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Sullivan, Effective Leadership and Management, 8/e
Chapter 2
Question 1
Type: MCSA
Using the classical organizational theory model, what would be the most appropriate method for the nurse to voice concern over unfair client workload assignments?
1. Circulate a petition to all staff seeking support for change in assignment policy and present the signed petition to the nursing supervisor.
2. Discuss the problem with the nurse’s team leader and then the charge nurse if the problem remains unsolved.
3. Invite the vice president in charge of nursing to a unit meeting.
4. Organize a unit meeting to discuss the problem on all shifts.
Correct Answer: 2
Rationale 1: Circulating a petition among staff does not follow the formal chain of command inherent in classical organizational theory.
Rationale 2: In classical theory there is a formal chain of command and system for communication. Discussing the issue with the team leader is the first step in the chain of command. If that strategy is ineffective, the next step is discussing the issue with the charge nurse.
Rationale 3: Taking concerns straight to the vice president in charge of nursing does not follow the formal chain of command inherent in classical organizational theory.
Rationale 4: Organizing a unit meeting does not follow the formal chain of command inherent in classical organizational theory.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-1: Discuss how organizational theories differ.

Question 2
Type: MCSA
Which relationship is an example of staff authority in classical theory?
1. The shift supervisor directs the staff nurse to help another nurse admit two new clients.
2. The unit manager asks the staff nurse to participate in a unit conference.
3. The team leader asks the staff nurse to assume care of an extra client after another nurse goes home ill.
4. The staff nurse’s mentor calls to see how the nurse’s first day on a new unit progressed.
Correct Answer: 4
Rationale 1: The staff nurse/shift supervisor is an example of line authority. The shift supervisor is responsible for the work of the staff nurse.
Rationale 2: The staff nurse/unit manager relationship is an example of line authority. The unit manager is responsible for the work of the staff nurse.
Rationale 3: The staff nurse/team leader relationship is an example of line authority. The team leader is responsible for the work of the staff nurse.
Rationale 4: The staff nurse/mentor relationship is one in which the mentor offers advice and recommendations to the staff nurse but is not responsible for the care the nurse provides.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-1: Discuss how organizational theories differ.

Question 3
Type: MCSA
The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory?
1. Span of control
2. Line authority
3. Hawthorne effect
4. Adhocracy
Correct Answer: 3
Rationale 1: Span of control is the number of persons a manager can effectively supervise.
Rationale 2: Line authority is a linear hierarchy through which activity is directed.
Rationale 3: The Hawthorne effect is the tendency of people to perform as expected because of special attention.
Rationale 4: Adhocracy is a fluid structure in which management, staff, and experts work together on teams.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 4
Type: MCSA
A community-owned hospital has been purchased by a health care conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse?
1. “If our new bosses want a classical organization, we can expect a strong hierarchy.”
2. “If we don’t want to see lots of changes, we should hope our new bosses don’t like chaos theory.”
3. “If this new company is based on systems theory, there will be a lot of focus on how much work we can produce.”
4. “If this new company is based on contingency theory, we will see lots of focus on how our environment impacts our work.”
Correct Answer: 3
Rationale 1: Classical organizational theory focuses on structure with a strong hierarchy.
Rationale 2: Those who support chaos theory believe that organizational function and integrity must be guided by flexibility, fluidity, speedy adaptability, and cultural sensitivity. Change is inevitable and embraced.
Rationale 3: Systems theory focuses on “input” or resources, “throughput” or the work done, and “output” or the product of the work.
Rationale 4: Contingency theory posits that organization performance can be enhanced by matching an organization’s structure to its environment.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-1: Discuss how organizational theories differ.

Question 5
Type: MCSA
During a performance evaluation the nurse manager states, “My span of control is just too large.” How should the unit supervisor interpret this statement?
1. The nurse manager is not capable of performing all the duties expected of the role.
2. The nurse manager may have too many staff members to manage.
3. The nurse manager is burned out and needs time away from the unit.
4. The nurse manager is not educationally prepared for the role.
Correct Answer: 2
Rationale 1: Span of control is not directly related to the number of duties expected.
Rationale 2: Span of control addresses the number of employees a manager can effectively supervise.
Rationale 3: Span of control issues may result in burnout, but there is no indication from this scenario that this is the case.
Rationale 4: There is no indication that the nurse manager’s level of education is insufficient for the role.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 6
Type: MCSA
During a nurse’s interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?
1. The nurse will have to choose a provider from within the HMO.
2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges.
3. For an additional premium, the nurse can choose any provider.
4. By joining this HMO, the nurse is entitled to unlimited treatment and services.
Correct Answer: 1
Rationale 1: An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.
Rationale 2: The HMO system will not pay for services provided “out of network.”
Rationale 3: The ability to choose a provider who is “out of network” for an additional premium is a feature of point-of-service plans.
Rationale 4: The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-2: Describe the different types of health care organizations.

Question 7
Type: MCSA
A long-term care facility’s organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy?
1. The nursing department is responsible for writing the client’s comprehensive care plan.
2. The dietary department is responsible for nutritional assessment.
3. All nursing tasks fall under the nursing department.
4. Physical and occupational therapy departments coordinate and evaluate activities of daily living.
Correct Answer: 1
Rationale 1: In functional structure, individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a comprehensive care plan without input from other departments.
Rationale 2: In functional structure, individual departments are grouped and responsible for specific tasks. The dietary department would be responsible for nutritional assessment in this structure, so this is not a weakness.
Rationale 3: In functional structure, individual departments are grouped and responsible for specific tasks. All nursing tasks would be grouped under the nursing department, so this is not a weakness.
Rationale 4: In functional structure, individual departments are grouped and responsible for specific tasks. Physical and occupational therapy would logically coordinate and evaluate activities of daily living, so this is not a weakness.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 8
Type: MCSA
A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method?
1. Concentric diversification
2. Conglomerate diversification
3. Capitation
4. Joint venture
Correct Answer: 4
Rationale 1: Concentric diversification is expansion of services into new markets.
Rationale 2: Conglomerate diversification is expansion into areas that differ from the original service.
Rationale 3: Capitation is a fixed fee paid per enrollee for services in an HMO.
Rationale 4: A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 9
Type: MCSA
A client who is being discharged from the hospital will need follow-up for wound care. The client’s spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?
1. Long-term-care facility
2. Public health department
3. Temporary service agency
4. Home health agency
Correct Answer: 4
Rationale 1: Long-term-care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery.
Rationale 2: The public health department’s focus is usually community health, not individual primary care.
Rationale 3: Temporary service agencies are used to provide health care organizations with professional and nonprofessional personnel when the latter are short staffed.
Rationale 4: With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-2: Describe the different types of health care organizations.

Question 10
Type: MCSA
A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory?
1. Contingency theory
2. Closed-systems theory
3. Classical theory
4. Chaos theory
Correct Answer: 4
Rationale 1: Contingency theorists study the environment in which the organization will exist and create the structure to match that environment.
Rationale 2: Closed systems are self-contained and do not exist in organizations dependent on the interplay of people. Examples can be found in the physical sciences.
Rationale 3: Classical leadership theory focuses on developing a well-structured and stable environment where chain of command and control are valued.
Rationale 4: Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-1: Discuss how organizational theories differ.

Question 11
Type: MCSA
What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure?
1. Adaptation and innovation are encouraged.
2. The medical staff has become autonomous from the organization.
3. Two lines of authority have been created.
4. Organizational structure is becoming much clearer.
Correct Answer: 1
Rationale 1: Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation.
Rationale 2: The medical staff is autonomous from the organization in parallel structure. This autonomy is reduced by service-line structure.
Rationale 3: Parallel structure exists when there are two lines of authority in an organization.
Rationale 4: Organizational structure is much clearer in a parallel structure.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 12
Type: MCSA
Which structure is reflected by the statement “Nursing practice is best determined by nurses”?
1. Hybrid
2. Shared governance
3. Matrix
4. Functional
Correct Answer: 2
Rationale 1: Hybrid structure is typical of a growing institution and consists of both self-contained units and functional units. Top administrators still make many of the decisions for the organization.
Rationale 2: Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered.
Rationale 3: Matrix structure combines functional structure and product structure into one overlapping structure. The dual authority created can be frustrating and confusing. Managers and administrators make many of the organizational decisions.
Rationale 4: Functional structure is a traditional structure in which employees are grouped in departments by specialty. Most decisions are made by senior managers.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 13
Type: MCSA
“We want to be the hospital of choice in the Midwest” is which type of statement?
1. Value statement
2. Mission statement
3. Vision statement
4. Philosophy statement
Correct Answer: 3
Rationale 1: The value statement concerns the beliefs or attitudes esteemed by the organization’s leaders.
Rationale 2: The mission statement is a broad statement of the organization’s reason for existence. An example is “Our mission is to improve the health of the people of the Midwest.”
Rationale 3: A vision statement describes the goal to which the organization aspires—in this case, to be the hospital of choice in the Midwest.
Rationale 4: A philosophy statement reflects the organization’s values, vision, and mission, so it is all-inclusive.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.

Question 14
Type: MCSA
What is the best example of a pediatric unit’s organizational culture?
1. All client rooms are private.
2. Nurses wear colorful scrubs.
3. The nurse-to-client ratio is 4 to 1.
4. The primary nursing model is used for care.
Correct Answer: 2
Rationale 1: Organizational climate is based on physical attributes and policy and procedure. Private rooms are an example of organizational climate.
Rationale 2: Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
Rationale 3: Organizational climate is based on physical attributes and policy and procedure. The nurse-to-client ratio is an example of organizational climate.
Rationale 4: Organizational climate is based on physical attributes and policy and procedure. Using primary nursing models is an example of organizational climate.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 15
Type: MCMA
The nurse applying for a position is told, “This hospital has a very traditional organizational structure.” The nurse would expect the organization to use which structure?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Functional
2. Shared governance
3. Service-line
4. Parallel
5. Matrix
Correct Answer: 1,4,5
Rationale 1: A functional structure is a traditional organizational structure.
Rationale 2: Shared governance is a new, more relationship-based organizational structure.
Rationale 3: A service-line structure is a new, more relationship-based organizational structure.
Rationale 4: A parallel structure is a traditional structure, even though it is more modern than a functional structure.
Rationale 5: Matrix is a traditional structure.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 16
Type: MCMA
A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. There may be lack of coordination of services across the different departments in the organization.
2. Senior nursing managers may be overwhelmed with work and decisions.
3. There may be unrest because of the high proportion of management positions filled from outside the organization.
4. There is continual upheaval as the organization responds rapidly to changes in the external environment.
5. Managers have limited knowledge of general management techniques.
Correct Answer: 1,2,5
Rationale 1: Coordination across functions can be complex and poor in a functional structure.
Rationale 2: Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work.
Rationale 3: Typically, in a functional structure, promotion occurs from within.
Rationale 4: Typically, response to changes in the external environment is very slow in organizations with functional structure.
Rationale 5: Many managers in functionally structured organizations rise “up the ranks” to their position; there is often very little formal management training.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 17
Type: MCSA
The nurse’s friend says, “I’ve been thinking about going to that health care clinic in the grocery store so someone can look at my daughter’s rash. What do you think?” Which response by the nurse is appropriate?
1. “Most of those retail clinics are not very good. I’d go somewhere else.”
2. “That would be okay, but you have to pay extra for the convenience.”
3. “If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care.”
4. “I would use the clinic for myself, but not for my children.”
Correct Answer: 3
Rationale 1: Studies on the quality of care provided by these clinics have shown it to be comparable to care provided elsewhere.
Rationale 2: Most retail clinics are less expensive than physician offices or emergency departments.
Rationale 3: Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made.
Rationale 4: There is no indication that the clinic is not appropriate for children.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.

Question 18
Type: MCSA
A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, “I am going to call the hospitalist.” How should the client interpret this statement?
1. The nurse is going to call the medical intern to assess the client.
2. The nurse is going to call the client’s physician’s on-call group.
3. The nurse is going to call a physician who cares for inpatients.
4. The nurse is going to call the emergency department and request that a physician see this client.
Correct Answer: 3
Rationale 1: The medical intern is not a hospitalist.
Rationale 2: The physician’s on-call group is likely a group of physicians from the same office or organization of physicians with office practices. They are not hospitalists.
Rationale 3: A hospitalist provides care only to hospital inpatients.
Rationale 4: Emergency department physicians are not the same as hospitalists.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.

Question 19
Type: MCSA
The health care institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy?
1. “We will increase client satisfaction by 15 percent.”
2. “We will increase productivity by 10 percent on the surgical floor.”
3. “We believe in honest communication.”
4. “We believe clients are most important.”
Correct Answer: 4
Rationale 1: This statement specifies an outcome to be achieved. This is a goal.
Rationale 2: This statement is specific to a particular unit and is an objective.
Rationale 3: This is a statement of the organization’s values.
Rationale 4: The philosophy is a written statement that reflects the organization’s values, vision, and mission. It is broader than a value statement.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.

Question 20
Type: MCSA
The nurse works in a school clinic that is part of an integrated health care network. How would this nurse explain to parents and teachers the focus of care provided in the clinic?
1. Hospital focused
2. Primary care focused
3. Specialty care focused
4. Home care focused
Correct Answer: 2
Rationale 1: The goal of an integrated health care network is to keep clients healthy and out of the hospital.
Rationale 2: Primary care is the focus of integrated health care networks.
Rationale 3: The goal of an integrated health care network is to keep clients healthy, thereby minimizing the need for specialty care visits.
Rationale 4: The goal of an integrated health care system is to keep clients healthy so that more expensive options, like home care, are not needed.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.

Question 21
Type: MCMA
A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these health care providers should ensure which resources are available?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Electronic medical records (EMR) technology
2. A sufficient number of older adults who require long-term care
3. An understanding of the complexity of multiple-need clients
4. A robust marketing plan that describes the home’s physical environment
5. A plan for compensation for the primary care provided
Correct Answer: 1,3,5
Rationale 1: For medical homes to be most effective, EMR should be implemented.
Rationale 2: A medical home is not the same as a long-term-care facility.
Rationale 3: One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions.
Rationale 4: The medical home is not a bricks-and-mortar facility.
Rationale 5: Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.

Question 22
Type: MCSA
Which situation is an example of organizational culture?
1. Every Friday the administrator allows everyone to wear crazy hats while on the units.
2. The cafeteria opens at 7:00 a.m. for breakfast, 11:00 a.m. for lunch, and 5:00 p.m. for dinner.
3. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts.
4. ICU nurses know to take turns covering each other’s clients to facilitate eating breakfast and lunch on the day shift.
Correct Answer: 4
Rationale 1: As this is a systemwide condition initiated by the administrator, it is an example of organizational environment.
Rationale 2: These are set rules published for everyone, including visitors, and make up part of the organizational environment.
Rationale 3: This is a systemwide “rule” established by administration and is part of the organizational environment.
Rationale 4: The nurses have created this system of coverage informally as part of their daily work. This is an example of organizational culture and may vary from unit to unit.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 23
Type: MCMA
A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Any changes to processes in the facility will be approved at the vice president level.
2. Nurses who have made over five medication errors in the last 12 months will be terminated.
3. Outcome data will be analyzed to identify successful interventions.
4. The primary focus will be on a few major initiatives.
5. Previous quality improvement efforts may or may not be discarded.
Correct Answer: 3,5
Rationale 1: Decentralization empowers staff to implement process improvements.
Rationale 2: Lean thinking focuses on the system rather than on individuals.
Rationale 3: In lean thinking, the concentration is on interventions that improve outcomes.
Rationale 4: This redesign strategy is called “big-dot focus” and may or may not reflect lean thinking.
Rationale 5: Decentralization provides a quality improvement infrastructure that disregards only previous efforts that have not proven effective.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.

Question 24
Type: MCMA
The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Experts in hospital physical design
2. Other nurses who work at the hospital
3. Physicians
4. Hospital administrators
5. Representatives from local insurance offices
Correct Answer: 2,3,4,5
Rationale 1: Experts in hospital physical design are considered a resource rather than stakeholders.
Rationale 2: Employees of the hospital are considered stakeholders.
Rationale 3: Physicians are considered stakeholders.
Rationale 4: Administrators are considered stakeholders.
Rationale 5: Community representatives are considered stakeholders.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.

Question 25
Type: MCMA
The administration of a health care system advertises that it promotes “a healthy work environment.” Which events would cause a nurse working in this system to question this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing’s position in any disagreements.
2. When staff nurses ask for the nurse manager’s opinion on client care issues, the response is frequently, “I’ll leave that decision up to you.”
3. Administration has developed a plan in which each week two nurses from each unit are recognized as “best nurse of the week.”
4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift.
5. The nurse executive communicates with managers mostly by email.
Correct Answer: 1,2,3,5
Rationale 1: The collaboration characteristic of a healthy work environment is “true collaboration.” Lobbying for physician support is not true collaboration.
Rationale 2: Effective decision making is a characteristic of a healthy work environment. If the staff nurse was comfortable making a decision without input, the nurse would not ask for help.
Rationale 3: Recognition should be meaningful. Recognizing two nurses from each unit each week is not meaningful.
Rationale 4: Appropriate staffing is a tenet of a healthy work environment.
Rationale 5: While email is a convenient method of communication, it should not be the only method employed.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 26
Type: MCMA
A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Much of the care provided is based on standard operating procedure.
2. Information from the organization refers to the work done as “throughput.”
3. There is a well-defined chain of command in the organization.
4. During interviews with staff, the words creativity and flexibility are often used.
5. The facility’s organizational chart reveals departmentalization.
Correct Answer: 1,3,5
Rationale 1: Division of work, specialization, and standardization are valued in the classical theory.
Rationale 2: Input, throughput, and output are terms used in systems theory.
Rationale 3: The classically organized facility has a well-defined chain of command.
Rationale 4: Creativity, flexibility, and fluidity are all prized components of the chaos theory.
Rationale 5: Classical theorists developed the concept of departmentalization as a means to maintain control, reinforce authority, and provide a formal system for communication.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-1: Discuss how organizational theories differ.

Question 27
Type: MCMA
As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. “Decrease the amount of time from client admission to the room to completion of the admission assessment.”
2. “Increase client satisfaction survey scores regarding meals.”
3. “Decrease the number of medication errors on the unit.”
4. “Initiate intravenous therapy within 30 minutes of the order being taken.”
5. “Use scanning mechanisms to record the numbers of supplies used.”
Correct Answer: 4,5
Rationale 1: Decreasing the time from admission to assessment is an objective. There is no indication of how this is to be accomplished.
Rationale 2: Increasing client satisfaction with better meals is an objective. There is no indication of how this would be accomplished.
Rationale 3: Decreasing the number of medication errors is an objective. There are no strategies given for how this would be accomplished.
Rationale 4: Initiating IV therapy within a specific time is a strategy. It is specific to the task and specifies an action to take.
Rationale 5: Using scanning mechanisms is an example of how something would be done, so it is a strategy.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.

Question 28
Type: MCMA
The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Collaboration and work sharing are becoming more common among nurses in specialty care units.
2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements.
3. Nurses have begun questioning the wisdom of standardizing some nursing procedures.
4. Staffing has become less flexible as more nurses specialize in one aspect of care.
5. A recently updated organizational chart indicates the line authority for each position.
Correct Answer: 1,2,3
Rationale 1: Collaboration and work sharing are more closely identified with systems theory.
Rationale 2: In the classical approach, work is divided into departments and specialties.
Rationale 3: Standardization is a means of control of work, which is common in the classical organizational approach.
Rationale 4: Specialization of labor is a common finding in classical theory.
Rationale 5: Chain of command and line authority are characteristic of classical theory.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2-6: Discuss how the organizational environment and culture affect workplace conditions.

Question 29
Type: MCSA
Which situation is an example of a major weakness of service-integrated structure?
1. Two different units have purchased a demonstration model that could be used by both units.
2. The pharmacy has been asked to compromise on the times medications are delivered to the units.
3. Nurse managers in several units are interviewing new graduates for staff positions.
4. The nurse manager of a unit is involved in a conflict between hospital management and the medical staff.
Correct Answer: 1
Rationale 1: Duplication of resources is a major weakness of service-integrated structures.
Rationale 2: Coordination across functions and the ability to coordinate, collaborate, and compromise are strengths of service-integrated structure.
Rationale 3: One of the strengths of a service-integrated structure is that the same activities can occur in several units and can be unit specific.
Rationale 4: When there are two lines of authority, as in the parallel structure, conflicts may occur at the department or unit level.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-3: Explain how health care organizations are structured.

Question 30
Type: MCSA
Which situation reflects the primary service provided by home health care?
1. The physical therapy assistant performs range-of-motion exercises three times each week.
2. The nurse changes the client’s abdominal dressing daily.
3. Oxygen is provided in the home and managed by a durable medical equipment company.
4. Diabetic testing supplies are delivered to the client’s home each month.
Correct Answer: 2
Rationale 1: Physical therapy is an important aspect of home health care but is not the major service provided.
Rationale 2: Nursing care is the primary service provided by home health agencies.
Rationale 3: Provision of durable medical equipment is an important aspect of home health care but is not the primary service provided.
Rationale 4: Provision of medical supplies is an important aspect of home health care but is not the primary service provided.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.

 

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