Chapter 01: Leadership and Management
Motacki: Nursing Delegation and Management of Patient Care, 3rd Edition

MULTIPLE CHOICE

	1.	Nurses can be leaders without being managers. Which nursing actions demonstrate leadership?
a.	Assisting a new nurse with enteral tube feedings	
b.	Counseling a new nurse regarding attendance	
c.	Adjusting assignments after a staff member calls in sick	
d.	Calling a physician for new order clarification	

ANS:	A
Leaders act as role models and mentor new staff. The other options are incorrect because they are management responsibilities and not leadership roles.

DIF:	Cognitive Level: Application

	2.	Which nursing actions demonstrate the role of management in nursing?
a.	Encouraging autonomous decision making	
b.	Observing the documentation of appropriate charges to patients	
c.	Assisting in a code	
d.	Asking the patient/family about advance directives	

ANS:	B
Managers are responsible for the budget of their units. The other options are incorrect because those are leadership or mentoring roles.

DIF:	Cognitive Level: Application

	3.	Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities?
a.	A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients.	
b.	A staff nurse acts quickly when a cardiac arrest is called on her patient.	
c.	A staff nurse notifies another staff member that she is being “pulled” today.	
d.	A new nurse volunteers to work when another staff member must leave work because her child is ill.	

ANS:	A
Nurse leaders are interested in changing practice based on evidence. Options B and D are incorrect because they are actions taken by nurses as part of the functional structure of the unit. Option C is incorrect because it is an action taken by a manager.

DIF:	Cognitive Level: Analysis

	4.	A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager?
a.	A nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients.	
b.	A nurse acts quickly when a cardiac arrest is called on her patient.	
c.	A nurse notifies another staff member that she is being “pulled” today.	
d.	A nurse volunteers to work when another staff member must leave work because her child is ill.	

ANS:	C
Determining who gets “pulled” is a management decision. Option A is incorrect because it is a role taken by a nurse leader. Option B is incorrect because it is an action taken by staff as part of the functional structure of the unit. Option D is incorrect because it is an action taken by staff as part of the functional structure of the unit.

DIF:	Cognitive Level: Analysis

	5.	A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit?
a.	Nurse manager mandates changes.	
b.	Staff takes responsibility for assignments.	
c.	Staff participates on hospital committees.	
d.	Nurses are recognized for excellence in practice.	

ANS:	C
Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because excellence in practice is not seen solely in autonomous environments.

DIF:	Cognitive Level: Analysis

	6.	The fundamental element of any patient care delivery combines work allocation with
a.	patient acuity.	
b.	leadership.	
c.	clinical decision making.	
d.	delegation.	

ANS:	C
Work allocation is necessary in any patient care delivery system. The other options are incorrect because it is not necessarily useful in determining the appropriate patient care delivery systems needed.

DIF:	Cognitive Level: Analysis

	7.	The student nurse, shadowing on a medical-surgical unit, observes the charge nurse. Which action would the student identify as a leadership quality in the nurse’s actions?
a.	Making patient care assignments distributed equally to staff	
b.	Sitting with a confused combative patient	
c.	Calling the nursing office for extra staff when an RN calls in sick	
d.	Assisting in a code	

ANS:	B
Leaders act as role models and do what is right for the patient. The other options are incorrect because these actions are expected as part of the functioning of the unit.

DIF:	Cognitive Level: Analysis

	8.	Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business?
a.	Ability to pressure staff to do what you want	
b.	Resource utilization	
c.	Cutting corners to make money	
d.	Providing bonuses to staff members who help the organization to save money	

ANS:	B
The ability to manage a budget is essential to being a manager in health care today. The other options are incorrect because they are only a perception of the public regarding successful managers.

DIF:	Cognitive Level: Application

	9.	The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict?
a.	Coordinating institutional goals with the immediate demands of the clinical area	
b.	Determining which of the staff members should get better raises than other members	
c.	Deciding which employees should be recommended for promotion	
d.	Determining which staff members get Christmas day off	

ANS:	A
Many times the goals of the institution conflict with the goals of the individual employees of a particular clinical area and the nurse manager must implement institutional changes regardless of the nurse’s personal opinion. The other options are incorrect because those roles should not provoke as much conflict.

DIF:	Cognitive Level: Application

	10.	Nurse managers can best be described as people who
a.	develop institutional goals based on staff suggestions.	
b.	develop institutional goals based on a personal theory.	
c.	motivate staff to meet institutional goals through positional power.	
d.	inspire staff to meet institutional goals through personal power.	

ANS:	C
Managers motivate staff to make changes. Options A and B are incorrect because nurse managers usually do not make institutional goals. Option C is incorrect because leaders inspire, not managers.

DIF:	Cognitive Level: Application

	11.	There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager?
a.	Responding to a patient complaint	
b.	Deciding to incorporate walking rounds shift report hospitalwide	
c.	Reevaluating the nursing policy permitting IV push of certain medications by RNs	
d.	Designating assignment of new admissions	

ANS:	A
The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because reevaluating the nursing policy permitting IV push of certain medications by RNs is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because designating assignment of new admissions would be the responsibility of the charge nurse.

DIF:	Cognitive Level: Analysis

	12.	The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process?
a.	Identifying the problem of the lack of ICU beds	
b.	Organizing a meeting to address the problem	
c.	Establishing an alternate site within the hospital for these patients	
d.	Assigning experienced staff to implement care of these patients	

ANS:	A
Establishing objectives should be seen in the planning step following identification of the problem. Option B is the organizing step. Option C is the directing step. Option D is the controlling step.

DIF:	Cognitive Level: Application

	13.	The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process?
a.	Organizing a meeting to address the problem	
b.	Establishing an alternate site within the hospital for these patients	
c.	Assigning experienced staff to implement care of these patients	
d.	Establishing the new area as a step-down unit	

ANS:	D
Decision making is a result of the other steps. The other options are different steps in the management process.

DIF:	Cognitive Level: Application

	14.	First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager?
a.	Making daily staffing assignments	
b.	Managing the unit’s budget	
c.	Maintaining currency in profession	
d.	Making daily patient rounds	

ANS:	B
Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other activities are not specific to first-level managers.

DIF:	Cognitive Level: Application

	15.	Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager?
a.	Maintaining currency in profession	
b.	Planning for changes within the service line in the organization	
c.	Being responsible for activities on the unit 24/7	
d.	Supervising patient care delivery	

ANS:	B
The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not the exclusive responsibility of the middle-level manager.

DIF:	Cognitive Level: Application

	16.	Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager?
a.	Supervising patient care delivery	
b.	Establishing strategic goals for nursing	
c.	Maintaining currency in profession	
d.	Being responsible for activities on the unit 24/7	

ANS:	B
Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels.

DIF:	Cognitive Level: Application

	17.	The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts?
a.	Take responsibility for a team of patients.	
b.	Delegate care to the UAPs.	
c.	Assist the RNs to prioritize their patients and their responsibilities.	
d.	Call the supervisor for more staff.	

ANS:	C
As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other actions may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills.

DIF:	Cognitive Level: Application

MULTIPLE RESPONSE

	1.	To become a leader, one must develop certain personal aspects. Which of the following can be identified as competencies expected in creating leadership in oneself? (Select all that apply.)
a.	Asking for overtime	
b.	Asking for certain patient assignments	
c.	Personal and professional accountability	
d.	Acquiring advanced degrees	
e.	Personal discipline	

ANS:	C, D, E
Options C, D, and E are competencies identified in the text for developing leadership in oneself. Although they may be associated with a good work ethic, the other options do not apply to the development of leadership competencies.

DIF:	Cognitive Level: Analysis

	2.	The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.)
a.	Work allocation	
b.	Accountability	
c.	Allocation of resources	
d.	Mission statement	
e.	Leadership style	
f.	Cultural diversity of patients	

ANS:	A, B, D
Options A, B, and D are correct because the text lists these as fundamental elements of any patient care delivery system. Options C, E, and F are not fundamental elements of a patient care delivery system.

DIF:	Cognitive Level: Application

	3.	A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which (Select all that apply.)
a.	a staff nurse provides advice and guidance to new nurses.	
b.	a clinical ladder is used for advancement.	
c.	a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them.	
d.	annual performance appraisals are provided with competitive raises.	
e.	decisions are made from the top down.	

ANS:	A, B, C
Options A, B, and C are correct because a transformational leadership environment encourages consultation and collaboration, empowering and motivating staff. The other options are examples of transactional leadership.

DIF:	Cognitive Level: Analysis

	4.	A nurse leader, according to the American Organization of Nurse Executives (AONE), is competent in the areas of (Select all that apply.)
a.	knowledge of the health care environment.	
b.	communication.	
c.	business management.	
d.	demanding participation by the staff.	
e.	providing a financial incentive.	

ANS:	A, B, C
Options A, B, and C are identified by AOEN as a competencies of nurse leaders. The other options are not competencies recommended by the AOEN.

DIF:	Cognitive Level: Analysis

	5.	The organizational hierarchy is used in which of the following situations? (Select all that apply.)
a.	A staff member is observed taking money from a patient’s bedside table.	
b.	A staff member is found to be drinking alcohol while at work.	
c.	A nurse refuses to care for a patient receiving peritoneal dialysis because he has not been trained on this procedure.	
d.	A nurse refuses to be floated to the ICU while still in orientation.	
e.	A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient.	

ANS:	A, B, E
Options A, B, and E are correct because inappropriate actions by staff are managed by the hierarchy of any organization. Options C and D are incorrect because they are scenarios requiring actions not relegated to the hierarchy of the organization.

DIF:	Cognitive Level: Analysis