Chapter 1.

1. ANS: C
For the receiver to receive the message as transmitted, interference such as inappropriate directions must be overcome.

2. ANS: D
Clarification is used when one is not sure what the other person is saying.
3. ANS: A
Enhancing value differs from criticism. A merit may be a part of an idea, a good intention, an important issue that was addressed, or part of an action.
One can ensure understanding and value by asking people about the value of their ideas.
4. ANS: D
Style for oral communications involves planning to engage the audience through the use of eye contact, physical space, and body movement.

5. ANS: C
Structure begins with a forecast of the main ideas to capture the audience’s attention and gives the audience an outline of the message. This can be
done with PowerPoint presentations.
6. ANS: B
Presentation software creates visual displays such as overhead projections and slides for oral presentations.

7. ANS: D
Database software collects and catalogs information so that lots of well-organized data can be located and displayed.

8. ANS: C
Breaches of confidentiality may involve unauthorized use of another’s password.
9. ANS: B
Upward communication provides a means for motivating and satisfying personnel by allowing employee input. The manager summarizes information
and passes it upward to the next level for use in decision-making.
10. ANS: D
Informal communication spreads at an increasing rate as individuals from clusters inform other small groups of people who work nearby or with whom
they have contact.

11. ANS: A
People unconsciously use selective perception to hear what they want to hear in terms of their biases.
12. ANS: B
Time pressures, used as an excuse for not listening, are a barrier to communication.
ANS: D
13. Personal versus contextual style is one form of gender difference in communication, with males using the role-centered contextual style, and females
using the personal style stressing equality.

14. ANS: C
White Americans of European origin tend to view eye contact as indicating trustworthiness.

ANS: B
15. The face is considered the organ of emotion. It is a source of nonverbal communication.
16. ANS: B
Communications should be well organized and expressed in simple words, a clear style, and the shortest sentences possible.
17. ANS: C
One must consider the setting in which one communicates and time one’s message for maximal impact. Listening, an active process that requires
conscious attention, is critical to good communication.
18. ANS: C
Adult tantrums are the grown-up version of childhood tantrums that are a defense mechanism to cope with feelings of fear, helplessness, and
frustration. The exploder should be given time to finish the tantrum and regain self-control.

19. ANS: D
Complainers may dump on one directly or may complain about other “awful” people. Complaining helps people appear blameless and innocent, at least
to themselves.

20. ANS: D
Trashing is a form of character assassination that sets women against one another.
21. ANS: D
In parent-to-child interactions one person takes a psychologically superior position to the other.
22. ANS: A
“If it weren't for you” is the blaming game in which people who feel inadequate blame others for their inability to achieve.
23. ANS: B
Harried executives work hard to maintain a sense of being OK.
24. ANS: C
People with the “I'm OK, you're not OK” life position do not believe they can rely on anyone but themselves.
25. ANS: B
Fogging is agreeing with the truth, agreeing in principle, or agreeing with the odds rather than denying the criticism, getting defensive, or
counterattacking with criticism.

Chapter 2

1. ANS: B
Nurses face stress related to their exposure to life-and-death situations and their need to know how to use numerous pieces of equipment and deal with
the consequences of equipment failure.
2. ANS: C
Many events in life, such as marriage or remarriage, produce an individual stress reaction.
3. ANS: D
Whether one will experience eustress or distress depends largely on the person’s perceptions, physical activity or inactivity, or mental activity or
inactivity.
4. ANS: B
Well-educated, intelligent, creative people in management are at high risk for burnout.
5. ANS: C
 Symptoms of burnout include blaming and criticizing others, engaging in backbiting, and talking behind others’ backs.
6. ANS: C
To reduce the stress from promotion to a management position, one can set aside time for reading about leadership and management or for observing
a leader or manager. This is called time blocking.
7. ANS: D
One should take time to identify a feeling, label it, distinguish between thinking and feeling, and accept the feeling for what it is rather than talking
oneself into what it should be.
8. ANS: D
Biofeedback uses mechanical devices to enable the individual to achieve self-regulation to control autonomic responses. People with migraine and
tension headaches, hypertension, and gastrointestinal problems have responded well to biofeedback therapy.
9. ANS: B
Voluntary service groups and self-help groups provide support in working toward specific purposes, such as stopping alcohol consumption.
10. ANS: D
By not allowing employees to enter the seclusion room alone, the nurse manager is protecting staff from workplace violence.
11. ANS: A
A leader or manager decides what to delegate, selects the appropriate person, communicates the responsibilities to that person, grants authority with
the responsibility, provides support, monitors the situation, and evaluates the results. Delegation is one way for a manager to maximize his or her time.
12. ANS: C
An RN can delegate passing out medications to an LPN/VN according to the Nurse Practice Act.
13. ANS: B
A registered nurse can delegate initiating and maintaining intravenous lines to LPNs/VNs.
ANS: D
14. Performance standards clarify how the leader or manager measures achievement. These standards define the quantity or quality of work expected and
the time allowed for its accomplishment.

15. ANS: A
Good communications, sharing of information, and feedback are important to provide support to the staff.

16. ANS: A
Hispanic-Americans tend to value the nuclear and extended family.

17. ANS: B
Some leaders and managers may like to do the work and think that doing it themselves will get the work done better and faster. This is underdelegating.
18. ANS: C
Procrastinators do not do what was delegated, especially if they feel they are being “gofers.”

19. ANS: A
Lack of guidelines, standards, and control are reasons that staff nurses do not accept tasks that are delegated.

20. ANS: B
Some people have insufficient information to complete a job, do inadequate follow-up, or have so many interruptions they cannot get a job done. This is
a form of nonemotional procrastination.

21. ANS: A
Making a commitment to someone or a wager can help overcome procrastination.
22. ANS: A
Determining and ranking goals serves to focus activities and prevent people from spending time doing inappropriate or unimportant tasks. Making time
estimates and setting time limits help regulate work flow.
23. ANS: B
Organizational charts help clarify who is responsible to whom and for what. Multiple bosses, confusion over who is responsible and who has authority
for what, and duplication of tasks can be prevented with planning. A nurse’s aide giving a report to the team leader is an effective use of the
organizational chart.
24. ANS: D
Before writing job descriptions, management decides which assignments to delegate. Job descriptions are based on the functional needs of the agency
and clarify the responsibility of the individual’s position and the objectives of the work.
25. ANS: C
It is essential that leaders and managers teach others how to do the work instead of doing it themselves.

Chapter 3

1. ANS: B
Problem solving is a skill that can be learned, and because staff nurses can learn by observing their leaders, good decision making by the leader may
do more than solve immediate problems. More important for the long term, it can foster good decision making by staff nurses.
2. ANS: D
Managers identify the cause or causes of a problem by analyzing available information. Then they begin exploring possible solutions.
3. ANS: D
After a decision has been made, it must be implemented. A decision that is not put into action is useless.
ANS: B
4. The bureaucratic model is based on the promises of historical norms and operating routines. This model values operational efficiency based on history
and tradition. It does not recognize informal channels of communication and ignores political struggles for power.
5. ANS: D
Reasoning is only as sound as the evidence on which it is based. The evidence should be clear, relevant, accurate, adequate, fairly gathered and
reported, and consistently applied.
6. ANS: A
All reasoning is an attempt to prevent or solve a problem, figure something out, or answer a question.

7. ANS: C
Formal committees are part of the organizational structure and have specific duties and authority. Formal committees tend to be permanent.

8. ANS: B
Ad hoc committees are generally most useful when appointed for a specific purpose. A committee appointed to collect data, analyze it, and make
 recommendations is an ad hoc committee.
9. ANS: C
Although the ultimate responsibility for a decision is the top administrator’s, that burden can be shared through the use of committees and shared
governance councils.
10. ANS: D
To build consensus, the nurse manager (or chairperson) listens to all committee members, uses the ideas, and gets people onto the team by involving
them in critical thinking, creative thinking, and realistic critiquing of ideas.
11. ANS: A
The size of a committee is important. Effective committee size may range from 5 to 15 persons.

12. ANS: B
Groupthink seeks fast solutions with little critical thinking or input from group members. People may feel invulnerable, ignore negative feedback,
stereotype differing views as misinformed, and use peer pressure to suppress doubters. People conform rather than challenge ideas, and poor
decisions can result.
13. ANS: B
Repetition of the same thoughts with no new ideas or interpretations is a sign of fatigue and indicates that it is a good time to start the incubation period.
Switching one’s attention provides a necessary respite.
ANS: C
14. Reverse brainstorming or negative brainstorming can reverse the problem or challenge it by asking what causes the problem instead of how to prevent
it.
15. ANS: C
The stepladder technique structures the entry of group members into the group to ensure that each member contributes to the decision-making
process.
16. ANS: B
The checklist method is used to assemble items on a checklist, sort them, prioritize them, eliminate items, and add others.

17. ANS: C
Negative attitudes, self-censorship, inflexibility, lack of confidence, misconceptions, lack of effort, habits, conformity, and reliance on authority all block
creativity.

18. ANS: D
External consultants have more diverse backgrounds, bring new ideas and a different perspective to the situation, and are independent of the power
structure; consequently, they have more power.
19. ANS: C
Justice means treating people equally and fairly. Equals should be treated equally, and unequals should be treated according to their differences.
Allocation of holidays, vacation time, and days off to attend conferences should reflect performance as well as who is next on the list.
20. ANS: D
Rule ethics expects obedience to laws, rules, professional codes, and authority.
21. ANS: A
In the priestly model, the nurse is paternalistic and makes decisions without considering others’ values or seeking others’ input. Autocratic leadership
may follow the priestly model.

22. ANS: B
Nursing leaders need to use distributive justice to address the professional responsibility for the collective practice of nursing on the unit, in the facility,
and throughout the profession and all of health care.
23. ANS: C
The principles of global ethics are controversial but may include global justice through international laws, social responsibility, environmental
stewardship, interdependence, responsibility for the whole, and reverence for place.
24. ANS: D
In CPM a single time estimate, the longest possible time, is calculated for each activity. Critical paths have been used to indicate standard practices for
care.
25. ANS: C
Management information systems can be used for client acuity tracking, calculation of client care requirements, client classification, inventory control,
supplies and material management, staff scheduling, documentation of policy and procedure changes and announcements, determination of client
charges, generation of budget information and budget management, record location and tracking, maintenance of personnel records, and generation
and storage of statistical reports, administrative reports, and memos.

Chapter 4
1. ANS: C
Thwarting the social needs of individuals may stimulate resistance and antagonism that defeat management’s objectives. According to Maslow’s
Hierarchy of Needs, the nurse manager was interfering with the social needs of her staff members.
2. ANS: B
The needs classified as safety/security needs in Maslow’s hierarchy have been modified by Alderfer and renamed existence needs.
3. ANS: D
According to Herzberg, work motivations include achievement, growth, responsibility, advancement, recognition, and the job itself. If people are satisfied
with their jobs, they are receiving positive feedback, developing skills, and improving their performance (e.g., through taking graduate courses or
courses leading to a certification).
4. ANS: A
According to Herzberg, dissatisfaction results when people perceive that they are being treated unfairly in pay, benefits, status, job security,
supervision, or interpersonal relationships. Herzberg classifies these as hygiene factors.
ANS: C
5. According to McClelland’s basic needs theory, people who have a high need for power want to be in control and desire influence over others, which can
lead to low morale among those whom they supervise.

6. ANS: B
According to McClelland’s basic needs theory, the need for achievement involves a desire to make a contribution, to excel, and to succeed. People with
a need for high achievement desire feedback about their performance.
ANS: C
7. Argyris suggests that management match personnel and jobs by taking advantage of people’s talents and interests, making jobs interesting and
challenging, helping personnel satisfy their needs for self-actualization, and improving interpersonal relationships.
8. ANS: D
According to Vroom’s expectancy theory, if someone has a low valence (negative) and a low expectancy (0), the motivation will be low and the job may
not be completed.
 9. ANS: B
When desired results are not obtained, managers should analyze the situation. First, they should assess the working environment for interference.
10. ANS: C
According to the equity theory, if people feel overworked and underpaid, they are likely to decrease their productivity.
11. ANS: C
According to McGregor’s theories, a manager with a theory Y philosophy will use positive incentives such as praise and recognition, give general
supervision, provide opportunities for individual growth, delegate responsibilities, and encourage participation in problem solving.
12. ANS: C
Likert’s research indicated that employee-centered supervision is more productive than job-centered supervision and that more supervision leads to
lower productivity.
13. ANS: C
Quality circles are formed when 2 to 10 employees meet to identify problems, explore options, and make decisions.

14. ANS: B
Goleman labels the ability to work with individuals and groups as emotional intelligence and identifies the five components of emotional intelligence as
self-awareness, self-regulation, motivation, empathy, and social skills.
15. ANS: D
According to Goleman, motivation can help people reach goals by prompting them to strive to meet a standard of excellence, align their personal goals
with group and organizational goals, take advantage of opportunities, and maintain a positive attitude toward the pursuit of goals despite obstacles and
setbacks.
16. ANS: A
According to Goleman, social skills are adeptness at inducing desirable responses in people by exerting influence, listening and sending convincing
messages, resolving disagreements, inspiring others, managing change, nurturing relationships, collaborating and cooperating toward shared goals,
and creating group synergy through team development.
17. ANS: D
Cherniss and Adler described several model programs for promoting emotional intelligence, such as training in conflict management, self-management,
stress management, emotional competence, empathy, and human relations; achievement motivation programs; supervisory training; caregiver support
programs; executive coaching; and leadership laboratories.

18. ANS: C
Bar-On and Parker identified key components to be taught as (1) awareness of self and others; (2) positive attitudes and values; (3) responsible
decision making; (4) communication skills; and (5) social skills.
19. ANS: D
A person who is apathetic, cowardly, disorderly, devious, fearful, complaining, or rebellious demonstrates low morale.
20. ANS: A
Organizational morale is the attitudes of workers toward the quality of their work lives.
21. ANS: D
Horizontal violence is dysfunctional behavior that includes antagonism, bullying, criticism, gossiping, scapegoating, undermining, and withholding
information.
22. ANS: D
One practical solution to reduce horizontal violence is to validate assumptions and perceptions before drawing conclusions.
23. ANS: B
The manager can help prevent burnout by rotating undesirable as well as popular and unpopular tasks.

24. ANS: C
Factors contributing most strongly to job satisfaction for men include wage levels, opportunity for advancement, company management and policies,
and task interest.
25. ANS: B
Considerable time and money are required to recruit and select a replacement for someone who leaves a position. The orientation period is expensive
because of educational costs and decreased productivity.

Chapter 5

1. ANS: C
In referent power, the leader is admired and exerts influence because the followers desire to be like the leader.
2. ANS: D
People gain expert power through knowledge, skills, and information. Personal power can be derived from the ability to make decisions because of
expert or information power and from the ability to provide resources because of reward power.
ANS: B
3. Interpersonal power comes from connection, information, and group decision-making powers. Group decision-making power can create synergy when
people come together to make decisions and go forth as a united force.
4. ANS: D
Relevance is a characteristic of positions related to central objectives and issues of the organization and contributes to greater position power. Trainer
or mentor, evaluator, and advocate or representative are relevantly powerful positions.
5. ANS: C
Staff authority carries no command privileges. Staff have only the right to advise or assist managers in the performance of their duties.
6. ANS: A
Personal psychological resources are important for gaining control. One needs to be able to admit mistakes and look for solutions instead of seeking
someone to blame.
7. ANS: A
Finding opportunities for small successes or a small-wins strategy can help build self-confidence and lead to bigger successes. Leaders and managers
can divide large problems into smaller ones and delegate simpler tasks before more complex ones.
8. ANS: B
Magnet institutions involve nurses at all levels of the organization and give nurses a voice in policy formation.
9. ANS: B
Nurses have found that communicating with legislators, building coalitions, being knowledgeable about current issues, providing testimony, solving
problems, educating other nurses, and knowing the legislator before needing help are the most successful political strategies.
10. ANS: D
A face-to-face meeting with legislators and their staff is generally an effective lobbying strategy. Appointments are set up ahead of time. The nurse
should prepare a short, well-written statement of what legislative action is preferred and why, specifying the direct impact it will have on the legislator’s
constituents.
11. ANS: C
 Bills are prefixed with HR when introduced in the House of Representatives and S when introduced in the Senate.
12. ANS: C
After referral to a standing committee, a bill is then referred to a subcommittee. The subcommittee usually schedules public hearings and invites
testimony from private and public witnesses.

13. ANS: D
The Family and Medical Leave Act requires employers with 50 or more employees to provide up to 12 weeks per year of unpaid, job-protected leave.
14. ANS: C
Union representatives present the contract solutions to the members for a ratification vote to accept or reject the offer during the contract negotiation
phase. The union makes most of the demands, whereas management defends itself against them and prepares for a strike. The threat of a strike
strengthens the union negotiator’s position.
15. ANS: C
Imagined grievances occur when a party incorrectly believes that there has been a violation. Employees sometimes imagine a grievance because they
do not understand their rights.
16. ANS: B
A hearing is similar to courtroom proceedings. Witnesses are presented and cross-examined in an alternating sequence. First, a witness testifies for the
initiator, and is cross-examined, and then a witness for the responding party testifies and is cross-examined.
17. ANS: A
Management may not contribute financial or other support or otherwise dominate or interfere during the development or administration of a labor
organization. This is considered to be unfair labor practices by management.
18. ANS: B
An employee organization must follow the required notification procedures before striking against the employer when negotiations have failed.
19. ANS: A
Managerial employees are not eligible to vote. People who have the authority to hire, fire, and direct others are considered managers. These individuals
may include nurse managers, head nurses, and charge nurses.
20. ANS: C
If employees no longer want to be represented by the existing labor organization, they can initiate a decertification election by obtaining a requisite
show of interest by 30% of the organization members.
21. ANS: C
If certification of a bargaining unit is denied because of insufficient votes, the labor organization is not permitted to seek certification among the same
group of employees until 12 months have passed, and the management group should rectify the problems identified during the organizational phase.
22. ANS: C
A preliminary hearing is held before an election is scheduled. This provides participants an opportunity to express their opinions.
23. ANS: D
Collective bargaining is mandatory for grievances related to conditions of employment, work hours, and remuneration.
24. ANS: C
A maintenance-of-membership clause requires union members to maintain their membership during a specific period, such as the duration of the
contract.

25. ANS: C
Nurse leaders and managers can facilitate interest-based bargaining and use strategies such as participative management and governing councils that
develop more satisfying relationships than collective bargaining.

Chapter 6

1. ANS: B
Line-staff conflict, which is usually horizontal, is commonly a struggle among domains related to activities, expertise, and authority. The need for
consensus, requirements of work sequence, and use of shared facilities or services are potential areas of conflict aggravated by differing departmental
goals.
2. ANS: A
Intrasender conflict originates in the sender, who gives conflicting instructions or expects conflicting or mutually exclusive behavioral responses.
3. ANS: D
If individuals cannot meet the differing expectations held of them, they will experience role overload.
4. ANS: B
Attention getting may involve seeking highly visible jobs, engaging in loud or excessive talking, wearing bright or sexy clothing or unusual hair styles, or
driving flashy cars.
5. ANS: C
An individual may unconsciously convert an emotional conflict into physical symptoms (somatization), such as the common headache.
6. ANS: D
Coalition formation gets other people involved and is a power strategy.
7. ANS: C
Affective states such as stress, tension, anxiety, fear, mistrust, anger, and hostility are present during felt conflict.
8. ANS: D
Trust is a significant factor in the development of a manifest conflict. If the individuals involved possess trusting attitudes, they share information and
control and recognize their mutual vulnerability. In the absence of trust, individuals may withhold information so it cannot be used against them or distort
communications to their advantage.
9. ANS: A
Avoiding is not acknowledging the conflict and consequently not addressing the problem to solve it. Withdrawing from a conflict does not resolve it, and
the individual who retreats may harbor a gnawing anger over a situation that drains energy needed for more constructive purposes.
10. ANS: C
Collaborating is a “win-win” strategy and contributes to effective problem solving because both parties try to find mutually satisfying solutions. Generally,
this is a most effective method of conflict resolution.
11. ANS: A
Mediation is a friendly intervention by consent and invitation for settling differences between parties. It is negotiation that involves a third party who is
knowledgeable about negotiation procedures and can help the parties do their bargaining.
12. ANS: B
In distributive bargaining, the two sides are bargaining over the distribution of fixed resources. In such bargaining, one party may use dirty tricks, carry
out deception, make threats, give ultimatums, and overpower and outsmart the other party.
13. ANS: C
Positional pressure tactics, such as refusal to negotiate, extreme demands, escalating demands, and calculated delays, are common dirty tricks in labor
negotiations.
14. ANS: C
 A definitive statement such as “I know you are an intelligent person” limits the freedom of the other person,because it demeans the other party with
sarcasm.
15. ANS: C
The game is changed by reframing instead of rejecting. The personal attack should be reframed as an attack on the problem.
16. ANS: D
Differences cannot be resolved without first understanding them, so it is important to explore the opponent’s views.
17. ANS: C
The basic strategy when dealing with allies is to bring them into the organization and treat them as members.
18. ANS: A
One essential rule of negotiation is to show no fear in the face of intimidation.
19. ANS: C
The leader or manager, if present, should act as a mediator and ask the complainant to explain the perceived problem to the opponent.
20. ANS: D
One helpful mediating strategy is to encourage each party to listen actively and try to understand the other person’s point of view.
21. ANS: A
If one wants to be less direct, one can give or send a highlighted version of the company’s sexual harassment statement to the offender.
22. ANS: B
During a round-robin session, each person in turn states one team performance goal, which is then written on a chalkboard or paper for all to see.
23. ANS: C
Decision charting is a major phase of team development and is concerned with who should be involved in decision making and with the nature of that
involvement. A decision chart helps one visualize the decision-making process.
24. ANS: B
Numerous bullying behaviors are displayed in the workplace, such as undermining, manipulation of reputation, social isolation, intimidation, abuse,
aggressiveness, offensive joke telling, stalking, and designation of unreasonable assignments.

25. ANS: C
Training topics include risk factors that cause or contribute to assaults; information on multicultural diversity to develop sensitivity to racial and ethnic
issues and differences; and methods of dealing with hostile persons.

Chapter 7

1. ANS: D
The leader or manager who adopts the bureaucratic style relies on rules and policies, takes an autocratic approach to directions, and expects
compliance.
2. ANS: B
Integrative leadership is a holistic approach to oneself and others that requires adaptive behavior. Leaders need to be aware of their own behavior and
influence on others, the individual differences of followers, group characteristics, motivation, task structures, environmental factors, and situational
variables and adjust their leadership style accordingly.
ANS: C
3. Positional power refers to the authority inherent in a position; the power to use rewards and punishment; and the organization’s support of one’s
decisions.
4. ANS: A
The situational leadership theory predicts which will be the most appropriate leadership style based on the level of maturity of the followers.

5. ANS: D
The leader in transformational leadership uses individualized approaches, provides a sense of direction, and encourages self-management.
6. ANS: B
Frank and Lillian Gilbreth emphasized the benefits of job simplification and the establishment of work standards, as well as the effects of incentive wage
plans and fatigue on work performance.
7. ANS: D
Max Weber, the “father of organizational theory,” conceptualized bureaucracy, with its emphasis on rules instead of individuals and on competence over
favoritism, as the most efficient basis for organization.
8. ANS: C
Behavioral science theorists stress the importance of maintaining a positive attitude toward people, training managers, fitting supervisory actions to the
situation, meeting employees’ needs, promoting employees’ sense of achievement, and obtaining commitment through participation in planning and
decision making.
9. ANS: D
Henri Fayol believed in the division of work and argued that specialization increases efficiency.
10. ANS: B
Sometimes an informal organization resists the formal goals in the consultative system, whereas in the participative management system, there would
be no informal organization resisting the goals of the formal organization because the goals of both are the same.
11. ANS: C
Peter Drucker introduced management by objectives as a way to manage managers.
12. ANS: B
Robert Greenleaf wrote Servant Leadership. Servant leadership puts serving first, takes a holistic approach, shares decision making, and builds
community.
13. ANS: D
Peter Senge’s theory is based on five disciplines: (1) systems thinking, (2) personal mastery, (3) mental models, (4) shared vision, and (5) team
learning and tools and strategies to build a learning organization. Daniel Goleman stressed the importance of teaching emotional competence.
14. ANS: C
According to Goleman, one necessary emotional intelligence competency is being a visionary who can mobilize others to follow a vision through self-
confidence, empathy, action as a change catalyst, and visionary leadership.
15. ANS: B
Administrative support is the single most important factor predicting implementation success.
16. ANS: C
Both male and female leaders maintain a complex network of relationships with people outside the organization.
17. ANS: C
In 1990, Congress passed the Americans with Disabilities Act to eliminate discrimination against people with physical or mental disabilities in the
workplace. Applicants with disabilities have indicated that they have been refused job interviews, turned down for jobs for which they are qualified, given
lesser responsibilities than others, passed over for promotions, and denied health insurance.
18. ANS: B
Conformist followers believe that they must always please the boss.
 19. ANS: B
The staff nurse should probably start with a private meeting with the nurse manager with recommendations in hand. The staff nurse would need
administrative support to change the policy and should not catch the manager by surprise in public.

20. ANS: C
A deterioration in language and increasingly self-destructive behavior, such as premature sexual activity, indicate a need for character development.
21. ANS: B
To promote character development, the organization must be a caring community.
22. ANS: C
The Code of Ethics makes it clear that a nurse’s responsibility is first to the patient and second to the institution.
23. ANS: A
The American Association of Colleges of Nursing and the American Organization of Nurse Executives specify the need for education about information
systems for nurse administrators.
24. ANS: A
Nursing leadership is broader than management and is concerned with doing the right things. It does overlap some with management, but the latter is
more process oriented and is concerned with doing things right.
25. ANS: D
Health care economics, globalization, innovation, succession, safety as it relates to the nursing shortage, and achievement of magnet status are topics
of major importance for leaders and managers in the twenty-first century.

Chapter 8

1. ANS: C
Nurse managers are more likely to be involved in operational planning.

2. ANS: D
Strategic planning determines the direction of the organization, allocates resources, assigns the responsibilities, and determines time frames.
3. ANS: D
Operational planning is carried out in conjunction with budgeting, usually a few months before the new fiscal year.
4. ANS: C
Increased use of high-cost technology was a response to the competitive environment and the greater acuity of care in acute care settings, tertiary
settings, and homes.
5. ANS: A
Medicare spending has increased as the population continues to grow older.
6. ANS: B
It became increasingly important to be cost efficient, seek out partnerships, share resources, decrease duplication of services, and provide high-quality
care.
7. ANS: D
Executives using the strategic planning process give direction to the organization, improve efficiency, weed out poor or underused programs, eliminate
duplication of efforts, concentrate resources on important elements, and improve communications and coordination of activities.
8. ANS: B
Development of a strategic vision involves identification of goals and objectives as well as identification of strategies for reaching these goals.
9. ANS: C
External threats include shortage of nurses, decrease in the number of insured patients, and legislative changes.
10. ANS: B
A market analysis includes an analysis of customers, competitors, and resources.
11. ANS: D
Lower-level managers, such as managers of nursing units, patient care coordinators, charge nurses, team leaders, case managers, and primary care
nurses, perform operational planning of daily, weekly, and monthly activities that support the other organizational plans.
12. ANS: A
The mission or purpose influences the philosophy, goals, and objectives of an organization.

13. ANS: B
Theorists Johnson and Roy emphasize the client. Sister Callista Roy’s adaptation model is particularly useful in acute care settings.
14. ANS: B
The institution is organized and staffed to accomplish its goals.
15. ANS: D
It is appropriate for the board of directors and top administrators to set institutional goals and objectives and for the vice president of nursing to set the
goals and objectives for nursing. Staff nurses and patient care coordinators help set goals and objectives for the unit.
16. ANS: C
It is appropriate for staff members to determine unit goals and objectives.
17. ANS: B
Objectives are more specific ways to reach the goal. It is recommended that objectives be achievable, specific, measurable, and outcome oriented.
Each objective should specify a single result with a target date.
18. ANS: D
Policies and procedures have different purposes. State law influences the policies and procedures that relate to what tasks personnel can have
delegated to them. The organization’s structure also influences who can delegate what. Nurse managers should implement the policies consistently.
19. ANS: B
Originated policies are usually developed to guide subordinates in their functions. Imposed policies come from external sources such as laws and labor
unions.
20. ANS: B
Procedure manuals standardize procedures and equipment and can provide a basis for orientation and staff development.
21. ANS: C
Written procedures may use a consistent format that includes how to locate items needed, make requests, and dispose of materials used.
22. ANS: C
The purpose or mission statement, philosophy, goals, objectives, policies, and procedures are all consequences of planning and set the stage for
smooth operations.
23. ANS: B
Evidence-based practice information is useful for developing policies and procedures as well as for making other management decisions.
24. ANS: A
An Institute of Medicine report described evidence-based practice as the integration of patient values, clinical expertise, and the best research
evidence.
25. ANS: A
 The novice level of skill acquisition is the stage at which the person has no background or experience for the current situation. This level can apply to a
nursing student or to a professional nurse out of his or her area of expertise.

Chapter 9

1. ANS: B
Health care costs have been rising because of the aging of the population, the consequent increase in the number of individuals with chronic diseases,
increased health care needs, and an increased number of uninsured people.
2. ANS: C
A prospective reimbursement system encourages the implementation of cost-effective health care services. Reimbursement is based on the cost of
treatment of specific DRGs rather than on per diem costs or total hospital costs divided by patient-days. The payment unit is the diagnosis rather than
the patient-day.
3. ANS: D
A capitated system is a health care plan in which the health care provider receives a fixed amount per month (or per year) for each plan participant for
delivery of a specified amount of health care services.
4. ANS: C
Managed competition exists among prepaid providers such as health maintenance organizations, preferred provider organizations, and independent
practice associations and leads to increased use of advanced practice nurses as substitutes for physicians and psychologists.
5. ANS: B
Nurse managers and others need to prepare for a large-scale infectious disease outbreak. Clinical care protocols should be developed, alternate space
use designs should be planned, and adequate disease testing equipment should be put in place.

6. ANS: C
The fiscal manager coordinates fiscal planning, plans to budget, organizes the justification, implements the budget process, determines resource
requirements within the existing constraints, and evaluates technology.
7. ANS: C
Personnel budgets estimate the cost of direct labor required to fulfill the agency’s objectives. The nurse manager decides on the types of nursing care
necessary to meet the nursing needs of the estimated patient population.
8. ANS: B
Capital expenditures include expenditures on physical items, such as replacement or expansion of the plant, major equipment, and inventories.
9. ANS: B
One advantage of budgeting is that the weakness in the organization can be revealed and corrective measures can be taken.

10. ANS: D
Department heads formulate and review goals and objectives and prepare the budgets for their departments.
11. ANS: D
Healthy living programs, such as promotion of exercise activities, stocking of heart-wise foods in the cafeteria, and smoking cessation classes, may help
keep workers healthy and thus reduce sick time, absenteeism, and health care costs.
12. ANS: B
The carrying cost is the expense involved in holding inventories. To keep carrying costs down, the nurse manager should place small orders frequently.
13. ANS: A
Delegation of appropriate tasks to unlicensed personnel can save more expensive nurses’ time for activities requiring more knowledge and skill.
14. ANS: D
Marginal costs are the extra costs created by providing care to one more service unit. They are calculated as the difference between the total costs
before and after adding one additional service unit.
15. ANS: B
Staff development, travel to gain new experiences, staff meetings held on company time, provision of seed money, and maintenance work can lead
indirectly to cost savings.

16. ANS: B
Recognition is a reward for most types of agency achievement.
17. ANS: C
NT is equal to the amount of nursing time per intensity level for a diagnosis-related group (DRG).
ANS: D
18. The equation for the McCloskey model uses nursing intervention (NI) instead of intensity level for a diagnosis-related group to cost out nursing services.

19. ANS: C
Sought publics are desired by the agency but are not necessarily interested in the agency. For instance, wealthy people who are potential donors could
be a sought public.
20. ANS: B
Social marketing applies generic marketing techniques to change the social behavior of a target audience or the well-being of society in general.
21. ANS: C
Concentrated marketing aims at a specific market segment.
22. ANS: B
The growth stage occurs when the number of customers and the size of the market increase.
23. ANS: B
Profit-maximizing pricing tries to set the maximum price that demand for the product or service will bear.
24. ANS: A
Forms of publicity include public service announcements, public relations campaigns, speakers’ bureaus, interviews, health fairs, and screening
programs.

25. ANS: A
Marketing promotion leads to awareness, understanding, interest, decision, utilization, satisfaction, reutilization, and recommendations.

Chapter 10
1. ANS: C
Absence of boundaries empowers employees, and enrichment of work through performance of multiple tasks can increase creativity in complex, flat
organizations.

2. ANS: A
As part of the response to the rising costs of health care and managed care, many hospitals have implemented disease management programs as
managed health care plans. Disease management programs are population-based health programs that focus on a given disease or health condition
and provide care to groups requiring specialized health services.
 3. ANS: A
Leaders evaluate the organizational structure and model the use of decentralized power.
4. ANS: B
Managers develop the organizational chart, are knowledgeable about the structure, establish a chain of command, and maintain and clarify the
channels of communications.
5. ANS: B
The informal organization is not usually depicted on an organizational chart. It is related to relationships that influence a great deal of what happens in
the organization.
6. ANS: D
In newer organizational structures, the chain of command is flatter, with communications flowing in all directions, and authority and responsibility are
delegated to the lowest operational level possible.
7. ANS: C
First-level managers, which include case managers, are concerned with a specific unit’s workflow. They deal with immediate problems in day-to-day
operations.
8. ANS: A
Decentralization fosters informality and democracy in management and brings decision making closer to the action. Thus decisions may be more
effective, because the people who know the situation and have to implement the decisions are the ones who make them.
9. ANS: D
Departmentalization by client makes sense when service is important and the welfare of the client is of primary interest.
10. ANS: B
Quality control personnel or control staff do not advise. They control by restraining line authority. They control directly by acting as an agent for a line
manager or indirectly through evaluation of procedural compliance and interpretation of policies and reports.
11. ANS: C
The roles of the nurse manager throughout organizational redesign, restructuring, and reengineering include team building, coaching, mentoring,
initiating change, reducing costs, and improving quality of care.
12. ANS: A
Function is associated with specialization. Having individuals consistently perform the same or similar tasks and having divisions with specific functions
can help expand the range of control.
13. ANS: C
A dual management approach separates technical and administrative responsibilities. This dual hierarchy gives equal status to managers and technical
professionals.
14. ANS: B
Task forces composed of personnel reassigned from their usual duties are sometimes created for special projects. Establishment of a task force allows
personnel with special qualifications to combine their expertise and concentrate on a project in a manner that would not be possible if they also had to
perform their usual duties.
15. ANS: C
The authority and responsibility of every individual should be clearly defined in writing. This reduces role ambiguity.

16. ANS: D
Ordinarily, increased delegation and general rather than close supervision increase performance effectiveness, production, and employee satisfaction.
17. ANS: B
In a matrix organization, the functional manager shares responsibilities with the project manager, because management by project objectives is
important in a matrix organization.
18. ANS: B
The decision-making process in European-style management varies from one country to another, but in every case it is the board that makes policy
decisions.
19. ANS: C
Participatory management is the foundation of shared governance. The nurse executive retains the decision-making authority and may or may not
agree with committee recommendations.
20. ANS: C
Nurses have opportunities for leadership and management positions in corporations and may operate their own corporations.
21. ANS: C
As nursing becomes increasingly decentralized and incorporated, it also becomes increasingly important to create a network instead of preserving a
pyramid.
22. ANS: B
Formal affiliations occur when two or more organizations formalize the undertaking of limited activities.
23. ANS: C
There is a need for coordination of care of people identified to be at risk and a need for case management for the 20% of the population requiring
integrated economic and care management.

24. ANS: C
When institutions merge, managers should give assurances about what is not going to change, warn people in advance of what changes will occur,
explain the need for the changes, and send consistent messages.
25. ANS: B
Case management and clinical pathways provide the groundwork for the management of outcomes in global patient care. Information technology is the
foundation for global health care and the marketing of it.

Chapter 11
1. ANS: B
A collective culture is characterized by highly affiliative staff who can embrace the mission, values, and vision statements of the organization.
Teamwork, consensus building, interdependency, and following orders are not a part of an expert culture, an individualistic culture, or transculturalism.
2. ANS: C
Tolerance of ambiguity involves at least three factors: tolerance of novelty, tolerance of complexity, and tolerance of insolubility.
3. ANS: D
Role stress or role dissonance is caused by a difference between role enactment and role expectations. The greater the difference, the greater the
stress.
4. ANS: B
Multiculturalism refers to the maintenance of several different cultures simultaneously.
5. ANS: D
Integration of differences is the internalization of bicultural frames of reference. It is the acceptance of an identity that is not based entirely on one
culture.
6. ANS: C
 Clearly written policies and provision of equal support and career development resources to all employees can help reduce both discrimination and
reverse discrimination.
7. ANS: A
Heroes personify the values of the organizational culture. They show that success is attainable, set a standard for performance, preserve what is
special in the organization, motivate employees, serve as role models, and symbolize the organization to the outside world.
8. ANS: D
The cultivation culture is attentive, emotional, enabling, humanistic, nurturing, people driven, personal, promotive, and relaxed. The leader is a catalyst,
cultivator, empowerer, inspirer, promoter, and steward.
9. ANS: B
Subcultures or microsystems have the same elements that cultures have, including distinct patterns of shared ideologies and sets of cultural forms.
10. ANS: B
Attitudes and behaviors are the most significant internal barriers to change.

11. ANS: A
Nurse managers who use empirical-rational strategies are likely to want the appropriate persons for specific positions.
12. ANS: C
Refreezing is comparable to the evaluation and reaffirmation steps of the nursing process.
13. ANS: C
The nurse manager plans a strategy for reducing the restraining forces and strengthening the driving forces.
14. ANS: C
Social relationship norms are norms about mixing business with pleasure and socializing with co-workers.
15. ANS: A
Once the cultural change has been accomplished, it is important to sustain the change by implementing the management skills track and then the team
building track to develop leadership.
16. ANS: B
The persuasion stage is a feeling phase in which people form a favorable or unfavorable attitude toward an innovation. People want to know how easily
the innovation can be implemented and what its advantages and disadvantages are for them.
17. ANS: D
The rejecters were identified in Rogers’s 1983 book as opposing change and encouraging others to reject change as well.

18. ANS: B
Changes in organizational and decision-making structures are needed to adapt to new complexity. The organization copes by developing job
descriptions, programs, policies, and procedures.

19. ANS: D
Culture shock occurs when the members of an organization realize that the organization is out of touch with its settings, mission, and assumptions.
20. ANS: A
If people do not reach the stage of acceptance and personal reorganization after experiencing an organizational change that they perceive as a loss,
they may disengage by quitting or retiring.
21. ANS: C
Causes of resistance to change include the following: threatened self-interest; embarrassment; insecurity; habits; complacency; inaccurate perceptions;
perceived loss of power, rewards, or relationships; objective disagreement; psychological reactions; low tolerance for change; opposition of the change
to current trends; and previous long-term system stability.
22. ANS: C
Covert resisters are people who resist the change behind the scenes.
23. ANS: B
Incompetent executives may be transferred to positions for which they are more qualified. They may be moved from line to staff authority.
24. ANS: B
Organizations advance when there is structural tension that requires structural understanding, leadership, and organizational learning. Progression
creates a cycle that leads to results that are evaluated.
25. ANS: D
The Organizational Culture Assessment Instrument can be used to diagnose organizational culture, which is the primary source of resistance to
change.