Chapter 1

Question 1

An experienced nurse is exhibiting signs of stress associated with workload issues and has been abrupt with co-workers. The manager requests a meeting with the nurse to determine how to best support her. What aspect of mindfulness supports the nurse learning this technique? (Select all that apply.)
a) Prevents mental drift.
b) Enhances authentic thinking.
c) Causes knee jerk reactions.
d) Dampens negative thoughts

Answer 1

a) Prevents mental drift.
b) Enhances authentic thinking.
d) Dampens negative thoughts

Question 2

After a meeting with members of the family of a dying patient, the nursing manager discusses with you the family’s desired approach to care, and you support the manager’s decision. Your actions indicate that you are acting in what role?
a) Leadership
b) Management
c) Evidence-informed
d) Followership

Answer 2

d) Followership

Question 3

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 believe it is insulting to be required to participate in a competency program. Which behaviour 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 accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
c) Schedule a meeting with the chief nurse executive to apprise her of the situation.
d) Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

Answer 3

d) Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

Question 4

A nurse manager on a busy rehabilitation unit recognizes that a new nurse graduate has potential to become a leader in mentoring and supporting other nurse graduates. The manager considers this nurse to possess characteristics of high emotional intelligence. Which of the following characteristics manifest in emotional intelligence? (Select all that apply.)
a) Showing sensitivity to the experience of others.
b) Taking an advanced leadership course.
c) Mentoring new nurses.
d) Enhanced communication skills.

Answer 4

a) Showing sensitivity to the experience of others.
d) Enhanced communication skills.

Question 5

Shortly after being informed of fetal death, a labouring woman asks why she is not able to hear her baby’s heartbeat on the monitor anymore. Although the monitor volume had been turned off so that the patient would be able to sleep between contractions, the nurse responded that there was no heartbeat to hear because the baby had died in utero; then the nurse asked whether the patient would like to talk about how she was feeling. This response demonstrates:
a) Lack of empathy.
b) Complexity science.
c) Ethical leadership.
d) A coercive relationship.

Answer 5

c) Ethical leadership.

Question 6

Which category is unique to leadership but is not part of management?
a) Developing people
b) Initiating change
c) Information management
d) Personal qualities

Answer 6

a) Developing people

Question 7

According to complexity science, which of the following should be the focus of measurement?
a) Staff morale and budgets.
b) Cost per hospital day.
c) Bed utilization.
d) Infection rates.

Answer 7

a) Staff morale and budgets.

Question 8

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 beginning to distance themselves from the family. After inviting the concerns of staff, you explain that the organization values patient-centred care and suggest that evidence indicates 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-centred in these situations. In this situation, you are taking on which role?
a) Follower
b) Management
c) Visionary
d) Leadership

Answer 8

d) Leadership

Question 9

As the nurse manager, you want to increase motivation by providing motivating factors. Which action would you select?
a) Implement a model of shared governance
b) Provide a hierarchical organizational structure.
c) Promote the development of a flexible benefits package.
d) Collaborate with the human resources/personnel department to develop on-site daycare services.

Answer 9

a) Implement a model of shared governance

Question 10

Sarah is concerned about your direction regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you whether you both could talk about the guidance that you have given after you have had an opportunity to read the articles. This is an example of (Select all that apply.)
a) Management.
b) Insubordination.
c) Leadership.
d) Followership

Answer 10

c) Leadership.
d) Followership

Question 11

The Canadian government identifies the first point of care for Canadian residents.
a) Hospitalization
b) Primary care
c) Specialized services
d) Acute care

Answer 11

b) Primary care

Question 12

Chart audits have revealed significant omissions of data that could have legal and funding guidelines. 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) Decision making.
c) Management.
d) Vision

Answer 12

c) Management.

Question 13

An RN staff member had to inform a licensed practical nurse on the unit nursing team that the care that she was providing needed improvement. The RN provided her with some practical examples of ways to improve her nursing care. After the discussion, the licensed practical nurse thanked the RN for the constructive criticism, and the two nurses proceeded to the cafeteria to have a coffee break together. Which follower characteristic did the RN display during this encounter?
a) Willingness to learn.
b) Being a team player.
c) Being an effective communicator.
d) Active participation.

Answer 13

c) Being an effective communicator.

Question 14

As the head of a nursing program, you consistently invite your team to develop ideas about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try other ideas. You are employing _____ leadership.
a) Situational
b) Contingency-based
c) Transformational
d) Trait-based

Answer 14

c) Transformational

Question 15

As a leader on a rehabilitation unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making, but not as a hierarchal role. This view of decision-making and leadership is consistent with:
a) Trait theories.
b) Situated theory.
c) Emotional intelligence.
d) Complexity science

Answer 15

d) Complexity science

Question 16

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 older adult patients. According to complexity principles, what would be the best approach to take in making this change?
a) Hire a geriatric specialist to oversee and control the project.
b) Leverage the hierarchical management position to get unit staff involved in assessment and planning.
c) Focus the assessment on the unit, and omit the hospital and community environment.
d) Engage involved staff at all levels in the decision-making process.

Answer 16

d) Engage involved staff at all levels in the decision-making process.

Question 17

A charge nurse on a busy 40-bed medical/surgical unit is approached by a patient’s son, who begins to complain loudly about the quality of care his mother is receiving. His behaviour 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 behaviour by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
a) Notifying nursing administration of the situation
b) Discussing the concern with the patient after the family member has left
c) Trying to catch up with the angry family member to resolve the concern
d) Reflection to obtain insight into how the situation could be handled differently in the future

Answer 17

d) Reflection to obtain insight into how the situation could be handled differently in the future

Question 18

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 such situations. What role are you assuming through this action?
a) Leader
b) Manager
c) Follower
d) Laissez faire

Answer 18

b) Manager

Question 19

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. In the practice of a strengths-based nursing leader, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
a) Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.
b) Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be calling in frequently in the future.
c) Place the nurse on unpaid leave for the remainder of his wife’s treatment.
d) Line up agency nurses who can be called in to work on short notice.

Answer 19

a) Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.

Question 20

As the charge nurse on the night shift in a small long-term care facility, you have found that there is little turnover among your licensed practical nurse and nursing assistant (NA) staff members, but they are not very motivated to work beyond their job descriptions. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
a) Allow the licensed practical nurses and NAs greater decision-making power within the scope of their positions in the institution.
b) Help the licensed practical nurses and NAs with their work, whenever possible.
c) Ask the director of nursing to offer higher wages and bonuses for extra work for the night licensed practical nurses and NAs.
d) Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

Answer 20

a) Allow the licensed practical nurses and NAs greater decision-making power within the scope of their positions in the institution.

Question 21

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. Because you are a nursing colleague, your response demonstrates understanding that the perception of the new graduate:
a) Has been influenced by nurse leaders and managers who leave for other positions.
b) Is accurately reflected in the new graduate’s statement.
c) Would benefit from further understanding of her role as a professional in relation to decision-making.
d) Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.

Answer 21

c) Would benefit from further understanding of her role as a professional in relation to decision-making.

Question 22

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity science, you are engaging which principle?
a) Bottom-up interactions.
b) Systematic thinking.
c) Development of networks.
d) Empowerment.

Answer 22

c) Development of networks.

Question 23

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:
a) Empowering.
b) A leadership tag
c) A symbol.
d) A management task.

Answer 23

b) A leadership tag

Question 24

You walk into a patient’s room and find him yelling at the licensed practical nurse. The patient is obviously very upset, and after you speak with him regarding his behaviour, you determine that he has not slept for three nights because of unrelieved pain levels. The licensed practical nurse is very upset with him and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest that the patient’s behaviour was aggressive but is related to lack of sleep and to pain. You ask, “Can both you and the patient together determine triggers for the pain and effective approaches to controlling his pain?” This approach demonstrates:
a) Leadership behaviour.
b) Concern with placating the patient.
c) Management behaviour.
d) Lack of empathy and understanding for the licensed practical nurse.

Answer 24

a) Leadership behaviour.

Question 25

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 the actions. What would be the best course of action at this time?
a) Ask each party to examine her own motives and issues in the conflict.
b) Send the two disputants away to reach their own resolution.
c) Continue to listen as the parties repeat their thoughts and feelings about the conflict.
d) Involve another staff nurse in the discussion so as to clarify issues.

Answer 25

a) Ask each party to examine her own motives and issues in the conflict.

Question 26

When attending a clinical rotation in a geriatric setting a group of student nurses, Ashley observed all staff worked seamlessly, morale was high, and resident and family satisfaction rates are high. Upon discussing with the nurse manager their observations, the term “authentic leadership” was identified as the primary reason. What characteristics of authentic leadership support this observation? (Select all that apply.)
a) Apply balanced processing.
b) Awareness of the people around them.
c) Are swayed by external pressures.
d) Align words to match beliefs.

Answer 26

a) Apply balanced processing.
b) Awareness of the people around them.
d) Align words to match beliefs.

Question 27

The manager of a surgical area envisions a future that requires the addition of registered nurse (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 of the RNs in relation to this change.
b) Dropping the idea and trying for the change in another year or so.
c) Leaving the RNs alone for a time so they can think about the change before they are approached again.
d) Hiring the assistants and allowing the RNs to see what good additions they are.

Answer 27

a) Exploring the values of the RNs in relation to this change.

Question 28

Marie-Claire, 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 Marie-Claire. After reflection and discussion with others, Marie-Claire recognizes that she also feels threatened by his behaviour. 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. Marie-Claire is demonstrating
a) Acquiescence.
b) Leadership.
c) A positive self-concept.
d) Deepening self-awareness

Answer 28

d) Deepening self-awareness

Question 29

Which category is unique to management but is not part of leadership?
a) Developing people
b) Initiating change
c) Personal qualities
d) Information management

Answer 29

d) Information management

Question 30

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you do the following:
a) Adjourn the meeting and provide explanation through e-mail.
b) Explain the reasons for change, emphasizing the need to reduce costs.
c) Repeat the information several times, giving detailed budget overviews.
d) Acknowledge the loss.

Answer 30

d) Acknowledge the loss.