Advanced Nursing Leadership
Midterm Exam
Course Introduction
Advanced Nursing Leadership explores the theories, principles, and strategies required for effective leadership within contemporary healthcare environments. The course emphasizes the development of advanced skills in critical thinking, decision-making, communication, and conflict resolution, while fostering professional growth and adaptability. Students analyze diverse leadership styles, change management processes, and ethical considerations in nursing, while examining policy development and quality improvement initiatives. Through practical applications and case studies, participants gain the expertise to lead interdisciplinary teams, influence organizational outcomes, and advocate for patients, staff, and the nursing profession in dynamic clinical and administrative settings.
Recommended Textbook
Leadership and Nursing Care Management 6th Edition by Diane Huber
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Page 2
Chapter 1: Leadership and Management Principles
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Q1) _____ are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals.
A) Managers
B) Motivators
C) Visionaries
D) Followers
Answer: D
Q2) Which of the following traits describe a transactional leader? (Select all that apply.)
A) Functions in a caregiver role.
B) Surveys their followers' needs and sets goals for them.
C) Uses charisma to produce greater effort in followers.
D) Focuses on the maintenance and management of ongoing and routine work.
E) Motivates followers to perform to their full potential.
Answer: A, B, D
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Chapter 2: Change and Innovation
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Q1) _____ is an expected part of change and is often related to fear and anxiety.
A) Depression
B) Resistance
C) Acceptance
D) Denial
Answer: B
Q2) An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued?
A) "These changes need to be made because the state and CMS require it."
B) "We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building."
C) "We need to make this change because it will help our lawsuit."
D) "This change is being made so that there is no further harm to another patient."
Answer: D
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Chapter 3: Organizational Climate and Culture
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Q1) Characteristics of a Magnet hospital include:
A) multidisciplinary collaboration.
B) nursing leader authority.
C) physician control.
D) social worker retention.
Answer: A
Q2) A professor at the local college of nursing is teaching at a new clinical site. She notes that the nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the _____ of the unit.
A) climate
B) culture
C) interactions
D) operation
Answer: A
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Chapter 4: Managerial Decision Making
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Q1) A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager and they determine that the equipment is urgent for patient safety in the new unit. The manager orders the necessary equipment from another company even though it is slightly more expensive. This is an example of:
A) clinical decision making
B) prioritization
C) triage decision
D) clinical reasoning
Q2) A family member of a patient files a complaint that her mother's dentures were lost when the patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used?
A) Delegation
B) Direct intervention
C) Indirect intervention
D) Purposeful inaction
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Chapter 5: Managing Time and Stress
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Sample Questions
Q1) Nurses who are successful at time management:
A) display an ability to set measurable goals and objectives.
B) frequently volunteer for new and creative projects.
C) hesitate to delegate because of perfectionist characteristics.
D) tend to accomplish specific activities within a time frame.
Q2) Which of the following responses may occur related to stress? (Select all that apply.)
A) Increased heart rate
B) Decreased blood glucose levels
C) Emotional exhaustion
D) Burnout
E) Chronic health conditions
Q3) The first critical step in creating an environment to prevent and address work-related stress is:
A) delegation.
B) motivation.
C) innovation.
D) intention.
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Chapter 6: Legal and Ethical Issues
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Q1) To establish legal liability on the grounds of malpractice, the injured party must prove which of the following? (Select all that apply.)
A) A duty of care was owed to the injured party.
B) An agreement was made to assume another party's liability.
C) There was a breach of duty.
D) Causation was present.
E) Actual harm or damages were suffered by the plaintiff.
Q2) The nurse on a medical unit is caring for a 19-year-old with complications from a congenital heart defect. The client's mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother?
A) Discuss personal information that the client shared with the nurse in confidence.
B) Provide the mother with any information required for continuity of care.
C) Explain that client confidentiality prevents the nurse from disclosing information.
D) Ask the client if he gives permission for the nurse to share information with the mother.
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8
Chapter 7: Communication Leadership
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Sample Questions
Q1) Organizational tones are based mostly on:
A) unspoken cultural norms.
B) commitment to success.
C) communication behavior.
D) leadership styles.
Q2) Which communication technique is most effective when handling patient complaints?
A) Persuasion
B) Bargaining
C) Negotiation
D) Non-verbal cues
Q3) A communication system developed originally to address communication patterns in critical situations is:
A) VERA framework.
B) NVC model.
C) crucial conversations.
D) TeamSTEPPS.
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Page 9
Chapter 8: Team Building and Working With Effective Groups
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Q1) The hospital's regulatory department is experiencing The Joint Commission survey. The surveyors want to review hospital policies for infection control before they leave for the evening. The regulatory team leader states that she can stay past her regular hours to wait for them and acknowledges that there will be a need for a policy change before the surveyors return the following day. All of the department managers stay to assist the regulatory team leader with the required documentation. This is an example of a: A) work group.
B) committee.
C) true team. D) group.
Q2) The critical care unit of a hospital utilizes team huddles at change of shift. This is an opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) _____ meeting.
A) information-sharing
B) opinion-seeking
C) problem-solving D) strategy
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Chapter 9: Delegation in Nursing
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Q1) Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.)
A) Nurse apprentices
B) Personal care attendants
C) Family members at bedside
D) Physicians
E) Nursing assistants
Q2) Who is ultimately accountable for the appropriateness and supervision of the delegated task?
A) The nurse who delegated the task
B) The UAP who accepted the task
C) The nursing manager
D) The hospital CEO
Q3) With regard to delegation, what organizational principles are considered? (Select all that apply.)
A) Legal guidelines and policies
B) Patient safety and accountability
C) Relationship management and patient support
D) Cost containment
E) Knowledge and education
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Chapter 10: Power and Conflict
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Q1) Subunit or _____ power refers to relationships across departments.
A) vertical
B) organizational
C) horizontal
D) exertional
Q2) Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.)
A) Connection power is based on the perception that the influencer has access to powerful people or groups.
B) Legitimate power is based on fear.
C) Expert power results from expertise, special skill, or knowledge.
D) Information power refers to skill in making rational appeals.
E) Referent power is based on admiration for a person.
Q3) _____ is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important.
A) Assertiveness
B) Ingratiation
C) Rationality
D) Upward appeal
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Page 12
Chapter 11: Workplace Diversity
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Q1) This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as:
A) baby boomers.
B) Generation X.
C) Internet Generation.
D) Mature Generation.
Q2) Which of these are true regarding millennials in the work environment? (Select all that apply.)
A) They need clear definitions of outcomes.
B) They thrive on deadlines.
C) Most enjoy working on their own.
D) They struggle with multitasking.
E) They lack problem-solving skills.
Q3) Which of these is the fastest growing minority group in the United States?
A) Asians
B) Caucasians
C) Blacks
D) Hispanics
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Page 13
Chapter 12: Organizational Structure
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Q1) The network or pattern of social relationships and friendship circles within an organization is known as the:
A) clique.
B) formal structure.
C) informal structure.
D) hierarchy.
Q2) Which of the following statements describe the benefits of specialization in the health care setting? (Select all that apply.)
A) Improved work performance
B) Increase in expertise
C) Improved efficiency and outcomes
D) Increased workload
E) Increased error reporting
Q3) Which of the following factors influences the structure of an organization?
A) Age of the building
B) Brand of computer system
C) Number of employees
D) Square footage of the facility
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Chapter 13: Decentralization and Shared Governance
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Q1) In organizations that practice shared governance, staff, managers, and leaders are responsible for:
A) technology.
B) budgeting.
C) education.
D) innovation.
Q2) Decentralization occurs when:
A) equipment is being purchased from approved vendors.
B) hiring decisions are made at the executive level.
C) power is distributed to those closest to the work of caregiving.
D) supplies are distributed from one central supply area in the hospital.
Q3) In organizations that practice shared governance, the responsibility for unit outcomes rests with the:
A) nursing team.
B) nurse manager.
C) individual nurse.
D) chief nursing officer (CNO).
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Chapter 14: Strategic Management
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Sample Questions
Q1) The first step of the strategic planning process is to:
A) develop strategic goals.
B) survey the environment.
C) implement the action plan.
D) formulate the organization's mission and vision.
Q2) A nurse manager enjoys implementing new programs and beginning new projects. She is beginning to find herself overwhelmed and needs to decrease her workload. Which of the following ideas might best help decrease her workload?
A) Comparing her vision with that of the institution
B) Following the strategic objectives and mission of the hospital
C) Reviewing the action plan and vision of the hospital system
D) Using her intuition to determine which project should continue
Q3) An action plan:
A) breaks a strategic plan into manageable parts.
B) details a futuristic view of the institution.
C) outlines the steps in performing a procedure.
D) provides a strategic plan for actualizing the mission.
Q4) A competitive move or business approach designed to produce a successful outcome is called _______.
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Chapter 15: Professional Practice Models
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Q1) Organizations need to integrate the behaviors of employees to avoid random chaos and maintain some order, function, and structure. A(n) _____ is a guideline that has been formalized. It directs the action for thinking about and solving recurring problems related to the objectives of the organization.
Q2) Critical paths:
A) are designed only for critical care or trauma patients.
B) determine lifesaving interventions for a specific population.
C) outline optimal care and time milestones for the routine patient.
D) provide a list of supplies and equipment needed for care.
Q3) Mary Lou is a nurse in the critical care unit. She works 12-hour shifts. Each shift she is assigned to one or two critical care patients. She is responsible for planning and delivering the care and treatment for each one of the patients she is assigned to. This is an example of which nursing model?
A) Team nursing
B) Managed care
C) Total patient care
D) Functional nursing
Q4) A(n) _____ is the operational mechanism by which care is actually provided to patients and families.
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Chapter 16: Case and Population Health Management
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Q1) The CM dyad team model-composed of a nurse case manager and social worker-has been widely adopted in hospitals. Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on: (Select all that apply.)
A) minimization of inpatient transitions.
B) promotion of patient and family satisfaction through efforts of advocacy.
C) maximization of health care benefits.
D) reduction of cost by decreasing the length of stay.
E) enhanced discharge planning.
Q2) The nurse who uses collaboration to coordinate care for an individual's and family's comprehensive health needs through communication and available resources to promote patient safety and quality, cost-effective outcomes is performing:
A) population health management.
B) managed care.
C) disease management.
D) case management.
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18
Chapter 17: Evidence-Based Practice: Strategies for Nursing Leaders
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Q1) A clinical nurse specialist is meeting one on one with staff nurses while they are working to discuss data about the evidence-based practice. This is known as:
A) academic detailing.
B) champion coaching.
C) individual instruction.
D) professional mentoring.
Q2) The CNO at Mercy Hospital is implementing a new evidence-based practice for fall prevention. List the steps in order she should take to advance stakeholders (both people and systems) through the process of diffusion.
A) Integrating and sustaining use
B) Creating awareness and interest
C) Promoting action and adaptation
D) Building knowledge and commitment
Q3) Evidence-based practice includes:
A) collaborative practice dynamics between health care professionals.
B) documentation of patient care as evidence of nursing practice.
C) integration of research with clinical expertise and patient values.
D) mutual goal setting and application in the clinical setting.
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Chapter 18: Quality and Safety
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Q1) The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the:
A) care delivery quotient.
B) excellence index.
C) quality of health care.
D) standard of care.
Q2) Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety?
A) We make sure that we don't have any errors on this unit.
B) We identify who made the error and take corrective action.
C) We provide remedial training for all staff on the unit when there is an error.
D) We report any medical error or near-miss to help us find the root cause of the problem.
Q3) _____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
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Chapter 19: Measuring and Managing Outcomes
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Q1) A(n) _____ is the result or results obtained from the efforts to accomplish a goal.
Q2) Areas of data evaluation on a balanced scorecard include: (Select all that apply.)
A) metrics.
B) key performance indicators.
C) environmental.
D) turnover rates
E) benchmarks
Q3) _____ involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators.
Q4) The outcomes concept that emphasizes the multidisciplinary process of providing health care is known as outcomes:
A) maintenance.
B) management.
C) measurement.
D) monitoring.
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21
Chapter 20: Prevention of Workplace Violence
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Q1) The most prevalent source of violence against nurses is from:
A) a current or former employee.
B) customers, clients, or patients.
C) criminals with no other connection to the workplace but who simply intend to commit a crime.
D) someone who is not employed at the workplace but has a personal relationship with an employee.
Q2) An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by ______.
Q3) Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is:
A) hazard prevention.
B) environmental designs.
C) behavior modification.
D) administrative control.
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Chapter 21: Confronting the Nursing Shortage
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Q1) Stacy has been asked by the corporate financial officer to report on the current organizational costs for nurse turnover. To determine the cost of nurse turnover, Stacy should review: (Select all that apply.)
A) vacancy costs.
B) accident rates.
C) competitor wages.
D) advertising expenses.
E) orientation and training.
Q2) The ability to continue the employment of qualified individuals, that is, nurses and/or other health care providers/associates who might otherwise leave the organization is called:
A) transfer.
B) selection.
C) turnover.
D) retention.
Q3) An important predictor of job satisfaction with new graduates is:
A) culture.
B) compensation.
C) benefit package.
D) staffing adequacy.
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Chapter 22: Staffing and Scheduling
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Q1) The hospital units most likely to employ a decentralized staffing model include: (Select all that apply.)
A) the telemetry unit.
B) labor and delivery.
C) the medical-surgical unit.
D) the emergency department.
E) the neonatal critical care unit.
Q2) The nursing manager of a general medical-surgical unit in a large hospital has gathered data reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The patient classification system that the nursing manager has used is criticized for its:
A) lack of reliability.
B) medical elements.
C) stereotyping of patients.
D) subjective basis.
Q3) When the needs and characteristics of the patient clinical unit, or system, are matched with a nurse's competencies, _____ results.
Q4) The amount of work performed by a unit is referred to as its _____.
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24
Chapter 23: Budgeting, Productivity, and Costing Out Nursing
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Q1) A(n) _____ is the difference between the budgeted and actual amounts.
A) expense
B) margin
C) revenue
D) variance
Q2) Supply budgets are a major component of the operating budget. Items such as office supplies, intravenous solutions, instruments, linen, gloves, and other personal protective equipment are examples of _____ costs.
A) fixed
B) flexible
C) variable
D) resource
Q3) A measure of the severity of illness of an individual patient or the aggregate patient population on a unit is called _____.
Q4) Revenues minus expenses equals:
A) cash flow.
B) expense incurred.
C) income.
D) total reimbursement.
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Chapter 24: Performance Appraisal
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Q1) This management technique is used to help employees improve performance in a service-oriented profession. This technique, in which the manager guides the employee through a conversation about his or her past successes as a way of identifying strengths, and then has a detailed discussion about how the employee can use the strengths to enhance future performance, is known as:
A) feedforward.
B) counseling.
C) goal setting.
D) mentoring.
Q2) Carrie, the manager of the pediatric floor, is being evaluated by her director. Carrie set goals last year such as increasing patient satisfaction on her unit by 20% and decreasing staff turnover by 10%. Carrie's performance appraisal today is based on how well she achieved those goals. This type of performance appraisal measures: A) traits.
B) behaviors.
C) competencies.
D) results.
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Chapter 25: Emergency Management and Preparedness
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Q1) The nursing leadership role once the all-hazards preparedness plan is completed is to:
A) confirm that resources are allocated appropriately.
B) ensure that every facility department understands their role is a disaster situation.
C) establish goals for all-hazards preparedness.
D) provide rewards for the committee's accomplishments.
Q2) Which of the following questions should be considered in the hospital gap analysis survey of safety and security readiness in the event of a disaster? (Select all that apply.)
A) Does the facility have a lockdown plan in case of emergency?
B) Does the facility have procedures in place for use of PPE?
C) Does the facility have a mechanism of tracking costs associated with the event?
D) Do you have a plan for allowing staff entry into the facility during an emergency?
E) Does the facility have emergency-powered phones in case of a disaster?
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Chapter 26: Data Management and Clinical Informatics
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Q1) The first person to analyze patient outcomes associated with nursing care delivery was:
A) Clara Barton.
B) Dorothea Dix.
C) Florence Nightingale.
D) Luther Christman.
Q2) _____ was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care.
A) Nurse anesthesia
B) Nursing informatics
C) Nurse-midwifery
D) Clinical nurse specialist
Q3) Management information systems describe a broad scope of activities that includes but is not limited to the management of:
A) decision support systems.
B) merchandise.
C) products.
D) nursing services.
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28
Chapter 27: Marketing
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Q1) A nurse leader is attempting to attract experienced nurses to her unit. Which of the following marketing strategies should she use? (Select all that apply.)
A) Disciplinary actions
B) Professional development opportunities
C) Workplace fun
D) Shared governance
E) Physician champions
Q2) Marketing mix from a seller's point of view includes:
A) client service, charges, comfort, and connecting.
B) customer solution, cost, convenience, and communication.
C) patient, physicians, perfection, and publicity.
D) product, price, place, and promotion.
Q3) How is the business of health care different from the practice of health care? (Select all that apply.)
A) The practice of health care is an exchange relationship.
B) The business of health care is transactional.
C) The business of health care is based on mutual caring and support.
D) The practice of health care is based on trade for mutual benefit.
E) The practice of health care is like a communal relationship.
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