Effective Leadership & Management in Nursing, 9e (Sullivan)
Chapter 1 Introducing Nursing Management
1) A nurse manager is participating in the healthcare organization's strategic planning committee.
Which factor is the primary driving force and controlling factor in new initiatives this committee
might recommend?
1. Cost of care
2. Access to care
3. Availability of care
4. Quality of care
Answer: 1
Explanation: 1. While all of the options given are driving forces in today's healthcare
environment, the cost of providing care is still the primary issue. Cost of care controls access,
availability, and quality.
2. Access to care is controlled by the ability to pay.
3. Care will not be available if it cannot be funded.
4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that
quality care must also be funded care.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
1
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,2) A nurse has been invited to discuss healthcare costs at a senior citizens' club. What
information should the nurse plan to include in this discussion?
1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy
spent on healthcare has slowly declined to less than 12%.
2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should
bring financial relief to healthcare consumers.
3. The United States spends more money on healthcare than any other country.
4. Healthcare spending in the United States is slowly declining due to passage of bills such as the
Patient Protection and Affordable Care Act (PPACA).
Answer: 2
Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross
domestic product.
2. Implementation of PPACA and its regulations have not been formulated.
3. The United States spends more than $2.5 trillion on healthcare annually, more than any other
country.
4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Education
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by
the nurse would indicate to the nurse manager a need for additional understanding of this
situation?
1. "I wonder if there was a break of sterility when this catheter was inserted."
2. "Thankfully we can treat this with an antibiotic."
3. "This could potentially cost the hospital a lot of money."
4. "I will talk to my unlicensed assistants about proper urinary catheter care."
Answer: 2
Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about
the process that might have contributed to this infection.
2. The nurse who focuses on taking care of the results of a potential medical mistake is not
accepting the seriousness of the situation.
3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by
medical mistakes. This urinary tract infection could cost the hospital the cost of treatment,
including increased length of stay.
4. The nurse has identified that improper care may result in poor outcomes for the client.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
2
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VERIFIEDBRAINBOOSTER
,4) Which healthcare situations reflect the philosophy of quality management as designed by
Deming?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. A nurse asks visitors to leave because it is after visiting hours.
2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing
by mouth (NPO) status.
3. A nurse tells the manager that a housekeeper's work is not up to standards.
4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.
5. A nurse who has not made a medication error in two years asks for a salary increase.
Answer: 2, 3, 4
Explanation: 1. The philosophy of quality management is focus on the needs of the client. If
there is no reason for the visitors to leave other than it is after visiting hours, this is not focused
on client need.
2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is
an example of quality management.
3. Quality management empowers the employee to evaluate quality.
4. This nurse has seen a need and is working to improve the quality of service. This is quality
management.
5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase
is not quality management.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
3
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VERIFIEDBRAINBOOSTER
,5) A client who was discharged yesterday is very upset about the quality of care received during
hospitalization for gastric surgery. What options for reporting concerns does this client have?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. There is no mechanism for complaint because the client is no longer hospitalized.
2. The client can indicate dissatisfaction on the survey often sent to clients after discharge.
3. The client can call the hospital administration.
4. The client can make a formal complaint through the American Nursing Association (ANA).
5. The client can make a public report through the Agency for Healthcare Research and Quality
(AHRQ).
Answer: 2, 3, 5
Explanation: 1. The client can still voice concerns even after discharge.
2. These client satisfaction surveys are a good mechanism for discussing care issues.
3. Telephone calls are a means of discussing client care issues.
4. ANA is not a forum for complaints about care in a specific hospitalization.
5. The AHRQ has a mechanism for reporting care issues.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client
should choose which hospital for care during this procedure?
1. The hospital closest to the client's home
2. The hospital that has done the greatest number of these surgeries in the last two years
3. The hospital chosen by the client's primary healthcare provider
4. The hospital with the highest performance ratings for this procedure
Answer: 4
Explanation: 1. This may or may not be the best choice of hospital for this procedure.
2. Just because a hospital is high volume does not mean it is high quality.
3. This may or may not be the best hospital for this procedure.
4. The Leapfrog Group focuses on quality indicators including the use of higher-performing
hospitals for high-risk procedures.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
4
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VERIFIEDBRAINBOOSTER
,7) The quality management director of a large healthcare conglomerate wishes to initiate
benchmarking strategies to assess care. Which directive should this manager publish?
1. We will compare outcome indicators with other healthcare conglomerates of similar size and
organization.
2. Outcome data of hospitals within the organization will be compared to assess quality.
3. Each client care unit in the organization will establish specific unit goals for quality.
4. Each unit in the organization will create a quality monitor to assess how well unit policies are
followed.
Answer: 1
Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of
a similar organization to address strengths and challenges.
2. Because the hospitals with the organization are likely managed in a similar manner, this is not
an example of benchmarking.
3. While establishing goals is a part of quality management, it is not benchmarking.
4. Setting up a quality monitor is a quality initiative, but it is not benchmarking.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
8) The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has
called staff nurses together for input. Which question, as posed by the manager, reflects the first
step of the EBP process?
1. "What outcomes are we expecting from this work?"
2. "Is anyone prepared to evaluate the statistics we will find?"
3. "What is the exact clinical issue with which we are dealing?"
4. "Where can we look for information?"
Answer: 3
Explanation: 1. Assessing outcomes is the last step of the EBP process.
2. Evaluation of the evidence is step 3.
3. Identifying the clinical question is the first step in the EBP process.
4. Acquiring the evidence to answer the question is step 2.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Leadership
Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.
5
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VERIFIEDBRAINBOOSTER
, 9) The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse
replies, "I don't know why I started doing it this way. I've never read any research on it, but this
technique always works for me." The manager would place this technique into which category of
evidence?
1. Case study
2. Anecdotal
3. Nonexperimental design research
4. Statistical
Answer: 2
Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical
situations.
2. Anecdotal evidence is derived from experience.
3. Nonexperimental design research includes gathering factors related to a clinical condition.
4. Statistical evidence is built from a scientific approach.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the
future.
6
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
Chapter 1 Introducing Nursing Management
1) A nurse manager is participating in the healthcare organization's strategic planning committee.
Which factor is the primary driving force and controlling factor in new initiatives this committee
might recommend?
1. Cost of care
2. Access to care
3. Availability of care
4. Quality of care
Answer: 1
Explanation: 1. While all of the options given are driving forces in today's healthcare
environment, the cost of providing care is still the primary issue. Cost of care controls access,
availability, and quality.
2. Access to care is controlled by the ability to pay.
3. Care will not be available if it cannot be funded.
4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that
quality care must also be funded care.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
1
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
,2) A nurse has been invited to discuss healthcare costs at a senior citizens' club. What
information should the nurse plan to include in this discussion?
1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy
spent on healthcare has slowly declined to less than 12%.
2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should
bring financial relief to healthcare consumers.
3. The United States spends more money on healthcare than any other country.
4. Healthcare spending in the United States is slowly declining due to passage of bills such as the
Patient Protection and Affordable Care Act (PPACA).
Answer: 2
Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross
domestic product.
2. Implementation of PPACA and its regulations have not been formulated.
3. The United States spends more than $2.5 trillion on healthcare annually, more than any other
country.
4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Education
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by
the nurse would indicate to the nurse manager a need for additional understanding of this
situation?
1. "I wonder if there was a break of sterility when this catheter was inserted."
2. "Thankfully we can treat this with an antibiotic."
3. "This could potentially cost the hospital a lot of money."
4. "I will talk to my unlicensed assistants about proper urinary catheter care."
Answer: 2
Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about
the process that might have contributed to this infection.
2. The nurse who focuses on taking care of the results of a potential medical mistake is not
accepting the seriousness of the situation.
3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by
medical mistakes. This urinary tract infection could cost the hospital the cost of treatment,
including increased length of stay.
4. The nurse has identified that improper care may result in poor outcomes for the client.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
2
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
,4) Which healthcare situations reflect the philosophy of quality management as designed by
Deming?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. A nurse asks visitors to leave because it is after visiting hours.
2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing
by mouth (NPO) status.
3. A nurse tells the manager that a housekeeper's work is not up to standards.
4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.
5. A nurse who has not made a medication error in two years asks for a salary increase.
Answer: 2, 3, 4
Explanation: 1. The philosophy of quality management is focus on the needs of the client. If
there is no reason for the visitors to leave other than it is after visiting hours, this is not focused
on client need.
2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is
an example of quality management.
3. Quality management empowers the employee to evaluate quality.
4. This nurse has seen a need and is working to improve the quality of service. This is quality
management.
5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase
is not quality management.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
3
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
,5) A client who was discharged yesterday is very upset about the quality of care received during
hospitalization for gastric surgery. What options for reporting concerns does this client have?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. There is no mechanism for complaint because the client is no longer hospitalized.
2. The client can indicate dissatisfaction on the survey often sent to clients after discharge.
3. The client can call the hospital administration.
4. The client can make a formal complaint through the American Nursing Association (ANA).
5. The client can make a public report through the Agency for Healthcare Research and Quality
(AHRQ).
Answer: 2, 3, 5
Explanation: 1. The client can still voice concerns even after discharge.
2. These client satisfaction surveys are a good mechanism for discussing care issues.
3. Telephone calls are a means of discussing client care issues.
4. ANA is not a forum for complaints about care in a specific hospitalization.
5. The AHRQ has a mechanism for reporting care issues.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client
should choose which hospital for care during this procedure?
1. The hospital closest to the client's home
2. The hospital that has done the greatest number of these surgeries in the last two years
3. The hospital chosen by the client's primary healthcare provider
4. The hospital with the highest performance ratings for this procedure
Answer: 4
Explanation: 1. This may or may not be the best choice of hospital for this procedure.
2. Just because a hospital is high volume does not mean it is high quality.
3. This may or may not be the best hospital for this procedure.
4. The Leapfrog Group focuses on quality indicators including the use of higher-performing
hospitals for high-risk procedures.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
4
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
,7) The quality management director of a large healthcare conglomerate wishes to initiate
benchmarking strategies to assess care. Which directive should this manager publish?
1. We will compare outcome indicators with other healthcare conglomerates of similar size and
organization.
2. Outcome data of hospitals within the organization will be compared to assess quality.
3. Each client care unit in the organization will establish specific unit goals for quality.
4. Each unit in the organization will create a quality monitor to assess how well unit policies are
followed.
Answer: 1
Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of
a similar organization to address strengths and challenges.
2. Because the hospitals with the organization are likely managed in a similar manner, this is not
an example of benchmarking.
3. While establishing goals is a part of quality management, it is not benchmarking.
4. Setting up a quality monitor is a quality initiative, but it is not benchmarking.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those
resulting from implementation of the Affordable Care Act; demands to reduce errors and
improve patient safety; and evolving medical and communication technology.
8) The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has
called staff nurses together for input. Which question, as posed by the manager, reflects the first
step of the EBP process?
1. "What outcomes are we expecting from this work?"
2. "Is anyone prepared to evaluate the statistics we will find?"
3. "What is the exact clinical issue with which we are dealing?"
4. "Where can we look for information?"
Answer: 3
Explanation: 1. Assessing outcomes is the last step of the EBP process.
2. Evaluation of the evidence is step 3.
3. Identifying the clinical question is the first step in the EBP process.
4. Acquiring the evidence to answer the question is step 2.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Leadership
Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.
5
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
, 9) The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse
replies, "I don't know why I started doing it this way. I've never read any research on it, but this
technique always works for me." The manager would place this technique into which category of
evidence?
1. Case study
2. Anecdotal
3. Nonexperimental design research
4. Statistical
Answer: 2
Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical
situations.
2. Anecdotal evidence is derived from experience.
3. Nonexperimental design research includes gathering factors related to a clinical condition.
4. Statistical evidence is built from a scientific approach.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the
future.
6
Copyright © 2018 Pearson Education, Inc.
VERIFIEDBRAINBOOSTER
