Effective Leadership And Management in Nursing 7th Edition by Eleanor J. Sullivan – Test Bank A+

Chapter 2 Designing Organizations

1) Using the classical organizational theory model, the most appropriate method for the nurse to voice concern
over unfair client workload assignments would be to:

1. Invite the director of nursing to a unit meeting.
2. Organize a unit meeting to discuss the problem on all shifts.
3. Discuss the problem with the team leader and then the charge nurse/unit supervisor if the problem
remains unsolved.
4. Circulate a petition to all staff seeking support for change in assignment policy.

Answer: 3

Explanation: 1. Classical theory provides a formal chain of command and system for communication. The
other options would be inappropriate and not take into consideration the chain of command
inherent in classical theory.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

2. Classical theory provides a formal chain of command and system for communication. The
other options would be inappropriate and not take into consideration the chain of command
inherent in classical theory.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

3. Classical theory provides a formal chain of command and system for communication. The
other options would be inappropriate and not take into consideration the chain of command
inherent in classical theory.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

4. Classical theory provides a formal chain of command and system for communication. The
other options would be inappropriate and not take into consideration the chain of command
inherent in classical theory.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

Learning Outcome: 2-1: Explain how organizational theories differ.
Test Taking Tip: Be prepared to apply management theories in client situations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 25

2) Which is an example of staff authority in classical theory?
1. Nurse/mentor relationship
2. Nurse/team leader relationship
3. Nurse/shift supervisor relationship
4. Nurse/manager relationship

Answer: 1

Explanation: 1. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The
other relationships have line authority.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

2. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The
other relationships have line authority.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

3. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The
other relationships have line authority.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application

4. As stated in classical theory, the nurse/mentor relationship is an advisory relationship. The
other relationships have line authority.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-1: Explain how organizational theories differ.
Test Taking Tip: Look for patterns. The only option not moving up from the employee is the nurse/mentor relationship.Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 26

3) The management of a local hospital has decided to close a postsurgical unit in the hospital due to the nursing
shortage. Of which organizational theory is this an example?
1. Chaos theory
2. Classical theory
3. Systems theory
4. Contingency theory
Answer: 4
Explanation: 1. Contingency theorists believe organizational performance can be enhanced by matching an
organizationʹs structure to its environment. The environment is made up of internal and
external forces. The nursing shortage is an external force that impacts the environment and
performance of the organization.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Contingency theorists believe organizational performance can be enhanced by matching an
organizationʹs structure to its environment. The environment is made up of internal and
external forces. The nursing shortage is an external force that impacts the environment and
performance of the organization.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Contingency theorists believe organizational performance can be enhanced by matching an
organizationʹs structure to its environment. The environment is made up of internal and
external forces. The nursing shortage is an external force that impacts the environment and
performance of the organization.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Contingency theorists believe organizational performance can be enhanced by matching an
organizationʹs structure to its environment. The environment is made up of internal and
external forces. The nursing shortage is an external force that impacts the environment and
performance of the organization.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-1: Explain how organizational theories differ.
Test Taking Tip: Be prepared to apply theories in nursing situations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 27
4) Which statement indicates a nursing student is in need of more study time?
1. ʺChaos theorists believe change is inevitable.ʺ
2. ʺClassical theorists believe in organizational hierarchy.ʺ
3. ʺSystems theorists discuss outputs and inputs.ʺ
4. ʺContingency theorists believe the environment forces organizational change.ʺ
Answer: 3
Explanation: 1. According to systems theory the ʺinputʺ or employees are imported from the environment. The
work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the
environment. The student neglected to include ʺthroughputʺ and the remaining choices are
correct.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
2. According to systems theory the ʺinputʺ or employees are imported from the environment. The
work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the
environment. The student neglected to include ʺthroughputʺ and the remaining choices are
correct.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
3. According to systems theory the ʺinputʺ or employees are imported from the environment. The
work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the
environment. The student neglected to include ʺthroughputʺ and the remaining choices are
correct.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
4. According to systems theory the ʺinputʺ or employees are imported from the environment. The
work or ʺthroughputʺ is performed to produce a product. The ʺoutputʺ is then exported to the
environment. The student neglected to include ʺthroughputʺ and the remaining choices are
correct.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
Learning Outcome: 2-1: Explain how organizational theories differ.
Test Taking Tip: Be prepared to apply theories in nursing situations and read the stem carefully. This question requires
looking for the wrong choice.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 28
5) The nurse manager is determining placement for a client in need of medical and nursing care in an inpatient
setting for less than 30 days. Which statement indicates the correct placement?
1. ʺThe client requires a long-term care facility.ʺ
2. ʺThis client requires a managed care organization.ʺ
3. ʺThis client needs an ambulatory care center.ʺ
4. ʺThis client needs a hospital.ʺ
Answer: 4
Explanation: 1. The American Hospital Association defines an acute care hospital as a facility in which the
average length of stay is less than 30 days. The other choices are not appropriate as they are
either for different length of stays or related to how the overall care is organized.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
2. The American Hospital Association defines an acute care hospital as a facility in which the
average length of stay is less than 30 days. The other choices are not appropriate as they are
either for different length of stays or related to how the overall care is organized.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
3. The American Hospital Association defines an acute care hospital as a facility in which the
average length of stay is less than 30 days. The other choices are not appropriate as they are
either for different length of stays or related to how the overall care is organized.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
4. The American Hospital Association defines an acute care hospital as a facility in which the
average length of stay is less than 30 days. The other choices are not appropriate as they are
either for different length of stays or related to how the overall care is organized.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
Learning Outcome: 2-2: Describe the different types of health care organizations.
Test Taking Tip: Be familiar with terms and look for patterns.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 29
6) During the nurseʹs interview for a new job, the health benefits are described as a group of health care providers
in the local town who have agreed to provide treatment and health services for the clinic employees. This is an
example of a (an):
1. PPO.
2. HMO.
3. POS.
4. SSI.
Answer: 2
Explanation: 1. An HMO is a geographically organized system that provides an agreed -upon package of
health maintenance and treatment services. A PPO is a managed care organization that
contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security
insurance.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
2. An HMO is a geographically organized system that provides an agreed -upon package of
health maintenance and treatment services. A PPO is a managed care organization that
contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security
insurance.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
3. An HMO is a geographically organized system that provides an agreed -upon package of
health maintenance and treatment services. A PPO is a managed care organization that
contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security
insurance.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
4. An HMO is a geographically organized system that provides an agreed -upon package of
health maintenance and treatment services. A PPO is a managed care organization that
contracts with independent caregivers. A POS is a hybrid HMO/PPO. SSI is Social Security
insurance.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
Learning Outcome: 2-2: Describe the different types of health care organizations.
Test Taking Tip: Familiarize yourself with the ʺalphabet soupʺ and be prepared to answer questions about these basic
types.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 30
7) Which indicates a weakness of a functional structure in a long-term care facility?
1. All nursing tasks fall under the nursing department.
2. The dietary department is responsible for nutritional assessment.
3. Physical and occupational therapy coordinate and evaluate activities of daily living.
4. The nursing department is responsible for writing the care plan.
Answer: 4
Explanation: 1. Nursing tasks falling under the nursing department, the dietary department being responsible
for nutritional assessment, and physical and occupational therapy coordinating and evaluating
activities of daily living all reflect a functional structure in which individual departments are
grouped and responsible for specific tasks. A weakness of the functional structure is that
coordination of services across departments is poor. Nursing would find it difficult to write a
care plan without input from other departments while the other options relay stand-alone
tasks with little required input from other departments.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Nursing tasks falling under the nursing department, the dietary department being responsible
for nutritional assessment, and physical and occupational therapy coordinating and evaluating
activities of daily living all reflect a functional structure in which individual departments are
grouped and responsible for specific tasks. A weakness of the functional structure is that
coordination of services across departments is poor. Nursing would find it difficult to write a
care plan without input from other departments while the other options relay stand-alone
tasks with little required input from other departments.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Nursing tasks falling under the nursing department, the dietary department being responsible
for nutritional assessment, and physical and occupational therapy coordinating and evaluating
activities of daily living all reflect a functional structure in which individual departments are
grouped and responsible for specific tasks. A weakness of the functional structure is that
coordination of services across departments is poor. Nursing would find it difficult to write a
care plan without input from other departments while the other options relay stand-alone
tasks with little required input from other departments.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Nursing tasks falling under the nursing department, the dietary department being responsible
for nutritional assessment, and physical and occupational therapy coordinating and evaluating
activities of daily living all reflect a functional structure in which individual departments are
grouped and responsible for specific tasks. A weakness of the functional structure is that
coordination of services across departments is poor. Nursing would find it difficult to write a
care plan without input from other departments while the other options relay stand-alone
tasks with little required input from other departments.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-3: Explain how health care organizations are structured.
Test Taking Tip: Think about key words; the word ʺfunctionalʺ can give a hint about the correct answer.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 31
8) A nurse practitioner collaborating with physicians and as a general business partner to provide needed services
is an example of which diversification method?
1. Joint venture
2. Conglomerate diversification
3. Concentric diversification
4. Capitation
Answer: 1
Explanation: 1. A joint venture is a partnership in which each partner contributes different areas of expertise or
resources to create a product or service. Conglomerate diversification is the expansion into
areas that differ from the original service. Concentric diversification is expansion of services
into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. A joint venture is a partnership in which each partner contributes different areas of expertise or
resources to create a product or service. Conglomerate diversification is the expansion into
areas that differ from the original service. Concentric diversification is expansion of services
into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. A joint venture is a partnership in which each partner contributes different areas of expertise or
resources to create a product or service. Conglomerate diversification is the expansion into
areas that differ from the original service. Concentric diversification is expansion of services
into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. A joint venture is a partnership in which each partner contributes different areas of expertise or
resources to create a product or service. Conglomerate diversification is the expansion into
areas that differ from the original service. Concentric diversification is expansion of services
into new markets. Capitation is a fixed fee paid per enrollee for services in an HMO.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-3: Explain how health care organizations are structured.
Test Taking Tip: Look for patterns in the options. The only option involving a partnership is the joint venture.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 32
9) In planning for discharge of a client needing follow-up for diabetic education, the nurse should contact a:
1. Long-term care facility.
2. Home health agency.
3. Temporary service agency.
4. Public health department.
Answer: 2
Explanation: 1. With shorter hospital stays, home health agencies are frequently used to provide clients with
intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities
are used for rehabilitation and care needed for extended periods of time. Temporary service
agencies are used to provide health care agencies with professional and nonprofessional
personnel when they are short staffed. The public health department focus is usually
community health and not individual primary care.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. With shorter hospital stays, home health agencies are frequently used to provide clients with
intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities
are used for rehabilitation and care needed for extended periods of time. Temporary service
agencies are used to provide health care agencies with professional and nonprofessional
personnel when they are short staffed. The public health department focus is usually
community health and not individual primary care.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. With shorter hospital stays, home health agencies are frequently used to provide clients with
intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities
are used for rehabilitation and care needed for extended periods of time. Temporary service
agencies are used to provide health care agencies with professional and nonprofessional
personnel when they are short staffed. The public health department focus is usually
community health and not individual primary care.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. With shorter hospital stays, home health agencies are frequently used to provide clients with
intermittent or temporary follow-up care such as diabetic teaching. Long-term care facilities
are used for rehabilitation and care needed for extended periods of time. Temporary service
agencies are used to provide health care agencies with professional and nonprofessional
personnel when they are short staffed. The public health department focus is usually
community health and not individual primary care.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-2: Describe the different types of health care organizations.
Test Taking Tip: Be familiar with terms and look for patterns. Follow-up education is indicative of a post-hospital client
need appropriate for home health.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 33
10) A nurse manager who encourages the nursing staff members to assist in developing a new creative staffing
pattern in response to recent resignations and people going back to school subscribes to what organizational
theory?
1. Neoclassical theory
2. Systems theory
3. Chaos theory
4. Classical theory
Answer: 3
Explanation: 1. Chaos theory proposes an organization is dependent on its adaptability and response to
change in its environment. Nurse managers must create an environment that accepts change,
tolerates conflict, and promotes creative solutions.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Chaos theory proposes an organization is dependent on its adaptability and response to
change in its environment. Nurse managers must create an environment that accepts change,
tolerates conflict, and promotes creative solutions.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Chaos theory proposes an organization is dependent on its adaptability and response to
change in its environment. Nurse managers must create an environment that accepts change,
tolerates conflict, and promotes creative solutions.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Chaos theory proposes an organization is dependent on its adaptability and response to
change in its environment. Nurse managers must create an environment that accepts change,
tolerates conflict, and promotes creative solutions.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-1: Explain how organizational theories differ.
Test Taking Tip: Be prepared to apply organizational theory when taking nursing exams.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 34
11) Which statement indicates a reason why the parallel structure in hospitals is being used less frequently?
1. Parallel structure causes complex relationships.
2. Newer models of organizational structure exist.
3. Parallel structure creates two lines of authority.
4. Parallel structure calls for increased authority of medical staff.
Answer: 3
Explanation: 1. Parallel structure exists when there are two lines of authority in an organization. Due to new
models of organizational structure, medical staff may have less direct authority and may be
included as staff members and adhere to hospital policy. The staff relationships are then less
complex.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Parallel structure exists when there are two lines of authority in an organization. Due to new
models of organizational structure, medical staff may have less direct authority and may be
included as staff members and adhere to hospital policy. The staff relationships are then less
complex.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Parallel structure exists when there are two lines of authority in an organization. Due to new
models of organizational structure, medical staff may have less direct authority and may be
included as staff members and adhere to hospital policy. The staff relationships are then less
complex.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Parallel structure exists when there are two lines of authority in an organization. Due to new
models of organizational structure, medical staff may have less direct authority and may be
included as staff members and adhere to hospital policy. The staff relationships are then less
complex.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-3: Explain how health care organizations are structured.
Test Taking Tip: Look for the option that might include other option choices.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 35
12) Which structure is reflected by the statement ʺnursing practice is best determined by nursesʺ?
1. Heterarchy structure
2. Shared governance
3. Strategic planning
4. Matrix structure
Answer: 2
Explanation: 1. Shared governance is a form of participative decision making. Nurses gain control over
practice, are more accountable, and feel empowered. Heterarchy structure is a relational design
based on the concept of connections. Planning is an activity that projects the organizationʹs
goals and actions into the future. Matrix structure combines functional structure and product
structure into one overlapping structure.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Shared governance is a form of participative decision making. Nurses gain control over
practice, are more accountable, and feel empowered. Heterarchy structure is a relational design
based on the concept of connections. Planning is an activity that projects the organizationʹs
goals and actions into the future. Matrix structure combines functional structure and product
structure into one overlapping structure.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Shared governance is a form of participative decision making. Nurses gain control over
practice, are more accountable, and feel empowered. Heterarchy structure is a relational design
based on the concept of connections. Planning is an activity that projects the organizationʹs
goals and actions into the future. Matrix structure combines functional structure and product
structure into one overlapping structure.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Shared governance is a form of participative decision making. Nurses gain control over
practice, are more accountable, and feel empowered. Heterarchy structure is a relational design
based on the concept of connections. Planning is an activity that projects the organizationʹs
goals and actions into the future. Matrix structure combines functional structure and product
structure into one overlapping structure.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-3: Explain how health care organizations are structured.
Test Taking Tip: Be prepared to apply knowledge about organizations to nursing situations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 36
13) ʺWe want to be the hospital of choice in the Midwestʺ is which type of statement?
1. Mission statement
2. Vision statement
3. Value statement
4. Philosophy statement
Answer: 1
Explanation: 1. The mission statement is a broad statement of the organizationʹs reason for existence. A vision
statement describes the goal to which the organization aspires. The value statement is the
beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the
organizationʹs values, vision, and mission.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The mission statement is a broad statement of the organizationʹs reason for existence. A vision
statement describes the goal to which the organization aspires. The value statement is the
beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the
organizationʹs values, vision, and mission.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The mission statement is a broad statement of the organizationʹs reason for existence. A vision
statement describes the goal to which the organization aspires. The value statement is the
beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the
organizationʹs values, vision, and mission.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The mission statement is a broad statement of the organizationʹs reason for existence. A vision
statement describes the goal to which the organization aspires. The value statement is the
beliefs or attitudes esteemed by the organizational leaders. A philosophy statement reflects the
organizationʹs values, vision, and mission.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-4: Demonstrate how strategic planning guides the organizational decision making.
Test Taking Tip: Be prepared to apply organizational planning basics in nursing situations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 37
14) What is the best example of a pediatric unitʹs organizational culture?
1. All client rooms are private.
2. Nurse-to-client ratio is 4 to 1.
3. Nurses wear colorful scrubs.
4. Primary nursing model is used for care.
Answer: 3
Explanation: 1. Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
Organizational climate is based on physical attributes and policy and procedure. Private
rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of
organizational climate.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
Organizational climate is based on physical attributes and policy and procedure. Private
rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of
organizational climate.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
Organizational climate is based on physical attributes and policy and procedure. Private
rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of
organizational climate.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
Organizational climate is based on physical attributes and policy and procedure. Private
rooms, the nurse-to-client ratio, and using the primary nursing model for care are examples of
organizational climate.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-5: Discuss how organizational environment affects success.
Test Taking Tip: Look for patterns. Only the colorful scrubs option may be specific to a pediatric floor.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 38
15) Which are the traditional organizational structures? Select all that apply.
1. Heterarchical
2. Hybrid
3. Matrix
4. Hierarchical
5. Classical
6. Chaos
Answer: 1, 2, 3
Explanation: 1. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
2. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
3. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
4. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
5. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
6. Heterarchical, hybrid, and matrix are all types of organizational structures. Hierarchical,
classical, and chaos are all organizational theories (or parts of them).
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
Learning Outcome: 2-2: Describe the different types of health care organizations.
Test Taking Tip: Learn to organize lists into the correct classification.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 39
16) Students are trying to learn organizational structures. Which statement indicates more studying time is
needed?
1. ʺSelf-organizing is a part of relationship organizing structures.ʺ
2. ʺShared governance believes all professions should share governance of others.ʺ
3. ʺHeterarchical structures are based on the connectedness between individuals.ʺ
4. ʺThe parallel structure exists only in health care organizations.ʺ
Answer: 2
Explanation: 1. Shared governance is a type of structure in which the members of one profession govern that
profession. Governance is not shared with other professions. The other options are correct
statements and thus not the correct answer.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Shared governance is a type of structure in which the members of one profession govern that
profession. Governance is not shared with other professions. The other options are correct
statements and thus not the correct answer.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Shared governance is a type of structure in which the members of one profession govern that
profession. Governance is not shared with other professions. The other options are correct
statements and thus not the correct answer.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Shared governance is a type of structure in which the members of one profession govern that
profession. Governance is not shared with other professions. The other options are correct
statements and thus not the correct answer.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-2: Describe the different types of health care organizations.
Test Taking Tip: Be aware of what the question is asking for. Looking for the wrong option is a frequently used question
strategy.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 40
17) Which portion of strategic planning is indicated by the statement: ʺThe nursing department will increase client
satisfaction scores by 20% by Juneʺ?
1. Mission
2. Objective
3. Goal
4. Value
Answer: 2
Explanation: 1. The objective statement is specific to each unit or department within the organization.
Objectives specify how each department will meet the goals set for the entire organization. The
goal statement applies to the entire organization, as does the mission statement.
Nursing Process: Implementation
Safe, Effective Learning Environment
Cognitive Level: Application
2. The objective statement is specific to each unit or department within the organization.
Objectives specify how each department will meet the goals set for the entire organization. The
goal statement applies to the entire organization, as does the mission statement.
Nursing Process: Implementation
Safe, Effective Learning Environment
Cognitive Level: Application
3. The objective statement is specific to each unit or department within the organization.
Objectives specify how each department will meet the goals set for the entire organization. The
goal statement applies to the entire organization, as does the mission statement.
Nursing Process: Implementation
Safe, Effective Learning Environment
Cognitive Level: Application
4. The objective statement is specific to each unit or department within the organization.
Objectives specify how each department will meet the goals set for the entire organization. The
goal statement applies to the entire organization, as does the mission statement.
Nursing Process: Implementation
Safe, Effective Learning Environment
Cognitive Level: Application
Learning Outcome: 2-4: Demonstrate how strategic planning guides the organizational decision making.
Test Taking Tip: Look for patterns in the options. The only option applicable to one department is the objective statement
of strategic planning.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 41
18) Which indicate the purpose of strategic planning? Select all that apply.
1. Identify external strengths.
2. Identify external weaknesses.
3. Recognize potential changes.
4. Evaluate goals, objectives, and activities.
5. Determine the market position of competitors.
6. Determine market position once yearly.
Answer: 1, 3, 4, 6
Explanation: 1. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
5. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
6. The strategic planning process identifies external strengths, internal weaknesses, looks for
potential environmental changes, evaluates performance on goals, objectives, and activities, as
well as determines the market position of competitors. Strategic Nursing Process: Planning is
an ongoing process, and not one that only occurs yearly.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-4: Demonstrate how strategic planning guides the organizational decision making.
Test Taking Tip: Read each option carefully and determine whether the entire option is accurate.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 42
19) Which of the following statements represents an organizationʹs philosophy?
1. ʺWe will increase client satisfaction by 15%.ʺ
2. ʺWe will increase productivity by 10% on the 2nd floor.ʺ
3. ʺWe believe clients are most important.ʺ
4. ʺWe believe in honest communication.ʺ
Answer: 3
Explanation: 1. The philosophy is a statement of beliefs held by the organization; values are specific aspects of
personal relationships or specific situations; the vision statement is the overall outcome desired
by the organization; the mission is the reason the organization exists.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
2. The philosophy is a statement of beliefs held by the organization; values are specific aspects of
personal relationships or specific situations; the vision statement is the overall outcome desired
by the organization; the mission is the reason the organization exists.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
3. The philosophy is a statement of beliefs held by the organization; values are specific aspects of
personal relationships or specific situations; the vision statement is the overall outcome desired
by the organization; the mission is the reason the organization exists.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
4. The philosophy is a statement of beliefs held by the organization; values are specific aspects of
personal relationships or specific situations; the vision statement is the overall outcome desired
by the organization; the mission is the reason the organization exists.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Comprehension
Learning Outcome: 2-4: Demonstrate how strategic planning guides the organizational decision making.
Test Taking Tip: Be prepared to recognize and apply organizational terms.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 43
20) The house supervisor is instructing new nurse managers on positive managerial skills. Teaching has been
effective if the house supervisor hears which comment?
1. ʺThere is no way I am leaving my door open for the staff to come in whenever.ʺ
2. ʺI expect my staff to be on time every day to work, without exceptions.ʺ
3. ʺI will help my staff whenever they might need an extra hand with something.ʺ
4. ʺI wonʹt call in my on-call person until I absolutely have no other choice.
Answer: 3
Explanation: 1. Offering assistance when needed helps raise morale and foster a positive work environment.
This in turn will affect the overall success of the organization. The others do not and would
require further instruction.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Offering assistance when needed helps raise morale and foster a positive work environment.
This in turn will affect the overall success of the organization. The others do not and would
require further instruction.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Offering assistance when needed helps raise morale and foster a positive work environment.
This in turn will affect the overall success of the organization. The others do not and would
require further instruction.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Offering assistance when needed helps raise morale and foster a positive work environment.
This in turn will affect the overall success of the organization. The others do not and would
require further instruction.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-5: Discuss how organizational environment affects success.
Test Taking Tip: Be alert when asked to look for the option that asks for ʺadditional teaching.ʺ The correct answer will
actually be the wrong one.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 44
21) Which are aspects of a positive organizational environment? Select all that apply.
1. Resonant leaders
2. Environmental dissonance
3. Client advocacy
4. Open communication
5. Staff recognition
Answer: 1, 3, 4, 5
Explanation: 1. Resonant leaders are emotionally intelligent, are client advocates, keep all channels of
communication open, and recognize staff frequently for a job well done. These are all aspects
of a positive organizational environment. Environmental dissonance occurs when different
cultures and/or traditions or subcultures collide.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Resonant leaders are emotionally intelligent, are client advocates, keep all channels of
communication open, and recognize staff frequently for a job well done. These are all aspects
of a positive organizational environment. Environmental dissonance occurs when different
cultures and/or traditions or subcultures collide.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Resonant leaders are emotionally intelligent, are client advocates, keep all channels of
communication open, and recognize staff frequently for a job well done. These are all aspects
of a positive organizational environment. Environmental dissonance occurs when different
cultures and/or traditions or subcultures collide.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Resonant leaders are emotionally intelligent, are client advocates, keep all channels of
communication open, and recognize staff frequently for a job well done. These are all aspects
of a positive organizational environment. Environmental dissonance occurs when different
cultures and/or traditions or subcultures collide.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
5. Resonant leaders are emotionally intelligent, are client advocates, keep all channels of
communication open, and recognize staff frequently for a job well done. These are all aspects
of a positive organizational environment. Environmental dissonance occurs when different
cultures and/or traditions or subcultures collide.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-5: Discuss how organizational environment affects success.
Test Taking Tip: Know new terms and be prepared to apply them in nursing situations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 45
22) Which constitutes organizational culture?
1. All nurses know to take turns covering each otherʹs clients to facilitate eating breakfast and lunch on day
shift.
2. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts.
3. The cafeteria opens at 0700 for breakfast, 1100 for lunch, and 1700 for dinner.
4. Every Friday the administrator allows everyone to wear crazy hats while on the units.
Answer: 1
Explanation: 1. The unspoken rules of the organization make up the culture. Thus, nurses covering for each
other is the appropriate option. The other options are part of the organizational environment.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The unspoken rules of the organization make up the culture. Thus, nurses covering for each
other is the appropriate option. The other options are part of the organizational environment.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The unspoken rules of the organization make up the culture. Thus, nurses covering for each
other is the appropriate option. The other options are part of the organizational environment.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The unspoken rules of the organization make up the culture. Thus, nurses covering for each
other is the appropriate option. The other options are part of the organizational environment.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-5: Discuss how organizational environment affects success.
Test Taking Tip: Look for patterns in the options. The only one specific to nurses is the first one.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 46
23) Why would a health care organization want to become a magnet hospital? Select all that apply.
1. To improve nurse recruitment
2. To foster ability to retain physicians
3. To attain higher client satisfaction
4. To broaden the use of evidence-based practice
Answer: 1, 2, 3, 4
Explanation: 1. Obtaining magnet status can improve nurse recruitment, thus retain physicians because of
better staffing with higher trained nurses, and thus attain higher client satisfaction. In addition,
better trained nurses are more likely to use evidence-based practice in client care.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Obtaining magnet status can improve nurse recruitment, thus retain physicians because of
better staffing with higher trained nurses, and thus attain higher client satisfaction. In addition,
better trained nurses are more likely to use evidence-based practice in client care.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Obtaining magnet status can improve nurse recruitment, thus retain physicians because of
better staffing with higher trained nurses, and thus attain higher client satisfaction. In addition,
better trained nurses are more likely to use evidence-based practice in client care.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Obtaining magnet status can improve nurse recruitment, thus retain physicians because of
better staffing with higher trained nurses, and thus attain higher client satisfaction. In addition,
better trained nurses are more likely to use evidence-based practice in client care.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-6: Explain how to become a magnet hospital.
Test Taking Tip: Get familiar with current trends in the nursing profession. Licensing exams frequently include questions
about them.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 47
24) Organizations must apply for magnet status through which organization?
1. American Nurses Credentialing Center
2. American National Credentials Commission
3. Joint Commission for the Accreditation of Healthcare Organizations
4. Joint Credentialing Association for Healthcare Organizations
Answer: 1
Explanation: 1. The American Nurses Credentialing Center awards magnet status after the organization
applies for, and is accepted for the award. The American National Credentials Commission
and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint
Commission for the Accreditation of Healthcare Organizations is the agency that accredits
hospitals.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The American Nurses Credentialing Center awards magnet status after the organization
applies for, and is accepted for the award. The American National Credentials Commission
and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint
Commission for the Accreditation of Healthcare Organizations is the agency that accredits
hospitals.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The American Nurses Credentialing Center awards magnet status after the organization
applies for, and is accepted for the award. The American National Credentials Commission
and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint
Commission for the Accreditation of Healthcare Organizations is the agency that accredits
hospitals.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The American Nurses Credentialing Center awards magnet status after the organization
applies for, and is accepted for the award. The American National Credentials Commission
and the Joint Credentialing Association for Healthcare Organizations are fictitious. The Joint
Commission for the Accreditation of Healthcare Organizations is the agency that accredits
hospitals.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-6: Explain how to become a magnet hospital.
Test Taking Tip: Be familiar with and be prepared to apply the roles different governing agencies play in health care
organizations.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 48
25) The organization that awards magnet status would look for environments in which:
1. Nurses are involved in decision making.
2. Rewards are given to those with money-saving ideas.
3. Decisions are made and then followed.
4. Nurses do not have to work overtime.
Answer: 1
Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity
among the nursing staff. Nurses becoming involved in decision making would fall under these
attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients;
demanding that all decisions are followed does not foster autonomy and independence;
overtime is sometimes a necessity to ensure clients have quality care that is documented and
completed by the end of the shift.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Magnet status designates organizations that foster independence, autonomy, and creativity
among the nursing staff. Nurses becoming involved in decision making would fall under these
attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients;
demanding that all decisions are followed does not foster autonomy and independence;
overtime is sometimes a necessity to ensure clients have quality care that is documented and
completed by the end of the shift.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Magnet status designates organizations that foster independence, autonomy, and creativity
among the nursing staff. Nurses becoming involved in decision making would fall under these
attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients;
demanding that all decisions are followed does not foster autonomy and independence;
overtime is sometimes a necessity to ensure clients have quality care that is documented and
completed by the end of the shift.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Magnet status designates organizations that foster independence, autonomy, and creativity
among the nursing staff. Nurses becoming involved in decision making would fall under these
attributes. Money-saving ideas are not necessarily good ideas for the staff or the clients;
demanding that all decisions are followed does not foster autonomy and independence;
overtime is sometimes a necessity to ensure clients have quality care that is documented and
completed by the end of the shift.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 2-6: Explain how to become a magnet hospital.
Test Taking Tip: Look for the outcome of each option and decide whether or not it is desirable.

Chapter 24 Managing Stress
1) An ICU nurse manager noticed a competent nurse has become forgetful and has made medication errors in the
past few months. This type of behavior is unusual for this nurse. What action should the manager take?
1. Issue a written warning to the nurse.
2. Meet individually with the nurse to discuss the behavior.
3. Meet with other nursing staff to discuss the behavior.
4. Report the nurse to the human resources department.
Answer: 2
Explanation: 1. Meeting with the nurse will provide information. The nurse may be experiencing unusual
stress at home, may be unaware of her behavior, or may have a medical condition. The first
step should be to address and assess the situation. It is inappropriate to discuss the matter with
other staff. It is premature to report the nurse to the human resources department and to issue
a written warning.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Meeting with the nurse will provide information. The nurse may be experiencing unusual
stress at home, may be unaware of her behavior, or may have a medical condition. The first
step should be to address and assess the situation. It is inappropriate to discuss the matter with
other staff. It is premature to report the nurse to the human resources department and to issue
a written warning.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Meeting with the nurse will provide information. The nurse may be experiencing unusual
stress at home, may be unaware of her behavior, or may have a medical condition. The first
step should be to address and assess the situation. It is inappropriate to discuss the matter with
other staff. It is premature to report the nurse to the human resources department and to issue
a written warning.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Meeting with the nurse will provide information. The nurse may be experiencing unusual
stress at home, may be unaware of her behavior, or may have a medical condition. The first
step should be to address and assess the situation. It is inappropriate to discuss the matter with
other staff. It is premature to report the nurse to the human resources department and to issue
a written warning.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer that is a realistic and impartial approach.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 541
2) A rural hospital has been at capacity for the past 3 months. The CNO (chief nurse officer) has heard numerous
complaints from the nursing staff. Most of the complaints are issues related to other nursing departments and
are minor. The CNO realizes:
1. The nursing staff are inefficient in managing the client load.
2. This is a typical reaction amongst nursing departments.
3. The nursing staff is stressed due to a sustained, increased workload.
4. The nurses are ready to unionize.
Answer: 3
Explanation: 1. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to
do the tasks assigned because of a lack of preparation/experience, and insufficient information
regarding the assignment. The nursing staffʹs efficiency is not in question. The staff are
complaining about other departments and the CNO believes the complaints are minor.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to
do the tasks assigned because of a lack of preparation/experience, and insufficient information
regarding the assignment. The nursing staffʹs efficiency is not in question. The staff are
complaining about other departments and the CNO believes the complaints are minor.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to
do the tasks assigned because of a lack of preparation/experience, and insufficient information
regarding the assignment. The nursing staffʹs efficiency is not in question. The staff are
complaining about other departments and the CNO believes the complaints are minor.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to
do the tasks assigned because of a lack of preparation/experience, and insufficient information
regarding the assignment. The nursing staffʹs efficiency is not in question. The staff are
complaining about other departments and the CNO believes the complaints are minor.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-2: Describe the organizational, interpersonal, and individual factors that cause stress.
Test Taking Tip: Focus on the answer that addresses the amount of stress and the extended period of time.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 542
3) A busy ICU unit has a high noise level. The charge nurse is frustrated due to the noise level and the inability to
focus when entering physiciansʹ orders into the electronic medical record. Which of the following would be an
appropriate action by the ICU nurse manager?
1. Decrease the noise level on the unit.
2. Inform other staff they are to lower their voices.
3. Close the doors to the clientsʹ rooms.
4. Arrange an area that is quiet and removed from the nurseʹs work area to enter orders.
Answer: 4
Explanation: 1. The physical environment is stressful. Participative management can reduce job stress. It is
appropriate for the manager to investigate other measures to lower the noise level. It is
inappropriate at times to close doors to the clientsʹ rooms. This does not allow for the nurse to
visualize the client or monitors.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The physical environment is stressful. Participative management can reduce job stress. It is
appropriate for the manager to investigate other measures to lower the noise level. It is
inappropriate at times to close doors to the clientsʹ rooms. This does not allow for the nurse to
visualize the client or monitors.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The physical environment is stressful. Participative management can reduce job stress. It is
appropriate for the manager to investigate other measures to lower the noise level. It is
inappropriate at times to close doors to the clientsʹ rooms. This does not allow for the nurse to
visualize the client or monitors.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The physical environment is stressful. Participative management can reduce job stress. It is
appropriate for the manager to investigate other measures to lower the noise level. It is
inappropriate at times to close doors to the clientsʹ rooms. This does not allow for the nurse to
visualize the client or monitors.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer that addresses a proactive approach to the situation.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 543
4) A medical-surgical nurse manager has received a complaint by a client regarding the noise level on the unit.
The manager reviews the schedule and reprimands the nursing staff that cared for the client. This action by the
manager is:
1. Appropriate and timely.
2. Inappropriate and increases the nursing staffʹs level of stress.
3. Inappropriate and should be reported.
4. Appropriate and should be a model for future disciplinary actions.
Answer: 2
Explanation: 1. Authoritative or punitive supervisory behavior is closely related to stress levels. It may or may
not be appropriate to report this situation to administration. More information is needed to
determine the extent of the reprimand.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Authoritative or punitive supervisory behavior is closely related to stress levels. It may or may
not be appropriate to report this situation to administration. More information is needed to
determine the extent of the reprimand.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Authoritative or punitive supervisory behavior is closely related to stress levels. It may or may
not be appropriate to report this situation to administration. More information is needed to
determine the extent of the reprimand.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Authoritative or punitive supervisory behavior is closely related to stress levels. It may or may
not be appropriate to report this situation to administration. More information is needed to
determine the extent of the reprimand.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-2: Describe the organizational, interpersonal, and individual factors that cause stress.
Test Taking Tip: Focus on the answer that is a harsh reaction to the situation.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 544
5) A director over multiple nursing units has known for the past year of the implementation of a new electronic
bar coding medication administration system and has done nothing to prepare staff for the transition. After the
first month of implementation the nursing staff is much stressed. The CNO (chief nurse officer) is concerned
because the director:
1. Did not implement the bar coding system in a timely fashion.
2. Did not schedule additional staff while implementing the new system.
3. Did not take a client care assignment.
4. Has not participated in the administration of medications.
Answer: 2
Explanation: 1. New technology, increased expectations, and increased pressures for efficiency has made the
role for nurses stressful. The directorʹs ability to administer medications and/or take a client
assignment will not be as helpful as ensuring adequate staff is available during a time of
transition to a new process.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. New technology, increased expectations, and increased pressures for efficiency has made the
role for nurses stressful. The directorʹs ability to administer medications and/or take a client
assignment will not be as helpful as ensuring adequate staff is available during a time of
transition to a new process.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. New technology, increased expectations, and increased pressures for efficiency has made the
role for nurses stressful. The directorʹs ability to administer medications and/or take a client
assignment will not be as helpful as ensuring adequate staff is available during a time of
transition to a new process.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. New technology, increased expectations, and increased pressures for efficiency has made the
role for nurses stressful. The directorʹs ability to administer medications and/or take a client
assignment will not be as helpful as ensuring adequate staff is available during a time of
transition to a new process.
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-6: Explain how organizations can help reduce stress in the workplace.
Test Taking Tip: The key concept in the question is the length of time the director had to prepare for the implementation of
a new process.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 545
6) A CNO(chief nurse officer) has received numerous complaints from nursing staff regarding their nurse
manager. The CNO has received reports regarding retaliation if a nurse reports an issue or complaint regarding
another co-worker. The CNO realizes this will cause increased stress among the nursing staff because the:
1. Nurses must feel comfortable in reporting issues to their manager.
2. Manager is not delegating tasks to staff.
3. Manager is reporting the issues to human resources.
4. Assistant manager is working as a staff nurse.
Answer: 1
Explanation: 1. Authoritarian or punitive supervisory behavior is closely related to stress levels. Staff must
feel comfortable in reporting necessary information to their manager so issues can be
addressed and resolved. The manager may report the information to human resources but
should report the incidents to her manager, typically a director or CNO.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Authoritarian or punitive supervisory behavior is closely related to stress levels. Staff must
feel comfortable in reporting necessary information to their manager so issues can be
addressed and resolved. The manager may report the information to human resources but
should report the incidents to her manager, typically a director or CNO.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Authoritarian or punitive supervisory behavior is closely related to stress levels. Staff must
feel comfortable in reporting necessary information to their manager so issues can be
addressed and resolved. The manager may report the information to human resources but
should report the incidents to her manager, typically a director or CNO.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Authoritarian or punitive supervisory behavior is closely related to stress levels. Staff must
feel comfortable in reporting necessary information to their manager so issues can be
addressed and resolved. The manager may report the information to human resources but
should report the incidents to her manager, typically a director or CNO.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-3: Explain the consequences that result from stress, including burnout and compassion fatigue.
Test Taking Tip: Focus on the answer that addresses the nurseʹs reaction to the managerʹs management style.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 546
7) A night shift nurse is calling a physician about a clientʹs condition. The nurse gives the physician his
head-to-toe assessment. The physician becomes angry, gives orders, and hangs up on the nurse. The next day
the physician reported the nurse to the unitʹs nurse manager. What caused the physician to become angry?
1. The nurse called the physician in the middle of the night.
2. The nurse provided too much information.
3. The supervisor should have called the physician.
4. The nurse should have waited until the morning to notify the physician.
Answer: 2
Explanation: 1. The nurse should provide pertinent information to the physician. There is not enough
information to determine if the information could have waited until the morning to report to
the physician.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The nurse should provide pertinent information to the physician. There is not enough
information to determine if the information could have waited until the morning to report to
the physician.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The nurse should provide pertinent information to the physician. There is not enough
information to determine if the information could have waited until the morning to report to
the physician.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The nurse should provide pertinent information to the physician. There is not enough
information to determine if the information could have waited until the morning to report to
the physician.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-4: Discuss how individuals can manage stress.
Test Taking Tip: Focus on the answer that would address the physicianʹs anger.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 547
8) A night shift nurse who has returned from maternity leave is much stressed. The nurse has difficulty focusing
on her tasks. Which of the following would apply to the nurseʹs level of stress? Select all that apply.
1. Family problems related to different shift schedules
2. The physiological stress adjusting to the shift
3. A change in the family dynamics
4. Being married
5. Assistance from other nursing staff
Answer: 1, 2, 3
Explanation: 1. Conflict from family and professional roles, evening/night shift, and changes in family work
schedules add stress. Assistance from nursing staff should decrease the nurseʹs level of stress
along with the assistance of a spouse.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Conflict from family and professional roles, evening/night shift, and changes in family work
schedules add stress. Assistance from nursing staff should decrease the nurseʹs level of stress
along with the assistance of a spouse.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Conflict from family and professional roles, evening/night shift, and changes in family work
schedules add stress. Assistance from nursing staff should decrease the nurseʹs level of stress
along with the assistance of a spouse.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Conflict from family and professional roles, evening/night shift, and changes in family work
schedules add stress. Assistance from nursing staff should decrease the nurseʹs level of stress
along with the assistance of a spouse.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
5. Conflict from family and professional roles, evening/night shift, and changes in family work
schedules add stress. Assistance from nursing staff should decrease the nurseʹs level of stress
along with the assistance of a spouse.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-4: Discuss how individuals can manage stress.
Test Taking Tip: Focus on the answers that would increase a nurseʹs level of stress.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 548
9) A night shift nurse is having difficulty adjusting to the physiological stress of the shift. A seasoned night shift
nurse offered advice. Which of the following would be beneficial in managing the physiological stress of
working the night shift?
1. Adequate rest and a healthy diet between shifts
2. Increasing intake of caffeine prior to the shift
3. Taking frequent bathroom breaks
4. Obtaining a prescription for a sleeping aid
Answer: 1
Explanation: 1. Reducing physiological stress can occur by receiving adequate rest and work breaks, rotating
staff between two shifts, and never scheduling ʺdouble backʺ shifts (shifts in which the
employee has only 8 hours of rest between shifts).
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Reducing physiological stress can occur by receiving adequate rest and work breaks, rotating
staff between two shifts, and never scheduling ʺdouble backʺ shifts (shifts in which the
employee has only 8 hours of rest between shifts).
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Reducing physiological stress can occur by receiving adequate rest and work breaks, rotating
staff between two shifts, and never scheduling ʺdouble backʺ shifts (shifts in which the
employee has only 8 hours of rest between shifts).
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Reducing physiological stress can occur by receiving adequate rest and work breaks, rotating
staff between two shifts, and never scheduling ʺdouble backʺ shifts (shifts in which the
employee has only 8 hours of rest between shifts).
Nursing Process: Planning
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answers that are reasonable actions to manage stress.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 549
10) A human resources (HR) director has brought to a nurse directorʹs attention a high turnover rate for their
department. The nurse director informs the HR director that the department has experienced several staff with
personal issues that have caused them stress. The director informs the HR director it is a coincidence. The HR
director informs the CNO (chief nurse officer) of the turnover rate and discussion with the nurse manager.
Which action would be appropriate by the CNO?
1. Investigate the matter with current nursing staff and those who have left the organization.
2. Call the nurse director and inquire as to why turnover rate is high.
3. Discuss the matter with other nursing directors.
4. Discuss the matter with the CEO (chief executive officer).
Answer: 1
Explanation: 1. The CNO should investigate the matter to determine what has caused a high turnover in staff.
The HR director has already discussed the issue with the nurse director, who does not
acknowledge there is an issue with turnover. Reviewing exit interview notes of employees who
have left and discussing the matter with current staff will provide the CNO with information
regarding the directorʹs management style.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. The CNO should investigate the matter to determine what has caused a high turnover in staff.
The HR director has already discussed the issue with the nurse director, who does not
acknowledge there is an issue with turnover. Reviewing exit interview notes of employees who
have left and discussing the matter with current staff will provide the CNO with information
regarding the directorʹs management style.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. The CNO should investigate the matter to determine what has caused a high turnover in staff.
The HR director has already discussed the issue with the nurse director, who does not
acknowledge there is an issue with turnover. Reviewing exit interview notes of employees who
have left and discussing the matter with current staff will provide the CNO with information
regarding the directorʹs management style.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. The CNO should investigate the matter to determine what has caused a high turnover in staff.
The HR director has already discussed the issue with the nurse director, who does not
acknowledge there is an issue with turnover. Reviewing exit interview notes of employees who
have left and discussing the matter with current staff will provide the CNO with information
regarding the directorʹs management style.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-6: Explain how organizations can help reduce stress in the workplace.
Test Taking Tip: Focus on the answer that addresses investigating the matter.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 550
11) A newly hired registered nurse is having difficulty focusing and performing nursing tasks. The nurse manager
has noted a decrease in the nurseʹs performance. When meeting with the nurse, the manager learns the nurse
has experienced many life changes. Which of the following can contribute to the nurseʹs level of stress? Select
all that apply.
1. Marriage
2. Purchasing of a new home
3. Decreased work load
4. Assistance from other nursing staff
5. Difficult relationships with the nursing staff
Answer: 1, 2, 5
Explanation: 1. Stress can occur from personal factors. Rate of life changes such as marriage, pregnancy,
and/or purchasing of a new home can generate stress.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Stress can occur from personal factors. Rate of life changes such as marriage, pregnancy,
and/or purchasing of a new home can generate stress.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Stress can occur from personal factors. Rate of life changes such as marriage, pregnancy,
and/or purchasing of a new home can generate stress.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Stress can occur from personal factors. Rate of life changes such as marriage, pregnancy,
and/or purchasing of a new home can generate stress.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
5. Stress can occur from personal factors. Rate of life changes such as marriage, pregnancy,
and/or purchasing of a new home can generate stress.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on those answers that can cause stress.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 551
12) A staff nurse is conversing with other nurses regarding their managerʹs inability to obtain IV (intravenous)
access. One of the staff nurses informs this nurse, ʺIt is not a core competency for our manager to maintain this
skill.ʺ The nurse inquires as to the meaning of ʺcore competency.ʺ Which of the following is an accurate
response?
1. ʺA competence is the ability to perform a task.ʺ
2. ʺIt is a term that means the manager is able to perform various nursing tasks.ʺ
3. ʺIt is a course to develop skills.ʺ
4. ʺIt means it is not a primary skill the manager must have to perform her job.ʺ
Answer: 4
Explanation: 1. Core competencies for nurse managers include a different set of managerial skills, not excelling
at clinical skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Core competencies for nurse managers include a different set of managerial skills, not excelling
at clinical skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Core competencies for nurse managers include a different set of managerial skills, not excelling
at clinical skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Core competencies for nurse managers include a different set of managerial skills, not excelling
at clinical skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer that differs from a typical nursing skill.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 552
13) A physician meets with the CNO (chief nurse officer) to discuss concerns regarding the ICU nursesʹ level of
skill. The physician informs the CNO she has addressed her concerns to the manager and director of this unit.
The physician informs the CNO the director does not see any issues with the nursing staffʹs level of skill. This is
an example of:
1. Core competency.
2. Lack of motivation.
3. Low skill recognition.
4. Skill recognition.
Answer: 3
Explanation: 1. Low skill recognition needs the most attention in an unstable and unpredictable environment.
Low skill recognition is a tendency not to recognize the role oneʹs own ability has played in
producing stress. This affects both managers and staff when facing something unfamiliar.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Low skill recognition needs the most attention in an unstable and unpredictable environment.
Low skill recognition is a tendency not to recognize the role oneʹs own ability has played in
producing stress. This affects both managers and staff when facing something unfamiliar.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Low skill recognition needs the most attention in an unstable and unpredictable environment.
Low skill recognition is a tendency not to recognize the role oneʹs own ability has played in
producing stress. This affects both managers and staff when facing something unfamiliar.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Low skill recognition needs the most attention in an unstable and unpredictable environment.
Low skill recognition is a tendency not to recognize the role oneʹs own ability has played in
producing stress. This affects both managers and staff when facing something unfamiliar.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-3: Explain the consequences that result from stress, including burnout and compassion fatigue.
Test Taking Tip: Focus on the answer that addresses an individualʹs lack of addressing or recognizing a problem.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 553
14) A new nurse is adjusting to the medical-surgical unit. The nurse has completed orientation. The nurse is
confiding in a peer regarding his level of stress and feeling incompetent. The nurse informs the new nurse this
is a typical reaction and is called, ʺreality shock.ʺ Which of the following describes reality shock?
1. The inability to function as a registered nurse
2. The transition from the student nurse to work nurse environment
3. The transition from orientation to the actual work environment
4. The difficulty in functioning as a competent nurse
Answer: 2
Explanation: 1. Reality shock is the stress experienced when students change their role to a professional
practitioner role. The new nurse is a registered nurse, and orientation is just a period of time
for the nurse to learn the processes on the unit and within the organization.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Reality shock is the stress experienced when students change their role to a professional
practitioner role. The new nurse is a registered nurse, and orientation is just a period of time
for the nurse to learn the processes on the unit and within the organization.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Reality shock is the stress experienced when students change their role to a professional
practitioner role. The new nurse is a registered nurse, and orientation is just a period of time
for the nurse to learn the processes on the unit and within the organization.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Reality shock is the stress experienced when students change their role to a professional
practitioner role. The new nurse is a registered nurse, and orientation is just a period of time
for the nurse to learn the processes on the unit and within the organization.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-4: Discuss how individuals can manage stress.
Test Taking Tip: Focus on the answer that best describes the new nurseʹs situation.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 554
15) The medical surgical nurse manager is having difficulties with the nursing staff who assume the charge nurse
role. The charge nurses perform their duties differently from one another and are inconsistent. One charge
nurse informs the manager, ʺI get tired of them complaining so I enter their orders into the system.ʺ The nurse
manager is aware this is an interrole conflict. Which of the following describes an interrole conflict?
1. The role is inconsistently performed.
2. The manager is not directing the assigned nursing tasks.
3. There is conflict between the charge nurse and nursesʹ roles.
4. The charge nurses are not fulfilling their role.
Answer: 3
Explanation: 1. Interrole conflict occurs when there is conflict between the roles of nurse manager and a nurse.
Inconsistencies with the charge nurse role can add stress to the unit environment. The manager
is not the issue regarding the roles and conflict described in the question.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Interrole conflict occurs when there is conflict between the roles of nurse manager and a nurse.
Inconsistencies with the charge nurse role can add stress to the unit environment. The manager
is not the issue regarding the roles and conflict described in the question.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Interrole conflict occurs when there is conflict between the roles of nurse manager and a nurse.
Inconsistencies with the charge nurse role can add stress to the unit environment. The manager
is not the issue regarding the roles and conflict described in the question.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Interrole conflict occurs when there is conflict between the roles of nurse manager and a nurse.
Inconsistencies with the charge nurse role can add stress to the unit environment. The manager
is not the issue regarding the roles and conflict described in the question.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-2: Describe the organizational, interpersonal, and individual factors that cause stress.
Test Taking Tip: Focus on the answer that addresses the conflict between the charge nurse and staff nurse.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 555
16) An ER (emergency room) nurse has applied for a job in the OB department. During the interview the OB
manager inquires as to the ER nurseʹs ability to manage stressful situations. The manager learns the ER nurse is
leaving the ER environment due to stress. The manager asks these questions to determine:
1. The ER nurseʹs ability to work independently.
2. Past work experience.
3. Past coping experiences that will assist the manager in determining the nurseʹs ability to manage stress.
4. More about the ER environment
Answer: 3
Explanation: 1. Past experience in coping with stress provides insight into an individualʹs ability for successful
coping in current experiences.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Past experience in coping with stress provides insight into an individualʹs ability for successful
coping in current experiences.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Past experience in coping with stress provides insight into an individualʹs ability for successful
coping in current experiences.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Past experience in coping with stress provides insight into an individualʹs ability for successful
coping in current experiences.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-1: Explain why stress is necessary.
Test Taking Tip: Focus on the answer that will assist the manager in determining the nurseʹs ability to manage stress.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 556
17) A medical surgical nurse has been trained to work in the ICU unit. The nurse has been working in ICU for the
past 2 years. During the nurseʹs annual appraisal the ICU manager informs the nurse that his performance in
not adequate to provide nursing care to this population. The manager informs the nurse they he be transferred
back to the medical-surgical unit. Over the past few weeks the manager has pulled this nurse to work in the
ICU unit. This type of management style causes:
1. Increased stress.
2. Role ambiguity.
3. Mistrust.
4. Disharmony.
Answer: 2
Explanation: 1. Role ambiguity results form unclear expectations for oneʹs performance. Role ambiguity may
cause increased stress, disharmony, and mistrust.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Role ambiguity results form unclear expectations for oneʹs performance. Role ambiguity may
cause increased stress, disharmony, and mistrust.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Role ambiguity results form unclear expectations for oneʹs performance. Role ambiguity may
cause increased stress, disharmony, and mistrust.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Role ambiguity results form unclear expectations for oneʹs performance. Role ambiguity may
cause increased stress, disharmony, and mistrust.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-2: Describe the organizational, interpersonal, and individual factors that cause stress.
Test Taking Tip: Focus on the answer that correlates to the described behavior in the question.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 557
18) An assistant nurse manager is assisting the nursing staff so they can get to lunch. The assistant manager
realizes there is a nursing administration meeting at noon. Later in the afternoon the manager of the unit is
irate with the assistant manager because she missed the meeting. This is an example of:
1. Poor leadership.
2. Mismanagement of the unit.
3. Role conflict.
4. Miscommunication.
Answer: 3
Explanation: 1. Role conflict occurs when an individual has two competing roles. The unit was managed
effectively so staff could get to lunch, which reflects good management and leadership skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Role conflict occurs when an individual has two competing roles. The unit was managed
effectively so staff could get to lunch, which reflects good management and leadership skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Role conflict occurs when an individual has two competing roles. The unit was managed
effectively so staff could get to lunch, which reflects good management and leadership skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Role conflict occurs when an individual has two competing roles. The unit was managed
effectively so staff could get to lunch, which reflects good management and leadership skills.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-6: Explain how organizations can help reduce stress in the workplace.
Test Taking Tip: Focus on the answer that describes the issue of conflicting roles.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 558
19) A nurse who has advanced to assistant nurse manager has been demoted to staff nurse. The manager gives the
nurse a client assignment with clients of low acuity. The nurse is efficient, unhappy, and bored. The nurse is
looking for other employment opportunities. This is an example of ʺrole underload.ʺ Which describes these
phenomena?
1. Low self-esteem
2. Low morale
3. Mismanagement
4. Underutilization of staff
Answer: 4
Explanation: 1. Being underutilized or not having much responsibility may be seen as stressful by a person
who is a high achiever or who has high self-esteem.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Being underutilized or not having much responsibility may be seen as stressful by a person
who is a high achiever or who has high self-esteem.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Being underutilized or not having much responsibility may be seen as stressful by a person
who is a high achiever or who has high self-esteem.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Being underutilized or not having much responsibility may be seen as stressful by a person
who is a high achiever or who has high self-esteem.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-3: Explain the consequences that result from stress, including burnout and compassion fatigue.
Test Taking Tip: The key terms in the question are, ʺdemoted,ʺ ʺefficient,ʺ ʺunhappy,ʺ and ʺbored.ʺ
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 559
20) A nurse has worked on the medical surgical unit for the past 10 years. The nurse has applied for a transfer to
the ER (emergency room). When the nurse informs the unit manager of the request to transfer, the nurse
informs the manager, ʺIʹm burned out.ʺ Which of the following describes burnout?
1. The nurse is unable to function as a nurse.
2. The nurse is exhausted physically, emotionally, and cognitively.
3. The nurse is not challenged by his current position.
4. The nurse is ready to leave the nursing profession.
Answer: 2
Explanation: 1. The term burnout refers to the perception that an individual has used up all available energy to
perform the job and feels he or she does not have the energy to complete the task.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The term burnout refers to the perception that an individual has used up all available energy to
perform the job and feels he or she does not have the energy to complete the task.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. The term burnout refers to the perception that an individual has used up all available energy to
perform the job and feels he or she does not have the energy to complete the task.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. The term burnout refers to the perception that an individual has used up all available energy to
perform the job and feels he or she does not have the energy to complete the task.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-3: Explain the consequences that result from stress, including burnout and compassion fatigue.
Test Taking Tip: Recall the definition of burnout.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 560
21) A paramedic who is working in the emergency room has been having severe mood swings. The nurse manager
meets with the paramedic in private and inquires as to the rationale for the mood swings. The manager learns
the paramedic has been working in the field in addition to the ER. The manager suggests the paramedic take
advantage of the organizationʹs employee assistance program. The manager suspects the paramedic is:
1. Suicidal.
2. Suffering from posttraumatic stress disorder.
3. Not challenged.
4. Suffering from compassion fatigue.
Answer: 4
Explanation: 1. Compassion fatigue is secondary traumatic stress experience by caregivers. It is similar to
posttraumatic stress disorder but is a term originated in nursing. It includes those individuals
who care for others who are experiencing physical and/or emotional pain.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Compassion fatigue is secondary traumatic stress experience by caregivers. It is similar to
posttraumatic stress disorder but is a term originated in nursing. It includes those individuals
who care for others who are experiencing physical and/or emotional pain.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Compassion fatigue is secondary traumatic stress experience by caregivers. It is similar to
posttraumatic stress disorder but is a term originated in nursing. It includes those individuals
who care for others who are experiencing physical and/or emotional pain.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Compassion fatigue is secondary traumatic stress experience by caregivers. It is similar to
posttraumatic stress disorder but is a term originated in nursing. It includes those individuals
who care for others who are experiencing physical and/or emotional pain.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer that leads to the emotional and compassionate toll this paramedic is experiencing in
extremely stressful environments.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 561
22) A charge nurse has become very stressed regarding her role. The charge nurse discovered she were trying to
please all of her coworkers and neglecting her role. The charge nurse took some time to think about her level of
stress and decided to manage her role differently. This is an example of:
1. Role conflict.
2. Role definition.
3. Role redefinition.
4. Interrelated conflict.
Answer: 3
Explanation: 1. Role redefinition involves clarifying roles and attempting to integrate or tie together the
various roles individuals play. This may cause role negotiation in an attempt to lessen the
workload.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. Role redefinition involves clarifying roles and attempting to integrate or tie together the
various roles individuals play. This may cause role negotiation in an attempt to lessen the
workload.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. Role redefinition involves clarifying roles and attempting to integrate or tie together the
various roles individuals play. This may cause role negotiation in an attempt to lessen the
workload.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. Role redefinition involves clarifying roles and attempting to integrate or tie together the
various roles individuals play. This may cause role negotiation in an attempt to lessen the
workload.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-4: Discuss how individuals can manage stress.
Test Taking Tip: Focus on the questionʹs description of the nurseʹs assessment and implementation of changes to her role.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 562
23) A medical-surgical nurse has transferred to the ICU unit and has completed his orientation. After a few weeks
the nurse is stressed and requests a meeting with the manager. The manager learns the nurse is not confident
of his skills. Which option would be an appropriate option that would benefit the nurse and the unit?
1. Reduce the nurseʹs client assignment.
2. Transfer the nurse back to the medical-surgical unit.
3. Provide written instruction regarding the desired unit specific skills.
4. Provide additional weeks to orientation with a focus on skill development.
Answer: 4
Explanation: 1. If staff appear to be under great deal of stress, the manager must help identify the source and
decide how these can be reduced or eliminated. Transferring the nurse to the medical -surgical
unit may add to his stress and is not a win-win situation for both parties. Written instructions
and reducing the nurseʹs work load are not addressing the nurseʹs concerns or requests.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. If staff appear to be under great deal of stress, the manager must help identify the source and
decide how these can be reduced or eliminated. Transferring the nurse to the medical -surgical
unit may add to his stress and is not a win-win situation for both parties. Written instructions
and reducing the nurseʹs work load are not addressing the nurseʹs concerns or requests.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
3. If staff appear to be under great deal of stress, the manager must help identify the source and
decide how these can be reduced or eliminated. Transferring the nurse to the medical -surgical
unit may add to his stress and is not a win-win situation for both parties. Written instructions
and reducing the nurseʹs work load are not addressing the nurseʹs concerns or requests.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
4. If staff appear to be under great deal of stress, the manager must help identify the source and
decide how these can be reduced or eliminated. Transferring the nurse to the medical -surgical
unit may add to his stress and is not a win-win situation for both parties. Written instructions
and reducing the nurseʹs work load are not addressing the nurseʹs concerns or requests.
Nursing Process: Evaluation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer that is a collaborative and supportive solution for both parties.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 563
24) A manager questions a nurse as to her analysis of the managerʹs job performance. A reason the manager may
ask this question would be:
1. The manager is questioning his leadership style and its effectiveness.
2. The manager wants information regarding how the nurse views him.
3. The manager is attempting to appear helpful.
4. The manger is inquiring about other leadership styles the nurse has encountered.
Answer: 1
Explanation: 1. Nurse managers are in a position to help their employees. Assessing whether their
management or leadership style is helpful or appropriate allows managers to enhance their
performance. Attempting to appear helpful or obtaining the nursesʹ view of the manager will
only encourage an environment of mistrust in the future.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Nurse managers are in a position to help their employees. Assessing whether their
management or leadership style is helpful or appropriate allows managers to enhance their
performance. Attempting to appear helpful or obtaining the nursesʹ view of the manager will
only encourage an environment of mistrust in the future.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Nurse managers are in a position to help their employees. Assessing whether their
management or leadership style is helpful or appropriate allows managers to enhance their
performance. Attempting to appear helpful or obtaining the nursesʹ view of the manager will
only encourage an environment of mistrust in the future.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Nurse managers are in a position to help their employees. Assessing whether their
management or leadership style is helpful or appropriate allows managers to enhance their
performance. Attempting to appear helpful or obtaining the nursesʹ view of the manager will
only encourage an environment of mistrust in the future.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-5: Discuss how managers can help themselves and their staff manage stress.
Test Taking Tip: Focus on the answer in which the manager wants feedback regarding his role.
Effective Leadership and Mgmt in Nursing, 7e (Sullivan) — CVC 12/3/08 — Page 564
25) The CNO (chief nurse officer) conducts open nursing staff meetings to allow for effective communication. A
new nurse manager asks the CNO the rationale for the meetings. Which of the following would be an
appropriate response?
1. ʺI believe in being visible to the staff.ʺ
2. ʺI canʹt rely on nurse managers to communicate information to staff.ʺ
3. ʺI believe in open communication so staff are aware of whatʹs going on within the organization.ʺ
4. ʺIt allows me to get to know the nursing staff.ʺ
Answer: 3
Explanation: 1. Communication and social support are additional factors in reducing stress. Both upward and
downward communication channels should be open. Keeping personnel informed about what
is going on in an organization helps to reduce suspicion and rumors.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
2. Communication and social support are additional factors in reducing stress. Both upward and
downward communication channels should be open. Keeping personnel informed about what
is going on in an organization helps to reduce suspicion and rumors.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
3. Communication and social support are additional factors in reducing stress. Both upward and
downward communication channels should be open. Keeping personnel informed about what
is going on in an organization helps to reduce suspicion and rumors.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
4. Communication and social support are additional factors in reducing stress. Both upward and
downward communication channels should be open. Keeping personnel informed about what
is going on in an organization helps to reduce suspicion and rumors.
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Analysis
Learning Outcome: 24-6: Explain how organizations can help reduce stress in the workplace.
Test Taking Tip: Focus on the answer that is beneficial to both the CNO and nursing staff.