Advanced Nursing Leadership
Pre-Test Questions
Course Introduction
Advanced Nursing Leadership focuses on the development of transformational leaders within the nursing profession who can influence healthcare outcomes at individual, team, and organizational levels. This course examines key leadership theories, change management strategies, and decision-making models essential for effective nursing leadership. Emphasis is placed on building advanced communication skills, ethical and legal responsibilities, strategic planning, and fostering interprofessional collaboration to improve patient care and achieve organizational goals. Students will critically analyze real-world case studies and explore the impact of policy, finance, and cultural competence in complex healthcare environments.
Recommended Textbook
Leading and Managing in Nursing Revised Reprint 5th Edition by Patricia S. Yoder
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30 Chapters
758 Verified Questions
758 Flashcards
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Chapter 1: Leading, Managing, and Following
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Sample Questions
Q1) A dispute arises between an RN staff member and an LPN over a patient issue.The tension between the two begins to affect other staff members,who are drawn into the conflict; eventually,the team becomes polarized toward either the RN or the LPN.This situation might have been prevented through:
A) Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.
B) Asking other staff members what the real issues were in the dispute between the RN and the LPN.
C) Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves.
D) Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.
Answer: A
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3
Chapter 2: Patient Safety
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Sample Questions
Q1) In complying with Crossing the Quality Chasm,you ensure that:
A) Patients are actively encouraged to make decisions related to care.
B) Rules and decisions are made through centralized processes.
C) You monitor the performance of each staff member closely.
D) Preference is given to increasing staff numbers rather than staff credentials.
Answer: A
Q2) As a result of the Joint Commission assessment,a healthcare facility loses it accreditation.What is the primary consequence for this institution?
A) Loss of funding
B) Organizational shift to profit status
C) Practices continue as usual
D) Staff morale and care standards remain high
Answer: A
Q3) Traditional approaches to ensuring patient safety have focused on:
A) Assigning blame.
B) Finding solutions to systems issues.
C) Instituting best practices in response to errors.
D) Hiding errors from potential litigation.
Answer: A
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Page 4
Chapter 3: Developing the Role of Leader
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Sample Questions
Q1) As the clinical director of 24 employees,you have been asked to explain to staff members why they are not getting a raise this year,even though they have been working short-handed for many months and patient satisfaction scores have never been higher.Because you believe yourself to be a transformational leader,you will approach this problem by:
A) Telling the assistant clinical director and asking her to share the bad news with the other staff members.
B) Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them.
C) Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.
D) Meeting with a small group of seasoned staff members and asking them how to break the news.
Answer: C
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Chapter 4: Developing the Role of Manager
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Sample Questions
Q1) In developing an orientation program,the hospital educator breaks essential organizational information down into chunks,which she develops as online modules.This is an application of which of Drucker's functions of management?
A) Establishment of goals and objectives
B) Motivation and communication
C) Analysis and interpretation of performance
D) Organization of activities into manageable tasks
Q2) As a manager with a high percentage of young professionals,you increase job satisfaction among this young staff by:
A) Providing high levels of job structure and task orientation.
B) Developing schedules that are fair and observing contractual obligations.
C) Utilizing skills in the staffing mix to optimize the delivery of patient care.
D) Establishing opportunities to self-schedule.
Q3) In orienting a 25-year-old nurse,the unit manager understands that this worker:
A) Likes to attend to detail.
B) Is highly proficient in math and reading skills.
C) Enjoys being managed by superiors.
D) Likes to solve problems without being given solutions.
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6
Chapter 5: Legal and Ethical Issues
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Sample Questions
Q1) The principle that requires nurses to uphold a professional code of ethics,to practice within the code of ethics,and to remain competent is which of the following?
A) Beneficence
B) Autonomy
C) Fidelity
D) Honesty
Q2) Three gravely ill patients are candidates for the only available bed in the ICU.As the supervisor,you assign the bed to the patient with the best chance of recovery.This decision reflects which of the following ethical principles?
A) Beneficence
B) Autonomy
C) Veracity
D) Nonmaleficence
Q3) Which ethical principle is primarily involved in informed consent?
A) Veracity
B) Autonomy
C) Beneficence
D) Nonmaleficence
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Chapter 6: Making Decisions and Solving Problems
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Sample Questions
Q1) Sue,a nurse manager,has a staff nurse that has been absent a great deal for the past three months.A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school.Because of this,Sue decides to do which of the following?
A) Immediately fire the staff nurse.
B) Speak to the whistleblower and elicit more information.
C) Speak to the staff nurse and ask her to resign.
D) Do nothing.
Q2) The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking.To make a high-quality decision,the nurse manager would:
A) Involve the rehab staff in the decision.
B) Involve the sales representative.
C) Make the decision alone.
D) Involve administration in the decision.
Q3) High-quality decisions are most likely to be made in nursing situations when:
A) Team leaders make the crucial decisions.
B) Individuals are advised of the problems.
C) Group size is neither too small nor too large.
D) Members are passively involved.
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Page 8
Chapter 7: Health Care Organizations
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Sample Questions
Q1) A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization).The nurse manager has had to educate staff and personnel about the financial implications of this partnership.A health maintenance organization:
A) Provides more expensive care than other types of insurance plans.
B) Has a centralized administration that directs and compensates physician services.
C) Pays physicians on a fee-for-service basis.
D) Does not pay as much for acute care as other practice plans.
Q2) Tracy is an RN case manager who interfaces between the Centers for Medicare and 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) Which of the following is an outcome of managed care?
A) Shift of patients to outpatient and home health services
B) Less complexity in funding sources
C) Less complexity in rules for consumers to follow
D) Greater consistency in the quality of care
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9
Chapter 8: Understanding and Designing Organizational
Structures
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Sample Questions
Q1) Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education,consultation,and training support.Sarah has:
A) Direct responsibility for patient care.
B) Direct accountability for patient outcomes.
C) An authority relationship to staff.
D) An influence over patient outcomes.
Q2) A hospital is working toward becoming a Magnet hospital.The chief nursing officer is aware that professional nursing departments of the future will:
A) Not be directed by nurses.
B) Be virtual organizations.
C) Be designed to maintain nursing standards of practice.
D) Be entitled to have client care departments.
Q3) "At Thoroughcare,we provide healthcare for women and children in transition" is an example of a:
A) Vision statement.
B) Mission statement.
C) Goal statement.
D) Statement of philosophy.
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Chapter 9: Cultural Diversity in Health Care
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Sample Questions
Q1) In coaching Sarah (Question 24),you suggest which of the following?
A) "Explain to Jim that there is no smoking in the hospital."
B) "Inform Jim that fires are not allowed in the hospital."
C) "Insist that he give you his tobacco because it is unhealthy for him."
D) "Ask him what he means by a smudge and what meaning it has for him."
Q2) Cultural diversity is the term used to describe a vast range of cultural differences.Events have symbolic meanings for the nurse manager and the staff.The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a:
A) Task force formed to commemorate a New Year's celebration in the Western tradition.
B) Project to provide Christmas gifts to the children in a daycare program.
C) Celebration of National Nurses' Week with the focus on cultural care.
D) Task force to develop a poster for the unit depicting religions of the world.
Q3) Rajib,RN,asks you,a senior staff member,about your mother,who is a patient on another unit.This question reflects:
A) Lack of concern for your cultural orientation.
B) Lack of understanding about his role.
C) Caring and concern for you.
D) How individuals in his culture relate to persons in authority.
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Page 11
Chapter 10: Power, Politics, and Influence
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Sample Questions
Q1) A nurse manager must implement a 2% budget cut on the nursing unit.Which approach should 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) A manager relies on his director (immediate supervisor)for advice about enrolling in graduate school to prepare for a career as a nurse executive.The director may exercise what kinds of power in the relationship with the manager in this advisory situation?
A) Expert, coercive, and referent
B) Reward, connection, and information
C) Referent, expert, and information
D) Reward, referent, and information
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Page 12
Chapter 11: Caring,Communicating,and Managing With Technology
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Sample Questions
Q1) Nurses need to know how to operate a computer,compare data across time,and look for patterns in client responses to treatments.These are examples of:
A) JCAHO standards.
B) Information systems.
C) Informatics competencies.
D) Requirements for nursing licensure.
Q2) The clinic nurse has just accessed a client's chart on the computer.The resident comes over and asks her to stay logged on because he needs to add a note to that client's chart.She should say:
A) "No problem. Just log me off when you're done."
B) "I'll put the note in for you. What do you want to say?"
C) "Just make sure that you sign your note because it's under my password."
D) "I'm sorry, but you will have to enter the information using your own password."
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Chapter 12: Managing Costs and Budgets
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Sample Questions
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) Which of the following factors is not implicated in rising healthcare costs?
A) Rising expectations of consumers for cure and care
B) Unintentional injuries
C) Socioeconomic conditions
D) Rising Medicare costs
Q3) The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is:
A) A contractual allowance.
B) A profit.
C) A flat rate.
D) Revenue.
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Chapter 13: Care Delivery Strategies
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Sample Questions
Q1) You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model.In considering this proposal,you recognize that significant costs specific to operationalizing this model are related to:
A) Implementation of an all-RN staff complement.
B) Significant changes in the physical structure of units.
C) Orientation of staff to new roles and responsibilities.
D) Testing and piloting technology at the bedside.
Q2) The model outlined in Question 12 might be particularly effective in:
A) Promoting communication among diverse team members.
B) Facilitating multiple perspectives on the total care of a patient.
C) Avoiding patient-provider conflict.
D) Developing competence and confidence in unskilled workers.
Q3) Complex care of acutely ill patients is required on a surgical unit,which utilizes differentiated nursing practice as its model of care delivery.The concept of differentiated nursing practice is based on:
A) Licensure status.
B) Experience in the agency.
C) Leadership capabilities.
D) Education and expertise.
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Chapter 14: Staffing and Scheduling
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Sample Questions
Q1) In evaluating mortality rates on the weekend,the head nurse on the cardiac unit is surprised to find that it is 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) In Question 10,the classification system that is used:
A) Utilizes financial data to determine number of staff to patient ratios.
B) Utilizes DRGs to determine acuity on a unit.
C) Combines interventions and time required for interventions to determine levels of care required.
D) Combines financial resources and nursing interventions to determine patient contact hours.
Q3) The difference between staffing and scheduling is that staffing:
A) Puts the right person in the right position.
B) Puts the right person in the right time and place.
C) Refers to the number of nursing hours per patient per day.
D) Looks after interpretation of benefits and compensation.
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Page 16
Chapter 15: Selecting, Developing, and Evaluating Staff
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Sample Questions
Q1) The final section of a performance appraisal is a rating scale.This scale is very detailed and relates to competency standards specific to surgical clients.The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved.This type of evaluation is most commonly known as:
A) A traditional rating scale.
B) Management by objectives/learning goals.
C) A forced distribution scale.
D) A behavior-anchored rating scale.
Q2) John notes that the next section is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as:
A) A behavior-anchored rating scale.
B) Management by objectives/learning goals.
C) The forced distribution scale.
D) A traditional rating scale.
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Chapter 16: Strategic Planning, Goal-Setting, and Marketing
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Q1) To conduct assessment of the internal environment,the strategic planning team for Pacific Hospital:
A) Invites community members and staff of the hospital to an evening focus groups session.
B) Discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital.
C) Invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing.
D) Asks the board to provide a summary of major opportunities for the future.
Q2) Assessment of the needs of the consumer or client (in developing a strategic marketing plan)focuses on:
A) Present needs only.
B) Present and future needs.
C) The development of surveys.
D) Secondary analysis of existing data.
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Chapter 17: Leading Change
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Sample Questions
Q1) The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems.The best approach to address this need for change,yet to have the best outcomes for clients,staff nurses,and the organization,is to:
A) Select one of the change models.
B) Use Lewin's model and principles of change.
C) Apply both planned and nonlinear approaches.
D) Form a task force of nursing staff and wound care specialists.
Q2) To effectively achieve a change goal/outcome in a change situation,the wound care specialist will:
A) Preserve the status quo.
B) Diminish facilitators and reinforce barriers.
C) Weigh the strength of forces.
D) Strengthen facilitating forces.
Q3) Elizabeth is an example of a(n):
A) Early adopter.
B) Late adopter.
C) Laggard.
D) Resister.
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Page 19
Chapter 18: Building Teams Through Communication and Partnerships
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Sample Questions
Q1) Marcy,a new staff nurse,is very concerned about "fitting in" on the rehabilitation unit.She addresses her concerns and speaks with the head nurse.The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group.Which of the following statements would she not include in her talk? "Staff members who feel included:
A) Are more cooperative."
B) Are harder workers."
C) Are part of the 50% who feel their strengths are used."
D) Bring enthusiasm and commitment to the group."
Q2) From the information presented in this chapter,which of the following statements best defines an accomplished team? Effective teams:
A) Can create a form of synergism in which the outcome is greater than the sum of the individual performances.
B) Do not necessarily need goals, objectives, vision, and a clearly stated purpose.
C) Do not always have effective communication patterns.
D) May or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.
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Page 20
Chapter 19: Collective Action
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Sample Questions
Q1) While making rounds,a night supervisor finds a unit with a low census and too many staff members.The night supervisor is performing as a statutory supervisor when he or she:
A) Assigns nurses to care for specific clients.
B) Develops a protocol for unlicensed personnel.
C) Recommends transferring a nurse to another service.
D) Teaches a nurse to use a new piece of equipment.
Q2) A Magnet hospital surveys the staff about job satisfaction.This type of environment,in which nurses have authority and autonomy,is linked with:
A) Client satisfaction with the healthcare organization.
B) Organizations with a limited number of nurse managers.
C) Private, specialty organizations in urban areas.
D) Sophisticated academic health sciences universities.
Q3) Collective action is effective in:
A) Ensuring that needs of nurses are placed ahead of other disciplines.
B) Defining nursing as a profession.
C) Advising patients of the needs of nurses.
D) Amplifying the influence of individuals.
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21
Chapter 20: Managing Quality and Risk
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Sample Questions
Q1) Examples of sentinel events include
A) Forceps left in an abdominal cavity.
B) Patient fall, with injury.
C) Short staffing.
D) Administration of morphine overdose.
E) Death of patient related to postpartum hemorrhage.
Q2) Hospital Magnet decides against creating a separate department to lead and monitor quality activities because:
A) Total organizational involvement is critical to QI.
B) Data generated by a single, separate department are generally flawed.
C) Monitoring and commitment to QI can come only from senior level managers.
D) Staff resent suggestions for improvement that originate outside of their unit.
Q3) Before beginning a continuous quality improvement project,a nurse should determine the minimal safety level of care by referring to the:
A) Procedure manual.
B) Nursing care standards.
C) Litigation rate of unsafe practice.
D) Job descriptions of the organization.
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22
Chapter 21: Translating Research Into Practice
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Q1) The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care.What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care?
A) Conducting an interactive educational workshop
B) Distributing educational materials on clinical units
C) Sharing the results of a chart audit with staff
D) Providing staff with a short DVD on the topic
Q2) At an organizational level,which of the following strategies would assist in ensuring that EBP is incorporated into nursing care?
A) Formation of nursing-only implementation teams
B) Restriction of evidence to RCT's
C) Formation of a network of individuals doing research and/or interested in research utilization
D) Avoidance of partnership with experienced researchers
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23
Chapter 22: Consumer Relationships
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Q1) A nurse makes a medication error that is not serious and does not cause harm to the patient.As the head nurse,your best action would be to:
A) Call attention to it by posting the critical incidents report at the nursing station.
B) Include the mistake on the nurse's performance appraisal.
C) Apologize to the patient for the error, and indicate that discipline has occurred.
D) Educate the nurse on how to provide an apology to the patient.
Q2) During review of a patient's progress,the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient.The patient is unable to pay.As the head nurse,you persist in ensuring that this patient receives the treatment.You are:
A) Empowering the patient.
B) Avoiding litigation.
C) Advocating for the patient.
D) Supporting the clinical pathway.
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Chapter 23: Conflict: the Cutting Edge of Change
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Q1) 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.
Q2) Jill is the head nurse on a unit in a large hospital.Two of the staff nurses are constantly arguing and blaming each other,and a resolution has not occurred in months.To solve the existing conflict,which is the most desirable conflict resolution?
A) Avoiding
B) Competing
C) Compromising
D) Collaborating
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25
Chapter 24: Managing Personalpersonnel Problems
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Q1) Arrange the strategies from Question 16 in the order in which they should occur in progressive discipline.
A) A, B, C, D
B) B, A, C, D
C) C, B, A, D
D) C, A, B, D
Q2) Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team.Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?
A) Increased absenteeism over the past month
B) Increased attempts to discuss his concerns with his colleagues
C) Testing of workplace guidelines
D) Frequent defensiveness
Q3) The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
A) Using replacement personnel with new ideas may be beneficial.
B) Salary costs are lower because personnel are fewer, and outcome is favorable.
C) Absence on the part of the rest of the staff is decreased.
D) Unacceptable patient care may result.
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Page 26
Chapter 25: Workplace Violence and Incivility
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Sample Questions
Q1) During coffee and other breaks,Rosalie,the new RN,is shut out of conversations with the other staff.When she approaches other staff on the unit to ask questions,they turn and walk off in the other direction.The behavior of the staff is characteristic of:
A) Dislike.
B) Lack of trust in Rosalie's abilities.
C) Horizontal violence.
D) Cultural incompetence.
Q2) In designing a new healthcare facility,it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings?
A) Emergency
B) Psychiatry
C) Gerontology
D) Maternal-child
Q3) In Question 19,which of the four is most likely to be a perpetrator of violence?
A) Becky
B) Sarah
C) Sharon
D) Donna
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Page 27
Chapter 26: Delegation: An Art of Professional Practice
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Q1) County Hospital has position descriptions for all staff,including RN Team Leaders.Sarah,a team leader on the rehab unit,assesses the needs of the patients in her area,assesses the skills and backgrounds of each of the individuals on her team,and then assigns and delegates the appropriate care provider to each patient and task.Sarah's activity in the example described is termed:
A) Passive delegation.
B) Passive accountability.
C) Active delegation.
D) Active responsibility.
Q2) In Question 18,before assigning Evelyn to Mrs.N.'s care,the most appropriate action of the care coordinator would have been to:
A) Determine Evelyn's educational background and preparation for this role.
B) Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.
C) Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator.
D) Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.
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Chapter 27: Role Transition
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Q1) A nurse is interviewing for a manager's position.Which of the following actions is considered a role preview?
A) Formal commitment of the employment contract
B) Improving role performance
C) Touring the unit
D) Disillusionment about the expectations of the job
Q2) As a result of Amy's coaching,Sarah (Question 16)completes a ROLES assessment.This assessment is helpful in
A) Identifying her clinical knowledge.
B) Role development.
C) Areas of conflict in expectations.
D) Management responsibilities.
Q3) The new nurse manager feels pulled between the expectations of staff,the demands of hospital administrators,and family obligations.According to Hardy (1978),unrelieved role stress and strain will lead to:
A) Frustration and anger.
B) Alienation of family and friends.
C) Low productivity and performance.
D) Physical symptoms and acute illness.
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Chapter 28: Self-Management: Stress and Time
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Q1) "Stress-buffering" behaviors can be elicited to reduce stress.All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except:
A) Distancing oneself from work.
B) Using cognitive reframing to change irrational thoughts.
C) Journaling and keeping an informal diary of daily events and activities.
D) Exercising regularly.
Q2) An example of role conflict occurs when:
A) The director of ICU and the manager of the surgical unit wish to hire the same new employee.
B) Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.
C) The nurse manager for ICU believes he does not receive as many resources as the nurse manager for nephrology.
D) Line managers believe that support staff use their technical knowledge to intrude on their authority.
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Chapter 29: Managing Your Career
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Q1) A nurse manager has been employed in the same facility for 20 years and has held the same position.This career style is known as:
A) Linear.
B) Spiral.
C) Steady state.
D) Entrepreneurial/transient.
Q2) You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project.Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path?
A) You are pressured to do so by your supervisor.
B) The organization has no other suitable candidate for the position.
C) You have limited knowledge of information technology and no real interest, but this will increase your knowledge.
D) Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.
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Chapter 30: Thriving for the Future
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Q1) Healthcare demographics,changing funding levels,and alternative approaches to care all interact with and influence one another.Nursing at individual,unit,and systems levels influences health care and society and vice versa.The implication of this is:
A) Funding levels will reduce the number of nursing positions.
B) The ethical influence of nursing on political decisions increases public trust in nursing.
C) Negative publicity by politicians will negatively affect public perceptions of nursing.
D) The public has little impact on the organization of health care.
Q2) Harry works with adolescents in an addictions clinic and has a staff of two RNs.The clinic has been extraordinarily successful because of Harry's ability to inspire staff and to inspire adolescent clients to achieve success.What connected leadership strength is Harry displaying?
A) Authenticity and accountability
B) Quest for meaning
C) Ethical political savvy
D) Leadership through expectation
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