Test Bank - Leading and Managing in Nursing 6th Edition
TEST BANK
Leading and Managing in Nursing
Patricia S. Yoder-Wise
6th Edition
Page 1
, Test Bank - Leading and Managing in Nursing 6th Edition
Table of Contents
PART 1: CORE CONCEPTS
1. Leading, Managing, and Following
2. Patient Safety
3. Developing the Role of Leader
4. Developing the Role of Manager Context
5. Legal and Ethical Issues
6. Making Decisions and Solving Problems
7. Healthcare Organizations
8. Understanding and Designing Organizational Structures
9. Cultural Diversity in Health Care
10. Power, Politics, and Influence
PART 2: MANAGING RESOURCES
11. Caring, Communicating, and Managing with Technology
12. Managing Costs and Budgets
13. Care Delivery Strategies
14. Staffing and Scheduling
15. Selecting, Developing, and Evaluating Staff
PART 3: CHANGING THE STATUS QUO
16. Strategic Planning, Goal-Setting, and Marketing
17. Leading Change
18. Building Teams Through Communication and Partnerships
19. Collective Action
20. Managing Quality and Risk
21. Translating Research into Practice
PART 4: INTERPERSONAL AND PERSONAL SKILLS INTERPERSONAL
22. Consumer Relationships
23. Conflict: The Cutting Edge of Change
24. Managing Personal/Personnel Problems
25. Workplace Violence and Incivility
26. Delegation: An Art of Professional Practice Personal
27. Role Transition
28. Self-Management: Stress and Time
29. Managing Your Career Future
30. Thriving for the Future
Page 2
, Test Bank - Leading and Managing in Nursing 6th Edition
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is
asked to assess and adapt the unit to better meet the unique needs of the older adult patient.
Using complexity principles, what would be the best approach to take in making this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and
planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit, and omit the hospital and community environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore, all levels of staff would be involved in decision making.
REF: Page 8 TOP: AONE competency: Communication and Relationship-Building
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has
called in sick five times in the past month. He tells the manager that he very much wants to come
to work when scheduled but must often care for his wife, who is undergoing treatment
for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to
satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be
calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off
around his wife’s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs
and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
patient care and threaten the needs of staff to feel competent. Arranging the schedule around
the wife’s needs meets the needs of the staff and of patients while satisfying the nurse’s need
for affiliation.
, Test Bank - Leading and Managing in Nursing 6th Edition
REF: Page 10 TOP: AONE competency: Communication and Relationship-Building
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first
mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit
manager continues to reiterate the reasons for her actions. What would be the best course of
action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
ANS: C
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the
interests and involvement of participants in the conflict by examining the real issues of all
parties.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.
It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the dispute.
ANS: B
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is
recommended if resolution fails.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of RN
assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have
always practiced in a primary nursing–delivery system and are very resistant to this idea. The
best initial strategy in this situation would include:
a. Exploring the values and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is
implemented.
c. Dropping the idea and trying for the change in a year or so when some of the present RNs
have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling
relationships, deepening self-awareness in self and others, motivating others, and managing
emotions. Motivating others recognizes that values are powerful forces that influence
acceptance of change. Leaving the RNs alone for a period of time before implementation does
not provide opportunity to explore different perspectives and values. Avoiding discussion
until the team changes may not promote adoption of the change until there is opportunity to
explore perspectives and values related to the change. Hiring of the assistants demonstrates
lack of empathy for the perspectives of the RN staff.
REF: Page 7 | Page 15
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that
there is little turnover among your LPN and nursing assistant (NA) staff members, but they are
not very motivated to go beyond their job descriptions in their work. Which of the following
strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night
LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their
positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual
workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign
contracts that guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with
Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction.
Motivator factors such as recognition and satisfaction with work promote a satisfying and
enriched work environment. Transformational leaders use motivator factors liberally to inspire
work performance and increase job satisfaction.
REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating factors, which
action would you select?
a. Collaborate with the human resource/personnel department to develop on-site daycare
services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore all levels of staff would be involved in decision making. This
principle is the foundation of shared governance.
REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who
begins to complain loudly about the quality of care his mother is receiving. His behavior is so
disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects
any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the
nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined
leadership skills in an emotionally intelligent practitioner?
a. Reflect to gain insight into how the situation could be handled differently in the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
Goleman suggests that emotional intelligence involves insight and being able to step outside
of the situation to envision the context of what is happening as well as being able to manage
emotions such as frustration effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
9. 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. Which 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.
ANS: D
The manager role involves guiding others through a set of derived practices that are evidence-
based and known to satisfy preestablished outcomes such as participation in a competency
program. This involves engagement of staff through sharing of concerns and ideas. A close
analysis of the IOM report and the summary of the PPACA suggests that no health reform can
unfold without active nursing engagement. Each document emphasizes that nurses must lead,
, Test Bank - Leading and Managing in Nursing 6th Edition
manage, and behave as active collaborators with other members of the health team and with
those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
10. As the manager, you have been asked to implement an evidence-based approach to teach
ostomy patients self-management skills postoperatively that is being operationalized throughout
your organization. Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar
to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs
that the new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in
mentoring and teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting where a
team has gathered to ensure the best clinical decision making and actions are taken to achieve
clinical or organizational outcomes. Followership promotes good clinical decisions and use of
clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
11. You overhear a newly graduated RN telling one of your colleagues that leadership and
management belong to the unit manager and not to her. As a nursing colleague, you respond by
demonstrating understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence
may affect the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied in
their jobs.
ANS: B
Care coordination that involves the intersection of individual, family, and community-based
needs requires that nurses have self-confidence, knowledge of organizations and health
systems, and an inner desire to lead and manage. There is often a view that leadership is
isolated to those holding managerial positions and that a direct care nurse is subject to
following by adhering to the direction of others. Such views fail to acknowledge that to be a
nurse requires each licensed individual to lead, manage, and follow when practicing at the
point-of-care and beyond.
, Test Bank - Leading and Managing in Nursing 6th Edition
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously
very upset and after you speak with him regarding his behavior, you determine that he has not
slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith
and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest
that Mr. Smith’s behavior was aggressive but is related to lack of sleep and to pain. You say to
Miss Jones, “Can you both, together with Mr. Smith, determine triggers for the pain and
effective approaches to controlling his pain?” This approach demonstrates:
a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr. Smith.
c. Leadership behavior.
d. Management behavior.
ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved
patient symptoms and aggressiveness toward a staff member. Providing engaged,
collaborative guidance and decision making in a complex situation where there is no
standardized solution reflects leadership.
REF: Page 4 TOP: AONE competency: Leadership
13. After assessing an older adult patient in long-term care who has been slowly deteriorating for
weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The
nurse manager’s decision and actions are based on:
a. An established clinical pathway.
b. Confirmatory scientific evidence.
c. Unit protocol.
d. Experience.
ANS: D
The nurse manager is employing knowledge and experience in determining that the patient is
dying, because the course of dying is not standardized and cannot be determined by clinical
pathways.
REF: Page 4 TOP: AONE competency: Knowledge of the Health Care Environment
14. Chart audits have revealed significant omissions of data that could have legal and funding
guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings
and to find approaches that will address the gaps in charting and achieve desired goals. This is
an example of:
a. Leadership.
b. Management.
c. Decision making.
d. Vision.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: B
The process of guiding others to meet established goals, outcomes, and procedures is
management. This can require collaborative decision making to determine how best to reach
pre-determined goals and follow established practices.
REF: Page 5 TOP: AONE competency: Knowledge of the Health Care Environment
15. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. What role are you
assuming through this action? a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
As a manager, you are concerned with managing and coordinating resources to achieve
outcomes in accordance with established clinical processes. Referral to a social worker
alleviates demand on staff time and is consistent with hospital procedures.
REF: Page 5 TOP: AONE competency: Communication and Relationship-Building
16. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. In response to this
situation, you approach the unit manager to apprise her of your concerns that the family
dynamics of the patient involved may lead to staff-family and patient-family conflicts. You
suggest that the physician may need to discuss the treatment plan with the family. The unit
manager advises that he will arrange this discussion. If, after the meeting with family members,
this is identified as a desired approach, you support the manager’s decision. Your actions
indicate that you are acting in what role? A
. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
, Test Bank - Leading and Managing in Nursing 6th Edition
In the followership role, you bring to the manager your concerns about potential litigation and
maximization of outcomes and accept the direction given by the manager in response to your
concerns.
REF: Page 3 | Page 4
TOP: AONE competency: Knowledge of the Health Care Environment
17. You pull staff together to assess a situation in which the family of a seriously ill patient is
anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning
of treatment decisions. Staff members are becoming distanced from the family. After inviting
the concerns of staff, you explain that the organization values patient-centered care and that
evidence supports that acting as an advocate and a listener is helpful to families. You ask the
staff for ideas as to strategies that are effectively patient-centered in these situations. In this
situation, you are taking on which role?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
As a leader, you provide and communicate vision and direction based on evidence and
experience, and you engage others in decision making that moves them toward the vision with
a reasonable level of risk taking.
REF: Page 4 | Page 5 TOP: AONE competency: Leadership
18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas
has many ideas, and his manner of presenting them irks Joan. After reflection and discussion
with others, Joan recognizes that she also feels threatened by his behavior. She comes to
understand that Thomas is trying to establish his own role on the unit, is not trying to challenge
her, and needs guidance, coaching, and affirmation. Joan is demonstrating:
a. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
According to Goleman (1995), stepping outside oneself to envision the situation while
assuming ownership is a component of emotional intelligence.
REF: Page 7 | Page 8 TOP: AONE competency: Professionalism
TEST BANK
Leading and Managing in Nursing
Patricia S. Yoder-Wise
6th Edition
Page 1
, Test Bank - Leading and Managing in Nursing 6th Edition
Table of Contents
PART 1: CORE CONCEPTS
1. Leading, Managing, and Following
2. Patient Safety
3. Developing the Role of Leader
4. Developing the Role of Manager Context
5. Legal and Ethical Issues
6. Making Decisions and Solving Problems
7. Healthcare Organizations
8. Understanding and Designing Organizational Structures
9. Cultural Diversity in Health Care
10. Power, Politics, and Influence
PART 2: MANAGING RESOURCES
11. Caring, Communicating, and Managing with Technology
12. Managing Costs and Budgets
13. Care Delivery Strategies
14. Staffing and Scheduling
15. Selecting, Developing, and Evaluating Staff
PART 3: CHANGING THE STATUS QUO
16. Strategic Planning, Goal-Setting, and Marketing
17. Leading Change
18. Building Teams Through Communication and Partnerships
19. Collective Action
20. Managing Quality and Risk
21. Translating Research into Practice
PART 4: INTERPERSONAL AND PERSONAL SKILLS INTERPERSONAL
22. Consumer Relationships
23. Conflict: The Cutting Edge of Change
24. Managing Personal/Personnel Problems
25. Workplace Violence and Incivility
26. Delegation: An Art of Professional Practice Personal
27. Role Transition
28. Self-Management: Stress and Time
29. Managing Your Career Future
30. Thriving for the Future
Page 2
, Test Bank - Leading and Managing in Nursing 6th Edition
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is
asked to assess and adapt the unit to better meet the unique needs of the older adult patient.
Using complexity principles, what would be the best approach to take in making this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and
planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit, and omit the hospital and community environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore, all levels of staff would be involved in decision making.
REF: Page 8 TOP: AONE competency: Communication and Relationship-Building
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has
called in sick five times in the past month. He tells the manager that he very much wants to come
to work when scheduled but must often care for his wife, who is undergoing treatment
for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to
satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be
calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off
around his wife’s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs
and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
patient care and threaten the needs of staff to feel competent. Arranging the schedule around
the wife’s needs meets the needs of the staff and of patients while satisfying the nurse’s need
for affiliation.
, Test Bank - Leading and Managing in Nursing 6th Edition
REF: Page 10 TOP: AONE competency: Communication and Relationship-Building
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first
mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit
manager continues to reiterate the reasons for her actions. What would be the best course of
action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
ANS: C
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the
interests and involvement of participants in the conflict by examining the real issues of all
parties.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution.
It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the dispute.
ANS: B
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is
recommended if resolution fails.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of RN
assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have
always practiced in a primary nursing–delivery system and are very resistant to this idea. The
best initial strategy in this situation would include:
a. Exploring the values and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is
implemented.
c. Dropping the idea and trying for the change in a year or so when some of the present RNs
have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling
relationships, deepening self-awareness in self and others, motivating others, and managing
emotions. Motivating others recognizes that values are powerful forces that influence
acceptance of change. Leaving the RNs alone for a period of time before implementation does
not provide opportunity to explore different perspectives and values. Avoiding discussion
until the team changes may not promote adoption of the change until there is opportunity to
explore perspectives and values related to the change. Hiring of the assistants demonstrates
lack of empathy for the perspectives of the RN staff.
REF: Page 7 | Page 15
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that
there is little turnover among your LPN and nursing assistant (NA) staff members, but they are
not very motivated to go beyond their job descriptions in their work. Which of the following
strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night
LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their
positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual
workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign
contracts that guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with
Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction.
Motivator factors such as recognition and satisfaction with work promote a satisfying and
enriched work environment. Transformational leaders use motivator factors liberally to inspire
work performance and increase job satisfaction.
REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating factors, which
action would you select?
a. Collaborate with the human resource/personnel department to develop on-site daycare
services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore all levels of staff would be involved in decision making. This
principle is the foundation of shared governance.
REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who
begins to complain loudly about the quality of care his mother is receiving. His behavior is so
disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects
any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the
nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined
leadership skills in an emotionally intelligent practitioner?
a. Reflect to gain insight into how the situation could be handled differently in the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
Goleman suggests that emotional intelligence involves insight and being able to step outside
of the situation to envision the context of what is happening as well as being able to manage
emotions such as frustration effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
9. 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. Which 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.
ANS: D
The manager role involves guiding others through a set of derived practices that are evidence-
based and known to satisfy preestablished outcomes such as participation in a competency
program. This involves engagement of staff through sharing of concerns and ideas. A close
analysis of the IOM report and the summary of the PPACA suggests that no health reform can
unfold without active nursing engagement. Each document emphasizes that nurses must lead,
, Test Bank - Leading and Managing in Nursing 6th Edition
manage, and behave as active collaborators with other members of the health team and with
those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
10. As the manager, you have been asked to implement an evidence-based approach to teach
ostomy patients self-management skills postoperatively that is being operationalized throughout
your organization. Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar
to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs
that the new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in
mentoring and teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting where a
team has gathered to ensure the best clinical decision making and actions are taken to achieve
clinical or organizational outcomes. Followership promotes good clinical decisions and use of
clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
11. You overhear a newly graduated RN telling one of your colleagues that leadership and
management belong to the unit manager and not to her. As a nursing colleague, you respond by
demonstrating understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence
may affect the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied in
their jobs.
ANS: B
Care coordination that involves the intersection of individual, family, and community-based
needs requires that nurses have self-confidence, knowledge of organizations and health
systems, and an inner desire to lead and manage. There is often a view that leadership is
isolated to those holding managerial positions and that a direct care nurse is subject to
following by adhering to the direction of others. Such views fail to acknowledge that to be a
nurse requires each licensed individual to lead, manage, and follow when practicing at the
point-of-care and beyond.
, Test Bank - Leading and Managing in Nursing 6th Edition
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously
very upset and after you speak with him regarding his behavior, you determine that he has not
slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith
and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest
that Mr. Smith’s behavior was aggressive but is related to lack of sleep and to pain. You say to
Miss Jones, “Can you both, together with Mr. Smith, determine triggers for the pain and
effective approaches to controlling his pain?” This approach demonstrates:
a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr. Smith.
c. Leadership behavior.
d. Management behavior.
ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved
patient symptoms and aggressiveness toward a staff member. Providing engaged,
collaborative guidance and decision making in a complex situation where there is no
standardized solution reflects leadership.
REF: Page 4 TOP: AONE competency: Leadership
13. After assessing an older adult patient in long-term care who has been slowly deteriorating for
weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The
nurse manager’s decision and actions are based on:
a. An established clinical pathway.
b. Confirmatory scientific evidence.
c. Unit protocol.
d. Experience.
ANS: D
The nurse manager is employing knowledge and experience in determining that the patient is
dying, because the course of dying is not standardized and cannot be determined by clinical
pathways.
REF: Page 4 TOP: AONE competency: Knowledge of the Health Care Environment
14. Chart audits have revealed significant omissions of data that could have legal and funding
guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings
and to find approaches that will address the gaps in charting and achieve desired goals. This is
an example of:
a. Leadership.
b. Management.
c. Decision making.
d. Vision.
, Test Bank - Leading and Managing in Nursing 6th Edition
ANS: B
The process of guiding others to meet established goals, outcomes, and procedures is
management. This can require collaborative decision making to determine how best to reach
pre-determined goals and follow established practices.
REF: Page 5 TOP: AONE competency: Knowledge of the Health Care Environment
15. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. What role are you
assuming through this action? a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
As a manager, you are concerned with managing and coordinating resources to achieve
outcomes in accordance with established clinical processes. Referral to a social worker
alleviates demand on staff time and is consistent with hospital procedures.
REF: Page 5 TOP: AONE competency: Communication and Relationship-Building
16. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not
yet able to come, call the unit continuously, asking for updates and wanting to express concern.
You speak with the distant family members and suggest that you are going to refer them to the
hospital social worker, whose role is to work with people in such situations. In response to this
situation, you approach the unit manager to apprise her of your concerns that the family
dynamics of the patient involved may lead to staff-family and patient-family conflicts. You
suggest that the physician may need to discuss the treatment plan with the family. The unit
manager advises that he will arrange this discussion. If, after the meeting with family members,
this is identified as a desired approach, you support the manager’s decision. Your actions
indicate that you are acting in what role? A
. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
, Test Bank - Leading and Managing in Nursing 6th Edition
In the followership role, you bring to the manager your concerns about potential litigation and
maximization of outcomes and accept the direction given by the manager in response to your
concerns.
REF: Page 3 | Page 4
TOP: AONE competency: Knowledge of the Health Care Environment
17. You pull staff together to assess a situation in which the family of a seriously ill patient is
anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning
of treatment decisions. Staff members are becoming distanced from the family. After inviting
the concerns of staff, you explain that the organization values patient-centered care and that
evidence supports that acting as an advocate and a listener is helpful to families. You ask the
staff for ideas as to strategies that are effectively patient-centered in these situations. In this
situation, you are taking on which role?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
As a leader, you provide and communicate vision and direction based on evidence and
experience, and you engage others in decision making that moves them toward the vision with
a reasonable level of risk taking.
REF: Page 4 | Page 5 TOP: AONE competency: Leadership
18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas
has many ideas, and his manner of presenting them irks Joan. After reflection and discussion
with others, Joan recognizes that she also feels threatened by his behavior. She comes to
understand that Thomas is trying to establish his own role on the unit, is not trying to challenge
her, and needs guidance, coaching, and affirmation. Joan is demonstrating:
a. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
According to Goleman (1995), stepping outside oneself to envision the situation while
assuming ownership is a component of emotional intelligence.
REF: Page 7 | Page 8 TOP: AONE competency: Professionalism
