Which of the following is not a kind of leadership skill required for effective leadership?

7 th Edition

Sullivan & Decker

NCLEX® Review Note: Some questions in this exercise may have more than one correct answer. To answer such questions correctly, you must select all the correct answers. Also, some questions will require you to type your answer in the space provided.

CHAPTER: 1 Introducing Nursing Management

1) Integrated health care systems function in a variety of models. Which of the following is a common characteristic of all systems? a) Deliver selective care only b) Deliver a whole continuum of care c) Treat patients only in the hospital d) Provide care only in the primary care setting Reason: The deliverance of a whole continuum of care is a common characteristic of all systems.

2) Quality management and benchmarking are two approaches used to improve the quality of care. The major difference between these two approaches is which of the following? a) Quality management is not useful in the outpatient setting.

b) Benchmarking compares outcomes in a variety of settings and disciplines. c) Quality management is used only in the primary care setting.

d) Benchmarking looks only at outcomes specific to nursing. Reason: The major difference between quality management and benchmarking is that benchmarking compares outcomes in a variety of settings.

3) Cultural diversity presents an important challenge to nurse managers due to which of the following? a) A nursing shortage exists. b) Staff nurses are not trained to be culturally sensitive. c) 80% of nursing staff comes from one or more minority groups.

d) The increase in cultural diversity is seen both in the patient population and the nursing staff. Reason: Cultural diversity presents an important challenge to nurse managers due to the increase in cultural diversity seen both in the patient population and the nursing staff.

4) One of the most important driving forces behind health care policy changes is which of the following? a) New technology b) Outsourcing of services c) Emerging role of nurse practitioners d) Ability to pay for health care Reason: One of the most important driving forces behind health care policy changes is the ability to pay for health care.

5) Which of the following is an important emerging challenge to changes in health care? a) Decrease in immigration b) Nursing staff shortages c) Bioterrorism d) Increased surgical procedures Reason: Bioterrorism is an emerging challenge to changes in health care.

6) Advanced technology in health care, such as integrated health records, has allowed the nurse to do which of the following? a) Skip the assessment step of the nursing process

b) Order medications

c) Take blood samples d) Track patients' vital signs Reason: Advanced technology in health care has allowed the nurse to track patients' vital signs.

7) A staff nurse attends a continuing education class on advanced technology in health care. The nurse manager should interpret this as which of the following? a) Only important for nurse managers b) Not important c) A waste of time d) Essential to nursing care Reason: Information technology will become increasingly integrated into systems of care.

8) The nurse manager is talking with the CNA about her time management. Which of the following is an example of a nurse manager as coach? a) "Your timely response to patients' call lights is exemplary."

b) "Your appearance is seldom professional." c) "You must get the vital signs taken on time or you will be disciplined."

d) "You never report AM blood sugar levels on time." Reason: Nurse managers must also be coaches, teachers, and facilitators.

9) Which of the following skills is essential for nurses in today's health care environment? a) Communication b) Supervision & Management c) Delegation d) All of above Reason: Management, supervision, delegation, and communication are all skills essential for nurses in today's health care environment.

1. In our culturally diverse society, barriers to health care result from: a) Prejudice. b) Different socioeconomic status. c) Differences in language. d) All of above. Reason: The main factors that constitute barriers to health care are differences in language, different socioeconomic status, and prejudice. Telehealth is using telecommunications technology to provide medical and nursing services from afar.

2. "Organizations are made up of intertwined links and diversified choices that generate unanticipated consequences." This defines which of the following theories? a) Contingency theory b) Closed system theory c) Open system theory d) Chaos system theory Reason: The chaos theory is characterized by organizations that are made up of intertwined links and diversified choices that generate unanticipated consequences. The contingency theory best depicts the current health care delivery systems. Contingency theorists believe organizational performance can be enhanced by matching an organization's structure to its environment. Closed systems are self-contained, and usually can be found only in the physical sciences. An open system, in contrast, interacts both internally and with its environment.

3. Of the following types of HMOs (Health Maintenance Organizations), which contracts with two or more IPAs (Independent Practice Associations)? a) Staff model b) Point of service model c) Network model d) Group model Reason: A network model of HMOs contracts two or more IPAs. A staff model is when physicians are HMO employees paid a salary. A group model is when the HMO contracts with a multi-specialty group to provide services for a negotiated fee. Point-of-service plans are not part of HMO systems.

4. Which of the following scenarios would be an example of shared governance on a nursing unit? a) Staff nurses delegate activities to CNAs.

b) Procedure manuals are written by a committee of nurse managers. c) Staff nurses and CNAs make their own schedules.

d) A unit manager seeks advice from her supervisor. Reason: Shared governance is based on the philosophy that nursing practice is best determined by nurses.

1. Which of the following are essential components of strategic planning? a) Values b) Vision & Mission statement c) Reengineering d) A & B Reason: Values and vision and mission statements are all part of strategic planning.

2. While interviewing for a position at City Hospital, the nurse asks about the organizational structure of the institution. She is told that hospital is organized into departments based on specialty (e., nursing, dietary, pharmacy, etc.). Based on what you know about organizational structure, select the structure in this example. a) Parallel b) Functional c) Service-integrated d) Matrix Reason: In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group, similar groups operating out of

the same department, and similar departments reporting to the same manager.

1. Achieving Magnet Hospital designation offers hospitals the following advantages: (Select all that apply.) a) Greater client satisfaction. b) Improved nursing recruitment. c) Greater client workload. d) Nurses who are independent decision makers. Reason: Organizations that achieve magnet recognition demonstrate greater nursing retention and successful nursing recruitment. The empowered, independent problem solving nurses help to create greater client satisfaction and improved nursing care.

2. The nurse is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select all that apply.) a) Expected length of stay b) Assigned staff nurse c) Patient outcomes d) Medical diagnosis Reason: Critical pathways are developed when there are usual expected outcomes for client's with a particular medical diagnosis. A critical pathway is developed with an expected length of stay that is appropriate for the medical diagnosis and treatment plan. A critical pathway can be developed for any medical diagnosis that has a usual set of outcomes and length of stay.

3. A staff nurse is working with a patient who is on a critical pathway for education in preparation for home care. Which one of the following responsibilities would the nurse address first? a) Taking vital signs b) Answering the client's questions c) Evaluating client teaching d) Reviewing the information with the client and family Reason: Assessment is the first phase of the nursing process and history is part of client assessment that precedes all others. The nurse should review pertinent information with the client and family and establish goals for care.

4. What are the key elements essential to implementation of case management? (Select all that apply.) a) Collaborative practice teams b) Established critical pathways c) Quality management system d) All of above Reason: Established critical pathways, collaborative practice teams, qualified nurse case managers, and quality management systems are the key elements of case management.

5. The staff nurse is caring for the client with total accountability and is in continual communication with the client, the family, the physicians, and other members of the health care team. This type of nursing delivery system is known as: a) Total patient care b) Qualified nurse case managers c) Established critical pathways d) Quality management system Reason: Total patient care is the original model of nursing care delivery, in which one RN is responsible for all aspects of one or more patients' care.

6. A high-volume maternity unit uses differentiated practice as its staffing model. As a new graduate employed on this unit, the nurse can expect that: a) Evidence-based practice guides risk management principles.

b) Client teaching is the responsibility of the team leader. c) The initial level of practice responsibility will be limited.

d) Seniority is the main determination of client assignments. Reason: The scope of nursing practice and responsibility are defined for each level of practice. A new graduate will have limited experience so the level of practice will be limited.

1. When would a critical pathway need to be revised? a) When it becomes too long. b) When the variances show a new trend. c) When a member of the team retires. d) When the client leaves the hospital. Reason: The length of the critical pathway is determined by the medical or surgical condition, interventions, and the length of stay.

CHAPTER: 4

1. The manager of a medical-surgical unit is very task-motivated. Using Fiedler's Contingency Theory, under what circumstances would the manager be most effective? a) Only during highly stressful situations.

b) When there is little to no stress. c) Under highly structured situations.

d) When the situation is loosely structured. Reason: Task-motivated managers function best under highly structured situations where priorities are generally clear. In less structured or stressful situations, the order of task performance is less clear; the manager may feel frustrated under those circumstances.

1. Which of the following types of leadership behaviors would be most useful when managing a staff of newly trained CNAs (Certified Nursing Assisstants)? a) Achievement-oriented b) Supportive c) Participative d) Directive Reason: Directive leadership involves telling employees what is expected, giving specific guidance, ensuring adherence to rules and procedures, and scheduling and coordinating work efforts. Participative leadership is a leadership style that involves consultation with subordinates in decision making. Supportive leadership style focuses on the needs of employees. Achievement-oriented leadership is a leadership style that includes goal setting and maintaining high levels of performance in order to motivate employees.

2. Which of the following leaders would be considered a transformational leader? a) The supervisor of a unit who requests staff to work overtime.

b) The unit secretary who encourages staff to use the proper forms. c) A unit manager who reminds a CNA (Certified Nursing Assistant) to work on time management skills.

d) The Advanced Practice Nurse who encourages a staff nurse to pursue additional education for career advancement. Reason: Transformational leaders focus on effecting change through a commitment to the organization's vision and seek to elevate followers. A focus on tasks like using proper forms, time management, or making requests is not representative behavior of transformational leaders.

1. The complexities of the current health care delivery systems require a variety of leadership styles. Which of the following is one that has emerged in response to these changes? a) Quantum b) Servant c) Autocratic d) Democratic Reason: The quantum theory of leadership addresses complexity in organizations. Autocratic leadership seeks to minimize complexity, while democratic leadership looks to build consensus. Servant leadership is based on the premise that in serving, one may be called to lead.

2. Which of the following are managerial functions, according to Mintzberg? (EXCEPT) a) Leading and linking at the people level

b) Communicating and controlling at the information level c) Deciding pay structures d) Doing at the action level Reason: Mintzberg believed that managing involves: communicating and controlling at the information level; leading and linking at the people level; and doing at the action level. Pay structure is a decision outside the range of managerial functions.

1. A ___________ manager supervises a number of first-level managers, usually within related specialties. a) self-directed b) first-level c) middle-level d) self-motivated Reason: A middle-level manager supervises a number of first-level managers, usually within related specialties.

CHAPTER: 5

1. In determining a way to make shift change more effective for the nurse and the client, a hospital implemented a course of action. After a week of implementation, the decision was deemed inappropriate. What step of Roger's diffusion of innovations is this? a) Confirmation b) Implementation c) Knowledge d) Persuasion Reason: The stage of confirmation seeks reinforcement of the action taken. In the implementation stage, the innovation is put to use, and reinvention or alterations may occur. In persuasion stage, a favorable (or unfavorable) attitude toward the innovation forms. In the knowledge stage, the decision-making unit is introduced to the innovation and begins to understand it.

2. When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action? a) Collection of data b) Planning c) Analyzing data d) Identification Reason: Planning is the time to make people uncomfortable with the norm.

3. The changes brought forth by the state boards of nursing are an example of which type of change agent? a) Resistance b) Empirical–rational c) Normative–reeducative d) Power–coercive Reason: Power–coercive strategies are based on the application of power by a legitimate authority. In the empirical–rational model of change strategies, the power ingredient is knowledge. The assumption is that people are rational, and will follow their rational self-interest if that self-interest is made clear to them. Normative–reeducative strategies of change rest on the assumption that people act in accordance with social norms and values. Resistance is opposing the change.

4. Even though this is not easy, facilitating ____________ is a mandatory skill for all nurse managers and is crucial in the success of the manager. a) resistance b) change c) planning d) collection of data Reason: Successful change agents demonstrate certain characteristics that can be cultivated and mastered with practice. Making change is a mandatory skill for managers.

5. Change is a mandatory skill for managers. Successful change agents display certain characteristics. Some of these characteristics are: (Select all that apply.) a) Energy. b) Confidence. c) Realistic thinking. d) Trustworthiness. Reason: Energy, confidence, realistic thinking, and trustworthiness are among the characteristics that successful change agents demonstrate.

CHAPTER: 6

Managing and Improving Quality

1. A client is admitted to a medical-surgical unit after six hours in the emergency room. He requests that his AM care be delayed to allow him to rest. The nurse complies with his request. This is an example of which type of management philosophy? a) Continuous quality improvement b) Total quality management c) Six sigma d) Quality management Reason: Total Quality Management is customer-focused.

2. A family member slips on the wet floor and hits her head. You understand that completion of an incident report is necessary for which hospital process? a) Risk management b) Outcome management c) Quality management d) Peer review Reason: Risk management deals with all incidents of error in the hospital.

3. A client experiences difficulty breathing after the change of shift. The nurse on duty discovers that the IVFs were infusing at a rate 10 times the calculated normal. After notifying the physician, and correcting the rate what should be the next step in the client's care? a) Notify family b) Discipline the previous nurse c) Complete an incident report d) Obtain legal consult Reason: Completion of an incident report is necessary after notification of the physician. And legal consult may not be necessary.

4. A client experiences an air emboli, resulting in a stroke, during an IV start. This can be classified as which type of risk? a) Patient dissatisfaction b) Medical-legal incident c) Medication error d) Diagnostic procedure Reason: Any incident occurring during a procedure is known as a diagnostic procedure risk.

5. A client complains every morning that the night shift nursing staff do not answer his call light promptly to assist his elimination needs. His concerns are not shared with the Nurse Manager, and he falls while trying to walk to the bathroom. This fall could be attributed to which of the following? a) Breakdown in communication b) Lack of staff c) Lack of concern d) Breakdown in management Reason: Communication with the staff allows a better understanding of safety concerns.

6. In order to best reduce the potential for risk, the development of which type of atmosphere is needed? a) Nurse-focused b) Physician-focused c) Family-focused d) Patient-focused Reason: The patients will believe that their best interest is at heart.

7. A staff nurse develops an innovative documentation system for post-op patients. The nurse manager grants the nurse paid leave to develop one for medical patients. What type of power is the nurse manager using? a) Legitimate power b) Reward power c) Expert power d) Information power Reason: Reward power is based on inducements in exchange for contributions towards the manager's objectives. Legitimate power stems from the manager's right to make a request because of the authority associated with job and rank in an organizational hierarchy. Expert power is based on possession of unique skills, knowledge, and competence. Information power is based on access to valued data.

8. The hospital administration plans to introduce a new system of patient transport within the hospital. The nurse managers, when communicating with the staff about the change, should use which source of power to make certain the transition goes smoothly? a) Connection power b) Expert power c) Information power d) Reward power Reason: The nurse managers have access to the information, planning, and rationale for the change. It is important to communicate information in a positive way that reinforces the benefits to the staff and patients. Connection power refers to the manager using relationships to achieve results. Reward power suggests that the manager can offer some inducement for the staff to accept the change. The manager is not an expert on transportation issues in the hospital.

9. A staff nurse wants to become instrumental in changing a policy regarding scheduling. Which of the following might be helpful in this situation? a) Talking to the Director of Nursing b) Compiling data that would support the policy change c) Demonstrating positional power d) Using image power Reason: Using facts and figures to demonstrate the effectiveness of a policy change is an effective tool. Image refers to presentation of oneself in a given situation. The staff nurse does not have positional power sufficient to effect change. It would be inappropriate for the staff nurse to communicate with the Director of Nursing without prior communication with the unit manager.

10. A staff nurse tells other staff nurses that the manager is ineffective in order to move into the manager position. Which of the following would describe the nurse's actions? a) Using punishment power b) Using a power play c) Using personal power d) Using information power Reason: A power play is an attempt to diminish an opponent. Punishment, or coercive, power is based on the penalties a manager might impose on an individual or a group. Personal power refers to one's credibility, reputation, expertise, experience, control of resources or information, and ability to build trust. Information power is based on access to valued data.

11. Which of the following are effective ways to apply power and politics in nursing? (EXCEPT) a) Picketing the employer b) Networking with other professionals c) Writing letters to legislators d) Joining professional organizations Reason: Networking with other professionals, campaigns, and joining professional organizations are some of the effective ways to apply power and politics in nursing.

12. Politics is defined as the art of influencing the allocation of scarce resources. An example of a scarce resource allocated by the manager of a patient care unit is: a) Rises for the staff. b) Patient supplies in the utility room. c) Staffing that minimizes overtime. d) Paper for the printer. Reason: Scarce resources include money, time, personnel, and materials. Staffing is a budget issue and resource over which the manager has control. The manager would expect the staff to use resources wisely but would not have direct control over them. Raises are granted by the institution, not the manager.

13. A nurse who is planning to run for the local school board will find which of the following sources of power important? a) Connection b) Reward c) Charisma d) Expert Reason: Connection and information are two main sources of power important in political action. The nurse will want to use relationships to build coalitions and get information. The nurse does not have to be charismatic to use power effectively. The nurse is not an expert on education and as a candidate does not have rewards to grant.

14. A nurse manager needs to resolve a conflict between the staff nurses and the physical therapy department. What type of power might the manager utilize? (EXCEPT) a) Connection and referent power b) Reward and punishment power c) Legitimate power d) Information power Reason: Referent power is based on admiration and respect for an individual. Connection power is based on an individual's formal and informal links to influential or prestigious persons within and outside an area or organization. Information power is based on access to valued data. Reward power is based on the inducements the manager can offer group members in exchange for cooperation and contributions that advance the manager's objectives. Punishment, or coercive, power is based on the penalties a manager might impose on an individual or a group. Legitimate power stems from the manager's right to make a request because of the authority associated with job and rank in an organizational hierarchy. This manager may need to use several types of power to resolve an important issue that crosses departmental lines.

15. Politics is a means for influencing events and the decision of others. The nurse

Thinking Critically, Making Decisions, Solving Problems

1. After examining her client's abdomen and noting assessment of significant findings, even though the client says it doesn't hurt, the nurse says to a colleague, "I think something is going on here; I am going to investigate further." This nurse is using: a) Deductive reasoning. b) Intuition. c) Trial and error. d) Modified scientific method. Reason: Intuition is the "gut feeling" one has without the conscious use of reasoning.

2. How does decision making differ from problem solving? a) Decision making always involves selecting from a set of alternatives.

b) Problem solving always involves selecting one of several alternatives. c) Problem solving never involves decision making.

d) Decision making always involves solving a problem. Reason: Decision making always involves selecting one of several alternatives; problem solving always involves diagnosing a problem. Both problem solving and decision making can involve aspects of the other.

1. A nurse manager has two out of six staff nurses call in sick for one shift. Because of reduced availability of staff, the manager decides to manage the unit with the three remaining nurses, which keeps the unit at minimal staffing standards What type of decision-making strategy would this be? a) Satisfycing b) Routine c) Adaptive d) Rationalizing Reason: Satisficing is a decision-making strategy whereby the person chooses an alternative that is not ideal but good enough given the circumstances.

2. A nurse manager asks the staff to submit written suggestions for a change in policy. The group would then vote on the different suggestions. What type of decision-making technique did the nurse manager use? a) Statistical aggregation b) Nominal group technique c) Brainstorming d) Delphi Reason: The nominal group technique primarily uses a written method for exchange of ideas. In the Delphi technique, ideas are collected through a carefully designed sequence of questionnaires interspersed with summaries of information and opinions derived from previous questionnaires. In statistical aggregation, individuals are polled regarding a specific problem, and their responses are tallied. Brainstorming is a decision-making method in which group members meet and generate diverse ideas about the nature, cause, definition, and/or solution to a problem.

3. A new nurse manager is attempting to solve a management issue by using one

solution after another until she solves the problem. This would be known as what type of method? a) Decision making b) Trial and error c) Experimentation d) Analysis Reason: Trial and error is usually used by people with little management experience. Experimentation is a type of problem solving in which a theory is tested to enhance knowledge, understanding, or prediction.

1. Scientific methods for problem solving are useful when time is not an issue. For problems requiring immediate action, nurses can use an organized method that involves seven specific steps. What is this method? a) Nominal group technique b) Delphi method c) Problem-solving process d) Brainstorming Reason: The problem-solving method is an organized seven-step process useful for problems that require immediate action.

2. Which of the following can cause negative effects on decision making among groups? a) Rationalization b) Groupthink c) Risky shift d) Dialectical inquiry Reason: Groupthink is a negative phenomenon occurring in highly cohesive, isolated groups in which group members come to think alike, which interferes with critical thinking. Dialectical inquiry is a technique used to minimize groupthink through the use of a formal debate format. Risky shift is a phenomenon seen in groups in which riskier, more controversial decisions are made.

3. A client who is in pain refuses to be repositioned. In making a decision about what to do, what should the nurse consider first? a) Why a decision is needed. b) Who actually gets to make the decision? c) What are the alternatives? d) When a decision is needed. Reason: Decision making requires the nurse to select the best action to meet a desired goal. When a decision is needed comes after determining why a decision is needed. Who actually makes the decision is important, but not the first thing to consider. What the alternatives are comes after determining why a decision is needed, who makes the decision, and when a decision is needed.

4. A __________ is often helpful to use when a problem is not easily identified. a) trial and errors b) delphi method c) political decision making model d) affinity map Reason: A tool often helpful to use when a problem is not easily identified is an affinity map.

5. Which of the following are characteristics of reflective inquiry as described by

Which of the following is not a kind of leadership required for effective leadership?

What are the 4 types of leadership skills?

Which of the following is not a feature of effective leadership skills?

Which of the following is not leadership style?