Strategic Management in Nursing
Exam Answer Key
Course Introduction
Strategic Management in Nursing explores the principles and practices of strategic planning, leadership, and decision-making within healthcare organizations. The course emphasizes the development and implementation of strategies to improve patient outcomes, enhance organizational performance, and address dynamic challenges in the nursing profession. Students will examine case studies, analyze internal and external environments, and learn to align nursing practices with organizational missions, visions, and goals. Topics such as change management, resource allocation, quality improvement, and the role of nurse leaders in shaping healthcare policies are also discussed to prepare students for advanced leadership roles in nursing.
Recommended Textbook
Leading and Managing in Nursing 7th Edition by Yoder Wise
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Chapter 1: Leading, Managing, and Following
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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
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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) Sarah is a second-year nursing student.The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do.The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team.What competency does this action outline?
A) QSEN
B) IHI
C) DNV/NIAHO
D) AHRQ
Answer: A
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Chapter 3: Legal and Ethical Issues
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Q1) The principle that requires nurses to uphold a professional code of ethics,to practice within the code of ethics,and to remain competent is which of the following?
A) Veracity
B) Autonomy
C) Fidelity
D) Honesty
Answer: C
Q2) 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
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Chapter 4: Cultural Diversity and Inclusion in Health Care
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Q1) When interviewing a candidate for a nursing position who has an Aboriginal background,you recognize that the candidate's lack of eye contact reflects the candidate's:
A) lack of confidence.
B) professional behavior.
C) cultural sensitivity.
D) ethnicity.
Q2) Sarah,RN,complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking.In responding to Sarah,you consider that differences across cultures that are relevant to this situation include:
A) eye contact.
B) personal space.
C) harassment.
D) expressions of feeling.
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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) A staff nurse is the person on the unit everyone seeks for input and asks questions.What type of leadership position is the staff nurse displaying?
A) Position leadership
B) Informal leadership
C) Personal leadership
D) Formal leadership
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Chapter 6: Being an Effective Follower
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Q1) The nurse manager is working with a group of new nurses.The new nurses ask questions about leadership and the role of a manager in leading nursing.The manager shares the desire to have engaged staff nurses who participate in a team environment.What is the manager describing?
A) Effective follower
B) Effective leader
C) Ineffective follower
D) Ineffective leader
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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Chapter 7: Managing Self: Stress and Time
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Q1) A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS.She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings.One reasonable stress-management strategy would be to:
A) start taking yoga lessons.
B) make an appointment to meet with a psychiatrist.
C) start jogging 5 to 6 miles every day.
D) plan to go out for a drink with fellow nurses after work every day.
Q2) Time management is very essential for the nurse manager.Which of the following is not a good time-management technique?
A) Decide what not to do.
B) Learn to say "No."
C) Learn to delegate.
D) Break down your workload into smaller, manageable tasks.
Q3) High levels of work-related stress affect all but which of the following?
A) Job satisfaction
B) Absenteeism and turnover
C) Nurses' health
D) Client welfare
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Page 9
Chapter 8: Communication and Conflict
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Q1) Two staff nurses are arguing about whose turn it is to work on the upcoming holiday.In trying to resolve this conflict,the nurse manager understands that interpersonal conflict arises when:
A) risk taking seems to be unavoidable.
B) people see events differently.
C) personal and professional priorities do not match.
D) the ways in which people should act do not match the ways in which they do act.
Q2) John is a circulating nurse in the operating room.He is usually assigned to general surgery,but on this day he is assigned to the orthopedic room.He is unfamiliar with the routines and studies the doctor's preference cards before each patient.The fourth patient comes into the room and John prepares a site for a biopsy using a Betadine solution.The surgeon prefers another solution.He notices what John has done and immediately corrects him by rudely insulting John.What is the appropriate approach to conflict resolution in this example?
A) Collaboration
B) Compromising
C) Avoiding
D) Withdraw
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Chapter 9: Power,Politics,and Influence
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Q1) What is the best example of skilled negotiation?
A) Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children.
B) Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return.
C) George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods.
D) Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.
Q2) Amy has worked in the dialysis unit on staff for about 12 years.She is frequently consulted by other nursing staff regarding protocols and policies on the unit.What type of power is Amy using?
A) Position power
B) Expert power
C) Personal power
D) Competency power
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Chapter 10: Healthcare Organizations
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Q1) A nurse manager in a for-profit environment finds it difficult to recruit staff.This difficulty may be most related to aggressive profit goals and:
A) lower salary compensation for staff.
B) rising expectations of impoverished and indigent individuals for services.
C) poor orientation and retention practices for staff.
D) an overwhelming emphasis on accepting learners from health disciplines.
Q2) Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid.Tracy's responsibilities most likely would include:
A) managing physician-led research.
B) monitoring physician documentation of the need for medical care.
C) determining which services are designated fee-for-service.
D) identifying errors in physician diagnoses.
Q3) 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) At Orangetown Hospital,the nursing department is developing a mission statement for nursing.What would be a suitable mission statement?
A) "Nursing provides services for patients admitted to Orangetown Hospital."
B) "To participate fully in the professional services offered by Orangetown Hospital."
C) "To lead by the lamp; services for seniors."
D) "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."
Q2) Because of rapid turnover and the ongoing hiring of new graduates,the skill levels of staff in a busy CCU are varied.Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff.As the manager,you propose the addition of a nurse in advanced practice to provide consultation and education for staff.What is this position considered?
A) Hierarchical position
B) Ancillary
C) Line position
D) Staff position
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Page 13
Chapter 12: Care Delivery Strategies
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Q1) 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.
Q2) The nurse manager is comparing functional nursing and primary nursing for potential adoption.The nurse manager determines that patient and nurse satisfaction in primary nursing are:
A) similar to those in functional nursing.
B) not of significance in either model.
C) low by comparison with functional nursing.
D) high when compared with functional nursing.
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Chapter 13: Staffing and Scheduling
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Q1) A nurse manager must also consider a number of internal variables that will affect staffing patterns.An internal variable to be considered is:
A) organizational staffing policies.
B) state licensing standards.
C) American Nurses Association.
D) consumer expectations.
Q2) A strategy to increase RN staff retention at Valley Hospital includes:
A) better compensation and benefits.
B) clearer position descriptions.
C) lay-offs of nursing assistants.
D) adequate staffing to meet acuity levels.
Q3) A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs.An external variable to be considered is:
A) organizational staffing policies.
B) staffing models.
C) changes in services that will be offered.
D) department of Health licensing standards.
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Chapter 14: Work Force Engagement Through Collective
Action and Governance
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Q1) Martin,the unit manager,receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care.Martin checks the patient teaching sheets and notes that the sheets are initialed by staff.He calls the agencies and indicates that teaching has been done.Potential outcomes of Martin's actions include:
A) poor morale on the unit.
B) disruption in community relationships.
C) corruption of patient-staff relationships.
D) patient outcomes for quality care are met.
Q2) Nursing labor-management partnerships:
A) engage nurses at all levels in problem solving for better patient care.
B) require unions and management to negotiate in good faith regarding hours of work and wages.
C) have been shown to have negligible effects on nurse turnover and patient outcomes.
D) have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.
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Page 16
Chapter 15: Making Decisions and Solving Problems
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Q1) In a rural hospital,the unit for which you are charge nurse has a particularly busy morning.A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver.A child with asthma is experiencing early signs of an attack.The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience.An unlicensed assistant is available to assist.You must decide which patient situation you will take and where the new graduate RN's skills can best be used.Given the limitations in skills and experience,number of staff available,and time constraints,you must make a decision that involves:
A) a higher order thinking process.
B) selecting the best option for reaching a predefined goal.
C) optimizing.
D) satisficing.
Q2) 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) As a nurse manager,you want to institute point-of-care devices on your unit.The rationale that you provide to support the point-of-care devices includes:
A) reduction in incidents of medication error.
B) immediate documentation of care.
C) comparison of patient data with previous data.
D) immediate access to staffing schedules.
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 nonclinical 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.
Q3) A necessary,basic condition for successful integration of clinical information systems is:
A) software.
B) standard medical nomenclature.
C) confirmatory evidence from nursing-led studies.
D) strong interdisciplinary cultures.
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Chapter 17: Delegating: Authority, Accountability,
Responsibility in Delegation Decisions
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Q1) The charge nurse is making patient assignments for the next shift on the unit.There is one critical patient on the unit,who is going to require more care than the other patients.Before delegating this patient in an assignment,what is the appropriate action by the charge nurse?
A) Delegate the admission assessment to the LPN.
B) Review the employee's performance assessment for the most recent period.
C) Assess the amount of guidance and support needed for the nursing care of the patient.
D) Create a task analysis of critical behaviors for the individual.
Q2) Leslie,a UNP,transfers a patient while using improper technique.The patient is injured,and as a result,a suit is launched in which both Sarah (the delegator)and Leslie (the delegatee)are named.Sarah is named in the suit because she:
A) retains accountability for the care of the patient.
B) worked the same shift as Leslie.
C) has passive accountability for delegation.
D) retains accountability for the outcomes of care for the patient.
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Page 19
Chapter 18: Leading Change
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Q1) Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973),this comment may originate from failure in which phase of the six phases of planned change?
A) Generating self-renewal
B) Choosing the solution
C) Diagnosing the problem
D) Building a relationship
Q2) An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards,early majority,late majority,and rejecters is to:
A) encourage teamwork.
B) transfer to a different unit.
C) require attendance at staff meetings.
D) delegate the roles and tasks of change.
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Chapter 19: Building Effective Teams
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Q1) Trust is an important aspect of helping relationships,therapeutic communications,and the positive communications model.Which statement does not involve or define trust? Trust:
A) involves decisions to manipulate situations to gain advantage over another.
B) is the basis by which leaders facilitate the activities and progress of a team.
C) is low among members and leaders in poorly performing teams.
D) involves what we say and not necessarily what we do.
Q2) The mediator asked each staff member to reflect on his or her communication style.Which of the following best describes communication? Communication:
A) is a reflection of self-analysis.
B) is a result of thoughtful consideration.
C) consists of thoughts, ideas, opinions, emotions, and feelings.
D) focuses on the sender of the message.
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Chapter 20: Managing Costs and Budgets
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Q1) The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget.A nurse manager can best describe a budget as a:
A) day-to-day plan for operations.
B) unit of service.
C) statement of revenues and services.
D) financial plan.
Q2) Of the following,which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?
A) Training nurses on accurate documentation of supplies used for patient care
B) Reducing the number of overtime hours worked by staff
C) Reducing the number of staff on a unit
D) Making decisions for patients about which care is important to their health
Q3) The chief nursing office of a Magnet hospital has conducted a study of ways to improve healthcare services.Healthcare services that add value for clients:
A) accomplish healthcare goals.
B) minimize costs.
C) decrease the number of services used.
D) use high-technology treatments.
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Page 22
Chapter 21: Selecting, developing, and Evaluating Staff
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Q1) Joanne,a new nurse manager,writes certain assumptions regarding the organization's objectives into her budget.Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization,and that she needs to clarify these objectives with her supervisor.Joanne apologizes and says she had more latitude with the budget where she previously worked.This is an example of:
A) role complexity.
B) role ambiguity.
C) role conflict.
D) time-dependent roles.
Q2) A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit.This type of appraisal is a:
A) rating scale.
B) collaboratively based appraisal system.
C) narrative instrument.
D) behaviorally anchored rating scale.
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23
Chapter 22: Person-Centered Care
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Q1) In writing the patient satisfaction survey,the nurse manager is aware of the education levels of the families.What is the most critical element in the concept of health literacy?
A) Providing instructional materials at appropriate reading levels
B) Facilitating access to translators for persons with language barriers
C) Obtaining, processing, and understanding basic health information so appropriate decisions can be made
D) Knowing that most people have limited health literacy skills
Q2) The complexity of the healthcare environment for consumers is increased by:
A) falling levels of education among the public.
B) increased levels of poverty.
C) complex compensatory systems and a variety of delivery systems.
D) increased numbers of uninsured or underinsured.
Q3) An example of a factor that would impede a patient's learning is:
A) poverty.
B) limited health insurance.
C) being an older adult.
D) heavy sedation.
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Chapter 23: Managing Quality and Risk
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Q1) 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.
Q2) A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?
A) Histogram
B) Flowchart
C) Fishbone diagram
D) Pareto chart
Q3) Patient perceptions are useful in:
A) determining disciplinary actions in QI.
B) establishing the competitive advantage of QI decisions.
C) providing one source of data for QI initiatives.
D) establishing blame for poor-quality care.
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Chapter 24: Translating Research Into Practice
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Q1) Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice,it is important to:
A) consider whether patients' families see this as necessary for the well-being of family members.
B) search large databases such as CINAHL to amass further evidence.
C) clarify the clinical practice question.
D) solicit input regarding integration with practice.
Q2) A strategic goal for nursing in the facility developed by the chief nursing officer is to implement an evidence-based practice program.What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program on the unit?
A) Conducting a review of adverse events and incident reports
B) Soliciting input from staff members
C) Reviewing specialty organization guidelines
D) Identifying patients with extended lengths of stay
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Chapter 25: Managing Personal and Personnel Problems
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Q1) When progressive discipline is used,the steps are followed progressively only for repeated infractions of the same rule.On some occasions,rules that are broken are so serious that the employee is:
A) transferred to another unit.
B) suspended indefinitely.
C) asked to attend a union grievance meeting.
D) terminated after the first infraction.
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.
Q3) 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
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Chapter 26: Role Transition
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Q1) Sarah is a nursing graduate of 5 years who is very confident in her clinical skills.She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus.She is excited about being able to use her knowledge and interest by being hired as a nurse manager.Before beginning her new position,Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage.Sarah's actions are important in avoiding role:
A) ambiguity.
B) transition.
C) development.
D) negotiation.
Q2) As a result of Amy's coaching,Sarah,a nursing graduate of 5 years,completes a ROLES assessment.This assessment is helpful in:
A) identifying her clinical knowledge.
B) role development.
C) areas of conflict in expectations.
D) expected work time commitments.
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Chapter 27: Managing Your Career
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Q1) To enhance team leadership skills for your team leaders,you arrange opportunities for:
A) certification.
B) continuing education.
C) graduate courses.
D) volunteerism.
Q2) An example of a career is:
A) employment in short-term contract jobs in business, nursing, and whatever is available.
B) involvement in an area of practice that is regulated.
C) continuous employment in the same position and the same arrangement for 20 years.
D) moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.
Q3) In preparing for a fair interview process as a hiring manager,you should:
A) put water out for the candidates.
B) ensure that you know the names of all candidates.
C) dress comfortably and professionally.
D) prepare a schedule of questions to be asked of all candidates.
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Page 29
Chapter 28: Developing the Role of Leader
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Q1) As the clinical director of 24 employees,you have been asked to explain to staff members why they are not getting a raise this year,even though they have been working short-handed for many months and patient satisfaction scores have never been higher.Because you believe yourself to be a transformational leader,you will approach this problem by:
A) telling the assistant clinical director and asking her to share the bad news with the other staff members.
B) posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them.
C) showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.
D) meeting with a small group of seasoned staff members and asking them how to break the news.
Q2) The style of leadership that Kari is exhibiting is likely to:
A) ensure that the organization is financially stable.
B) stifle innovative thinking about ways to move out of financial jeopardy.
C) lead to apathy and disinterest in the organizational goals.
D) lead to decreased attrition of staff on her unit.
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Chapter 29: Developing the Role of Manager
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Sample Questions
Q1) Nancy is a staff nurse who works on a rehabilitation unit.Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training.Nancy is exhibiting which trait of a follower?
A) Provides a vision for safety that is communicated.
B) Thrives on taking risks in identifying the problem with safety.
C) Coordinates the development of knowledge and skills necessary to use the lift.
D) Assumes responsibility for identifying a safety concern and concedes authority for solution to you.
Q2) A nurse manager's responsibility for financial management involves making budgetary decisions.Budgets that allow the nurse manager to allocate resources at the unit level allow:
A) minimal nurse manager input.
B) limited rationale for budgetary requests.
C) budgetary allocations at the executive nurse level.
D) budgetary decision making at the point-of-service (POS).
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Chapter 30: The Strategic Planning Process
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Sample Questions
Q1) Assessment of the needs of the consumer or client (in developing a strategic marketing plan)focuses on:
A) present needs only.
B) present and future needs.
C) the development of surveys.
D) secondary analysis of existing data.
Q2) To meet the social and human needs of a target market,it is critical to:
A) assess the needs and priorities of the target market.
B) revise the organization's mission statement to reflect external needs.
C) assess the internal culture and needs.
D) develop highly sophisticated media.
Q3) 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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Chapter 31: Thriving for the Future
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Sample Questions
Q1) Which aspect of our tradition and history in nursing may impede our movement toward future-oriented thinking?
A) Lack of confidence
B) Focus on the discipline of nursing
C) Focus on details in the everyday practice
D) Mistrust of trends and new evidence
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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