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Test Bank For Nursing Leadership and Management, 3rd Edition

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    Chapter 1: Nursing Leadership and Management Chapter 1: Nursing Leadership and Management MULTIPLE CHOICE 1. According to Henri Fayol, the functions of planning, organizing, coordinating, and controlling are considered which aspect of management? a. Roles c. Functions b. Process d. Taxonomy ANS: B The management process includes planning, organizing, coordinating, and controlling. Management roles include information processing, interpersonal relationships, and decision making. Management functions include planning, organizing, staffing, directing, coordinating, reporting, and budgeting. A taxonomy is a system that orders principles into a grouping or classification. PTS: 1 DIF: Comprehension REF: THE MANAGEMENT PROCESS 2. Which of the following is considered a decisional managerial role? a. Disseminator c. Leader b. Figurehead d. Entrepreneur ANS: D The decisional managerial roles include entrepreneur, disturbance handler, allocator of resources, and negotiator. The information processing managerial roles include monitor, disseminator, and spokesperson. The interpersonal managerial roles include figurehead, leader, and liaison. PTS: 1 DIF: Comprehension REF: MANAGERIAL ROLES 3. A nurse manager meets regularly with other nurse managers, participates on the organization’s committees, and attends meetings sponsored by professional organizations in order to manage relationships. These activities are considered which function of a manager? a. Informing c. Monitoring b. Problem solving d. Networking ANS: D The role functions to manage relationships are networking, supporting, developing and mentoring, managing conflict and team building, motivating and inspiring, recognizing, and

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    rewarding. The role functions to manage the work are planning and organizing, problem solving, clarifying roles and objectives, informing, monitoring, consulting, and delegating. PTS: 1 DIF: Application REF: THE MANAGEMENT PROCESS 4. A nurse was recently promoted to a middle-level manager position. The nurse’s title would most likely be which of the following? a. First - line manager c. Vice president of patient care services b. Director d. Chief nurse executive ANS: B A middle-level manager is called a director. A low managerial-level job is called the first-line manager. A nurse in an executive level role is called a chief nurse executive or vice president of patient care services. PTS: 1 DIF: Application REF: THE MANAGEMENT PROCESS 5. A nurse manager who uses Frederick Taylor’s scientific management approach, would most likely focus on which of the following? a. General principles c. Labor productivity b. Positional authority d. Impersonal relations ANS: C The area of focus for scientific management is labor productivity. In bureaucratic theory, efficiency is achieved through impersonal relations within a formal structure and is based on positional authority. Administrative principle theory consists of principles of management that are relevant to any organization. PTS: 1 DIF: Comprehension REF: SCIENTIFIC MANAGEMENT 6. According to Vroom’s Theory of Motivation, force: a. is the perceived possibility that the goal will be achieved. b. describes the amount of effort one will exert to reach one’s goal. c. describes people who have free will but choose to comply with orders they are given. d. is a naturally forming social group that can become a contributor to an organization. ANS: B According to Vroom’s Theory of Motivation, Force describes the amount of effort one will exert to reach one’s goal. Valence speaks to the level of attractiveness or unattractiveness of the goal. Expectancy is the perceived possibility that the goal will be achieved. Vroom’s Theory of Motivation can be demonstrated in the form of an equation: Force =

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    Valence ´ Expectancy (Vroom, 1964). The theory proposes that this equation can help to predict the motivation, or force, of an individual as described by Vroom. PTS: 1 DIF: Comprehension REF: TABLE 1-2 MANAGEMENT THEORIES 7. According to R. N. Lussier, motivation: a. is unconsciously demonstrated by people. b. occurs externally to influence behavior. c. is determined by others’ choices. d. occurs internally to influence behavior. ANS: D Motivation is a process that occurs internally to influence and direct our behavior in order to satisfy needs. Motivation is not explicitly demonstrated by people, but rather it is interpreted from their behavior. Motivation is whatever influences our choices and creates direction, intensity, and persistence in our behavior. PTS: 1 DIF: Comprehension REF: MOTIVATION THEORIES 8. According to R. N. Lussier, there are content motivation theories and process motivation theories. Which of the following is considered a process motivation theory? a. Equity theory b. Hierarchy of needs theory c. Existence - relatedness - growth theory d. Hygiene maintenance and motivation factors ANS: A The process motivation theories are equity theory and expectancy theory. The content motivation theories include Maslow’s hierarchy of needs theory, Aldefer’s existence-relatedness-growth (ERG) theory, and Herzberg’s hygiene maintenance factors and motivation factors. PTS: 1 DIF: Comprehension REF: MOTIVATION THEORIES 9. The theory that includes maintenance and motivation factors is: a. Maslow’s hierarchy of needs. c. McGregor’s theory X and theory Y. b. Herzberg’s two - factor theory. d. Ouchi’s theory Z. ANS: B The two-factor theory of motivation includes motivation and maintenance factors. Maslow’s hierarchy of needs includes the following needs: physiological, safety, security, belonging, and self-actualization. In theory X, employees prefer security, direction, and minimal responsibility.

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    In theory Y, employees enjoy their work, show self-control and discipline, are able to contribute creatively, and are motivated by ties to the group, organization, and the work itself. The focus of theory Z is collective decision making and long-term employment that involves slower promotions and less direct supervision. PTS: 1 DIF: Comprehension REF: TWO-FACTOR THEORY 10. A nurse is appointed to a leadership position in the local hospital. The nurse’s position would be considered which of the following? a. Informal leadership c. Leadership b. Formal leadership d. Management ANS: B Formal leadership is based on occupying a position in an organization. Informal leadership is shown by an individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group. Leadership is a process of influence whereby the leader influences others toward goal achievement. Management is a process to achieve organizational goals. PTS: 1 DIF: Application REF: DEFINITION OF LEADERSHIP 11. A nursing instructor is evaluating whether the nursing students understand the three fundamental qualities that leaders share. According to Bennis and Nanus, the fundamental qualities of effective leaders are: a. guided vision, passion, and integrity. b. knowledge of self, honesty, and maturity. c. intelligence, self - confidence, and determination. d. honesty, self - awaren ess, and sociability. ANS: A Bennis and Nanus list guided vision, passion, and integrity as fundamental qualities of effective leaders. Knowledge of self, honesty and maturity; intelligence, self-confidence and determination; self-awareness and sociability are all desirable traits in leaders as well as in others. PTS: 1 DIF: Application REF: LEADERSHIP CHARACTERISTICS 12. The six traits identified by Kirkpatrick and Locke that separate leaders from non-leaders were: a. respectability, trustworthi ness, flexibility, self - confidence, intelligence, sociability. b. self - confidence, progression of experiences, influence of others, personal life factors, honesty, drive.

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    c. intelligence, self - confidence, determination, integrity, sociability, honesty. d. drive, desire to lead, honesty, self - confidence, cognitive ability, knowledge of business. ANS: D Research by Kirkpatrick and Locke concluded that leaders possess six traits: drive, desire to lead, honesty, self-confidence, cognitive ability, and knowledge of the business. Woods identified five dominant factors that influenced leadership development: self-confidence, innate qualities, progression of experience, influence of significant others, and personal life factors. Stogdill identified the following traits of a leader: intelligence, self-confidence, determination, integrity, and sociability. Murphy and DeBack identified the following leader characteristics: caring, respectability, trustworthiness, and flexibility. PTS: 1 DIF: Comprehension REF: LEADERSHIP CHARACTERISTICS 13. A nurse manager who uses a leadership style that is participatory and where authority is delegated to others is most likely using which of the following leadership styles? a. Autocratic c. Laissez - faire b. Democratic d. Employee - centered ANS: B Democratic leadership is participatory, and authority is delegated to others. Autocratic leadership involves centralized decision making, with the leader making decisions and using power to command and control others. Laissez-faire leadership is passive and permissive, and the leader defers decision making. Employee-centered leadership focuses on the human needs of subordinates. PTS: 1 DIF: Application REF: BEHAVIORAL APPROACH 14. A characteristic of the consideration dimension of leadership behavior is: a. focus on the work to be done. c. focus on production. b. focus on the task. d. focus on the employee. ANS: D The leadership dimension of consideration involves activities that focus on the employee. Initiating structures of leadership involves an emphasis on the work to be done, and a focus on the task and production. PTS: 1 DIF: Comprehension REF: BEHAVIORAL APPROACH

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    15. The leadership theory that considers follower readiness as a factor in determining leadership style is: a. contingency. c. situational. b. path goal. d. charismatic. ANS: C Situational leadership considers the follower readiness as a factor in determining leadership style. Contingency theory views the pattern of leader behavior as dependent on the interaction of the personality of the leader and the needs of the situation. In path goal theory, the leader works to motivate followers and influence goal accomplishment. Charismatic leadership has an inspirational quality that promotes an emotional connection from followers. PTS: 1 DIF: Comprehension REF: HERSEY AND BLANCHARD’S SITUATIONAL THEORY 16. In contingency theory, the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader are called: a. task structure. c. l ow task structure. b. position power. d. leader - member relations. ANS: D In contingency theory, leader-member relations are the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader. Task structure of contingency theory means the degree that work is defined, with specific procedures, explicit directions, and goals. Low task structure involves work that is not routine, predictable, or clearly defined. Position power in contingency theory is the degree of formal authority and influence associated with the leader. PTS: 1 DIF: Comprehension REF: FIEDLER’S CONTINGENCY THEORY 17. In situational theory, a telling leadership style is considered: a. high task, high relationship behavior. c. low task, high relationship behavior. b. high task, low relationship behavior. d. low task, low relationship behavior. ANS: B A telling leadership style is high task behavior and low relationship behavior. A high task, high relationship style is called a selling leadership style. A low task and high relationship style is called a participating leadership style. A low task and low relationship style is called a delegating leadership style.

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    PTS: 1 DIF: Comprehension REF: HERSEY AND BLANCHARD’S SITUATIONAL THEORY 18. A nursing group has been very successful in achieving its goals even though the group has lacked leadership. Which of the following factors is probably most responsible for the group’s success in goal achievement? a. Life experience c. Informal organizational structures b. Extrinsic satisfaction d. Cohesive groups ANS: D Substitutes for leadership are variables that eliminate the need for leadership or nullify the effect of the leader’s behavior. These include cohesive groups, work experience, intrinsic satisfaction, formal organizational structures, professionalism, indifference to rewards, routine tasks, feedback provided by the task, rigid adherence to rules, role distance, and low position power of the leader. PTS: 1 DIF: Analysis REF: SUBSTITUTES FOR LEADERSHIP 19. The new nurse manager of a medical unit focuses on day-to-day operations and short-term goals, while the nurse manager of the mental health unit is committed to the vision that empowers the staff. The manager of the medical unit would most likely be considered which type of leader? a. Transformational leader c. Transactional leader b. Charismatic leader d. Autocratic leader ANS: C A transactional leader focuses on operations and short-term goals. A transformational leader inspires and motivates others to excel and participate in a vision that goes beyond self-interests. A charismatic leader displays self-confidence and strength in convictions and communicates high expectations. An autocratic leader makes decisions and uses power to command and control others. PTS: 1 DIF: Analysis REF: TRANSFORMATIONAL LEADERSHIP THEORY 20. The nursing staff perceive the newly hired Chief Nurse Administrator as a leader who is committed to a vision that empowers others. The Chief Nurse Administrator is most likely employing which type of leader? a. Transformational leader c. Transactional leader b. Charismatic leader d. Autocratic leader

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    ANS: A A transformational leader empowers others. A charismatic leader has an appeal based on personal power. A transactional leader focuses on day-to-day operations. An autocratic leader has central power and does not empower others. PTS: 1 DIF: Application REF: TRANSFORMATIONAL LEADERSHIP THEORY 21. The nurse manager on one of the hospital units views the staff as basically lazy and only motivated by threats and coercion. Which theory of motivation would support the manager’s beliefs? a. Theory W c. Theory Y b. Theory X d. Theory Z ANS: B The Theory X view is that in bureaucratic organizations, employees prefer security, direction, and minimal responsibility. Coercion, threats, or punishment are necessary because people do not like their work to be done. PTS: 1 DIF: Application REF: THEORY X AND THEORY Y 22. A group of new nurse managers is undergoing a series of management training sessions. Which statement by one of the nurse managers would indicate use of McClelland’s Model of Motivation? “McClelland’s Model focuses on: a. achievement, power, and affiliation.” b. growth needs, relatedness needs, and existence needs.” c. collective decision making, quality circles, and mentoring.” d. self - actualization needs, safety and security needs, and self - esteem needs.” ANS: A McClelland’s Model of Motivation focuses on achievement, power, and affiliation. Growth needs, relatedness needs, and existence needs are aspects of Adler’s model. Collective decision making, quality circles, and mentoring are the focus of Ouchi’s model. Self-actualization needs, safety and security needs, and self-esteem needs are reflected in Maslow’s model. PTS: 1 DIF: Application REF: TABLE 1-1 NURSING LEADERSHIP CHARACTERISTICS AND ROLE ACTIVITIES 23. A nurse manager finds two employees arguing about the assigned schedule. Which role would be appropriate for the nurse manager to implement at this time? a. Advocate role c. Decision - making role

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    b. Interpersonal role d. Information - processing role ANS: C The decision-making role of a nurse manager would include being an entrepreneur, handling disturbances, and allocating resources. The information-processing role involves managing the information that the people need. The interpersonal role focuses on functioning as a figurehead, leader, or liaison. In the advocate role, the nurse manager would focus on supporting employee rights. PTS: 1 DIF: Application REF: MANAGERIAL ROLES 24. A nurse manager who implements the bureaucratic management style will most likely do which of the following? a. Emphasize efficiency b. Use explicit rules and regulations for governing activities c. View the individual worker as the source of control, motivation, and productivity d. Expect unity of command and direction ANS: B Bureaucratic management focuses on the use of explicit rules and regulations for governing activities. The human relations approach views the individual worker as the source of control, motivation, and productivity. Administrative principles focus on unity of command and direction. PTS: 1 DIF: Application REF: BUREAUCRATIC MANAGEMENT 25. The nursing supervisor has traditionally made rounds at the same time each day. When the supervisor visits each unit, the staff appear to be extremely busy even when the census is very low. Today the supervisor visited a unit two hours early and found several staff members watching television and drinking coffee in the visi tor’s lounge. The supervisor recognizes that the staff’s previous behavior have been a result of which of the following? a. Coincidence c. Diligence of staff b. Hawthorn effect d. Time management ANS: B Because the nursing supervisor traditionally made rounds at the same time each day, the staff members were prepared for the visit. When the supervisor arrived unexpectedly, the staff members were most likely caught off-guard. The Hawthorn effect occurs when recognition that one is being studied or observed results in a change in behavior. Coincidence, diligence of staff, and time management would not account for the dramatic change in behavior.

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    PTS: 1 DIF: Analysis REF: HUMAN RELATIONS MULTIPLE RESPONSE 1. A nurse manager who structures her approach on the McClelland Model of Motivation would most likely focus on which of the following? Select all that apply. a. Power d. Achievement b. Affiliation e. Mentoring c. Quality circles f. Collective decision making ANS: A, B, D McClelland’s Model of Motivation focuses on power, achievement, and affiliation. Ouchi’s model focuses on quality circles, collective decision making, long-term employment, and mentoring. PTS: 1 DIF: Application REF: FIGURE 1-1 KEY LEADERSHIP DIMENSIONS 2. A nurse manager who follows Herz berg’s Two-Factor Theory would recognize that which of the following are hygiene-maintenance factors? Select all that apply. a. Job security d. Relationships with others b. Advancement opportunities e. Status c. Working conditions f. Achievement ANS: A, C, D, E Herzberg’s hygiene-maintenance factors include status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others. Advancement opportunities, achievement, recognition, the work itself, personal growth, and responsibility are all motivation factors. PTS: 1 DIF: Application REF: TABLE 1-2 MANAGEMENT THEORIES 3. A nursing instructor determines that the nursing students understand the concept of “knowledge worker” if the students describe which of the following tasks of the knowledge worker? Select all that apply. a. Provide service b. Represent the organization c. Interact with the customer d. Focus on personal, life - long goals and achievement e. Bring expert knowledge f. Accomplish goals ANS: A, B, C, E, F

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    According to Peter Drucker, knowledge workers provide service, interact with the customer, represent the organization, and accomplish its goals. These workers bring specialized, expert knowledge to the organization, and they are valued for what they know. The knowledge worker focuses more on organizational goals than personal goals. PTS: 1 DIF: Analysis REF: H1: KNOWLEDGE WORKERS Chapter 2: The Health Care Environment Chapter 2: The Health Care Environment MULTIPLE CHOICE 1. Which of the following individuals observed that noise, food, rest, light, fresh air, and cleanliness were instrumental in health and illness patterns? a. W. Edwards Deming c. Isabel Hampton Robb b. Florence Nightingale d. Dorothea Dix ANS: B Florence Nightingale was the first to observe that noise, food, rest, light, fresh air, and cleanliness were instrumental in health and illness patterns. W. Edwards Deming is known for his contribution to continuous performance improvement, and Isabel Hampton Robb was the first president of the ANA and a pioneer in nursing education. Dorothea Dix is best known for her patient advocacy, particularly in the areas of improved conditions for jails and mental asylums. PTS: 1 DIF: Knowledge REF: HISTORY OF HEALTH CARE 2. A nursing instructor asks a student what discoveries are attributable to Florence Nightingale. The instructor determines that further teaching is needed if the student responds: a. the need to monitor health care practitioners. b. the importance of structuring hospitals around care. c. the importance of collecting and using data for quality assessment. d. the importance of being informed regarding the activities of government policymakers. ANS: B Nightingale is credited with a variety of discoveries related to health care such as the importance of structuring hospitals around nursing care (not merely care), the need to monitor/be informed regarding health care practitioners and government policymakers, and the importance of collecting and using data for quality assessment. PTS: 1 DIF: Application REF: STRUCTURING HOSPITALS AROUND NURSING CARE

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    3. A new graduate wants to explore the three components of each heath care system before applying for a position. The graduate would plan to explore which of the following? a. Strategy, outcome, and performance c. Structure, process, and outcome b. Process, strategy, and opportunity d. Outcome, procedure, and structure ANS: C The three simple elements of health care systems are structure (resources or “structures” required to deliver health care), process (quality activities, procedures, and tasks performed to deliver quality health care), and outcome (the results of good health care delivery). PTS: 1 DIF: Application REF: ORGANIZATION OF HEALTH CARE 4. Which of the following organizations has set forth three primary goals for good health care? a. The Institute of Medicine b. The Centers for Disease Control and Prevention c. The Agency for Healthcare Research and Quality d. The World Health Organization ANS: D The World Health Organization (WHO) has been a leading advocate of quality health care delivery, as evidenced by its three primary goals for what good health care should do. The Institute of Medicine (IOM) is best known for its quality data reports such as To Err Is Human (IOM, 1999), and the Centers for Disease Control and Prevention is a leading infection and disease agency in the United States. The Agency for Healthcare Research and Quality is another quality-based organization and produces reports such as the National Healthcare Disparities Report (NHDR). PTS: 1 DIF: Comprehension REF: ORGANIZATION OF HEALTH CARE 5. A nurse working on the unit budget would recognize that the resources needed to deliver quality health care such as nurses, practitioners, medical records, buildings, and pharmaceuticals are considered which aspects of health care? a. Process c. Organization b. Structure d. Practice ANS: B The health care structure is comprised of the resources or structures needed to produce quality health care. Some of these structures or resources are human (staff and personnel) or physical (buildings or facilities).

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    PTS: 1 DIF: Application REF: ORGANIZATION OF HEALTH CARE 6. The human resource manager understands that an example of a quality performance outcome measure involves which of the following? a. Patient satisfaction c. Staff satisfaction b. Return on assets (ROI) d. Organizational climate ANS: C An outcome for a quality performance measure related to human resources is staff satisfaction. Patient satisfaction is a clinical care outcome, and return on assets (ROI) is a financial management outcome. The organizational climate is a human resource process, as opposed to the outcome. PTS: 1 DIF: Application REF: TABLE 2-1 EXAMPLES OF PERFORMANCE MEASURES BY CATEGORY 7. A nurse is on vacation visiting a number of countries. If the nurse becomes ill, in which country will the nurse most likely be hospitalized in a government hospital, with the government paying the bills. a. Canada c. Taiwan b. New Zealand d. Germany ANS: B If the nurse became ill in New Zealand health care would be provided in a government hospital with the government paying the bills. Canada and Taiwan rely on private-sector providers, paid for by government-run insurance. Germany, the Netherlands, Japan, and Switzerland provide universal coverage using private doctors, private hospitals, and private insurance plans. PTS: 1 DIF: Analysis REF: HEALTH CARE PAYMENT IN OTHER COUNTRIES 8. An instructor wants to determine if a group of nursing students know the important features related to the benefits of primary care. Which of the following responses by the students would indicate that further teaching is necessary? a. Care that is continuous b. Care that began at first contact with the patient c. Care that is integral d. Care that is community orientated ANS: C

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    The seven important features of primary care are care that is continuous, community oriented, comprehensive (not integral), coordinated, family centered, culturally competent, and begun at the first contact with the patient. PTS: 1 DIF: Application REF: NEED FOR PRIMARY HEALTH CARE 9. A group of nursing students are given a test on Starfield’s (1998) foundations of primary care. Which of the following responses by the students describing the foundations of primary care would indicate that further teaching is necessary? a. Comprehensiveness c. First contact b. Organization d. Coordination ANS: B According to Starfield (1998), both clinicians and patients need to work together to appropriately utilize services based upon these four foundations of primary care: first contact (conduct the initial evaluation and the plan for the dysfunction, treatment options, and health goals), longitudinality (maintaining the clinician-patient relationship continuously over time), comprehensiveness (managing the wide range of needs for each patient), and coordinatio n (care is organized and integrated, thus eliminating duplication of services). PTS: 1 DIF: Application REF: NEED FOR PRIMARY HEALTH CARE 10. Which agency/division is not a part of the U.S. Department of Health and Human Services? a. Food and Drug Administration (FDA) b. Centers for Disease Control and Prevention (CDC) c. Institute of Medicine (IOM) d. Indian Health Service (HIS) ANS: C Some of the major divisions and agencies that comprise the U.S. Department of Health and Human Services are Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), Indian Health Service (HIS), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid (CMS), Health Resources and Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA). The Institute of Medicine (IOM) is not under the auspices of the U.S. Department of Health and Human Services. PTS: 1 DIF: Knowledge REF: THE FEDERAL GOVERNMENT 11. Which of the following was not identified as an area of health care disparities according to the 2008 National Healthcare Disparities Report?

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    a. Age groups c. Geographic areas b. Socioeconomic groups d. Racial and ethnic populations ANS: A The 2008 National Healthcare Disparities Report found that health care disparities often persist across socioeconomic groups, racial and ethnic populations, and geographic areas. The report also noted that across the process of care measures tracked, patients received the recommended care less than sixty percent of the time. PTS: 1 DIF: Analysis REF: HEALTH CARE DISPARITIES 12. Which of the following is not one of the three key pieces of legislation that established national standards that states use to regulate health insurance? a. ELISA c. HIPAA b. COBRA d. ERISA ANS: A Three integral pieces of federal legislation that states use to regulate health insurance through the development of national standards are COBRA (Consolidated Omnibus Budget Reconciliation Act), HIPAA (Health Insurance Portability and Accountability Act), and ERISA (Employee Retirement Income Security Act). ELISA (Enzyme-Linked ImmunoSorbent Assay) is a biochemical test used to determine certain serum antibody concentrations such as HIV. PTS: 1 DIF: Knowledge REF: STATE REGULATION OF HEALTH INSURANCE 13. Thorpe, Woodruff, and Ginsburg (2005) have noted a variety of key elements that have contributed to the rising costs of health care. Which of these elements does not belong? a. Aging of the population c. Practitioner behavior b. Increased use of new technologies d. Nursing shortage ANS: D Thorpe, Woodruff, and Ginsburg’s (2005) key factors that contribute to the rising costs of health care are an aging population with the resultant growth in the demand for health care, increased use of expensive new technologies, pharmaceuticals, practitioner behavior, rising hospital care costs, cost shifting, and administrative costs. The nursing shortage is not a key factor contributing to rising costs of health care. PTS: 1 DIF: Knowledge REF: FACTORS CONTRIBUTING TO RISING HEALTH CARE COST

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    14. A staff nurse has volunteered to work on the hospital’s Quality Insurance Committee. As part of the training, the nurse would be taught that tracking the rate of medication errors is a clinical: a. outcome. c. structure. b. practice. d. process. ANS: D Tracking the rate of medication errors as a performance measure is considered a clinical process. An example of a clinical structure is the percentage of nurses and pharmacists who are certified or licensed, and an example of a clinical outcome is the number of deaths from medical errors. PTS: 1 DIF: Application REF: TABLE 2-1 EXAMPLES OF PERFORMANCE MEASURE BY CATEGORY 15. The hospital pharmacist explains to a group of nursing students that the use of generic drugs and drug formulary are which type of performance measures? a. Clinical care measure c. Financial management process b. Financial management structure d. Clinical care structure ANS: C Using generic drugs and drug formulary as a quality performance measure is an example of a financial management process. An example of a financial management structure is the use of preadmission criteria, and a clinical care structure for performance measurement is the presence of magnet recognition. PTS: 1 DIF: Application REF: EXAMPLES OF PERFORMANCE MEASURES BY CATEGORY 16. There are numerous factors that contribute to the rising number of uninsured in the United States. Which is not necessarily a contributing factor? a. People being eligible for public programs c. People between jobs or unemployed b. Higher premiums d. Employers not offering health insurance ANS: A Some of the factors that contribute to the large volume of uninsured in the United States are people being between jobs or unemployed, not being eligible for public programs, higher premiums, and employers not offering health insurance options. PTS: 1 DIF: Comprehension REF: HEALTH CARE COSTS 17. Raising prices to offset lower monies paid from Medicaid and Medicare is called: a. price fixing. c. capitation. b. cost shifting. d. cost containment.

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    ANS: B The practice of raising prices for the privately insured to offset the lower health care payments received from Medicare and Medicaid and nonpayment from the uninsured is called cost shifting (shifting the cost for services from one payer to another). PTS: 1 DIF: Comprehension REF: COST SHIFTING 18. In an effort to control health care costs, measures were taken to restrict the amount of monies paid to a predetermined fixed amount for Medicare Part A services. This measure is called: a. DRG. c. PPS. b. RBRVS. d. PPD. ANS: C The Tax Equity and Fiscal Responsibility Act, passed in 1982, mandated the Prospective Payment System (PPS) to control health care costs. PPS is a method of reimbursement based upon a predetermined fixed amount. DRGs are diagnosis-related groups. The RBRVS (Resource-Based Relative Value Scale) is a cost containment measure to determine payments made for Medicare Part B services. PPD is a tuberculosis skin test. PTS: 1 DIF: Comprehension REF: PROSPECTIVE PAYMENT 19. Supplementing clinical expertise with judicious implementation of the most current evidence along with patient preferences and values is called: a. evidence - based nursing practice. c. disease optimization. b. evidence - based practice. d. evidence - based care. ANS: B The use of clinical expertise with conscientious and judicious implementation of the most current and best evidence along with patient values and preferences to guide health care decision making is called evidence-based practice. Evidence-based nursing practice refers only to nursing care. PTS: 1 DIF: Comprehension REF: EVIDENCE-BASED PRACTICE 20. According to Starfield (1998) one of the four foundations of primary care is coordination. Which of the following best describes coordination? a. Build upon longitudinality by following and integrating care received through referrals and other provi thus averting unnecessary services and duplication of services. b. Conduct the initial evaluation and define the health dysfunction, treatment options, and health goals. c. Sustain a patient - clinical relationship continuously over time throughout the patient’s illness, acute nee disease management.. d. Manage the wide range of health care needs across health care settings and among health care professio

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    ANS: A According to Starfield, coordination involves building upon longitudinality and care received through referrals and other providers is followed and integrated, averting unnecessary services and duplication of services. Option b refers to the “First Contact, ” option c refers to “Longitudinality,” and option d refers to “Comprehensiveness.” PTS: 1 DIF: Comprehension REF: NEED FOR PRIMARY HEALTH CARE 21. When a health care organization manages the wide range of health care needs across health care settings and among different health care professionals, the organization is performing which of Starfield’s (1988) four foundations of primary care? a. First Contact c. Longitudinality b. Comprehensiveness d. Coordination ANS: B According to Starfield (1998), “Comprehensiveness involves managing the wide range of health care needs, across health care settings and among different health care professionals.” First Contact involves conducting the initial evaluation and defining the health dysfunction, treatment options, and health needs. Longitudinality involves sustaining a patient-clinician relationship continuously over time, and coordination involves building upon longitudinality. PTS: 1 DIF: Comprehension REF: NEED FOR PRIMARY HEALTH CARE 22. Which federal agency funds health services research on the effectiveness of health care services and outcomes? a. Health Resources and Services Administration (HRSA) b. Centers for Medicare and Medicaid Services (CMS) c. Agency for Health Care Research and Quality (AHRQ) d. National Institutes of Health (NIH) ANS: C The Agency for Health Care Research and Quality (AHRQ) funds health services research on the effectiveness of health care services and outcomes. PTS: 1 DIF: Comprehension REF: THE FEDERAL GOVERNMENT 23. A nurse is seeking funding to continue with education as a Nurse Practitioner. Which federal agency would most likely be an appropriate funding source for the nurse’s continuing education?

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    a. NIH c. SAMHSA b. AHRQ d. HRSA ANS: D Health Resources and Services Administration (HRSA) would most likely be a possible source of funds for the nurse’s continuing education. HRSA administers training programs for health care clinicians. HRSA also provides Funding for pregnant women and children, programs for persons with HIV/AIDS, and programs serving low-income, underserved, and rural populations. PTS: 1 DIF: Application REF: THE FEDERAL GOVERNMENT 24. As a result of financial problems, a hospital had to terminate several nurses. These nurses would be eligible to retain their insurance for up to 18 months as a result of which of the following? a. COBRA c. HIPAA b. ERISA d. CHAMPUS ANS: A Once terminated, the nurses would be eligible to retain their insurance for up to 18 months through COBRA. PTS: 1 DIF: Analysis REF: STATE REGULATION OF HEALTH INSURANCE MULTIPLE RESPONSE 1. A group of faculty members is overhauling the curriculum for the nursing program based on recommendations set forth by the Institute of Medicine. The nursing program would most likely include which of the following in the outcomes for students attending the program? Select all that apply. a. Ability to provide patient - centered care b. Ability to work effectively with teams c. Understanding evidence - based practice d. Understanding tha t only medial diagnoses are important e. Ability to use health information technology f. understanding that nursing is more important than other health care professions ANS: A, B, C, E Recommendations set forth by IOM include the ability to provide patient-centered care, ability to work effectively with teams, understand evidence-based practice, and the ability to use health information technology. There was no mention of any one profession being more important than

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    another, nor was there any mention of the fact that only medial diagnoses are important. Nursing diagnoses are important to nurses because they identify areas of patient need that are addressed by nurses. PTS: 1 DIF: Comprehension REF: IMPROVING QUALITY THROUGH HEALTH PROFESSIONS EDUCATION 2. Which of the following may increase health services utilization? Select all that apply. a. Expanded use of existing drugs b. Growth in national population c. Better understanding of risk factors for disease d. Increase in chronic conditions e. Quality standards for food and water distribution f. More functional limitations associated with aging ANS: A, B, D, F Health services utilization increases with the expanded use of existing drugs, growth in national population, increase in chronic conditions, and more functional limitations associated with aging. Other factors that would increase utilization include consumer documents and guidelines that recommend increased utilization, new procedures and technologies, as well as changes in clinician practice. If risk factors for disease were better understood, there would be a decreased use of services. Improved quality for food and water distribution would also cause reduced utilization. PTS: 1 DIF: Analysis REF: TABLE 2-5 FACTORS THAT AFFECT OVERALL HEALTH CARE UTILIZATION 3. Which of the following are foundations of primary care? Select all that apply. a. Longitudinality d. Second contact b. Comprehensiveness e. Consensus building c. First contact f. Coordination ANS: A, B, C, F Foundations of primary care include first contact, longitudinality, comprehensiveness, and coordination. First contact involves the initial evaluation of the client, when the health dysfunction, treatment, and goals are defined. Longitudinality refers to sustaining a clinician- patient relationship over time. Comprehensiveness refers to managing a wide variety of health care needs across health settings and among different health professionals. Coordination involves

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    referrals and follow-up. Second contact and consensus building are not related to the foundations of primary care. PTS: 1 DIF: Comprehension REF: NEED FOR PRIMARY HEALTH CARE Chapter 3: Organizational Behavior and Magnet Hospitals Chapter 3: Organizational Behavior and Magnet Hospitals MULTIPLE CHOICE 1. Schermerhorn, Hunt, and Osborn define organizational behavior as the study of: a. human behavior in organizations. b. the organization’s output or end product. c. systems theory within an organization. d. strategic planning for long - term survival. ANS: A Schermerhorn, Hunt, and Osborn define organizational behavior as the study of human behavior in organizations. PTS: 1 DIF: Knowledge REF: ORGANIZATIONAL BEHAVIOR 2. According to Lynn and Redman, organizational behavior emphasizes: a. products, sales, an d revenue generation. b. job satisfaction, loyalty, and productivity. c. economic constraints, customer base, and sales. d. machine - like or assembly line work process. ANS: B Organizational behavior emphasizes actions and attitudes of people within organizations such as job satisfaction, commitment (loyalty), and performance (productivity). PTS: 1 DIF: Comprehension REF: ORGANIZATIONAL BEHAVIOR 3. A nursing instructor wants to determine whether the nursing students understand the principles that scientific management emphasizes. Which response by the students would indicate that they understand scientific management? a. Products, sales, and revenue generation b. Job satisfaction, loyalty, and productivity c. Economic constraints, customer base, and sales

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    d. Machine - like or assembly line work processes ANS: D Scientific management emphasizes the machine-like or assembly line focus of work processes and the precise sets of instructions and time-motion studies assumed to enhance productivity. PTS: 1 DIF: Application REF: EVOLUTION OF ORGANIZATIONAL BEHAVIOR 4. The nursing staff of the medical unit recognize that according to Schermerhorn et al., an organization can be considered effective if it: a. maintains a growth rate of no less than 10 percent per year. b. can continue to grow and have a healthy bottom line. c. has a quality workforce and commitment to success. d. can increase productivity without increasing employees. ANS: C Schermerhorn et al. state important contributions to the effectiveness of any organization are the quality of its workforce and their commitment to the goals and success of the organization. PTS: 1 DIF: Application REF: IMPORTANCE OF ORGANIZATIONAL BEHAVIOR 5. Intellectual capital can be defined as: a. work created by an individual but owned solely by the organization. b. an individual’s knowledge, skills, and abilities that have value and portability. c. ideas and creations formulated at work and sold for profit by the organization. d. an organization’s collective inf ormation, which is in written, electronic, or cryptic format. ANS: B Intellectual capital includes an individual’s knowledge, skills, and abilities that have value and portability in a knowledge economy. PTS: 1 DIF: Comprehension REF: EVOLUTION OF ORGANIZATIONAL BEHAVIOR 6. In order to increase productivity, the nurse manager of the surgical unit removes obstacles for motivated and empowered individuals. This behavior is common in which type of organizational model? a. Autocratic c. Collegial b. Custodial d. Technological ANS: C

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    In Table 3-1, Clark summarizes and compares models of organizational behavior. The collegial model is based on partnership, teamwork, and employee support that removes obstacles for motivated and empowered individuals. Both autocratic and custodial models are managed by power, authority, economics, and money, which have employees dependent on the boss or the organization. Technology is not a model or organizational behavior discussed. PTS: 1 DIF: Application REF: EVOLUTION OF ORGANIZATIONAL BEHAVIOR 7. Organizational behavior has impacted the autocratic model of behavior by moving from: a. dependence on the organization to responsibility for self. b. dependence on the boss to empowering the individual. c. passive cooperation by the employee to active participation. d. motivation by money, security and benefits to motivation by job performance. ANS: B The autocratic model focuses on dependency on the boss, while the study of organizational behavior has shown today ’s health care employees prefer a more supportive and collegial work environment empowering the individual. Passive cooperation is seen in the custodial model. Dependency on the organization is seen in the custodial model. Motivation by money, security, and benefits is seen in the custodial model. PTS: 1 DIF: Comprehension REF: EVOLUTION OF ORGANIZATIONAL BEHAVIOR 8. A high-performance organization can be characterized by which of the following characteristics? a. Brings out the best in people b. Values knowledge and pays top salaries c. Continues to change with consumer demands d. Is job centered to guarantee efficiency of work ANS: A High-performance organizations operate in a way that brings out the best in people and produces sustainable high performance over time. They have the ability to attract, motivate, and retain talented people. PTS: 1 DIF: Comprehension REF: HIGH-PERFORMANCE ORGANIZATIONS 9. Maintaining high quality-of-work-life environments requires the commitment of:

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    a. owners and sto ckholders of a company. b. human and financial resource departments. c. leaders and employees of the organization. d. maintenance, housekeeping, and other service departments. ANS: C Maintaining high quality-of-work-life environments requires the commitment of both leaders and employees in organizations. Leaders in high-performance organizations recognize that the single best predictor of an organization’s capacity to attract, motivate, and sustain talented people is to maintain a high quality work-life environment. PTS: 1 DIF: Comprehension REF: HIGH-PERFORMANCE ORGANIZATIONS 10. Saint Cecil’s hospital recently achieved “magnet” status. This means that the hospital has met the: a. AHA distinguished service award for excellence in community service. b. JC patient care performance measures with no deficiencies. c. OSHA compliance with all guidelines and no deficiencies. d. ANCC nursing excellence requirements. ANS: D Magnet status is awarded to health care organizations that have met the rigorous nursing excellence requirements of the American Nurses Credentialing Center (ANCC), a division of the American Nurses Association (ANA). Achievement of magnet status designation represents the highest level of recognition the ANCC accords to health care organizations that provide the services of registered professional nurses. PTS: 1 DIF: Application REF: MAGNET HOSPITALS 11. The initial proposal for the Magnet Hospital Recognition Program was approved by the ANA Board of Directors in: a. 1983. c. 1990. b. 1987. d. 1994. ANS: C The initial proposal for Magnet Hospital Recognition Program was approved by the ANA Board of Directors in December 1990. This proposal indicated that the program would be built upon the 1983 ANA magnet hospital study. PTS: 1 DIF: Knowledge

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    REF: HISTORICAL OVERVIEW OF MAGNET HOSPITALS 12. The University of Washington Medical Center in Seattle became the first magnet facility in which year? a. 1985 c. 1994 b. 1989 d. 2000 ANS: C RAT: The University of Washington Medical Center in Seattle became ANCC’s first magnet facility in 1994. By 1998, 13 hospitals achieved magnet designation, and, by mid-2006, more than 200 facilities had achieved magnet designation. PTS: 1 DIF: Knowledge REF: THE ANCC MAGNET FACILITIES 13. The Magnet Hospital Recognition Program was created to achieve three major goals. Which of the following is considered a goal? a. Decrease and attempt to abolish the nursing shortage b. “Pay for performance” or higher wages for higher quality work c. Identify excellence in the delivery of nursing services to patients d. Drive down the soaring cost of health care in the United States ANS: C The goals are to identify excellence in the delivery of nursing services to patients, promote quality in a milieu that supports professional nursing practice, and provide a mechanism for the dissemination of best practices in nursing services. PTS: 1 DIF: Comprehension REF: GOALS OF THE MAGNET RECOGNITION PROGRAM 14. Nine characteristics define magnet nursing services. Which of the following is NOT a characteristic of the program’s appraisal process? a. High quality patient care c. Community involvement b. Clinical autonomy and responsibility d. High compensation and benefits ANS: D Nine characteristics define magnet nursing services: high quality patient care, clinical autonomy and responsibility, participatory decision making, strong nurse leaders, two-way communication with staff, community involvement, opportunity and encouragement of professional development, effective use of staff resources, and high levels of job satisfaction. PTS: 1 DIF: Comprehension REF: TABLE 3-3 NINE CHARACTERISTICS DEFINING MAGNET SERVICES

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    15. One of the top benefits of magnet designation for a hospital is: a. being self - insured for all emp loyees. b. improved nurse recruitment and retention. c. lower on - job back injuries reported by staff. d. larger number of culturally diverse employees. ANS: B Hospitals attaining magnet designation may achieve multiple benefits. The major benefits are improved patient quality outcomes, enhanced organizational culture, improved nurse recruitment and retention, enhanced safety outcomes, enhanced competitive advantage, and higher nurse job satisfaction. PTS: 1 DIF: Comprehension REF: BENEFITS OF MAGNET RECOGNITION 16. Improvement in quality patient outcomes has been reported in magnet organizations. According to several studies, which of the following is thought to contribute significantly to quality patient outcomes? a. Nurse’s work environment c. Performance improvement practices b. Quality assessment practices d. Shorter lengths of stay in the hospital ANS: A Research by Lake and Friese; Aiken, Smith, and Lake; and Aiken, Sloane, Lake, Sochalski, and Weber support the importance of the nurse’s work environment to enhanced continuity of patient care, increased levels of patient satisfaction, and lower mortality rate. PTS: 1 DIF: Application REF: IMPROVEMENT IN QUALITY PATIENT OUTCOMES 17. A staff nurse asks the supervisor, “What is an essential element to giving quality care in magnet hospitals?” Which response by the supervisor would be the most appropriate? a. Higher salary, benefits, and paid time off than in non - magnet hospitals b. Adequate nurse staffing and support for continuing profession al development c. Cross - training for flexibility in practice and higher compensation when flexed d. Moving from one magnet hospital to another without loss of seniority or benefits ANS: B There are eight essentials of magnetism: opportunities to work with other nurses who are clinically competent, good nurse-physician relationships, nurse autonomy and accountability,

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    supportive nurse managers, control over nursing practice, support for education, adequate nurse staffing, and concern for the patient. PTS: 1 DIF: Application REF: TABLE 3-5 EIGHT ESSENTIALS OF MAGNETISM 18. Magnet hospitals are known for enhanced safety outcomes. According to Aiken, Sloane, and Klocinski, magnet hospitals are known to have: a. less than 1 percent nosocomial infections pe r year. b. zero to five reported OSHA violations per year. c. fewer needle sticks. d. fewer back injuries. ANS: C Aiken, Sloane, and Klocinski state that magnet hospitals have been found to have fewer needle stick injury rates among nurses. PTS: 1 DIF: Knowledge REF: ENHANCED SAFETY OUTCOMES 19. A nurse manager is assisting with the magnet application process when a staff nurse asks, “What is a gap analysis?” The most appropriate response by the nurse manager would be which of the following? a. The spac e between where the organization is and where it wants to be b. A research study of community needs that are not being met by the organization c. An audit of the organization’s financial ability to undertake the magnet process d. A study of the community’s need for a magnet - recognized organization ANS: A The gap analysis examines the space between where the organization is and where it wants to be, an assessment of the differences between the expected magnet requirements and the organization’s current performance on these requirements. PTS: 1 DIF: Application REF: MAGNET APPRAISAL PROCESS 20. After achieving magnet status, a nurse manager asks the Director of Nursing, “How often are the site visits for the re-designation of magnet status for orga nizations?” The most appropriate response from the Director would be which of the following? a. 2 years c. 4 years b. 3 years d. 5 years ANS: C

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    Interim reports are submitted every year. Site visits are scheduled every 4 years for the re- designation process. PTS: 1 DIF: Application REF: MAGNET APPRAISAL PROCESS 21. A nurse recognizes that the most important essential of magnetism is which of the following? a. Concern for the patient c. Control over nursing practice b. Good nurse - physician relationships d. Authoritative nursing managers ANS: A The most important essential of magnetism is concern for the patient. Other essentials include opportunities to work with other nurses who are clinically competent, good nurse-physician relationships, nurse autonomy and accountability, supportive nurse managers, control over nursing practice, support for education, and adequate nurse staffing; however, concern for the patient is always paramount. PTS: 1 DIF: Application REF: TABLE 3-5 EIGHT ESSENTIALS OF MAGNETISM 22. During preparation of the application for magnet status, a nurse asks the supervisor, “What is meant by nursing sensitive indicators?” The supervisor would be correct in responding: a. Indicators that a nurse is vulnerable to depression b . Indications as to whether a nurse is sensitive to stress c. Nurses working with sensitive and confidential information d. Measures that reflect the outcomes of nursing actions and care ANS: D The supervisor would be correct in responding that nursing sensitive indicators measure the outcome of nursing care. These indicators represent the patient’s response to the various strategies implemented by the nursing staff. PTS: 1 DIF: Application REF: THE MAGNET MODEL 23. A new graduate has accepted a position at a hospital that is considered a high-performance organization. The hospital most likely has which of the following characteristics? a. Discourages the use of technology b. Refuses release time to all nurses for continuing education c. Focuses only on the hospital’s internal environment d. Empowers nurses to use self - directive and personal initiative ANS: D

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    High-performance organizations empower their employees to use self-directive and personal initiative. This type of organization brings out the best in people and produces sustainable high performance. High-performance organizations encourage the use of technology, focus on both the internal and external environment, and are supportive of their staff’s involvement in continuing education. PTS: 1 DIF: Application REF: TABLE 3-2 FIVE CHARACTERISTICS OF HIGH-PERFORMANCE ORGANIZATIONS 24. Which of the following provides a competitive advantage for hospitals with magnet designation? a. High turnover and low job satisfaction c. High turnover and high job satisfaction b. Low turnover and high job satisfaction d. Low turnover and low job satisfaction ANS: B Low turnover and high job satisfaction gives a competitive advantage to hospitals with magnet designation. High turnover and low job satisfaction would indicate that there are problems in the hospital’s internal environment. Problems such as unsafe working conditions, low salaries, and poor leadership or management are just a few of the situations that can create dissatisfaction and high turnover. PTS: 1 DIF: Analysis REF: ENHANCED COMPETITIVE ADVANTAGES 25. Nurses employed in organizations that follow a Custodial Model of organizational behavior would most likely observe which of the following related to performance outcomes? a. Passive cooperation c. Enthusiasm b. Engagement d. Drive and cooperation ANS: A A Custodial Model of organizational behavior would most likely be characterized by passive cooperation. Enthusiasm and engagement are more characteristic of a Collegial Model, and drive and cooperation are characteristic of a Supportive Model. PTS: 1 DIF: Application REF: TABLE 3-1 MODEL OF ORGANIZATIONAL BEHAVIORS MULTIPLE RESPONSE 1. If a local hospital follows a Supportive Model of organizational behavior, which of the following would most likely be demonstrated? Select all that apply. a. Passion

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    b. Passive cooperation c. Meeting employee’s need for recognition d. The basis of the model is leadership e. The managerial orientation is authority f. An employee orientation of self - discipline ANS: A, C, D The basis of the Supportive Model is leadership. This model is characterized by passion, support, good job performance, participation, acknowledgement of the employee’s need for status and recognition. Passive cooperation is characteristic of a Custodial Model, a managerial orientation of authority is characteristic of an Autocratic Model, and an employee orientation of self- discipline is characteristic of the Collegial Model. PTS: 1 DIF: Comprehension REF: TABLE 3-1 MODEL OF ORGANIZATIONAL BEHAVIORS 2. Which of the following are among the fourteen forces of magnetism? Select all that apply. a. Quality care d. Autonomy b. Image of nursing e. Quality of medical leadership c. Professional development f. Management style ANS: A, B, C, D, F Quality care, image of nursing, professional development, autonomy and management style are part of the fourteen forces of magnetism. Quality of medical leadership is not one of the forces; however, quality of nursing leadership is. PTS: 1 DIF: Comprehension REF: TABLE 3-6 THE FOURTEEN FORCES OF MAGNETISM 3. A new graduate has been visiting several of the local hospitals to determine which facility would be a good place to begin a career. The graduate has visited both hospitals with and without magnet designation. Which of the following benefits related to organizational culture would be more apparent in the magnet-designated facilities? Select all that apply. a. Shared decision making b. Visible nurse leaders c. Lower patient morbidity and mor tality d. Greater nurse empowerment structures e. Increased culture of respect for nurses f. Lower incidence of needle stick rates among nurses

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