Exam TEST_BANK
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. 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 the older adult patient. Using 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
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, every voice counts, and therefore,
all levels of staff would be involved in decision making.
REF: Page 8 TOP: AONE competency: Communication and Relationship-Building
2. 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. According to
Maslow’s need hierarchy theory, 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
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs and demotivate
the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of
staff to feel competent. Arranging the schedule around the wife’s needs meets the needs of the staff and of
patients while satisfying the nurse’s need for affiliation.
REF: Page 10 TOP: AONE competency: Communication and Relationship-Building
3. 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 her 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
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests
and involvement of participants in the conflict by examining the real issues of all parties.
,REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It
would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off
period. b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the
dispute. ANS: B
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is recommended
if resolution fails.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of 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 and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is implemented. c.
Dropping the idea and trying for the change in a year or so when some of the present RNs have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling relationships,
deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others
recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a
period of time before implementation does not provide opportunity to explore different perspectives and
values. Avoiding discussion until the team changes may not promote adoption of the change until there is
opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack
of empathy for the perspectives of the RN staff.
REF: Page 7 | Page 15
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that there is little
turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go
beyond their job descriptions in their work. Which of the following strategies might motivate the staff and
lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and
NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the
institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are
lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign contracts that
guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg’s two-factor
theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and
satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use
motivator factors liberally to inspire work performance and increase job satisfaction.
,REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating factors, which action
would you select?
a. Collaborate with the human resource/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
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout
systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore
all levels of staff would be involved in decision making. This principle is the foundation of shared
governance.
REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins
to complain loudly about the quality of care his mother is receiving. His behavior 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 behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent
practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b.
Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to
envision the context of what is happening as well as being able to manage emotions such as frustration
effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
9. 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 feel it is insulting to be required to participate in a
competency program. Which behavior 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 JCAHO accreditation.
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
The manager role involves guiding others through a set of derived practices that are evidence-based and known
to satisfy preestablished outcomes such as participation in a competency program. This involves engagement
of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the
PPACA suggests that no health reform can unfold without active nursing engagement. Each document
emphasizes that nurses must lead, manage, and behave as active collaborators with other members of the
health team and with those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
, 10. As the manager, you have been asked to implement an evidence-based approach to teach ostomy
patients self-management skills postoperatively that is being operationalized throughout your organization.
Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs that the
new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and
teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered
to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes.
Followership promotes good clinical decisions and use of clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
11. You overhear a newly graduated RN telling one of your colleagues that leadership and management
belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating
understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence may affect
the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related
to the general perception that nurse leaders and managers are not satisfied in their jobs. ANS: B
Care coordination that involves the intersection of individual, family, and community-based needs requires
that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead
and manage. There is often a view that leadership is isolated to those holding managerial positions and that a
direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge
that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-
care
and beyond.
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously very upset
and after you speak with him regarding his behavior, you determine that he has not slept for three nights
because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an “ugly, old man.”
You acknowledge her feelings and concerns and then suggest that Mr. Smith’s behavior was aggressive but is
related to lack of sleep and to pain. You say to Miss Jones, “Can you both, together with Mr. Smith,
determine triggers for the pain and effective approaches to controlling his pain?” This approach
demonstrates: a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr.
Smith. c. Leadership behavior.
d. Management
behavior. ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient
symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision
making in
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th Edition
MULTIPLE CHOICE
1. 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 the older adult patient. Using 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
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, every voice counts, and therefore,
all levels of staff would be involved in decision making.
REF: Page 8 TOP: AONE competency: Communication and Relationship-Building
2. 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. According to
Maslow’s need hierarchy theory, 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
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs and demotivate
the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of
staff to feel competent. Arranging the schedule around the wife’s needs meets the needs of the staff and of
patients while satisfying the nurse’s need for affiliation.
REF: Page 10 TOP: AONE competency: Communication and Relationship-Building
3. 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 her 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
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests
and involvement of participants in the conflict by examining the real issues of all parties.
,REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It
would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off
period. b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the
dispute. ANS: B
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is recommended
if resolution fails.
REF: Page 16 TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of 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 and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is implemented. c.
Dropping the idea and trying for the change in a year or so when some of the present RNs have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling relationships,
deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others
recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a
period of time before implementation does not provide opportunity to explore different perspectives and
values. Avoiding discussion until the team changes may not promote adoption of the change until there is
opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack
of empathy for the perspectives of the RN staff.
REF: Page 7 | Page 15
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that there is little
turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go
beyond their job descriptions in their work. Which of the following strategies might motivate the staff and
lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and
NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the
institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are
lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign contracts that
guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg’s two-factor
theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and
satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use
motivator factors liberally to inspire work performance and increase job satisfaction.
,REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating factors, which action
would you select?
a. Collaborate with the human resource/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
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout
systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore
all levels of staff would be involved in decision making. This principle is the foundation of shared
governance.
REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins
to complain loudly about the quality of care his mother is receiving. His behavior 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 behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent
practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b.
Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to
envision the context of what is happening as well as being able to manage emotions such as frustration
effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
9. 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 feel it is insulting to be required to participate in a
competency program. Which behavior 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 JCAHO accreditation.
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
The manager role involves guiding others through a set of derived practices that are evidence-based and known
to satisfy preestablished outcomes such as participation in a competency program. This involves engagement
of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the
PPACA suggests that no health reform can unfold without active nursing engagement. Each document
emphasizes that nurses must lead, manage, and behave as active collaborators with other members of the
health team and with those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
, 10. As the manager, you have been asked to implement an evidence-based approach to teach ostomy
patients self-management skills postoperatively that is being operationalized throughout your organization.
Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs that the
new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and
teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered
to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes.
Followership promotes good clinical decisions and use of clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
11. You overhear a newly graduated RN telling one of your colleagues that leadership and management
belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating
understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence may affect
the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related
to the general perception that nurse leaders and managers are not satisfied in their jobs. ANS: B
Care coordination that involves the intersection of individual, family, and community-based needs requires
that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead
and manage. There is often a view that leadership is isolated to those holding managerial positions and that a
direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge
that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-
care
and beyond.
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12. You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously very upset
and after you speak with him regarding his behavior, you determine that he has not slept for three nights
because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an “ugly, old man.”
You acknowledge her feelings and concerns and then suggest that Mr. Smith’s behavior was aggressive but is
related to lack of sleep and to pain. You say to Miss Jones, “Can you both, together with Mr. Smith,
determine triggers for the pain and effective approaches to controlling his pain?” This approach
demonstrates: a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr.
Smith. c. Leadership behavior.
d. Management
behavior. ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient
symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision
making in
