Final Exam

1. Typical hospital processes focus on predictability, equilibrium, and evolution while limiting flexibility, variation, and creativity in order to achieve the goals of the process. What type of change do typical hospital processes promote?

a. Horizontal change b. Lateral change

*c. Linear change d. Vertical change

2. _______ is a unique type of change that is novel and dramatic and fundamentally restructures the deep social and economic value of an organization.

*a. Innovation b. Digitization c. Stagnation d. Modernization a. Legal mandate

3. As a nurse, your license is proof that you are capable of performing your role and you do not take your obligations lightly. Failure to adhere to the regulations of your license put you at risk for severe penalties. Performing your role as a nurse is not simple a duty. Which of the following describes your role?

*b. Social mandate c. Employer mandate d. Federal mandate a. Educational background b. Employment history

4. Which of the following enumerates the conditions of membership and the statutory requisites for membership and practice of a profession?

*c. Licensing regulations d. Accreditation standards a. analysis

5. The ultimate goal of _______ is to observe the system acting and interacting as a whole in a way that represents the desired state.

*b. synthesis c. management d. leadership a. Leadership

6. The leadership characteristics of accountability, ownership, equity, and empowerment are all examples of which type of competency?

*b. Participation c. Interpersonal d. Conceptual a. Collaboration b. Accreditation

7. As a nurse leader, it is easy to permit the reflective work of the profession to be sacrificed through unrelenting work expectations and by keeping team members busy without giving them an opportunity to think about what they are doing. Which of the following is this behavior encouraging?

*c. Alienation d. Confrontation

8. For a leader to be effective in managing conflict, he or she must learn to confront conflict by overcoming which personal barrier?

*a. Fear b. Uncertainty c. Negativity d. Inexperience a. Stability b. Homogeneity

9. Your facility recently implemented a new workforce management system. After a year of using this system, it is realized that the system is unable to measure what it is designed to measure and does not have the ability to quantify and predict patient needs for nursing care. Which of the following is this system lacking?

*c. Validity d. Equivalence a. Stability b. Homogeneity c. Heterogeneity

10. Which of the following refers to the extent to which different nurses use the same workforce system to measure the same individual at the same time to derive consistent results?

*d. Equivalence

11. As a nurse leader, you recognize that one of your patients is clearly at the end of life and no treatments are proving beneficial for improving this patient's condition; therefore, further treatments are withheld. This process of withholding treatment is an example of which of the following? a. Ethical dilemma b. Health advocacy

*c. Medical futility d. Nonmaleficence a. Bioethics

12. Which of the following is a recently developed moral theory based on the insights of Gilligan that rejects the traditional male-centered ethics focused on rationality, individuality, and abstract principles in favor of emotion, caring relationships, and concrete situations?

*b. Ethics of care c. Utilitarianism d. Rationalization a. Hierarchy b. Leadership c. Management

13. Which of the following is essential to the decision-making process and team collaboration and vital in terms of the kinds of team members sitting around the table and their particular behaviors?

*d. Diversity

14. All of the following are critical factors for the effectiveness of the team leader's role except: a. the use of a good process. b. adequate structuring of the team. d. the progress of the team toward its goals or fulfillment of its purpose.

*c. constant monitoring of team behavior.

15. The involvement of government, the intractable uncertainty in many healthcare areas, the barriers to accessing services, and the role of third-party agents in brokering and managing funds are all unique characteristics of: a. health management. c. decision making. d. healthcare legislation.

*b. healthcare economics.

16. Onboarding, employee rounding, social networking, employee recognition, and developmental stretch assignments are five practices that have been identified for increasing which of the following?

*a. Nurse retention b. Nurse turnover c. Patient satisfaction d. Employee wellness a. The sustainability of healthcare services fully depends on how the point-of-service professionals function individually and collectively. b. The emergence of knowledge organizations demonstrates that knowledge is not fixed or finite and does not operate simply as a capacity. c. In a continuum of care approach, no one healthcare organization can own, control, or unilaterally mandate all of the service linkages and connections necessary to fully serve a specific population. a. The whole is never greater than the parts. b. A problem in one part of the system ultimately affects the whole system. c. All disciplines serve the user and/or serve someone who serves the user. d. In complex adaptive systems, form and function interact with each other; otherwise, they do not have a dependent relationship. e. The whole is never greater than the parts, a problem in one part of the system ultimately affects the whole system, and in complex adaptive systems, form and function interact with each other; otherwise, they do not have a dependent relationship. f. A problem in one part of the system ultimately affects the whole system, all disciplines serve the user and/or serve someone who serves the user, and in complex adaptive systems, form and function interact with each other; otherwise, they do not have a dependent relationship. a. Complex adaptive system providers are integrated in a collaborative and linked relationship that synthesizes well around the needs of the user. b. The primary driving point of decision making in a complex clinical delivery system is the place where the provider and the user meet. c. Data must be available at point-of-service to support caregivers in decision making, in clinical activities, and in the evaluation of impact and value. d. Both complex adaptive system providers are integrated in a collaborative and linked relationship that synthesizes well around the needs of the user, and the primary driving point of decision making in a complex clinical delivery system is the place where the provider and the user meet.

17. There are several reasons why the shared governance organizational structure operates effectively in complex adaptive systems like the healthcare environment. These reasons include which of the following?

*d. All of these are correct.

18. For complex adaptive systems to thrive, which of the following principles must be in operation?

*g. All of these are correct.

19. For a system to be effective, which of the following considerations must be addressed?

*e. All of these are correct.

20. All of the following statements are true about accountability in shared governance except: a. Accountability drives the work of professionals. b. Accountability is the foundation for all knowledge work performance. c. Every member of a complex adaptive system has both rights and obligations that generate from the full participation in the life and activities of the system. d. Every member of the system must fully contribute to the extent of his or her capacity in a way that ensures that the system thrives and fulfills its essential value.

*e. All of these are correct.

21. The role of management in shared governance is: a. stewardship. b. unilateral decision making. c. servant leadership. d. ensuring a seamless interface between the system's purpose and resources. e. both stewardship and servant leadership.

*f. stewardship, servant leadership, and ensuring a seamless interface between the system's purpose and resources.

22. All of the following are elements of a professional nurse portfolio except: a. continuing education records. c. committee contributions. d. contributions to the community. a. Remediation

*b. attendance records.

23. As a professional nurse, you are required to participate in an ongoing synthesis of knowledge, skills, and abilities required to practice safely and effectively in accordance with the scope of nursing practice. Which of the following refers to this requirement?

*b. Continuing competence c. Certification d. Licensure

24. Strategies for enhancing personal balance include: a. minimizing negative thoughts. b. a specific time for reflection and planning for the future. c. being mindful of self within or after professional practice situations. d. stress management.

*e. All of these are correct.

25. A coach is: a. a wise and trusted advisor who guides others on a particular journey. c. a unit manager or leader. d. None of these is correct. a. Ethical dilemma b. Boundary violation

*b. one who assists others with developing viable solutions, prioritizing them, and then acting on them.

26. As a registered nurse for a number of years, you find yourself not caring as much about your patients as you once did. Which of the following are you experiencing?

*c. Compassion fatigue d. Emotional breakdown

27. As a nurse leader, you notice there is a growing interest among your employees with regards to policy issues and the relationship to individual nurse performance and the ability to practice. Which of the following stages of political development are you recognizing among your employees?

*a. Buy-in b. Self-interest c. Political sophistication d. Leadership

28. Considerations for being “media ready” include: a. practicing with internal public relations staff. b. avoiding off-the-record comments. c. defining key messages and staying on message.

*d. All of these are correct.

29. Which of the following is the agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care in the United States?

*a. Agency for Healthcare Research and Quality b. Commonwealth Fund c. Institute of Medicine d. Organization of Nurse Executives

30. The Institute of Medicine is: a. an organization that serves to promote health care that emphasizes access, quality, and greater efficiency, particularly for society's most vulnerable people. c. the U.S. government's principal agency for protecting the health and well-being of all Americans through the provision of essential human services, especially for those who are most needy. d. None of these is correct. a. Patient history

*b. a nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

31. A nurse assisting with a surgical procedure witnesses a physician explain the procedure to the patient, explain the risks involved, the expected outcomes, the potential complications, and the available alternative treatments. Which of the following has the nurse just witnessed?

*b. Informed consent c. Implied consent d. Refusal of treatment a. Licensed practical nurse

32. Occasionally, nurses may need to delegate some of their duties to others to ensure they are performed properly and in a timely fashion. Who would not be appropriate personnel for a nurse to delegate to?

*b. Advanced practice nurse c. Medical assistant d. Licensed vocational nurse

33. A delegation can be improper if any of the five “rights” are violated. These “rights” include: a. the right task. b. the right patient. c. the right circumstances. d. the right directions. e. the right supervision.

*f. All of these are correct.

34. Underdelegation is when: b. the workload is beyond what the delegate can reasonably do in the assigned time. c. the delegator is constantly looking over the shoulders of the person asked to do the work. d. any of the five rights are violated. a. Refusal by delegate b. Overdelegation

*a. not enough work is delegated.

35. As a nurse, occasionally you will ask someone to do something they have not achieved the proper competency for or are not licensed to perform. Which challenge of delegation have you just encountered?

*c. Boundary clarity d. Oversupervision

36. All of the following are principles of delegation from the ANA or NCSBN websites except: a. Delegation to competent individuals. b. Care coordination and the use of assistants in providing patient care. d. The essence of professional responsibility and accountability. a. Ultimatum b. Bargaining point c. Balance of power

*c. Ensuring the integrity of the physical plant.

37. At the beginning of negotiation, one party states “there is absolutely no deal unless a certain action occurs.” Which of the following has that party just established?

*d. Bottom line

38. Bargaining: a. is the phase of negotiation that emphasizes the give and take related to the variety of positions at the table. b. is the work of exchange. c. initiates the serious give and take necessary to determine which legitimate positions emerge and the degree of support for any particular position or view.

*d. All of these are correct.

39. You will encounter many different personalities throughout negotiations. Becoming more visual by putting thoughts in writing, using visual presentations, placing submissions in a bullet-point format, or restating the participant's contribution as a way of clarifying will go a long way when dealing with which type of negotiator?

*a. Unclear negotiator b. Indecisive negotiator c. Aggressive negotiator d. Emotional negotiator

40. Collective bargaining is protected by: a. the Department of Commerce. b. the National Labor Relations Act. c. the Taft-Hartley Act. d. Public Law 93-360. e. Both the Department of Commerce and the National Labor Relations Act. g. All of these are correct

*f. The National Labor Relations Act, the Taft-Hartley Act, and Public Law 93-360.

41. Collective bargaining agreements include all of the following except: a. salaries. b. benefits. c. working conditions. a. Accountability b. Authority c. Autonomy

*d. healthcare costs.

42. To date, performance evaluations review the worker in the context of the capacity to function and the ability of the worker to do or perform the work. In reality, what are performance evaluations assessing?

*d. Responsibility

43. It is not uncommon to hear nurses refer to their profession as a job with a laundry list worth of tasks, functions, actions, and effort, and it doesn't take long for that attitude to spread throughout the entire staff where everyone considers their profession a job. Which of the following represents this mindset?

*a. Employee work group syndrome b. Nurse fatigue c. Compassion fatigue d. Collaboration

44. Value is: a. doing the right work rather than doing a good job. b. work that is informed by purpose. c. the product of a measured and defined relationship between an effective process and a meaningful outcome.

*d. All of these are correct.

45. Risk is: a. a sign of the continuous and dynamic reach of the human experience in new directions in new ways. b. exploring new territory in a way that advances the human experience and improves it in important ways. c. to be avoided in the healthcare arena. d. present at some level with all meaningful change. f. All of these are correct. a. Accountability generally reflects an individual's professional commitment to performance and to action. b. Accountability demands a dynamic convergence between ownership, action, impact, and outcome. c. Individual accountability cannot be sustained if the system structure does not allow it to be legitimately expressed by those who own it. a. Autonomy

*e. a sign of the continuous and dynamic reach of the human experience in new directions in new ways, exploring new territory in a way that advances the human experience and improves it in important ways, and present at some level with all meaningful change.

46. The central characteristics of accountability that are nonnegotiable for the profession represent which of the following principles?

*d. All of these are correct.

47. As a nurse leader, your responsibility is to make sure the necessary power to decide and act is located in the place where the right to decide to act is located. Which of the following characteristics refers to this responsibility?

*b. Authority c. Accountability d. Competence

48. Nurses should know the: a. source of healthcare policies. b. content of healthcare policies. c. consequences of healthcare policies. d. role of the professional in providing feedback to policymakers when policies are no longer effective. a. Laws b. Regulations

*e. All of these are correct.

49. Just because you are a licensed, professional nurse does not mean you are going to behave and conduct yourself in a professional manner. Which of the following are in place to ensure the unique trust society has for licensed, professional nurses?

*c. Codes of ethics d. Performance evaluations

50. Nursing career management includes all of the following except: a. maintaining a current license. b. maintaining continuing competence. c. participating in professional organizations.

*d. exploring alternative careers.

51. Knowledge workers (professionals): a. need a very specific organizational context in order to facilitate good practice and positive outcomes. b. are intrinsically motivated. c. see their work as more than simply a job. d. both need a very specific organizational context in order to facilitate good practice and positive outcomes and are intrinsically motivated.

*e. All of these are correct.