instructor proof - test bank and solution manual · web viewexplain the key advantages of shared...

Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test Bank Chapter 4Question 1Type: MCMA

The organizational analysis documentation describes the organization as one with centralized leadership with a clearly defined organization chart hierarchy. The organization is divided into departments and follows detailed rules and regulation. This organization follows which theories?

Standard Text: Select all that apply.

1. Classical.

2. Systems.

3. Integrated delivery system.

4. Vertical integration theory.

5. Bureaucratic.

Correct Answer: 1,5

Rationale 1: The first principle of classical organization theory is division of labor, which is done in this organization through establishing departments. This theory is also demonstrated by the clear delineation of the policies and procedures and a defined hierarchy.

Rationale 2: In systems theory there is one entity with multiple elements that interact independently.

Rationale 3: This system focuses on a continuum of care, using a decentralized leadership style. There is a merging (horizontal of vertical) of various components of the system.

Rationale 4: This is an organizational style that is part of an integrated delivery system.

Rationale 5: Bureaucratic organizations incorporate the key principles of classical theory with a division of labor, clearly defined hierarchy, and detailed rules and regulations.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 01. Compare and contrast the key organizational theories.

Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

Question 2Type: MCMA

The health care organization is undergoing reorganization to a service-line structure. What are the benefits of this structure?


1. There is a clear delineation of the organization’s rules.

2. Each staff member reports to only one supervisor.

3. Staff members are not encouraged to use creative problem solving.

4. Departments are less likely to place blame on one another.

5. The nursing presence is strong and unified.

Correct Answer: 4

Rationale 1: This is not true of a service-line organization, but of a classical or bureaucratic organization.



Rationale 4: A service-line organization groups activities according to product or service. Therefore, one department cannot place blame on another department, because all departments are a part of the same service line.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 01. Compare and contrast the key organizational theories.

Question 3Type: MCSA

The director of nursing education for a hospital has been asked to provide continuing education on safety precautions to physicians, nurses, and all other disciplines providing patient care. Although the director is responsible for providing this education, the director is not responsible for assuring that physicians and health care managers adhere to the procedures. What type of health care organizational structure is present in this hospital?


1. Vertical structure.

2. Staff authority.

3. Span of control.

4. Horizontal structure.

Correct Answer: 2

Rationale 1: Vertical structure uses centralized decision making.

Rationale 2: When staff members function in an advisory capacity and cannot force other staff to do something they are operating under staff authority structure.

Rationale 3: Span of control describes the number of people supervised by one person or position.

Rationale 4: Horizontal structure uses decentralized decision making, and is organized around customer-oriented processes.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 02. Distinguish between structure and process.


The obstetrics department, which is composed of labor and delivery, postpartum, nurseries, and the neonatal intensive care unit, operates under what organizational structure?

1. Decentralized structure.

2. Matrix organizational structure.

3. Departmentalization.

4. Line authority.

Correct Answer: 3

Rationale 1: Decentralized structure spreads tasks and authority out over components of the organization.

Rationale 2: Matrix organization is used when staff members belong to a functional department, such as nursing, and to a service or product department, such as radiology.


Rationale 3: Departmentalization occurs when divided tasks are grouped based on related responsibilities or location.

Rationale 4: Line authority or chain of command identifies to whom each staff member reports up through the chain of command.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 02. Distinguish between structure and process.


Which statement should be included in a classroom discussion about organizational process?

1. It is a philosophy that becomes the basis for operationalizing the mission of the institution.

2. It answers the questions of “what does the organization look like.”

3. It directs staff as to whom they report.

4. It is a graphical representation of an organization’s flow of responsibility.

Correct Answer: 1

Rationale 1: The organizational process focuses on how the organization operates.

Rationale 2: The organizational process answers the question of “why” for the organization.

Rationale 3: This statement describes chain of command.

Rationale 4: This is a description of an organizational chart.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 02. Distinguish between structure and process.



Choose the statements that are correct about not-for-profit health care organizations.


1. There are stockholders who own stock in the organization.

2. These organizations do not have to make a profit to survive.

3. Typically these organizations are funded by charitable institutions, the government, or churches as well as by the typical reimbursement sources.

4. These organizations experience more ethical and legal problems.

5. Organizations are called voluntary or public health organizations.

Correct Answer: 3,5

Rationale 1: Stockholders or shareholders own stock or shares in for-profit organizations.

Rationale 2: Both for-profit and not-for-profit organizations have to make a profit to survive. The not-for-profit organizations invest all profits back into the organization.

Rationale 3: This is the typical funding source for not-for-profit health care organizations.

Rationale 4: Since for-profit organizations have a need for financial success, as a group they typically have more ethical and legal problems.

Rationale 5: Not-for-profit health care organizations are also known as voluntary or public health organizations.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 03. Explain the key differences between for-profit and not-for-profit health care organizations.


What has caused some of the concern about the use of unlicensed assistive personnel (UAP)?

1. Supervision is provided by the registered nurse.

2. UAPs do not provide quality care.

3. Home health aides are not supervised.


4. There is variability of education and training of all types of UAPs.

Correct Answer: 4

Rationale 1: Supervision by the registered nurse is not a concern as long as the RN assures they are able provide safe care.

Rationale 2: Most UAPs do provide quality care with appropriate supervision.

Rationale 3: Home health aides, although they work more independently than do UAPs in other organizations, are supervised by the home health RN.

Rationale 4: The amount of education and training of UAPs is highly variable, which has caused some concern about what they are able to do and the effect on the quality of care.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 04. Compare the key health care providers and their services.


The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model can these students most usually expect to follow?

1. Total patient care model.

2. Functional nursing model.

3. Primary nursing model.

4. Care management model.

Correct Answer: 1

Rationale 1: Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student’s progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving IV meds.

Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as wound care.


Rationale 3: In primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care, from admission to discharge.

Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 07. Compare and contrast the different nursing care models discussed in this chapter.


This morning, the RN is assigned to administer medications to all of the patients on the medical-surgical unit. From this assignment, the RN knows that this organization adheres to which type of patient care delivery model?

1. Total patient care model.

2. Functional nursing model.

3. Primary nursing model.

4. Care management model.

Correct Answer: 2

Rationale 1: The staff working for an organization that uses the total patient care model are assigned to provide all of the care for a patient while in the clinical area.

Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as passing out medications for the unit.

Rationale 3: IN primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care, from admission to discharge.

Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningFinkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

Learning Outcome: LO 07. Compare and contrast the different nursing care models discussed in this chapter.


What is a disadvantage of using the team approach for care delivery?

1. The team leader might not have the necessary leadership skills required to successfully lead the team.

2. There is a risk that care will be fragmented.

3. This approach often leads to greater staff dissatisfaction, with staff members feeling they are just grinding out tasks.

4. This approach may lead to decreased collaboration and redundancy in patient care.

Correct Answer: 1

Rationale 1: Using the team approach requires that the team leader have the necessary leadership skills to coordinate and delegate patient care.

Rationale 2: The team approach helps keep care from becoming fragmented.

Rationale 3: In this approach, each team member can contribute his or her own special expertise or skill in caring for the patient.

Rationale 4: There is generally a greater amount of collaboration and less redundancy or care.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: LO 07. Compare and contrast the different nursing care models discussed in this chapter.


The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model?

1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest-ranking member.

2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.

3. The mission statement of the hospital describes centralized power.Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

4. A staff nurse mentions that each individual staff member has complete autonomy.

Correct Answer: 2

Rationale 1: This documents that the hospital follows the classical theory of organization.

Rationale 2: Shared governance increases each nurse’s influence over the organization, empowering staff.

Rationale 3: This is a classical organizational model.

Rationale 4: Although the shared governance model does provide some autonomy, there is also an understanding that staff are expected to collaborate and function cooperatively with both management and colleagues.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: LO 08. Explain the key advantages of shared governance for nursing staff.


The patient is being discharged from the hospital after having a coronary artery bypass graft (CABG). Which level of the health care system will best serve the needs of this patient at this point?

1. Primary care.

2. Secondary care.

3. Tertiary care.

4. Public health care.

Correct Answer: 3

Rationale 1: The patient already has coronary heart disease, so primary care would not be appropriate for this problem.

Rationale 2: The patient has just been discharged from secondary care level services, where diagnosis and treatment was done.

Rationale 3: A patient recovering from a CABG will best be served by rehabilitation services, which is at the tertiary care level.

Rationale 4: There is no indication that the patient was having difficulty accessing health care prior to this episode, so public health care does not apply.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 03. Explain the key differences between for-profit and not-for-profit health care organizations.


The nurse is organizing a smoking cessation group for the residents of a retirement center. What level of health care services does this represent?

1. Primary care.

2. Secondary care.

3. Tertiary care.

4. Rehabilitation care.

Correct Answer: 1

Rationale 1: The nurse is providing health promotion and education, which falls within the level of primary care.

Rationale 2: Secondary care focuses on the diagnosis and treatment of an existing problem.

Rationale 3: Tertiary care services include long-term care, rehabilitation, and care of the dying.

Rationale 4: Rehabilitation care is a tertiary service.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 03. Explain the key differences between for-profit and not-for-profit health care organizations.


Which factor would least likely be included in the analysis of an organization?


1. Whether the organization’s mission and vision match staff performance.

2. Results from a staff opinion survey regarding the organization’s decision-making processes.

3. How the organization’s communication patterns have affected the change process.

4. The turnover rate of nursing personnel in a given unit.

Correct Answer: 4

Rationale 1: The vision and mission statements are the driving forces behind all decision, and provide critical information about the organization’s values and philosophy.

Rationale 2: It is important to analyze how staff members believe decisions are made.

Rationale 3: It is essential to analyze communication patterns because communication runs an organizations and its ability to function effectively.

Rationale 4: Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 05. Apply the process for analyzing an organization.

Question 15Type: FIB

The nurse manager supervises the neurologic intensive care unit, surgical intensive care unit, and cardiac intensive care unit. Each unit employs 35 nurses and 15 support staff. The span of control for this manager is _______.

Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 150

Rationale : The manager’s span of control is the total number of employees managed. In this case, 105 nurses and 45 support staff.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentFinkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 02. Distinguish between structure and process.


The primary physician identifies a health care provider to manage the care of a patient on the general medical unit of a hospital. Depending upon the facility, which health care provider may fill this role?


1. Nurse Practitioner Hospitalist.

2. Physician Intensivist.

3. Physician Hospitalist.

4. Physician’s Assistant.

5. Clinical Nurse Specialist Intensivist.

Correct Answer: 1,3

Rationale 1: Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient’s personal or primary care physician.

Rationale 2: Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have.

Rationale 3: Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient’s personal or primary care physician.

Rationale 4: PAs work under the direction of a physician.

Rationale 5: Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 04. Compare the key health care providers and their services.



An outside accreditation team is evaluating the organization’s mission statement. Which action, taken by the organization, is the most important in regard to this statement?

1. The organization must provide a current copy of the mission statement.

2. The organization must be certain that the mission statement is prominently displayed in public access areas.

3. The organization must provide the team with a written plan about how the mission statement will be followed.

4. The organization must provide evidence of how the mission statement is being followed.

Correct Answer: 4

Rationale 1: This is important, but not as important as evidence that the organization is actually following the mission.



Rationale 4: The fact that the mission statement is indeed being followed is the most important evidence that the organization can provide.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 05. Apply the process for analyzing an organization.


Compare and contrast input, process, and output in systems organizational theory by selecting the options that represent process.


1. The physician admits a patient to the hospital.

2. The nurse provides excellent care to a patient postoperatively.


3. The dietary manager orders supplies based upon cost-effectiveness.

4. The patient delivers a healthy infant.

5. The nursing unit secretary identifies a potential medical error before it occurs.

Correct Answer: 2,3,5

Rationale 1: This is a system input.

Rationale 2: This represents process.


Rationale 4: This is an outcome.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 01. Compare and contrast the key organizational theories.


What is a primary factor in the increasing interest in the use of chiropractic care?

1. There are more chiropractors available.

2. Chiropractors have been given medical doctor credentials.

3. Use of nontraditional medical interventions.

4. Chiropractors can now perform surgical procedures to reduce pain.

Correct Answer: 3

Rationale 1: This is a response to interest, not the cause of interest.

Rationale 2: This is not true.

Rationale 3: There is an increasing interest in chiropractic care because chiropractors focus on nontraditional interventions.


Rationale 4: This is not true.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO 04. Compare the key health care providers and their services.


Several small rural hospitals have been acquired by a large nationwide health care organization. Six months after the acquisition, the rural hospitals remain in conflict with the management team and with one another. Choose the questions that the management team should ask in order to identify the reasons for this continued discord.


1. How are the hospitals communicating with the organization and with one another?

2. Are the goals of the hospitals aligned with those of the organization?

3. Are the rural hospitals too focused on patient-centered care and safety?

4. How is the organization handling decision making with the hospitals?

5. Aren’t buyouts always this way?


Rationale 1: Communication is paramount in successfully working in a large organization.

Rationale 2: When subsections of the organization are separated by distance, it is easy for goals to be out of alignment.

Rationale 3: There can never be too much focus on being patient-centered and safety-minded.

Rationale 4: If the organization is making all of the decisions and passing them down to the hospitals, discord is likely to occur and continue.

Rationale 5: This question minimizes the issue and does not address the problems. If management takes this attitude, the problems will likely continue.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentFinkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: LO 05. Apply the process for analyzing an organization.


The American Organization of Nurse Executives (AONE) emphasizes that “the core of nursing is knowledge and caring.” To which portions of the Institute of Medicine core competencies does this statement relate?


1. Use of interprofessional teams.

2. Informatics.

3. Evidence-based practice.

4. Quality improvement.

5. Patient-centered care.

Correct Answer: 3,5

Rationale 1: Using interprofessional teams relates to managing the journey.

Rationale 2: Informatics applies to the synthesis of knowledge.

Rationale 3: This statement relates to both evidence-based practice and to patient-centered care.

Rationale 4: Quality improvement applies to the synthesis of knowledge.

Rationale 5: This statement relates to both evidence-based practice and to patient-centered care.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 06. Explain the purpose of nursing care models.


The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates


oxygen per mask and increases the patient’s IV rate while a colleague contacts the patient’s physician. Which critical element of nursing is this nurse demonstrating?


1. Autonomy.

2. Responsibility.

3. Delegation.

4. Accountability.

5. Relevance.


Rationale 1: Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them.

Rationale 2: This nurse was entrusted with a particular function, in this case, caring for a post-op patient.

Rationale 3: There is no indication that the nurse delegated care of this patient to anyone.

Rationale 4: Accountability is the acceptance of responsibility of the outcomes of care.

Rationale 5: This term is not one of the critical elements of nursing.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 06. Explain the purpose of nursing care models.


What is the oldest of the nursing care models?

1. Total patient care.

2. Functional nursing.

3. Team nursing.Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care 2nd Edition Test BankCopyright 2012 by Pearson Education, Inc.

4. Primary nursing.

Correct Answer: 1

Rationale 1: This is the oldest of the models. Nurses have provided this type of care for generations.

Rationale 2: This model is not as old as total patient care.



Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 06. Explain the purpose of nursing care models.


Which options are included in the six dimensions of shared governance?


1. Informal authority base.

2. Access to information about the organization.

3. Delegation of care to others.

4. Ability to set goals and negotiate conflict.

5. Control over professional practice.


Rationale 1: Shared governance requires formal authority granted by the organization.

Rationale 2: This is a part of shared governance.

Rationale 3: This is not a part of shared governance though it occurs in a shared governance organization.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 08. Explain the key advantages of shared governance for nursing staff.


What are the responsibilities of the nurse manager in most shared governance models?


1. Staffing.

2. Direct patient care.

3. Program evaluation.

4. Allocation of resources.

5. Long-range planning.

Correct Answer: 1,3,4,5

Rationale 1: This is a responsibility of the nurse manager in most shared governance models.

Rationale 2: In most shared governance models, the nurse manager is not responsible for providing direct patient care.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: LO 08. Explain the key advantages of shared governance for nursing staff.


instructor proof - test bank and solution manual · web viewexplain the key advantages of shared...

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