High individualism
d. Social consciousness
ANS: A
Feedback: The veteran generation is typically recognized as those nurses born between 1925
and 1942. Members of this generation are often noted to possess a high level of loyalty to
employers. Flexibility was valued more by subsequent generations. Individualism is noted
as a particular characteristic of later generations, and social consciousness is associated with
millennials.

TOP: Chapter Number: 17: Title: Generational Considerations for Staffing
17. What was the first generational work group that tended to value work hour flexibility and
opportunities for time off?
a. Veteran generation
b. Baby boomer
c. Generation X
d. Generation Y
ANS: C
Feedback: Generation Xers may lack the interest in lifetime employment at one place that
prior generations have valued, instead valuing greater work hour flexibility and
opportunities for time off.

18. The policies around scheduling and staffing are being amended in a health-care facility.
Managers must ensure that the policies to not violate which of the following? Select all that
apply.
a. Local laws
b. Labor laws
c. State laws
d. Union contracts
e. Federal laws
f. Local norms
ANS: B, C, D, E
Feedback: Staffing and scheduling policies must not violate labor laws, state or national
laws, or union contracts. There is no prohibition against violating local norms and traditions.
There are not normally local laws that address work scheduling.
19. The manager of a hospital unit is frustrated that the centralized staffing department does not
understand the unique staffing needs of the unit. What is the manager’s best action?
a. Advocate for a change to decentralized staffing.
b. Introduce a self-scheduling system.
c. Temporarily increase the use of agency nurses.
d. Increase the use of overtime to meet the unit’s staffing needs.
ANS: A
Feedback: Advantages of decentralized staffing are that the unit manager understands the
needs of the unit and staff intimately, which leads to the increased likelihood that sound
staffing decisions will be made. The increased use of overtime and agency nurses should not
be considered as long-term solutions due to cost. A self-scheduling system is unlikely to
address the fact that the centralized staffing department does not understand the unit’s
needs.

20. The increased use of agency nurses has been proposed by a health-care organization’s
personnel department. What implications of this practice should be considered? Select all
that apply.
a. Increased costs
b. Consequences of unfamiliarity with the unit
c. Liability from the use of unlicensed nurses
d. Decreased continuity of client care
e. Increased need for overtime
ANS: A, B, D
Feedback: The use of agency nurses is expensive and can result in poor continuity of
nursing care. As well, agency nurses are often unfamiliar with the unit, which can
negatively affect care. The use of agency nurses does not directly increase the need for
overtime. Agency nurses are fully licensed.

21. What is a leadership role associated with staffing and scheduling?

a. Role models the use of evidence in making appropriate staffing and scheduling
decisions
b. Uses patient classification tools to minimize understaffing
c. Periodically examines the unit standard of productivity to determine if changes are
needed
d. Evaluates scheduling and staffing procedures and policies on a regular basis
ANS: A
Feedback: Role modeling is classified as a leadership responsibility. The other options are
recognized management responsibilities associated with staffing and scheduling.

Functions Associated With Staffing and Scheduling
22. A centralized staffing department is being created at a health-care facility. What attributes of
this system should the nurse-manager expect? Select all that apply.
a. Increased individual flexibility
b. Improved client care
c. Cost savings
d. Increased consistency in staffing practices
e. Increased impartiality in staffing decisions
ANS: C, D, E
Feedback: Centralized staffing is generally fairer to all employees because policies tend to
be employed more consistently and impartially. Centralized staffing also allows for the most
efficient (cost-effective) use of resources because the more units that can be considered
together, the easier it is to deal with variations in patient census and staffing needs.
Centralized staffing, however, does not provide as much flexibility for the worker, nor can it
account as well for a worker’s desires or special needs. Neither system is noted to have a
direct effect on the quality of care.

23. A hospital unit has an exceptionally high census for several weeks and mandatory overtime
is being routinely required. What is the priority consequence of this practice?
a. Ethics violations
b. Increased continuity of care
c. Temporary cost savings
d. Decreased client safety
ANS: D
Feedback: Frequent use of overtime creates a safety risk because exhausted nurses are much
more likely to commit and error. This practice is costly but does not have a major bearing on
continuity of care. Ethics violations can occur in any staffing situation and are not
necessarily more common when overtime is used.

TOP: Chapter Number: 17: Title: The Impact of Nursing Staff Shortages on Staffing
24. Which statements are true regarding float pool nurses? Select all that apply.
a. They are classified as per diem staff.
b. The nurse trades increased personal flexibility for less pay.
c. Float pool nurses do not receive usual staff benefits.
d. They are crossed-trained on multiple units.
e. They are internal, not external, employees.
ANS: D, E
Feedback: Float pools are generally composed of employees who agree to cross-train on
multiple units so that they can work additional hours during periods of high census or
worker shortages. They are not necessarily hired on a per diem basis and do not receive less
pay. Float nurses receive benefits.

25. A manager is implementing a patient classification system (PCS). Which external and
internal variables should the manager address when implementing the PCS? Select all that
apply.
a. The presence of nursing students on the unit
b. The hiring of two graduates as staff
c. The increase of scheduled medical students
d. Language barriers presented by nursing staff
e. The hospital’s accreditation status
ANS: A, B, C, D
Feedback: Regarding PCS, the middle-level manager must be alert to internal or external
forces affecting unit needs that may not be reflected in the organization’s patient care
classification system. Examples of such forces could be a sudden increase in nursing or
medical students using the unit, a lower skill level of new graduates, or cultural and
language difficulties of recently hired foreign nurses. The hospital’s accreditation status
should not influence the use of the PCS.

26. A nurse manager is in charge of a unit that consists of a generationally diverse group of staff
nurses. The nurse manager knows that this type of staffing arrangement will:
a. require the baby boomer nurses have more flexibility in scheduling and time off as
compared to the generation X nurses.
b. create a nursing environment that will be more structured and focused on the use
of technology to provide the best care.
c. allow generation Y and Z nurses to create a secure and stable work environment.
d. establish a diverse working environment based on experience and technology.
ANS: D
Feedback: Generational diversity allows clients to receive care from both the most
experienced nurses as well as those with the most recent education and likely greater
technology expertise. Managers must be alert to how generational diversity may impact
staffing needs. Up to five generations of nurses are now working together. In previous years,
earlier retirement from nursing and shorter life spans kept the workforce typically to three
generations. Some researchers suggest that the different generations represented in nursing
today have different value systems that may impact staffing. For example, most experts now
identify five generational groups in today’s workforce: the veteran generation (also called
the silent generation or the traditionalist), the baby boomers, generation X, generation Y
(also called the millennials), and generation Z.

27. Mandatory minimum staffing ratios are being considered in the jurisdiction where a
nurse-manager works. Based on experiences of other states, the nurse should identify what
possible result of this legislation?
a. There may be a backlash from clients and families.
b. Predicted cost savings may take many years to realize.
c. Health-care organizations may be more reluctant to hire new graduates.
d. Increased numbers of staff may not necessarily improve client care.
ANS: D
Feedback: Critics of mandatory staffing ratios identify the fact that increased numbers of
staff do not necessarily translate into improved care. Legislation of this type tends to be
supported by clients and families and it is recognized that this increases staffing costs.
Mandatory staffing ratios have not been noted to reduce new graduates’ employment
opportunities.

TOP: Chapter Number: 17: Title: Should Minimum Registered Nurse to Patient Staffing
Ratios Be Mandated? KEY: Integrated Process: Nursing Process
28. A flextime system has been introduced at a health-care facility. The nurse-manager should
take what action to address the consequences of this staffing system?
a. Limiting flextime to those staff members who have at least 2 years experience on
the unit
b. Ensuring that overtime can be used to fill times when there is insufficient staffing
c. Providing incentives to ensure daytime weekday shifts are sufficiently staffed
d. Working to promote continuity of care when there are multiple start times and end
times for staff
ANS: D
Feedback: Flextime entails staff having their shifts begin and end at varied times. This can
affect continuity of care if the manager does not take action. It would be unfair to limit the
benefits of flextime to only those nurses who have multiple years of experience. Overtime
should be used as an action of last resort, not a structured approach to meeting staffing
needs. In most cases, weekday shifts are easier to fill than night shifts, holidays, and
weekends.

29. A nurse-manager is in charge of a unit that has a large proportion of recent graduates, most
of whom are members of Generation Y (millennials). The manager should anticipate that
many of these nurses will have what characteristics? Select all that apply.
a. Technologically savvy
b. Adept at teamwork
c. Loyal to a single, long-term employer
d. Comfortable with multiculturalism
e. Committed to environmental issues
ANS: A, B, D, E
Feedback: Millennials tend to be technologically savvy, eco-aware, comfortable with
multiculturalism, and skilled at working in teams. Long-term loyalty to a single employer is
more closely associated with the veteran generation, which changes jobs much less
frequently.

30. A nurse-manager works on a unit that has a decentralized self-scheduling system. When
managing with this scheduling option, the manager should:
a. oversee the system carefully to ensure sufficient staff coverage at all times.
b. avoid becoming involved with the system so that staff remain autonomous.
c. advocate for the most senior staff to receive the most desirable shifts.
d. refer any disputes to the organization’s personnel department.
ANS: A
Feedback: Although self-scheduling offers nurses greater control over their work
environment, it is not easy to implement. Success depends on the leadership skills of the
manager to support the staff and demonstrate patience and perseverance throughout the
implementation. The manager cannot afford to take a fully hands-off approach. It is more
likely that junior staff would need advocacy than senior staff. Because the organization’s
staffing is decentralized, it would not likely be possible for the nurse-manager to refer
disputes to a personnel department.

Chapter 18: Creating a Motivating Climate
1. A nurse-manager oversees approximately 12 employees. What strategy should the manager

prioritize when trying to motivate the employees?
a. Offer praise for exceptional performance.
b. Advocate for an increase in pay.
c. Apply motivational strategies that are personally meaningful to each employee.
d. Apply punishments objectively and fairly.
ANS: C
Feedback: Each person is a unique individual who is motivated by different things. The
comparatively small size of the staff allows the manager to determine and apply motivation
strategies that meet each employee’s needs. There is no guarantee that salary, praise, and
punishment will motivate every employee.

TOP: Chapter Number: 18: Title: Strategies for Creating a Motivating Climate
2. What did motivational theorist Victor Vroom state?

a. Personal motivators could be separated from job satisfiers.
b. People are motivated by three basic needs: achievement, affiliation, and power.
c. A manager’s assumptions about workers directly affect the intrinsic motivation of
the workers.
d. Employees’ expectations about their work environment or an event will affect their
behavior.
ANS: D
Feedback: Vroom’s expectancy model says that a person’s expectations about his or her
environment or a certain event will influence behavior. The other listed statements about
motivation are attributable to other theorists.

TOP: Chapter Number: 18: Title: Vroom KEY: Integrated Process: Nursing Process
3. A nurse-manager is applying Herzberg’s motivation–hygiene theory. What strategy would

the manager most likely use to motivate employees?
a. Advocating for an increase in salary
b. Approving vacation requests
c. Protecting employee’s job security
d. Praising an employee’s exceptional achievement
ANS: D
Feedback: Herzberg maintained that factors such as pay, working conditions, and job
security were maintenance factors that prevent dissatisfaction but which do not actually
motivate. He claimed that recognition and achievement, however, were motivators.
TOP: Chapter Number: 18: Title: Table 18.2 Herzberg's Motivators and Hygiene Factors
4. Which factor is most likely to provide intrinsic motivation to an employee?

a. The employee’s ambitious career aspirations
b. The employee’s need to elicit approval from the immediate supervisor
c. The employee’s need to avoid punishment for unsafe practice
d. The employee’s fear of being passed up for a promotion
ANS: A
Feedback: Intrinsic motivation comes from within the individual. An example is an
employee’s career aspirations. An employee’s desire for rewards or desire to avoid
punishment is an example of extrinsic rewards.

TOP: Chapter Number: 18: Title: Intrinsic Versus Extrinsic Motivation
5. According to McClelland, what motivates an achievement-oriented employee?

a. The extrinsic rewards to be acquired
b. A need to nurture others
c. A need to have legitimate power over others
d. The intrinsic need to be successful
ANS: D
Feedback: McClelland stated that achievement-oriented people will focus on improving
(succeeding) through action rather than seeking extrinsic rewards. Affiliation-oriented
people focus on relationships and nurturing others. Power-oriented people are motivated by
influence over others.

TOP: Chapter Number: 18: Title: McClelland
6. A nurse-manager who is operating from the position of McGregor’s Theory X will most
likely hold what assumption about employees?
a. Putting forth effort comes naturally for employees.
b. Workers are inherently diligent, responsible, and helpful.
c. Workers are fundamentally uncreative and indifferent toward their work.
d. It is impossible to accurately identify what motivates an employee.
ANS: C
Feedback: McGregor’s Theory X posits that workers are lazy, uncreative, and indifferent.
Theory Y emphasizes the natural altruism and motivation of workers. McGregor did not
explicitly state that it was impossible to know an employee’s motivations.

TOP: Chapter Number: 18: Title: Table 18.3 McGregor's Theory X and Theory Y
Assumptions KEY: Integrated Process: Nursing Process
7. According to Maslow, what statement best describes motivation?

a. All needs have equal power in motivation.
b. Unsatisfied needs trigger behavior.
c. Lower level needs are less valued.
d. Some individuals have hereditary needs.
ANS: B
Feedback: Hierarchy of need implies that people are motivated to satisfy certain needs,
ranging from basic survival to complex psychological needs, and people seek a higher need
only when the lower needs have been predominantly met. Needs exist within a hierarchy,
and lower level needs are prioritized over higher level needs.

TOP: Chapter Number: 18: Title: Maslow
8. What did Victor Vroom emphasize the importance of?

a. Managers knowing each employee’s expectation of reward
b. Managers being honest with their employees
c. Making sure that the employees’ lower level needs are met
d. Understanding that individuals react in a stimulus–response mode
ANS: A
Feedback: Victor Vroom emphasized the importance of managers knowing each employee’s
expectation of reward. The other options are not related to Vroom’s theory.

TOP: Chapter Number: 18: Title: Vroom KEY: Integrated Process: Nursing Process
9. A nurse-manager is applying the theory of Saul Gellerman to motivating employees. What

action by the manager would best exemplify Gellerman’s theory?
a. Determining whether employees are achievement-oriented, affiliation-oriented, or
power-oriented
b. Allowing employees to be self-directed in their choice of tasks and schedules
c. Providing constructive and positive feedback on a regular basis
d. Occasionally assigning employees tasks that are more difficult than usual
ANS: D
Feedback: Gellerman suggested stretching, which involves assigning tasks that are more
difficult than what the person is used to doing. Determining whether employees are
achievement-oriented, affiliation-oriented, or power-oriented is associated with McClelland.
Gellerman did not explicitly advocate feedback or self-direction.

TOP: Chapter Number: 18: Title: Gellerman
10. The nurse-manager can apply Skinner’s theory of motivation by performing what action?
a. Assigning employees outcomes and having them decide how to achieve them
b. Distributing rewards and punishments to influence behavior
c. Forming individualized, collaborative relationships with employees
d. Prioritize the role of financial rewards and incentives
ANS: B
Feedback: Skinner emphasized the role of rewards and punishment as conditioning
individuals’ behavior. Skinner did not emphasize a specific role for financial rewards or the
importance of relationships. He did not state that employees should decide independently
how to achieve outcomes.

TOP: Chapter Number: 18: Title: Skinner
11. For several months, a nurse-manager has been rewarding employees’ performance in an
effort to motivate them. The nurse-manager should be aware of what unintended
consequence of this practice?
a. Employees may set unrealistically high goals for themselves.
b. Unhealthy competition may develop between coworkers.
c. Employees’ intrinsic motivation may become blunted.
d. Employees may expect a corresponding increase in salary.
ANS: C
Feedback: The tendency of extrinsic motivation to interfere with intrinsic motivation is
known as the overjustification effect. This involves a decrease in intrinsically motivated
behaviors after the behavior is extrinsically rewarded and the reinforcement is subsequently
discontinued. Distribution of rewards is not noted to cause unrealistically high goals,
unhealthy competition, or an expectation for higher salaries.

TOP: Chapter Number: 18: Title: Incentives and Rewards
12. Which statement is typically true of job satisfaction levels?

a. They are generally higher for subordinates than for management staff.
b. They decline as the level of participation in unit decision making increases.
c. They are related to the degree of work life control subordinates perceive they have.
d. They are fairly static given that unit cultures are traditionally very difficult to
change.
ANS: C
Feedback: Job satisfaction levels can be correlated with the degree of control subordinates
perceive they have over their work life. It is untrue that subordinates enjoy greater job
satisfaction. Participation in decision making increases job satisfaction. Job satisfaction is
highly dynamic, depending on several factors.

Functions in Creating a Motivating Climate at Work KEY: Integrated
13. Which course of action would be most apt to help a demotivated nurse-manager with
personal and professional renewal?
a. Begin job hunting in a new field.
b. Start practicing self-care.
c. Take a management class.
d. Reduce work hours whenever possible.
ANS: B
Feedback: For self-care, the manager should seek time off on a regular basis to meet
personal needs, have recreation, form relationships outside the work setting, and have fun.
Friends and colleagues are essential for emotional support, guidance, and renewal. A proper
diet and exercise are important to maintain physical as well as emotional health. The
remaining options are not practical and lack the focus on self.

TOP: Chapter Number: 18: Title: Self-Care
14. Which activity demonstrates employee engagement?

a. Employee participates in hospital fundraiser.
b. Employee accepts position as charge nurse.
c. Employee completes annual performance review.
d. Employee arrives to work on time.
ANS: A
Feedback: The term used to describe an employee’s emotional commitment to the
organization and its goals is employee engagement. Engagement occurs when workers are
involved in, enthusiastic about, and committed to their work and workplace. Similarly,
Mizne (2018) defines employee engagement as proactively and passionately adding value
while aligning with the company mission and operational goals.

TOP: Chapter Number: 18: Title: Worker Engagement
15. Which of the following statements best describes an aspect of intrinsic motivation?
a. It is within a person and is unalterable.
b. It involves a quest for external rewards.
c. It can be influenced by others.
d. It is sufficient to motivate most workers.
ANS: C
Feedback: Intrinsic motivation comes from within the person, driving him or her to be
productive such as personal goals and aspirations. Despite the fact that it comes from within,
it can be influenced by others and is changeable. It is rarely sufficient to fully motivate a
worker.

16. A nurse-manager wants to express appreciation to an employee. What statement is most

effective?
a. “You’re doing an excellent job of provided care for you clients.”
b. “I really admire everything that you do on the unit.”
c. “You did an exemplary job of handling a very heavy workload this shift.”
d. “Your performance demonstrates a strong commitment to the profession.”
ANS: C
Feedback: Praise that is specific and evidence-based is generally more effective than broad,
general statements about an employee’s performance.

17. McClelland’s studies state that all people are motivated by specific, basic needs. What are
these needs? Select all that apply.
a. Self-esteem
b. Self-actualization
c. Achievement
d. Power
e. Affiliation
ANS: C, D, E
Feedback: McClelland’s studies state that all people are motivated by three basic needs:
achievement, affiliation, and power. McClelland does not include self-esteem and
self-actualization as needs associated with motivation.

TOP: Chapter Number: 18: Title: McClelland
18. A nurse-manager can best implement Gellerman’s theory of motivation by performing what
action?
a. Distributing praise and rewards equitably to all employees
b. Establishing authentic relationships with employees
c. Being transparent and accountable when administering punishments
d. Empowering employees by giving them authority to make decisions
ANS: D
Feedback: Gellerman states that most managers in organizations overmanage, making the
responsibilities too narrow and failing to give employees any decision-making power or to
stretch them often enough. Gellerman did not emphasize the importance of distributing
praise and rewards equitably, being open when punishing employees, and cultivating
relationships with employees.

TOP: Chapter Number: 18: Title: Gellerman
19. The nurse-manager recognizes the need to avoid burnout and maintain a high motivation
level. The manager can best achieve this by:
a. working on as large a variety of projects as possible.
b. asking supervisors to keep him or her closely accountable for work performance.
c. asking subordinates and superiors to provide positive reinforcement whenever
possible.
d. reflecting on his or her own needs and seeking help when necessary.
ANS: D
Feedback: It is imperative that discouraged managers acknowledge their own feelings and
seek assistance accordingly. A manager can easily become burnt out when working on a
large variety of projects. It is inappropriate to overtly ask for positive reinforcement,
whether from superiors or from subordinates. Accountability can enhance performance but
does not prevent burnout.
TOP: Chapter Number: 18: Title: Self-Care
20. What is one of the most powerful yet frequently overlooked or underused motivators that
the manager can use to create a motivating climate?
a. Continuing education
b. Fair and objective punishments
c. Positive reinforcement
d. Adequate self-care
ANS: C
Feedback: Positive reinforcement is one of the most powerful motivators the manager can
use and is frequently overlooked or underused. Continuing education is necessary but is not
identified as a motivator. Punishments are necessary in certain circumstances but are not
considered a standard motivation technique. Adequate self-care preserves health and
productivity but does not independently provide motivation.

TOP: Chapter Number: 18: Title: Positive Reinforcement
21. When attempting to create a work environment that includes appropriate and effective
monetary incentives, the nurse-manager will initially address which issue?
a. Whether incentives are traditionally used in the institution
b. Whether the budget will allow for monetary rewards large enough to create
incentive
c. Whether the staff views monetary incentives as having the greatest value
d. Whether other nurse-managers feel that monetary incentives are appropriate
ANS: C
Feedback: Organizations must be cognizant of the need to offer incentives at a level where
employees value them. This requires that the organization and its managers understand
employees’ collective values and devise a reward system that is consistent with that value
system. Although the other options represent reasonable areas to explore, they are not the
initial issue to be addressed because they would all be moot if employees did not value
monetary incentives.

22. Which is the basic factor involving staff engagement and motivation, and its relationship
with the achievement of unit-oriented goals?
a. The autonomy the staff has to achieve the stated goals
b. The input the staff has in establishing the unit goals
c. The value the staff places on the stated unit goals
d. The relationship staff has with their management
ANS: D
Feedback: The interpersonal relationship between an employee and his or her supervisor is
critical to the employee’s motivation level. We often forget that the only way to achieve our
goals is through the people who work with us. Although the other options reflect factors that
may impact goal achievement, they are not considered the basic factor.

TOP: Chapter Number: 18: Title: The Relationship Between the Employee and His or Her
Supervisor KEY: Integrated Process: Nursing Process
23. Which attribute plays a factor in intrinsic motivation?

a. Gender
b. Benefit
c. Culture
d. Salary
ANS: C
Feedback: Parents and peers often play major roles in shaping a person’s values about what
he or she wants to do and be, and cultural background also has an impact on intrinsic
motivation because some cultures value career mobility, job success, and recognition more
than others. Benefits and salary are considered extrinsic motivation when individuals are
motivated to perform a behavior or engage in an activity to earn a reward or avoid
punishment.

24. Which characteristics define the Theory Y employee? Select all that apply.
a. Needs only general supervision
b. Avoids responsibility
c. Has little ambition
d. Must be directed
e. Seeks responsibility
ANS: A, E
Feedback: These assumptions, which McGregor labeled Theory X and Theory Y, led to the
realization in management science that how the manager views, and thus treats, the worker
will have an impact on how well the organization functions. Theory X and Theory Y focus
on the employee’s attitudes about people and are described as two opposite attitudes that a
manager can possess.

25. Which reward is an example of intrinsic motivation?

a. The prized locker is awarded to the staff member voted “most helpful” by their
peers.
b. An extra vacation day is awarded for every 6 months a staff member has perfect
attendance.
c. The entire staff is treated to a pizza party each time the unit earns a client
satisfaction award.
d. A staff member is eager to obtain an advanced practice credential and is working
toward this end.
ANS: D
Feedback: Intrinsic motivation comes from within the individual. It is driven by a need to
improve and be more productive. Extrinsic motivation is motivation enhanced by the job
environment or external rewards. Rewards and reinforcements are given to encourage
certain behaviors and/or levels of achievement. The remaining options are examples of
extrinsic motivations.

26. A nurse-manager recognizes the need to foster creativity among employees. What action
will best promote creativity?
a. Encourage regular turnover of employees.
b. Hire young employees whenever possible.
c. Demote employees who show a lack of creativity.
d. Avoid micromanaging employees’ behaviors.
ANS: D
Feedback: Micromanaging is known to stifle creativity. In order to be creative, employees
must have a degree of freedom over their actions. Young employees are not necessarily
more creative than older employees, and frequent staffing turnover does not guarantee
creativity. Punitive actions are unlikely to promote the sense of exploration and freedom that
results in creativity.

TOP: Chapter Number: 18: Title: Worker Empowerment
27. What characteristic of a workplace is most likely to result in creativity and risk taking?
a. There are frequent changes in management and supervision.
b. There is a high proportion of recent nursing graduates.
c. Employees have frequent performance appraisals with the manager.
d. The employees feel empowered to advocate for change.
ANS: D
Feedback: In order to be creative and take risks, employees need to feel sufficiently
empowered to challenge the status quo. Instability in leadership and management does not
promote creativity and risk taking, and new graduates are less likely to be creative risk
takers than nurses who have more experience. Frequent performance appraisals are an
important part of good management, but these do not lead directly to creativity and risk
taking.

TOP: Chapter Number: 18: Title: Worker Empowerment
28. A nurse-manager has been distributing rewards to employees but has not identified a
resulting increase in motivation. What characteristic of the manager’s rewards may have
limited their effect on motivation?
a. The manager did not clearly communicate the intent of the rewards.
b. The manager has not been distributing the rewards consistently.
c. There is no precedent of giving rewards in the organization.
d. The manager’s supervisor does not acknowledge the benefits of rewards.
ANS: B
Feedback: Inconsistent distribution of rewards can frustrate and confuse workers, resulting
in decreased motivation. The manager does not have to be explicit about the intent of
rewards in order for them to motivate. Inexperience and unfamiliarity with rewards would
not necessarily limit their benefits, if applied correctly.

29. A nurse-manager is in a new position and has observed that many of the employees appear
to be unmotivated. The manager can promote employees’ motivation by:
a. establishing trusting and respectful relationships with the employees.
b. making expectations for motivation clearly known.
c. assigning preceptors to each of the unmotivated employees.
d. increasing recruitment efforts to add new employees to the unit.
ANS: A
Feedback: Collaborative and supportive relationships between managers and employees are
essential to creating an environment that promotes motivation. Motivation cannot be
demanded, and preceptors are not normally assigned to existing employees. Adding new
staff members will not necessarily increase motivation.

30. The nurse manager believes that her employees are self-motivated, creative, and willing to
take responsibility for their jobs. This belief represents:
a. Maslow’s hierarchy of needs.
b. McGregor’s Theory X.
c. McGregor’s Theory Y.
d. Herzberg’s two-factor theory.
ANS: C
Feedback: These assumptions, which McGregor labeled Theory X and Theory Y, led to the
realization in management science that how the manager views, and thus treats, the worker
will have an impact on how well the organization functions. Theory X and Theory Y focus
on the employee’s attitudes about people and are described as two opposite attitudes that a
manager can possess.

Chapter 19: Organizational, Interpersonal, and Group Communication
1. A nurse-manager is communicating with a subordinate. What component of this

communication would be considered as part of the external climate?
a. The clarity of the message
b. The subordinate’s personality
c. The culture of the organization
d. The manager’s stress level
ANS: C
Feedback: The organizational climate and culture would be considered part of the external
climate of this communication. The sender’s and receiver’s personality and stress levels are
components of the internal climate. The clarity of a message is not a component of the
external climate.

TOP: Chapter Number: 19: Title: The Communication Process
2. What strategy best increases the likelihood that a nurse-manager’s communication will be
accurately interpreted?
a. Using more than one mode of communication
b. Using face-to-face communication
c. Producing clear, simple, written communication
d. Repeating the message as often as possible
ANS: A
Feedback: Using various communication methods in combination increases the likelihood
that everyone in the organization who needs to hear the message actually will hear it. The
other options are single methods. Repeating a message is often not as effective as
communicating it in a different way using a different mode.

TOP: Chapter Number: 19: Title: Organizational Communication Strategies
3. Which principle should guide the nurse-manager’s use of nonverbal communication?

a. It is generally consistent across cultures, unlike verbal communication.
b. It supersedes verbal communication when the two are incongruent.
c. Nonverbal communication should be minimized because it confuses the receiver
regarding the true intent of the message.
d. Nonverbal communication is a significant part of the communication exchange
only when it is not congruent with the verbal exchange.
ANS: B
Feedback: Because nonverbal communication indicates the emotional component of the
message, it is generally considered more reliable than verbal communication. It varies
widely between cultures, and the manager does not normally have to make a conscious
effort to minimize it. It is always significant regardless of how it aligns with the verbal
message.

TOP: Chapter Number: 19: Title: Elements of Nonverbal Communication
4. An RN is a team leader for a small module of clients. While listening to a recorded report on
a client, one of the team members remarks, “My mother lives near him, and she says his
home life is in chaos.” How should the RN best respond?
a. Politely ask the team member to be quiet.
b. Include the information in report for the next shift.
c. Ask the team member how this information relates to the client’s care.
d. Ignore the team member’s comment.
ANS: C
Feedback: The role of the leader is to encourage communication that is appropriate and
discourage communication that is inappropriate among staff. The RN’s question about the
purpose of this communication helps to determine whether it was appropriate or not. This
should be clarified before deciding how to proceed.

Functions Associated With Organizational, Interpersonal, and Group Communication
5. A hospital is downsizing, but the RNs have been assured that everyone on the unit will keep
their jobs and that downsizing will occur through normal attrition. Today, the evening
charge nurse reported to the manager that the staff was discussing rumors about mass
layoffs. What is the best approach to take?
a. Tell an informal leader the truth and let the leader spread the news informally.
b. Hold a meeting for all staff members and tell them that the rumor is not true.
c. Ignore the rumor because it will soon pass.
d. Find out who started the rumor and correct the information.
ANS: B
Feedback: Nurse-leaders should intervene appropriately when communication problems (in
this case, rumors) arise. It is not particularly important who started the rumor if all staff
members are now privy to it. Direct action is preferred to indirect action, such as
introducing a competing message. Inaction would likely fuel the rumors.

TOP: Chapter Number: 19: Title: Integrating Leadership and Management in
Organizational, Interpersonal, and Group Communication in Team Building
6. A nurse-manager has recently established a “best practice committee” at the clinic. Which
behavior by the committee members suggests that it is in the “storming” stage?
a. Members attempt to impress each other with their credentials.
b. The short- and long-term goals for the group are agreed upon.
c. Group members achieve their stated goals.
d. The members receive their instructions and mandate from the manager.
ANS: A
Feedback: Competition and posturing characterize the storming stage. Agreeing on goals
occurs during norming, and these are accomplished during the performing stage. Initial
instructions are given during the forming stage.

TOP: Chapter Number: 19: Title: Group Communication
7. A nurse-manager has a reputation as being an assertive communicator. How does this

manager most likely communicate?
a. Through confrontation and intimidation
b. In an unfeminine way that is clear and direct
c. Directly and honestly, while respecting the rights of others
d. In a clear, but occasionally offensive, manner
ANS: C
Feedback: Assertive communication allows people to express themselves in direct, honest,
and appropriate ways that do not infringe on another’s rights. It is a myth that assertiveness
is “unfeminine,” offensive, or confrontational.

TOP: Chapter Number: 19: Title: Verbal Communication Skills
8. A nurse-manager is orienting a new graduate nurse to the unit and has found this
individual’s charting regarding assessment to be inadequate. What is the most appropriate
statement to initiate a discussion with the new RN?
a. “I’m concerned that your assessment charting seems to be unclear. Can I help you
with this?”
b. “Unfortunately, your charting is inadequate in every way.”
c. “Do you think a refresher course in charting would help you?”
d. “Are you having difficulty assessing your client?”
ANS: A
Feedback: Assertive communication is not rude or insensitive, nor is it passive–aggressive.
Backing up the communication to focus on the RN’s intention is respectful and
solution-oriented. The manager should not presume that the nurse is having difficulty with
assessment unless there is evidence of this. The manager should avoid accusatory
descriptors such as “inadequate in every way.” Suggesting remediation would likely be
premature before trying to work collaboratively with the nurse.

9. The RN overhears the nurses’ aide speaking in a harsh tone to a client with early
Alzheimer’s memory loss. Which statement should the RN make to begin addressing this
issue?
a. “You must remember to watch your tone of voice with clients. Someone might
overhear.”
b. “Do you think it would be a good idea to have an in-service on dealing with
Alzheimer’s patients?”
c. “I am concerned about your conversation with the client. It sounded short and
impatient.”
d. “I have decided to reassign that client to another aide.”
ANS: C
Feedback: Assertive communication effectively identifies and addresses an issue without
being rude, insensitive, or passive–aggressive. None of the remaining options actually
identifies the specific communication problem.

10. A new nurse-manager has been warned by colleagues about the prevalence of “the
grapevine in the organization’s communication.” What is the manager’s best initial response
to this phenomenon?
a. Seek to understand the patterns and contributors of this pattern of communication.
b. Inform subordinates about the harmful effects of grapevine communication and
that it will not be tolerated.
c. Instruct subordinates to use formal patterns of communication rather than informal
patterns.
d. Use grapevine communication to disseminate messages that are accurate and
respectful.
ANS: A
Feedback: Given the frequency of grapevine communication in all organizations, all
managers must attempt to better understand how the grapevine works in their own
organization as well as who is contributing to it. It cannot normally be dictated into
nonexistence, and the manager should avoid using this form of informal communication
because messages can be easily distorted.

TOP: Chapter Number: 19: Title: Channels of Communication
11. A nurse-manager is drafting a memo that will be distributed within the organization. When
using this form of communication, the manager should:
a. send it to everyone in the organization to ensure equal access to information.
b. begin with at least one page of background information to ensure clarity.
c. avoid using headings so the reader is not confused.
d. include only essential information.
ANS: D
Feedback: Only essential information is included in a memo because extraneous information
will detract from the message. Headers should be used to make the memo easier to read, and
it should only be sent to a small to moderate number of people. Brevity is valued, so one
page of background information would be excessive.

TOP: Chapter Number: 19: Title: Written Communication Within the Organization
12. The nurse-manager is sitting on a practice committee and has adopted the role of gatekeeper.
What action should the manager perform in this role?
a. Acknowledge and praise each member’s contributions.
b. Mediate, harmonize, and resolve conflict when it arises.
c. Facilitate and promote participation by all group members.
d. Record the group’s process and provide feedback to the group.
ANS: C
Feedback: The gatekeeper makes sure all voices in the group are heard in order to facilitate
and promote open communication. Acknowledging and praising each member’s
contributions is the role of the encourager. The recorder records the group’s process and
provides feedback to the group. The harmonizer mediates, harmonizes, and resolves
conflict.

TOP: Chapter Number: 19: Title: Group Building and Maintenance Roles
13. What statement about the maintenance of confidentiality is true?
a. It is the right of every client and must never be breached.
b. It is made easier with electronic technology.
c. It is primarily the duty of the medical records staff.
d. It can be violated when there is a legitimate professional need.
ANS: D
Feedback: Confidentiality is a right that must be upheld, unless there is a legitimate
professional need to know, such as when a provider must share information about a client
with another provider so that the other provider can assume care. New technologies pose
new threats to confidentiality, and every health-care provider shares responsibility for it.

TOP: Chapter Number: 19: Title: Communication, Confidentiality, and Health Insurance
Portability and Accountability Act
14. What principle should guide the nurse-manager’s understanding of gender differences in
communication?
a. Research has disproven any gender-based differences in communication that were
thought to exist.
b. Gender is the variable that has the greatest effect on an individual’s
communication style.
c. Men and women communicate and use language differently.
d. In contrast with stereotypes, women have been shown to be more competitive
communicators.
ANS: C
Feedback: Gender is a significant factor in organizational communication, as men and
women communicate and use language differently. Women are generally perceived as being
more relationship-oriented than men, but this is not always the case. Gender is significant
but is not seen as the most significant variable in communication.

TOP: Chapter Number: 19: Title: Variables Affecting Organizational Communication
15. The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease
and who is experiencing a new onset of dyspnea. When contacting the client’s care provider,
the nurse should state the client’s admitting diagnosis in what stage of the SBAR tool?
a. S
b. B
c. A
d. R
ANS: B
Feedback: The “B” in the SBAR tool denotes “background.” This is the stage of the tool
where the nurse communicates the clinical context, including the client’s diagnosis.

TOP: Chapter Number: 19: Title: Table 19.3 SBAR as a Communication Tool
16. What is the best example of downward communication by a nurse-manager?

a. The manager reports a nurse’s serious error to the chief nursing officer.
b. The manager seeks advice from a colleague about how to deal with an employee
who is chronically late.
c. The manager contacts a client’s physician to confirm the client’s scheduled
transfer.
d. The manager reviews the results of a nurse’s performance appraisal with the nurse.
ANS: D
Feedback: In downward communication, the manager relays information to subordinates.
Reporting to the chief nursing officer would be upward communication; communication
with a fellow manager would be horizontal. Communication with a physician would be
diagonal.

TOP: Chapter Number: 19: Title: Channels of Communication
17. The nurse-manager is using the GRRRR model of listening when interacting with a
colleague who exhibits challenging behaviors. What is the final action that the manager
should implement when using this model?
a. Confirm an action plan.
b. Request any necessary information from the colleague.
c. Thank the colleague for the collaborative conversation.
d. Reflect privately on the quality of the interaction.
ANS: C
Feedback: The final phase of the GRRRR model of listening involves reward, when both
parties reward each other by recognizing and thanking each other for a collaborative
exchange. The model does not explicitly prescribe a time of reflection. Confirming an action
plan and requesting information take place in earlier phases of the model.

TOP: Chapter Number: 19: Title: Table 19.4 GRRRR (Boynton, 2009) as a Listening Tool
18. A nurse-manager is having a difficult conversation with a subordinate whose performance
has long been inadequate. The emotional component of the manager’s message will be most
clearly conveyed by:
a. the formality or informality of the words the manager chooses.
b. the pace and pitch of the manager’s speech.
c. facial expressions, body movements, and gestures.
d. the amount of time that the manager lets the employee speaks before interrupting.
ANS: C
Feedback: Nonverbal communication is considered more reliable because it conveys the
emotional part of the message. The other variables are not as significant communicators of
emotion.

TOP: Chapter Number: 19: Title: Communication Modes
19. Feedback from a nurse-manager’s peers suggests that the manager’s face-to-face
communication is often ineffective. The manager should consider what potential cause of
this problem?
a. Incongruence between the manager’s verbal and nonverbal messages
b. Ineffective listening skills on the part of subordinates and colleagues
c. Inadequate formal training on communication skills
d. Career stagnation by the nurse-manager
ANS: A
Feedback: The incongruence between verbal and nonverbal messages is the most significant
barrier to effective interpersonal communication. Ineffective listening skills on the part of
the receivers may contribute to a perception of poor communication by the manager, but this
would be unlikely to be the case among many different individuals. Many people never
receive formal training on communication, but this does not necessarily inhibit them from
becoming reasonably skilled communicators. Career stagnation would be a problem, but it
would be less likely to affect overall communication skills.

20. The nurse-manager has consulted the hospital information system to address a clinical issue.
What characteristic is the hospital information system most likely to have?
a. It is likely based on a social media platform.
b. It is probably not freely available from the Internet.
c. There is a high likelihood that it is out of date.
d. It is probably accessible only from desktop computers, not wireless devices.
ANS: B
Feedback: For security and confidentiality purposes, hospital information systems are
typically not available to all on the Internet. However, they have the advantage of being easy
to update and are more likely to be up to date than paper-based equivalents. These systems
would not be hosted on a social media platform due to security risks. They can often be
accessed wirelessly, provided the user has access to the secure network.

TOP: Chapter Number: 19: Title: Hospital Information Systems and Intranets
21. How can the Internet be best used as a means of improving one’s personal nursing practice?
a. Accessing the latest research and best practice information
b. Communicating with other health-care team members
c. Minimizing the need for paper documentation
d. Securing client information for confidentially
ANS: A
Feedback: As an information source, the Internet allows nurses to access the latest research
and best practice information so that their care can be evidence-based. It is not a secure form
of communication in many cases. Electronic health records (not the Internet) replace paper
records. It is not secure, so the Internet is not used as a confidential repository of client
information.

TOP: Chapter Number: 19: Title: The Internet
22. A member of a work group that the nurse-manager leads is aloof and dismissive of the
group’s role. The member has occasionally made jokes during serious discussions and
seems skeptical that the group will meet its goals. What role is this member playing?
a. Blocker
b. Playboy
c. Dominator
d. Recognition seeker
ANS: B
Feedback: The playboy remains uninvolved and demonstrates cynicism, nonchalance, or
horseplay. The blocker persists in expressing negative points of view and resurrecting dead
issues. The dominator attempts to control and manipulate the group, whereas the recognition
seeker works to focus positive attention on himself or herself.

TOP: Chapter Number: 19: Title: Individual Roles of Group Members
23. Which nursing action demonstrates compliance with the American Nurses Association
(ANA) principles for social networking by nurses?
a. Strictly avoiding the use of social networking in a professional setting
b. Participating in the development of institutional policies governing online conduct
c. Ignoring any information that appears to have the potential to harm a patient’s
welfare
d. Realizing that social networking is not related to a nurse’s professional boundaries
ANS: B
Feedback: The ANA has developed principles for social networking that include
participation in policy development, nurse–patient boundaries, separating personal and
professional online information, and reporting to authorities when patient welfare has been
potentially harmed. There is not an absolute prohibition against the use of social media in a
professional setting, but it must adhere to strict guidelines.

TOP: Chapter Number: 19: Title: Social Media and Organizational Communication
24. Which vocal delivery suggests to a listener that a person is asking a question rather than
making a statement?
a. Loudness
b. Frequent pauses
c. Tentativeness
d. Rapid delivery
ANS: C
Feedback: Vocal clues such as tone, volume, and inflection add to the message being
transmitted. Tentative statements sound more like questions than statements, leading
listeners to think that you are unsure of yourself, and speaking quickly may be interpreted as
being nervous. Loud and frequent pauses can be barriers to communication but do not
suggest questioning.

TOP: Chapter Number: 19: Title: Vocal Expression
25. A nurse sits at the foot of a patient’s bed during an admission interview. This positioning
supports the proxemics concept of which psychological comfort zone?
a. Intimate relationships
b. Personal interactions
c. Social exchange
d. Public distance
ANS: C
Feedback: The study of how space and territory affect communication is called proxemics.
In the United States, between 6 and 18 inches of space is typically considered appropriate
only for intimate relationships, between 18 inches and 4 feet is appropriate for personal
interactions, between 4 and 12 feet is common for social exchanges, and more than 12 feet
is a public distance. Most Americans claim a territorial personal space of about 4 feet.

TOP: Chapter Number: 19: Title: Space
26. Electronic health records (EHRs) have recently been introduced in a health-care
organization, and the steering committee is ensuring that the system meets the criteria for
meaningful use. This characteristic of the EHR ensures that the system:
a. is readily accessible in any care setting, nationwide.
b. uses language that is accessible to and understandable by clients.
c. contains data that has the potential to improve client outcomes.
d. means the same thing to every user.
ANS: C
Feedback: EHRs must meet meaningful use requirements, which involve capturing the right
data that can improve client outcomes. This characteristic of EHRs does not specify their
accessibility or require that they mean the same thing to all users.

TOP: Chapter Number: 19: Title: Electronic Health Records
27. A large health-care organization has struggled to meet mandated electronic health record
(EHR) standards. What actions address the likely challenge that this organization is facing?
a. Improving communication between managers at the organization’s various sites
b. Increasing the organization’s budget for technology
c. Investing more in employee training
d. Engaging clients and families with the process
e. Increasing the use of evidence-based practice
ANS: B, C
Feedback: Many of the challenges faced during the adoption of EHRs involve inadequate
technology and training. Communication between managers has not been identified as a
major hurdle. Evidence-based practice enhances client care but does not directly address
challenges around EHRs. Similarly, engaging clients and families greatly benefits the care
that nurses provide but not the adoption of EHRs.

TOP: Chapter Number: 19: Title: Electronic Health Records
28. The nurse is caring for a postoperative client whose pain is not being relieved by the current
analgesia regimen. When using the SBAR model for communicating with the client’s
health-care provider, how should the nurse best address the “A” component of the model?
a. “The client is postoperative day 2 following total hip arthroplasty.”
b. “The client’s pain control might be inadequate because she’s been rating it at 9 out
of 10 for the past hour.”
c. “The client also has type 2 diabetes and atrial fibrillation.”
d. “An increase in her hydromorphone dose is probably a good idea.”
ANS: B
Feedback: The “A” in the SBAR or ISBAR model denotes “assessment,” in which the nurse
summarizes the client’s condition and states what the problem likely is.

TOP: Chapter Number: 19: Title: Table 19.3 SBAR as a Communication Tool
29. The nurse-manager has been approached by an angry employee whose vacation request was
denied. What should the manager do when communicating with this employee? Select all
that apply.
a. Tell the employee that anger will not be tolerated and then leave the situation.
b. State, “I understand that you are angry that your vacation request wasn’t
approved.”
c. Allow the employee sufficient opportunity to express what she wants from the
manager.
d. Tell the employee how her mode of communication is hindering the message.
e. Ask the employee, “Are you accusing me of bullying you by turning down your
request?”
ANS: B, C
Feedback: When dealing with an emotional employee, the manager should allow the
employee time to express what he or she wants and to make statements that reflect back the
employee’s message. The manager should not terminate the interaction unless there is a
plausible safety risk. Telling the employee how her tone is hindering communication and
asking whether the employee is accusing the manager are likely to escalate the situation,
further harming communication.
PTS: 1 DIF: Difficult REF: Page: 504–505

OBJ: 6
30. A manager is careful to address nonverbal aspects of communication when communicating
with employees. What practices should the manager adopt? Select all that apply.
a. Have communications in public places as much as possible to reduce intimidation.
b. Stand between 12 and 18 inches from an employee when having an important
conversation.
c. Be thoughtful about aspects of appearance that can be controlled by the manager.
d. Avoid crossing arms across the chest.
e. Limit eye contact with employees to avoid being perceived as aggressive.
ANS: C, D
Feedback: The manager should take care on aspects of appearance and should avoid crossed
arms, which communicate defensiveness or aggression. There are many communications
that are inappropriate to have in a public place and space of 12 to 18 inches is considered
unusually close. Even though some individuals and cultures perceive eye contract as
provocative or aggressive, it is still valued in most circumstances.

TOP: Chapter Number: 19: Title: Elements of Nonverbal Communication
Chapter 20: Delegation
1. What is an inappropriate reason for delegation?

a. To empower subordinates by “stretching” them in their work assignment
b. To free the manager to address more complex unit needs
c. The manager does not find the task intellectually challenging.
d. Someone else is better qualified to do the task.
ANS: C
Feedback: That the manager is not challenged by a task is not a valid reason for delegating
that task to another. The other options are all appropriate reasons to delegate tasks to
qualified staff.

TOP: Chapter Number: 20: Title: Common Delegation Errors
2. A performance appraisal states that the manager often underdelegates. What is potential
cause of this delegation error?
a. A high degree of trust in subordinates
b. A democratic leadership style
c. A need for perfectionism
d. Sufficient time to accomplish unit goals alone
ANS: C
Feedback: A manager with a need for perfectionism and control may believe that another
person will not complete a task. Trust in subordinates and a democratic leadership style
would support effective delegation. Delegating should not be based on the issue of time
exclusively.

TOP: Chapter Number: 20: Title: Underdelegating
3. A manager needs to delegate some tasks. What consideration should the manager prioritize
when identifying the appropriate person to whom to delegate a specific task?
a. Whose turn it is to delegate a task
b. The qualifications of the person regarding the task
c. The fiscal cost of delegating the task
d. Whether the person has experience with similar tasks
ANS: B
Feedback: Managers should ask the individuals to whom they are delegating if they are
capable of completing the delegated task. If the person lacks the appropriate qualifications,
the fact that he or she has experience is irrelevant. The manager should not base delegation
decisions primarily on whose turn it is or on cost.
TOP: Chapter Number: 20: Title: Select and Empower Capable Personnel
4. A nurse-manager delegates many tasks in the course of a day. Which practice should the
manager reconsider or discontinue?
a. The manager grants temporary authority to support completion of a delegated task.
b. The manager confirms that the person to whom a task is delegated is adequately
qualified.
c. The manager provides employees with exact instructions for each step of
completing the task.
d. The manager asks for regular updates from the employee when tasks take a long
time.
ANS: C
Feedback: If an employee has the skills necessary to complete a task, that employee should
be able to carry out the task with autonomy and be provided with the authority and resources
necessary. There should be no need for the manager to give excessively detailed
instructions. Depending on the complexity of the project, the manager should meet with the
employee for updates. The manager must always confirm employees’ qualifications.

TOP: Chapter Number: 20: Title: Be a Role Model and Provide Guidance
5. A manager’s subordinate is having difficulty carrying out a delegated task. What is the
a. Release the subordinate from the task so he or she will not become demoralized.
b. Be available to the employee as a role model and resource for the task.
c. Assign another more experienced employee to help with the task.
d. Reassign the employee a different, less complex task.
ANS: B
Feedback: A manager should be available to the employee to help identify solutions to
problems encountered with a delegated task and should encourage the employee to
persevere. Taking back a task that was originally delegated is an absolute last resort.
Reassigning and coassigning the task are options that are not initially considered, but which
may be necessary later.

6. What principle should guide the nurse’s delegation of tasks to unlicensed nursing assistive
personnel (NAP)?
a. It is safe to assume that the NAP has at least a high school diploma as a minimum
hiring criterion.
b. Like all members of the care team, NAP stands to lose their licensure in case of
negligent practice.
c. No federal or community standards have been established for training the broad
classification of NAP.
d. The nurse is protected from liability when allowing the NAP to perform only those
tasks the employer includes in their job description.
ANS: C
Feedback: No federal or community standards have been established for the training of the
NAP. The hiring policies of institutions vary regarding the employment qualifications of the
NAP, and many institutions do not have distinct job descriptions for NAP that define their
scope of practice. NAPs do not have a license that they can lose.

TOP: Chapter Number: 20: Title: Delegating to Unlicensed Assistive Personnel
7. Which action is considered a leadership role associated with delegation?

a. Creating job descriptions for all personnel
b. Providing formal recognition or reward for completion of delegated tasks
c. Demonstrating sensitivity to how cultural phenomena affect transcultural
delegation
d. Reprimanding employees who demonstrate overt resistance to the tasks they are
delegated
ANS: C
Feedback: Factors such as communication, space, social organization, timing,
environmental control, and biological variations affect delegation to a culturally diverse
staff and should be modeled as a leadership role. The other choices are all management
functions.

Functions Associated With Delegation KEY: Integrated Process: Nursing Process
8. Which statement is true regarding the general delegation liability of the registered nurse
(RN)?
a. It is minimal because subordinates alone are held accountable for practicing within
the accepted scope of practice for their job classification.
b. It is high because the RN is automatically held liable for the tasks delegated to all
recognized subordinates.
c. It is reduced when the RN delegates appropriately and supervises the completion
of the tasks.
d. It is avoided entirely as long as the nurse delegates only other licensed personnel.
ANS: C
Feedback: Proper delegation practices that include assessment and evaluation help protect
the RN from liability. In general, accountability is shared and does not lie solely with the
subordinate. Delegation to licensed personnel does not completely release a nurse from
liability.

Functions in Delegation KEY: Integrated Process: Nursing Process
9. What action should the nurse-manager perform when supporting the delegation of a task to a
subordinate?
a. Holding the subordinate’s professional development as the highest priority
b. Frequently reassuring the employee that if they are incapable of completing a
delegated task, it will be reassigned
c. Drafting a preliminary plan of how the task will be redone if the outcome does not
meet stated expectations
d. Occasionally providing learning or “stretching” opportunities for employees
ANS: D
Feedback: “Stretching” provides growth opportunities for employees, builds employee
self-esteem, and helps prevent boredom and demotivation. Client safety is prioritized over
professional development. The manager should avoid excessive reassurance and threats of
reassignment. The nurse should not presume that the task will need to be redone before the
subordinate has attempted it.

10. Periodically during the day, the RN checks with the team members to determine whether
they are having difficulty completing their assigned tasks. This describes which manager
role?
a. Skills evaluation
b. Client safety
c. Effective delegation
d. Micromanagement
ANS: C
Feedback: This manager provided the team with the autonomy to complete the work and
was available should any need arise. This describes effective delegation. This action does
not constitute micromanagement, provided it is not excessive. This promotes client safety
but is not synonymous with it. This practice is not a form of skills evaluation.
11. A member of the team has been delegated some tasks and reports, “I’ve been given too
much to do and I’m not going to be able to complete the work on time.” What is the RN’s
best initial action?
a. Assign the work to another team member.
b. Take on the responsibility of the tasks.
c. Have the team member perform only the most necessary tasks.
d. Examine the workload and assist the individual in reprioritizing.
ANS: D
Feedback: The manager should help the overwhelmed employee reprioritize the workload
with the goal of making it manageable for that employee. This strategy should be tried
before assigning work to another team member or having the employee abandon some of the
tasks. In most cases, it is ineffective if the RN takes on the tasks that the employee was
supposed to complete.

TOP: Chapter Number: 20: Title: Subordinate Resistance to Delegation
12. Which assessment should the RN prioritize when assigning tasks to nursing assistive
personnel (NAP)?
a. Determining the NAP’s skills and knowledge level
b. Assessing which tasks the NAP is motivated to perform
c. Evaluating the NAP’s ability to follow instructions
d. Asking colleagues to appraise the NAP’s strengths and weaknesses
ANS: A
Feedback: The nurse or manager must be knowledgeable about the skills and knowledge of
all members of the health-care team. These variables are more important than the NAP’s
motivation, ability to following instructions, or personal attributes because they are more
closely associated with client safety and the avoidance of liability.

13. Which task would the director of a home health agency not delegate another staff RN?
a. Assigning home health aides to specific client care
b. Serving on a diabetic study committee of community resources
c. Meeting with the agency’s administration regarding budget cuts
d. Reviewing the care assignment for the following shift
ANS: C
Feedback: Management responsibilities associated with budgeting would not normally be
delegated to another RN on the staff because this is a role that is not the responsibility of an
RN. The other options could be appropriately delegated to another RN in most
circumstances.

14. An RN needs to confirm the specific delegation parameters for RNs. The RN should refer to
guidelines from what organization?
a. The Joint Commission
b. U.S. Department of Health and Human Services
c. National League for Nursing (NLN)
d. The state board of nursing
ANS: D
Feedback: State boards of nursing are responsible for clarifying the delegation parameters
for RNs. None of the other options are involved in this process.

15. What must managers delegate to another RN in order to assure completion of a task?
a. Time and space
b. Leadership and creativity
c. Authority and responsibility
d. Personnel and knowledge
ANS: C
Feedback: Managers must delegate the authority and the responsibility necessary to
complete the task. Qualities like leadership, knowledge, and creativity are not transferable.
The remaining option choices are resources that are provided rather than delegated.

TOP: Chapter Number: 20: Title: Select and Empower Capable Personnel
16. The Omnibus Budget Reconciliation Act of 1987 established regulations for the education
and training of which category of health-care worker?
a. Certified nurse aide (CNA)
b. Registered nurse (RN)
c. Licensed practical nurse (LPN)
d. Ward clerk
ANS: A
Feedback: Although the Omnibus Budget Reconciliation Act of 1987 established
regulations for the education and certification of “nurse’s aides” (minimum of 75 hours of
theory and practice and successful completion of an examination in both areas), no federal
or community standards have been established for training the more broadly defined NAP.
LPNs and ward clerks are not addressed by this act.

17. A registered nurse (RN) was working with a nursing assistive personnel (NAP) and
delegated some tasks to the NAP. The NAP exceeded his scope of practice and caused
injury to a client. Ultimate responsibility for this adverse event lies with whom?
a. The NAP
b. The facility’s director of nursing
c. The unit’s nursing manager
d. The RN
ANS: D
Feedback: The team’s RN always bears the ultimate responsibility for ensuring that the
nursing care provided by his or her team members meets or exceeds minimum safety
standards. This is not the ultimate role of any of the other positions mentioned.

18. A nurse-manager is new to the unit and is worried about being perceived as incompetent or
underqualified by subordinates. The manager should recognize that this creates a risk for
what problem?
a. Underdelegating
b. Overdelegating
c. Improper delegating
d. Inappropriate delegating
ANS: A
Feedback: Underdelegating occurs when a manager has a false assumption that delegation
may be interpreted as a lack of ability on his or her part to do the job correctly or
completely. This insecurity may make the manager highly reluctant to delegate.

TOP: Chapter Number: 20: Title: Underdelegating
19. The nurse-manager is overseeing a culturally diverse group of staff. The manager should
consider what variables when planning delegation? Select all that apply.
a. Communication style
b. Concepts of time
c. Intelligence
d. Biological variations
e. Social organization
ANS: A, B, D, E
Feedback: There are six cultural phenomena that must be considered when working with
staff from a culturally diverse background: communication, space, social organization, time,
environmental control, and biological variations. Intelligence is not a cultural phenomenon.

TOP: Chapter Number: 20: Title: Delegating to a Multicultural Work Team
20. An RN is leading a care team on a busy hospital unit. What tasks is the RN justified in
delegating to NAP? Select all that apply.
a. Feeding a client who has unilateral weakness
b. Repositioning an immobile client every 2 hours
c. Assessing a client’s surgical wound
d. Weighing a client who has chronic heart failure
e. Transporting a client to a diagnostic test
ANS: A, B, D, E
Feedback: Assessment is beyond the scope of NAP. However, NAP can appropriately feed,
reposition, transport, and weigh clients.

TOP: Chapter Number: 20: Title: Display 20.4 Common Tasks Generally Considered
Appropriate for Delegation to Nursing Assistive Personnel
21. An experienced RN has seen a significant increase in the need for delegation skills over the
past several years. This change is most likely attributable to:
a. increased numbers of uninsured clients.
b. increased lengths of stay.
c. increases in the use of NAP.
d. decreases in nurse–client ratios.
ANS: C
Feedback: With the increased use of NAP in patient care, the need for nurses to have highly
developed delegation skills has never been greater. The impact of insurance, nurse–client
ratios, and hospitalization stays does not have as great an impact on delegation as does the
correct option. Hospital stays are shorter, not longer, than in the past.

22. A subordinate is reluctant to accept a task that the nurse-manager wants to delegate. The
manager suspects that the subordinate’s reluctance is due to a lack of self-confidence. What
is the manager’s best initial action?
a. Teach the subordinate about the value of self-confidence.
b. Try to empower the subordinate.
c. Offer a reward to the subordinate in order to motivate.
d. Restate the importance of the task to the subordinate.
ANS: B
Feedback: Empowering the subordinate who lacks self-confidence is an appropriate initial
action. If this is not possible, then reassigning the task may be necessary. Teaching about the
need for self-confidence rarely instills self-confidence in those who lack it. Restating the
importance of the task does not address the nurse’s confidence level.

23. Which action on the part of a unit’s nurse-manager demonstrates the mark of a great leader?
a. Acknowledging the accomplishments of staff members at the unit meeting
b. Providing onsite in-services on new equipment for the staff
c. Including funds in the unit’s budget of staff development
d. Stressing the importance of patient safety to all new employees
ANS: A
Feedback: The mark of a great leader is when he or she can recognize the excellent
performance of someone else and allow others to shine for their accomplishments. Although
the other options are appropriate, they are not identified as being the mark of a great leader
but rather an efficient manager.

24. The nurse-manager has asked an NAP for an update on delegated tasks, and the NAP has
said, “I’m swamped right now.” What is the manager’s best response?
a. “Don’t be afraid to let me know if you feel the project is overwhelming you.”
b. “Time management is key to keeping on schedule with your tasks.”
c. “I can give you a few solutions to help manage this heavy workload.”
d. “Do you want more time to complete your work?”
ANS: C
Feedback: If the worker is having difficulty carrying out the delegated task, the
leader-manager should be available as a role model and resource in identifying alternative
solutions. Leaders should encourage employees, however, to attempt to solve problems
themselves first, although they should always be willing to answer questions about the task
or to clarify desired outcomes as necessary. Suggesting solutions or removing the person
from the task prematurely does not demonstrate an understanding of effective guidance. The
NAP has already expressed feeling overwhelmed, so there is no need to give permission to
do so.

25. A nurse has successfully completed a difficult and complex task that the manager delegated.
What is the manager’s best action?
a. Document the fact that the nurse completed the task.
b. Assign a slightly more difficult task the next time.
c. Acknowledge the nurse’s significant accomplishment.
d. Ask the nurse to act as a role model for other staff members.
ANS: C
Feedback: It is important to reward employees for accomplishment. This must precede
“stretching” the nurse with even more difficult assignments or asking the nurse to act as a
role model.

TOP: Chapter Number: 20: Title: Reward Accomplishment
26. A nurse-manager has delegated some administrative tasks to an experienced RN. How does
this act of delegation differ from the usual practice of assigning work to subordinates?
a. The nurse’s task will be beyond his or her scope of practice.
b. The manager transfers the authority for the task to the nurse.
c. The nurse is practicing on the manager’s license.
d. The manager is released of the need to oversee the nurse.
e. The manager remains accountable for the task.
ANS: B, E
Feedback: In delegation, the individual transfers the authority to perform a specific activity
from their own practice, to an individual qualified to perform that task, but retains
accountability for the delegated task. Delegation does not involve going beyond the nurse’s
scope of practice, and there is still a need for oversight. The nurse does not perform on
someone else’s license when completing delegated tasks.

27. A nurse-manager has begun a new role in a community health center and will need to
delegate tasks often to subordinates. What actions should the manager perform when
delegating tasks? Select all that apply.
a. Choose the most time-consuming tasks to delegate to subordinates.
b. Evaluate the skills and education of subordinates before delegating.
c. Ensure that subordinates know the goal of any delegated task.
d. Avoid monitoring the subordinate unless there is evidence of a problem.
e. Evaluate subordinates’ performance after they have completed a task.
ANS: B, C, E
Feedback: Safe and effective delegation involves evaluating the skills and education of staff,
identifying goals clearly, and evaluating performance after completion. Tasks should not be
selected for delegation on the sole basis of being time-consuming for the manager.
Monitoring is appropriate and necessary and is not reserved just for problems or
emergencies.

TOP: Chapter Number: 20: Title: Display 20.2 Strategies for Successful Delegation
28. A nurse delegated some tasks to a nurse several hours ago. The manager has now learned
that the nurse did not complete any of the delegated tasks. What is the manager’s best initial
action?
a. Determine exactly why the nurse did not complete the delegated tasks.
b. Assertively state the expectation that delegated tasks will be completed on time.
c. Document the nurse’s insubordination and arrange a private meeting.
d. Take action to reestablish the authority power gap.
ANS: A
Feedback: If an employee does not complete delegated tasks, the manager should assess the
reasons for this before taking action. Addressing the problem before knowing the
circumstances or the cause would be premature.

29. A registered nurse has been leading teams of NAP for several years and will soon be leading
licensed practical nurses for the first time. In preparation for delegating to these nurses, the
RN should:
a. delegate the same tasks to the LPNs that the RN normally delegated to NAPs.
b. review the practical nurse scope of practice in the jurisdiction where they are
working.
c. ask each LPN what tasks he or she is comfortable performing.
d. consult a decision tree for delegation to unlicensed assistive personnel.
ANS: B
Feedback: Delegation to a LPN is different from delegation to a NAP. The parameters vary
from state to state, and the RN should review the scope of practice. The LPN’s comfort level
is secondary to his or her knowledge, skills, and scope practice. A decision tree for
delegation to unlicensed assistive personnel would guide delegation to NAPs, not LPNs.

TOP: Chapter Number: 20: Title: Identify Necessary Skills and Education Levels
30. A health-care organization has laid off several RNs and hired numerous NAPs in their place.
What effect is this change most likely to have on the remaining RNs?
a. There will be a risk of the RNs underdelegating.
b. The RNs’ level of liability will increase.
c. Cultural variables will become a larger consideration.
d. The RNs’ scope of practice will become expanded.
ANS: B
Feedback: In general, increasing delegation to NAPs increases the scope of liability for the
RN. There is no reason why this change in staffing would create a risk for underdelegating
or make culture a more salient concern. The RNs’ scope of practice is enacted in the
jurisdiction’s nurse practice act and is not affected by this change.

Chapter 21: Effective Conflict Resolution and Negotiation
1. The nurse-manager is preparing for negotiations. When negotiating, what is the manager’s
most appropriate action?
a. Be willing to win at any cost.
b. Communicate only when asked direct questions.
c. Compromise only as a last resort.
d. Begin with a high but realistic expectations.
ANS: D
Feedback: The selected starting point in negotiations should be at the upper limits of the
negotiator’s expectations, within reason. However, negotiators must realize they may have
to come down to a lesser goal. Winning at any cost is counterproductive, and the manager
should expect to compromise. Plentiful and accurate communication is necessary at all
stages of negotiation.

TOP: Chapter Number: 21: Title: Before the Negotiation
2. A charge nurse has assisted two employees to resolve their conflict, with the outcome being
that the two opposing goals were discarded and new goals were adopted. What is this an
example of?
a. Smoothing of conflict by the leader
b. Facilitating collaboration
c. A majority rule approach
d. A good lesson in compromising
ANS: B
Feedback: In collaboration, all parties set aside their original goals and work together to
establish a common goal. In promoting collaboration, the charge nurse has not simply
smoothed over the conflict. The formation of new goals differentiates between collaboration
and compromise. There is no evidence that a majority rule approach has been taken because
there are two parties involved.

TOP: Chapter Number: 21: Title: Collaborating
3. Which is a true statement about destructive negotiation tactics?

a. Ridicule often takes the form of ambiguous or inappropriate questioning and is a
diversionary tactic.
b. Most managers successfully resist the helplessness tactic because of their nursing
preparation.
c. Negotiation tactics can sometimes be manipulative; thus, managers must be
cognizant of the other party’s motives.
d. Nurses are known to be particularly vulnerable to the tactic of flattery.
ANS: C
Feedback: Destructive negotiation tactics are never a part of a successful collaborative
conflict resolution. An astute nurse-manager must stay cognizant of the other party’s
motives and behaviors in order to identify manipulative tactics. Ridicule is a separate tactic
from ambiguous and inappropriate questioning. Nurses can be particularly vulnerable to the
helplessness tactic because nurses are educated and inclined to help others. Nurses are not
noted to be exceptionally vulnerable to flattery, however.

TOP: Chapter Number: 21: Title: Destructive Negotiation Tactics
4. What statement about conflict most closely reflects the interactionist theories of
organizational conflict?
a. “The most important response to conflict is to deal with it immediately.”
b. “Conflict can actually be a good thing and can help us to grow.”
c. “The presence of conflict in our workplace shows that there is bad management.”
d. “The best organizations are places where there is no conflict.”
ANS: B
Feedback: The interactionist movement encouraged organizations to promote conflict as a
means of producing growth. Interactionist did not see conflict as evidence of bad
management or dysfunction. Interactionists did not particularly emphasize the need to deal
with conflict immediately.

TOP: Chapter Number: 21: Title: The History of Conflict Management
5. A nurse-manager has accepted a new position on a hospital unit. An experienced nurse on

the unit tells the manager, “We all work really well with each other. There’s never any
conflict.” How should the manager interpret this statement?
a. The unit may be lacking in growth and new ideas.
b. There is a need for the manager to introduce conflict.
c. The manager needs to ensure that this characteristic continues.
d. There is likely conflict that the nurse is not recognizing or acknowledging.
ANS: A
Feedback: Some level of conflict in an organization appears to be desirable because it
appears to prevent organizational stagnation. Despite this, it would normally be
inappropriate for the manager to deliberately introduce conflict for the purpose of promoting
growth. There is no reason to believe that the nurse’s statement is untrue.
6. Which nurse is experiencing intrapersonal conflict?

a. A manager who has received a negative performance appraisal and who wishes to
dispute the findings
b. A manager who has to confront a nurse who made a medication error but did not
follow up with documentation
c. A manager who is in conflict with a long-standing employee who often ignores the
manager’s directives
d. A manager who perceives a dilemma between loyalty to staff and loyalty to the
organization in a particular situation
ANS: D
Feedback: Intrapersonal conflict occurs within the person. Each of the other examples
constitutes interpersonal conflict.

TOP: Chapter Number: 21: Title: Intergroup, Intrapersonal, and Interpersonal Conflict
7. Which of the following workplace situations would be categorized as latent conflict?

a. A nurse expresses frustration to a colleague who did not perform some tasks that
were clearly delegated.
b. A nurse expresses anger to the manager, accusing the manager of preferential
treatment toward other nurses.
c. The most experienced nurses on a unit are allowed to self-schedule, but less
experienced nurse are not.
d. Two nurses were in conflict about inequities in their work assignment but were
able to resolve the conflict.
ANS: C
Feedback: The first stage in the conflict process, latent conflict, implies the existence of
antecedent conditions such as inequities in staffing. In this stage, conditions are ripe for
conflict, although no conflict has actually yet occurred. In each of the other examples, the
conflict has progressed beyond this antecedent stage.

TOP: Chapter Number: 21: Title: The Conflict Process
8. A nurse-manager was involved in conflict where the other individual adopted a competing
approach. This approach is evident in what circumstances?
a. When fair play is important to all involved parties
b. When one party wins at the expense of the others
c. When managers need to control a volatile situation
d. When an appropriate political strategy is necessary
ANS: B
Feedback: The competing approach is used when one party pursues what it wants at the
expense of the others. Because only one party typically wins, the competing party seeks to
win regardless of the cost to others. Neither manager control nor political strategy is
necessarily associated with the competing approach to resolving conflict.

TOP: Chapter Number: 21: Title: Competing
9. A nurse is in a conflict with a colleague, but both nurses are committed to collaboration. To
promote collaboration, the nurses should:
a. identify a common goal that is important to both of them.
b. possess the ability to negotiate without having emotion get involved.
c. have a relationship that existed before the conflict.
d. ask a neutral third party to mediate in the conflict.
ANS: A
Feedback: In collaboration, all parties set aside their original goals and work together to
establish a supraordinate or priority common goal. This does not necessarily require the
preexistence of a relationship or mediation. Collaboration is still possible even if the conflict
has an emotional element.

TOP: Chapter Number: 21: Title: Collaborating
10. A registered nurse reports to the nurse-manager that the team’s nursing assistant regularly
fails to complete assigned tasks. The nurse-manager responds that it is the nurse’s initial
responsibility to talk with the nursing assistant about this problem. The manager is engaged
in what aspect of conflict?
a. Conflict avoidance
b. Conflict smoothing
c. Encouraging competitive conflict resolution
d. Facilitating conflict resolution
ANS: D
Feedback: Managers should not intervene in every conflict but should urge subordinates to
handle their own problems. This is an example of supporting conflict resolution. In most
circumstances, this approach should be implemented before the manager becomes directly
involved. The manager’s deference does not indicate conflict avoidance or conflict
smoothing.

TOP: Chapter Number: 21: Title: Managing Unit Conflict
11. Which statement best defines conflict?

a. It involves an internal struggle resulting from value-related discord.
b. Its basis is the violation of personal rights or values.
c. It centers on either internal discord or external discord between individuals.
d. It is the outcome of a visible struggle between individuals.
ANS: C
Feedback: Conflict is generally defined as the internal or external discord that results from
differences in ideas, values, or feelings between two or more people. The remaining options
describe only limited aspects of conflict.

12. A nurse-manager will be participating in negotiations around the skills mix in the
organization. Before these negotiations begin, the manager should perform what action
first?
a. Identify the ideal skills mix for the organization.
b. Choose an appropriate negotiation strategy.
c. Interact with the other party to identify any hidden agendas.
d. Learn as much as possible about the issue.
ANS: D
Feedback: For managers to be successful, they must systematically prepare for the
negotiation. As the negotiator, the manager begins by gathering as much information as
possible regarding the issue to be negotiated. This data-gathering phase should precede the
other listed actions.

TOP: Chapter Number: 21: Title: Before the Negotiation
13. A nurse-manager is participating in negotiations around the allocation of resources in the
organization. During the negotiations, the manager should:
a. try to speak the same amount or slightly more than the other party.
b. use open-ended questions rather than yes or no questions.
c. declare his or her bottom line at the start of negotiations.
d. ensure that the negotiations proceed at a rapid pace.
ANS: B
Feedback: The manager should encourage the other negotiator to talk by asking lots of
open-ended questions that cannot be answered with a simple “yes” or “no.” It is not
beneficial to openly declare the bottom line before negotiations have even begun. The
manager should listen 70% of the time and talk only 30% of the time. Speed is not a goal
during negotiation and can lead to hasty decisions.

TOP: Chapter Number: 21: Title: During the Negotiation
14. The nurse-manager is negotiating for the funds necessary to purchase several new isolettes
for the facility’s newborn nursery. The chief financial officer (CFO) states, “I’ve always
been curious about that piece of equipment; how does it actually work?” What negotiation
action has the CFO engaged in?
a. Collaborating
b. Smoothing
c. A diversionary tactic
d. Appropriate fact finding
ANS: C
Feedback: The CFO was consciously or unconsciously using a diversionary tactic that
deflects from the issue at hand. There is no evidence of collaboration with this question, and
it is unnecessary information. Smoothing is an approach to conflict, not negotiation.

15. Several RNs on the unit want to address the possibility of initiating flextime on the unit
because they state that the current scheduling system is unfair. What is the manager’s best
initial response?
a. Assuring the RNs that every effort is being made to streamline the current
scheduling system
b. Asking the RNs to circulate a partition to be signed by employees who support the
change
c. Arranging for the RNs to air their views at the next staff meeting
d. Sharing with the RNs that they need to address the issue with upper management
ANS: C
Feedback: This manager should plan to let employees air their views at the next staff
meeting. Nursing managers can no longer afford to respond to conflict traditionally (to
avoid, deflect, or suppress conflict) because this is nonproductive. Putting off the nurses be
providing false reassurance or referring them elsewhere is not a direct and respectful
response to conflict.

16. The nurse-manager has learned that two employees are in conflict. The manager’s fact
gathering reveals that the conflict exists because each employee misunderstands the job
description and role of the other employee. What conflict management strategy should the
manager implement first?
a. Responsibility charting
b. Confrontation
c. Behavior change
d. Third party consultation
ANS: A
Feedback: When a supervisor delineates job duties to persons in conflict, it is called
responsibility charting. This attempt at clearing up the misunderstanding should be
attempted before resorting to other strategies.

17. An employee has come to the manager with a long list of complaints about a coworker, all
of which are attributable to personality factors rather than unsafe practice. What is the
a. Encourage the employee to speak directly with the coworker.
b. Ask the employee to e-mail or text message the complaints to the coworker.
c. Arrange for third-party mediation.
d. Acknowledge and document the employee’s complaints.
ANS: A
Feedback: When team members inappropriately expect the manager to solve their
interpersonal conflicts, managers can urge subordinates to attempt to handle their own
problems by using face-to-face communication to resolve conflicts. This basic approach
should be attempted before mediation. E-mails and text messages are too impersonal for
interpersonal conflicts that can have significant conflict aftermath. Acknowledging and
documenting the complaints offers no course of action to the employee.

18. The manager has learned that some of the more experienced nurses on the unit have been
playing pranks on a newly hired nurse and delegating their most challenging tasks to the
nurse. What is the manager’s best response after confirming that these events took place?
a. Offer support and encouragement to the newly hired nurse.
b. Confront the more experienced nurses directly about their behavior.
c. Implement a structure change so the experienced nurses no longer work at the
same time as the new nurse.
d. Arrange for third-party consultation involving the more experienced nurses, the
manager and the new nurse.
ANS: B
Feedback: The manager must address bullying directly and promptly. The nurse should also
offer support to the bullied nurse, but the priority is addressing the behaviors. Separating the
group from the individual or having mediation may eventually be necessary, but the
manager would first confront the behavior.

TOP: Chapter Number: 21: Title: Workplace Violence: Scope of the Problem
19. Which of the following behaviors should the nurse-manager identify as workplace violence,
incivility, or bullying? Select all that apply.
a. A group of nurses consistently refuse to help a nurse when that nurse has a heavy
workload, despite having time to do so.
b. Staff members assign an unwanted nickname to a colleague.
c. A nurse’s specific vacation request is denied by the manager for 2 years in a row.
d. A nurse asks a colleague to assess a known verbally abusive client without
warning to see how the colleague will respond.
e. A nurse tells a nursing student to rush to room 311, knowing that the unit has no
room 311.
ANS: A, B, D, E
Feedback: Workplace incivility can take many forms, including name-calling, refusing help,
setting up a colleague for failure, or playing pranks. Vacation denials can happen for many
reasons and would not necessarily constitute an uncivil act.

20. Two groups in the health-care organization have been unable to reach an agreement after
prolonged negotiation. The groups have agreed to arbitration. What will happen during this
process?
a. A neutral party will facilitate new negotiations, starting from the beginning.
b. A neutral party will listen to both groups and then present a binding
recommendation.
c. A neutral third party will act as a “go between” in the negotiations.
d. Negotiations will continue in a court setting, and a lawyer will mediate between
the groups.
ANS: B
Feedback: Arbitration is a binding conflict resolution process in which the facts of the case
are heard by an individual who makes a final decision for the parties in conflict. It does not
involve repeating the negotiations and does not take place in a court setting.

TOP: Chapter Number: 21: Title: Alternative Dispute Resolution
21. A nurse-manager is attempting to help a group of staff members reach a consensus on a

sensitive issue. What is a consequence of using a consensus-based approach?
a. One group will be perceived as the “winner” and one group as the “loser.”
b. It is likely that neither group will achieve their desired “ideal” outcome.
c. A solution that is ideal to both groups will be selected.
d. There is an increased risk for similar conflict in the future.
ANS: B
Feedback: Consensus means that negotiating parties reach an agreement that all parties can
support, even if it does not represent everyone’s first priorities. Consensus decision making
does not provide complete satisfaction for everyone involved, and the solution is unlikely to
be described as “ideal” by anyone involved. Reaching a consensus does not involve an
increased risk for future conflict.

TOP: Chapter Number: 21: Title: Seeking Consensus
22. An employee who is involved in a dispute has sought the assistance of the organization’s
ombudsperson. What role will the ombudsperson play in resolving the employee’s conflict?
a. Providing expert testimony in conflict cases
b. Providing psychosocial support to employees in distress
c. Investigating the employee’s grievance against the other party
d. Monitoring the implementation of the terms of a conflict’s compromise
ANS: C
Feedback: Ombudspersons investigate grievances filed by one party against another and
ensure that individuals involved in conflicts understand their rights as well as the process
that should be used to report and resolve the conflict. They do not normally provide expert
testimony, psychosocial support, or monitor implementation of a solution.

23. A negotiating session has just concluded with a compromise agreement. What is the
manager’s best action?
a. Clearly restate the terms of the compromise to all involved before dispersing.
b. Give feedback to the members of the other negotiating team on their behavior and
performance.
c. Evaluate the fairness of the compromise to all involved parties.
d. Restate each party’s original bottom line.
ANS: A
Feedback: Once a compromise has been reached, restate it so that everyone is clear about
what has been agreed on. Giving feedback to others after negotiation is not a usual practice.
The fairness of the compromise would be considered as it was negotiated, not after the fact.
There is no benefit to stating the original bottom lines.

TOP: Chapter Number: 21: Title: Closure and Follow-Up to Negotiation
24. A nurse-manager is engaged in a negotiation with staff representatives when the discussion
becomes controlled by a particularly aggressive member. Which action will the
nurse-manager take to assure that the process is successful?
a. Ask that the aggressive individual recognize the rights of all the other members.
b. State, “I need to have time to think over all that we have discussed.”
c. Halt any discussion until new representatives can be appointed.
d. Share with the members that aggressiveness negatively impacts the negotiations.
ANS: B
Feedback: Some people win in negotiation simply by rapidly and aggressively taking over
and controlling the negotiation before other members realize what is happening. If managers
believe that this may be happening, they should call a halt to the negotiations before
decisions are made. Saying simply, “I need to have time to think this over” is a good method
of stopping an aggressive takeover. The other options are much less effective and may even
lead to increased aggressiveness among team members.

25. Which personal characteristics will best help meet the psychological needs of conflict
negotiation?
a. Perseverance and assertiveness
b. Calmness and self-assuredness
c. Compassion and reflectiveness
d. Organization and self-reflection
ANS: B
Feedback: Negotiation is psychological and verbal. The effective negotiator always appears
calm and self-assured. The other options are not as impactful when considering the
psychological aspects of the negotiation process.

TOP: Chapter Number: 21: Title: During the Negotiation
26. The nurse-manager is participating in negotiations that have become confrontational and
unproductive. As a result, both parties have agreed to mediation. This mechanism for
dispute resolution will have what characteristics? Select all that apply.
a. The mediator will be a respected person from within the organization.
b. Both parties are required to accept the mediator’s decision.
c. The mediator addresses the process but not the issues.
d. The mediator meets with each group separately as well as meeting with them
together.
e. The mediator is an individual who has no vested interest in the outcome.
ANS: D, E
Feedback: A mediator is a neutral third party who has no conflict of interest and who is
from outside the organization. The mediator’s decision is not binding, unlike arbitration.
The mediator has a broad role that can address process as well as the issues in dispute.

27. A recent graduate has begun working at a health center and finds the behaviors of colleagues
stressful and intimidating. The nurse’s colleagues whisper when she is around, roll their
eyes at her, and laugh when she asks for assistance or clarification. What is this recent
graduate’s best action?
a. Organize a meeting to confront the colleagues about their behavior.
b. Avoid the offending colleagues whenever possible.
c. Report these behaviors to the nurse-manager.
d. Seek assistance from the organization’s ombudsperson.
ANS: C
Feedback: The nurse-manager should be made aware of this behavior so that action can be
taken. It is unrealistic to expect a new graduate to organize a staff meeting to confront a
group of more experienced colleagues about their behavior. Ombudspersons generally deal
with disputes and grievances, not the immediate management of workplace violence. The
nurse may be tempted to simply avoid these colleagues, but this is not sustainable and does
not address this unacceptable behavior.

28. A hospital unit is in a major transition from a nursing model that was exclusively RNs to
one that involves a mix of RNs, LPNs, and NAPs. The transition has resulted in several
conflicts between staff. What conflict resolution strategy will the manager most likely need
to use?
a. Third-party consultation
b. Behavior change
c. Responsibility charting
d. Structure change
ANS: C
Feedback: The transition from a homogenous workforce to a highly diverse one with a
complex skills mix is likely to cause conflict around roles and jurisdictions. This type of
conflict can be addressed by reviewing and reinforcing the responsibilities of each team
member. Each of the other listed strategies may be necessary for some conflicts on the unit,
but the most likely strategy is the one that directly addresses roles and responsibilities.

29. The nurse-manager is mediating a conflict between two nurses on the unit. What goal
should the manager prioritize when addressing this conflict?
a. A solution is chosen that minimizing the effect on other employees.
b. The nurses emerge from the resolution with a close personal relationship.
c. A solution is identified that can be easily and quickly implemented.
d. The nurses agree to a solution that is mutually beneficial.
ANS: D
Feedback: The optimal goal in resolving conflict is creating a win–win solution for all
involved. Speed and ease of implementation are not priority goals and may in fact lead to a
simplistic or hasty solution. It may be necessary for other employees to be affected by a fair
and desirable solution. A win–win solution does not necessarily lead to the development of
a close relationship between the parties.
TOP: Chapter Number: 21: Title: Conflict Management
30. Two nurses in a small community are in conflict because the first nurse’s son committed a
violent assault on the second nurse’s son. In recent weeks, workplace interactions between
the two have become increasingly tense. What is the nurse-manager’s best strategy for
resolving this conflict?
a. Confrontation
b. Soothing
c. Responsibility charting
d. Structure change
ANS: D
Feedback: The manager does not have the ability to mitigate the realities of these nurses’
relationship, and it may be unrealistic to expect them to set aside this significant event. As a
result, it may be necessary for one of the nurses to change work locations. This issue has
nothing to do with roles or responsibilities, so responsibility charting is irrelevant. Soothing
is always a temporary solution. Confrontation has the potential to exacerbate this particular
conflict because there is no solution that changes the facts of their circumstances.

TOP: Chapter Number: 21: Title: Conflict Management
Chapter 22: Collective Bargaining, Unionization, and Employment Laws
1. One of the nurses comes to the manager and reports, “I didn’t receive overtime pay when I
acted as ambulance support last week. Our union contract says that we’re supposed to. Will
you please follow up and see that I get the overtime on my next check?” What is this an
example of?
a. An issue around the implementation of a contract
b. An employee contributing to a toxic workplace setting
c. A formal grievance about a contract
d. A problem that needs to be reported to the director of nursing immediately
ANS: A
Feedback: This example is a unit-level dispute about the terms of a contract. A dispute does
not constitute a toxic work environment. This is not a serious of significant event that must
be reported immediately. A grievance is a formal, written complaint about a specific point
of contract implementation.

TOP: Chapter Number: 22: Title: Unions and Collective Bargaining
2. As a result of downsizing in the 1990s, a nursing surplus appeared in some parts of the
country. What occurs in this type of situation?
a. Nurses tend to join unions to protect their jobs.
b. No change would be expected in the rapid unionization of nurses.
c. There would typically be less union activity by nurses.
d. There is no historical perspective that indicates what nurses would do.
ANS: C
Feedback: In times of nurse surplus, union activity tends to decrease rather than increase
because nurses feel less confident that management would be amenable to nursing demands.

TOP: Chapter Number: 22: Title: Historical Perspective of Unionization in America
3. What event tends to be the primary reason for an increase in the numbers of unions being
formed?
a. Salaries are not keeping pace with the economy.
b. Organizations are insensitive to employees’ needs.
c. There is an economic downturn.
d. Jobs are scarce.
ANS: B
Feedback: One reason that unions are started is to protect workers’ rights against
management that is insensitive to their needs. Although economic issues do play a role, the
primary reason for increased union formation is a more general dissatisfaction among
employees.

TOP: Chapter Number: 22: Title: Historical Perspective of Unionization in America
4. How did the Civil Rights Act of 1964 affect employees?

a. It defined sexual harassment and specified penalties for violation.
b. It allowed veterans to return to jobs they held before their military service.
c. It prohibited job discrimination based on factors unrelated to job qualifications.
d. It eliminated discrimination on the basis of age.
ANS: C
Feedback: The Civil Rights Act of 1964 prohibited job discrimination based on factors
unrelated to job qualifications. It did not address sexual harassment, the rights of veterans,
or age discrimination, however.

TOP: Chapter Number: 22: Title: Civil Rights Act of 1964
5. A nurse has accepted a position in a health-care organization that is a “closed shop.” How
will this characteristic most affect the nurse?
a. There will be a “lockout” that prevents employees from working until a union
contract is signed.
b. Employees are currently refusing to work because of unsettled grievances.
c. The employee will be required to join the union.
d. The employee will have the option of joining a union, usually after a probationary
period.
ANS: C
Feedback: A closed shop, also called a union shop, is characterized by a requirement that all
employees join the union. Lockouts can occur whether or not a closed shop exists. Refusal
to work constitutes a strike, not a closed shop.

TOP: Chapter Number: 22: Title: Common Reasons Nurses Join Unions
6. By contract, employees are to receive overtime pay when their workday exceeds 8 hours. A
staff member attended a mandatory, hospital-sponsored CPR certification class after
working an 8-hour shift. What type of paycheck adjustment can the employee expect?
a. Overtime for the time spent in the class
b. Regular pay for the class because there was no charge for the class
c. No pay for the class because it was identified as mandatory
d. Equal compensated time back during the next pay period
ANS: A
Feedback: The employee should receive overtime for the class because overtime is paid for
“hours worked” over the standard number of hours. “Hours worked” includes all the time an
employee is required to be on duty, including classes, orientation, and conferences.
Mandatory classes are to be considered as time required on duty. Compensated time is not
considered the same as overtime pay.

TOP: Chapter Number: 22: Title: Minimum Wages and Maximum Hours
7. An affirmative action plan has been established in the jurisdiction where a nurse works. The
nurse should understand what characteristic of this program?
a. The terms of the plan are laid out in United States Equal Employment Opportunity
legislation.
b. It aims to prevent workplace discrimination on the basis of age or sexual
orientation.
c. It actively seeks members of underemployed groups to fill job vacancies.
d. Few affirmative action programs still exist because they encourage reverse
discrimination.
ANS: C
Feedback: Affirmative action is legislation that actively seeks underemployed groups to fill
job vacancies. Some individuals claim that affirmative action causes reverse discrimination,
but this contention is not universally accepted and has not led to the demise of these
programs. The terms of such programs are laid out by court decisions, not by United States
Equal Employment Opportunity legislation; this legislation focuses on preventing
discrimination, not promoting opportunity for certain groups. Affirmative action does not
normally focus on discrimination based on age or sexual orientation.

TOP: Chapter Number: 22: Title: Civil Rights Act of 1964
8. A senior manager is ensuring that organizational policies for compensation align with the
Equal Pay Act of 1963. What domains of work should the manager examine? Select all that
apply.
a. The potential for promotion or advancement in the job
b. The working conditions associated with the job
c. The amount of responsibility that the job carries
d. The effort that is required to perform the job
e. The level of job satisfaction associated with the job
f. The skill that is needed to perform the job
ANS: B, C, D, F
Feedback: The Equal Pay Act of 1963 states that employees with jobs that require equal
skill, equal effort, equal responsibility, and similar working conditions must receive equal
pay. The Act did not explicitly address the potential for advancement or the level of job
satisfaction.

TOP: Chapter Number: 22: Title: The Equal Pay Act of 1963
9. Under which circumstance could the manager of an oncology unit deviate from the federal
guidelines for handling chemotherapy agents?
a. The state has instituted a policy that is more restrictive than the federal one.
b. The director of nurses requested more personalized guidelines be put in place.
c. The organization has been accident-free for the last 10 years.
d. The state has a less restrictive policy that supersedes the federal one.
ANS: A
Feedback: If an organization is in a state that has health and safety regulations similar to
those required by the Occupational Health and Safety Act, nurses must comply with
whichever regulations are more stringent. None of the other options allow for disregard of
the federal guidelines.

TOP: Chapter Number: 22: Title: The Occupational Safety and Health Act
10. Which statement concerning the 1967 and 1987 Age Discrimination and Employment Acts
is true?
a. Maximum age restrictions were lifted for almost all job categories.
b. Employees can be forced to retire at age 70 years if their health is poor.
c. Underage minors can be employed up to 20 hours per week.
d. Individuals seeking retirement before the age of 60 years may be exempt from
company pension plans.
ANS: A
Feedback: Under the 1967 and 1987 Age Discrimination and Employment Acts,
employment of older people is protected and is based on their ability rather than their age.
Consequently, retirement cannot normally be forced at age 70 years. This Act does not
address underage minors or exemptions from pension plans.
TOP: Chapter Number: 22: Title: Age Discrimination and Employment Act
11. Which action by the manager is most likely to reduce the incidence of sexual harassment in
the workplace?
a. Limit one-on-one interaction between female and male employees whenever
possible.
b. Encourage workers to confront the “harasser” directly and resolve the conflict.
c. Provide desensitivity training to minimize employee reactions.
d. Actively pursue an investigation of all complaints.
ANS: D
Feedback: The manager must take all incidents of perceived sexual harassment seriously
and actively pursue an investigation of all such complaints. Employees’ knowledge that this
will be the approach is likely to prevent some instances of harassment. The onus should not
be placed on the victim to confront the harasser. Desensitivity training would be a simplistic
and misguided approach. Limiting interaction is also a simplistic approach that would be
impractical in most settings.

TOP: Chapter Number: 22: Title: Sexual Harassment
12. A nurse executive wants to decrease the chances of unionization of the nursing service
department. To accomplish this goal, where should financial and energy resources best be
directed?
a. Publicizing the potential cost and harm of unionization
b. Increasing the quality and amount of equipment available to nurses
c. Implementing a shared decision-making model in the department
d. Emphasizing the identity of nursing as a “helping” profession that prioritizes
others’ needs
ANS: C
Feedback: The use of improved communication, fairness, and shared decision-making tools
will improve job satisfaction and perhaps prevent nursing staff from wanting to join a union.
A negative approach that attempts to dissuade nurses from unionizing may have the
opposite effect. Availability of equipment is likely a minor consideration compared with
nurses’ ability to make professional decisions that affect their work life. It would be
inappropriate to use guilt-based approaches that suggest nurses’ rights are incompatible with
helping others.

TOP: Chapter Number: 22: Title: Integrating Leadership Skills and Management
Functions When Working With Collective Bargaining, Unionization, and Employment
Laws
13. A nurse who provides care at a county hospital is involved in a unionization drive. This
nurse’s right to unionize is enacted in which of the following?
a. Civil Rights Act of 1964
b. Fair Labor Standards Act
c. The Equal Pay Act of 1963
d. Kennedy Executive Order 10988
ANS: D
Feedback: Executive Order 10988 allowed public employees (such as those working at
county hospitals) to join unions. The other listed pieces of legislation did not directly
address the right to unionize.

TOP: Chapter Number: 22: Title: Table 22.1 Legislation Leading to Unionization in
Health Care KEY: Integrated Process: Nursing Process
14. During orientation to a new job, a nurse is reviewing the relevance of labor standards to the
new position. What aspects of the job will these standards affect? Select all that apply.
a. The number of hours that the nurse will work
b. The nurse’s right to a safe workplace
c. The way the nurse’s salary is determined and paid
d. The nurse’s continuing education requirements
e. The nurse’s accountability to his or her supervisor
ANS: A, B, C
Feedback: Labor standards are regulations dealing with the conditions of the employee’s
work, including physical conditions, financial aspects, and the number of hours worked.
Labor standards do not address the specifics of supervision or continuing education.

TOP: Chapter Number: 22: Title: Labor Standards
15. Which members of a private health-care organization have their right to join a union
protected by the National Labor Relations Act (NLRA)? Select all that apply.
a. A registered nurse with 6 months of experience in the organization
b. A licensed practical nurse
c. A first-level manager
d. A registered nurse with 2 years’ experience in the organization
e. A mid-level manager
ANS: A, B, D
Feedback: The NLRA establishes certain protections for private sector employees who want
to form or join a labor union. These protections do not, however, extend to supervisors. As a
result, nurses would hold the right to unionize that managers would most likely not.

TOP: Chapter Number: 22: Title: The Nurse as Supervisor: Eligibility for Protection
Under the National Labor Relations Act KEY: Integrated Process: Nursing Process
16. Why does membership in the American Nurses Association (ANA) pose a conflict in
loyalty for some nurses in management positions?
a. It fails to support male nurses sufficiently.
b. Minorities are not represented on its board of directors.
c. Membership is based on years of nursing experience.
d. It acts as a professional association and a collective bargaining agent.
ANS: D
Feedback: The ANA acts as a professional association for RNs and a collective bargaining
agent. This dual purpose poses a conflict in loyalty to some nurses who work in
management positions. The other options are not true statements.

17. A situation has occurred in a health-care organization where it is important to determine

whether a particular nurse is categorized as a “staff nurse” or as a supervisor. What criterion
should be used to make this differentiation?
a. The nurse’s position in the hierarchy of the unit based on years of experienced
b. The nurse position on the organization’s salary scale
c. The nurse’s level of influence on his or her peers and colleagues
d. The percentage of time that the nurse spends as charge nurse versus giving direct
client care
ANS: D
Feedback: Under current legislation, nurses with less than 10% to 15% (equal to about one
shift per pay period) of their time as charge nurse are considered staff nurses, whereas
nurses working more than 15% of their professional time as charge nurses are considered
supervisors. This differentiation is not based on salary, experience, or interpersonal
influence.

18. Which organizational characteristic is most likely to make the employees view a union as an
appealing option?
a. This organizational mission is perceived as being too broad or ambitious to be
achieved.
b. The organization is perceived as being insensitive to employees’ needs and
well-being.
c. The employees earn less than the average salary of comparable employees in the
region.
d. The organizational mission is insensitive to the population it serves.
ANS: B
Feedback: Management that is perceived to be deaf to the workers’ needs provides a fertile
ground for union organizers because unions thrive in a climate that perceives the
organizational philosophy to be insensitive to the worker. The other options are not believed
to have the influence that insensitivity to employees has.

TOP: Chapter Number: 22: Title: Unions and Collective Bargaining
19. A unionization drive is taking place in a health-care organization. The National Labors
Relations Board (NLRB) requires that what criterion must be met before an election for
unionization can be held?
a. Employees must demonstrate substandard wages or working conditions.
b. At least 30% of the employees must sign an interest card.
c. Management of the organization must give their written approval.
d. A court order must be obtained by the organizers of the union drive.
ANS: B
Feedback: The first step in establishing a union is demonstrating an adequate level of desire
for unionization by the employees. The NLRB requires that at least 30% of employees sign
an interest card before an election for unionization can be held. There is no obligation to
obtain a court order, seek management permission, or demonstrate substandard conditions.

TOP: Chapter Number: 22: Title: Steps to Establish a Union
20. The manager of a hospital unit has heard rumors about a unionization drive for several
weeks and has just learned that the employees on the unit are planning to launch a formal
drive. What is the manager’s best action?
a. Arrange meetings the organizers to independently address the factors that have
prompted the drive.
b. Collaborate with upper management and the personnel department to best address
the workers’ concerns.
c. Apply disciplinary action to the employees who are leading the unionization drive.
d. Strengthen relationships with employees who are known to be skeptical about the
drive.
ANS: B
Feedback: Middle-level and first-level managers should never independently attempt to deal
with union-organizing activity. They should always seek assistance and guidance from
upper management and the personnel department. For this reason, the manager’s best action
is to notify others accordingly.

21. What is the nurse-manager’s initial action when it becomes obvious that the unit will not
meet staffing levels?
a. Ask for volunteers to work overtime.
b. Close the unit to additional admissions.
c. Notify upper level management of the situation.
d. Begin transferring patient to units with lower censuses.
ANS: C
Feedback: If, during times of short staffing, supervisors are unable to meet this level of
staffing, they must communicate this to the upper level management so that there can be a
joint resolution. The other options fail to appropriately address the issue safely.

TOP: Chapter Number: 22: Title: State Health Facilities Licensing Boards
22. A nurse filed a grievance against the employer and the matter has proceeded to arbitration.
What is true about this employee’s grievance?
a. Arbitration is likely the initial step in resolving the grievance.
b. A neutral third party will impose a solution to the grievance.
c. The grievance took place at a public health-care organization.
d. The employer is likely trying to avert a strike.
ANS: B
Feedback: Arbitration is the terminal step in the grievance procedure, where a third party
reviews the grievance, completes fact finding, and reaches a decision. Arbitration is not
limited to public facilities and may or may not be part of a larger effort to avoid a strike.

TOP: Chapter Number: 22: Title: Display 22.2 Collective Bargaining Terminology
23. Which management function (in contrast to leadership role) related to collective bargaining
and unionization should the nurse-manager perform?
a. Examine the work environment periodically to ensure that it is supportive for all
members.
b. Create a work environment that is sensitive to employee needs, reducing the need
for unionization.
c. Actively seek a culturally and ethnically diverse workforce.
d. Understand and appropriately implement union contracts.
ANS: D
Feedback: It is the manager’s role to understand and implement union contracts. The other
options represent leadership roles.

Functions Associated With Collective Bargaining, Unionization, and Employment Laws
24. An organization is attempting to prevent unionization. Which intervention demonstrates the

administration’s lack of understanding regarding employee motivation and satisfaction?
a. Establish a well-developed formal procedure for handling employee grievances.
b. Promote some of the potential union organizers to management positions.
c. Have an effective performance appraisal system in place.
d. Ensure that all managers are well-trained and effective.
ANS: B
Feedback: Practices that have shown effective and that the organization may put in place to
discourage union activity include all the options except promoting potential union
organizers. This is a short-sighted solution that does not address the root causes of worker
dissatisfaction.

TOP: Chapter Number: 22: Title: Display 22.5 Before the Union Comes
25. What aspect of the collective bargaining and unionization process is most likely to present
an ethical dilemma for a nurse?
a. Navigating relationships with managers in the organization
b. Identifying career goals that can be achieved by unionization
c. Deciding whether participating in a strike is appropriate
d. Adhering to the Occupational Safety and Health Act (OSHA)
ANS: C
Feedback: For many nurses, the issues associated with a strike are ethically challenging,
more so than relating to managers, adhering to OSHA guidelines, or identifying career
goals.

TOP: Chapter Number: 22: Title: Common Reasons Nurses Do Not Join Unions
26. A nurse-manager works in a nonunionized medical unit that employs numerous RNs. The
manager can best prevent conditions that would promote a union drive by:
a. rotating the nurses’ work assignments frequently.
b. offering to assist with bedside care during busy times.
c. demonstrating genuine concern for the well-being of the nurses.
d. ensuring that the terms of the current contract are adhered to.
ANS: C
Feedback: Apathy about the interests and well-being of employees is among the most
significant contributors to unionization. Rotating nurses’ work assignments is unlikely to
have an effect of their desire to unionize. Helping with bedside care as permitted and
possible acknowledges the heavy workload of nurses, but this is just one manifestation of
showing concern for their well-being. Adhering to the contract is an essential duty of the
manager that may or may not prevent a union drive.

TOP: Chapter Number: 22: Title: Averting the Union
27. What statement by a nurse most directly reflects a common complaint about the roles of the
American Nurses Association (ANA)?
a. “It doesn’t seem fair that every nurse contributes to the ANA but nurses in only a
few states benefit from it.”
b. “It’s incompatible for the ANA to represent staff nurses and nursing managers at
the same time.”
c. “It doesn’t seem right that the ANA simultaneously tries to advance the nursing
profession while it bargains for nurses’ contracts.”
d. “It could be unethical for the ANA to promote nurses’ rights in a profession that
was founded on helping others.”
ANS: C
Feedback: Some nurses believe that there is a conflict between the ANA’s role as an
advocate for the profession and its activity as a collective bargaining agent. The other
statements do not reflect this potential conflict as it is perceived by some nurses and
members of the public.

TOP: Chapter Number: 22: Title: American Nurses Association and Collective Bargaining
28. Working conditions have deteriorated in recent months at a hospital, and there is a strong
impetus for unionization. As a result, a majority of the nurses have signed interest cards.
What will happen next in the steps to starting a union?
a. A vote on the matter will be held among eligible staff members.
b. A union will be established at the hospital.
c. Management will have the opportunity to respond to the issue.
d. A final decision will be made by the state board of nursing.
ANS: A
Feedback: After a designated number of cards have been generated, the organization is
forced to have an election. At that time, all employees of the same classification, such as
RNs, would vote on whether they desire unionization. Establishment of a union cannot take
place without this step, and progress is not contingent on management’s response. The state
board of nursing does not make decisions around nurses’ unionization.

29. The managers of a clinic have been accused of creating an unpleasant work schedule and
increased workload for a nurse who helped lead an unsuccessful union drive. How should
the managers’ actions be best interpreted?
a. Creating schedules and work assignment are valid management roles.
b. These actions are violations of labor relations law.
c. Management is within its rights but in violation of ethics standards.
d. These actions are criminal offenses.
ANS: B
Feedback: Punishing an employee for union activity is a violation of labor relations law. It is
true that scheduling and work assignment are valid management roles, but it is not permitted
to perform these roles in a punitive manner. These are not criminal matters, and
management is ultimately not within its rights.

TOP: Chapter Number: 22: Title: The Nurse as Supervisor: Eligibility for Protection
Under the National Labor Relations Act KEY: Integrated Process: Nursing Process
30. A nurse has over four decades of work experience and is weighing the benefits of retiring
versus continuing to work. How will the Age Discrimination in Employment Act affect this
nurse?
a. The nurse may continue to work but must forfeit job security.
b. The nurse will be required to retire once he or she turns 70 years.
c. The nurse will be required to retire once he or she turns 65 years.
d. The nurse may retire, or continue to work, as long as he or she is capable of
performing the job.
ANS: D
Feedback: The purpose of the Age Discrimination in Employment Act (ADEA) was to
promote the employment of older people based on their ability rather than age. The ADEA
was amended to increase the protected age to 70 years and then Congress voted to remove
even this age restriction except in certain job categories. This eliminated mandatory
retirement in many cases and continuing to work did not require the forfeiture of job
security.

TOP: Chapter Number: 22: Title: Age Discrimination and Employment Act
Chapter 23: Quality Control
1. A novice nurse-manager is a member of a team that will oversee quality control in a

health-care organization. What action should the nurse and the other members off the team
perform first?
a. Take corrective action to address standards that are known to be challenging.
b. Collect the essential data that will give a general overview of performance data.
c. Determine the specific criteria and standards by which quality will be measured.
d. Assign tasks between the team members to address identified standards.
ANS: C
Feedback: The first step in quality control is to determine criteria and standards. Measuring
performance, assigning tasks, or making corrections is impossible if standards have not been
clearly established.

TOP: Chapter Number: 23: Title: Quality Control as a Systematic Process/FOCUS PDCA
2. An RN is a supervisor in an organization that has total quality management (TQM) as the

basis for its organizational goals and objectives for quality control. How should the RN
practice TQM on the unit?
a. Encourage colleagues to create vision and mission statements.
b. Develop a quota system for number of clients cared for.
c. Explain to the staff that “if it’s not broke, don’t fix it.”
d. Promote teamwork rather than individual accomplishments.
ANS: D
Feedback: In TQM, team efforts are favored over individual accomplishments. Quota
systems and maintaining the status quo work against quality in this philosophy. It is
beneficial for a unit to have a mission and vision statement, but these are not core
components of the TQM philosophy.

TOP: Chapter Number: 23: Title: Total Quality Management
3. A nurse-manager is focusing on management controlling functions that are associated with

quality control. What task best addresses this goal?
a. Periodically evaluating the unit mission and philosophy
b. Creating the daily client care assignments to distribute workload evenly
c. Contributing to the development of the annual budget
d. Distributing staffing policies related to the choice of vacation time
ANS: A
Feedback: Examples of management controlling functions include the periodic evaluation of
unit philosophy, mission, goals, and objectives; the measurement of individual and group
performance against preestablished standards; and the auditing of patient goals and
outcomes. Scheduling and budgeting are less directly related to controlling functions related
to quality control.

4. What task will best allow a health-care organization to benchmark its performance?
a. Comparing its performance on key indicators to its performance the previous year
b. Setting ambitious but realistic goals for the coming year
c. Comparing the organization’s performance with that of best performing
institutions
d. Seeking input from clients and families about the organization’s performance
ANS: C
Feedback: In benchmarking, an organization compares its performance with that of best
performing institutions. Benchmarking is not achieved by comparing with the previous
year’s performance. Seeking input from clients and setting useful goals are valid
components of quality improvement and quality control, but these actions are not part of
benchmarking.

5. Thirty-eight percent of the people who attended a smoking cessation clinic were not
smoking 1 year after completing treatment. What type of audit provided this type of data?
a. Structure
b. Process
c. Outcome
d. Concurrent
ANS: C
Feedback: An outcome audit determines what outcomes resulted from specific nursing
interventions for clients. In a smoking cessation program, abstinence from tobacco would be
desired outcome. This does not meet the criteria for a structure, process, or concurrent
outcome.

TOP: Chapter Number: 23: Title: Outcome Audit
6. High-achieving nursing students were found to have studied in small groups, attended class
100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet
for 1 week before the examination. What type of audit provided data about the students’
preparation?
a. Structure
b. Process
c. Outcome
d. Concurrent
ANS: B
Feedback: A process audit assumes that a relationship exists between the process used and
the quality of the result. The details of the students’ preparation are not an outcome or a
structure. These data are retrospective and not concurrent.

TOP: Chapter Number: 23: Title: Process Audit
7. A nurse-manager is overseeing an organization that uses the Nursing Minimum Data Set
(NMDS). What will the use of the NMDS achieve?
a. Comparing the quality of nursing care and medical care with reference to
standardized data
b. Identifying minimal levels of quality necessary for nurses to maintain licensure
c. Standardizing the collection of nursing data for use by multiple users
d. Identify only “nursing-sensitive” client outcome measures
ANS: C
Feedback: The NMDS standardizes the collection of nursing data for use by multiple data
users. The NMDS is not designed for comparing nursing interventions with medical
interventions, and it does not lay out criteria for licensure. It is not limited to
nursing-sensitive outcome measures.

TOP: Chapter Number: 23: Title: Standardized Nursing Languages
8. What role has The Joint Commission assumed in ensuring quality at the organizational
level?
a. Establishing clinical practice guidelines
b. Reducing diagnosis-related group reimbursement levels
c. Standardizing clinical outcome data collection
d. Assessing monetary fines for organizations that fail to meet standards
ANS: C
Feedback: Under ORYX, The Joint Commission ensures quality at the organizational level
by requiring participating organizations to choose from among 60 acceptable performance
measurement systems. The Joint Commission is not actively involved in any of the other
options.

TOP: Chapter Number: 23: Title: ORYX KEY: Integrated Process: Nursing Process
9. Which of the following would be considered sentinel events that should be reported to The
Joint Commission? Select all that apply.
a. A client with ischemic heart disease dies of a myocardial infarction.
b. A client with dementia falls and suffers a hip fracture while trying to walk to the
bathroom.
c. A client files a formal complaint about the inattention of staff while he was in the
hospital.
d. A client experiences nephrotoxicity and requires dialysis because of a medication
error.
e. A client experiences a transfusion reaction after receiving the wrong type of
packed red blood cells.
ANS: B, D, E
Feedback: Drug errors causing harm, falls causing injury, and blood transfusion reactions
are considered sentinel events. Deaths related to an underlying diagnosis and client
dissatisfaction are not considered sentinel events.
PTS: 1 DIF: Moderate REF: Page: 633, 634

OBJ: 15
TOP: Chapter Number: 23: Title: Sentinel Event Reporting, Display 23.7 Sentinel Events
Identified by The Joint Commission KEY: Integrated Process: Nursing Process
10. Which is a true statement regarding TQM?

a. It is based on the premise that the organization knows what is best for the
consumer.
b. Its guiding purpose is to save the organization money.
c. It recognizes that the customer is the focal element on which production and
service depend.
d. It assumes that inspection and removal of errors lead to the delivery of quality
services.
ANS: C
Feedback: TQM is based on the premise that the customer is the focal element on which
production and service depend and that the customer knows best. The primary focus is on
quality and not cost. The avoidance of errors does not necessarily guarantee high quality.

TOP: Chapter Number: 23: Title: Total Quality Management
11. What action should the nurse-manager and other leaders in the health-care organization
perform in order to ensure that a quality control program will be effective?
a. Set a goal of meeting federal and state standards.
b. Set quality control standards at minimum acceptable levels so the organization will
score well on self-assessment audits.
c. Integrate quality control through all levels of the organizational hierarchy.
d. Focus quality improvement efforts on reacting to problems that have been
identified.
ANS: C
Feedback: For any quality control program to be effective, a belief in the importance of
quality control must be integrated through all levels of the organizational hierarchy. A
proactive approach should be sought rather than just a reactive approach. Meeting minimum
standards (whether imposed or self-identified) will not guarantee high levels of quality.

TOP: Chapter Number: 23: Title: Display 23.1 Hallmarks of Effective Quality Control
Programs KEY: Integrated Process: Nursing Process
12. What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)?
a. The Joint Commission has not updated the HEDIS since 2009.
b. Managed care organizations are not required to collect HEDIS data.
c. Performance indicators are exclusively process focused rather than outcome
focused.
d. HEDIS performance measures focus on medical interventions and do not address
nursing actions.
ANS: B
Feedback: The NCQA, not The Joint Commission, has developed HEDIS. One of the most
significant weaknesses of NCQA accreditation is that such accreditation is voluntary, so
some managed care organizations do not currently undergo such review. The varied
measures are not limited to processes and medical interventions.

TOP: Chapter Number: 23: Title: National Committee for Quality Assurance
13. As part of the quality control, managers have set standards for performance and assessed
whether these standards are being met. It has been determined that several standards are not
being met. What is the priority response to this finding?
a. Release the findings to the public to ensure transparency.
b. Compare the organization’s results to benchmarks.
c. Determine whether similar organizations in the region are experiencing similar
results.
d. Perform interventions that will correct the deficiencies.
ANS: D
Feedback: Applying corrective actions is the essential response to deficiencies revealed in
the quality control process. It is not always necessary or appropriate to disseminate these
findings publicly. Comparison to benchmarks would take place earlier in the quality control
process. Comparison to other similar organizations is not a priority over resolving
deficiencies.

14. What is the best course of action to stimulate broad participation of employees in quality
control efforts?
a. Encourage regular meetings between middle management and upper management.
b. Educate staff about the relationship between the organization’s accreditation and
their own licensure.
c. Engage closely with the frontline staff who provide client care.
d. Educate staff about the correct way to document and report sentinel events.
ANS: C
Feedback: Staff should be involved in determining criteria or standards, reviewing
standards, and collecting data. To encourage broad participation, it is vital for managers and
leaders to engage closely with the frontline staff. This affects more employees than meetings
between upper and middle management. In general, an organization’s accreditation (or lack
thereof) does not affect a nurse’s ability to maintain licensure. Responses to sentinel events
are important but do not promote the wider practice of participating in quality control and
improvement.

TOP: Chapter Number: 23: Title: Who Should Be Involved in Quality Control?
15. A nurse-manager is participating in a hospital’s quality control efforts and is collating data
sources. What data source should the manager identify as a qualitative source?
a. The hospital’s rate of nosocomial infections
b. The hospital’s readmission rate
c. Results of interviews with discharged clients
d. The previous year’s budget for continuing education initiatives
ANS: C
Feedback: Infection rates, spending, and readmission rates are all quantifiable. Interview
data, however, is qualitative in nature.
16. A client was treated in the hospital for a stroke and was the client’s family members assert
that the client was discharged too early and did not receive sufficient rehabilitation. The
client’s early discharge may have been attributable to:
a. the effect of diagnosis-related groups.
b. a sentinel event.
c. the application of total quality management.
d. deliberate malpractice.
ANS: A
Feedback: As a result of DRGs, hospitals became part of the prospective payment system
(PPS), whereby providers are paid a fixed amount per patient admission regardless of the
actual cost to provide the care. This system has been criticized as promoting abbreviated
hospital stays. Early discharge would most likely be incompatible with the principles of
TQM. Deliberate malpractice would be highly unlikely. The client’s early discharge would
only be considered to a sentinel event if it were an overt error.

17. A nurse-manager has referred staff members to a clinical practice guideline (CPG) that
addresses the prevention of pressure ulcers. What is a characteristic of this CPG?
a. The CPG will lay out the criteria that the health-care organization must meet in
order to be reimbursed for treating a client’s pressure ulcer.
b. It will describe interventions for nurses to follow in an effort to provide
evidence-based care.
c. It will describe the treatment for pressure ulcers that is provided at the best
performing organizations.
d. The CPG will summarize the etiology and diagnosis of pressure ulcers.
ANS: B
Feedback: CPGs provide diagnosis-based, step-by-step interventions for nurses to follow in
an effort to promote evidence-based, high-quality care and yet control resource utilization
and costs. They go beyond just describing the etiology and diagnosis of a problem; the focus
is on treatment. Recommendations are based on evidence and not common practices at
high-performing organizations. CPGs do not directly address issues related to
reimbursement.

TOP: Chapter Number: 23: Title: The Development of Standards
18. A nurse-manager is opposing the expansion of the prospective payment system (PPS). What
argument against the PPS should the manager cite?
a. Diagnosis-related groups have caused an increase in health-care costs.
b. The PPS has unnecessarily increased the length of hospital stays.
c. The PPS is linked to increased prices for pharmaceuticals.
d. The PPS has been linked to a decline in the quality of care.
ANS: D
Feedback: Critics of the PPS argue that although DRGs may have helped to contain rising
health-care costs, the associated rapid declines in length of hospital stay and services
provided have resulted in declines in the quality of care.

OBJ: 11
19. A health-care organization has experienced a rise in medical errors and has committed to
implementing Leapfrog initiatives. What aspects of health care should the organization
address? Select all that apply.
a. Expanding the use of computerized physician–provider order entry
b. Increasing the budget for continuing education for nurses
c. Ensuring that hospital referrals are evidence-based
d. Utilizing the National Quality Forum–endorsed Safe Practices scores
e. Ensuring that adequately trained intensive care physicians are easily accessible
ANS: A, C, D, E
Feedback: The Leapfrog Group identified four evidence-based standards that they believe
will provide the greatest impact on reducing medical errors: computerized
physician–provider order entry, evidence-based hospital referral, ICU physician staffing,
and the use of National Quality Forum–endorsed Safe Practices scores. Continuing
education for nurses is not specifically addressed.
PTS: 1 DIF: Moderate REF: Page: 640, 641–642

OBJ: 17
TOP: Chapter Number: 23: Title: The Leapfrog Group, Table 23.1 Evidence-Based
Leapfrog Initiatives KEY: Integrated Process: Nursing Process
20. Which practice has the U.S. Food and Drug Administration (FDA) suggested in order to
decrease the risk of medication errors?
a. Computerized order entry with a drug bar code system
b. Medications automatically dispensed to clients at predetermined times
c. Use of medication nurses to administer all ordered medications
d. Have clients’ medications secured at the bedside for self-administration
ANS: A
Feedback: The FDA has suggested that a drug bar code system coupled with a computerized
order entry system would greatly decrease the risk of medication errors. The FDA has not
promoted automatic distribution or the use of dedicated medication nurses. Storing
medications at clients’ bedsides is unsafe.

TOP: Chapter Number: 23: Title: The Leapfrog Group
21. When creating a clinical practice guideline for the management of aggressive behavior on a
mental health unit, the nursing committee should perform what action first?
a. Interviewing senior staff for practice suggestions
b. Conducting a search of the literature for research results
c. Reviewing client satisfaction data to identify the unit’s strengths and weaknesses
d. Educating all unit nursing staff on the need to adhere to established guidelines
ANS: B
Feedback: Clinical practice guidelines reflect evidence-based practice; that is, they should
be based on cutting-edge research and best practices. The other options may be helpful but
should occur after the review of the research literature.

TOP: Chapter Number: 23: Title: The Development of Standards
22. The nurse is admitting a new client and is reviewing the results of the medication
reconciliation. What data will be included in the client’s medication reconciliation? Select
all that apply.
a. The medications that the client was taking prior to admission
b. The client’s expectations for treatment with medications during admission
c. The client’s medication administration record from any previous admissions
d. The results of the nurse-manager’s review of the client’s treatment plan
e. The list of medications the client has been prescribed by the admitting physician
ANS: A, E
Feedback: Medication reconciliation is the process of comparing the medications a patient is
taking (or should be taking) with newly ordered medications. It does not involve a
manager’s review of treatment, the client’s expectations, or medications from previous
admissions.

TOP: Chapter Number: 23: Title: Medication Reconciliation
23. In order to improve the likelihood that errors in the health-care system will be reported,
nurse-managers should:
a. give professionals the choice of whether or not to report errors.
b. establish firm and meaningful punishments for staff who commit an error.
c. assign “safety officers” whose exclusive role is to monitor for, identify, and follow
up errors.
d. foster a climate where analysis of errors is not solely focused on blame.
ANS: D
Feedback: A just culture avoids focusing solely on blame and punishment while still
promoting accountability. Errors should always be reported in some manner, and the use of
“safety officers” has not been broadly advocated.

TOP: Chapter Number: 23: Title: Reporting and Analyzing Errors in a Just Culture
24. During a quality improvement initiative, the leadership of a health-care organization has
worked with senior managers to implement the principles of Lean Manufacturing. This
initiative will focus on what factor?
a. Identifying sentinel events
b. Identifying and preventing waste
c. Engaging all staff members
d. Performing root cause analysis of errors
ANS: B
Feedback: The main focus in Lean Manufacturing is the removal of waste from a value
stream. It does not focus on sentinel events, staff engagement, or root cause analysis of
errors.

TOP: Chapter Number: 23: Title: Six Sigma Approach and Lean Manufacturing
25. Which action is associated with the nursing leadership role in quality improvement?
a. Inspiring staff to establish and maintain high standards regarding patient care
b. Being aware of the changes in quality control regulations
c. Reviewing research results upon which to base changes
d. Identifying outcomes that support quality nursing care
ANS: A
Feedback: Inspiring subordinates to establish and achieve high standards of care is a
leadership skill. The remaining options are management roles.
Functions With Quality Control KEY: Integrated
26. As part of a quality improvement initiative, administrators are conducting outcomes analysis
and have included nursing-sensitive outcome measures. These outcome measures will:
a. highlight the aspects of nursing that are contentious or controversial.
b. cause the quality improvement process to prioritize nurses over other providers.
c. separate out the unique contributions that nurses make to client outcomes.
d. require other members of the health-care team to rate nurses’ contributions.
ANS: C
Feedback: There is growing recognition that it is possible to separate the contribution of
nursing to the patient’s outcome; this recognition of outcomes that are nursing-sensitive
creates accountability for nurses as professionals and is important in developing nursing as a
profession. This does not focus on controversial issues or prioritize nursing interests over
others in the overall quality improvement process. This does not require other providers to
“rate” nurses.

27. A hospital system is trying to address some of the deficits in care that were described in To
Err Is Human. When addressing the errors that this report identified, the hospital’s leaders
should focus on what factor?
a. Systemic flaws in health-care delivery
b. Malice on the part of some health-care providers
c. Lack of education for health-care workers
d. Increased use of nursing assistive personnel
ANS: A
Feedback: This IOM report concluded that most errors did not occur from individual
recklessness. Instead, they occurred because of basic flaws in the way that the health
delivery system is organized and delivered. This report did not highlight lack of education,
use of NAP, or malice.

TOP: Chapter Number: 23: Title: Medical Errors: An Ongoing Threat to Quality of Care
28. A hospital is using the guidelines of the Leapfrog Group to inform safety improvements in
the organization. What action will best incorporate these guidelines?
a. Replacing practical nurses with registered nurses whenever possible
b. Eliminating the use of high-risk medications and increasing the role of pharmacists
c. Purchasing a computerized physician–provider order entry system
d. Converting shared rooms to single-occupant rooms
ANS: C
Feedback: The use of computerized order entry is one of the Leapfrog Group’s four key
recommendations. These guidelines do not address the nursing skills mix, single-occupant
rooms, or the use of high-risk medications.

TOP: Chapter Number: 23: Title: The Leapfrog Group
29. A nurse-manager and several colleagues are reviewing the results of the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) survey. These results will
allow the team to make what assessment?
a. The root causes of adverse incidents
b. Clients’ perspectives on the care they received
c. Consumers’ health outcomes at 3 and 6 months after discharge
d. Clients’ health status at admission versus at discharge
ANS: B
Feedback: HCAHPS is a publicly reported survey of clients’ perspectives of hospital care.
These surveys do not address adverse incidents or clients’ objective health outcomes.

TOP: Chapter Number: 23: Title: Hospital Consumer Assessment of Healthcare Providers
and Systems Survey KEY: Integrated Process: Nursing Process
30. What piece of data should the nurse-manager include in an outcome audit?
a. Nursing handoffs occur at the client’s bedside and include family input.
b. Client–nurse ratios are capped at 3:1 in the day and 4:1 at night.
c. Technology is acquired so documentation can be completed at the bedside.
d. At discharge, a client was able to ambulate 40 feet unassisted.
ANS: D
Feedback: A particular client’s change in health status is an outcome. The other responses
address the structure and process of care.

Chapter 24: Performance Appraisal
1. What should the manager do in completing an annual performance appraisal?

a. Consider the employee’s good intentions as well as actual performance.
b. Base the appraisal on a standard to which all are held accountable.
c. Prioritize subjective data over objective data whenever possible.
d. Closely observe the employee for several days preceding the appraisal conference.
ANS: B
Feedback: For an objective appraisal, the manager must have a fair performance appraisal
tool that is used for all employees in the same classification. Objective data is valued over
subjective data, and the employee’s actions matter more than intentions. Appraisal should be
based on data gathered over time, not solely a condensed period of scrutiny.

2. The nurse-manager recognizes that performance appraisals can be intense and wants to
make sure that the process will have a positive outcome for employees. What action best
promotes this goal?
a. The manager refrains from making any specific comments about employees’
performance.
b. Each employee is required to identify three areas of satisfactory performance.
c. The employees provide input into developing the performance standards.
d. The manager identifies no more than three areas of deficient performance for each
employee.
ANS: C
Feedback: If the employee has some input into developing the standards or goals on which
his or her performance is judged, there is more of a chance that the appraisal will have a
positive outcome. Appraisals must be specific in order to have value, and it is unrealistic to
places “caps” on the number of deficiencies or employees’ input.

TOP: Chapter Number: 24: Title: Display 24.2 Factors Influencing Effective Performance
Appraisal KEY: Integrated Process: Nursing Process
3. What action should the manager take to arrive at a more fair and accurate assessment during
performance appraisals?
a. Written anecdotal notes regarding the employee’s performance should be
maintained throughout the evaluation period.
b. Evaluation criteria that reflect on the employee as a person rather than just on work
performance should be used.
c. Data gathered by the manager in preparation for the performance appraisal should
be limited to not more than two sources, so no conflicting information is received.
d. The manager should rate all employees using central tendency whenever possible.
ANS: A
Feedback: Because a manager will tend to remember an employee’s performance better in
the weeks or months directly preceding the appraisal, a manager should take notes on an
employee’s performance throughout the year. Appraisal should address work performance,
not the employee’s personal identity or character. Multiple sources reduce subjectivity. The
manager who falls into the central tendency trap is hesitant to risk true assessment and
therefore rates all employees as average.

TOP: Chapter Number: 24: Title: Strategies to Ensure Accuracy and Fairness in the
Performance Appraisal KEY: Integrated Process: Nursing Process
4. Which principle should guide the manager’s use of self-appraisals for employees?
a. Self-appraisal is known to be more objective than the other types of appraisal.
b. Self-appraisals are intended to provide an opportunity for giving positive feedback
to employees.
c. Self-appraisals usually require reflection and introspection on the part of the
employee.
d. Self-appraisals should always be read before the supervisor does an appraisal.
ANS: C
Feedback: Although they require some work on the employees’ part, self-appraisals can
provide introspection and personal growth. This type of appraisal is inherently subjective
and self-appraisal is not focused exclusively on providing positive feedback. Reading an
employee’s self-appraisal has the potential to create bias, so some managers avoid reading
them beforehand.

TOP: Chapter Number: 24: Title: Self-Appraisals
5. The leadership of a large health-care organization is considering the adoption of

Behaviorally Anchored Rating Scales (BARS) for the performance appraisal system. This
change in practice may require what task by the nurse-manager?
a. Conducting performance appraisals of employees that he or she has little
interaction with
b. Helping develop a separate rating form for each job classification
c. Conducting performance appraisals that focus on personal traits rather than
performance of duties
d. Creating a template for performance appraisal that can be completed without
face-to-face interaction between the supervisor and employee
ANS: B
Feedback: Because separate BARS are needed for each job, the greatest disadvantage in
using this tool with large numbers of employees is the time and expense. BARS do not
require that appraisers and employees not know each other or avoid face-to-face contact.
BARS focus on behaviors, not personality traits.

TOP: Chapter Number: 24: Title: Behaviorally Anchored Rating Scales
6. Which statement correctly describes using self-appraisal as a performance appraisal tool?

a. It should be unstructured so employees can write about whatever they believe is
important.
b. It is as effective as other methods because most professional nurses are self-aware
and rate themselves accurately.
c. It works best when used in conjunction with other appraisal tools rather than in
isolation.
d. It relieves the manager of the responsibility for preparing the performance
appraisal.
ANS: C
Feedback: Because employees cannot be objective concerning their own performance, a
self-appraisal is most effective when used in conjunction with other appraisal tools. A
self-appraisal should be structured, and it does not relieve the manager’s responsibility for
thoughtful, thorough appraisals.

TOP: Chapter Number: 24: Title: Self-Appraisals
7. Following much debate, a health-care organization has adopted a system of peer review for
the first time. How can the success of this system be best promoted?
a. Ensure that employees are not made aware of the peer who completed his or her
review.
b. Require that personal and professional relationships not influence reviews.
c. Orient employees thoroughly to the purpose and process of the new system.
d. Have members of other health disciplines perform nurses’ reviews and have nurses
review members of other disciplines.
ANS: C
Feedback: Peer review is effective only when adequate time is spent orienting staff to the
process and the necessary support is provided to complete the process. Peer review occurs
between members of the same discipline. The use anonymity is controversial and is not
universally practiced. It is unrealistic to declare that individuals set aside relationships,
history, and interactions when performing a review.

TOP: Chapter Number: 24: Title: Peer Review
8. An employee believes that the performance appraisal was unfairly influenced by a drug
error that the employee committed several weeks ago. The employee states, “The manager
focused almost exclusively on this one mistake, and that event characterized my entire
appraisal.” This employee may have experienced what phenomenon?
a. A halo effect
b. A horns effect
c. Central tendency
d. A job dimension scale
ANS: B
Feedback: Data should be gathered from many different sources and must reflect the entire
time period of the appraisal to avoid the horns effect, which is when some negative aspect of
an employee’s performance unduly influences all other aspects of his or her performance.
The halo effect exists when one positive event overshadows other aspects of performance.
Defaulting to central tendency exists when managers rate all employees as being average. A
job dimension scale is a form of objective appraisal tool.

9. A nurse-manager is using management by objectives (MBO) as a performance appraisal

tool. When using this form of performance appraisal, the manager should:
a. determine the objectives each employee should accomplish during the upcoming
evaluation period.
b. delegate the performance appraisal process to senior employees.
c. support employees to help them reach mutually identified goals.
d. set highly challenging goals in an effort to stretch the employees to their full
potential.
ANS: C
Feedback: MBO is in use when the manager supports employees to reach goals they identify
for themselves. Goals are not unilaterally imposed by the manager in this system nor is
performance appraisal delegated. MBO does not require that exceptionally difficult goals be
set.

TOP: Chapter Number: 24: Title: Management by Objectives
10. An employee has had a performance appraisal and signed the appraisal form at the
conclusion of the meeting with the manager. What does the employee’s signature denote?
a. The employee agrees with everything written on the form.
b. The employee accepts the goals specified on the form.
c. The employee acknowledges the truth of the manager’s evidence.
d. The employee has read the appraisal information and met with the manager.
ANS: D
Feedback: The employee’s signature on the performance appraisal form denotes that the
employee has received and read the appraisal information. The signature does not mean that
the employee agrees with or disagrees with the appraisal.

TOP: Chapter Number: 24: Title: After the Interview
11. Which is the manager’s best example of coaching used to encourage and improve an
employee’s daily work performance?
a. “I want to tell you how to become a better nurse.”
b. “Did you enjoy working as team leader this weekend? Having you in that role
would greatly reduce my workload.”
c. “Would you consider taking on the role of preceptor?”
d. “I’d like to help you become more assertive when communicating with physicians
during care conferences.”
ANS: C
Feedback: For coaching to be effective, it must be specific, not self-serving, directed toward
behavior that can be changed, well timed, and understood by the employee. When the
manager identifies a specific need (assertiveness) in a specific context (care conferences
with physicians), it meets these criteria. Focusing on the manager’s workload is self-serving.
Asking the employee to act as a preceptor without elaborating leaves the manager’s motive,
meaning, and intent unclear. Saying, “I want to tell you how to become a better nurse” is
vague and disheartening for the employee.

TOP: Chapter Number: 24: Title: Becoming an Effective Coach
12. In order to adhere with the recommendations of The Joint Commission (TJC) around
employee performance appraisals, the manager should:
a. conduct appraisals at least every 6 months and more often with new employees.
b. ensure the appraisal is based on employee job descriptions.
c. ensure there is a witness present when conducting an employee’s appraisal.
d. base appraisals on employees’ personal goals.
ANS: B
Feedback: TJC advocates that employee performance appraisals be based on employee job
descriptions. TJC does not mandate appraisal every 6 months or the presence of witnesses.
TJC does not specify that employees’ personal goals form the basis of appraisals.

TOP: Chapter Number: 24: Title: Performance Appraisal Tools
13. A nurse-manager is planning a performance appraisal of an employee who has a number of

performance deficiencies. What is the best approach to the performance appraisal of this
employee?
a. Tell the employee that he or she is not performing well and ask the employee
where improvement is needed.
b. Prepare a list of the employee’s deficiencies and give him or her time to look it
over before asking for a response.
c. Acknowledge the employee’s strengths, focus on the key deficiencies, and create a
long-term coaching plan.
d. Tell the employee that he or she is liked as a person but is not meeting the
requirements for the job and will need to brush up on skills during the next year.
ANS: C
Feedback: An employee who is overwhelmed with negative feedback during the
performance appraisal cannot grow as a result of the appraisal. The manager should
recognize the employee’s strengths, focus on the key deficiencies, and create a long-term
coaching plan. Vague approaches (“ . . . not performing well”; “ . . . not meeting the
requirements”) are generally not beneficial.

TOP: Chapter Number: 24: Title: During the Interview
14. The nurse-manager is preparing for the unit ward clerk’s annual evaluation and sends out a
short questionnaire requesting feedback on the ward clerk’s job effectiveness in her job. The
nurse-manager sent the request to one doctor who uses the unit frequently, to a staff nurse
on each shift, to the housekeeping department head, and to the head of the volunteer
program. In addition, the nurse-manager interviews three clients to determine how courteous
the ward clerk is when answering call lights from the unit desk. What is this an example of?
a. Peer review
b. A 360-degree evaluation
c. An overreaching performance review
d. An anecdotal performance review
ANS: B
Feedback: Seeking feedback from patients, staff, and other departments who interact with an
employee to determine his or her effectiveness in his or her job is called a 360-degree
evaluation. None of the other options are associated with the scenario described.
TOP: Chapter Number: 24: Title: The 360-Degree Evaluation
15. A nurse-manager is preparing to perform a 360-degree evaluation of a nurse on the unit.

What is the manager’s best action when preparing to do this type of evaluation?
a. Compare the nurse’s personality traits with his or her behaviors on the unit.
b. Ask the nurse to prepare a self-evaluation that focuses on each area of the job
description.
c. Give the nurse at least 10 days’ notice to write an essay before the appraisals.
d. Take action to protect the nurse’s right to confidentiality.
ANS: D
Feedback: The most challenging aspect of the 360-degree evaluation typically is the
evaluators’ concerns about confidentiality. This concern must be proactively addressed by
the manager. This type of evaluation is not essay-based, and it does not focus on personality
traits or self-evaluation.

TOP: Chapter Number: 24: Title: The 360-Degree Evaluation
16. The performance appraisal system in a health-care organization has been replaced by
performance management. Under this new system, the nurse-manager should perform what
actions? Select all that apply.
a. Work with employees to set performance goals.
b. Hold frequent, informal evaluations with employees.
c. Delegate performance appraisal to experienced employees.
d. Provide leadership training to employees.
e. Provide coaching to employees on an ongoing basis.
ANS: A, D, E
Feedback: In performance management, appraisals are eliminated. Instead, the manager
places his or her efforts into ongoing coaching, mutual goal setting, and the leadership
training of subordinates. This model does not include informal evaluations or the delegation
of performance appraisal.

TOP: Chapter Number: 24: Title: Performance Management
17. A focus group has been organized so that employees can give feedback on their manager’s
work performance. What characteristic of the focus group will best ensure a productive and
positive process?
a. Hold the focus group off of the organization’s property to ensure confidentiality.
b. Have an impartial employee relations officer facilitate the discussion.
c. Provide a monetary bonus for employees who participate.
d. Limit the focus group to employees who have at least 2 years of experience on the
unit.
ANS: B
Feedback: When focus groups are used, an experience qualified employee relations
specialist facilitates the discussion so that it does not dissolve into a gripe session. Paying
employees for their feedback may be ethically problematic, depending on the circumstances.
Excluding new employees would be inappropriate, and there is no reason to hold the focus
group off of the organization’s property.

TOP: Chapter Number: 24: Title: When Employees Appraise Their Manager's
Performance KEY: Integrated Process: Nursing Process
18. The nurse-manager is taking action to avoid the recency effect when conducting employees’
performance appraisals. What is the manager’s best action?
a. Avoid conducting performance appraisals more than once per year.
b. Avoid conducting performance appraisals more than every 18 months.
c. Keep ongoing notes on each employee’s performance.
d. Ask for employees’ feedback on their performance appraisals immediately after
they are completed.
ANS: C
Feedback: Taking regular notes on employee performance is a way to avoid the recency
effect, which favors appraisal of recent performance over less recent performance during the
evaluation period. This effect is not the result of frequent appraisals, and asking for
employee feedback does not address it.

19. The nurse-manager is completing a competence assessment of an unlicensed care provider

(UAP) on the unit. What components should the manager evaluate? Select all that apply.
a. The UAP’s knowledge level for giving care
b. The UAP’s skill level
c. The UAP’s completion of assigned tasks
d. The UAP’s personality traits
e. The UAP’s career aspirations
ANS: A, B
Feedback: A competence assessment evaluates whether an individual has the knowledge
and skills to perform the task, whereas a performance evaluation examines how well that
individual actually completes that task. Competence assessment does not address
personality or career aspirations.

20. A job dimension scale will be used to appraise the performance of clinic staff. In order to
apply this tool correctly, what is needed?
a. Knowledge of each employee’s personality type
b. A neutral, third party to interview the client
c. Personal experience with the same job as the employee
d. A detailed job description for each employee
ANS: D
Feedback: Job dimension scales require that a rating scale be constructed for each job
classification. For this reason, it is necessary to have full job descriptions for each
employee. There is no need for the manager to have personal experience doing the
employee’s job, and there is no need for a third party. Personality traits are not a component
of this assessment.

TOP: Chapter Number: 24: Title: Job Dimension Scales
21. What action should the nurse-manager perform to increase the likelihood that performance
appraisals will motivate employees and be seen as fair?
a. Reflect carefully on his or her own biases and values and their possible effect on
appraisals.
b. Offer rewards to employees who have the best performance appraisals.
c. Avoid getting to know employees on an individual level to ensure objectivity.
d. Include no more than one deficiency in an employee’s appraisal.
ANS: A
Feedback: The appraiser should develop an awareness of his or her own biases, values, and
prejudices in order to promote fair appraisals that motivate employees. Appraisals should
not be construed as being competitive, with high-performing employees receiving rewards.
It is appropriate and important for the manager to get to know employees as individuals.
Limiting an appraisal to one deficit would greatly reduce the validity and usefulness of a
performance appraisal.

22. What factor contributes most to a performance appraisal being viewed as valid and relevant
by the employees?
a. The ratio of deficiencies to strengths containing in the appraisal
b. Belief that it is based on the performance of job description–related tasks
c. The perception that the manager truly likes and approves of them personally
d. The formality with which the appraisal is conducted and presented
ANS: B
Feedback: If employees believe that the appraisal is based on their job description rather
than on whether the manager approves of them, they are more likely to view the appraisal as
relevant. Formality is not a major factor, and the appropriateness in the number of strengths
and deficiencies is specific to each employee.

TOP: Chapter Number: 24: Title: Using the Performance Appraisal to Motivate Employees
23. What goal should the nurse-manager prioritize when preparing performance appraisals?
a. Promotion of employee growth
b. Compliance with institutional policies and legal regulations
c. Identification of ineffective staff
d. Providing a basis for staff wage increases
ANS: A
Feedback: A performance appraisal wastes time if it is merely an excuse to satisfy
regulations and the goal is not employee growth. None of the remaining options express the
goal of a performance appraisal.

24. Which factor should the nurse-manager prioritize when writing an employee’s performance
evaluation?
a. Knowledge level
b. Individual skills related to providing care
c. The employee’s level of experience
d. History of completing required tasks
ANS: D
Feedback: A competence assessment evaluates whether an individual has the knowledge,
education, skills, or experience to perform the task, whereas a performance evaluation
examines how well that individual actually completes that task.

25. An inexperienced nurse-manager has provided vague and ambiguous feedback to an

employee during a performance appraisal. What is the most likely outcome of this practice?
a. The employee receives the information in a positive manner.
b. The manager is able to avoid the appearance of being too negative.
c. The employee is uncertain of the value of the feedback.
d. The manager is viewed as being an ineffective communicator.
ANS: C
Feedback: Indirectness and ambiguity are more likely to inhibit communication than
enhance it, and the employee is left unsure about the significance of the message. The
employee is not likely to feel positive about the process. When the feedback is presented
appropriately, the manager will not be viewed as too negative but rather honest and helpful.

TOP: Chapter Number: 24: Title: During the Interview
26. One of the experienced nurses on a unit frequently approaches the manager to provide
feedback on a recently hired nurse’s performance. When preparing the new nurse’s
performance appraisal, how should the manager integrate the experienced nurse’s feedback?
a. Ask the experienced nurse to put the feedback in writing so that it can be included
in the new nurse’s performance appraisal.
b. Disregard the nurse’s feedback because it is likely that the nurse has ulterior
motives.
c. Consider the nurse’s feedback but supplement it extensively with data from several
other sources.
d. Educate the experienced nurse about the fact that performance appraisal is the
manager’s exclusive responsibility.
ANS: C
Feedback: It is essential for the manager to collect data from multiple sources in order to
promote objectivity. The experienced nurse’s input should not be wholly rejected but neither
should it be prioritized over other sources.

TOP: Chapter Number: 24: Title: Leadership Skills and Management Functions in
Conducting Performance Appraisals KEY: Integrated Process: Nursing Process
27. The nurse-manager has received a memo from the director of human resources stating that
the organization will be adopting a performance management system. The manager should
recognize what implication of this announcement?
a. The manager will likely be assigned a coach from outside the work unit.
b. The results of employees’ performance appraisals will be available to their peers.
c. Annual performance reviews will likely be discontinued.
d. Managers will now be appraised by their subordinates.
ANS: C
Feedback: In performance management, appraisals are eliminated, and the manager places
his or her efforts into ongoing coaching, mutual goal setting, and the leadership training of
subordinates. This system does not involve the assignment of coaches, public dissemination
of results, or appraisal of manager by subordinates.

TOP: Chapter Number: 24: Title: Performance Management
28. Which employee is most likely experiencing the Matthew effect in his or her performance
appraisal?
a. A nurse whose performance appraisal describes nearly twice as many deficiencies
as strengths
b. A nurse whose overall appraisal has benefited from his occasional willingness to
work overtime when no other nurse is willing
c. A nurse who was caught calling in sick to go shopping and who believes this event
tainted her overall appraisal
d. A nurse whose performance appraisal has included the same points for several
consecutive years
ANS: D
Feedback: The Matthew effect is said to occur when employees receive the same appraisal
results, year after year. This effect does not involve a mismatch between the number of
strengths and the number of deficiencies. A nurse who was caught calling in sick to go
shopping and who believes this event tainted her overall appraisal may be experiencing the
horns effect. A nurse whose overall appraisal has benefited from his occasional willingness
to work overtime when no other nurse is willing may be experiencing the halo effect.

29. An inexperienced nurse-manager has been excessively favorable to employees in their

performance appraisals in an effort to garner their approval and acceptance. This strategy is
likely to lead to what unintended consequence?
a. Employees will be unable to gauge their improvements in subsequent years.
b. Employees will be less likely to approve of the manager.
c. The manager’s ability to gather performance data in subsequent years will be
reduced.
d. The manager’s more experienced peers may adopt the same approach.
ANS: A
Feedback: If employees’ appraisals are excessively positive, they risk “hitting a ceiling”
where there is no possibility of documenting future growth. In the short term, this strategy
may bring approval, but it is unsustainable and counterproductive in the longer term. It is
less likely to affect the data-gathering process, and more experienced managers are unlikely
to emulate this short-sighted approach.

30. The nurse-manager will be using management by objectives (MBO) to appraise employees’
performance. When using MBO, the manager should:
a. finalize a list of the employee’s performance outcomes before the initial meeting
with the employee.
b. coach and support the employee in an effort to help the employee meet goals and
outcomes.
c. clearly describe the negative consequences if the employee does not meet
performance targets.
d. prioritize the role of personality type and personal traits in appraisal.
ANS: B
Feedback: With MBO, the manager’s role is supportive, assisting the employee to reach
goals by coaching and counseling. Goals and outcomes are identified collaboratively, and it
does not involve a punitive approach. MBO focuses on outcomes and results and not on
personal traits.

TOP: Chapter Number: 24: Title: Management by Objectives
Chapter 25: Problem Employees: Rule Breakers, Marginal Employees, and the
Chemically or Psychologically Impaired
1. A nurse-manager needs to discipline an employee and wants to ensure that it leads to

constructive outcomes. What is the primary difference between constructive and destructive
discipline?
a. The manager is more empathetic to the employee in constructive discipline than in
destructive discipline, so that their relationship becomes closer.
b. Constructive discipline excludes punishment, but destructive discipline is primarily
focused on punishment.
c. The person who has received constructive discipline always appreciates it, whereas
destructive discipline is always resented.
d. Constructive discipline helps the person grow to meet organizational goals;
destructive discipline focuses more on punishment.
ANS: D
Feedback: Constructive discipline focuses on helping the employee grow. Punishment can
be included in constructive discipline, but it is the near-exclusive focus in destructive
discipline. The difference between the two is not based on the presence or absence of
empathy. Even if properly applied, there is no guarantee that an employee will appreciate
constructive discipline.

TOP: Chapter Number: 25: Title: Constructive Versus Destructive Discipline
2. How can the nurse-manager best promote the development of self-discipline in employees?
a. Eliminate punishment from the unit’s culture and procedures.
b. Allow employees full autonomy in choosing tasks and the means for carrying out
those tasks.
c. Clearly communicate expectations, rules, and policies to employees.
d. Hire employees who have a history of being compliant and collaborative.
ANS: C
Feedback: The highest level and most effective form of discipline is self-discipline. When
employees know expectations, rules, policies, and procedures, self-discipline is enhanced.
The presence of self-discipline does not wholly eliminate the possibility of punishment.
Granting employees full autonomy erodes the sense of structure and boundaries that
promotes self-discipline. There is no guarantee that employees who are compliant will
possess high levels of self-discipline.

TOP: Chapter Number: 25: Title: Self-Discipline and Group Norms
3. The nurse-manager is updating the unit rules and is trying to ensure that they are fair and
effective. What actions should the manager perform? Select all that apply.
a. Make sure all employees know that rule violations will result in discipline.
b. Avoid issuing more than two warnings before an employee’s rule violations are
punished.
c. Maximize the number of rules and regulations so employees are clear about
expectations.
d. Make sure that discipline for rule violations is consistent and impartial.
e. Administer discipline as soon as possible after a rule is broken.
ANS: A, D, E
Feedback: Forewarning, consistency, and immediacy are characteristics of effective rules.
An organization can have too many rules, making enforcement very difficult. Giving
repeated warnings before administering discipline devalues a rule.

TOP: Chapter Number: 25: Title: Fair and Effective Rules
4. The nurse-manager is initiating the process of progressive discipline in response to an

employee’s tardiness. The manager should:
a. write a brief letter of warning to the employee without providing a copy to the
personnel department.
b. write a brief letter of warning to the employee and send a copy to the personnel
department.
c. avoid confronting the employee but observe the employee’s behavior closely in the
near future.
d. privately administer a verbal reprimand to the employee.
ANS: D
Feedback: The first step of the progressive disciplinary process is an informal reprimand or
verbal warning. This reprimand is followed by a formal reprimand or written warning when
the behavior has not been changed. Progressive discipline begins with a direct warning, not
just further observation.

TOP: Chapter Number: 25: Title: Discipline as a Progressive Process
5. An employee is found to have grossly mistreated a client, which the employee has never
done before. What consequence should be administered to the employee?
a. Suspension with pay
b. Suspension without pay
c. Termination
d. Written admonishment
ANS: C
Feedback: For a first infraction of gross mistreatment of a client, the most appropriate level
of employee discipline would probably be termination. The organization’s first
responsibility is in the protection of patients.

TOP: Chapter Number: 25: Title: Table 25.1 Guide to Progressive Discipline
6. What action should the nurse-manager perform when preparing for and conducting a
disciplinary conference?
a. Soften criticisms to reduce the employee’s defensiveness and emotional response.
b. Schedule the conference in advance at a time agreeable to both the employee and
the manager.
c. Ask a small number of trusted employees to join the conference so it can be used
as a teaching tool.
d. Adopt a nurturing and counseling role to ensure the conference ends on a positive
note.
ANS: B
Feedback: All formal disciplinary conferences should be scheduled in advance at a time
agreeable to both the employee and the manager. The manager should be clear and assertive,
not softening necessary criticisms. Privacy must be ensured, and it is inappropriate for the
manager to adopt a nurturing or counseling role.

TOP: Chapter Number: 25: Title: Timing and Conference Length
7. The nurse-manager is preparing to terminate an employee for continuous rule breaking.

What is the manager’s best action?
a. Arrange for the employee to be escorted from the building by security staff.
b. Collaborate with the employee to work out a 2-week termination period.
c. Describe what, if any, references will be supplied to future employers.
d. Arrange for a meeting between the employee and senior administration.
ANS: C
Feedback: When a manager terminates an employee for continuous rule breaking, the
manager should tell the employee what, if any, references will be supplied to future
employers. Security should become involved only if there is a plausible security risk. It is
usually best to allow the employee who has been dismissed to leave the organization
immediately. If the employee continues to work on the unit after dismissal has been
discussed, it can be demoralizing for all the employees who work on that unit.

TOP: Chapter Number: 25: Title: The Termination Conference
8. Which statement is accurate when describing performance deficiency coaching?

a. It is less spontaneous and requires more planning than ongoing coaching.
b. It is a one-time way of solving problems.
c. It requires the manager to assume the role of enforcer rather than supporter or
enabler.
d. It occurs as a component of an employee’s annual performance appraisal.
ANS: A
Feedback: This form of coaching is less spontaneous and requires more managerial planning
than ongoing coaching. In performance deficiency coaching, the manager actively brings
areas of unacceptable behavior or performance to the attention of the employee and works
with him or her to establish a plan to correct deficiencies. This activity could not be
compressed into the time of a performance appraisal.

TOP: Chapter Number: 25: Title: Performance Deficiency Coaching
9. The nurse-manager is working in a unionized health-care organization. When administering

discipline to employees, the manager should:
a. communicate with the union’s attorneys rather than directly with employees.
b. defer to the organization’s personnel department rather than administering
discipline directly.
c. assist employees with filing grievances.
d. follow specific steps and penalties within an established time frame.
ANS: D
Feedback: Unionized employees must generally be disciplined according to specific,
preestablished steps and penalties within an established time frame. This does not normally
mean that the manager must liaise with an attorney or defer to the centralized personnel
department. It is not the nurse-manager’s responsibility to assist with filing grievances,
although he or she must respond to them appropriately.

TOP: Chapter Number: 25: Title: Disciplining the Unionized Employee
10. What event is most likely to result in an employee filing a grievance?

a. The manager and employee have a relationship that precedes an episode of
discipline.
b. An employee knowingly breaks an established rule.
c. An employee wants to have an impartial third party impose a solution.
d. The employee believes he or she has been disciplines unjustly.
ANS: D
Feedback: A grievance is usually motivated by an employee’s belief that he or she was dealt
with unfairly. The presence or absence of a relationship between the employee and manager
is not relevant. Not every episode of rule breaking results in a grievance. Involvement of a
third party characterizes arbitration.

TOP: Chapter Number: 25: Title: Grievance Procedures
11. What action should the manager take when implementing the second step in the progressive
disciplinary process?
a. Suspend the employee from work for a specified period of time.
b. Explain in detail the nature of the inappropriate behavior.
c. Complete a formal written reprimand.
d. Verbally instruct the employee not to repeat the infraction.
ANS: C
Feedback: The second step in the progressive disciplinary process is for the manager to
complete a formal written reprimand signed by the employee and the manager. The second
step in the progressive disciplinary process does not involve any of the other options.

12. A nursing aide has been given a formal written warning regarding arguing repeatedly with
the team leader about the given assignment. Today, the nursing aide has taken four lengthy
personal phone calls during work time. This is the first offense of this nature. How will the
manager deal with this disciplinary situation?
a. Provide a verbal warning that includes the rules related to personal telephone calls.
b. Monitor the employee’s behavior closely for the next few weeks.
c. Present the employee with a formal written reprimand.
d. Suspend the employee for a week.
ANS: A
Feedback: The best choice of action in this case would be to provide an explanation for the
rule and proceed to give a verbal admonishment. Because this is a new infraction, the
progressive discipline starts with a verbal warning again and none of the other options.

13. A novice nurse-manager admits to feeling nervous about the possibility of disciplining
employees. How should the manager be encouraged by superiors to view discipline?
a. As a necessary means for controlling an unmotivated and self-centered workforce
b. As a “big stick” that management can use to eliminate behavior that conflicts with
organizational goals
c. As a means of narrowing the power–authority gap
d. As a necessary part of fostering excellence in the organization
ANS: D
Feedback: Discipline is an occasional, but necessary, part of creating excellence in an
organization and growth in employees. It is not simply a tool to narrow the power–authority
gap. Managers should adopt a strengths-based view of employees.

Functions When Dealing With Problem Employees KEY: Integrated Process:
Nursing Process
14. What variable should the nurse-manager prioritize when dealing with employees who break
the rules?
a. Terminating employment when necessary
b. Modelling empathy
c. Counseling employees to promote their personal and professional growth
d. Ensuring organizational goals are met
ANS: D
Feedback: The larger organizational goals are prioritized over the personal interests of
individual employees. Modeling empathy is not the main goal when addressing
insubordination, and the manager should not adopt the role of counselor. Not all situations
would result in termination.

Functions When Dealing With Problem Employees KEY: Integrated Process:
Nursing Process
15. When monitoring medication inventories for possible diversion or theft by nurses with a
substance use disorder, what medication classifications should the manager monitor most
closely? Select all that apply.
a. Anticholinergics
b. Opioid analgesics
c. Central nervous system stimulants
d. Antidepressants
e. Benzodiazepines
f. Nonsteroidal anti-inflammatories
ANS: B, C, E
Feedback: CNS stimulants, opioids, and benzodiazepines are among the most commonly
used medications by nurses with substance use disorders. Anticholinergics, NSAIDs, and
antidepressants are much less commonly used by these nurses.

TOP: Chapter Number: 25: Title: Commonly Misused or Abused Drugs
16. A nurse is uncharacteristically extroverted on today’s shift, with an unsteady gait. The
manager suspects that the nurse may be chemically impaired. What is the manager’s most
appropriate action?
a. Document this finding and communicate with the personnel department.
b. Monitor the nurse’s behavior closely for the remainder of the shift.
c. Promptly confront the nurse to discuss this suspicion.
d. Ask the other nurses and staff members on the unit if they have noticed the same
thing.
ANS: C
Feedback: For safety reasons and to protect clients, employees should be confronted as soon
as possible after chemical impairment is recognized. Delaying could be unsafe for clients.
The manager has a responsibility to collect data, but this should not take precedence if the
nurse is impaired at this point in time.

TOP: Chapter Number: 25: Title: Confronting the Chemically Impaired Employee
17. A manager is preparing to confront an employee regarding suspected chemical impairment.

What response should the manager anticipate?
a. Emphatic denial and defensiveness
b. Reluctant acceptance
c. Gratefulness for finally being discovered
d. Silence
ANS: A
Feedback: Employee denial and defensiveness are the most common behaviors in those who
are confronted with their impairment, even though the other responses are possibilities.

TOP: Chapter Number: 25: Title: Confronting the Chemically Impaired Employee
18. The nurse-manager is contributing to the plan for the workplace reentry of an employee with
a history of substance use disorder. What should be included in the reentry plan?
a. The nurse should have a 50% work assignment for the first several months.
b. Clients and families should be made aware of the nurse’s history.
c. Reentry should not occur until the nurse has been chemical-free for at least 18
months.
d. The employee should agree to random urine screening.
ANS: D
Feedback: Most nurses successfully return to work following a treatment program, and this
generally takes 1 year. Often, the conditions that the employee has successfully changed his
or her lifestyle and will submit to random drug tests must be met before the employee can
be allowed to return to work. Informing clients of the nurse’s history would violate the
nurse’s right to confidentiality. A reduced work assignment is not typically required.

TOP: Chapter Number: 25: Title: The Chemically Impaired Employee's Reentry to the
Workplace KEY: Integrated Process: Nursing Process
19. What consideration should the nurse-manager prioritize when creating a program to deal
with the issue of employees with substance use disorders?
a. The program should emphasize punishment due to the safety risk posed by
impaired employees.
b. The program may be unnecessary because state boards of nursing have authority
over this issue.
c. The program should emphasize screening, prevention, and early intervention.
d. For confidentiality reasons, the program should be planned and executed by the
personnel department.
ANS: C
Feedback: Prevention and early detection should be cornerstones of any substance use
disorder program in the workplace. The focus should not be primarily punitive. State boards
of nursing have purview over this issue, but this does not mean that organizational programs
are unnecessary. Such programs do not need to be limited to the personnel department.

TOP: Chapter Number: 25: Title: The Manager's Role in Assisting the Chemically
Impaired Employee KEY: Integrated Process: Nursing Process
20. The nurse-manager oversees an experienced employee who is earnest and pleasant, but who
struggles to maintain minimum performance standards. What is the manager’s best initial
approach to this employee?
a. Arrange for the nurse to complete extra continuing education.
b. Provide interventions that will increase the nurse’s motivation.
c. Affirm the nurse’s strengths in an effort to encourage excellence.
d. Provide coaching that addresses the employee’s main deficiencies.
ANS: D
Feedback: Coaching is a key approach to helping marginal employees improve. Affirming
strengths may bolster confidence with no consequent improvement in performance. There is
no evidence that the nurse’s deficits are based on a lack of knowledge or motivation, so
continuing education and motivational strategies may not be appropriate.

TOP: Chapter Number: 25: Title: The Marginal Employee
21. A nurse became frustrated with a client and deliberately damaged the medication cart in a
subsequent outburst. How should the manager discipline this employee?
a. Dismissal
b. Suspension
c. Written admonishment
d. Verbal warning
ANS: C
Feedback: An employee caught willfully damaging property is initially presented with a
written admonishment.

TOP: Chapter Number: 25: Title: Table 25.1 Guide to Progressive Discipline
22. How should the nurse-manager implement McGregor’s hot stove rules when setting
standards for employee behavior on the unit?
a. Any rule that is outdated or irrelevant must be eliminated promptly.
b. Rules should be called “norms” in an effort to make them less authoritarian.
c. All employees should be made aware of the rules and associated punishments
beforehand.
d. Rules should be reviewed on a regular basis to ensure they are necessary.
ANS: C
Feedback: All employees must be forewarned that if they break a rule, they will be punished
or disciplined. McGregor did not emphasize the need to review rules and eliminate
unnecessary ones, although these are both appropriate actions. There is no need to reframe
rules as “norms,” although some individuals and organizations do so.

TOP: Chapter Number: 25: Title: Fair and Effective Rules
23. What is the principle that guides constructive discipline?
a. Constructive discipline is fair but punitive in nature.
b. The focus of constructive discipline is employee growth.
c. Constructive discipline employs the manager as a counselor and support.
d. Increased motivation is the desired outcome of constructive discipline.
ANS: B
Feedback: Constructive discipline uses discipline as a means of helping the employee grow.
Even though punishment may be necessary, this is not the guiding principle or purpose of
the activity. The manager is not the employee’s counselor. Not every employee who
requires discipline is lacking in motivation.

TOP: Chapter Number: 25: Title: Constructive Versus Destructive Discipline
24. Which is a management function associated with dealing with a problem employee?
a. Applies a progressive discipline model when employees fail to meet standards
b. Ensures that the rights and the responsibilities of both the manager and the
employee are considered in addressing worker grievances
c. Examines the work environment for stressors that contribute to substance use
disorder
d. Understands group norms and is able to work within those norms to mold group
behavior
ANS: A
Feedback: Applying progressive discipline when needed is an important management
function. The other options are leadership roles.

Functions in Dealing With Problem Employees
25. The manager is working with a staff member who has twice arrived late for assigned shifts
over the past few weeks. What is the fundamental rationale for conducting a disciplinary
conference for this employee?
a. This behavior disrupts the efficiency of the nursing team.
b. The tardiness is costing the facility money.
c. This behavior encourages other staff to disregard rules.
d. The problem will get worse if it is ignored.
ANS: D
Feedback: Disciplinary problems, if unrecognized or ignored, generally do not go away;
they only get worse. The other options are likely outcomes of the staff member’s
unacceptable behavior but not the fundamental rational for the disciplinary action.

TOP: Chapter Number: 25: Title: Disciplinary Strategies for the Manager
26. The nurse-manager works at a unionized health-care facility and is preparing for a
disciplinary conference for an employee with a history of unexcused absences. What activity
should the manager prioritize in this conference?
a. Promoting rapport with the employee in order to protect their future working
relationship
b. Requiring the employee to present compelling evidence to prove that he or she is
innocent of rule breaking
c. Presenting a grievance that summarizes the way that the employee has failed to
meet organizational standards
d. Presenting objective evidence that demonstrates the employee’s deficient
performance
ANS: D
Feedback: A difference between unionized and nonunionized employee discipline lies in the
burden of proof, which typically is the responsibility of the employee without union
membership but is the responsibility of the manager of the employee who belongs to a
union. Employees file grievances; managers do not. The need to preserve rapport is not
prioritized over the need to fairly and directly address the employee’s behavior.

TOP: Chapter Number: 25: Title: Disciplining the Unionized Employee
27. A nurse-manager has been managing a medical unit for several weeks and has just learned
that a nurse has a reputation among colleagues for avoiding work responsibilities. What is
the manager’s best initial action?
a. Canvas the employees on the unit to identify any history of violence.
b. Review the employee’s available personnel records and files.
c. Contact the client and family and apologize for the nurse’s action.
d. Inform the client’s health-care provider about this incident.
ANS: B
Feedback: In preparing to discipline employees, the manager’s first step should be to obtain
the employee’s personnel file materials and review the file documents for a better
understanding of past performance and workplace behavior. Canvasing other employees
may be a violation of the nurse’s right to privacy. The manager should be careful not to
“own” the nurse’s behavior by apologizing to the client and should gather more facts first.
There is no obvious reason to inform the health-care provider if this event happened several
days ago.

TOP: Chapter Number: 25: Title: Disciplinary Strategies for the Manager
28. The nurse-manager has had difficulty improving the performance of a registered nurse who
is a marginal employee on the hospital medical unit. The manager no longer wishes to work
with the employee and has arranged a transfer to the postsurgical unit of the hospital. What
type of transfer has the manager arranged?
a. Lateral
b. Downward
c. Inappropriate
d. Accommodating
ANS: C
Feedback: Transferring an employee to another department for the sole reason of “getting
rid of” the employee is an inappropriate transfer. The manager’s motivation makes this an
inappropriate, rather than lateral, transfer.

TOP: Chapter Number: 25: Title: Transferring Employees
29. After the first few months on the job, the nurse-manager has recognized that an experienced
practical nurse at the clinic is a marginal employee. What strategy by the manager is most
likely to be effective?
a. Create a personalized improvement plan with the nurse and work with the nurse to
promote improvement.
b. Place the nurse on probation and set firm requirements for reinstatement.
c. Arrange for the nurse to receive an education leave and complete remedial courses
in basic nursing knowledge.
d. Apply disciplinary measures that have the potential to motivate the employee.
ANS: A
Feedback: Coaching can be a time-demanding, but effective, method of improving the
performance of marginal employees. Probation does not give the nurse tools to improve. For
some employees, increased learning does not translate into improved performance.
Similarly, it is possible for the nurse to be motivated yet still remain marginal.
TOP: Chapter Number: 25: Title: The Marginal Employee
30. A nurse-manager discovered that a nurse was retrieving narcotics from sharps containers
and has been abusing these medications for several months. When addressing this behavior
and assisting the nurse, what factor should the manager prioritize?
a. The safety of clients and families
b. The integrity of the unit
c. The nurse’s well-being
d. The nurse’s personal growth
ANS: A
Feedback: As with all nursing situations, the safety of clients is prioritized over other
factors.

TOP: Chapter Number: 25: Title: The Manager's Role in Assisting the Chemically
Impaired Employee KEY: Integrated Process: Nursing Process

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Chapter 01: Decision Making, Problem Solving, Critical Thinking, and Clinical

Reasoning: Requisites for Successful Leadership and Management

PTS: 1 DIF: Moderate REF: Page: 3 OBJ: 1

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3. Which statement is true regarding decision making?

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5. An experienced nurse-manager has been described as being a “right-brain thinker.” This

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6. The nurse-manager is applying an evidence-based approach to a clinical question around

PTS: 1 DIF: Moderate REF: Page: 14 OBJ: 5 | 6

PTS: 1 DIF: Easy REF: Page: 3 OBJ: 1

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9. Which statement is true concerning critical thinking?

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16. A nurse-manager is planning to apply a decision-making model to a clinical challenge.

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18. Which statement is true regarding an economic man style manager?

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19. What characteristic of a nurse-manager best demonstrates left-brained thinking?

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25. A team of nurse-managers is considering the purchase of pressure-reducing mattresses to

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6. A manager demonstrates one of the four principles of scientific management when he or

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10. Which statement best depicts leadership?

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18. The nurse-manager of a community clinic is applying the principles of interactional

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