Chapter 1: Nursing Leadership and Management
MULTIPLE CHOICE
1. According to Henri Fayol, the functions of planning, organizing, coordinating, and controlling are
considered which aspect of management?
a. Roles c. Functions
b. Process d. Taxonomy
ANS: B
The management process includes planning, organizing, coordinating, and controlling. Management
roles include information processing, interpersonal relationships, and decision making. Management
functions include planning, organizing, staffing, directing, coordinating, reporting, and budgeting. A
taxonomy is a system that orders principles into a grouping or classification.
PTS: 1 DIF: Comprehension
REF: THE MANAGEMENT PROCESS
2. Which of the following is considered a decisional managerial role?
a. Disseminator c. Leader
b. Figurehead d. Entrepreneur
ANS: D
The decisional managerial roles include entrepreneur, disturbance handler, allocator of resources, and
negotiator. The information processing managerial roles include monitor, disseminator, and
spokesperson. The interpersonal managerial roles include figurehead, leader, and liaison.
PTS: 1 DIF: Comprehension REF: MANAGERIAL ROLES
3. A nurse manager meets regularly with other nurse managers, participates on the organization‘s
committees, and attends meetings sponsored by professional organizations in order to manage
relationships. These activities are considered which function of a manager?
a. Informing c. Monitoring
b. Problem solving d. Networking
ANS: D
The role functions to manage relationships are networking, supporting, developing and mentoring,
managing conflict and team building, motivating and inspiring, recognizing, and rewarding. The role
functions to manage the work are planning and organizing, problem solving, clarifying roles and
objectives, informing, monitoring, consulting, and delegating.
PTS: 1 DIF: Application REF: THE MANAGEMENT PROCESS
4. A nurse was recently promoted to a middle-level manager position. The nurse‘s title would most
likely be which of the following?
a. First-line manager c. Vice president of patient care services
b. Director d. Chief nurse executive
ANS: B
A middle-level manager is called a director. A low managerial-level job is called the first-line
manager. A nurse in an executive level role is called a chief nurse executive or vice president of
patient care services.
PTS: 1 DIF: Application REF: THE MANAGEMENT PROCESS
,5. A nurse manager who uses Frederick Taylor‘s scientific management approach, would most likely
focus on which of the following?
a. General principles c. Labor productivity
b. Positional authority d. Impersonal relations
ANS: C
The area of focus for scientific management is labor productivity. In bureaucratic theory, efficiency is
achieved through impersonal relations within a formal structure and is based on positional authority.
Administrative principle theory consists of principles of management that are relevant to any
organization.
PTS: 1 DIF: Comprehension
REF: SCIENTIFIC MANAGEMENT
6. According to Vroom‘s Theory of Motivation, force:
a. is the perceived possibility that the goal will be achieved.
b. describes the amount of effort one will exert to reach one‘s goal.
c. describes people who have free will but choose to comply with orders they are given.
d. is a naturally forming social group that can become a contributor to an organization.
ANS: B
According to Vroom‘s Theory of Motivation, Force describes the amount of effort one will exert to
reach one‘s goal. Valence speaks to the level of attractiveness or unattractiveness of the goal.
Expectancy is the perceived possibility that the goal will be achieved. Vroom‘s Theory of Motivation
can be demonstrated in the form of an equation: Force = Valence Expectancy (Vroom, 1964). The
theory proposes that this equation can help to predict the motivation, or force, of an individual as
described by Vroom.
PTS: 1 DIF: Comprehension
REF: TABLE 1-2 MANAGEMENT THEORIES
7. According to R. N. Lussier, motivation:
a. is unconsciously demonstrated by people.
b. occurs externally to influence behavior.
c. is determined by others‘ choices.
d. occurs internally to influence behavior.
ANS: D
Motivation is a process that occurs internally to influence and direct our behavior in order to satisfy
needs. Motivation is not explicitly demonstrated by people, but rather it is interpreted from their
behavior. Motivation is whatever influences our choices and creates direction, intensity, and
persistence in our behavior.
PTS: 1 DIF: Comprehension REF: MOTIVATION THEORIES
8. According to R. N. Lussier, there are content motivation theories and process motivation theories.
Which of the following is considered a process motivation theory?
a. Equity theory
b. Hierarchy of needs theory
c. Existence-relatedness-growth theory
d. Hygiene maintenance and motivation factors
ANS: A
, The process motivation theories are equity theory and expectancy theory. The content motivation
theories include Maslow‘s hierarchy of needs theory, Aldefer‘s existence-relatedness-growth (ERG)
theory, and Herzberg‘s hygiene maintenance factors and motivation factors.
PTS: 1 DIF: Comprehension REF: MOTIVATION THEORIES
9. The theory that includes maintenance and motivation factors is:
a. Maslow‘s hierarchy of needs. c. McGregor‘s theory X and theory Y.
b. Herzberg‘s two-factor theory. d. Ouchi‘s theory Z.
ANS: B
The two-factor theory of motivation includes motivation and maintenance factors. Maslow‘s hierarchy
of needs includes the following needs: physiological, safety, security, belonging, and
self-actualization. In theory X, employees prefer security, direction, and minimal responsibility. In
theory Y, employees enjoy their work, show self-control and discipline, are able to contribute
creatively, and are motivated by ties to the group, organization, and the work itself. The focus of
theory Z is collective decision making and long-term employment that involves slower promotions and
less direct supervision.
PTS: 1 DIF: Comprehension REF: TWO-FACTOR THEORY
10. A nurse is appointed to a leadership position in the local hospital. The nurse‘s position would be
considered which of the following?
a. Informal leadership c. Leadership
b. Formal leadership d. Management
ANS: B
Formal leadership is based on occupying a position in an organization. Informal leadership is shown
by an individual who demonstrates leadership outside the scope of a formal leadership role or as a
member of a group. Leadership is a process of influence whereby the leader influences others toward
goal achievement. Management is a process to achieve organizational goals.
PTS: 1 DIF: Application REF: DEFINITION OF LEADERSHIP
11. A nursing instructor is evaluating whether the nursing students understand the three fundamental
qualities that leaders share. According to Bennis and Nanus, the fundamental qualities of effective
leaders are:
a. guided vision, passion, and integrity.
b. knowledge of self, honesty, and maturity.
c. intelligence, self-confidence, and determination.
d. honesty, self-awareness, and sociability.
ANS: A
Bennis and Nanus list guided vision, passion, and integrity as fundamental qualities of effective
leaders. Knowledge of self, honesty and maturity; intelligence, self-confidence and determination;
self-awareness and sociability are all desirable traits in leaders as well as in others.
PTS: 1 DIF: Application REF: LEADERSHIP CHARACTERISTICS
12. The six traits identified by Kirkpatrick and Locke that separate leaders from non-leaders were:
a. respectability, trustworthiness, flexibility, self-confidence, intelligence, sociability.
b. self-confidence, progression of experiences, influence of others, personal life factors,
honesty, drive.
c. intelligence, self-confidence, determination, integrity, sociability, honesty.
d. drive, desire to lead, honesty, self-confidence, cognitive ability, knowledge of business.
, ANS: D
Research by Kirkpatrick and Locke concluded that leaders possess six traits: drive, desire to lead,
honesty, self-confidence, cognitive ability, and knowledge of the business. Woods identified five
dominant factors that influenced leadership development: self-confidence, innate qualities, progression
of experience, influence of significant others, and personal life factors. Stogdill identified the
following traits of a leader: intelligence, self-confidence, determination, integrity, and sociability.
Murphy and DeBack identified the following leader characteristics: caring, respectability,
trustworthiness, and flexibility.
PTS: 1 DIF: Comprehension
REF: LEADERSHIP CHARACTERISTICS
13. A nurse manager who uses a leadership style that is participatory and where authority is delegated to
others is most likely using which of the following leadership styles?
a. Autocratic c. Laissez-faire
b. Democratic d. Employee-centered
ANS: B
Democratic leadership is participatory, and authority is delegated to others. Autocratic leadership
involves centralized decision making, with the leader making decisions and using power to command
and control others. Laissez-faire leadership is passive and permissive, and the leader defers decision
making. Employee-centered leadership focuses on the human needs of subordinates.
PTS: 1 DIF: Application REF: BEHAVIORAL APPROACH
14. A characteristic of the consideration dimension of leadership behavior is:
a. focus on the work to be done. c. focus on production.
b. focus on the task. d. focus on the employee.
ANS: D
The leadership dimension of consideration involves activities that focus on the employee. Initiating
structures of leadership involves an emphasis on the work to be done, and a focus on the task and
production.
PTS: 1 DIF: Comprehension
REF: BEHAVIORAL APPROACH
15. The leadership theory that considers follower readiness as a factor in determining leadership style is:
a. contingency. c. situational.
b. path goal. d. charismatic.
ANS: C
Situational leadership considers the follower readiness as a factor in determining leadership style.
Contingency theory views the pattern of leader behavior as dependent on the interaction of the
personality of the leader and the needs of the situation. In path goal theory, the leader works to
motivate followers and influence goal accomplishment. Charismatic leadership has an inspirational
quality that promotes an emotional connection from followers.
PTS: 1 DIF: Comprehension
REF: HERSEY AND BLANCHARD'S SITUATIONAL THEORY
16. In contingency theory, the feelings and attitudes of followers regarding acceptance, trust, and
credibility of the leader are called:
a. task structure. c. low task structure.
, b. position power. d. leader-member relations.
ANS: D
In contingency theory, leader-member relations are the feelings and attitudes of followers regarding
acceptance, trust, and credibility of the leader. Task structure of contingency theory means the degree
that work is defined, with specific procedures, explicit directions, and goals. Low task structure
involves work that is not routine, predictable, or clearly defined. Position power in contingency theory
is the degree of formal authority and influence associated with the leader.
PTS: 1 DIF: Comprehension
REF: FIEDLER'S CONTINGENCY THEORY
17. In situational theory, a telling leadership style is considered:
a. high task, high relationship behavior. c. low task, high relationship behavior.
b. high task, low relationship behavior. d. low task, low relationship behavior.
ANS: B
A telling leadership style is high task behavior and low relationship behavior. A high task, high
relationship style is called a selling leadership style. A low task and high relationship style is called a
participating leadership style. A low task and low relationship style is called a delegating leadership
style.
PTS: 1 DIF: Comprehension
REF: HERSEY AND BLANCHARD'S SITUATIONAL THEORY
18. A nursing group has been very successful in achieving its goals even though the group has lacked
leadership. Which of the following factors is probably most responsible for the group‘s success in
goal achievement?
a. Life experience c. Informal organizational structures
b. Extrinsic satisfaction d. Cohesive groups
ANS: D
Substitutes for leadership are variables that eliminate the need for leadership or nullify the effect of the
leader‘s behavior. These include cohesive groups, work experience, intrinsic satisfaction, formal
organizational structures, professionalism, indifference to rewards, routine tasks, feedback provided by
the task, rigid adherence to rules, role distance, and low position power of the leader.
PTS: 1 DIF: Analysis REF: SUBSTITUTES FOR LEADERSHIP
19. The new nurse manager of a medical unit focuses on day-to-day operations and short-term goals, while
the nurse manager of the mental health unit is committed to the vision that empowers the staff. The
manager of the medical unit would most likely be considered which type of leader?
a. Transformational leader c. Transactional leader
b. Charismatic leader d. Autocratic leader
ANS: C
A transactional leader focuses on operations and short-term goals. A transformational leader inspires
and motivates others to excel and participate in a vision that goes beyond self-interests. A charismatic
leader displays self-confidence and strength in convictions and communicates high expectations. An
autocratic leader makes decisions and uses power to command and control others.
PTS: 1 DIF: Analysis
REF: TRANSFORMATIONAL LEADERSHIP THEORY
,20. The nursing staff perceive the newly hired Chief Nurse Administrator as a leader who is committed to
a vision that empowers others. The Chief Nurse Administrator is most likely employing which type
of leader?
a. Transformational leader c. Transactional leader
b. Charismatic leader d. Autocratic leader
ANS: A
A transformational leader empowers others. A charismatic leader has an appeal based on personal
power. A transactional leader focuses on day-to-day operations. An autocratic leader has central power
and does not empower others.
PTS: 1 DIF: Application
REF: TRANSFORMATIONAL LEADERSHIP THEORY
21. The nurse manager on one of the hospital units views the staff as basically lazy and only motivated by
threats and coercion. Which theory of motivation would support the manager‘s beliefs?
a. Theory W c. Theory Y
b. Theory X d. Theory Z
ANS: B
The Theory X view is that in bureaucratic organizations, employees prefer security, direction, and
minimal responsibility. Coercion, threats, or punishment are necessary because people do not like their
work to be done.
PTS: 1 DIF: Application REF: THEORY X AND THEORY Y
22. A group of new nurse managers is undergoing a series of management training sessions. Which
statement by one of the nurse managers would indicate use of McClelland‘s Model of Motivation?
―McClelland‘s Model focuses on:
a. achievement, power, and affiliation.‖
b. growth needs, relatedness needs, and existence needs.‖
c. collective decision making, quality circles, and mentoring.‖
d. self-actualization needs, safety and security needs, and self-esteem needs.‖
ANS: A
McClelland‘s Model of Motivation focuses on achievement, power, and affiliation. Growth needs,
relatedness needs, and existence needs are aspects of Adler‘s model. Collective decision making,
quality circles, and mentoring are the focus of Ouchi‘s model. Self-actualization needs, safety and
security needs, and self-esteem needs are reflected in Maslow‘s model.
PTS: 1 DIF: Application
REF: TABLE 1-1 NURSING LEADERSHIP CHARACTERISTICS AND ROLE ACTIVITIES
23. A nurse manager finds two employees arguing about the assigned schedule. Which role would be
appropriate for the nurse manager to implement at this time?
a. Advocate role c. Decision-making role
b. Interpersonal role d. Information-processing role
ANS: C
The decision-making role of a nurse manager would include being an entrepreneur, handling
disturbances, and allocating resources. The information-processing role involves managing the
information that the people need. The interpersonal role focuses on functioning as a figurehead,
leader, or liaison. In the advocate role, the nurse manager would focus on supporting employee
rights.
, PTS: 1 DIF: Application REF: MANAGERIAL ROLES
24. A nurse manager who implements the bureaucratic management style will most likely do which of the
following?
a. Emphasize efficiency
b. Use explicit rules and regulations for governing activities
c. View the individual worker as the source of control, motivation, and productivity
d. Expect unity of command and direction
ANS: B
Bureaucratic management focuses on the use of explicit rules and regulations for governing activities.
The human relations approach views the individual worker as the source of control, motivation, and
productivity. Administrative principles focus on unity of command and direction.
PTS: 1 DIF: Application REF: BUREAUCRATIC MANAGEMENT
25. The nursing supervisor has traditionally made rounds at the same time each day. When the supervisor
visits each unit, the staff appear to be extremely busy even when the census is very low. Today the
supervisor visited a unit two hours early and found several staff members watching television and
drinking coffee in the visitor‘s lounge. The supervisor recognizes that the staff‘s previous behavior
have been a result of which of the following?
a. Coincidence c. Diligence of staff
b. Hawthorn effect d. Time management
ANS: B
Because the nursing supervisor traditionally made rounds at the same time each day, the staff members
were prepared for the visit. When the supervisor arrived unexpectedly, the staff members were most
likely caught off-guard. The Hawthorn effect occurs when recognition that one is being studied or
observed results in a change in behavior. Coincidence, diligence of staff, and time management would
not account for the dramatic change in behavior.
PTS: 1 DIF: Analysis REF: HUMAN RELATIONS
MULTIPLE RESPONSE
1. A nurse manager who structures her approach on the McClelland Model of Motivation would most
likely focus on which of the following? Select all that apply.
a. Power d. Achievement
b. Affiliation e. Mentoring
c. Quality circles f. Collective decision making
ANS: A, B, D
McClelland‘s Model of Motivation focuses on power, achievement, and affiliation. Ouchi‘s model
focuses on quality circles, collective decision making, long-term employment, and mentoring.
PTS: 1 DIF: Application REF: FIGURE 1-1 KEY LEADERSHIP DIMENSIONS
2. A nurse manager who follows Herzberg‘s Two-Factor Theory would recognize that which of the
following are hygiene-maintenance factors? Select all that apply.
a. Job security d. Relationships with others
b. Advancement opportunities e. Status
c. Working conditions f. Achievement
ANS: A, C, D, E
, Herzberg‘s hygiene-maintenance factors include status, job security, quality of supervision, safe and
tolerable work conditions, and relationships with others. Advancement opportunities, achievement,
recognition, the work itself, personal growth, and responsibility are all motivation factors.
PTS: 1 DIF: Application REF: TABLE 1-2 MANAGEMENT THEORIES
3. A nursing instructor determines that the nursing students understand the concept of ―knowledge
worker‖ if the students describe which of the following tasks of the knowledge worker? Select all that
apply.
a. Provide service
b. Represent the organization
c. Interact with the customer
d. Focus on personal, life-long goals and achievement
e. Bring expert knowledge
f. Accomplish goals
ANS: A, B, C, E, F
According to Peter Drucker, knowledge workers provide service, interact with the customer, represent
the organization, and accomplish its goals. These workers bring specialized, expert knowledge to the
organization, and they are valued for what they know. The knowledge worker focuses more on
organizational goals than personal goals.
PTS: 1 DIF: Analysis REF: H1: KNOWLEDGE WORKERS
Chapter 2: The Health Care Environment
MULTIPLE CHOICE
1. Which of the following individuals observed that noise, food, rest, light, fresh air, and cleanliness
were instrumental in health and illness patterns?
a. W. Edwards Deming c. Isabel Hampton Robb
b. Florence Nightingale d. Dorothea Dix
ANS: B
Florence Nightingale was the first to observe that noise, food, rest, light, fresh air, and cleanliness were
instrumental in health and illness patterns. W. Edwards Deming is known for his contribution to
continuous performance improvement, and Isabel Hampton Robb was the first president of the ANA
and a pioneer in nursing education. Dorothea Dix is best known for her patient advocacy, particularly
in the areas of improved conditions for jails and mental asylums.
PTS: 1 DIF: Knowledge REF: HISTORY OF HEALTH CARE
2. A nursing instructor asks a student what discoveries are attributable to Florence Nightingale. The
instructor determines that further teaching is needed if the student responds:
a. the need to monitor health care practitioners.
b. the importance of structuring hospitals around care.
c. the importance of collecting and using data for quality assessment.
d. the importance of being informed regarding the activities of government policymakers.
ANS: B
, Nightingale is credited with a variety of discoveries related to health care such as the importance of
structuring hospitals around nursing care (not merely care), the need to monitor/be informed regarding
health care practitioners and government policymakers, and the importance of collecting and using
data for quality assessment.
PTS: 1 DIF: Application
REF: STRUCTURING HOSPITALS AROUND NURSING CARE
3. A new graduate wants to explore the three components of each heath care system before applying for a
position. The graduate would plan to explore which of the following?
a. Strategy, outcome, and performance c. Structure, process, and outcome
b. Process, strategy, and opportunity d. Outcome, procedure, and structure
ANS: C
The three simple elements of health care systems are structure (resources or ―structures‖ required to
deliver health care), process (quality activities, procedures, and tasks performed to deliver quality
health care), and outcome (the results of good health care delivery).
PTS: 1 DIF: Application REF: ORGANIZATION OF HEALTH CARE
4. Which of the following organizations has set forth three primary goals for good health care?
a. The Institute of Medicine
b. The Centers for Disease Control and Prevention
c. The Agency for Healthcare Research and Quality
d. The World Health Organization
ANS: D
The World Health Organization (WHO) has been a leading advocate of quality health care delivery, as
evidenced by its three primary goals for what good health care should do. The Institute of Medicine
(IOM) is best known for its quality data reports such as To Err Is Human (IOM, 1999), and the Centers
for Disease Control and Prevention is a leading infection and disease agency in the United States. The
Agency for Healthcare Research and Quality is another quality-based organization and produces
reports such as the National Healthcare Disparities Report (NHDR).
PTS: 1 DIF: Comprehension
REF: ORGANIZATION OF HEALTH CARE
5. A nurse working on the unit budget would recognize that the resources needed to deliver quality health
care such as nurses, practitioners, medical records, buildings, and pharmaceuticals are considered
which aspects of health care?
a. Process c. Organization
b. Structure d. Practice
ANS: B
The health care structure is comprised of the resources or structures needed to produce quality health
care. Some of these structures or resources are human (staff and personnel) or physical (buildings or
facilities).
PTS: 1 DIF: Application REF: ORGANIZATION OF HEALTH CARE
6. The human resource manager understands that an example of a quality performance outcome measure
involves which of the following?
a. Patient satisfaction c. Staff satisfaction
b. Return on assets (ROI) d. Organizational climate
, ANS: C
An outcome for a quality performance measure related to human resources is staff satisfaction. Patient
satisfaction is a clinical care outcome, and return on assets (ROI) is a financial management outcome.
The organizational climate is a human resource process, as opposed to the outcome.
PTS: 1 DIF: Application
REF: TABLE 2-1 EXAMPLES OF PERFORMANCE MEASURES BY CATEGORY
7. A nurse is on vacation visiting a number of countries. If the nurse becomes ill, in which country will
the nurse most likely be hospitalized in a government hospital, with the government paying the bills.
a. Canada c. Taiwan
b. New Zealand d. Germany
ANS: B
If the nurse became ill in New Zealand health care would be provided in a government hospital with
the government paying the bills. Canada and Taiwan rely on private-sector providers, paid for by
government-run insurance. Germany, the Netherlands, Japan, and Switzerland provide universal
coverage using private doctors, private hospitals, and private insurance plans.
PTS: 1 DIF: Analysis
REF: HEALTH CARE PAYMENT IN OTHER COUNTRIES
8. An instructor wants to determine if a group of nursing students know the important features related to
the benefits of primary care. Which of the following responses by the students would indicate that
further teaching is necessary?
a. Care that is continuous
b. Care that began at first contact with the patient
c. Care that is integral
d. Care that is community orientated
ANS: C
The seven important features of primary care are care that is continuous, community oriented,
comprehensive (not integral), coordinated, family centered, culturally competent, and begun at the first
contact with the patient.
PTS: 1 DIF: Application REF: NEED FOR PRIMARY HEALTH CARE
9. A group of nursing students are given a test on Starfield‘s (1998) foundations of primary care. Which
of the following responses by the students describing the foundations of primary care would indicate
that further teaching is necessary?
a. Comprehensiveness c. First contact
b. Organization d. Coordination
ANS: B
According to Starfield (1998), both clinicians and patients need to work together to appropriately
utilize services based upon these four foundations of primary care: first contact (conduct the initial
evaluation and the plan for the dysfunction, treatment options, and health goals), longitudinality
(maintaining the clinician-patient relationship continuously over time), comprehensiveness (managing
the wide range of needs for each patient), and coordination (care is organized and integrated, thus
eliminating duplication of services).
PTS: 1 DIF: Application REF: NEED FOR PRIMARY HEALTH CARE
10. Which agency/division is not a part of the U.S. Department of Health and Human Services?
a. Food and Drug Administration (FDA)
