,Chapter 01: Leading, Managing, and Following
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Yoder-Wise: Leading and Managing in Nursing, 8th Edition
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MULTIPLE CHOICE n7
1. A nurse manager of a 20-
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bed medical unit finds that 80% of the patients are older adults. She is asked to assess and
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adapt the unit to better meet the unique needs of the older adult patient. Using complexity
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
principles, what would be the best approach to take for implementation of this change?
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a. Leverage the hierarchical management position to get unit staff involved i
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n assessment and planning.
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b. Engage involved staff at all levels in the decision-making process.
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c. Focus the assessment on the unit and omit the hospital and communit
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y environment. n7
d. Hire a geriatric specialist to oversee and control the project.
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ANS: B n 7
Complexity theory suggests that systems interact and adapt and that decision making occu
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
rs throughout the systems, as opposed to being held in a hierarchy. In complexity theory,
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
every voice counts, and therefore, all levels of staff would be involved in decision makin
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
g.
TOP: AONE competency: Communication and Relationship-Building
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2. A unit manager of a 25-
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bed medical/surgical area receives a phone call from a nurse whohas called in sick five ti
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mes in the past month. He tells the manager that he very much wants to come to work w
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
hen scheduled but must often care for his wife, who is undergoing treatment for breast ca
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ncer. According to Maslow‘s need hierarchy theory, what would be the best approach to
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satisfying the needs of this nurse, other staff, and patients?
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a. Line up agency nurses who can be called in to work on short notice.
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b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
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c. Sympathize with the nurse‘s dilemma and let the charge nurse know that this nur n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
se may be calling in frequently in the future.
n7 n7 n7 n7 n7 n7 n7 n 7
d. Work with the nurse, staffing office, and other nurses to arrange hisschedul
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ed days off around his wife‘s treatments.
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ANS: D n 7
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic nee
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ds and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
patient care and threaten the needs of staff to feel competent. Arranging the schedule arou
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
nd the wife‘s needs meets the needs of the staff and of patients while satisfying the nurse‘s
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need for affiliation.
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TOP: AONE competency: Communication and Relationship-Building
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3. A grievance brought by a staff nurse against the unit manager requires mediation. At the fi
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rst mediation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, an
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d the unit manager continues to reiterate the reasons for the actions. What would be the bes
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t course of action at this time?
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a. Send the two disputants away to reach their own resolution.
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b. Involve another staff nurse in the discussion for clarity issues.
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, c. Ask each party to examine their own motives and issues in the conflict.
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d. Continue to listen as the parties repeat their thoughts and feelings about th
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
e conflict.
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ANS: C n7
For resolution of conflict, one should address the interests and involvement of participants i
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n the conflict by examining the real issues of all parties.
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TOP: AONE competency: Communication and Relationship-Building
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4. At a second negotiation session, the unit manager and staff nurse are unable to reach
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n7 a resolution. What is the appropriate next step?
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a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
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b. Elevate the next negation session to the next manager, one level above.
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c. Insist that participants continue to talk until a resolution has been reached.
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d. Back the unit manager‘s actions and end the dispute.
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ANS: B n7
Part of leadership is understanding conflict resolution and ability to negotiate and manage fo
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r resolution of issues and concerns. This situation has failed a second negotiation session, e
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
levation to a manager with additional training to facilitate conflict resolution is important a
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
t this point.
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TOP: AONE competency: Communication and Relationship-Building
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5. The manager of a surgical area has a vision for the future that requires the addition of RN
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7assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the sta
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ff have always practiced in a primary nursing-
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delivery system and are very resistant to this idea. What would be the best initial strategy f
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or implementation of this change?
n7 n7 n7 n7
a. Exploring the values and feelings of the RN group in relationship to this change
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b. Leaving the RNs alone for a time so they can think about the change before it
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n
is implemented 7 n7
c. Dropping the idea and trying for the change in a year or so when some of t
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
he present RNs have retired n7 n7 n7 n7
d. Hiring the assistants and allowing the RNs to see what good additions they are
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ANS: A n7
Influencing others requires emotional intelligence in domains such as empathy, handling re
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
lationships, deepening self- n7 n7
awareness in self and others, motivating others, and managing emotions. Motivating others
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n
7recognizes that values are powerful forces that influence acceptance of change. Leaving the
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
RNs alone for a period of time before implementation does not provide opportunity to expl
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ore different perspectives and values. Avoiding discussion until the team changes may not
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
promote adoption of the change until there is opportunity to explore perspectives and value
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
s related to the change. Hiring of the assistants demonstrates lack of empathy for the persp
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ectives of the RN staff. n7 n7 n7 n7
TOP: AONE competency: Knowledge of the Health Care Environment
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, 6. As the RN charge nurse on the night shift in a small long-
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term care facility, you‘ve found that there is little turnover among your LPN and nursing a
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ssistant (NA) staff members, but they are not very motivated to go beyond their job descri
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ptions in their work. Which of the following strategies might motivate the staff and lead t
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
o greater job satisfaction?
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a. Ask the director of nursing to offer higher wages and bonuses for extra work f
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or the night LPNs and NAs.
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b. Allow the LPNs and NAs greater decision-n7 n7 n7 n7 n7 n7
making power within the scope of their positions in the institution.
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c. Hire additional staff so that there are more staff available for enhanced care,an
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n
d individual workloads are lessened.
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d. Ask the director of nursing to increase job security for night staff by having the
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m sign contracts that guarantee work.
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ANS: B n7
Hygiene factors such as salary, working conditions, and security are consistent with Herzbe
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rg‘s two- n7
factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator facto
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rs such as recognition and satisfaction with work promote a satisfying and enriched work e
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nvironment. Transformational leaders use motivator factors liberally to inspire work perform
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ance and increase job satisfaction.
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TOP: AONE competency: Communication and Relationship-Building
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7. The nurse manager wants to increase motivation by providing motivating factors for thenur
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se on the unit. What action would be appropriate to motivate the staff?
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a. Collaborate with the human resource/personnel department to develop on- n7 n7 n7 n7 n7 n7 n7 n7
site daycare services. n7 n7
b. Provide a hierarchical organizational structure. n7 n7 n7 n7
c. Implement a model of shared governance. n7 n7 n7 n7 n7
d. Promote the development of a flexible benefits package.n7 n7 n7 n7 n7 n7 n7
ANS: C n7
Complexity theory suggests that systems interact and adapt and that decision making occurs
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throughout systems, as opposed to being held in a hierarchy. In complexity theory, every v
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
oice counts, and therefore all levels of staff would be involved in decision making. This pr
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inciple is the foundation of shared governance.
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TOP: AONE competency: Communication and Relationship-Building
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8. The nurse manager has been asked to implement an evidence-
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based approach to teach ostomy patients self-
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management skills postoperatively. The program is to be implemented across the entire faci
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lity. What illustrates effective leadership in this situation?
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a. The training modules are left in the staff room for times when staff are available.
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b. The current approach is continued because it is also evidence-
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based and is more familiar to staff. n7 n7 n7 n7 n7 n7
c. You decide to implement the approach at a later date because of feedback from t
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he RNs that the new approach takes too much time.
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d. An RN who is already familiar with the new approach of volunteers to take t
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he lead in mentoring and teaching others how to implement it.
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ANS: D n7
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Yoder-Wise: Leading and Managing in Nursing, 8th Edition
n7 n7 n7 n7 n7 n7 n7
MULTIPLE CHOICE n7
1. A nurse manager of a 20-
n7 n7 n7 n7 n7
bed medical unit finds that 80% of the patients are older adults. She is asked to assess and
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
adapt the unit to better meet the unique needs of the older adult patient. Using complexity
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
principles, what would be the best approach to take for implementation of this change?
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
a. Leverage the hierarchical management position to get unit staff involved i
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
n assessment and planning.
n7 n7 n7
b. Engage involved staff at all levels in the decision-making process.
n7 n7 n7 n7 n7 n7 n7 n7 n7
c. Focus the assessment on the unit and omit the hospital and communit
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
y environment. n7
d. Hire a geriatric specialist to oversee and control the project.
n7 n7 n7 n7 n7 n7 n7 n7 n7
ANS: B n 7
Complexity theory suggests that systems interact and adapt and that decision making occu
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
rs throughout the systems, as opposed to being held in a hierarchy. In complexity theory,
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
every voice counts, and therefore, all levels of staff would be involved in decision makin
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
g.
TOP: AONE competency: Communication and Relationship-Building
n7 n7 n7 n7 n7
2. A unit manager of a 25-
n7 n7 n7 n7 n7
bed medical/surgical area receives a phone call from a nurse whohas called in sick five ti
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
mes in the past month. He tells the manager that he very much wants to come to work w
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
hen scheduled but must often care for his wife, who is undergoing treatment for breast ca
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ncer. According to Maslow‘s need hierarchy theory, what would be the best approach to
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
satisfying the needs of this nurse, other staff, and patients?
n7 n7 n7 n7 n7 n7 n7 n7 n7
a. Line up agency nurses who can be called in to work on short notice.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
c. Sympathize with the nurse‘s dilemma and let the charge nurse know that this nur n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
se may be calling in frequently in the future.
n7 n7 n7 n7 n7 n7 n7 n 7
d. Work with the nurse, staffing office, and other nurses to arrange hisschedul
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ed days off around his wife‘s treatments.
n7 n7 n7 n7 n7 n7
ANS: D n 7
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic nee
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ds and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
patient care and threaten the needs of staff to feel competent. Arranging the schedule arou
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
nd the wife‘s needs meets the needs of the staff and of patients while satisfying the nurse‘s
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
need for affiliation.
n7 n7 n7
TOP: AONE competency: Communication and Relationship-Building
n7 n7 n7 n7 n7
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the fi
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
rst mediation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, an
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
d the unit manager continues to reiterate the reasons for the actions. What would be the bes
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
t course of action at this time?
n7 n7 n7 n7 n7 n7
a. Send the two disputants away to reach their own resolution.
n7 n7 n7 n7 n7 n7 n7 n7 n7
b. Involve another staff nurse in the discussion for clarity issues.
n7 n7 n7 n7 n7 n7 n7 n7 n7
, c. Ask each party to examine their own motives and issues in the conflict.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
d. Continue to listen as the parties repeat their thoughts and feelings about th
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
e conflict.
n7
ANS: C n7
For resolution of conflict, one should address the interests and involvement of participants i
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
n the conflict by examining the real issues of all parties.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
TOP: AONE competency: Communication and Relationship-Building
n7 n7 n7 n7 n7
4. At a second negotiation session, the unit manager and staff nurse are unable to reach
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
n7 a resolution. What is the appropriate next step?
n7 n7 n7 n7 n7 n7 n 7
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
b. Elevate the next negation session to the next manager, one level above.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
c. Insist that participants continue to talk until a resolution has been reached.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
d. Back the unit manager‘s actions and end the dispute.
n7 n7 n7 n7 n7 n7 n7 n7
ANS: B n7
Part of leadership is understanding conflict resolution and ability to negotiate and manage fo
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
r resolution of issues and concerns. This situation has failed a second negotiation session, e
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
levation to a manager with additional training to facilitate conflict resolution is important a
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
t this point.
n7 n7
TOP: AONE competency: Communication and Relationship-Building
n7 n7 n7 n7 n7
5. The manager of a surgical area has a vision for the future that requires the addition of RN
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n
7assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the sta
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ff have always practiced in a primary nursing-
n7 n7 n7 n7 n7 n7 n7
delivery system and are very resistant to this idea. What would be the best initial strategy f
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
or implementation of this change?
n7 n7 n7 n7
a. Exploring the values and feelings of the RN group in relationship to this change
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
b. Leaving the RNs alone for a time so they can think about the change before it
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n
is implemented 7 n7
c. Dropping the idea and trying for the change in a year or so when some of t
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
he present RNs have retired n7 n7 n7 n7
d. Hiring the assistants and allowing the RNs to see what good additions they are
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ANS: A n7
Influencing others requires emotional intelligence in domains such as empathy, handling re
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
lationships, deepening self- n7 n7
awareness in self and others, motivating others, and managing emotions. Motivating others
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n
7recognizes that values are powerful forces that influence acceptance of change. Leaving the
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
RNs alone for a period of time before implementation does not provide opportunity to expl
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ore different perspectives and values. Avoiding discussion until the team changes may not
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
promote adoption of the change until there is opportunity to explore perspectives and value
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
s related to the change. Hiring of the assistants demonstrates lack of empathy for the persp
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ectives of the RN staff. n7 n7 n7 n7
TOP: AONE competency: Knowledge of the Health Care Environment
n7 n7 n7 n7 n7 n7 n7 n7
, 6. As the RN charge nurse on the night shift in a small long-
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
term care facility, you‘ve found that there is little turnover among your LPN and nursing a
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ssistant (NA) staff members, but they are not very motivated to go beyond their job descri
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
ptions in their work. Which of the following strategies might motivate the staff and lead t
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
o greater job satisfaction?
n7 n7 n7
a. Ask the director of nursing to offer higher wages and bonuses for extra work f
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
or the night LPNs and NAs.
n7 n7 n7 n7 n7
b. Allow the LPNs and NAs greater decision-n7 n7 n7 n7 n7 n7
making power within the scope of their positions in the institution.
n7 n7 n7 n7 n7 n7 n7 n7 n7 n7
c. Hire additional staff so that there are more staff available for enhanced care,an
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n
d individual workloads are lessened.
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d. Ask the director of nursing to increase job security for night staff by having the
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m sign contracts that guarantee work.
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ANS: B n7
Hygiene factors such as salary, working conditions, and security are consistent with Herzbe
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rg‘s two- n7
factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator facto
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rs such as recognition and satisfaction with work promote a satisfying and enriched work e
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nvironment. Transformational leaders use motivator factors liberally to inspire work perform
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ance and increase job satisfaction.
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TOP: AONE competency: Communication and Relationship-Building
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7. The nurse manager wants to increase motivation by providing motivating factors for thenur
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se on the unit. What action would be appropriate to motivate the staff?
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a. Collaborate with the human resource/personnel department to develop on- n7 n7 n7 n7 n7 n7 n7 n7
site daycare services. n7 n7
b. Provide a hierarchical organizational structure. n7 n7 n7 n7
c. Implement a model of shared governance. n7 n7 n7 n7 n7
d. Promote the development of a flexible benefits package.n7 n7 n7 n7 n7 n7 n7
ANS: C n7
Complexity theory suggests that systems interact and adapt and that decision making occurs
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throughout systems, as opposed to being held in a hierarchy. In complexity theory, every v
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oice counts, and therefore all levels of staff would be involved in decision making. This pr
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inciple is the foundation of shared governance.
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TOP: AONE competency: Communication and Relationship-Building
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8. The nurse manager has been asked to implement an evidence-
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based approach to teach ostomy patients self-
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management skills postoperatively. The program is to be implemented across the entire faci
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lity. What illustrates effective leadership in this situation?
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a. The training modules are left in the staff room for times when staff are available.
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b. The current approach is continued because it is also evidence-
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based and is more familiar to staff. n7 n7 n7 n7 n7 n7
c. You decide to implement the approach at a later date because of feedback from t
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he RNs that the new approach takes too much time.
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d. An RN who is already familiar with the new approach of volunteers to take t
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he lead in mentoring and teaching others how to implement it.
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ANS: D n7
