Issuu

Test Bank For Leadership and Management for Nurses Core Competencies for Quality Care, 5th Edition by Anita Finkelman m2024 Chapter 1-20 Chapter 1

Conceptual Base for Leadership and Management

1) The nurse manager asked all staff nurses to develop effective leadership competencies. How should the staff nurses interpret this request? 1. This is an unrealistic expectation, because only managers are leaders. 2. This is possible if the nurses learn about and use relevant leadership and management theories and styles. 3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done. 4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation. Answer: 2 Explanation: 1. A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders. 2. In today's healthcare environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices. 3. Control, competition, and getting the job done are past theories and styles that are not as useful in today's environment. 4. Leadership is a skill that can be learned. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 2) Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization? 1. The control of the organization is centralized, and decisions are made by upper-level management. 2. Staff nurses are expected to provide support and nurturing for management's decisions. 3. The organization's approach to leadership is autocratic and bureaucratic. 4. Staff nurses provide input into planning and changes for their own unit. Answer: 4 1 Copyright © 2024 Pearson Education, Inc.

Explanation: 1. In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization. 2. The theory is that the staff should be nurtured to promote greater leadership competency. 3. According to Drucker, when staff participate in the core functions of management, the organization is more effective. 4. According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 3) Which behavior demonstrates the nurse's competency as an emotionally intelligent leader? 1. The nurse is proficient in technical skills. 2. The nurse relies on policies, not options. 3. The nurse supports team members. 4. Productivity is not a major concern. Answer: 3 Explanation: 1. While technical skill is important for all nurses, it is not a hallmark of a competent leader. 2. Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered. 3. In Emotional Intelligence theory, team members support each other and feel supported by the team leader. 4. This statement reflects the country club leadership style. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

4) The nurse executive of a healthcare organization wishes to prepare and develop nurse managers for several new units that the organization will open next year. What should be the primary goal for this work? 1. Focus on rewarding current staff for doing a good job with their assigned tasks by selecting them for promotion. 2. Prepare these managers so that they will focus on maintaining standards of care. 3. Prepare these managers to oversee the entire healthcare organization. 4. Prepare these managers to interact with hospital administration. Answer: 2 Explanation: 1. This is an illustration of the "Peter Principle," which is promoting people to management positions just because they are doing a good job in their current position. Management level employees should be selected based upon the potential ability to manage and their desire to do so. 2. Nurse managers are directly responsible for maintaining standards of care, and managing fiscal resources and development of staff. 3. This is not the responsibility of most nurse managers. In this question, it is clear that managers of nursing units are being prepared and developed. 4. Interacting with hospital administration is a rare requirement for a unit nurse manager and, if it is required, it is not as important as maintaining standards of care. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 5) Describe the primary focus of a manager in a knowledge-work environment. 1. Developing the most effective teams 2. Taking risks 3. Routine work 4. Understanding the history of the organization Answer: 1 Explanation: 1. The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many. 2. Risk taking is a part of knowledge work, but is not the most important of this manager's tasks. 3. Knowledge work is a combination of routine and nonroutine work, so the manager will have focus on the routine. This is not the manager's most important focus. 4. Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems 3 Copyright © 2024 Pearson Education, Inc.

leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.; LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 6) The nursing staff communicates that the new manager has a focus on the "bottom line," and little concern for the quality of care. What is likely true of this nurse manager? 1. The manager is looking at the total care picture. 2. The manager is communicating the importance of a caring environment. 3. The manager understands the organization's values and how they mesh with the manager's values. 4. The manager is unwilling to listen to staff concerns unless they have an impact on costs. Answer: 4 Explanation: 1. This action would enable the manager to make a decision and not just evaluate the financial status of the environment. 2. If the manager is indeed focusing only on the "bottom line," the manager is not promoting a caring environment on the unit. 3. The organization may set great value on the "bottom line," but also must be concerned about quality of care. Problems with quality of care can impact the "bottom line." If the manager believes the financial status of the organization is the only organization value, a misunderstanding has probably occurred. 4. This manager has primary focus on the financial issues associated with provision of care. This will make the manager ineffective in the role. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

7) A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? 1. Use critical thinking to solve problems on the unit. 2. Give assignments clearly, taking staff expertise into consideration. 3. Understand complex healthcare environments. 4. Maintain an autocratic approach to influence results. Answer: 2 Explanation: 1. Critical thinking is important for every RN, not just a manager, and will not diminish the manager's authority. 2. Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group. 3. Nurse managers work in complex healthcare environments, but must create an appropriate organizational environment as a way of exercising authority. 4. In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers. 8) What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit? 1. "I know I told you that you could have the weekend off, but I really need you to work." 2. "The others work many extra shifts, why can't you?" 3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs." 4. "I can't believe you need help with such a simple task. Didn't you learn that in school?" Answer: 3 Explanation: 1. To develop trust, managers who make promises to staff must keep the promise. 2. This statement implies that the staff nurse is not a team player. It also sets up one nurse against the remainder of the staff. Effective managers must be fair and supportive with all staff. 3. This manager is standing up for staff by not allowing another unit to take a nurse today. 4. This statement is belittling to the staff nurse. This attitude does not demonstrate trust that staff performances will be effective. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems 5 Copyright © 2024 Pearson Education, Inc.

leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 9) The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately." 3. "Give your best nurses extra attention and rewards for their help." 4. "Never get into a disagreement with a staff member." Answer: 1 Explanation: 1. Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff. 2. When errors occur, the manager should use the opportunity for improvement, not punishment. 3. When staff feel some staff are given extra credit, they will feel uncomfortable with the manager and resentment will build. 4. Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers. 10) A key skill in today's healthcare environment is the ability to collaborate with others. A nurse identifies need to improve in this area. Which skills or traits would be essential for an effective nurse manager to develop to improve collaboration with others? Select all that apply. 1. Flexibility 2. The ability to share information and ideas 3. A service orientation 4. A desire to work hard 5. The ability to listen to others Answer: 1, 2, 5 Explanation: 1. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise. 2. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others 6 Copyright © 2024 Pearson Education, Inc.

and include them in his or her work, and must work together toward the best solution to any problems that might arise. 3. While a service orientation is common among nurses, it is not an essential trait for collaboration. 4. This is not an essential skill for ability to collaborate. 5. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership. 11) The new chief operating officer (COO) of the healthcare facility states, "I believe that Fiedler had it right in his Contingency Theory." The nurse executive understands that this COO will work to create which type of environment in the facility? Select all that apply. 1. Positive relationships between leaders and employees 2. A low amount of structure in task assignments 3. A decentralization of power from the leadership to the employees 4. A static approach to leadership matters 5. Leadership must change as the situation changes Answer: 1, 5 Explanation: 1. Fiedler believed that the best type of situation occurs when there are positive leader-member relations. 2. Fiedler believed that high task structure resulted in the best situations. 3. Fielder believed that high position power resulted in the best situations. 4. This is not a static approach to leadership, but rather a situational approach. 5. In this theory, as the groups and situations change, leadership also changes. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

12) The nurse wishes to improve personal emotional intelligence (EI) in hopes of a promotion to nurse manager. Which skills are important for this nurse to improve? Select all that apply. 1. Self-confidence 2. Knowledge base of nursing 3. Proficiency in technical skills 4. Empathy 5. Ability to initiate change Answer: 1, 4, 5 Explanation: 1. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership. 2. While this is an important aspect of professional nursing, it is not a competency of EI. 3. While this is an important aspect of professional nursing, it is not a competency of EI. 4. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership. 5. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 13) The nurse executive wishes to be a transformational leader. What should this nurse focus on to become effective in this role? Select all that apply. 1. Improving interpersonal skills 2. Advancing personal formal education 3. Identifying mentors 4. Becoming an expert clinician 5. Creating a vision for the future of nursing in the facility Answer: 1, 5 Explanation: 1. Transformational leadership requires interpersonal skills and having a vision for the future. 2. While formal education might increase the nurse's knowledge base for decision making, it is not a requirement for transformational leadership. 3. Having a mentor is not a requirement of transformational leadership. 4. This does not guarantee that the nurse will be a transformational leader. 5. Transformational leadership requires interpersonal skills and having a vision for the future. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered 8 Copyright © 2024 Pearson Education, Inc.

care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 14) Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply. 1. Focus is change 2. Have the ability to influence others 3. Control the environment 4. Focus is on people 5. Focus on efficiency Answer: 3, 5 Explanation: 1. The manager accepts the status quo, while the leader challenges it. 2. The manager controls people, while the leader influences others. 3. The manager controls the environment, patient care, and the staff that deliver that care. 4. The leader focuses on people, while the manager focuses on systems and structure. 5. Managers focus on efficiency, while leaders focus on effectiveness. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 15) Which scenarios are examples of issues facing nursing in an age of healthcare change? Select all that apply. 1. Six of the 18 nurses working on a unit speak English as their second language. 2. The hospital has decreased medication errors dramatically in each of the last two quarters. 3. The unit manager has been asked to use a creative strategy for scheduling with fewer staff. 4. There was a report on the nightly news about recruitment and retention of nurses. 5. An Emergency Room nurse was injured by a patient seeking drugs. Answer: 1, 3, 4, 5 Explanation: 1. An issue is the need for nurses to work as a team, despite differences in age, language, and culture. 2. There is a need to develop a culture of safety, which this hospital is doing already. 3. An issue is the need to be creative in doing more with less. 4. An issue is the increasing press coverage of recruitment and retention of nurses. 5. An issue is the increase in workplace violence. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems 9 Copyright © 2024 Pearson Education, Inc.

leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership. 16) Typically, the nurse manager of a unit uses a participatory style of leadership. Today, a patient suffered a cardiac arrest. The manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply. 1. Bureaucratic 2. Autocratic 3. Permissive 4. Directive 5. Authoritarian Answer: 2, 4, 5 Explanation: 1. This style is focused on organizational rules and policies. 2. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 3. This is a "hands-off" approach. 4. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 5. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. Cognitive Level: Applying Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 17) There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing? 1. Autocratic 2. Bureaucratic 3. Laissez-faire 4. Authoritarian 10 Copyright © 2024 Pearson Education, Inc.

Answer: 3 Explanation: 1. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. 2. Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur. 3. This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients. 4. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 18) Compare and contrast transformational leaders and bureaucratic leaders by choosing the options that are examples of transformational leadership. Select all that apply. 1. The leader focuses on organizational functions and the structure to get work done. 2. The most common type of leader in today's healthcare arena. 3. This leader follows the leadership style that is recommended by the Institute of Medicine. 4. The leader allows the staff to take risks to improve care within the organization. 5. The leader seeks to guide staff in their understanding of their importance to the work of the facility. Answer: 2, 3, 4, 5 Explanation: 1. This is a characteristic of a bureaucratic organization and leadership—stick to the structure and identified functions. 2. This is the transformational leader. 3. The IOM recommended transformational leadership in its report Leadership by Example (2003). 4. This is a quality of transformational leadership. 5. This is a quality of transformational leadership. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered 11 Copyright © 2024 Pearson Education, Inc.

care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 19) Select the reason that transformational leadership sometimes fails in an organization. 1. The need to change is addressed urgently. 2. The coalition guiding the facility is too diverse. 3. Influence, power, and empowerment are all used. 4. Poor recognition of organizational culture and does not value staff. Answer: 4 Explanation: 1. Failure often results from a lack of urgency. 2. Failure often results from a lack of a guiding diverse coalition. 3. Failure often results from not applying influence, power, or empowerment. 4. This is a reason for failure of transformational leadership. Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 20) The rural hospital has experienced a very small patient census over the last two months. Salary costs for this period have been over budget, and the nurse manager announces that all nurses will be required to rotate taking unpaid furlough days until the census improves. Which type of leadership does this manager exemplify? 1. Impoverished leadership 2. Country club leadership 3. Authority-obedience leadership 4. Team leadership Answer: 3 Explanation: 1. This style of leadership has limited interest in production or people. 2. This type of leader has an interest in people, but productivity is not a major focus. 3. This type of leadership focuses on efficiency and getting the job done and is not as concerned with staff members as people, but in this case this most likely is the only approach that the nurse manager can take. 4. This type of leader is very concerned about productivity and about staff morale and satisfaction. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and 12 Copyright © 2024 Pearson Education, Inc.

collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 21) Choose the option that best describes knowledge management theory. 1. Leaders are intelligent. 2. Focus is on routine work. 3. The knowledge worker is critical as an organization asset. 4. Evidence-based practice is the core. Answer: 3 Explanation: 1. Knowledge is more important than intelligence. 2. Focus is on routine and nonroutine work. 3. Knowledge management sees the knowledge worker such as nurses as critical assets to success. 4. Evidence-based practice is important, but so are other concerns such as quality. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 22) The staff nurse is considered to be a leader by nursing peers on the unit. What characteristics does this nurse likely possess? Select all that apply. 1. Awareness of happenings throughout the hospital 2. Ability to encourage newly hired nurses 3. Skepticism about using technology for standard nursing tasks 4. Adaptability 5. Collaboration skills Answer: 1, 2, 4, 5 Explanation: 1. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 2. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 3. An important aspect of being a leader is being able to see the benefits of technology. 4. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 5. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 13 Copyright © 2024 Pearson Education, Inc.

Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 23) The AONE identifies important principles for nurse managers and executives. Which statements represent these principles? Select all that apply. 1. Relationships are important. 2. The core of nursing is caring. 3. Knowledge is synthesized. 4. Care is patient- and family-centered. 5. Nurse managers are the same as nurse leaders. Answer: 1, 3, 4 Explanation: 1. This is an AONE principle. 2. The core of nursing is caring and knowledge. 3. This is an AONE principle. 4. This is an AONE principle 5. This is not an AONE principle—not all managers are leaders. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 24) Which strategy supports a professional practice environment? Select all that apply. 1. Provide an effective staff education program. 2. Promote leadership advancement. 3. Attract nurses to leadership positions by increasing salaries. 4. Engage nurses in decision making. 5. Nursing philosophy focus is on collaboration. Answer: 1, 2, 4 Explanation: 1. Education is necessary to support a professional practice environment. 2. Leadership is recognized in a professional practice environment. 3. Leadership opportunity is greater than salaries. 4. This is part of the perspective of professional practice environment. 14 Copyright © 2024 Pearson Education, Inc.

5. Collaboration should be part of the philosophy, but should also include quality and safety, and collaboration should be interprofessional. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers. 25) Keeping Patients Safe and The Future of Nursing reports both address important nursing issues related to leadership and management. What aspect of healthcare delivery do they both emphasize in relationship to nurses? 1. Nursing image is an important aspect of the profession and its success. 2. Nurses should be leaders in quality improvement, but are not fully prepared for this leadership. 3. Nursing leadership is focused on formal management positions in healthcare organizations. 4. Nursing scope of practice is important and needs to be broadened. Answer: 2 Explanation: 1. Nursing image is not a strong focus in both reports. 2. Both reports recognize need for nurses to be leaders in quality improvement, but there is need for more preparation in quality improvement and leadership. 3. Nurses are leaders in many positions, not only in management, and this is not addressed in both reports. 4. The Future of Nursing report comments on scope of practice, but not Keeping Patients Safe. Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine The Future of Nursing report, and their relevance to nursing leadership and outcomes. 26) Porter-O'Grady, a nursing leader, comments on a critical concern for nursing, as noted in this chapter. What is this concern? 1. Need to increase the number of advanced practice registered nurses 2. Need for more nursing publications 3. Need to engage and embrace change 4. Need for more nursing research Answer: 3 Explanation: 1. This is important, but not what Porter-O'Grady comments on. 2. This is important, but not what Porter-O'Grady comments on. 15 Copyright © 2024 Pearson Education, Inc.

3. This is what Porter-O'Grady thinks the nursing profession must do to succeed in the changing healthcare environment. 4. This is important, but not what Porter-O'Grady comments on. Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership. 27) Which modern leadership theory focuses on changes within the organization and external to the organization? 1. Contingency 2. Connective 3. Leadership 2.0 4. Deming's theory Answer: 1 Explanation: 1. This describes contingency theory. 2. This theory focuses on caring and collaboration. 3. This theory focuses on the integration of multiple theories. 4. This theory focuses on teams/groups. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. 28) A nurse manager is preparing performance appraisal evaluations. Which management function is the manager demonstrating? 1. Planning 2. Organizing 3. Leading 4. Controlling Answer: 4 Explanation: 1. This is not planning. If the manager took the information from performance appraisals and made a staff education plan, it would be planning. 2. This is not organizing, but if the manager was deciding how she would do her performance 16 Copyright © 2024 Pearson Education, Inc.

appraisals and in what order, this would be organizing. 3. The focus is not on the function of leading—though some aspects of leading are found in all of the other three management functions. 4. This function is controlling, as the manager is ensuring quality and meeting standards. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers. 29) Which of The Future of Nursing report recommendations will have an impact on nursing leadership? 1. Associate degree nursing programs should increase by 20%. 2. Nurses who provide direct care are critical and provide leadership. 3. The rate of completion of the doctoral degree is at a high level. 4. There should be an increase of 80% in BSN graduates. Answer: 4 Explanation: 1. This is not a report recommendation. 2. This is not a report recommendation. 3. This is not a report recommendation. 4. This is a report recommendation and is designed to increase nursing leadership by recognizing the need for the BSN as the entry-level degree for nursing. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine The Future of Nursing report, and their relevance to nursing leadership and outcomes. 30) The Future of Nursing progress report indicates which of the following has occurred? Select all that apply. 1. Number of Magnet hospitals is increasing. 2. Enrollment in PhD programs continues to decline. 3. Majority of states have granted nurse practitioners full practice and prescriptive authority. 4. The recommendation to increase BSN graduates to 80% has been met. Answer: 1, 2 Explanation: 1. Magnet hospitals are increasing, adding 30 more in 2017. 2. There are now more nurses enrolling in DNP programs than PhD programs. 17 Copyright © 2024 Pearson Education, Inc.

3. Authority for nurse practitioners is increasing but not for the majority of states. 4. As of 2018, the recommendation to increase BSN graduates to 80% by 2020 has not been met and the percentage of BSN graduates has to increase to meet the 2020 deadline. Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine The Future of Nursing report, and their relevance to nursing leadership and outcomes.

Leadership and Management for Nurses: Core Competencies for Quality Care, 5e (Finkelman) Chapter 2 Healthcare Policy, Legal Issues, and Ethics in Healthcare Delivery 1) Which option represents a situation exemplifying the need for nurses to become involved in healthcare policy development? Select all that apply. 1. The nurse omitted documentation of a surgical dressing change. 2. The nurse must have a nursing license and be certified as APRN to prescribe medications. 3. The nurse administered oral medications to the patient in the home. 4. The nurse discussed do-not-resuscitate decisions with the patient and the family. Answer: 2, 4 Explanation: 1. This scenario represents a violation of standards and a potential malpractice issue, not an issue of healthcare policy. 2. Changes in legislation and regulation (which might be influenced by nurses involved in healthcare planning) affect nursing practice. 3. This scenario is unlikely to be altered by changes in legislation or regulation. 4. This scenario might be altered by changes in legislation or regulation. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

2) Which strategy could the nurse use to avoid disparity in healthcare delivery? 1. Recognize the cultural issue related to patient care. 2. Request more health plan options. 3. Care for more patients even if quality suffers. 4. Campaign for fixed nurse-patient ratios. Answer: 1 Explanation: 1. Disparities often occur because the healthcare professional does not recognize cultural differences or has a cultural bias. 2. This is a consumer demand related to insurance. The nurse has little effect on this issue. 3. This is an unacceptable strategy to nursing. 4. This scenario is unlikely to have impact on health disparities. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process. 3) Which option best illustrates a positive outcome from managed care? 1. Reshaped current policy 2. Consumer involvement in the healthcare political process 3. Increase in quality care with reduced cost 4. Managed care is now the method used for reimbursement. Answer: 2 Explanation: 1. This is not an outcome of managed care, but rather a part of the political process regarding legislation. 2. Managed care resulted in many consumers speaking out against managed care, and this led to more developed healthcare consumerism. 3. Quality is still a problem and costs have not been reduced due to managed care. 4. Managed care is not as strong as it was in the past. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process. 4) The nursing assistant left a side rail down upon exiting the room of a patient who had just 20 Copyright © 2024 Pearson Education, Inc.

returned from the recovery room postoperatively. What does this scenario most closely illustrate? 1. Personal injury 2. Criminal intent 3. Malpractice 4. Negligence Answer: 4 Explanation: 1. It is not yet clear that any personal injury has occurred. 2. There is no indication that this nursing assistant had any criminal intent when leaving the side rail down. 3. Malpractice is the failure of a professional person to act in accordance with the prevailing professional standards or failure to foresee consequences that a professional person, having the necessary skill and education, should foresee. 4. Negligence is the failure to act as an ordinary prudent person would under similar circumstances, and is based upon that person's education and training. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

5) The risk manager is reviewing these events that occurred over the weekend. Which scenario should the risk manager be most concerned would represent malpractice? 1. The nurse did not obtain an apical pulse on a patient prior to administering digoxin 0.25 mg orally. 2. The nurse did not raise the bed when changing the linens for a patient who was up in the chair. 3. A nurse did not obtain consent before drawing blood. 4. The nurse continued to assess the diabetic patient's blood sugar before each meal. Answer: 1 Explanation: 1. This action is not in accordance with professional standards in assessing an apical pulse prior to administering digoxin. 2. This action is more likely to harm the nurse than it is to harm the patient. 3. This is more likely to be seen as battery than as malpractice. 4. This is an appropriate action expected from a professional nurse. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

6) Which scenario is an example of informed consent? 1. The nurse omits diabetic education for a patient who has had diabetes for 10 years. 2. The nurse applies restraints to a patient who is trying to remove the nasogastric tube. 3. The patient understands the surgical procedure that will occur in the morning. 4. The patient asks the nurse for pain medication. Answer: 3 Explanation: 1. This was a negligent action on the part of the nurse. 2. This could be construed as assault and battery. 3. This patient is able to make an informed decision about healthcare. 4. This is a routine nursing intervention and when the nurse brings the medication consent is implied. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

7) On admission, the patient states, "My son can make healthcare decisions for me if it is necessary." What does this statement imply? 1. The patient has a living will. 2. The son has durable power of attorney. 3. This patient has violated the Patient Self-Determination Act. 4. The patient requests do-not-resuscitate status. Answer: 2 Explanation: 1. In a living will, there is no person appointed to make decisions. The living will is a statement of the patient's wishes in writing. 2. The son is a competent person who has been designated to make healthcare decisions for his parent. This is a durable power of attorney. 3. This act requires that all healthcare providers ask patients about living wills and durable powers of attorney. There is no indication that there is any violation. 4. There is no indication that this is true. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

8) Which situation illustrates the ethical concept of autonomy? 1. The patient is instructed on the technique of insulin administration. 2. The patient is asked to choose from which arm to have blood drawn. 3. The patient's information can be used for research purposes. 4. The patient is informed of privacy rights. Answer: 2 Explanation: 1. This is provision of patient education. 2. Autonomy means that the patient has the right to make decisions about healthcare. 3. This concerns the matter of patient privacy. 4. This concerns the matter of patient privacy, not autonomy. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice. 9) Which nursing action best illustrates the ethical concept of beneficence? 1. Providing a walker for a patient prior to ambulating in the hall 2. Allowing the patient to choose what time to have a shower 3. Asking the patient about the existence of a living will or durable power of attorney 4. Continually communicating with the patient regarding procedures Answer: 1 Explanation: 1. This is the principle of doing good, inflicting no harm. 2. This is an example of patient autonomy. 3. This is required by the Patient Self-Determination Act. 4. This illustrates informed consent. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

10) Which action, taken by the nurse, best illustrates the ethical concept of justice? 1. The nurse witnesses consent prior to a surgical procedure for a patient. 2. The nurse advises the patient to take slow, deep breaths to try to relax before a urinary catheter is inserted. 3. The nurse provides discharge teaching to a postoperative patient and spends time with a patient who is depressed. 4. The nurse works with a physician to solve a patient problem. Answer: 3 Explanation: 1. This is a standard role of the nurse and is associated with the legality of informed consent. 2. This illustrates the principle of beneficence. 3. This is an example of justice because the nurse is providing fair treatment and giving time to both patients. 4. This is an example of collaboration in healthcare. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

11) Which nursing action is the best example of the ethical principle of veracity? 1. Supporting the patient's right to refuse any part of planned nursing care 2. Informing the patient that the pain medication to be given is not the same as what was administered the previous day 3. Maintaining the privacy of the patient's personal medical information 4. Supporting the patient when ambulating and instructing the patient on the use of a walker Answer: 2 Explanation: 1. This is an example of autonomy. 2. Veracity is truth telling, which is essential for effective communication and trust. 3. This illustrates confidentiality. 4. This illustrates beneficence or "do no harm." Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice. 12) Why does the process of developing public health policy seem familiar to most nurses? 1. It is very similar to the nursing process. 2. It is taught in all nursing schools. 3. It is emphasized on NCLEX-RN. 4. It reflects common sense. Answer: 1 Explanation: 1. The process whereby public health policy is developed closely replicates the nursing process. 2. This process is not taught in all schools. 3. This process is not emphasized on NCLEX-RN. 4. While much of the process does reflect common sense, the best answer is that it is similar to the nursing process. Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process. 13) Which statements correctly apply to the process of developing public policy? Select all that apply. 27 Copyright © 2024 Pearson Education, Inc.

1. The two types of public policy are regulatory and allocative. 2. Since public policy supports the general population, decisions regarding policy are typically straightforward and easy to make. 3. Often, in order to pass a policy, deals have to be made. 4. Public policy may benefit some at the expense of others. 5. By law, political influence is separate from policy development. Answer: 1, 3, 4 Explanation: 1. These are the two types of public policy. 2. It is difficult to develop public policy because there are often conflicts that must be considered. It is also impossible to meet the needs of all people. 3. Deals and compromises are a part of developing public policy. 4. Allocative policies provide benefits for some at the expense of others to ensure that certain public objectives are met. 5. Politics is deeply involved in developing public policy. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

14) Evaluate the following: The patient is labeled as a "complainer," and has not been informed of the treatment plan. The patient has no insurance, and the nursing staff is discussing the situation in the hallway. Choose the principles that have been violated. Select all that apply. 1. Justice 2. Confidentiality 3. Veracity 4. Autonomy 5. Beneficence Answer: 2, 3, 4 Explanation: 1. There is nothing that indicates that justice is not being done for this patient. The patient is in the hospital for care. 2. The discussion in the hallway is not keeping the patient's medical information private. 3. The patient has not been informed of the treatment plan. 4. The patient has not been given information to make decisions regarding care. 5. There is nothing that indicates that harm has come to this patient yet. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

15) What is different about today's healthcare environment that makes it crucial that nurses are involved in the development of healthcare policy? Select all that apply. 1. The focus of this new environment is on one-to-one nursing care. 2. There has been a shift from curing patients to prevention of illness. 3. Care must be cost-effective. 4. There is a need to reinvent nursing's professional culture. 5. High-quality care will again be provided primarily in acute care settings. Answer: 2, 3, 4 Explanation: 1. The focus is on care of populations. 2. Prevention is now becoming the focus of much of healthcare. 3. Cost-effectiveness is a primary issue in healthcare. 4. Nursing must reinvent its culture in light of the new healthcare environment. 5. There is a call for high-quality care in all types of settings and by all providers. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

16) What was the American Nurses Association's stance on the healthcare reform plan supported by the Obama administration? Select all that apply. 1. This law is a significant victory for patients. 2. The debate over healthcare reform is finally over. 3. There is need to help nurses understand the significance of this law. 4. Access to primary care will be more difficult for most Americans. 5. There will be greater protection against being denied health insurance. Answer: 1, 3, 5 Explanation: 1. "The ANA strongly believes that this law is a significant victory for the patients we serve." 2. "…we recognize that the debate over reform is not over." 3. "We are committed to helping nurses and the public understand how this change affects their lives." 4. "…they'll have better access to primary care." 5. "They'll have greater protection against losing or being denied health insurance coverage..." Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

17) A staff nurse in a small, rural hospital is concerned about the future of healthcare in the rural environment. How can this nurse be involved in healthcare policy development? Select all that apply. 1. Join local and national nursing organizations. 2. Contact elected representatives regarding nursing and healthcare. 3. Act as a patient advocate. 4. Use the internet to keep current on healthcare policy issues. 5. Serve on the Infection Control committee of the local hospital. Answer: 1, 2, 3, 4 Explanation: 1. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 2. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 3. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 4. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 5. While this is considered service to the institution, it is not as likely to impact healthcare policy on a state or national level. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

18) A patient is angry about the nursing care delivered on the past two shifts and demands to see his medical record. What should the nurse consider prior to granting this request? 1. The patient always has the right to view his medical record. 2. In some cases, the patient does not have the right to view his medical record. 3. The patient does not have the right to view his medical record. 4. The patient must have permission from the physician prior to viewing the medical record. Answer: 2 Explanation: 1. This is not true in every case. 2. In most cases, the patient does have the right to view the medical record, but there are some exceptions to this rule. The nurse should review the policy and procedure manual for these exceptions. 3. In most cases, the patient does have this right. 4. There is no requirement for approval of the physician. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

19) The nurse closely follows hospital policy for recording patient charges. After attending a conference breakout session on reimbursement, the nurse realizes that the hospital policy is in violation of Medicare rules. Is this nurse guilty of fraud? 1. Yes, but since the nurse was following hospital policy no charges can be filed. 2. Yes, this is a clear example of fraud. 3. No, but the hospital is clearly guilty of fraud. 4. No, fraud requires intention to do wrong. Answer: 4 Explanation: 1. Fraud requires intent. 2. Fraud requires intent. 3. It would have to be proved that the hospital intended to violate this policy. 4. In order to be guilty of fraud, the nurse would have to have intention of doing wrong. That is not present in this case. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

20) Which question, asked of a patient, reflects the observance of the Patient Self-Determination Act of 1990? 1. Have you recently changed physicians? 2. Why did you come to the hospital today? 3. Do you have a durable power of attorney? 4. Would you sign this release of information form? Answer: 3 Explanation: 1. This is an assessment question, but has no relationship to the Patient Self-Determination Act. 2. This is an assessment question, but has no relationship to the Patient Self-Determination Act. 3. As a result of this act, healthcare providers are required to ask about living wills and durable powers of attorney. 4. This question reflects patient privacy concerns. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

21) The nurse is considering "blowing the whistle" on a potential Medicare fraud situation occurring in a physician's office. The nurse has worked at this office for 12 years and has many friends among the staff and patients. What incentive does this nurse have for assuming the whistle-blower role? 1. The nurse is entitled to a percentage of any money recovered. 2. After the nurse exposes the potential fraud, the nurse's responsibility in the case is complete. 3. By law, the nurse can be subject to no negative actions related to whistle-blowing. 4. The nurse can "leak" the information to a news source first and still be protected by whistle-blowing laws. Answer: 1 Explanation: 1. The nurse will be entitled to a percentage of any money recovered as a result of this disclosure. 2. The nurse will have to testify. 3. While there is a law against overt punishment for disclosure, covert punishment may still exist. 4. The information must come from the nurse, not from a secondary source. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

22) The nurse has been invited to join the healthcare facility's interprofessional ethics committee. What factors should the nurse consider when making a decision about this invitation? Select all that apply. 1. The decisions made by these committees are advisory in nature. 2. Most of the cases discussed by these committees are related to financial considerations. 3. Nurses are generally active members in these committees and talk freely about ethical issues in nursing. 4. It might be best for the nurse to gain experience on a nursing ethics committee before joining an interprofessional committee. 5. The nurse can expect to be well compensated for work done on the committee. Answer: 1, 4 Explanation: 1. These are advisory bodies. 2. Although financial considerations are becoming more frequent, the primary topics considered are patient care issues. 3. Nurses are often hesitant to discuss the ethical issues in nursing. 4. If the nurse has no experience in working on ethics committees, the experience may be uncomfortable and the nurse may not be a viable member of the committee. 5. These committees are generally seen as service to the facility with little or no additional compensation offered. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

23) Consumer advocacy is more common today in healthcare policy. What are the common concerns that consumers have? Select all that apply. 1. Increasing costs of care 2. Impersonal care 3. Decreased communication 4. Provider competence 5. Decreasing quality of care Answer: 1, 2, 3, 4, 5 Explanation: 1. This is a consumer concern. 2. This is a consumer concern. 3. This is a consumer concern. 4. This is a consumer concern. 5. This is a consumer concern. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

24) Identify strategies that will help the nurse prevent malpractice lawsuits. Select all that apply. 1. Effective communication 2. Establishing security rules 3. Effective leadership 4. Caring attitude 5. Following the rules Answer: 1, 3, 4 Explanation: 1. This is true of effective communication with other healthcare providers, as well as with staff and patients. Clear communication is essential to understanding. 2. This has little to do with malpractice. 3. Effective leaders have a good understanding of legal and ethical principles that guide healthcare. 4. When patients and people on the healthcare team believe that the nurse is genuinely interested in them and in quality care, the risk for lawsuits diminishes. 5. While it is good to follow policy and procedures, the expert nurse will learn when it is best for the patient for the rules to be modified. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

25) Identify typical healthcare areas in which the states have input. Select all that apply. 1. Public health and safety 2. Provision of indigent care 3. Purchase care 4. Regulation 5. Resource allocation Answer: 1, 2, 3, 4, 5 Explanation: 1. These are all areas in which states have input into healthcare policy, legislation, and regulation. 2. These are all areas in which states have input into healthcare policy, legislation, and regulation. 3. These are all areas in which states have input into healthcare policy, legislation, and regulation. 4. These are all areas in which states have input into healthcare policy, legislation, and regulation. 5. These are all areas in which states have input into healthcare policy, legislation, and regulation. Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

26) Healthcare delivery has experienced many changes and problems. Based on an examination of these changes and problems, what would you consider a major concern today? 1. Cost is not related to quality. 2. Healthcare is complex. 3. Quality care is improving rapidly. 4. A functional system is more costly. Answer: 2 Explanation: 1. Cost is related to quality, and cost and quality are major concerns. 2. Healthcare is complex, a major concern today, and this makes it difficult to adjust to changes and improve. 3. Quality care is not improving rapidly. 4. A dysfunctional system is more costly. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

27) Which of the following include comments about and strategies related to healthcare disparity? Select all that apply. 1. Agency for Healthcare Research and Quality 2. Medicare reimbursement requirements 3. Institute of Medicine/National Academy of Medicine reports 4. National Quality Care Reports (annual) Answer: 1, 3, 4 Explanation: 1. AHRQ has many services and resources on disparity. 2. This does not include disparities as a requirement. 3. The IOM/NAM reports on quality include disparities. 4. The quality reports include indicators directly related to disparities. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process. 28) Healthcare in the United States would best be described by which of the following statements? 1. The United States has a national healthcare system. 2. The United States has universal health coverage insurance. 3. The United States has a local, state, and federal system of healthcare. 4. The United States focuses on a public system to provide care. Answer: 3 Explanation: 1. The United States does not have a national healthcare system. 2. There is no universal healthcare coverage. 3. The U.S. system is a mix of local, state, and federal services. 4. The system is a combination of private and public, with private as the major focus. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process. 29) You are serving on a state committee to develop a state health policy. Which of the following strategies should be done early in the process? 1. Coalition building 42 Copyright © 2024 Pearson Education, Inc.

2. Select the solution 3. Monitor the outcomes 4. Implement the policy Answer: 1 Explanation: 1. Coalition building should be done very early to ensure that you understand the stakeholders and begin to build support. 2. Solutions are selected after the problem is understood and possible solution options identified. 3. This is the last step in the process. 4. Implementation occurs after the problem is described, solution understood, and policy developed. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

30) What changes in the organization of healthcare delivery services does the Affordable Care Act of 2010 support? Select all that apply. 1. Nurse-managed health centers 2. Accountable care organizations 3. Increase in number of acute care hospitals 4. Medical homes 5. Focus on state-run clinics Answer: 1, 2, 3 Explanation: 1. Nurse-managed health centers are mentioned. 2. Accountable care organizations are mentioned. 3. Medical homes are mentioned. 4. The ACA does not include provisions to increase acute care hospitals; had greater emphasis on primary care. 5. There is no provision to focus on state-run clinics. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery. Leadership and Management for Nurses: Core Competencies for Quality Care, 5e (Finkelman) Chapter 3 Operational and Strategic Planning: Change, Innovation, and Decision Making 1) The manager of a maternal-child health unit announces that the unit will be redesigned to help meet the Institute of Medicine healthcare competencies. What scenario is one that the staff of this unit might expect? 1. Nursery, labor and delivery, and postpartum nurses will be cross-trained to work in each of these areas. 2. The nurses will be expected to participate in telehealth throughout a three-state region. 3. There will be a reduction in staff numbers. 4. The unit will be closed for remodeling. Answer: 1 Explanation: 1. Cross-training is an example of redesign or reengineering of healthcare. 2. This would require reregulating professional practice. 3. This is an example of rightsizing. 4. This is not what is meant by redesign in this case. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and 44 Copyright © 2024 Pearson Education, Inc.

2) In which situation would it be necessary to reregulate practice? Select all that apply. 1. Nurses are asked to cross-train to another specialty. 2. An insurance company opens a nationwide nurse call line. 3. The hospital hires unlicensed assistive personnel. 4. A nursing school revises its curriculum. 5. The healthcare organization goes national and hopes to encourage mobility among its administrative nurses. Answer: 2, 5 Explanation: 1. This is a redesign practice used by many organizations to compensate for the nursing shortage. 2. The use of telemedicine requires reregulating professional practice because nurses can use this technology to provide care in situations in which the patient is in a different state from the one where the nurse is licensed and located. 3. This is a redesign practice used by many organizations to compensate for the nursing shortage. 4. This is an example of restructuring in which nursing education attempts to prepare nurses for the "real world." 5. This mobility would result in the nurses working in different states from where they live and are licensed. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

3) Management has called a meeting to discuss the increase in negative patient satisfaction surveys. Which stage of Lewin's model of change does this represent? 1. Moving 2. Refreezing 3. Unfreezing 4. Working Answer: 3 Explanation: 1. The moving stage is the planning phase of the model and focuses on the development of goals and outcomes. 2. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes. 3. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem. 4. Working is not a stage of Lewin's model. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

4) The hospital would like to decrease the number of medication errors made secondary to transcription errors. In order to accomplish this, it is hoped that all physicians will be trained in the use of computerized physician orders by the end of the fiscal year. This is an example of which stage of Lewin's model of change? 1. Refreezing 2. Unfreezing 3. Moving 4. Working Answer: 3 Explanation: 1. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes. 2. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem. 3. This is an example of the moving stage, because the hospital has developed a goal and outcomes to help resolve the problem. 4. Working is not one of the stages of the model. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

5) Which activities represent the eight-step process for organizational change? Select all that apply. 1. Management has created a sense of urgency for the change by publishing outcome data on the organization's intranet. 2. Management has worked to develop and communicate a vision that can be shared by all employees. 3. Management has empowered employees to make changes. 4. Management is engaged in "deep change." 5. Management has orchestrated and celebrated some short-term successes along the path to change. Answer: 1, 2, 3, 5 Explanation: 1. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 2. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 3. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 4. This is not part of the eight steps. This is a coping strategy for what Quinn describes as "slow death." 5. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

6) The nurse manager is coping with a staff member who is very resistant to change. Which strategy would be beneficial for this nurse manager? 1. Maintain open communication with this staff member to establish trust. 2. Help the staff member focus on parts of the change rather than on the whole change at one time. 3. Take over all of the processes of the change. 4. Ignore any hidden agendas brought by this staff member. Answer: 1 Explanation: 1. Having an open and trusting relationship with staff will help to reduce resistance to change. 2. Focusing on parts and being unable to see the whole picture can result in territoriality. 3. Staff will not be innovative if managers overdirect, overobserve, or overreport. 4. Staff with hidden agendas or motives are barriers to change and should not be ignored. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

7) The nurse manager is aware of a significant change that will occur sometime in the next six months. How can this manager begin to prepare the staff for this change? Select all that apply. 1. Keep the staff apprised of as much information about the change as is possible. 2. Attempt to keep the unit staffing as stable as possible during the time of change. 3. Insist that all discussions about the change be conducted in a respectful manner. 4. Let the initial information about the change come "through the grapevine." 5. Avoid surprises by telling the staff about how the change will increase workload very early in the process. Answer: 1, 2, 3 Explanation: 1. Fear of the unknown is a primary reason people resist change. 2. Stability will help the staff cope with the idea of a change. 3. All discussions should be respectful and professional. 4. Being upfront with information will prevent staff from believing the manager is trying to hide the change. 5. Focusing on what the staff will lose (having to work harder) will likely increase resistance. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

8) Which option best describes a change agent that demonstrates a transformational style of leadership during the change process? 1. The change agent describes the vision for the change, sets high expectations, and is a role model for the staff. 2. The change agent expresses personal views about the change and empathizes with the staff. 3. The change agent expects staff to follow the change agent's directions required to meet the goal. 4. The change agent provides the staff members with the resources needed to do their job. Answer: 1 Explanation: 1. The charismatic change agent is an envisioning leader. 2. These actions describe an enabling change agent. 3. These actions describe a missionary change agent. 4. This is an instrumental or transactional change agent. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process. 9) During the change process to implement an electronic medical record, a nurse manager says, "We are experiencing a 'slow death.'" What evidence would the manager have to not support this conclusion? 1. Work processes that seem scattered 2. Staff burnout with complaints increasing 3. Use of a detailed project plan 4. Staff refusing to assume more assignments Answer: 3 Explanation: 1. Inability to do work effectively is a sign of "slow death." 2. Staff burnout is a sign of "slow death." 3. Using a detailed plan is a positive step and should not lead to "slow death" during change. 4. Staff who are less enthusiastic is a sign of "slow death." Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Apply the change process to the decision-making process. 10) A nurse manager is collecting staff views about a current unit problem to make a decision about actions to take. Which style of decision making is this manager employing? 52 Copyright © 2024 Pearson Education, Inc.

1. Unilateral 2. Individual 3. Authoritarian 4. Consensus Answer: 4 Explanation: 1. This style depends on a small amount of data, but arrives at one decision. 2. This style focuses on individuals. 3. This style tells the staff what will be done with the manager making the decision. 4. This style engages the staff to arrive at a consensus. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process. 11) A patient's fingerstick blood sugar registers 70. The nurse must follow the policy and procedure for caring for a patient with hypoglycemia. This is an example of what type of decision-making process? 1. Programmed decision making 2. Crisis decision making 3. Time-limited decision making 4. Nonroutine decision making Answer: 1 Explanation: 1. Programmed decision making is more repetitive and routine and typically related to a policy or procedure. 2. The situation is not a crisis. 3. This is not a time-limited situation. 4. Nonroutine decision making is not routine, can be crisis-oriented, and can require more time and consultation with others. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process. 12) A problem has been identified in the healthcare facility. What should the nurse who has been assigned the task of change agent do next? 53 Copyright © 2024 Pearson Education, Inc.

1. Develop an alternative plan. 2. Gather data. 3. Collaborate with others. 4. Empower staff. Answer: 2 Explanation: 1. Developing alternative plans is done after a diagnosis is made. 2. After the first step of the change process of acknowledging the problem, then it is necessary to gather the data necessary to be able to define the problem and develop a plan of action. 3. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase. 4. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

13) The nurse is working in a facility that is considering a major change by incorporating interprofessional teams in all departments and units. Which type of planning is required? 1. Policy planning 2. Strategic planning 3. Project planning 4. Strategic planning and project planning Answer: 4 Explanation: 1. Policy planning is not required but may be part of project planning. 2. Strategic planning is required; policy planning is not required but may be included. 3. This proposed change requires planning at levels above project planning. 4. Both strategic planning and project planning are required, because the move toward an interprofessional approach rather than a single discipline-run unit requires a change to the organization's components (departments) and operational matters within the organization. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

14) The nurse has been assigned to be a change agent for the facility's change to a computerized charting system. What type of planning will this require? 1. Strategic 2. Policy 3. Project 4. Both strategic and project Answer: 3 Explanation: 1. Strategic planning will not be necessary because changes will not be made to the organizations' departments or services provided. 2. This change probably will not change the value system, nor will laws and regulations be changing. Therefore, policy planning will not be necessary. 3. Since this change involves a specific time-limited initiative for the nursing department, this requires project planning. 4. Strategic planning will not be necessary because changes will not be made to the organization's departments or services provided. Project planning will be required. Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

15) What is the first step in coping with changes that occur in the healthcare environment? 1. Understanding personal response to change 2. Identifying the change agent 3. Investigating the facility's history of change 4. Identifying the purpose of the change Answer: 1 Explanation: 1. Some people have an immediate negative response to change. Other people are invigorated by change, whether the change is positive or negative. The nurse must understand personal response to the idea of change so that response to a particular change can be unbiased. 2. While this is important information, the nurse must first identify personal response to the concept of change. 3. While this is important information, the nurse must first identify personal response to the concept of change. 4. While this is important information, the nurse must first identify personal response to the concept of change. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

16) The nurse manager is developing a staff education session on change in healthcare. Which concepts should be included in this information? Select all that apply. 1. Oftentimes, before one change in healthcare is completed, another is taking place. 2. Most changes are focused on the organization's structure. 3. Change has been the normal state for healthcare providers for some time. 4. Change disturbs the organization's equilibrium. 5. Sometimes multiple changes occur together in healthcare. Answer: 1, 3, 4, 5 Explanation: 1. This is certainly a pertinent topic in today's healthcare environment. 2. Important examples of change are related to the organization's structure, but change is also affecting roles and responsibilities, communication methods and systems, policies and standards, culture, leadership and management approaches, and competencies and attitudes. 3. This is certainly a pertinent topic in today's healthcare environment. 4. The equilibrium does become disturbed, so staff must learn to tolerate this equilibrium in order to be effective. 5. This is certainly a pertinent topic in today's healthcare environment. Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; VI. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.