Healthcare Systems Leadership
Exam Answer Key
Course Introduction
Healthcare Systems Leadership explores the principles and practices of effective leadership within complex healthcare environments. The course examines organizational structures, leadership theories, and strategies for driving change, improving quality of care, and promoting teamwork across interdisciplinary teams. Students will learn to assess and respond to challenges in policy, finance, and technology while fostering collaborative, ethical, and culturally competent healthcare delivery. Emphasis is placed on developing critical decision-making, communication, and strategic planning skills to lead healthcare organizations through an evolving landscape.
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) The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of _____ leadership.
A) authoritarian
B) democratic
C) laissez-faire
D) servant
Answer: A
Q2) Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice.
A) vision
B) supervision
C) delegation
D) problem solving
Answer: 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) A nurse manager recognizes that her staff's emotional responses to organizational change are similar to:
A) adaptation techniques.
B) integrative tactics.
C) symptoms of mental illness.
D) the grief model.
Answer: D
Q3) The identification of forces that drive and restrain change is called a(n):
A) equilibrium evaluation.
B) force field analysis.
C) status quo analysis.
D) refreezing system.
Answer: B
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Page 4
Chapter 3: Organizational Climate and Culture
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Q1) A process used to achieve and internalize knowledge, skills, and behaviors of professional nursing in order to belong and participate is referred to as professional:
A) actions.
B) conduct.
C) ownership.
D) insight.
Answer: D
Q2) The nursing manager of a telemetry unit has developed a policy in which all nurses automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager's actions are positively affecting the _____ of the unit.
A) climate
B) culture
C) interactions
D) operation
Answer: B
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Page 5
Chapter 4: Managerial Decision Making
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Q1) A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. When the nurse recognizes the change and deploys the rapid response team and physician, which skill is being demonstrated?
A) Leadership
B) Clinical judgment
C) Clinical decision making
D) Management
Q2) A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making tool?
A) Pilot project
B) Simulation
C) Shared governance
D) Data analytics
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Chapter 5: Managing Time and Stress
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Q1) Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress?
A) Job stress
B) Overload of role
C) Moral distress
D) Role conflict
Q2) An internal obstacle that may contribute to moral distress is:
A) lack of resources.
B) lack of confidence.
C) lack of structure.
D) lack of processes.
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Chapter 6: Legal and Ethical Issues
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Q1) The most common source of legal liability for nurse managers is a(n):
A) medical malpractice suit.
B) organizational nursing issue.
C) tort.
D) vicarious liability.
Q2) A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.)
A) Justice
B) Autonomy
C) Veracity
D) Confidentiality
Q3) The major responsibility for upholding patient care standards belongs to the:
A) chief executive officer of the facility.
B) nurse manager.
C) on-call physician.
D) staff nurse providing patient care.
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Page 8
Chapter 7: Communication Leadership
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Q1) Which of the following are examples of patient privacy or security breaches? (Select all that apply.)
A) Encrypted e-mail communications
B) Fax transmission sent to incorrect physician office
C) Prescription given to patient with wrong label attached
D) Case management coordinator obtaining information about a patient's diagnosis
E) Discharge summary given to patient's spouse
Q2) Effective communication is fostered through which of the following ingredients? (Select all that apply.)
A) Trust
B) Humility
C) Respect
D) Empathy
E) Sympathy
Q3) Which communication format was developed to address the communication arm of the TeamSTEPPS model?
A) NVC (nonviolent communication)
B) SBAR (situation, background, assessment, and recommendation)
C) VERA (validation, emotion, reassurance, activity)
D) MI (motivational interviewing)
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Chapter 8: Team Building and Working With Effective Groups
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Q1) Work group disruption has been shown to be linked to negative outcomes. What are some factors that can contribute to work group disruptions? (Select all that apply.)
A) Budget constraints
B) Multidisciplinary attendance
C) Reorganization
D) Absenteeism
E) Turnover
Q2) Group interactions are composed of which of the following elements? (Select all that apply.)
A) The unique way the group interrelates and begins to work together
B) The values and norms of each individual
C) The process of problem solving
D) The communication that occurs among group members
E) The roles played by each member
Q3) In nursing, the reason groups form is:
A) monetary rewards.
B) mandatory obligations.
C) physical needs.
D) professional socialization.
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Chapter 9: Delegation in Nursing
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Q1) Leadership style may be a significant barrier to effective delegation. Which of the following describes the "invincible" style? (Select all that apply.)
A) Prefers to do everything themselves so as not to transfer control.
B) Wants to be everyone's friend.
C) Comes across as a pushover.
D) Often stays late to complete documentation.
E) Micromanages the UAP.
Q2) When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.)
A) Potential for harm
B) Complexity of the task
C) Amount of problem solving required
D) Predictability of the outcome
E) Level of patient interaction
Q3) Delegating requires clear and skillful _____ to avoid liability.
A) negotiation
B) communication
C) corrective action
D) planning
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Page 11
Chapter 10: Power and Conflict
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Q1) Which of the following are the formal dimensions of power? (Select all that apply.)
A) Social aspect
B) Relational aspect
C) Dependence aspect
D) Independent aspect
E) Sanctioning aspect
Q2) Nurses must use which of these to facilitate change in health care organizations? (Select all that apply.)
A) Actualization
B) Authorization
C) Influence
D) Ratification
E) Power
Q3) Subunit power is derived from:
A) being independent within the organization.
B) providing resources on which the organization most depends.
C) supplying multiple cross-trainable functions within the organization.
D) voicing unique opinions and values within the organization.
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Chapter 11: Workplace Diversity
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Q1) What is the most modifiable factor in the provision of equitable health care?
A) Availability of services
B) Socioeconomic status
C) Care that is responsive to cultural needs
D) Education level
Q2) Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition?
A) World Health Organization
B) Affordable Care Act
C) Centers for Disease Control
D) Agency for Healthcare Research and Quality
Q3) Eliminating ___________ can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided.
A) diversity
B) cultural incompetence
C) health disparities
D) miscommunication
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Page 13
Chapter 12: Organizational Structure
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Q1) The division of work by occupation or function is a form of:
A) specialization.
B) interdependence.
C) uncertainty.
D) technology.
Q2) The nursing staff on a critical care unit thought that professional growth could be enhanced. Which of the following interventions would support empowerment of the nursing staff? (Select all that apply.)
A) Eliminating computers and reverting back to paperwork
B) Increasing pay wages for ancillary and professional staff
C) Providing various methods for ongoing education and continuing education units
D) Working to make equipment and medications readily available
Q3) An organizational chart is used to depict: (Select all that apply.)
A) a visual display of the organization s positions.
B) the intentional relationships among positions.
C) open positions within human resources.
D) flow of authority.
E) advisory committees.
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Chapter 13: Decentralization and Shared Governance
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Q1) One obstacle in the implementation of a shared governance model is that nurses have:
A) empowered participation in committee meetings.
B) limited time to work on projects.
C) the same basic educational foundation.
D) traditionally worked in decentralized structures.
Q2) Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more _____ philosophy.
A) centralized
B) decentralized
C) autocratic
D) democratic
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) A new cancer center is being built in the local hospital. A patient survey has revealed that patients are not certain which caregiver is the registered nurse (RN) during their hospital stay. A group is formed to recommend methods to help patients identify which caregiver is their RN for the new cancer center. Which of the following groups best represents those who should be involved in forming recommendations?
A) Chief medical officer, public relations vice president, and human resources
B) Oncology clinical nurse specialist, nurse's aides, and RNs
C) Physicians, unit secretaries, and vice president of finance
D) Vice president of nursing, decentralized pharmacist, and licensed practical/vocational (LPN/LVN) nurses
Q2) The guiding framework that describes the organization's purpose and future direction is the:
A) futuristic guidelines.
B) mission and vision.
C) strategic plan.
D) core purpose.
Q3) A competitive move or business approach designed to produce a successful outcome is called _______.
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Page 16
Chapter 15: Professional Practice Models
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Q1) Functional nursing:
A) divided and distributed nursing tasks.
B) enhanced client-oriented care.
C) provided a smooth care delivery system.
D) was expensive once implemented.
Q2) Which of the following is true about team nursing?
A) It includes only registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs).
B) Each team member has his or her own patient assignments.
C) Team members must have dual degrees.
D) The nurse with a bachelor's of science in nursing degree is the leader of the team.
Q3) The presence of a nurse professional practice model (PPM) is the nurse's: (Select all that apply.)
A) control over practice.
B) career focus.
C) job satisfaction.
D) psychological needs.
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) Which of the following factors best suggests an individual is motivated to engage in a disease management program?
A) Mistrust of insurance companies
B) Enrollment at initial contact
C) Can afford the cost of enrollment
D) Has a need that would benefit from the program
Q2) A disease management program usually focuses on patients with:
A) chronic conditions.
B) mental health issues.
C) outpatient procedures.
D) surgical diagnoses.
Q3) Which of the following governmental agencies tracks population and health trends?
(Select all that apply.)
A) U.S. Census Bureau
B) The Joint Commission
C) CDC
D) Bureau of Labor Statistics (BLS)
E) Health Resources and Services Administration (HRSA)
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Chapter 17: Evidence-Based Practice: Strategies for Nursing Leaders
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Q1) A team has formed to determine which methods have worked best and which factors influence the implementation of an evidence-based practice program. This is known as _____ research.
A) authoritarian
B) autocratic
C) transformational
D) translational
Q2) Jenny is an advanced practice nurse on the telemetry unit. How might Jenny's skills be used to contribute to a culture of evidence-based practice? (Select all that apply.)
A) She can facilitate meetings.
B) She can function as team leader.
C) She can assist with problem solving.
D) She can identify potential roadblocks.
E) She can increase her patient load.
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.
Page 19
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Chapter 18: Quality and Safety
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Sample Questions
Q1) The purpose of a root cause analysis (RCA) is to:
A) discipline the staff involved in the patient safety event.
B) disclose the medical error to the patient/patient s family.
C) identify the person(s) responsible for committing the error.
D) identify the systems issues that led to a sentinel event.
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) 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.
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Page 20
Chapter 19: Measuring and Managing Outcomes
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Q1) Implementation of the Transitional Care Model (TCM) has been associated with which of the following favorable outcomes? (Select all that apply.)
A) Decreased length of stay
B) Reductions in total health care costs
C) Reductions in preventable hospital readmissions
D) Increased overall satisfaction with the care experience
E) Long-term improvements in physical health, functional status, and quality of life
Q2) Outcome indicators such as nurse burnout, turnover, and job satisfaction are examples of which type of indicator?
A) Patient-focused
B) Provider-focused
C) Organizational-focused
D) Nursing-focused
Q3) Outcomes measurement is complex because:
A) budgets are unable to allocate sufficient funds.
B) health care is multidimensional.
C) patients may not cooperate.
D) treatments are not always necessary.
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Chapter 20: Prevention of Workplace Violence
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Q1) Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by:
A) the FBI.
B) threat assessment team.
C) human resources.
D) senior leadership.
Q2) Employee assistance programs:
A) allow employers to place staff into anger management programs designed to help control potentially violent behavior.
B) encourage employees to provide assistance to co-workers experiencing workplace violence.
C) provide services to help employees cope with stressors that occur at home or work.
D) train employees to deescalate violent situations.
Q3) An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by ______.
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Chapter 21: Confronting the Nursing Shortage
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Sample Questions
Q1) The Institute of Medicine recommends increasing the proportion of nurses with a baccalaureate degree to _______ by 2020.
A) 40%
B) 80%
C) 60%
D) 50%
Q2) One of the findings of a study by Aiken and colleagues (2002) was that nurses with the highest nurse-to-patient ratios were more likely to describe feelings of: (Select all that apply.)
A) grief.
B) anger.
C) burnout.
D) job dissatisfaction.
E) emotional exhaustion.
Q3) The average age of the registered nurse (RN) population is _____ years.
A) 26
B) 36
C) 45
D) 56
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Page 23
Chapter 22: Staffing and Scheduling
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Sample Questions
Q1) The new nursing care model, developed by the American Association of Critical-Care Nurses (2016), focuses on the needs of the patient and the competencies of the nurse. It is known as the:
A) Synergy Model for Patient Care.
B) Case Management Model.
C) Primary Nursing Model.
D) Clinical Nurse Leader Model.
Q2) An approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations in the 1990s. These changes in skill mix led to:
A) decreases in RN workload.
B) increased nursing satisfaction.
C) decreased patient satisfaction.
D) decreased patient safety concerns.
Q3) The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called _____.
Q4) The amount of work performed by a unit is referred to as its _____.
Q5) When the needs and characteristics of the patient clinical unit, or system, are matched with a nurse's competencies, _____ results.
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Chapter 23: Budgeting, Productivity, and Costing Out Nursing
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Q1) A measure of the severity of illness of an individual patient or the aggregate patient population on a unit is called _____.
Q2) A staff nurse's accurate recording of all services and supplies used to provide care to each client in her assignment is necessary for determining calculations used in which of the following budgets?
A) Expense
B) Gross
C) Inpatient
D) Revenue
Q3) The key advantage of activity-based costing is:
A) workload is determined based on the required hours of nursing care.
B) it reflects what it costs to provide services and identifies why costs were incurred.
C) data can be used in constructing a personnel budget because it is linked to the volume indicator of patient days.
D) the judgment of an expert nurse clinician must override an empirical system and be based on patient's needs in real time.
Q4) A(n) _____ is the difference between the budgeted and the actual amounts.
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Chapter 24: Performance Appraisal
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Q1) The goals of a performance improvement plan should include: (Select all that apply.)
A) education of the employee.
B) support in making improvements.
C) punishing negative behavior.
D) promotion of successful performance.
E) providing a raise if earned through positive behavior.
Q2) The nurse manager is evaluating Brandon, an emergency department (ED) nurse. The manager obtains input about Brandon's performance from another nurse in the ED, the ED physician, a patient-care assistant, and Brandon himself. The type of performance evaluation the nurse manager utilizes is:
A) just culture.
B) peer review.
C) 360-degree feedback review.
D) management by objectives.
Q3) _____ is a type of bias that occurs when individuals who are similar to the rater in some way are rated more favorably.
Q4) The term _____ refers to the inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair.
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Page 26
Chapter 25: Emergency Management and Preparedness
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Q1) Which combination of leadership is recommended for chairing an emergency management committee?
A) Chief executive officer and internal medicine physician
B) Chief financial officer and emergency care nurse liaison
C) Representative chief nurse officer and emergency care physician
D) Representative chief information technology officer and critical care physician
Q2) What are the two agencies that require all health care facilities to have detailed all-hazard preparedness plans? (Select two that are correct)
A) Patient Protection and Affordable Care Act
B) Health Insurance Portability and Accountability Act
C) The Joint Commission
D) National Response Plan
Q3) In an AHPTF, who would have primary responsibility for serving as spokesperson for emergency physician needs with regard to disaster preparedness?
A) Chief nursing officer
B) Marketing director
C) Department medical director
D) Chief information technology officer
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Chapter 26: Data Management and Clinical Informatics
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Q1) The implementation of an electronic health record (EHR) could enhance patient care by facilitating:
A) communication across the health care continuum.
B) diabetes mellitus education and ongoing care delivery.
C) one-on-one counseling between the provider and the client.
D) physical and occupational therapy dispensing errors.
Q2) 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.
Q3) 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.
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Chapter 27: Marketing
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Q1) Which of the following phrases best describes the focus of health care marketing?
A) Delivery of high-quality patient care
B) Pursuing a high level of patient satisfaction
C) Recruitment and retention of nurses
D) Creating and delivering superior customer value
Q2) Which of the following marketing strategies are examples of niche marketing?
(Select all that apply.)
A) Full-service community hospital
B) Children's hospital
C) Center for bariatric excellence
D) University hospital
E) Cancer specialty center
Q3) A hospital organizational culture that assumes customer needs and wants should determine the quality, price, and availability of a product. This type of orientation is:
A) product.
B) selling.
C) marketing.
D) holistic.
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