Advanced Nursing Leadership
Midterm Exam
Course Introduction
Advanced Nursing Leadership explores the principles and practices necessary for effective leadership in diverse healthcare environments. This course examines advanced theories of leadership, communication strategies, ethical decision-making, and the integration of evidence-based practice to influence organizational change. Students will analyze case studies, develop skills in team management, conflict resolution, and strategic planning, and learn to advocate for patients, staff, and the nursing profession. Emphasis is placed on critical thinking, emotional intelligence, and the development of personal leadership styles to meet the challenges faced by nurse leaders in todays dynamic healthcare systems.
Recommended Textbook
Leading and Managing in Nursing 7th Edition by Patricia
S. Yoder
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Chapter 1: Leading, Managing, and Following
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Q1) During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed.What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission?
A)Empowering
B)A leadership tag
C)A symbol
D)A management task
Answer: B
Q2) A grievance brought by a staff nurse against the unit manager requires mediation.At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions.What would be the best course of action at this time?
A)Send the two disputants away to reach their own resolution.
B)Involve another staff nurse in the discussion for clarity issues.
C)Ask each party to examine their own motives and issues in the conflict.
D)Continue to listen as the parties repeat their thoughts and feelings about the conflict. Answer: C
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Chapter 2: Clinical Safety: The Core of Leading, Managing, and Following
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Q1) How would the nurse executive begin to increase safety in patient care areas of the Valley Hospital?
A)Asking the community what the safety issues are
B)Consulting with a management expert about staffing schedules
C)Ensuring that the senior nursing officer attends the board meetings
D)Instituting improved practices to reduce needlestick injuries
Answer: C
Q2) As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices?
A)Hospitals
B)Business
C)Industry
D)Outpatient clinics
Answer: A
Q3) What does the SBAR approach to patient safety encourage?
A)Consistency in assessment and practices
B)Continuing education
C)Multidisciplinary approaches
D)Patient feedback
Answer: A
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Chapter 3: Legal and Ethical Issues
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Q1) While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient.This patient is 40 years of age and alert.When you meet later to discuss what you heard with the RN, it is important to:
A)discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans.
B)discuss that statute law provides for patient autonomy and refusal of treatment.
C)remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance.
D)acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.
Answer: B
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Chapter 4: Cultural Diversity and Inclusion in Health Care
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Q1) Mary joins 5W nursing unit.Mary is a new graduate who is anxious to fit in.She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing.She is demonstrating:
A)cultural awareness.
B)cultural sensitivity.
C)acculturation.
D)cultural marginality.
Q2) Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture.A nurse should understand that culture is determined by which of the following?
A)Behavior
B)Love for people
C)Shared vision
D)Genetic predisposition
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Chapter 5: Gaining Personal Insight: The Beginning of Being a Leader
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Q1) In developing leadership skills, one should focus on authentic leadership.The theory of authentic leadership focuses on various factors.What is the top priority in development of authentic leadership?
A)Honest relationships
B)Organizational task
C)Accomplishment of goals
D)Exploring others
Q2) Which of the following is an example of a formal leadership position on a nursing unit?
A)Staff nurse
B)Unit secretary
C)Unit manager
D)Nursing assistant
Q3) As a new nurse manager, you are aware of leadership, management, and followership principles.What is the first step to becoming an effective leader?
A)Being an effective follower
B)Taking a class on leadership
C)Taking a class on management
D)Getting an advanced degree
Page 7
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Chapter 6: Being an Effective Follower
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Q1) The nurse manager is working with a group of new nurses.The new nurses ask questions about leadership and the role of a manager in leading nursing.The manager shares the desire to have engaged staff nurses who participate in a team environment.What is the manager describing?
A)Effective follower
B)Effective leader
C)Ineffective follower
D)Ineffective leader
Q2) A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager.The nurse is studying the leader-follower relationship.What has the nurse discovered as accurate part of the leader-follower relationship?
A)Leaders are also followers.
B)Followers need to linear structures.
C)Followers are submissive in nature.
D)Leaders should dictate to the group.
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Chapter 7: Managing Self: Stress and Time
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Q1) Which one of the following statements has been proven to be true?
A)Recent research has found that women do not have a unique physiologic response to stress.
B)Both men and women interpret the same stressor in the same manner without regard to past experiences.
C)Stress influences the immune system in one complex manner.
D)Stressors that are identical do not necessarily have similar effects on each individual.
Q2) A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively.This would be considered a(n) ________ stress.
A)internal source
B)familial
C)burnout
D)external
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Chapter 8: Communication and Conflict
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Q1) A nursing instructor is teaching a class on conflict and conflict resolution.She relates to the class that conflict in an organization is important, and that an optimal level of conflict will generate:
A)creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers.
B)creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
C)creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.
D)a bureaucratic atmosphere, a strong team spirit, and motivation for its workers.
Q2) The nurse manager decides to use a mediator to help resolve the staff's conflict.A basic strategy for truly addressing this conflict is to:
A)identify the conflicting facts.
B)be determined to resolve the conflict.
C)schedule a meeting time for resolution.
D)have a clear understanding of the differences between the parties in conflict.
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Chapter 9: Power, Politics, and Influence
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Q1) A nurse manager must implement a 2% budget cut on the nursing unit.What approach would the manager use to most effectively empower the staff of the unit?
A)Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate.
B)Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only.
C)Provide the staff with handouts about the budget cuts and let them make recommendations in writing.
D)Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.
Q2) One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee.She suggests that this would be an excellent way to get to know people who share her interest in research.Her actions are an example of:
A)mentorship.
B)politics.
C)networking.
D)empowerment.
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Chapter 10: Health Care Organizations
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Q1) A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization.Not-for-profit organizations:
A)pay dividends to stockholders.
B)can refuse clients who are unable to pay.
C)have no paid employees.
D)pay no taxes.
Q2) Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid.Tracy's responsibilities most likely would include:
A)managing physician-led research.
B)monitoring physician documentation of the need for medical care.
C)determining which services are designated fee-for-service.
D)identifying errors in physician diagnoses.
Q3) Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days).This facility would likely be considered:
A)primary care, specialized.
B)tertiary care, long-term.
C)acute care, specialized.
D)public care, specialized.
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Chapter 11: Organizational Structures
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Q1) Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures.A hybrid organizational structure:
A)has many divisions of labor.
B)best fits long-term care units.
C)has a mixture of the characteristics of various organizational types.
D)places the authority for decision making closest to the places where workers perform.
Q2) Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on.The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on.The primary disadvantage of this organizational structure is:
A)breakdown in function and communication across specialties.
B)lack of congruence in culture and organizational values.
C)highly centralized decision making and authority.
D)wide span of control.
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Chapter 12: Care Delivery Strategies
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Q1) In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation.What type of design constitutes a partnership care delivery model?
A)RN and LPN/LVN
B)RN and RN
C)RN and medication assistants
D)RN and certified nurses' aides
Q2) The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model.Which of the following methods would be the most cost-effective?
A)Functional method
B)Case management method
C)Primary care method
D)Team method
Q3) Case managed care may enhance profit in a for-profit health organization by:
A)minimizing costs in high resource consumption areas.
B)combining licensed and non-licensed care providers in delivering patient care.
C)increasing reimbursement from third-party payers.
D)reducing the amount of technology used to support clinical decision making.
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Page 14
Chapter 13: Staffing and Scheduling
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Q1) In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays.In exploring the reasons for this apparent anomaly, the head nurse focuses on:
A)availability of diagnostic personnel.
B)availability of physicians.
C)communication with on-call providers.
D)acuity level of patients.
Q2) A nurse manager uses many sources of data when planning the unit's workload for the year.Which of the following data must be considered in the planning?
A)Hours of operation of the unit
B)Trends in acuity on the unit
C)Maximum work stretch for each employee
D)Weekend requirements
Q3) A busy neurologic ICU and step-down unit most likely would use which patient-classification system?
A)Factor evaluation
B)Prototype evaluation
C)Hybrid system
D)AHRQ system
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Chapter 14: Work Force Engagement Through Collective
Action and Governance
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Q1) Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital.The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives.For true shared governance to be seen as part of this approach:
A)it must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions.
B)stakeholders must be assured of the value of their input even though final decisions rest with senior executives.
C)publications must clearly outline how staff input was solicited and obtained.
D)staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.
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Chapter 15: Making Decisions and Solving Problems
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Q1) In a rural hospital, the unit for which you are charge nurse has a particularly busy morning.A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver.A child with asthma is experiencing early signs of an attack.The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience.An unlicensed assistant is available to assist.You must decide which patient situation you will take and where the new graduate RN's skills can best be used.Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves:
A)a higher order thinking process.
B)selecting the best option for reaching a predefined goal.
C)optimizing.
D)satisficing.
Q2) A clinic nurse has observed another nurse deviating from agency policy in performing wound care.The best approach for the clinic nurse to take is to:
A)stay out of it.
B)inform the nursing supervisor.
C)fill out a notification form (incident report).
D)assess the risk to the client and the agency before proceeding.
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Chapter 16: The Impact of Technology
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Q1) In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure.These devices involve:
A)biomedical technology.
B)telecommunications.
C)retrieval of patient history information.
D)Internet.
Q2) You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension.To support your planning, you draw out and present patient data from:
A)a clinical database.
B)biomedical technologies.
C)e-mail.
D)Internet sources.
Q3) A necessary, basic condition for successful integration of clinical information systems is:
A)software.
B)standard medical nomenclature.
C)confirmatory evidence from nursing-led studies.
D)strong interdisciplinary cultures.
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Page 18
Chapter 17: Delegating: Authority, Accountability,
Responsibility in Delegation Decisions
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Q1) Which of the following exemplifies accountability? Karen, the nurse manager on 5E:
A)consistently submits her budgets on time.
B)gets along well with her staff and with other managers.
C)outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.
D)actively solicits ideas regarding scheduling from her staff.
Q2) An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient.Which of the following would be the most appropriate communication with her?
A)"How do you usually do this kind of dressing?"
B)"The dressing needs to be done today and tomorrow with the supplies on this cart."
C)"Here is what you need for the dressing, and I will show you what needs to be done."
D)"I know you know what you are doing.Let me know if you have any problems."
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19
Chapter 18: Leading Change
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Q1) Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.)
A)"What is working well for you during bedside reporting?"
B)"What has not worked for you today?"
C)"Is there someone on your team who deserves special recognition for her efforts in the implementation?"
D)"Did you have a good vacation?"
Q2) Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that:
A)Elizabeth will never adopt the change.
B)Elizabeth is insecure in her practice.
C)Elizabeth requires more information about the practice.
D)change involves emotions.
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Page 20
Chapter 19: Building Effective Teams
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Q1) The mediator noticed that tension was still evident between the nurse manager and staff members.He informed the chief nursing officer that to begin team building, it would be important that everyone:
A)work together in a respectful, civil manner.
B)use avoidance techniques when confronted with a conflict.
C)develop a personal friendship with each other.
D)socialize frequently outside of work.
Q2) Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit.Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about.This is an example of:
A)how expectations and objectives need to be made clear in team situations.
B)the need to encourage open discussion of disagreements in opinions.
C)the importance of involving all staff in discussions in group settings.
D)the enduring nature of first impressions.
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Chapter 20: Managing Costs and Budgets
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Q1) A nurse manager approves two staff nurses to attend a national conference.When reviewing the budget, the nurse manager looks at which line item?
A)Cash budget
B)Capital budget
C)Operating budget
D)Supply and expense budget
Q2) As an experienced nurse manager who is new to an organization, it would be important to:
A)know the difference between operating and capital budgets.
B)understand the budget timetable and level of involvement expected of individual managers in budget preparation.
C)know why a budget is essential to the well-being of an organization.
D)understand what factors drive up healthcare costs in the healthcare system.
Q3) Which of the following factors is not implicated in rising healthcare costs?
A)Rising expectations of consumers for cure and care
B)Marketing of drugs to consumers
C)Large administrative staffs to process medical billings
D)Rising Medicare costs
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Chapter 21: Selecting, Developing, and Evaluating Staff
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Q1) Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills.Sue's concerns reflect which best practices associated with performance appraisal?
A)Rating scales are too generalized to be considered valid or reliable.
B)The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills.
C)BARS is considered superior to simple rating scales in terms of performance appraisal. D)Rating scales need to be designed by users to be well accepted.
Q2) The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization.Common characteristics of empowered organizations are:
A)shared values, high salaries, and a human focus.
B)shared values, flexibility, and a human-capital focus.
C)commitment to communication, high salaries, and flexibility for evaluations.
D)creation of community and of effective stress management in the midst of divergent goals.
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Page 23
Chapter 22: Person-Centered Care
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Q1) The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction.The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the:
A)cultural sensitivity of staff.
B)cost-effectiveness of care delivery.
C)economic value of service.
D)outcomes for clients and their perceptions of care.
Q2) A nurse is admitted to a psychiatric unit.The staff expresses frustration with her because they have explained her medication regimen several times, and yet, when she leaves the unit with a pass, she fails to follow it.The staff believe that, as a nurse, she should be able to understand what is expected.The nurse's failure to follow the regimen indicates:
A)early cognitive impairment.
B)lack of motivation.
C)lack of health literacy.
D)worsening health state.
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Chapter 23: Managing Quality and Risk
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Q1) A new RN staff member asks you about the difference between QA and QI.You explain the difference by giving an example of QI.
A)"Last year, the management team established new outcomes that addressed issues such as medication errors."
B)"At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"
C)"A process audit was done recently to determine how much time was being spent on patient documentation."
D)"Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."
Q2) Hospital ABCD is a Magnet hospital.One reason this designation has been applied to Hospital ABCD because it:
A)facilitates active staff participation in decision making related to quality nursing care.
B)has implemented a graduate nurse orientation program.
C)espouses commitment to excellence in patient care.
D)is establishing career ladders for nurses.
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Chapter 24: Translating Research Into Practice
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Q1) Which of the following is most accurate regarding evidence-based practice?
A)Evidence-based practice replaces continuous quality improvement.
B)Evidence-based practice began with medicine and assists in determining which medical models can be applied in nursing practice.
C)Effective and efficient care can already be demonstrated, which means that EBP will soon become redundant.
D)EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.
Q2) To help staff nurses adjust to using research in practice, what strategy would the nurse manager use?
A)Attendance at a regional research conference
B)Formal classes in electronic search techniques
C)Establishing a journal club
D)Issuing reports on the adverse consequences of outdated practices
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26
Chapter 25: Managing Personal and Personnel Problems
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Q1) Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety.The manager can implement steps that help to alleviate uncivil behavior on a unit.Which of the following would not be an appropriate first step?
A)Suspending the staff member from work
B)Providing written admonishment that is discussed and placed in the employee's file
C)Providing verbal admonishment
D)Terminating the staff member
Q2) In keeping with guidelines of the organization, the nurse manager documents staff problems.Documentation of disciplinary problems should:
A)include a plan to correct them and to prevent future occurrences.
B)state a detailed history of past problems that are related to the current one.
C)be written at the convenience of the manager.
D)not be discussed until the formal performance evaluation.
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Chapter 26: Role Transition
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Q1) The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months.The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time.The phase of role transition being experienced is the role of:
A)acceptance.
B)negotiation.
C)discrepancy.
D)internalization.
Q2) Sarah is a nursing graduate of 5 years who is very confident in her clinical skills.She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus.She is excited about being able to use her knowledge and interest by being hired as a nurse manager.Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage.Sarah's actions are important in avoiding role:
A)ambiguity.
B)transition.
C)development.
D)negotiation.
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Page 28
Chapter 27: Managing Your Career
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Q1) Which of the following needs revision on a résumé or CV?
A)John Jones 87 Highway Drive City, MI 79110 Jjones@gmail.com
B)M.Howes Anyway Highway City, MO 77700 (H) 777-777-0000
E-mail: mh@gmail.com
C)Dr.L.Jones 99 Carway Drive City, NY 84003 (H) 999-999-0000 (Cell) 999-000-9999
D)Tanya Jones 67 Honeywell Drive City, MO 66907 Beerhog@hotmail.com
Q2) A functional résumé focuses on:
A)experience and skills gained in positions.
B)positions held and specific roles in the positions.
C)academic qualifications and achievements.
D)relating skills and experience to qualifications in a specific position.
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Chapter 28: Developing the Role of Leader
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Q1) As a senior executive, you are keen to develop your hospital as a learning organization.Part of your purpose in translating this vision into practice is to: (Select all that apply.)
A)retain funding from third-party payers.
B)develop leaders.
C)maintain and/or improve quality of care.
D)stay abreast of new knowledge and evidence.
Q2) The adage "leaders are born and not made" reflects which of the following ideas around leadership?
A)Management can be taught; leadership depends on abilities.
B)Mentorship is important in developing innate skills of leaders.
C)Leadership is a natural skill that cannot be refined or developed.
D)Succession planning and formal education related to leadership are ineffective.
Q3) The style of leadership that Kari is exhibiting is likely to:
A)ensure that the organization is financially stable.
B)stifle innovative thinking about ways to move out of financial jeopardy.
C)lead to apathy and disinterest in the organizational goals.
D)lead to decreased attrition of staff on her unit.
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Chapter 29: Developing the Role of Manager
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Q1) A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff.She says she does not feel respected and is emotionally tired as a result.This situation represents:
A)bureaucratic organization.
B)realities of current health care.
C)negative organizational culture.
D)lack of engagement by administration.
Q2) The nurse manager is anticipating changes on the unit because of managed care.It is up to the manager to "sell" the staff on this care concept.A goal of managed care that the staff must understand is that managed care is:
A)grounded in business theory.
B)useful for long-term patients only.
C)designed to reduce unit resources and staff.
D)not concerned with the best interests of clients.
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Chapter 30: The Strategic Planning Process
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Q1) Northwestern Hospital has decided to implement peer review.As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month.The most important step in this process is to:
A)provide an educational session for staff on peer review.
B)revise the mission statement, objectives, and performance standards.
C)develop objectives and performance standards with employees.
D)implement objectives and performance standards.
Q2) Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment.
A)public
B)macro
C)competitive
D)social
Q3) Nurses are valuable partners in marketing strategies because they:
A)are more likely than other members of the organization to use marketing tools.
B)have a strong background in using evidence to support decisions.
C)have close involvement with patients, who are the target group for marketing.
D)constitute the largest staff group in most healthcare organizations.
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Page 32
Chapter 31: Thriving for the Future
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Q1) Which aspect of our tradition and history in nursing may impede our movement toward future-oriented thinking?
A)Lack of confidence
B)Focus on the discipline of nursing
C)Focus on details in the everyday practice
D)Mistrust of trends and new evidence
Q2) Which of the following will require greater attention in the future?
A)Chronic disorders
B)Obstetrical outcomes
C)Prevention of hospital-based errors
D)Team conflict resolution strategies
Q3) In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate: (Select all that apply.)
A)prevention strategies.
B)leadership skills and knowledge.
C)violence de-escalation strategies.
D)strategies for job security.
To view all questions and flashcards with answers, click on the resource link above. Page 33