Nursing Service Management
Solved Exam Questions
Course Introduction
Nursing Service Management focuses on the principles and practices involved in leading and coordinating nursing services within healthcare organizations. This course covers topics such as organizational structure, leadership styles, decision-making processes, staffing, budgeting, quality assurance, and legal-ethical considerations in management. Students will develop skills in planning, organizing, directing, and evaluating nursing care to improve patient outcomes and enhance the efficiency and effectiveness of nursing teams. Emphasis is placed on evidence-based management strategies, effective communication, and the promotion of a positive work environment that supports both staff well-being and high-quality patient care.
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) You notice that Sally,a student on your unit,is giving information to an anxious young teen,who seems very uncertain about preparation for an upper GI series.After Sally leaves the room,you ask her how she thought her conversation went and:
A) Encourage her to ask the patient if he has questions or concerns about the procedure.
B) Advise her to consider providing the patient with more information.
C) Suggest that she leave some brochures on the procedure with the patient.
D) Suggest that she also provide teaching to the adolescent's parents.
Answer: A
Q2) To increase safety in patient care areas of the Valley Hospital,the executive begins by:
A) Asking the community what the safety issues are.
B) Consulting with a management expert about staffing schedules.
C) Ensuring that the senior nursing officer attends the board meetings.
D) Instituting improved practices to reduce needle-stick injuries.
Answer: B
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Chapter 3: Developing the Role of Leader
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Sample Questions
Q1) As a senior executive,you are keen to develop your hospital as a learning organization.Part of your purpose in translating this vision into practice is to
A) Retain funding from third-party payers.
B) Develop leaders.
C) Maintain and/or improve quality of care.
D) Stay abreast of new knowledge and evidence.
Answer: B,C,D
Q2) The Sunny Long Term Care Facility has experienced numerous difficulties with staff relationships,despite its success in maintaining financial viability and judicious use of resources.Staff members complain that the primary concerns of the facility include applying policy,saving money,and ensuring that lawsuits are avoided.There is little trust in and involvement of staff members.This facility may be:
A) Well managed and well led.
B) Overly managed and not well led.
C) Poorly managed and well led.
D) Overly led and overly managed.
Answer: B
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Chapter 4: Developing the Role of Manager
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Sample Questions
Q1) A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:
A) Practicing legal nursing care.
B) Demonstrating respect for patient rights.
C) Avoiding risks.
D) Likely experiencing issues with informed consent.
Q2) A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage.During a called staff meeting,the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices.In doing this,the nurse manager is using the concept of collaboration to:
A) Demonstrate interdependence.
B) Depict flexibility and broadmindedness.
C) Focus all energies of staff members on a win-win strategy.
D) Defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.
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Chapter 5: Legal and Ethical Issues
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Sample Questions
Q1) Mr.M.complains to you that one of your staff asked him details about his sexual relationships and financial affairs.He says that these questions were probing and unnecessary to his care,but he felt that if he refused to answer,the nurse would be angry with him and would not provide him with good care.Mr.M.'s statements reflect concern with:
A) Privacy.
B) Confidentiality.
C) Veracity.
D) Informed consent.
Q2) The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth.This belief is an example of:
A) Justice.
B) Fidelity.
C) Beneficence.
D) Nonmaleficence.
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Page 7
Chapter 6: Making Decisions and Solving Problems
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Sample Questions
Q1) An outpatient surgery manager is evaluating infusion pumps for the operating room.The manager should:
A) Select the least expensive brand.
B) Use a decision-making tool to evaluate brands.
C) Ask the nursing staff which brand they prefer.
D) Select the vendor the institution usually buys from.
Q2) Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 shift.To resolve this problem,the nurse manager decides that the staff should have a brainstorming session.The goal of brainstorming is to:
A) Evaluate problem solutions.
B) Critique the ideas of others.
C) Generate as many solutions as possible.
D) Identify only practical and realistic ideas.
Q3) Decision making is described by the nursing educator as the process one uses to:
A) Solve a problem.
B) Choose between alternatives.
C) Reflect on a certain situation.
D) Generate ideas.
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Page 8
Chapter 7: Health Care Organizations
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Sample Questions
Q1) 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
Q2) As a nurse manager in a for-profit hospital,you are interested in promoting teaching programs for physicians,as evidence suggests that hospitals with teaching programs tend to promote better care for patients.Your administration indicates that it cannot support your ideas or proposal because of
A) Increased salary costs.
B) Duplication of tests and procedures.
C) Higher costs of technology.
D) Potential damage to reputation through learner error.
Q3) Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days).This facility would likely be considered:
A) Primary care, specialized.
B) Tertiary care, long-term.
C) Acute care, specialized.
D) Public care, specialized.
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Page 9
Chapter 8: Understanding and Designing Organizational Structures
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Sample Questions
Q1) Taylor Hospital has well-defined organizational units that provide maintenance,financial services,care for cardiac patients,care for surgical patients,and so on.The organizational chart indicates that surgical units report to a surgical manager,and that all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on.The primary disadvantage of this organizational structure is:
A) Breakdown in function and communication across specialties.
B) Lack of congruence in culture and organizational values.
C) Highly centralized decision making and authority.
D) Wide span of control.
Q2) In opening a new dialysis unit,the nurse manager has to develop a philosophy for the unit.This philosophy needs to:
A) Reflect the culture of the unit and its values.
B) Be developed by the nursing manager on the unit.
C) Identify the clients that will be served on the unit.
D) Replicate the organization's philosophy.
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Chapter 9: Cultural Diversity in Health Care
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Sample Questions
Q1) Mary joins 5W nursing unit.Mary is a new graduate who is anxious to fit in.She soon learns that some of her "book learning" is being criticized by her colleagues,so she adapts her practice to what others on the unit are doing.She is demonstrating:
A) Cultural awareness.
B) Cultural sensitivity.
C) Acculturation.
D) Cultural marginality.
Q2) As a nurse manager,you have to be effective in managing a culturally diverse staff.Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff ?
A) Stereotyping of others
B) Respect for others
C) Positive reinforcement
D) Knowledge about your staff
E) Age bias
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11
Chapter 10: Power, Politics, and Influence
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Sample Questions
Q1) Your colleague,Mary,a recent graduate announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing.While at your agency,she plans to give patients excellent care and to learn as much as she can,because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n):
A) Profession.
B) Occupation.
C) Flexible discipline.
D) Career with off and on ramps.
Q2) Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees,Tom refuses.His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text,Tom's view of involvement:
A) Is rare in nursing today.
B) Reflects a fear of power.
C) Reflects the essential process of power.
D) Reflects empowerment and capacity to make his own decisions.
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Chapter 11: Caring,Communicating,and Managing With Technology
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Sample Questions
Q1) A nurse manager was orienting new staff members to computerized charting.To understand computerized charting,staff members must understand informatics.The three core concepts in informatics are:
A) Hardware, software, and printers.
B) Data, information, and knowledge.
C) Decision making, data gathering, and reporting.
D) Wireless technology, voice recognition, and handheld devices.
Q2) As a nurse manager representative on a clinical information system selection team,you would be particularly concerned if the favored system:
A) Involves screen displays that are best configured for non-clinical users.
B) Requires an upgrade to servers in the facility.
C) Requires staff orientation and training during implementation of the software.
D) Minimizes the amount of data entry necessary.
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13
Chapter 12: Managing Costs and Budgets
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Sample Questions
Q1) Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care.The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs.Which of the following would most likely prompt the action of administrators?
A) The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.
B) Local home care services are expressing concern about the increased acuity of patients being discharged into their care.
C) The resource-based relative scale for physicians does not account for the increased length of stay.
D) Acute care patients are being denied entry to the hospital because of the increased stay of patients.
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
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Page 14
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) You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes.To achieve maximum reimbursement for a client who is recovering from a hip replacement,the nursing staff most likely will follow the nursing care guidelines presented in the:
A) Nursing care plan.
B) Physician's orders.
C) Critical pathway.
D) Clinical practice guidelines.
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15
Chapter 14: Staffing and Scheduling
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Sample Questions
Q1) In a job interview for a staff position,which of the following indicates your knowledge of patient safety?
A) "Will I be able to get overtime hours on your unit?"
B) "If there is an opportunity to work extra shifts, I would really like that."
C) "Is there a strategy in place to reduce the number of overtime hours on the unit?"
D) "I see no reason why I wouldn't be able to work overtime."
Q2) In reviewing the job description of a nurse manager,the staff becomes aware that a nurse manager's role is complex.Which of the following duties are required of a nurse manager ?
A) Responsibility for nursing benchmarks
B) No responsibility for knowledge of staffing benchmarks
C) Responsibility for planning staffing of UNPs only
D) Preparing a unit budget
E) Changing staffing plans based on service needs
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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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) During the performance appraisal session,the manager should
A) Maintain a relaxed and professional manner.
B) Inquire about the employee's personal life and how it is affecting performance.
C) Allow the employee to express opinions orally and in writing.
D) Plan to give specific examples only for poor performance.
Q3) Anecdotal notes:
A) Should be completed only when there are performance concerns.
B) Can be used to support and justify fairness in termination discussions.
C) Are unnecessary if the evaluation instrument is thorough.
D) Need to be completed at the end of a performance period.
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Page 17
Chapter 16: Strategic Planning, Goal-Setting, and Marketing
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Sample Questions
Q1) After a year,the staff at Pacific Hospital is frustrated,and implementation of evidence-based practice has gone poorly.In responding to this situation,the strategic planning team at Pacific Hospital:
A) Recommends that the mission, objectives, and goals of the hospital be reassessed.
B) Revises the goal statements in the strategic plan.
C) Consults an external team on preparation of materials on evidence-based practice.
D) Holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.
Q2) Northwestern Hospital has decided to implement peer review.As a clinical leader in the emergency department,you have overall responsibility for ensuring that this is in place by next month.The most important step in this process is to:
A) Provide an educational session for staff on peer review.
B) Revise the mission statement, objectives, and performance standards.
C) Develop objectives and performance standards with employees.
D) Implement objectives and performance standards.
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18
Chapter 17: Leading Change
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Sample Questions
Q1) As a new manager,you are shocked to learn that your unit is still using heparin in heparin locks.You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit.You are in which stage of Lewin's stages of change?
A) Unfreezing
B) Experiencing the change
C) Integrating the change
D) Refreezing
Q2) In Question 12,staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process?
A) Persuasion
B) Knowledge
C) Confirmation
D) Decision
Q3) Resistance is most likely when change:
A) Is not well understood.
B) Involves many layers in an organization.
C) Involves nonprofessional workers.
D) Threatens personal security.
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Page 19
Chapter 18: Building Teams Through Communication and Partnerships
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Sample Questions
Q1) The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive.For example,the group agreement,"We will speak supportively," prevents:
A) Side conversations during meetings.
B) Gossip and backbiting.
C) Feedback when one member of the group disagrees with the discussion.
D) Voting negatively on motions.
Q2) Which of the following is not a necessary requirement for formation of a team? In forming a team,the leader should keep in mind that the team:
A) Should include only members with similar personalities.
B) Is responsible for creating its own vision.
C) Should decide the goals and objectives.
D) Should encourage participants to be actively involved.
Q3) What is not a key concept in a well-functioning team?
A) Absence of disagreement or conflict
B) Special work that is understood and supported by all
C) Willingness to work together respectfully
D) Dedication to a mission
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Chapter 19: Collective Action
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Sample Questions
Q1) Sandra,an RN on the surgery unit,is assisting with a procedure in the patient examination room.The physician orders a medication to be given through IV.Sandra questions the order,based on her knowledge of the patient's history and of other medications that the patient has been given.The physician reiterates the order and Sandra refuses to give it.In this instance,Sandra is demonstrating:
A) Autonomy.
B) Accountability.
C) Authority.
D) Best practice.
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.
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21
Chapter 20: Managing Quality and Risk
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Sample Questions
Q1) A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:
A) NANDA.
B) AHRQ.
C) NIOSH.
D) Nursing process.
Q2) An example of an effective patient outcome statement is:
A) Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse. Practitioner within 3 hours of presentation in the Emergency Department.
B) Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs.
C) The hospital will reduce costs by 3% through the annual budget process.
D) Quality is a desired element in patient transactions.
Q3) A method commonly used in Quality Assurance to monitor adherence to established standards is:
A) A Pareto chart.
B) Brainstorming.
C) Patient interviews.
D) Chart audit.
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22
Chapter 21: Translating Research Into Practice
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Sample Questions
Q1) Which of the following is most accurate regarding evidence-based practice?
A) Evidence-based practice replaces continuous quality improvement.
B) Evidence-based practice began with medicine and assists in determining which medical models can be applied in nursing practice.
C) Effective and efficient care can already be demonstrated, which means that EBP will soon become redundant.
D) EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.
Q2) 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.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 22: Consumer Relationships
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Sample Questions
Q1) In orienting new staff nurses to a pediatric intensive care unit,the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?"
A) Making sure that they receive complete information during each encounter with a member of the nursing staff
B) Assessing parents' preferences for the amount of information desired
C) Allowing parents to observe key aspects of their child's nursing care
D) Making sure that patient education brochures explaining ICU protocols are readily available
Q2) In the situation described in the Multiple Response Question below,treating the patient with chest pain ahead of the patient with a migraine is a:
A) Product aspect.
B) Service dimension.
C) Compassionate decision.
D) Ritual.
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Chapter 23: Conflict: the Cutting Edge of Change
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Q1) The nurse manager is aware that conflict is occurring on her unit; however,she is focused on preparing for a state health department visit,so she ignores the problem.A factor that can increase stress and escalate conflict is:
A) The use of avoidance.
B) An enhanced nursing workforce.
C) Accepting that some conflict is normal.
D) Managing the effects of fatigue and error.
Q2) 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 taskforce 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
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Chapter 24: Managing Personalpersonnel Problems
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Q1) The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager:
A) Is a counselor and friend to the employee.
B) Should reprimand and suspend the employee as a last resort.
C) Should rehire the employee after a reasonable length of time.
D) Should terminate the employee if the problem persists.
Q2) A nurse manager must be familiar with the agency's policies regarding termination.Termination procedures include which of the following?
A) Following specific procedures from other organizations
B) Having an attorney present at the termination meeting
C) Having adequate written documentation to support the action
D) Having a friend present during the termination meeting
Q3) 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
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Chapter 25: Workplace Violence and Incivility
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Sample Questions
Q1) In selecting the appropriate action in Question 13,it is important that:
A) All documentation is reviewed.
B) Usual processes for discipline are followed.
C) Confidentiality is assured.
D) An incident report is filed.
Q2) A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question regarding directions in treatment.When you respond,he moves closer in to you and puts both hands up on either side of your neck.No one else is in the hallway.Your best response at this point is to:
A) Yell at him to stop.
B) Calmly ask the patient to remove his hands.
C) Hit the patient in the mid section.
D) Use pepper spray.
Q3) In addressing the staff turnover rate in Question 13,you are:
A) Confirming the high correlation between managerial incompetence and violence.
B) Demonstrating awareness that workplace violence, if present, has significant costs.
C) Aware that staff and manager experiences contribute to high turnover.
D) Aware that violence is a rare but present factor in the workplace.
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Chapter 26: Delegation: An Art of Professional Practice
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Sample Questions
Q1) The nurse on the 11-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP)employee.The night nurse should remain:
A) Accountable and responsible.
B) Accountable and liable.
C) Authoritative and liable.
D) Responsible and task-oriented.
Q2) Sarah (Question 21)provides Colleen,her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift.This is an example of:
A) Accountability.
B) Responsibility.
C) Assignment.
D) Delegation.
Q3) A key advantage that a nurse manager has in terms of delegating is that:
A) Clients receive less attention because too many staff make it difficult to coordinate care.
B) Nurses report less pressure to perform necessary tasks themselves.
C) Administration can predict overtime more accurately.
D) Team skills can be used more effectively.
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28
Chapter 27: Role Transition
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Sample Questions
Q1) A nurse manager notices that Nathan,an RN who has been on the unit for approximately 3 years,has a particular interest in 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) After a year,Sarah (Question 11)successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive.Amy advises her that this is not possible because Sarah will need:
A) A graduate degree.
B) At least a nursing diploma.
C) 24 months of experience.
D) 5 years of successful experience.
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Chapter 28: Self-Management: Stress and Time
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Sample Questions
Q1) In helping nurse managers to manage their time,the chief nursing officer suggests that they:
A) Maintain a perfectionistic attitude.
B) Set up a complaint list.
C) Have good negotiation skills.
D) Have good information literacy skills.
Q2) Social stressors are considered a major factor in the stress nurses experience in the healthcare system.Which of the following is not considered to be a social stressor?
A) High amounts of stress in the nurse home environment
B) Changes in the current healthcare system such as nursing strategies
C) Disruptive behavior coming from physicians and other healthcare workers
D) Personal stress triggers such as self-criticism and overanalyzing
Q3) "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.
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Page 30
Chapter 29: Managing Your Career
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Sample Questions
Q1) During an interview for a manager's position,you find the supervisor and staff unfriendly.Responses to questions are met with vague responses.After the interview,you decide not to pursue the position.What follow-up,if any,is most appropriate?
A) There is no need for you to do anything further. You likely will not be offered the position anyway.
B) You should file a complaint with Human Resources about the supervisor's lack of interviewing skills.
C) You should send a thank you note to the interviewer, indicating appreciation for her time.
D) You should call and leave a voicemail, indicating your disinterest in the position.
Q2) 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 30: Thriving for the Future
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Sample Questions
Q1) 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
Q2) 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
Q3) A business condition that may assist forecasting but add to the complexity of change is:
A) Consulting with professional groups about change.
B) Researching about trends on futuristic sites.
C) Asking patients to examine options for change.
D) Building profit projects and sustainability into planning.
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