NURSE 446: Nursing Leadership & Healthcare Systems
Course Examination
Total Points: 200
Time Allowed: 3 Hours
Format: 100 Questions (75 Multiple Choice & 25 Select-All-That-Apply)
Exam Instructions:
Read each question carefully. Select the best possible answer for multiple-choice questions.
For Select-All-That-Apply (SATA) questions, select all options that are correct. Partial credit may
be awarded.
Choose only one answer for standard multiple-choice questions unless specified otherwise.
Use a No. 2 pencil to fill in the corresponding circle on your Scantron answer sheet.
Do not write on the exam booklet.
You may use the blank pages at the end of the booklet for scratch paper.
SECTION I: MULTIPLE CHOICE (75 Questions, 2 points each)
*Directions: For questions 1-75, select the single best answer and mark the corresponding letter on your
answer sheet.*
1. A nurse manager is implementing a shared governance model on a medical-surgical unit. Which
outcome best indicates that this model is successful?
a. Increased nurse satisfaction and retention
b. Decreased patient length of stay
c. Increased number of staff meetings
d. Decreased use of overtime
2. A charge nurse notices that two staff members are consistently late in completing their assigned
tasks. Which leadership style would be most effective in addressing this issue directly?
a. Laissez-faire
b. Democratic
c. Autocratic
d. Transformational
3. A nurse leader is applying Lewin’s change theory to implement a new electronic health record
system. After “unfreezing” the current state, what is the next phase?
a. Refreezing
b. Moving
c. Evaluating
d. Planning
4. A staff nurse identifies a potential safety hazard on the unit and reports it to the nurse manager.
The manager thanks the nurse but takes no action for two weeks. This behavior demonstrates
, which type of leadership?
a. Transactional
b. Passive-avoidant
c. Transformational
d. Authentic
5. A nurse executive is preparing the annual budget for the intensive care unit. Which type of
budget includes costs for staffing, supplies, and routine operations?
a. Capital budget
b. Operating budget
c. Personnel budget
d. Revenue budget
6. A nursing unit has a high turnover rate. Using Herzberg’s motivation-hygiene theory, which
intervention would address a hygiene factor to improve retention?
a. Offering tuition reimbursement for advanced degrees
b. Recognizing nurses publicly for excellent patient care
c. Increasing the base salary and improving parking facilities
d. Creating a shared governance council for practice decisions
7. A nurse manager is conducting a performance appraisal for a staff nurse who has been
frequently absent. Which type of interview is most appropriate?
a. Informal verbal warning
b. Problem-solving interview
c. Annual review interview
d. Exit interview
8. A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing assistant. Which task
is appropriate to delegate to the nursing assistant?
a. Administering an enema
b. Inserting a Foley catheter
c. Ambulating a patient with a walker
d. Assessing a patient’s post-operative incision
9. A charge nurse on a busy telemetry unit must assign patient care for the shift. Which patient
should be assigned to the most experienced registered nurse (RN)?
a. A patient with pneumonia requiring IV antibiotics
b. A patient with heart failure and frequent PVCs on a monitor
c. A patient scheduled for discharge teaching
d. A patient with diabetes requiring insulin administration
10. A nurse manager observes that a staff nurse consistently fails to wash hands between patients.
The manager addresses the issue privately, provides education, and sets a clear expectation for
change. This is an example of:
a. Progressive discipline
b. Constructive feedback
c. Termination counseling
d. Peer review
11. A hospital is implementing a new nurse residency program. Which outcome would be the most
important measure of program effectiveness?
, a. Decreased number of medication errors among new graduates
b. Increased patient satisfaction scores
c. Improved first-time NCLEX pass rates
d. Reduced number of nursing vacancies
12. A nurse leader is using situational leadership. When a staff nurse has low competence but high
commitment (enthusiastic beginner), which leadership style is most appropriate?
a. Delegating (low directive, low supportive)
b. Supporting (low directive, high supportive)
c. Coaching (high directive, high supportive)
d. Directing (high directive, low supportive)
13. A unit’s medication error rate has increased. The nurse manager forms a team to analyze the
root cause. Which step occurs first in root cause analysis?
a. Implement corrective actions
b. Identify contributing factors
c. Define the problem clearly
d. Collect data on near misses
14. A staff nurse expresses moral distress after caring for a patient receiving aggressive treatment
that the nurse believes is futile. Which action by the nurse manager is most supportive?
a. Tell the nurse to follow the physician’s orders regardless
b. Schedule the nurse to a different patient assignment
c. Facilitate a meeting with the ethics committee and the nurse
d. Document the nurse’s objection in the personnel file
15. A nurse manager is calculating the full-time equivalent (FTE) needed for a unit that requires 24-
hour coverage, 7 days per week, with two nurses per shift. Assuming 40-hour work weeks and 2
weeks of paid time off per year, how many FTEs are needed?
a. 4.2 FTEs
b. 6.0 FTEs
c. 8.4 FTEs
d. 10.5 FTEs
16. Which leadership behavior is characteristic of a transformational leader?
a. Rewarding employees for meeting specific targets
b. Monitoring deviations from rules and correcting them
c. Inspiring followers to transcend self-interest for the team
d. Avoiding decision-making unless absolutely necessary
17. A nurse manager is using a democratic leadership style to make a decision about changing shift
schedules. Which action best reflects this style?
a. The manager decides the new schedule alone and posts it
b. The manager asks staff to vote on three proposed schedules
c. The manager allows each nurse to choose their own schedule without limits
d. The manager delegates the scheduling decision to a single staff nurse
18. A hospital is applying for Magnet recognition. Which component is required for Magnet status?
a. Mandatory BSN for all staff nurses
b. Shared governance and professional development
Course Examination
Total Points: 200
Time Allowed: 3 Hours
Format: 100 Questions (75 Multiple Choice & 25 Select-All-That-Apply)
Exam Instructions:
Read each question carefully. Select the best possible answer for multiple-choice questions.
For Select-All-That-Apply (SATA) questions, select all options that are correct. Partial credit may
be awarded.
Choose only one answer for standard multiple-choice questions unless specified otherwise.
Use a No. 2 pencil to fill in the corresponding circle on your Scantron answer sheet.
Do not write on the exam booklet.
You may use the blank pages at the end of the booklet for scratch paper.
SECTION I: MULTIPLE CHOICE (75 Questions, 2 points each)
*Directions: For questions 1-75, select the single best answer and mark the corresponding letter on your
answer sheet.*
1. A nurse manager is implementing a shared governance model on a medical-surgical unit. Which
outcome best indicates that this model is successful?
a. Increased nurse satisfaction and retention
b. Decreased patient length of stay
c. Increased number of staff meetings
d. Decreased use of overtime
2. A charge nurse notices that two staff members are consistently late in completing their assigned
tasks. Which leadership style would be most effective in addressing this issue directly?
a. Laissez-faire
b. Democratic
c. Autocratic
d. Transformational
3. A nurse leader is applying Lewin’s change theory to implement a new electronic health record
system. After “unfreezing” the current state, what is the next phase?
a. Refreezing
b. Moving
c. Evaluating
d. Planning
4. A staff nurse identifies a potential safety hazard on the unit and reports it to the nurse manager.
The manager thanks the nurse but takes no action for two weeks. This behavior demonstrates
, which type of leadership?
a. Transactional
b. Passive-avoidant
c. Transformational
d. Authentic
5. A nurse executive is preparing the annual budget for the intensive care unit. Which type of
budget includes costs for staffing, supplies, and routine operations?
a. Capital budget
b. Operating budget
c. Personnel budget
d. Revenue budget
6. A nursing unit has a high turnover rate. Using Herzberg’s motivation-hygiene theory, which
intervention would address a hygiene factor to improve retention?
a. Offering tuition reimbursement for advanced degrees
b. Recognizing nurses publicly for excellent patient care
c. Increasing the base salary and improving parking facilities
d. Creating a shared governance council for practice decisions
7. A nurse manager is conducting a performance appraisal for a staff nurse who has been
frequently absent. Which type of interview is most appropriate?
a. Informal verbal warning
b. Problem-solving interview
c. Annual review interview
d. Exit interview
8. A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing assistant. Which task
is appropriate to delegate to the nursing assistant?
a. Administering an enema
b. Inserting a Foley catheter
c. Ambulating a patient with a walker
d. Assessing a patient’s post-operative incision
9. A charge nurse on a busy telemetry unit must assign patient care for the shift. Which patient
should be assigned to the most experienced registered nurse (RN)?
a. A patient with pneumonia requiring IV antibiotics
b. A patient with heart failure and frequent PVCs on a monitor
c. A patient scheduled for discharge teaching
d. A patient with diabetes requiring insulin administration
10. A nurse manager observes that a staff nurse consistently fails to wash hands between patients.
The manager addresses the issue privately, provides education, and sets a clear expectation for
change. This is an example of:
a. Progressive discipline
b. Constructive feedback
c. Termination counseling
d. Peer review
11. A hospital is implementing a new nurse residency program. Which outcome would be the most
important measure of program effectiveness?
, a. Decreased number of medication errors among new graduates
b. Increased patient satisfaction scores
c. Improved first-time NCLEX pass rates
d. Reduced number of nursing vacancies
12. A nurse leader is using situational leadership. When a staff nurse has low competence but high
commitment (enthusiastic beginner), which leadership style is most appropriate?
a. Delegating (low directive, low supportive)
b. Supporting (low directive, high supportive)
c. Coaching (high directive, high supportive)
d. Directing (high directive, low supportive)
13. A unit’s medication error rate has increased. The nurse manager forms a team to analyze the
root cause. Which step occurs first in root cause analysis?
a. Implement corrective actions
b. Identify contributing factors
c. Define the problem clearly
d. Collect data on near misses
14. A staff nurse expresses moral distress after caring for a patient receiving aggressive treatment
that the nurse believes is futile. Which action by the nurse manager is most supportive?
a. Tell the nurse to follow the physician’s orders regardless
b. Schedule the nurse to a different patient assignment
c. Facilitate a meeting with the ethics committee and the nurse
d. Document the nurse’s objection in the personnel file
15. A nurse manager is calculating the full-time equivalent (FTE) needed for a unit that requires 24-
hour coverage, 7 days per week, with two nurses per shift. Assuming 40-hour work weeks and 2
weeks of paid time off per year, how many FTEs are needed?
a. 4.2 FTEs
b. 6.0 FTEs
c. 8.4 FTEs
d. 10.5 FTEs
16. Which leadership behavior is characteristic of a transformational leader?
a. Rewarding employees for meeting specific targets
b. Monitoring deviations from rules and correcting them
c. Inspiring followers to transcend self-interest for the team
d. Avoiding decision-making unless absolutely necessary
17. A nurse manager is using a democratic leadership style to make a decision about changing shift
schedules. Which action best reflects this style?
a. The manager decides the new schedule alone and posts it
b. The manager asks staff to vote on three proposed schedules
c. The manager allows each nurse to choose their own schedule without limits
d. The manager delegates the scheduling decision to a single staff nurse
18. A hospital is applying for Magnet recognition. Which component is required for Magnet status?
a. Mandatory BSN for all staff nurses
b. Shared governance and professional development
