Chapter 01: Leadership and Management Principles
Test Bank
MULTIPLE CHOICE
1. Leadership is best defined as:
a. an interpersonal process of participating by encouraging fellowship.
b. delegation of authority and responsibility and the coordination of activities.
c. inspiring people to accomplish goals through support and confidence building.
d. the integration of resources through planning, organizing, and directing.
ANS: C
Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 4
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data?
a. Effective leadership
b. Management involvement
c. Mentoring
d. Rewards and recognition
ANS: A
Effective leadership is important in nursing because of the impact on nurses’ work lives, it being a stabilizing influence during change, and for nurses’ productivity and quality of care.
DIF: Cognitive Level: Apply (Application) REF: Page 1
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. A staff registered nurse (RN) is leading a multidisciplinary clinical pathway team in the development of care for patients with total knee replacement. Which of the following statements would exemplify leadership behaviors in a clinical pathway team meeting?
a. “Nursing is responsible for pain control of the total knee replacement patient.”
b. “Our pharmacist has provided some excellent pain control literature.”
c. “Physical therapy’s expertise is in rehabilitation, not pain control.”
d. “Total knee replacement patients require optimal pain control.”
ANS: B
Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers. The correct answer is supportive of a team member’s work and depicts some skill at interpersonal relationships.
DIF: Cognitive Level: Apply (Application) REF: Pages 3-4
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
4. Which of the following is true of management activities?
a. Inspiring a vision is a management function.
b. Management is focused on task accomplishment.
c. Management is more focused on human relationships.
d. Management is more important than leadership.
ANS: B
Management is focused on task accomplishment.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 2-3
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates:
a. adaptation.
b. empowerment.
c. flexibility.
d. relationship management.
ANS: B
Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.
DIF: Cognitive Level: Apply (Application) REF: Page 5
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills?
a. Care provider
b. Business principles
c. Care coordination
d. Change management
ANS: C
Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care.
DIF: Cognitive Level: Apply (Application) REF: Page 3
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
7. Interpersonal communication and the ability to apply are two critical skills every nurse needs to enhance professional practice.
a. vision
b. supervision
c. delegation
d. problem solving
ANS: D
Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 4
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as:
a. social awareness.
b. self-awareness.
c. self-management.
d. relationship management.
ANS: A
Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 4
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. The manager of the emergency department in a large hospital focuses on customer service, exudes the nursing code of ethics, and sees his or her job as an occupation with a lifetime commitment. This is a concept known as:
a. leadership.
b. management.
c. professionalism.
d. vision.
ANS: C
Professionalism is an approach to an occupation that distinguishes it from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 5
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals.
a. Managers
b. Motivators
c. Visionaries
d. Followers
ANS: D
Without followers there is not leadership. Followers are vital because they accept or reject the leader and determine the leader’s personal power.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 6
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
11. The best leadership style for unfavorable conditions is:
a. leader–member relations.
b. task-oriented structure.
c. position power.
d. laissez faire.
ANS: B
The need for task-oriented leaders occurs when the situation is extreme. The best leadership style for unfavorable conditions is task-oriented.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 10, 12
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. Nursing management is defined as:
a. delegation of authority and responsibility and the coordination of tasks. b. the integration of resources through planning, organizing, and directing. c. the process of influencing patients to accomplish goals.
d. the coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives.
ANS: D
The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives is the definition of nursing management.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 22
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
13. A nursing unit has demonstrated lower patient satisfaction scores during the last quarter. The manager of the unit has formed a small team to set long- and short-term goals for the unit with action plans to increase patient satisfaction. This is an example of which management
process?
a. Planning
b. Organizing
c. Coordinating
d. Controlling
ANS: A
Planning is the managerial function of selecting priorities, results, and methods to achieve results.
DIF: Cognitive Level: Apply (Application) REF: Pages 23-24
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
14. A nursing unit has discovered a series of medication errors with regards to a particular computerized physician order set and the calculation within the order. The unit manager has a theory on changes that should be made within the order to decrease the confusion for nursing staff. However, the nurse manager realizes that changes would need to be made with
pharmacy input as well as other nursing units within the facility and the multi-hospital system. Which of the following management theories is exemplified when the nurse manager
considers the impact of change on the organization as a whole?
a. Contingency theory
b. Systems theory
c. Complexity theory
d. Chaos theory
ANS: B
Systems theory helps managers recognize their work as being embedded within a system. Managers use this theory to learn that changing one part of a system inevitably affects the whole system.
DIF: Cognitive Level: Apply (Application) REF: Pages 30-32
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
15. The role of the is to provide leadership and direction for all aspects of nursing care.
a. nurse manager
b. care provider
c. nurse executive
d. senior leader
ANS: C
The nurse executive is accountable for the environment in which clinical nursing practice occurs. The nurse executive provides leadership and direction for all aspects of nursing care.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 34
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
16. The postoperative patient with anterior cervical laminectomy is complaining of tightness in
his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of leadership.
a. authoritarian
b. democratic c. laissez-faire d. servant
ANS: A
Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.
DIF: Cognitive Level: Apply (Application) REF: Page 10
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiological Adaptation
17. A quality improvement team is working to enhance teamwork among the staff in a newly developed Alzheimer’s program. Which of the following statements would be an expected behavior that illustrates quantum leadership?
a. “After the meeting today, each member on this team will be a role model of good communication techniques to other staff members.”
b. “How would you describe an ideal collaborative practice environment?”
c. “What do you think about sharing our opinions today in a mutually respectful manner as we move around the table?”
d. “You folks are highly motivated and smart enough to develop a plan on your own.
I’ll support you as needed.”
ANS: B
Quantum leadership fosters an environment of curiosity, questioning, and exploration. Answer
A depicts an authoritarian leadership style.
DIF: Cognitive Level: Apply (Application) REF: Page 16
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
18. A nursing executive is leading a multidisciplinary team of professionals who have worked well together on prior initiatives. Which of the following leadership styles might work best in this situation?
a. Authoritarian
b. Democratic
c. Transformational
d. Transactional
ANS: B
Democratic leadership would work best in this situation.
DIF: Cognitive Level: Apply (Application) REF: Pages 10, 14
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
1. Which of the following behavioral aspects are present in the feminist perspective leadership style (select all that apply)?
a. Builds relationships
b. Focuses on completing tasks and achieving goals
c. Empowers others
d. Fosters an environment of mothering
e. Supports bargaining of tasks and roles
f. Promotes personal growth
ANS: A, C, F
Leaders using the feminist perspective build connections, empower others, and support personal growth to promote teamwork and to accomplish goals.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 11
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A nurse manager at Great Lakes Hospital is meeting with the dean of a well-recognized university who is the keynote speaker today at the nursing conference. He remembers that one of the RNs is interested in attending a well-known university to obtain a doctorate. The nurse manager arranges for the RN to meet with this dean. The nurse manager is exhibiting leadership behaviors consistent with (select all that apply):
a. feminist perspective.
b. servant leadership.
c. transactional leadership.
d. transformational leadership.
ANS: A, B, D
This behavior nurtures personal growth (servant leadership) and assists the RN to attain his or her fullest potential (transformational leadership). This behavior also helps the RN build a connection with the dean, a representative of the university (feminist perspective).
DIF: Cognitive Level: Apply (Application) REF: Pages 11, 14, 16
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. A nurse manager at Morgan Hill Community Hospital is known to be an excellent nursing manager by the personnel working on her nursing unit. The nurse manager exhibits which of the following behaviors (select all that apply)?
a. Knows the personnel and addresses them by name
b. Intervenes when she receives complaints
c. Has a consistent style that never varies
d. Is visible on the nursing unit by all shifts on a frequent basis
e. Evaluates a number of aspects of problems prior to making decisions
f. Uses decision by consensus to resolve conflicts
g. Fosters collaboration
ANS: A, D, E, G
These behaviors foster teamwork and positive morale.
DIF: Cognitive Level: Apply (Application) REF: Pages 6-8
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. To reach Magnet status the nursing service in a hospital must attain competency in which of the following areas (select all that apply)?
a. Professionalism
b. Use of critical thinking skills
c. Business skills and principles
d. Leadership
e. Communication and relationship management
f. Knowledge of the health care environment
g. Implementation of an acuity-based staffing system
ANS: A, C, D, E, F
Magnet hospitals are recognized for the nurse’s critical role in the business of health care. Professionalism, leadership, communication, and the ability to work with others as well as understanding the business and principles of running a hospital business and health care environment are required.
DIF: Cognitive Level: Apply (Application) REF: Pages 2-3
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. Which of the following behaviors build trust between leaders and employees in an organization (select all that apply)?
a. Sharing relevant information
b. Encouraging competition via winners and losers
c. Reducing controls
d. Meeting expectations
e. Avoiding discussion of sensitive issues
ANS: A, C, D
Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.
DIF: Cognitive Level: Apply (Application) REF: Pages 8-9
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. Which of the following traits describe a transactional leader (select all that apply)?
a. Functions in a caregiver role
b. Surveys their followers’ needs and sets goals for them
c. Uses charisma to produce greater effort in followers
d. Focuses on the maintenance and management of ongoing and routine work
e. Motivates followers to perform to their full potential
ANS: A, B, D
A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers’ needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 14
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. Which of the following factors are central to successful nursing leadership (select all that apply)?
a. Access to information and resources
b. Respectful and collaborative teamwork
c. Supportive cultures in which nurses are valued for their expertise
d. Formal and informal power
e. Vertical compensation
ANS: A, B, C, D
Formal and informal power, access to information and resources, opportunity for growth, supportive organizational cultures in which nurses are valued for their expertise, respectful teamwork, and adequate compensation are factors central to successful nursing leadership.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 17
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. 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.
ANS: B, C, D, E
Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations’ money, facilities and supplies are directed in a manner which achieves the best results.
DIF: Cognitive Level: Apply (Application) REF: Page 21
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Chapter 04: Critical Thinking and Decision-Making Skills
Test Bank
MULTIPLE CHOICE
1. What is the definition of the process of making choices that will provide maximum benefit?
a. Critical thinking b. Problem solving c. Decision making d. Leading
ANS: C
Decision making is the process of making choices that will provide maximum benefits.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 66
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. Which of the following examples best depicts Benner’s stages and appropriate critical-thinking processes in this situation?
a. Advanced beginner—thinks that the patient is trying to be funny
b. Competent—thinks that the patient is experiencing effects from cerebral edema
c. Novice—thinks that the patient is stressed and has had a surge of adrenaline
d. Proficient—thinks that the patient is waking up from a coma
ANS: B
The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure.
DIF: Cognitive Level: Analyze (Analysis) REF: Pages 67-68
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiological Adaptation
3. A staff registered nurse (RN) has been struggling with the delivery system from central supply. He documents a delay of 1 to 3 hours from the time that the order is sent to central supply to the time that the requested equipment is sent to the floor. The RN asks, “Why does a central supply unit need to service the entire hospital? Why not consider a decentralized central supply established for each floor?” This is an example of what type of thinking?
a. Amiable thinker
b. Critical thinker
c. Traditional thinker
d. Unrealistic thinker
ANS: B
A critical thinker challenges and questions the norm.
DIF: Cognitive Level: Apply (Application) REF: Page 67
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. A staff RN is leading a quality improvement team on the care of the total hip replacement patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem
statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques?
a. Problem solving
b. Evaluating the consequences
c. Inclusive judgment
d. Problem processing
ANS: A
Problem solving occurs when moving from an undesirable to a desirable state. It occurs in a variety of nursing contexts.
DIF: Cognitive Level: Apply (Application) REF: Page 66
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. How is leadership 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.
ANS: A
The challenges of leadership belong to every nurse, not just those in formal administrative or management roles. Leadership at the staff level may take a different form. For instance, a staff nurse adapting to a challenging patient assignment, taking initiative to change practice
through performance improvement, or challenging the status quo is participating in unit culture construction.
DIF: Cognitive Level: Apply (Application) REF: Page 61
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. Family members of a dying patient are arguing about terminating life support. The nurse educates the two opposing groups individually about terminating life support and discusses the dying process. This is an example of:
a. delegation.
b. negotiation.
c. clinical judgment.
d. purposeful inaction.
ANS: C
Clinical judgment is a decision-making process in nursing related to quality of care that is patient-centered.
DIF: Cognitive Level: Apply (Application) REF: Pages 67-68
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Physiological Adaptation
7. A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager. This is an example of:
a. incrementalism.
b. optimizing.
c. mixed scanning.
d. strategic planning.
ANS: B
An optimizing decision includes comparing all possible solutions with desired objectives and selecting the optimal solution that best meets objectives.
DIF: Cognitive Level: Apply (Application) REF: Page 70
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. Nursing students are working on a long-term care unit at a new clinical site. The instructor is concerned because the clinical site is missing some needed components. In a discussion with the director of nursing, it is determined that the instructor should document the expected and actual outcomes of the experience and compare them. This type of decision making is made utilizing (the):
a. rational model. b. process model. c. political model.
d. outcome evaluation.
ANS: B
The process model uses standard operating procedures and guidelines.
DIF: Cognitive Level: Analyze (Analysis) REF: Page 74
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. 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
ANS: B
Direct intervention is carrying out an activity to intervene in a situation and resolve a problem.
DIF: Cognitive Level: Apply (Application) REF: Page 77
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Basic Care and Comfort
10. Which of the following problem definitions is matched with an accurate example?
a. Problem solving: A nurse ignores a client’s requests to stop his dialysis.
b. Dilemma: A nurse is scheduled to work over the weekend, and she has a family outing to attend.
c. Critical thinking: A nurse is counseling a woman with breast cancer about terminating her pregnancy and receiving chemotherapy or completing the pregnancy and possibly not surviving.
d. Purposeful action: A nurse has been offered an exciting new position with a dramatic increase in salary, but she would have to move out of state, away from her ailing parents.
ANS: C
In this case, there may not be a logical solution to the problem, because the baby or mother may not survive. The nurse utilizes critical thinking in dealing with the situation, because the nurse uses reflection to analyze, conceptualize events, and obtain complex information to provide to the patient.
DIF: Cognitive Level: Analyze (Analysis) REF: Page 66
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
11. Nurses working on the intermediate care unit have had many hours of overtime in the last 6 months. Before forming a team, the nurse manager gathers data about patient condition severity, staffing ratios, educational levels of staff, and personality mixes on each shift. What level of decision making is this process?
a. Establishment of solution evaluation criteria
b. Evaluation of the alternative solutions
c. Identification of a problem, issue, or situation
d. Search for alternative solutions or actions
ANS: C
Data should be collected to identify properly the actual problem, issue, or situation. The five core elements to decision making are the following: (1) identification of a problem, issue, or situation; (2) establishment of the criteria to be used to evaluate potential solutions; (3) search for alternative solution or actions; (4) evaluation of the alternative; and (5) selection of a specific alternative.
DIF: Cognitive Level: Apply (Application) REF: Page 69
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. A continuous quality improvement team has considered all aspects of a decision to purchase two new computed tomography scanners to meet the needs of the community. The team decides to go with the less expensive, larger machines with few additional capabilities because of current budget restraints, even though it will mean purchasing newer smaller models with more capabilities in the future when moving to a new hospital in 3 years. This decision is known as a(n) decision.
a. cost-conscious
b. group
c. optimizing
d. satisficing
ANS: D
A satisficing decision results in an outcome that is sufficient, satisfies basic requirements, and minimally meets desired objectives.
DIF: Cognitive Level: Apply (Application) REF: Page 70
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
13. The nursing education department is revising its orientation curriculum for nurse externs. A consultant has been hired to revise the program completely. When the curriculum is completed, most of the prior curriculum and activities are found to be the same. This is an example of which of the following decision-making distortions?
a. Anchoring trap
b. Confirming evidence trap
c. Framing trap
d. Status quo trap
ANS: D
Status quo trap is the strong bias to choose alternatives that perpetuate the status quo, keeping the situation or environment as it has always been.
DIF: Cognitive Level: Apply (Application) REF: Page 70
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
14. The marketing department of a major children’s hospital is hosting a fund-raiser for the local Ronald McDonald House. In the past, fund-raisers were successful when scheduled in the spring. This year, the fund-raiser is scheduled in the fall, when the city and several local organizations have community festivals. The first fund-raiser was scheduled 10 years ago in the fall and raised $50,000, only one eighth of the goal. This depicts an example of which of the following decision-making distortions?
a. Confirming evidence trap
b. Estimating and forecasting trap
c. Status quo trap
d. Sunk cost trap
ANS: B
Estimating and forecasting trap is the natural tendency of human behavior to disregard negative outcomes and remember the positive ones. In this case, the marketing department is not taking the failure of a previous fall fund-raiser into account when planning this event.
DIF: Cognitive Level: Apply (Application) REF: Page 71
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
15. An intravenous infusion center is considering switching intravenous pumps to another vendor.
A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team and the nurse leader vote to determine which pumps to use. This example depicts which of the following decision styles?
a. Autocratic
b. Consultative
c. Delegative
d. Facilitative
ANS: D
The leader and followers work together to reach a shared decision.
DIF: Cognitive Level: Apply (Application) REF: Page 77
TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
16. A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making style?
a. Autocratic
b. Consultative
c. Delegative
d. Facilitative
ANS: C
The leader gives up control to the group in the delegative decision-making style.
DIF: Cognitive Level: Apply (Application) REF: Page 77
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
17. A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in the emergency medical service system. Questions are asked such as, “Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?” Which of the following decision-making strategies would work best in this situation?
a. Cost-benefit analysis
b. Decision tree
c. Problem critique
d. Trial and error
ANS: B
A decision tree starts to the left and flows to the right, displaying the options, outcomes, and risks to be anticipated. Decision trees and algorithms are used for developing protocols for therapy administration.
DIF: Cognitive Level: Apply (Application) REF: Page 74
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
18. A team consisting of preoperative, operative, and postoperative health care professionals and ancillary staff is examining the turnaround time from the preoperative area to discharge for patients having tonsillectomies. The goal is to decrease waiting times for clients. Which of the following techniques would delineate processes that are delaying time for patients having tonsillectomies?
a. Cost-benefit analysis
b. Trial and error
c. Shared decision making
d. Scenario planning
ANS: C
Shared decision making uses a variety of strategies to make decisions aimed at solving problems. A variety of strategies are utilized to achieve the goal.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 74
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
19. A disaster team is planning strategies to use in the event of multiple catastrophes. Various questions are posed such as, “If we lost all electricity in Kent County, what challenges would we face in providing care? If the Grand River flooded, which institutions would not be available for health care? What other facilities could be used as a backup system? Which roadways would be available in the event of a flood?” This is an example of which of the following decision-making strategies?
a. Creativity techniques
b. Decision trees
c. Simulated trial and error
d. Worst case scenarios
ANS: D
Worst case scenarios are used to make decisions involving risk.
DIF: Cognitive Level: Apply (Application) REF: Page 75
TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
20. A nationwide community health care nursing organization has formed a team to assist with disaster victim relocation and to plan for psychological, physical, and emotional needs that the victims may encounter. In which stage of decision making is this group?
a. Deliberation
b. Evaluation c. Judgment d. Selection
ANS: A
Deliberation involves the beginning stages of identification of a problem, issue, or situation.
DIF: Cognitive Level: Apply (Application) REF: Page 69
TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. Two cognitive processes that nurses use in clinical judgments include (select two answers):
a. analysis.
b. brainstorming.
c. fish boning.
d. intuition.
ANS: A, D
Two cognitive processes used in critical thinking for nursing judgments are analysis and intuition.
DIF: Cognitive Level: Analyze (Analysis) REF: Page 65
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Nurses in clinical practice need to be able to make decisions based on the needs of the client, situations, or practice problems. Which of the following statements are true regarding critical thinking in nursing (select all that apply)?
a. Critical thinkers challenge the norm.
b. Critical thinkers consider unintended consequences when making decisions.
c. Critical thinkers utilize the step-by-step nursing process in order.
d. Critical thinkers are creative in their thinking.
e. Critical thinking should be left to the discretion of the nurse leader.
ANS: A, B, D
Critical thinkers go beyond the step-by-step processes outlined in the nursing process and traditional problem solving. A critical thinker challenges and questions the norm and considers the context of the decision-making potential for unintended consequences. Critical thinkers
are creative in their thinking. Nurse leaders and managers have an obligation to create climates that encourage critical thinking among staff.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 67-68
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process (select two that apply)?
a. Develop and implement an action plan for problem solution.
b. Establish criteria for what you want to accomplish.
c. Define the problem and determine why anything should be done about it. d. Evaluate the decision through monitoring, troubleshooting, and feedback. e. Determine the best choice or alternative.
ANS: C, D
The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 69
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. A client becomes confused after surgery. He is in a room farthest away from the nurses’ station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize (select all that apply)?
a. Critical thinking
b. Problem solving
c. Autocratic decision
d. Financial decision
ANS: A, B
Critical thinking and decision-making strategies were utilized in determining the measures that would promote patient safety and prevent a fall.
DIF: Cognitive Level: Apply (Application) REF: Pages 66-68
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
5. Which of the following are examples of formal decision-making strategies (select all that apply)?
a. Trial and error
b. Anchoring
c. Pilot project
d. Creativity technique
e. Decision tree
ANS: A, C, D, E
Examples of formal decision-making strategies include trial and error, the use of pilot projects, creativity techniques, and the use of a decision tree.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 73-75
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. Effective managers utilize group problem solving to discuss and participate in solving a problem. Which are examples of decision-making strategies that are useful in groups (select all that apply)?
a. Incrementalism
b. Scenario planning
c. Worst-case scenario
d. Six Sigma
e. Budgetary model
ANS: B, C, D
Scenario planning, worst-case scenario, and the use of Six Sigma are all effective group problem-solving tools.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 74-76
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Chapter 07: Communication Leadership
Test Bank
MULTIPLE CHOICE
1. The art of being able to structure and transmit a message in a way that another can understand easily and accept is:
a. articulation.
b. communication.
c. evaluation.
d. pronunciation.
ANS: B
Communication is the art of being able to structure and transmit a message in a way that another can understand easily and accept.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 111
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Unspoken affective or expressive behaviors best describe which type of communication?
a. Effective communication
b. Ineffective communication c. Nonverbal communication d. Verbal communication
ANS: C
Nonverbal communication is unspoken. It is composed of affective or expressive behaviors. The effectiveness of verbal communication depends on vocabulary, language, phrases, sentence structure, sentence clarity, rate of speech, diction, tone, rhythm, and volume. Nonverbal behavior includes gestures, facial expression, eye contact, body language, and positioning (Hersey et al., 2008).
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. A nursing theory used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being is the:
a. Humanizing Nursing Communication Theory (HNCT).
b. situation, background, assessment, and recommendation (SBAR) Communication
Theory.
c. Behavioral System Model.
d. Human Relationship Model.
ANS: A
The HNCT is used to describe the manner of communicating that acknowledges the unique characteristics of the holistic human being.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 115-116
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as:
a. advisement. b. consultation. c. persuasion.
d. suggestion.
ANS: C
Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 112
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