Chapter Test Bank Flashcards
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 patients. According to 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
Rationale: 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, everybody’s opinion counts; therefore, all levels of staff would be involved in decision-making.
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. 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
Rationale: Placing the nurse on unpaid leave may threaten physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten staff members’ sense of competence. Strengths-based nurse leaders honour the uniqueness of individuals, teams, systems, and organizations; therefore arranging the schedule around the wife’s needs would result in a win-win situation, also creating a work environment that
promotes the health of all the nurses and facilitates their development.
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. 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
Rationale: Nurses and leaders must assess each situation as unique, determining appropriate actions accordingly. Leaders must adapt their styles to complement specific issues being faced, such
as conflict. Examining motives and issues for the conflict in perceptions promotes equal
representation of each point of view.
As the nurse manager, you want to increase motivation by providing motivating factors.
Which action would you select?
a. Collaborate with the human resources/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.
ANS: C
Rationale: Complexity theory suggests that systems interact and adapt and that decision-making occurs throughout systems, as opposed to being made unilaterally by different levels of the organizational hierarchy. In complexity theory, every person’s opinion counts, and therefore
all levels of staff would be involved in decision-making. This principle underlies shared governance. Shared governance is an example of nurse decision-making in which nurses at different organizational levels engage in shaping policy and practices.
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. Reflection to obtain insight into how the situation could be handled differently in
the future
b. Trying to catch up with the angry family member to resolve the concern
c. Discussing the concern with the patient after the family member has left
d. Notifying the nursing administration of the situation
ANS: A
Rationale: Emotional intelligence is closely aligned with individuals’ capacity to know themselves and
others. Reflecting to obtain insight and being able to “step” outside the situation to envision the context of what is happening is an example of the actions of an emotionally intelligent practitioner.
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 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 the 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.
ANS: D
Rationale: The manager’s role involves guiding other people through a set of derived practices that are evidence-informed and known to satisfy pre-established outcomes such as participation in a competency program. This involves the engagement of staff through the sharing of concerns and ideas. This type of leader can instill hope and trust in followers, which influence their behaviours and attitudes (such as engagement and satisfaction) and cause work environments to become more positive.
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. Lack of empathy and understanding for the licensed practical nurse.
b. Concern with placating the patient.
c. Leadership behaviour.
d. Management behaviour.
ANS: C
Rationale: The situation between the patient and the licensed practical nurse is complex, involving unrelieved symptoms and aggressiveness toward a staff member. Health care is now delivered in a collaborative, and most often, an interdisciplinary manner, whereby select
leadership/management roles (e.g., first-line nurse leaders) serve as conduits for information
and care coordination. Providing engaged, collaborative guidance and decision-making in a
complex situation for which there is no standardized solution reflects leadership.
Which category is unique to management but is not part of leadership?
a. Initiating change
b. Personal qualities
c. Developing people
d. Information management
ANS: D
Rationale: Information management is a category of management only. Developing people is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership.
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. Management.
c. Decision making.
d. Vision.
ANS: B
Rationale: The process of guiding other people to meet established goals, outcomes, and procedures is management. This can require collaborative decision-making to determine how best to reach
predetermined goals and follow established practices.
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. Followership
d. Evidence-informed
ANS: C
Rationale: Followership is engaging with other people who are leading or managing by contributing to
the work that needs to be done. By accepting and implementing the desired approach to care
direction given by the manager in response to your concerns, you are demonstrating followership.
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. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
Rationale: Individuals demonstrate emotional intelligence by raising their self-awareness and better
regulating their emotions. Being empathetic and showing sensitivity to the experiences of others help nurse leaders develop their emotional intelligence.
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. Trait-based
c. Contingency-based
d. Transformational
ANS: D
Rationale: Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.
As a leader in 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. Complexity science.
c. Situated theory.
d. Emotional intelligence.
ANS: B
Rationale: Complexity science involves decision-making distributed among the human assets within an organization, without regard to hierarchy.
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. Empowerment.
b. Systematic thinking.
c. Development of networks.
d. Bottom-up interactions.
ANS: C
Rationale: According to complexity science, networks evolve around areas of common interest and can
respond to problems in creative and novel ways.
According to complexity science, which of the following should be the focus of measurement?
a. Cost per hospital day.
b. Bed utilization.
c. Infection rates.
d. Staff morale and budgets.
ANS: D
Rationale: In complexity science, principles to better understand the nature of relationships within complex social systems, objective data, and non-measurable data cannot be ignored because
both inform decisions.
The Canadian government identifies the first point of care for Canadian residents.
a. Hospitalization
b. Acute care
c. Primary care
d. Specialized services
ANS: C
Rationale: The Government of Canada website states primary health care services should be every Canadian resident’s first point of contact with our publicly funded health care system. Primary health care providers also coordinate patients’ health services from “diagnosis to recovery” and access to specialized services and hospitalization.
Sarah is concerned about your direction regarding the 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. Leadership.
b. Followership.
c. Management.
d. Insubordination.
ANS: A, B
Rationale: This is an example of followership. Followers can promote team effectiveness, for instance, by maintaining collaborative work relationships, offering constructive criticism, and sharing leadership and management responsibilities. In addition, Sarah demonstrated leadership in seeking and presenting evidence that may influence the decision-making of her nurse leader and manager.
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. Dampens negative thoughts.
b. Prevents mental drift.
c. Enhances authentic thinking.
d. Causes knee-jerk reactions.
ANS: A,B,C
Rationale: Mindfulness buffers against mental drift and it can also guard against ‘knee-jerk’ reactions.
Rather than immediately evaluating and labelling emotions in a situation, the mindful person
creates a neutral space for reflection. Mindfulness practice enhances positive and authentic
thinking.
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. Awareness of the people around them.
b. Apply balanced processing.
c. Align words to match beliefs.
d. Are swayed by external pressures.
ANS: A,B,C
Rationale: Authentic leaders have heightened awareness of themselves in relation to others around them; they have an internalized moral perspective, and they align their words and actions to match their underlying values and beliefs—they are not swayed by external pressures; they apply balanced processing or the thoughtful consideration of all.
Change in health care must occur at the micro, meso, and macro policy levels. Which of the
following addresses the meso level of change?
a. Emergency room
b. Clinic
c. Ministry of Health
d. College of Nurses
ANS: D
Rationale: The emergency room and Clinic is at the micro level. The Ministry of Health is at the macro level and the College of Nurses is at the meso level as a professional organization.
Nursing leaders require several competencies for successful leadership. Which of the following descriptions encompass the best candidate for Director of Nursing in a large urban hospital?
a. Graduate degree in Nursing, social skills, communication skills
b. Legal knowledge, philanthropy knowledge, an undergraduate degree in nursing
c. Finance knowledge, a graduate degree in nursing, excellent communication skills
d. Undergraduate degree in nursing, communication skills, social skills
ANS: C
Rationale: All are required to be in a leadership position. For a director of nursing, a graduate degree in nursing, finance knowledge, and excellent communication skills are the minimum needed. In addition legal and philanthropic experience would enhance the leader chosen.
Self-doubt in novice nurses is a common issue and is known as which of the following?
a. Insecurity
b. Imposter syndrome
c. Lack of confidence
d. Lack of knowledge
ANS: B
Rationale: Imposter syndrome is self-doubt is one’s ability to function adequately in one’s role and may prevent nurses from taking leadership roles.
Which of the following is a relational leadership approach?
a. Transactional
b. Laissez-faire
c. Transformational
d. Instrumental
ANS: C
Rationale: Transactional, Laissez-faire, and instrumental are task-focused. Transformational, resonant, and participatory leadership are relational leadership approaches.
The nurse manager in the emergency department needs to implement new staffing patterns.
As a transformational leader, the nurse manager should:
a. Explain in detail how well the new idea will work.
b. Make staff members think the idea was theirs in the first place.
c. Reason with staff members that the new idea will save money and allow more free time.
d. Imply that raises will be smaller than anticipated if the new idea is not accepted.
ANS: B
Rationale: Transformational leadership inspires and motivates other people through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises).
Which relational leadership approach is based on mindfulness and emotional intelligence?
a. Resonant
b. Instrumental
c. Participatory
d. Transactional
ANS: A
Rationale: Instrumental and transactional are task-focused. Participatory is based on respect and aims to optimize peoples’ strengths. Resonant is based on mindfulness, emotional intelligence, and openness and responsiveness without judgment.
Systematic reviews related to patient outcomes in nursing homes identified patients and
families responded to this leadership style.
a. Resonant
b. Transactional
c. Instrumental
d. Participatory
ANS: B
Rationale: The transactional style was identified as being more directional and clear-cut in providing resident care.
Nurse outcomes were identified to be predicated on which leadership styles?
a. Participatory and instrumental
b. Resonant and transformational
c. Laissez-faire and transformational
d. Transactional and instrumental
ANS: B
Rationale: Relational leadership approaches were described as influencing positive nurse outcomes. Transactional, laissez-faire, and instrumental are task-focused.
Hospital beds may be closed because of a nursing shortage and the increased amount of
overtime required to care for patients. For you as the nurse leader on the unit, which of the
following leadership approach is most effective to address this issue?
a. Transactional
b. Laissez-faire
c. Autocratic
d. Instrumental
ANS: D
Rationale: Instrumental leadership focuses on choosing strategy and resources to solve a problem.
Leaders with this style strive to maintain productivity and complete tasks that are in line with
the organization’s strategic direction.
Miles is interested in leadership positions within his nursing organization. Although he has
been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital’s succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. Miles is demonstrating attributes of which leadership style?
a. Transformational
b. Laissez-faire
c. Participatory
d. Transactional
ANS: B
Rationale: Laissez-faire leadership uses a hands-off approach allowing others to do the leading. They usually let things happen and do not address problems or assist others in making improvements.
Akash graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behaviour tends to alienate other staff members on the unit. Akash is demonstrating which leadership style?
a. Transformational
b. Participatory
c. Transactional
d. Resonant
ANS: A
Rationale: Leadership involves radiating positive energy and the ability to inspire and motivate others. Transactional leaders are closed-minded and controlling and exhibit negative behaviours using
blame and punishment. Transactional leaders do not consider input from others.
Which of the following nurses is most likely to inspire other professionals to do their best?
a. Nayla, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted.
b. Roger, RN, has been involved in nursing for several years and is well-liked by patients and families. He continually searches for new knowledge and skills, and his sense of humour and optimism are infectious.
c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life.
d. Katrin is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and
regularly checks up on what everyone is doing to ensure that it is done correctly.
ANS: B
Rationale: To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good and who is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire other professionals to achieve their highest level.
The adage “leaders are born and not made” reflects which of the following ideas about leadership?
a. Management can be taught; leadership depends on abilities.
b. Mentorship is important in developing the innate skills of leaders.
c. Leadership is a natural skill that cannot be refined and developed.
d. Succession planning and formal education related to leadership are ineffective.
ANS: A
Rationale: Leadership is an abilities-dependent role that can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned through traditional teaching techniques. Similarly, leadership is a learnable set of practices that requires continued opportunity for application and feedback.
Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings
that budget cuts are likely. She discusses this at the next unit meeting and tells staff members
that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?
a. Transformational
b. Transactional
c. Trusting
d. Truthful
ANS: B
Rationale: Transactional leaders tend to rely on position, power, and reward and punish according to performance and conformity with expectations.
The style of leadership that is exhibited by a nursing manager that indicates to staff that with
all of the budget cuts, there may be lost positions is likely to:
a. Ensure that the organization is financially stable.
b. Stifle innovative thinking about ways to move out of financial jeopardy.
c. Lead to apathy and disinterest in the organizational goals.
d. Lead to decreased attrition of staff on her unit.
ANS: B
Rationale: Whether the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that is demonstrated is likely to maintain the status quo within the organization, without an opportunity to generate more creative and innovative ideas to address the financial issues. Lower staff turnover is associated with
transformational leadership.
Future nursing leaders must consider which of the following concepts? (Select all that apply)
a. Leadership is a skill built over time.
b. Need to develop ongoing reflective practice.
c. Assume everyone has inherent leadership abilities.
d. To develop an intentional action plan.
ANS: A, B, D
Rationale: Nurse leaders of the future must have skills and knowledge related to population trends, and have competencies, which may expand what has traditionally been in nursing curricula. The knowledge, skills and attributes required for effective leadership are multifaceted and complex. As such, leadership is a skill that does not simply involve formal education but is developed over time.
The LEADS framework for leadership is being used to strengthen leadership in many
hospitals. Which of the following are considered elements of the LEAD framework when initiating change? (Select all that apply).
a. Does engage others.
b. Does lead self.
c. Does not pursue building coalitions.
d. Does achieve results.
e. Does not seek system transformation.
ANS: A, B, D
Rationale: Engages others: Without willing, energized, and engaged followers, a leader is unable to
accomplish results on any significant scale. Leads self: Effective leadership is associated with capabilities that can be learned by conscious and intentional effort. Achieves results: Leaders are accountable for managing the resources of the organization to achieve results.
Nurses are becoming engaged professionally through social media. They are able to share
expertise, ideas, and evidence, to become social media leaders at the micro to macro levels.
Which of the following are the outcomes of nurses’ engagement in social media? (Select all that apply).
a. Brings innovation to health care.
b. Shapes expert nurse leadership.
c. Engages nurses and patients.
d. Makes nurses more visible in health care.
ANS: A, B, C, D
Rationale: Social media is allowing more engagement between nurses, patients, and other health care providers, as it facilitates engagement of ideas, and allows for the evidence, opinions, expertise, and resources to be shared globally. It is important that students and registered nurses alike focus on developing their digital and interpersonal skills in order to become social media leaders. Through the use of data and social media listening tools, nurses can begin to understand and gain insight into a variety of issues. By using social media, nurses become visible and accessible role models.
Which of the following is a key function associated with the Canadian healthcare system?
a. Financing.
b. Accessibility.
c. Implementation of insurance programs.
d. Universality.
ANS: A
Rationale: Four key functions are associated with the Canadian healthcare system: (1) stewardship or governance, (2) financing, (3) human and physical resources, and (4) organization and management of service delivery.
What was the main purpose of the establishment of the Health Council of Canada in 2011?
a. Assess health and human resource allocation.
b. Monitor the progress of health care reform.
c. Evaluate the duplication in current scopes of practice.
d. Integrate technology in acute care institutions.
ANS: B
Rationale: As part of the renewal effort, the Health Council of Canada was established to monitor the progress and health outcomes (Health Council of Canada, 2011).
Which criterion of the Canada Health Act prohibits user charges or extra billing?
a. Universality.
b. Accessibility.
c. Public administration.
d. Universality.
ANS: B
Rationale: Accessibility is fulfilled when insured persons must have reasonable and uniform access to
insured health services, free of financial or other barriers. Contributions by patients through
user charges or extra billing are prohibited.
Who is responsible for providing health care funding for recent immigrants?
a. Local institutions.
b. Canada’s Immigrant Council.
c. Federal Government.
d. Provincial Government.
ANS: C
Rationale: The federal government directly funds services to such groups as First Nations and Inuit
people, military personnel, prisoners in federal penitentiaries, and recent immigrants.
A nurse manager at a home health care service has resigned to take a position at a local
ambulatory care centre. To initiate current changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care centre, which is a primary care institution. Primary care institutions are
facilities that provide:
a. Rehabilitative or long-term care.
b. Disease-restorative care.
c. First access to care.
d. Only outpatient services.
ANS: C
Rationale: In an ambulatory care institution, emphasis is placed on providing health maintenance and
chronic or long-term care in a team setting to individuals who have an identified need from
the time of diagnosis or impairment. This definition is consistent with that of primary healthcare.
A social determinant of health:
a. Is predictable of acuity.
b. Is biologic and genetic endowment.
c. Is related mainly to the psychological environment.
d. Has little impact on health status.
ANS: B
Rationale: Biologic and genetic endowment is one of 12 social determinants of health, as identified by the Canadian Nurses Association.
The Canadian Classification of Health Interventions database was created for:
a. Physicians.
b. Registered nurses.
c. Unregulated health care providers.
d. All health provider groups.
ANS: D
Rationale: The Canadian Classification of Health Interventions (Canadian Institute for Health Information, 2009) database includes a standardized list of diagnostic, therapeutic, support, and surgical interventions for all health provider groups.
An academic teaching hospital that provides care for patients who require inpatient and
ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
a. A health care network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.
ANS: B
Rationale: Tertiary care institutions or tertiary hospitals provide highly specialized services (e.g., academic teaching hospitals).
Instituting similarities in services across healthcare regions among provinces and territories is considerably complex because of:
a. A lack of knowledge and skill in their associated use.
b. The vast geographic areas present in the Canadian landscape.
c. Minimal diversity in provincial health care needs.
d. An inability to accurately reflect the exact cost per service provided.
ANS: B
Rationale: Efforts to reduce services to regions may be divisive if they are perceived to distribute funds unfairly or inequitably between similar regions within a province. Instituting similarities
across healthcare regions is also considerably complex because of the vast geographic areas and diversity present in Canadian contexts.
Samuel, a 4-year-old boy, has just received a diagnosis in the clinic of an extremely rare medical condition. The family is counselled that Samuel will be referred to which type of care?
a. Primary.
b. Secondary.
c. Tertiary.
d. Quaternary.
ANS: D
Rationale: Quaternary centres provide treatment of extremely rare medical conditions (they are
generally part of a large, tertiary care hospital).
In Canada, which of the following has the most authority over the management and delivery of health care?
a. Hospital board of directors.
b. Regional health boards.
c. Provincial government.
d. Federal government.
ANS: C
Rationale: Provinces and territories have the most authority over the organization, management, and delivery of health care.
which of the following has placed a considerable strain on the Canadian health care system?
a) decreasing costs
b) a stable economy
c) increase in elderly population
d) status quo health care services
ANS: C
Rationale: Scarce resources, increasing costs, a variable economy, an anticipated increase in the
number of elderly people who will require care, and a growing demand for improvement in
health care have placed considerable strain on the Canadian health care system.
The Office of Nursing Policy is an advisory body for:
a) the Canadian Nurses Association
b) The Canada Health Act Implementation Committee
c) Health Canada
d) Provincial and territorial ministries of health
ANS: C
rationale: The Office of Nursing Policy is an advisory body within Health Canada that advises Health
Canada on nursing perspectives, healthcare-related policies, issues, and programs.
Which response is not a tenet of Strengths-Based Nursing Leadership?
a. Understands the significance of subjective reality and created meaning.
b. Values self-determination.
c. Resides within the organization.
d. Recognizes the uniqueness of staff, nurse leaders, and the organization.
ANS: C
Rationale: Principles of Strengths-Based Nursing Leadership recognize the uniqueness of staff, nurse leaders and the organization, value self-determination, understand the significance of subjective reality and created meaning, and focus on the person, not the organization.
Expanding the scope of practice for nurses is expected to? (Select all that apply.)
a. Reduce the number of unregulated care workers.
b. Improve access to care.
c. Increase work efficiency.
d. Alleviate the costs of delivering care.
ANS: B, C, D
Rationale: Expanding the scope of practice for nurses is expected to alleviate the costs of delivering
care, improve access to care, and increase work efficiency. In Canada, unregulated health
care providers have been assigned some traditional nurse tasks, such as administering
routine medication and obtaining routine vital signs, and the number of unregulated health
care providers (UCPs) have increased.
Implementing electronic health records (EHRs) and other health information technology as widely as possible in Canada is to ensure: (Select all that apply.)
a. Delivery of better quality of care.
b. Delivery of more efficient health services.
c. Reducing errors.
d. Reducing health care costs.
ANS: A, B, C
Rationale: Canada Health Infoway was established in 2001 as a not-for-profit organization funded by
the federal government to work with healthcare organizations and others to foster and
“accelerate the development, adoption and effective use of digital health innovations across
Canada . . . [to] help deliver better quality and access to care and more efficient delivery of
health services for patients and clinicians” (Canada Health Infoway, 2014, p. 1).
Which of the following recommendations are included in the First Ministers’ 10-Year
Plan to Strengthen Health Care (2004)? (Select all that apply.)
a. Increase funds for the supply of health care professionals.
b. Implement primary health care.
c. Introduce the use of electronic records.
d. Develop primary care.
ANS: A, C, D
Rationale: Included in the plan were recommendations to decrease wait times; increase funds for home care, aboriginal health care, and supply of health care professionals; introduce the use of electronic records; and develop primary care. Primary care, not primary health care, was
included in this plan.
Canada’s regulated nursing workforce was the slowest in 10 years in 2017 at 0.7%
compared to 1.3% to 2.8% over the past decade. This decline is related to which of the
following factors? (Select all that apply.)
a. Increase in part-time and casual positions.
b. Growing number leaving the profession late in their careers.
c. Increase in application to nursing degree programs.
d. Declining number of new nursing graduates.
ANS: A, B, D
Rationale: This slowed growth is attributed to the declining number of new nursing graduates, the growing number leaving the profession late in their careers and an increase in part-time and casual positions (CIHI, 2017). An increase in application to nursing degree programs is not a factor in a declining workforce as the number of applications is not indicative of an increasing number of new graduates.
A hospital and a nursing education program form a partnership to recruit more nurses to the region. This organizational structure is:
a. Being responsive to changes in the environment.
b. Being bureaucratic.
c. Creating permanent professional boundaries.
d. Delineating structures for all decision making.
ANS: A
Rationale: Shared decision making across organizations can lead to growth and responsiveness in meeting emerging needs.
A hospital is working toward becoming a Magnet hospital. The chief nursing officer is
aware that professional nursing departments of the future will:
a. Not be directed by nurses.
b. Be virtual organizations.
c. Be designed to maintain nursing standards of practice.
d. Be entitled to have patient care departments.
ANS: C
Rationale: Professional nursing departments of the future will be focused on patient care outcomes and nursing satisfaction.
The chief nursing officer and the dean of the school of nursing believe that by establishing
rules and regulations and controlling the environment, this partnership will:
a. Promote professional medical authority, autonomy, and responsibility.
b. Diminish quickly with no central figure.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.
ANS: B
Rationale: Centralized decision-making structures that emphasize high control, and rules and regulations that lay out expectations, can be slow to respond to emerging trends.
Organizations that are controlled in a heavily centralized way can diminish quickly without the strong central figure.
A nurse manager understands that a matrix organizational structure:
a. Is a simplified organizational structure.
b. Has both a functional manager and a service or product-line manager.
c. Arranges departments strictly according to function.
d. Promotes harmony in organizational decision making.
ANS: B
Rationale: Matrix structures are complex, integrated organizational structures that involve both functional managers and service or product-line managers. In this structure, team members
or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager. Harmony or disharmony cannot be assumed.
Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure:
a. Has many divisions of labour.
b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
d. Places the authority for decision making closest to the places where workers
perform.
ANS: C
Rationale: Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.
In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to:
a. Reflect the culture of the unit and its values.
b. Be developed by the nursing manager on the unit.
c. Identify the patients who will be served on the unit.
d. Replicate the organization’s philosophy.
ANS: A
Rationale: The philosophy needs to state what the nurse manager and staff believe is the vision for
nursing management and practice, and sets the stage for establishing goals to make the
vision a reality. It is complementary to the organizational philosophy, but reflects the values of nursing. Shared governance enables staff and management to develop a vision and is congruent with contemporary views of management. The identification of patients to be served reflects a mission statement.
The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of patients.
c. Interview and hire staff nurses for designated nursing units.
d. Be granted functional authority to determine standards of nursing care and enforce
them.
ANS: A
Rationale: Staff positions provide support to line positions but have no direct accountability for staff or patient outcomes and therefore function through influence.
A new director of nursing in a small rural hospital wants to make changes from the
traditional model of governance to a shared-governance model. Of the following
characteristics, which best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for patients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated?
a. Bureaucratic.
b. Decentralized.
c. Delegated authority and responsibility.
d. Delegated responsibility but no authority.
ANS: D
Rationale: In traditional structures, decision-making authority is held by a centralized decision-making body; thus staff members have responsibility for certain functions but do not participate in decisions related to those functions.
The chief nursing officer is given the task of reviewing and revising the organization’s
mission, philosophy, and technology. In reviewing them, the chief nursing officer
understands that they should be reflected in:
a. The organizational structure.
b. Line and staff responsibilities.
c. The policies and procedures.
d. Government regulations.
ANS: A
Rationale: The mission statement is an important foundation for the organizational structure and
defines technology and human resources required for the organization.
The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you:
a. Know that this challenge is their issue and that it has nothing to do with your unit.
b. Understand that such events are localized and do not have an effect on the
organizational culture.
c. Know that the nature of challenges and reorganization in facilities will have an
effect on other areas.
d. Anticipate that your prior experiences with facilities have no effect on the current
situation.
ANS: C
Rationale: By nature, a system such as an organization is an interacting collection of parts that together function as the whole. Changes in one part affect other parts and the system as a whole.
“Bayshore Hospital will provide care that is a national example of consumer service” is a:
a. Vision statement.
b. Statement of philosophy.
c. Mission statement.
d. Rationale for care.
ANS: A
Rationale: A vision statement is an articulated goal that provides an inspirational target to which the organization aspires.
“At Thoroughcare, we provide health care for women and children in transition” is an
example of a:
a. Vision statement.
b. Mission statement.
c. Goal statement.
d. Statement of philosophy.
ANS: B
Rationale: Mission statements provide a reason or rationale for the existence of the organization and are indicative of the structure of the organization and of whom consumes the services provided.
Which of the following is the most appropriate mission statement for a nursing centre?
a. “At Wellness, we provide rehabilitative services for addicted adolescents.”
b. “Georgetown provides treatment and prevention services for county residents.”
c. “At Heart, our aim is to provide services that lead the nation in health education
and research.”
d. “At Coeur, we strive to achieve optimal pain management with patients who are
experiencing chronic pain.”
ANS: D
Rationale: The mission statements of nursing centres are oriented toward achieving optimal health status for a defined group of patients or consumers.
Which of the following most influences the organizational structure of the organization?
a. Mission statement.
b. Statement of philosophy.
c. Vision statement.
d. Goal statement.
ANS: A
Rationale: Mission statements specify the reasons for the organization’s existence and include the population served and services offered, which, in turn, influence which technologies and human resources will be required.
In which of the following situations would you expect low morale and frustration?
a. Statement of philosophy indicates “We value our staff.” When staff members
resign, careful evaluation is done to determine whether staff should be replaced by
full- or part-time employees.
b. Practices include annual staff recognition celebrations. During times of change,
staff members are actively included in issue identification and solution finding.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions
are given only to individuals with long-standing service and entrenched
relationships.
d. The vision indicates that there is strong commitment to lead in research. The
organization has tried to implement a strong campaign to attract leading nurse
researchers but has experienced difficulty in doing so.
ANS: C
Rationale: Although frustration may occur with external factors that affect ability to act on values and aspirations, lack of congruence between what is espoused as a value within the organization, such as promising advancement as an incentive to join the organization, and what is actually done, such as restricting advancement to internal candidates with much organizational history, can cause low morale and confusion.
At Limeville Hospital, the nursing department is developing a mission statement for nursing. Which of the following would be a suitable mission statement?
a. “Nursing provides services for patients admitted to Limeville Hospital.”
b. “Nurses participate fully in the professional services offered by Limeville
Hospital.”
c. “Limeville Hospital leads by the lamp, providing services for seniors.”
d. “At Limeville, the nursing department provides caring services that recognize the
diversity of patients and promote optimal health with patients through partnership
and education and in close partnership with other disciplines.”
ANS: D
Rationale: A nursing mission statement within an organization needs to establish the reason for nursing within the organization and specifies relationships with patients, the community, and members of other disciplines.
At Hospital XYZ, the current head nurse on unit Y3 is the third in 3 years. Donna, the
current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna’s effectiveness as a leader. They were told that the problem is probably staff related, that it is simply an unhappy group, and that nothing further will be done about their concerns. The philosophy of the organization
indicates that “open, transparent communication between staff and management is desired and supported” and that “innovation and creative thinking are the foundation of the organization’s progress.” In assessing this situation as a newly hired senior executive, you anticipate that:
a. Staff members will resolve the conflict on their own.
b. The situation will lead to ongoing disgruntlement and attrition.
c. No further discussion or concerns will come out of the situation.
d. The head nurse will be able to resolve the conflict on her own.
ANS: B
Rationale: Lack of congruence between the stated philosophy of the hospital and the experienced organizational culture does not support either the staff or the head nurse and will probably result in ongoing frustration and increased attrition.
In the Unity Health Care organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is
delineated by procedures and protocols. This exemplifies:
a. Transformational leadership.
b. Transactional leadership.
c. Bureaucratic organization.
d. Chaos theory.
ANS: C
Rationale: Organizational structure refers to the organization of a work group, rather than to its leadership, and includes where decisions are made and relationships between groups. In the example given, power is centrally located. All decisions regarding policies and procedures flow from this central location, which is characteristic of bureaucratic organizations. In organizations in which chaos theory is exemplified, decision making and accountability are decentralized.
In a health care agency that has a bureaucratic organization, communication flows:
a. Laterally.
b. Bottom to top.
c. Top to bottom.
d. Intermittently.
ANS: C
Rationale: In a bureaucratic organization, communication flows vertically from top to bottom.
A statement such as “We believe in the right of patients to make choices and to have care
that is sensitive to their preferences and needs” is a _____ statement.
a. Mission.
b. Goal.
c. Vision.
d. Philosophy.
ANS: D
Rationale: Philosophy statements capture significant beliefs and values of the organization.
What are key features of positive organizational culture? (Select all that apply.)
a. Supports professional development of members.
b. Promotes positive perceptions of unit leadership and workplace empowerment.
c. Respects values and norms.
d. Promotes new ways of improving practice.
ANS: A, B, C, D
Rationale: Organizational culture can be effective and promote success and positive outcomes, or it can be ineffective and result in disharmony, dissatisfaction, and poor outcomes for patients,
staff, and the organization. These key features reflect positive outcomes for the organization.
A nurse manager working in a hospital-based matrix structure understands that: (Select all
that apply.)
a. This structure includes reporting to both a functional manager and a service- or
product-line manager
b. This structure can be effective in the current health care environment
c. This structure leads to a decrease in bureaucracy
d. This structure permits better cross-communication among various organizational
units or departments
ANS: A, B, D
Rationale: A matrix structure causes an increase in bureaucracy, while a manager in this structure reports to different managers, thereby increasing better communication and effectiveness in health care.
Shared governance is a flat type of organizational structure that: (Select all that apply.)
a. Helps nursing staff have more autonomy to govern their practice.
b. Has a foundation of accountability.
c. Provides the functional areas needed to support professional practice.
d. Requires new behaviours of all staff.
ANS: A, B, C, D
Rationale: A shared governance model embraces that the structure’s foundation is the professional workplace rather than an organizational hierarchy and leads to nurse satisfaction and sense of empowerment.
Organizational culture includes: (Select all that apply.)
a. Norms.
b. Traditions.
c. Behaviours.
d. Values.
ANS: A, B, C, D
Rationale: Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviours that illustrate values and beliefs.
Complex care of acutely ill patients is required on a surgical unit in which differentiated nursing practice is its model of care delivery. The concept of differentiated nursing practice is based on:
a. Licensure status.
b. Experience in the agency.
c. Leadership capabilities.
d. Education and expertise.
ANS: D
Rationale: In differentiated nursing practice, rules are structured according to education and experience.
The relief charge nurse has assigned a newly registered baccalaureate-prepared nurse to be one of the team leaders for the shift from 1500 to 2300 hours. In making this decision, the charge nurse has overlooked this nurse’s:
a. Clinical expertise.
b. Leadership ability.
c. Communication style.
d. Conflict-resolution skills.
ANS: A
Rationale: The effective functioning of teams in this model is heavily reliant on the leadership, organization, and communication skills of the leader, in addition to comfort and confidence in providing care to a specific patient group. Although leadership and critical thinking are part of basic education in baccalaureate programs, the new registered nurse (RN) needs time to develop clinical confidence and expertise.
When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and in which the RNs handle all intravenous medications, admissions, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a. The case method.
b. Functional nursing.
c. Primary nursing.
d. Nurse case management.
ANS: B
Rationale: The functional care delivery model depends on the decision of care according to tasks or functions that are assigned to specific teams or team members.
You are the nurse manager of a nursing service organization that provides around-the-clock
care to patients in their homes. To achieve an optimal outcome for a patient who is
recovering from a hip replacement, the nursing staff will probably follow the nursing care guidelines presented in which of the following?
a. Nursing care plan.
b. Physician’s orders.
c. Critical pathway.
d. Clinical practice guidelines.
ANS: C
Rationale: A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care, and to optimize patient outcomes.
The nurse case manager is working with a patient admitted for end-stage renal disease. The
case manager’s major goal during this hospitalization is to:
a. Implement the care map on admission.
b. Provide direct nursing care throughout the hospitalization.
c. Supervise the nursing staff members who implement the care map.
d. Prevent the need for additional hospitalizations resulting from complications of the
patient’s disease.
ANS: D
Rationale: The goals and outcomes established in a care map or critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of the need for hospital readmissions.
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model.
Which of the following methods would be the most cost effective?
a. Functional method.
b. Case management method.
c. Primary care method.
d. Team method.
ANS: B
Rationale: Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable use of various types of health care providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost effective in patient care settings that have the potential for high resource consumption, such as settings with medically complex cases, through collaboration and close attention to outcomes.
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
a. Baccalaureate.
b. Associate,
c. Diploma.
d. Licensed practical nurse/licensed vocational nurse.
ANS: A
Rationale: Because of the breadth of nursing knowledge required, baccalaureate education is preferred
for primary nurses.
In a small rural nursing home a director of nursing decides to implement a partnership
model, because of a shortage of nurses, to help with certain tasks. What combination of
health care providers constitutes a partnership care delivery model?
a. RN and licensed practical nurse/licensed vocational nurse.
b. RN and RN.
c. RN and medication assistants.
d. RN and certified nurses’ aides.
ANS: C
Rationale: The partnership care delivery model is a variation of primary nursing in which an RN works with a medication assistant, who performs basic nursing functions.
The case method of care delivery could be best justified for which of the following
scenarios?
a. Stable patient population with long-term care and family needs.
b. Acute care surgical unit with predictable postsurgical outcomes and many
technical procedures.
c. Pediatric intensive care unit that heavily involves families and also patients.
d. Home health care environment with patients who have varying degrees of acute
illness.
ANS: C
Rationale: The setting in which the case method of delivery can be most justified is the pediatric
intensive care unit, in which the status of patients can rapidly change and complex functions
of care involve both patients and families.
During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
a. Case method.
b. Team nursing.
c. Functional nursing.
d. Nurse case management.
ANS: A
Rationale: The case method may involve an RN’s treatment of the “total patient.” Employment of the most highly paid nursing personnel (RNs) for all patient care is the most expensive model and may be difficult to operationalize in times of RN shortage.
A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask
one nurse for my pills, and she says, ‘That is not my job.’ I ask the pill nurse about my lab
tests, and she says that I should ask another nurse.” The nursing care delivery model most
likely to be employed in this situation is
a. Differentiated practice.
b. Team nursing.
c. Functional nursing.
d. Case management.
ANS: C
Rationale: In functional nursing, licensed and unlicensed personnel perform specific tasks for a large number of patients. A disadvantage of this system is that care is assigned by task and not by patient, which can leave patients with the experience of multiple caregivers and a sense of confusion.
The functional nursing model might be particularly effective in which of the following?
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient–provider conflict.
d. Developing competence and confidence in unlicensed workers.
ANS: D
Rationale: An advantage of functional nursing is that both unlicensed assistive personnel and licensed staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient’s nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.
For a nurse manager in the functional nursing model, which approach will assist in
maintaining staff satisfaction in this specific model?
a. Rotation of task assignments.
b. Frequent opportunities for in-service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.
ANS: A
Rationale: Although repetition of tasks increases confidence and competence, it can also lead to
boredom. In-service opportunities, adequate orientation, and building a team culture are strategies that are important to all models, but rotation of tasks can specifically reduce the boredom that is a potential disadvantage of this model.
In comparing team and functional models of care, a nurse manager favours the team model. In particular, she finds that the team model:
a. Can be effective in recognizing individual strengths and backgrounds of staff
members.
b. Promotes autonomy and independence of the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients with the use of a staffing
mix.
ANS: A
Rationale: Team nursing delivers care to a small group of patients; the team is a mix of licensed and unlicensed personnel. Assignment is based on the needs and background of the patient and on the strengths, licensure, and roles of team members. Team functioning and satisfaction
can be compromised unless the team leader has strong delegation, communication, and
leadership skills.
To effectively delegate in a team nursing environment, the RN team leader must be familiar
with the legal and organizational roles of each group of personnel and must:
a. Be able to effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to the supervisor.
ANS: C
Rationale: A particular challenge in team nursing is that staff mixes and personnel may change daily because of individual schedules and shortages.
A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in which way?
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Time period of accountability.
d. Levels and types of assessment.
ANS: C
Rationale: Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from a patient’s time of admission to discharge and 24 hours a day during the hospital stay.
A conflict develops between an associate nurse and a primary nurse over the assessment of a
patient with pulmonary edema. On the basis of her assessment of the patient, the associate
nurse insists that it is her role to change the care plan because she is the one who has made
the assessment. As the nurse manager, you clarify that:
a. It is the role of the primary nurse to make alterations on the basis of assessment
data and input.
b. The associate nurse is accountable and responsible while the primary nurse is off
duty and therefore is able to alter the care plan.
c. Neither the primary nurse nor the associate nurse should make changes without
first consulting you as the manager.
d. It really does not matter who alters the nursing care plan because it depends on
situation and time to do so.
ANS: A
Rationale: The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of
care and therefore for altering it with the input of an associate. The associate is responsible
for implementation of the care plan that has been established when the primary nurse is off
duty.
