Leadership in Nursing Practice
Midterm Exam
Course Introduction
Leadership in Nursing Practice explores the fundamental concepts, theories, and skills necessary for effective leadership within the evolving healthcare environment. This course examines various leadership styles, ethical and legal considerations, and strategies for fostering teamwork, communication, and evidence-based decision-making. Students will learn to apply leadership principles to clinical situations, manage change, advocate for patients and the nursing profession, and develop professional relationships to improve healthcare delivery and patient outcomes. The course emphasizes the critical role of nurse leaders in promoting quality care, safety, and innovation in diverse healthcare settings.
Recommended Textbook
Leading and Managing in Nursing 7th Edition by
Patricia S. Yoder
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31 Chapters
757 Verified Questions
757 Flashcards
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Page 2
Chapter 1: Leading, Managing, and Following
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Sample Questions
Q1) The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility.While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program.What behavior by the staff development coordinator is most appropriate in this situation?
A)Disregard staff concerns and continue with development of the program.
B)Inform the nurses that this program is a requirement for JCAHO accreditation.
C)Schedule a meeting with the chief nurse executive to apprise her of the situation.
D)Facilitate a meeting so nurses can articulate their values and concerns about a competency program.
Answer: D
Q2) According to the complexity theory, what would be the focus of measurement?
A)Cost per hospital day
B)Bed utilization
C)Infection rates
D)Staff morale and budgets
Answer: D
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Chapter 2: Clinical Safety: The Core of Leading, Managing, and Following
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Q1) What facilitate the development of decision-making skills related to safe patient care for a nurse manager?
A)Regular reflection on decisions
B)A culture of perfectionism
C)Recognition of who should be held responsible for individual errors
D)A culture of trust between the staff and you
Answer: A
Q2) Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously.Lately, she has fallen twice, and the family demands that she be restrained.As the unit manager, you have initiated a least restraint practice.What is an appropriate action in this situation?
A)Setting up a nursing team meeting to review practices
B)Calling the family to inform them of the practice
C)Initiating a multidisciplinary and family meeting to focus on Mary's needs
D)Restraining Mary to satisfy the family's wishes
Answer: C
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4
Chapter 3: Legal and Ethical Issues
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Q1) As a charge nurse, you counsel your RN staff member that they have has their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 0330 hours.The physician does not come in to assess the child and does not provide additional orders.The child dies at 0630 hours.As the charge nurse, you could be held liable for what?
A)Professional negligence
B)Assault
C)Avoidance
D)Murder
Answer: A
Q2) One means of ensuring that the nurses floated to other patient care areas in healthcare organizations are qualified to work in the areas they are floated is:
A)employing additional staff to assist with orientation processes.
B)cross-educating staff members to other areas of the institution.
C)transferring patients to units where the staffing pattern is optimal.
D)orienting staff members to all patient care areas as part of their general orientation to the institution.
Answer: B
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Chapter 4: Cultural Diversity and Inclusion in Health Care
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Q1) Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance.This example reflects:
A)stereotyping.
B)cultural diversity.
C)ethnocentricity.
D)transcultural care.
Q2) As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit.The organization and relationships on these units are distinct and very different from one another.Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care.This approach is consistent with which principle?
A)Transculturalism
B)Cross-culturalism
C)Multiculturalism
D)Acculturation
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Chapter 5: Gaining Personal Insight: The Beginning of Being a Leader
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Q1) Excellent leaders need to have or develop the skills of empathy and expressiveness when dealing with others in the workplace.This is also known as understanding and managing own feelings and emotions as well as discerning the emotions of others.What is this an example of required by good leaders?
A)Social awareness
B)Self-awareness
C)Emotional intelligence
D)Intellectual ability
Q2) The charge nurse of a unit is asking the staff what patients they had the day before to make assignments for the day.A new nurse complains about having the same patients every day.The charge nurse considers the new nurse request at an assigned to different patient for today.What type of leadership is the charge nurse displaying?
A)Informal leadership
B)Formal leadership
C)Favoritism
D)No leadership displayed
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Chapter 6: Being an Effective Follower
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Q1) In nursing theory, one theorist developed the theory of self-care of patients.In the theory, the nursing action of providing care and educating the patients can be interpreted in the form of followership for the patient.Who was their theorist?
A)Dorothea Orem
B)Patricia Benner
C)Ida Jean Orlando
D)Robert E.Kelley
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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8
Chapter 7: Managing Self: Stress and Time
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Q1) The chief nursing officer listens to nurse managers verbalize their feelings of internal stress.One common source of internal stress seems to be:
A)the death of a loved one.
B)perfectionism.
C)getting married.
D)losing a job.
Q2) Keep the meeting focused and directed toward accomplishing the set objectives.Select the correct order from the following options:
A)1, 2, 4, 5, 3
B)4, 1, 2, 5, 3
C)3, 1, 4, 5, 2
D)3, 4, 2, 1, 5
Q3) The nurse manager is implementing a shared governance model to help with communication and decision making.Although staff members like the concept, change is difficult.Staff nurses feel:
A)more empowered.
B)more communicative.
C)less stressed.
D)more powerless and devalued.
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Chapter 8: Communication and Conflict
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Q1) Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using?
A)Collaborating
B)Avoiding
C)Negotiating
D)Accommodating
Q2) Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities.They are given a set of new orders from the unit manager.Each nurse displays different emotions in response to the orders.Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why.This step in the process is which of the following in Thomas' stages of conflict?
A)Frustration
B)Conceptualization
C)Action
D)Outcomes
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Page 10
Chapter 9: Power, Politics, and Influence
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Q1) Politics is identified in what areas?
A)Confined to legislatures
B)Seen in dysfunctional workplaces
C)Found in all social organizations
D)A representation of self-interest
Q2) A nurse is participating in a baccalaureate course.For the class, she has to attend the legislative session regarding the new role of medication assistants.Why is it important for nurses to be involved in shaping public policy?
A)Involvement will enable nurses to take over the healthcare system at some point in the future.
B)Other healthcare professions are less concerned about the essential needs of clients.
C)Such activities are important career builders for nurses who seek top-level executive positions.
D)They are closest to the front line of health care and see how it affects clients and families.
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11
Chapter 10: Health Care Organizations
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Q1) With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health.School health programs are:
A)increasingly seen as primary care sites for children.
B)providing only health education programs for children and their parents.
C)capable only of providing referrals for health problems to primary care providers.
D)funded exclusively by local authorities.
Q2) As a nurse manager in a hospital, you would expect what to be the major contributor to funding and revenues in your organization?
A)The federal government
B)Medicare
C)Medicaid
D)Blue Cross/Blue Shield
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Chapter 11: Organizational Structures
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Q1) A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model.Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:
A)bureaucratic.
B)decentralized.
C)delegated authority and responsibility.
D)delegated responsibility but no authority.
Q2) The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions.A clinical specialist who has staff authority but no line authority typically is able to: A)function through influence.
B)take complete responsibility for the care of clients.
C)interview and hire staff nurses for designated nursing units.
D)be granted functional authority to determine standards of nursing care and enforce them.
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Chapter 12: Care Delivery Strategies
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Q1) In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model.The nurse manager's main responsibility is the needs of the: A)department. B)unit.
C)staff.
D)patient.
Q2) A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day."I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is:
A)differentiated practice.
B)team nursing.
C)functional nursing.
D)case management.
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Chapter 13: Staffing and Scheduling
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Q1) To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages.To maximize patient safety and reduce costs, the healthcare organization:
A)develops a centralized pool of float nurses.
B)assigns nurses from less busy units to ones with increased acuity levels.
C)floats nurses only between units on which the nurses have been cross-trained.
D)assigns float nurses to basic care only.
Q2) An important aspect of managing the costs on a unit is to plan accurately for staffing needs.Nurse managers use staffing plans to:
A)assign staff on the unit on a daily basis.
B)ensure that days off are planned for the staff.
C)outline the number of individuals by classification on a per-shift basis.
D)predict the numbers and classifications of float staff needed to augment regular staff.
Q3) A nurse staffing plan takes into account:
A)specific nurse-to-patient ratios per shift.
B)participation of nurses in projecting staffing needs.
C)compensation and benefits for each level of staff.
D)the occupancy load of a unit.
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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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16
Chapter 15: Making Decisions and Solving Problems
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Q1) 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.
Q2) The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift.The nurse manager knows that the best way to resolve the problem is to:
A)use creativity.
B)obtain support from the 7-3 shift.
C)use institutional research.
D)identify the problem.
Q3) A good nursing decision maker is one who:
A)uses various models to guide the process based on the circumstances of the situation.
B)adopts one model and uses it to guide all decision making.
C)decides not to use any models because they are all useless.
D)develops a new model each time a decision has to be made.
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Page 17
Chapter 16: The Impact of Technology
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Q1) A primary care clinic in a small urban center sees a high volume of cardiology patients.Patients who attend the clinic have smart cards that they use at hospitals, clinics, and Emergency Departments within that region of the state.A primary benefit of the smart card for these patients would be:
A)rapid and accurate treatment in emergency situations.
B)reduced wait times to see specialists.
C)e-mail notification of test results.
D)readily available information regarding medications.
Q2) As part of an information technology implementation team, you are implementing a clinical decision support system.Particular considerations for successful implementation of this project include:
A)ensuring that the system is reliable.
B)ensuring that patient information is reliable.
C)developing unique identifiers for individuals.
D)developing rules that support inferences.
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18
Chapter 17: Delegating: Authority, Accountability,
Responsibility in Delegation Decisions
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Q1) Sally is an experienced nurse on the unit and is very experienced with ICP monitoring.She is assigned David, a patient who has been admitted with a severe head injury.In communicating with Sally, what does is an appropriate action by the charge nurse?
A)Provide a detailed explanation of what she needs to do with ICP monitoring.
B)Tell her when she needs to provide an update about David's status.
C)Ask her to tell you what she knows about ICP monitoring and share expectations about reporting.
D)Advise her that you are available if she needs you.
Q2) 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.
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Chapter 18: Leading Change
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Questions
Q1) Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients.On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward.An appropriate response to Sarah's suggestion would be:
A)"That is a great suggestion, but we have no resources for such an expensive undertaking right now."
B)"Perhaps you can keep that in mind as we redesign our charting system."
C)"We have too many seniors as patients, and you know that they don't use technology."
D)"There is a great group here that meets to look at technology pilots.Let's see if you can join them and discuss your idea further."
Q2) The wound care nurse decided to involve those to be affected by change early in the change management process.This can positively result in: A)coordination.
B)resistance.
C)anticipation.
D)participation.
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Chapter 19: Building Effective Teams
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Q1) 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.
Q2) By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically.Some teams function synergistically because members:
A)do not volunteer unwanted information.
B)actively listen to each other.
C)listen to the person who believes he or she is an expert.
D)do not speak unless they are absolutely sure they are correct in their views.
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Chapter 20: Managing Costs and Budgets
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Q1) 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.
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) Which of the following might best conclude an interview?
A)"Thank you for your interest.Someone will be in touch with you soon."
B)"Before you go, we will make sure that we have your contact information.Thank you for coming."
C)"I will be in contact with all candidates by telephone by next Friday.It has been a pleasure to meet you."
D)"We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know.Thank you for coming."
Q2) The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool.The development of a performance appraisal tool should include:
A)organizational mission, philosophy, and position requirements.
B)a generalized overview of the duties of a position.
C)a skills checklist and accreditation requirements.
D)an ordinal scale that ranks all employees.
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Chapter 22: Person-Centered Care
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Q1) The nurse manager must develop a patient satisfaction survey.What is one of the critical elements in selecting a patient satisfaction instrument?
A)Being able to use the same instrument for all clinical units
B)Including items that are important from the patient's perspective
C)Being able to administer the instrument before a patient's discharge from the hospital
D)Being sure that the reading level is no higher than third grade
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: Managing Quality and Risk
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Q1) The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is:
A)physician-sensitive and nonmeasurable.
B)measurable and nursing-sensitive.
C)precise, measurable, and physician-sensitive.
D)patient care-centered and nonmeasurable.
Q2) Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design.This approach recognizes:
A)the importance of decentralized structure in QA.
B)that structure influences nurse burnout and participation in quality improvement initiatives.
C)the need to ensure sufficient supervisory staff to respond in a corrective manner when mistakes occur.
D)that a narrow hierarchy ensures accountability for errors and outcomes.
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Chapter 24: Translating Research Into Practice
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Q1) The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO):
A)reflect practice that is fiscally directed and sound.
B)articulate practice recommendations developed from synthesis and review of evidence.
C)are intended to increase awareness of issues in incontinence management.
D)reflect a compilation of information from a variety and range of sources related to incontinence.
Q2) Marie is a long-term staff nurse on the rehab floor.Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit.Marie's response has been that she rarely has time to provide care to patients, let alone families, and that there is no good reason to do anything different than what she is already doing.An approach that may gain Marie's support of the idea is to:
A)invite Marie to review the studies for herself.
B)suggest that she does not need to provide family-centered care.
C)avoid discussion of the idea with her until she initiates it.
D)secure the support of her closest colleagues on the unit.
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Chapter 25: Managing Personal and Personnel Problems
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Q1) Clinical incompetence is one of the more serious problems facing a nurse manager.Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse.After she investigates, it is obvious that Sarah's peers are covering for her.Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
A)"It is a nurse's professional responsibility to maintain quality control."
B)"All instances of clinical incompetence are to be reported."
C)"It is not considered being disloyal when one nurse reports another for poor care."
D)"Patient care is the number one concern.Meeting standards is mandatory and necessary."
Q2) A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:
A)verbal reprimand.
B)written reprimand.
C)reminder of employment standards.
D)day off without pay.
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Chapter 26: Role Transition
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Q1) A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3 years, has an interest in health technology and seems to be very enthused about working with software and hardware at home.She speaks with Nathan and asks him if he would lead investigation of software applications on the unit.This is an example of:
A)opportunity.
B)delegation.
C)role negotiation.
D)role transition.
Q2) John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing.According to Hardy's role theory, John is experiencing:
A)stress.
B)role stress.
C)role strain.
D)role exploration.
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Chapter 27: Managing Your Career
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Q1) Professional associations:
A)set regulatory requirements and establish entry requirements for nursing.
B)offer graduate programs for clinical and career advancement.
C)provide opportunities for career networking and support.
D)are open to all individuals who meet the criteria for membership.
Q2) Thomas has been a nurse in your ICU for 10 years.In facilitating Thomas' professional development, the nurse manager would focus on:
A)certification for the ICU environment.
B)discussions about how Thomas can fit with role expectations and relationships.
C)possible changes to other ICU environments.
D)encouraging him to lead changes that leave long-term impacts after his retirement.
Q3) A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology.She applied to take a certification exam.Certification is designed to recognize:
A)basic knowledge in a specified area.
B)advanced practice in functional roles.
C)special knowledge beyond basic licensure.
D)continued competence as a registered nurse.
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Chapter 28: Developing the Role of Leader
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Q1) After being interviewed for the unit manager position, the staff nurse reflects on the interview process.The staff nurse is aware that leadership begins:
A)within.
B)through a relationship with a mentor.
C)with the job description.
D)with the chief nursing officer of the organization.
Q2) The nurse manager in the Emergency Department needs to implement new staffing patterns.As a transformational leader, the nurse manager would:
A)explain in detail how well the new idea will work.
B)reinforce how this change will respond to the ideas and solutions generated by staff members.
C)reason with staff members that the new idea will save money and allow more free time.
D)imply that raises will be smaller than anticipated if the new idea is not accepted.
To view all questions and flashcards with answers, click on the resource link above.
Chapter 29: Developing the Role of Manager
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Sample Questions
Q1) Which of the following is not important in a positive work environment, as defined by the AONE?
A)Clear, open, trustful communication
B)Accountability and clarity of roles and responsibilities
C)Participatory decision making
D)Challenge and striving for excellence
Q2) A nurse manager has worked to bring the staff to participate in and then accept changes in the unit's mission, so that downsizing can be avoided.How is the nurse manager using change theory for this situation?
A)Focusing on past concerns related to the mission
B)Teaching staff members how to self-manage themselves
C)Determining accurately the direction of change in the institution
D)Requiring all staff members to review and reinforce their technological skills
Q3) Budgeting and protection of revenues is a function of:
A)leadership.
B)management.
C)team leadership.
D)followers.
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Chapter 30: The Strategic Planning Process
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Sample Questions
Q1) The clinic nurse understands that the advantages of planning include:
A)assisting staff in critical thinking and improving decisions.
B)orienting people to react instead of act.
C)forcing managers to be cost-efficient and cost-effective.
D)focusing on activities, not results.
Q2) 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.
Q3) A clinic nurse developed objectives for a diabetic education program.The characteristics of well-written objectives include that they should be what? (Select all that apply.)
A)Achievable
B)Understandable and specific
C)People-oriented
D)Manager-oriented
E)Means-oriented
F)Measurable
To view all questions and flashcards with answers, click on the resource link above.
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Chapter 31: Thriving for the Future
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Sample Questions
Q1) A necessary leadership strength for nurses of the future is:
A)inspiring others to work their best to create the future.
B)understanding the nuances of fundraising to make up funding shortfall.
C)guarding the tendency of other professions to encroach on nursing roles.
D)adapting work life to an aging nursing work force.
Q2) The chief nursing officer has been developing her portfolio for years.What is the chief nursing officer modeling?
A)Her clinical expertise
B)Affection for tradition
C)Her employability
D)Her busy professional life
Q3) As a nurse manager, it is important to become a "future thinker." Which is an example of a "future thinker"?
A)Keeping traditional practices
B)Moving toward evidence-based practices
C)Finding less need for more knowledge
D)Believing that macromarketing will be a necessity
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