Nursing Policy and Administration
Midterm Exam
Course Introduction
Nursing Policy and Administration examines the frameworks and processes that guide the development, implementation, and evaluation of policies impacting nursing practice and healthcare delivery. The course explores the roles of nurses as policymakers, administrators, and leaders, emphasizing advocacy, ethics, and the influence of legislation on health systems. Students learn about strategic planning, resource management, and the principles of effective leadership in nursing administration, preparing them to address complex organizational challenges, drive policy change, and foster quality and safety in diverse healthcare settings.
Recommended Textbook
Leadership and Nursing Care Management 6th Edition by Diane Huber
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Page 2
Chapter 1: Leadership and Management Principles
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Sample Questions
Q1) Which of the following definitions apply to management? (Select all that apply.)
A) It is a process of inspiring people to accomplish goals through support and confidence building.
B) It is the process of coordination and integration of resources to accomplish specific goals.
C) It includes the activities of planning, organizing, coordinating, directing, and controlling.
D) It is a process of planning and directing human effort to achieve established objectives.
E) It is the directing of the organizations' money, facilities, and supplies to achieve results.
Answer: B, C, D, E
Q2) The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture.
A) nurse manager
B) care provider
C) nurse executive
D) senior leader
Answer: C
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Page 3
Chapter 2: Change and Innovation
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Sample Questions
Q1) The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.)
A) Explain the rationale for a change so that individuals understand it.
B) Simply announce the change without laying a foundation.
C) Give participants all the information they need.
D) Rely only on formal authority in implementing change.
E) Help individuals cope with change.
Answer: A, C, E
Q2) The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the:
A) resister.
B) innovator.
C) change agent.
D) strategist.
Answer: C
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4
Chapter 3: Organizational Climate and Culture
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Sample Questions
Q1) Researchers study organizational climate in order to examine how the work environment influences behaviors. Which of the following characteristics are utilized to study climate? (Select all that apply.)
A) Supervisor support
B) Unit staffing and its effect on incident reporting
C) Autonomy
D) Peer cohesion
E) Rewards and recognition
Answer: A, C, D, E
Q2) Which of the following exemplifies a safety climate within a nursing unit?
A) Asking nursing staff to work a double shift
B) Encouraging nurses to take the blame when a medication error occurs
C) Asking staff to report medication errors only
D) Asking staff to report near-misses of adverse events
Answer: D
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5
Chapter 4: Managerial Decision Making
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Sample Questions
Q1) Which of these clinical decisions poses the greatest risk for committing an error?
A) Verifying medication dose prior to administration
B) Charting by exception
C) Prioritizing patient care activities
D) Independent interpretation of a medication order
Q2) How is decision making at the staff nurse level exemplified?
A) The staff nurse adapts to a challenging patient assignment.
B) The staff nurse refers issues to the performance improvement committee.
C) The staff nurse accepts the status quo.
D) The staff nurse questions current practice and refers to unit leadership for change.
Q3) A family member of a patient files a complaint that her mother's dentures were lost when the patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used?
A) Delegation
B) Direct intervention
C) Indirect intervention
D) Purposeful inaction
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Chapter 5: Managing Time and Stress
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Q1) Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4 days. Despite the grave prognosis, the client's family continues to want resuscitation at all cost. Jay knows that further medical care is futile. Jay is at risk for:
A) confrontational conflict.
B) resilience.
C) burnout.
D) moral distress.
Q2) In setting boundaries it is important to do which of the following?
A) Set rigid boundaries.
B) Set boundaries based on individual needs.
C) Consider where one is in the lifespan when setting boundaries.
D) Set boundaries even if it produces more stress than not having boundaries at all.
Q3) Nurses who are successful at time management:
A) display an ability to set measurable goals and objectives.
B) frequently volunteer for new and creative projects.
C) hesitate to delegate because of perfectionist characteristics.
D) tend to accomplish specific activities within a time frame.
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Chapter 6: Legal and Ethical Issues
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Q1) Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit? (Select all that apply.)
A) Staffing levels in the medical unit
B) Patient fall with injury
C) Heparin error
D) Failure to utilize rapid response team with change in vital signs
E) Failure to ensure telemetry monitor is on the correct patient
Q2) On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse's actions are an example of:
A) breach of contract.
B) common negligence.
C) intentional malpractice.
D) medical oversight.
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Chapter 7: Communication Leadership
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Sample Questions
Q1) _____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction.
A) Defensive
B) Disruptive
C) Negotiating
D) Humanizing
Q2) A communication system developed originally to address communication patterns in critical situations is:
A) VERA framework.
B) NVC model.
C) crucial conversations.
D) TeamSTEPPS.
Q3) Effective communication is fostered through which of the following ingredients? (Select all that apply.)
A) Trust
B) Humility
C) Respect
D) Empathy
E) Sympathy
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Page 9
Chapter 8: Team Building and Working With Effective Groups
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Sample Questions
Q1) The hospital's regulatory department is experiencing The Joint Commission survey. The surveyors want to review hospital policies for infection control before they leave for the evening. The regulatory team leader states that she can stay past her regular hours to wait for them and acknowledges that there will be a need for a policy change before the surveyors return the following day. All of the department managers stay to assist the regulatory team leader with the required documentation. This is an example of a: A) work group.
B) committee.
C) true team.
D) group.
Q2) The nurse manager within a small department has requested that the staff decide department coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision?
A) Autocratic decision procedure
B) Consultative decision procedure
C) Joint decision making
D) Delegated decision procedure
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Chapter 9: Delegation in Nursing
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Sample Questions
Q1) The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right:
A) interaction.
B) outcome.
C) supervision.
D) time.
Q2) With regard to delegation, what organizational principles are considered? (Select all that apply.)
A) Legal guidelines and policies
B) Patient safety and accountability
C) Relationship management and patient support
D) Cost containment
E) Knowledge and education
Q3) The process for a nurse to direct another person to perform nursing tasks and activities is:
A) authorization.
B) delegation.
C) empowerment.
D) supervision.
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Chapter 10: Power and Conflict
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Q1) Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.)
A) Connection power is based on the perception that the influencer has access to powerful people or groups.
B) Legitimate power is based on fear.
C) Expert power results from expertise, special skill, or knowledge.
D) Information power refers to skill in making rational appeals.
E) Referent power is based on admiration for a person.
Q2) A disagreement or differences between the members of two or more groups over authority, territory, and resources is called _____ conflict.
A) intragroup
B) intergroup
C) interpersonal
D) intrapersonal
Q3) Subunit or _____ power refers to relationships across departments.
A) vertical
B) organizational
C) horizontal
D) exertional
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Page 12
Chapter 11: Workplace Diversity
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Sample Questions
Q1) In order to make a positive contribution to care of patients, it is critical that nurses recognize which of the following aspects of culture? (Select all that apply.)
A) Culture of the clinician
B) Culture of the patient and family
C) Spiritual beliefs of the clinician
D) Culture of co-workers
E) Spiritual beliefs of the patient
Q2) Members of a generation who are linked through shared life experiences in their formative years are known as:
A) baby boomers.
B) generational markers.
C) generation gaps.
D) cohorts.
Q3) Which of these is the fastest growing minority group in the United States?
A) Asians
B) Caucasians
C) Blacks
D) Hispanics
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Chapter 12: Organizational Structure
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Sample Questions
Q1) According to organization theories, there are three perspectives regarding the nature of reality and knowledge within an organization. Which of the following are those perspectives? (Select all that apply.)
A) Objectivism
B) Subjectivism
C) Postmodernism
D) Realism
E) Idealism
Q2) The network or pattern of social relationships and friendship circles within an organization is known as the:
A) clique.
B) formal structure.
C) informal structure.
D) hierarchy.
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) In organizations that practice shared governance, the nurse manager's role is to: (Select all that apply.)
A) hire new employees.
B) mentor the nursing staff.
C) train new nurses in patient care.
D) support the decisions of the nursing team.
E) enable the staff to become effective leaders.
Q2) Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to:
A) patient care.
B) nursing liability
C) nursing salaries.
D) nursing turnover.
Q3) Research about shared governance suggests that it is:
A) enhancing the role of the nurse's aide within the organization.
B) improving organizational and patient outcomes.
C) not a cost-effective program when examining all areas of care.
D) too much additional work for the already overwhelmed RN.
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Page 15
Chapter 14: Strategic Management
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Sample
Questions
Q1) Strategic management, long used in business to ensure a competitive advantage over similar enterprises, involves: (Select all that apply.)
A) setting targets.
B) establishing goals.
C) evaluating success.
D) developing an action plan.
E) defining the core purpose.
F) conducting an environmental scan.
Q2) In a written strategic plan, the _______ contains all the documentation related to the strategic planning process so that the reader obtains a sense of the background information used by the strategic planners in order to arrive at the strategic plan.
Q3) The first step of the strategic planning process is to:
A) develop strategic goals.
B) survey the environment.
C) implement the action plan.
D) formulate the organization's mission and vision.
Q4) A competitive move or business approach designed to produce a successful outcome is called _______.
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Chapter 15: Professional Practice Models
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Sample Questions
Q1) Positive work environments are often found in Magnet-designated organizations. Organizational structures associated with Magnet-like healthy work environments are: (Select all that apply.)
A) professional development opportunities.
B) interdisciplinary collaboration.
C) top-down approach to governance.
D) decreased workloads.
E) culture of safety.
Q2) A(n) _____ is the operational mechanism by which care is actually provided to patients and families.
Q3) Disadvantages of private duty nursing include: (Select all that apply.)
A) private duty nurses have a great degree of autonomy.
B) private duty being a costly model.
C) job security being tenuous and irregular.
D) the nurse's focus being entirely on one client's needs.
E) nurses maintaining close relationships with colleagues.
Q4) A(n) _____ is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting.
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Chapter 16: Case and Population Health Management
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Q1) A patient has a history of diabetes mellitus, myocardial infarctions, and hypertension. His HgbA?c level dropped from 7.8% to 6.2% 2 months after he began a walking exercise program. The nurse case manager had provided diabetic education and suggested ways to enhance his cardiac reserve. This is an example of:
A) nursing empowerment.
B) nursing knowledge.
C) patient expertise.
D) patient participation in care.
Q2) The nurse who uses collaboration to coordinate care for an individual's and family's comprehensive health needs through communication and available resources to promote patient safety and quality, cost-effective outcomes is performing:
A) population health management.
B) managed care.
C) disease management.
D) case management.
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Chapter 17: Evidence-Based Practice: Strategies for Nursing Leaders
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Q1) To promote an organizational culture that embraces evidence-based practice, an organization must: (Select all that apply.)
A) recognize and reward the work.
B) adopt an evidence-based practice model.
C) provide education about evidence-based practice.
D) discourage nurses from questioning their practice.
E) recruit nurses with interest in evidence-based practice.
Q2) Once a new practice has been implemented on a unit, scaling up needs to be evaluated. What is scaling up?
A) A method used to implement the previous practice if the new practice has been found to be detrimental to patient care
B) A process used to expand the reach of effective clinical interventions in new settings
C) Recruitment of new nurses from different institutions who can help with role modeling and communication of the new practice
D) A tactic used to invigorate leaders to continue to communicate better with staff nurses and ancillary personnel
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19
Chapter 18: Quality and Safety
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Sample Questions
Q1) The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. The standards in areas of excellence include: (Select all that apply.)
A) leadership.
B) strategic planning.
C) environment of care.
D) human resource focus.
E) medication management.
Q2) TJC requires accredited organizations to participate in their core measure initiative. The current core measure sets include: (Select all that apply.)
A) stroke.
B) tobacco treatment.
C) pneumonia measures.
D) iatrogenic pneumothorax.
E) venous thromboembolism.
F) acute myocardial infarction.
Q3) _____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
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Chapter 19: Measuring and Managing Outcomes
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Q1) To determine whether her patient has responded favorably to a nursing intervention, a staff nurse should observe the client for:
A) improved health.
B) increased complaints.
C) outcome indicators.
D) signs and symptoms.
Q2) The process of managing outcomes includes five steps. List the five steps below in the correct order.
A) Variances are investigated.
B) Data are collected about outcomes.
C) Trends are identified from data analysis.
D) Changes are implemented and reevaluated.
E) Appropriate service delivery changes are determined.
Q3) _____ involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators.
Q4) A(n) _____ is the result or results obtained from the efforts to accomplish a goal.
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Chapter 20: Prevention of Workplace Violence
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Sample Questions
Q1) Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is:
A) hazard prevention.
B) environmental designs.
C) behavior modification.
D) administrative control.
Q2) _____ may be useful in preventing loss caused by domestic violence that extends to the workplace.
A) Employee assistance programs
B) Stress leave for up to 6 weeks
C) Termination of the perpetrator
D) Arrest and conviction of the perpetrator
Q3) Examples of environmental designs that can improve worker safety include: (Select all that apply.)
A) well-lit parking lots.
B) critical incident debriefing.
C) de-escalation training for all staff.
D) metal detectors at hospital entrances.
E) posting security guards in the main lobby.
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Chapter 21: Confronting the Nursing Shortage
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Q1) _____ is the process in which the application is reviewed before determining whether the nurse meets the preestablished criteria for the position.
Q2) A situation in which the demand for employment of nurses (how many nurses employers would like to employ) exceeds the available supply of nurses willing to be employed at a given salary is known as a nursing:
A) abundance.
B) deficit.
C) shortage.
D) surplus.
Q3) The newest approach to orienting is referred to as:
A) selecting.
B) onboarding.
C) submersion.
D) precepting.
Q4) The process of identifying applicants for potential employment is called: A) selection.
B) retention.
C) recruitment.
D) human resources.
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Chapter 22: Staffing and Scheduling
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Q1) Community Hospital is having a transient nursing shortage due to a high number of sick calls. The staffing office utilizes the staffing pool to obtain the required number of nurses. The staffing pool may include what types of nurses? (Select all that apply.)
A) Travel nurses
B) Foreign nurses
C) Registry nurses
D) Per diem nurses
E) Full-time nurses
Q2) Relationship-based care (RBC) is a common model used in care delivery. Person (2004) articulated that _____ is/are central nursing care delivery models.
A) continuity of care
B) case management
C) coordination of care
D) the needs or characteristics of the patients
Q3) Betty is calculating the total patient days on her unit. Her average daily census is 35 and her average length of stay is 2.4 days. In numerals, the total patient days on Betty's unit is _____ days.
Q4) The amount of work performed by a unit is referred to as its _____.
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Page 24
Chapter 23: Budgeting, Productivity, and Costing Out Nursing
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Q1) A(n) _____ is the difference between the budgeted and the actual amounts.
Q2) Revenues minus expenses equals:
A) cash flow.
B) expense incurred.
C) income.
D) total reimbursement.
Q3) The phases of the budget process are: (Select all that apply.)
A) preparation.
B) completing the forms.
C) auditing and monitoring.
D) revision and submission.
E) selection and evaluation.
Q4) The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment to furnish two additional examination rooms. The resource he must consider is the _____ budget.
A) capital
B) expense
C) operating
D) product line
25
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Chapter 24: Performance Appraisal
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Q1) A successful performance review system must be: (Select all that apply.)
A) in line with the organization's strategic objectives.
B) fair and transparent.
C) free from bias.
D) administratively practical.
E) effectively administered.
Q2) Stakeholders who might be represented within the employment review process of a CCU nurse include: (Select all that apply.)
A) patients/patient families.
B) physicians.
C) the chief financial officer.
D) organizational board members.
E) nurses in the CCU.
Q3) A newer focus of performance appraisal that has the ability to engage high-performing nurses and motivate people toward even higher levels of performance is:
A) coaching.
B) remedial learning.
C) feedback.
D) peer review.
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Chapter 25: Emergency Management and Preparedness
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Q1) In a disaster, it is most important that the:
A) clients are sent home quickly.
B) medications and supplies are secure.
C) nurses and their families feel safe.
D) security department increases its workforce.
Q2) All-hazards disaster is best defined as:
A) all types of natural and human terrorist events.
B) an event involving floods, tornadoes, hurricanes, and earthquakes.
C) an unforeseen and often unplanned event causing great damage.
D) any type of biological, chemical, radiological, or nuclear event.
Q3) 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
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Chapter 26: Data Management and Clinical Informatics
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Q1) The first person to analyze patient outcomes associated with nursing care delivery was:
A) Clara Barton.
B) Dorothea Dix.
C) Florence Nightingale.
D) Luther Christman.
Q2) Effectiveness research:
A) is the study of relationships among health care problems.
B) provides solutions to serious global health care issues.
C) reflects sound, reliable, and valid data that can be examined closely.
D) supplies data that are critical and worthy of gathering.
Q3) What are some of the expected outcomes in the client domain of nursing data? (Select all that apply.)
A) Patient satisfaction
B) Achieved care outcomes
C) Continuity of care
D) Level of dependency
E) Intensity of nursing care
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28
Chapter 27: Marketing
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Q1) What are four critical concepts that are essential to understanding and becoming fluent in the language of marketing? (Select all that apply.)
A) Segmentation and targeting clarify how customers will be served.
B) Segmentation breaks down the mass market into submarkets.
C) Targeting takes into account the whole market that can be considered in terms of smaller market segments.
D) Differentiation calls for the creation of superior value.
E) Positioning the product is completed in a manner where customers perceive it to be distinctive and desirable.
Q2) Nursing leaders and managers participate in marketing by promoting the value nursing brings to the organization. This level of market planning is:
A) corporate strategic planning.
B) strategic marketing.
C) strategic service.
D) marketing management.
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