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Module 8

LEADERSHIP AND MANAGEMENT



1. Ms. Castro is newly-promoted to a patient care manager position. She updates her knowledge on
the theories in management and leadership in order to become effective in her new role. She learns
that some managers have low concern for services and high concern for staff. Which style of
management refers to this?

a. Organization Man
b. Impoverished Management
c. Country Club Management
d. Team Management

Answer: (C) Country Club Management
Country club management style puts concern for the staff as number one priority at the expense of
the delivery of services. He/she runs the department just like a country club where every one is happy
including the manager.

2. Her former manager demonstrated passion for serving her staff rather than being served. She takes
time to listen, prefers to be a teacher first before being a leader, which is characteristic of

a. Transformational leader
b. Transactional leader
c. Servant leader
d. Charismatic leader

Answer: (C) Servant leader
Servant leaders are open-minded, listen deeply, try to fully understand others and not being
judgmental

3. On the other hand, Ms. Castro notices that the Chief Nurse Executive has charismatic leadership
style. Which of the following behaviors best describes this style?

a. Possesses inspirational quality that makes followers gets attracted of him and regards him with
reverence
b. Acts as he does because he expects that his behavior will yield positive results
c. Uses visioning as the core of his leadership
d. Matches his leadership style to the situation at hand.

Answer: (A) Possesses inspirational quality that makes followers gets attracted of him and
regards him with reverence
Charismatic leaders make the followers feel at ease in their presence. They feel that they are in good
hands whenever the leader is around.

4. Which of the following conclusions of Ms. Castro about leadership characteristics is TRUE?

a. There is a high correlation between the communication skills of a leader and the ability to get the
job done.
b. A manager is effective when he has the ability to plan well.
c. Assessment of personal traits is a reliable tool for predicting a managers potential.
d. There is good evidence that certain personal qualities favor success in managerial role.

Answer: (C) Assessment of personal traits is a reliable tool for predicting a managers
potential.
It is not conclusive that certain qualities of a person would make him become a good manager. It can
only predict a managers potential of becoming a good one.

5. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who
uses this theory?

a. Recognizes staff for going beyond expectations by giving them citations
b. Challenges the staff to take individual accountability for their own practice
c. Admonishes staff for being laggards.
d. Reminds staff about the sanctions for non performance.


Answer: (A) Recognizes staff for going beyond expectations by giving them citations
Path Goal theory according to House and associates rewards good performance so that others would
do the same

6. One leadership theory states that leaders are born and not made, which refers to which of the
following theories?

a. Trait
b. Charismatic
c. Great Man
d. Situational

Answer: (C) Great Man
Leaders become leaders because of their birth right. This is also called Genetic theory or the
Aristotelian theory

7. She came across a theory which states that the leadership style is effective dependent on the
situation. Which of the following styles best fits a situation when the followers are self-directed,
experts and are matured individuals?

a. Democratic
b. Authoritarian
c. Laissez faire
d. Bureaucratic

Answer: (C) Laissez faire
Laissez faire leadership is preferred when the followers know what to do and are experts in the field.
This leadership style is relationship-oriented rather than task-centered.

8. She surfs the internet for more information about leadership styles. She reads about shared
leadership as a practice in some magnet hospitals. Which of the following describes this style of
leadership?

a. Leadership behavior is generally determined by the relationship between the leaders personality
and the specific situation
b. Leaders believe that people are basically good and need not be closely controlled
c. Leaders rely heavily on visioning and inspire members to achieve results
d. Leadership is shared at the point of care.

Answer: (D) Leadership is shared at the point of care.
Shared governance allows the staff nurses to have the authority, responsibility and accountability for
their own practice.

9. Ms. Castro learns that some leaders are transactional leaders. Which of the following does NOT
characterize a transactional leader?

a. Focuses on management tasks
b. Is a caretaker
c. Uses trade-offs to meet goals
d. Inspires others with vision
Answer: (D) Inspires others with vision
Inspires others with a vision is characteristic of a transformational leader. He is focused more on the
day-to-day operations of the department/unit

10. She finds out that some managers have benevolent-authoritative style of management. Which of
the following behaviors will she exhibit most likely?

a. Have condescending trust and confidence in their subordinates
b. Gives economic or ego awards
c. Communicates downward to the staff
d. Allows decision making among subordinates
Answer: (A) Have condescending trust and confidence in their subordinates
Benevolent-authoritative managers pretentiously show their trust and confidence to their followers
Professional Adjustment

1. The nurse works with a colleague who consistently fails to use standard precautions or wear gloves
when caring for clients. The nurse calls the colleague's attention to these oversights. The colleague
tells the nurse that standard precautions and gloves aren't necessary unless the client is known to
have tested positive for the human immunodeficiency virus. What's the most appropriate action for
the nurse to take?

A. Ignore it because it isn't directly the nurse's problem.
B. Document the problem in writing for the manager.
C. Talk to other staff members to ascertain their practices.
D. Instruct the clients to remind this colleague to wear gloves.


2. An adult client is diagnosed with acquired immunodeficiency syndrome. The nurse who is caring for
the client is also his friend. The nurse tells the client's parents about the diagnosis; after all, they
know their son is the nurse's friend. Several weeks later, the nurse receives a letter from the client's
attorney stating that the nurse has committed an intentional tort. Which intentional tort has this nurse
committed?
A. Fraud
B. Defamation of character
C. Assault and battery
D. Breach of confidentiality

3. A nurse accidentally administers 40 mg of propranolol(Inderal) to a client instead of 10 mg.
Although the client exhibits no adverse reactions to the larger dose, the nurse should:
A. call the facility's attorney.
B. inform the client's family.
C. complete an incident report.
D. do nothing because the client's condition is stable.

4. The nurse is assigned to care for a postoperative client who has diabetes mellitus. During
the assessment interview, the client reports that he's impotent and says that he's concerned about
its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
A. encourage the client to ask questions about personal sexuality.
B. provide time for privacy.
C. provide support for the spouse or significant other.
D. suggest referral to a sex counselor or other appropriate professional.
5. The nurse is assigned to care for eight clients. Two nonprofessionals are assigned to work with the
nurse. Which statement is valid in this situation?
A. The nurse may assign the two nonprofessionals to work independently with a client assignment.
B. The nurse is responsible to supervise assistive personnel.
C. Nonprofessionals aren't responsible for their own actions.
D. Nonprofessionals don't require training before they work with clients.

6. Each state has guidelines that regulate the different levels of nursing : licensed practical
or vocational nurse, registered nurse, or advanced practice nurse. Legal guidelines outlining the
scope of practice for nurses are known as:
A. consent to treatment.
B. client's bill of rights.
C. nurse practice acts.
D. licensure requirements.

7. A client is dissatisfied with his hospitalization. He decides to leave against medical advice and
refuses to sign the paperwork. The nurse's next course of action is to:
A. detain him until he signs the paperwork.
B. detain him until his physician arrives.
C. call security for assistance.
D. let him leave.

8. The nurse is caring for a client admitted to the emergency department after a motor vehicle
accident. Under the law, the nurse must obtain informed consent before treatment unless:
A. the client is mentally ill.
B. the client refuses to give informed consent.
C. the client is in an emergency situation.
D. the client asks the nurse to give substituted consent.

9. The nurse is assigned to care for an elderly client who is confused and repeatedly attempts to climb
out of bed. The nurse asks the client to lie quietly and leaves her unsupervised to take a quick break.
While the nurse is away, the client falls out of bed. She sustains no injuries from the fall. Initially, the
nurse should treat this occurrence as:
A. a quality improvement issue.
B. an ethical dilemma.
C. an informed consent problem.
D. a risk-management incident.

10. The nurse receives an assignment to provide care to 10 clients. Two of them have had kidney
transplantation surgery within the last 36hours. The nurse feels overwhelmed with the number of
clients. In addition ,the nurse has never cared for a client who has undergone recent transplantation
surgery. What's the appropriate action for the nurse to take?
A. Speak to the manager and document in writing all concerns related to the assignment.
B. Refuse the assignment
.C. Ignore the assignment and leave the unit.
D. Trade assignments with another nurse.

ANSWERS WITH RATIONALE
1. B. RATIONALE: The nurse has spoken to her colleague under the appropriate circumstances and
the behavior hasn't changed. Therefore, the appropriate action is to bring the problem to the
manager's attention. It's unproductive to talk with other staff members about the situation
because they don't have the authority to bring the colleague's practice into compliance. The
nurse should never point out to a client that another staff member's practice isn't meeting
standards.

2. D. RATIONALE: A nurse shouldn't disclose confidential information about a client to a third
party who has no legal right to know; doing so is a breach of confidentiality. Defamation
of character is injuring someone's reputation through false and malicious statements. Assault
and battery occurs when the nurse forces a client to submit to treatment against the client's
will. A nurse commits fraud when she misleads a client to conceal a mistake she made during
treatment.
3. C. RATIONALE: The nurse should file an incident report. Incident reports highlight areas
of potential liability. It's then the risk manager's responsibility to notify the facility's attorney if
the incident is believed to be serious. The risk manager, in consultation with the physician
and facility administrator, will decide who should inform the family of the error. The
quality assurance coordinator may choose to use such incidents when trying to improve the
quality of care received by clients in a particular facility. Taking no action isn't an acceptable option.
4. D. RATIONALE: The nurse should refer this client to a sex counselor or other professional.
Making appropriate referrals is a valid part of planning the client's care. The nurse
doesn't normally provide sex counseling.
5. B. RATIONALE: Assistive personnel may not be assigned to care for clients without the supervision of a
professional nurse. The nurse doesnt delegate responsibility, keep in mind respond at superior. It's
essential that assistive personnel understand that they're responsible for their own actions.
Assistive personnel must be adequately trained to perform all tasks they're assigned to
perform.
6. C. RATIONALE: Each state has a nurse practice act that defines the scope of nursing practice within the
state. Consent to treatment refers to informed consent for a treatment or procedure. The
client's bill of rights defines the rights of clients. Licensure requirements are constructed
by the state board of nursing to set standards for receiving a nursing license.
7. D. RATIONALE: The nurse is obligated to let him leave. Detaining him in any form is a violation of
the patient's bill of rights.
8. C. RATIONALE: The law doesn't require informed consent in an emergency situation when the client is
unable to give consent and no next of kin is present
9. D. RATIONALE: The nurse should treat this episode as a risk-management incident; her immediate
responsibility is to fill out an incident report and notify the risk manager. Quality improvement and
ethics aren't the nurse's initial concerns. The facility may choose to look at these types of problems
and make changes to deliver a higher standard of care institutionally. Informed consent isn't a relevant
issue in this incident
10. A. RATIONALE: When a nurse feels incapable of performing an assignment safely, the appropriate action
is to speak to the manager or nurse in charge. The nurse should never abandon the assigned
clients by leaving the workplace or asking another nurse to care for them. The nurse may,
however, refuse to perform a task outside the scope of practice.


C. INTENSIVE NURSING PRACTICE
1. Mrs. Chua a 78 year old client is admitted with the diagnosis of mild chronic heart failure. The nurse
expects to hear when listening to clients lungs indicative of chronic heart failure would be:
a. Stridor
b. Crackles
c. Wheezes
d. Friction rubs

2. Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking
morphine. The nurse explains that morphine:
a. Decrease anxiety and restlessness
b. Prevents shock and relieves pain
c. Dilates coronary blood vessels
d. Helps prevent fibrillation of the heart

3. Which of the following should the nurse teach the client about the signs of digitalis toxicity?
a. Increased appetite
b. Elevated blood pressure
c. Skin rash over the chest and back
d. Visual disturbances such as seeing yellow spots

4. Nurse Trisha teaches a client with heart failure to take oral Furosemide in the morning. The reason
for this is to help
a. Retard rapid drug absorption
b. Excrete excessive fluids accumulated at night
c. Prevents sleep disturbances during night
d. Prevention of electrolyte imbalance

5. What would be the primary goal of therapy for a client with pulmonary edema and heart failure?
a. Enhance comfort
b. Increase cardiac output
c. Improve respiratory status
d. Peripheral edema decreased

6. Nurse Linda is caring for a client with head injury and monitoring the client with decerebrate
posturing. Which of the following is a characteristic of this type of posturing?
a. Upper extremity flexion with lower extremity flexion
b. Upper extremity flexion with lower extremity extension
c. Extension of the extremities after a stimulus
d. Flexion of the extremities after stimulus

7. A female client is taking Cascara Sagrada. Nurse Betty informs the client that the following maybe
experienced as side effects of this medication:
a. GI bleeding
b. Peptic ulcer disease
c. Abdominal cramps
d. Partial bowel obstruction

8. Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from
myocardial infarction. Which of the following is the most essential nursing action?
a. Monitoring urine output frequently
b. Monitoring blood pressure every 4 hours
c. Obtaining serum potassium levels daily
d. Obtaining infusion pump for the medication

9. During the second day of hospitalization of the client after a Myocardial Infarction. Which of the
following is an expected outcome?
a. Able to perform self-care activities without pain
b. Severe chest pain
c. Can recognize the risk factors of Myocardial Infarction
d. Can Participate in cardiac rehabilitation walking program

10. A 68 year old client is diagnosed with a right-sided brain attack and is admitted to the hospital. In
caring for this client, the nurse should plan to:
a. Application of elastic stockings to prevent flaccid by muscle
b. Use hand roll and extend the left upper extremity on a pillow to prevent contractions
c. Use a bed cradle to prevent dorsiflexion of feet
d. Do passive range of motion exercise

40. Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward
signs and symptoms related to Hepatitis that may develop. The one that should be reported
immediately to the physician is:
a. Restlessness
b. Yellow urine
c. Nausea
d. Clay- colored stools

41. Which of the following antituberculosis drugs can damage the 8th cranial nerve?
a. Isoniazid (INH)
b. Paraoaminosalicylic acid (PAS)
c. Ethambutol hydrochloride (myambutol)
d. Streptomycin

42. The client asks Nurse Annie the causes of peptic ulcer. Nurse Annie responds that recent research
indicates that peptic ulcers are the result of which of the following:
a. Genetic defect in gastric mucosa
b. Stress
c. Diet high in fat
d. Helicobacter pylori infection

43. Ryan has undergone subtotal gastrectomy. The nurse should expect that nasogastric tube
drainage will be what color for about 12 to 24 hours after surgery?
a. Bile green
b. Bright red
c. Cloudy white
d. Dark brown

44. Nurse Joan is assigned to come for client who has just undergone eye surgery. Nurse Joan plans
to teach the client activities that are permitted during the post operative period. Which of the following
is best recommended for the client?
a. Watching circus
b. Bending over
c. Watching TV
d. Lifting objects

45. A client suffered from a lower leg injury and seeks treatment in the emergency room. There is a
prominent deformity to the lower aspect of the leg, and the injured leg appears shorter that the other
leg. The affected leg is painful, swollen and beginning to become ecchymotic. The nurse interprets
that the client is experiencing:
a. Fracture
b. Strain
c. Sprain
d. Contusion

46. Nurse Jenny is instilling an otic solution into an adult male client left ear. Nurse Jenny avoids doing
which of the following as part of the procedure
a. Pulling the auricle backward and upward
b. Warming the solution to room temperature
c. Pacing the tip of the dropper on the edge of ear canal
d. Placing client in side lying position

47. Nurse Bea should instruct the male client with an ileostomy to report immediately which of the
following symptom?
a. Absence of drainage from the ileostomy for 6 or more hours
b. Passage of liquid stool in the stoma
c. Occasional presence of undigested food
d. A temperature of 37.6 C

48. Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The
nurse suspects which of the following complications?
a. Intestinal obstruction
b. Peritonitis
c. Bowel ischemia
d. Deficient fluid volume

49. Which of the following compilations should the nurse carefully monitors a client with acute
pancreatitis.
a. Myocardial Infarction
b. Cirrhosis
c. Peptic ulcer
d. Pneumonia

ANSWERS WITH RATIONALE
1. B. Left sided heart failure causes fluid accumulation in the capillary network of the lung. Fluid
eventually enters alveolar spaces and causes crackling sounds at the end of inspiration.
2. B. Morphine is a central nervous system depressant used to relieve the pain associated with
myocardial infarction, it also decreases apprehension and prevents cardiogenic shock.
3. D. Seeing yellow spots and colored vision are common symptoms of digitalis toxicity
4. C. When diuretics are taken in the morning, client will void frequently during daytime and will not
need to void frequently at night.
5. B. The primary goal of therapy for the client with pulmonary edema or heart failure is increasing
cardiac output. Pulmonary edema is an acute medical emergency requiring immediate intervention.
6. C. Decerebrate posturing is the extension of the extremities after a stimulus which may occur with
upper brain stem injury.
7. C. The most frequent side effects of Cascara Sagrada (Laxative) is abdominal cramps and nausea.
8. D. Administration of Intravenous Nitroglycerin infusion requires pump for accurate control of
medication.
9. A. By the 2nd day of hospitalization after suffering a Myocardial Infarction, Clients are able to
perform care without chest pain
10. B. The left side of the body will be affected in a right-sided brain attack.
11. D. Clay colored stools are indicative of hepatic obstruction
12. D. Streptomycin is an aminoglycoside and damage on the 8th cranial nerve (ototoxicity) is a
common side effect of aminoglycosides.
13. D. Most peptic ulcer is caused by Helicopter pylori which is a gram negative bacterium.
14. D. 12 to 24 hours after subtotal gastrectomy gastric drainage is normally brown, which indicates
digested food.
15. C. Watching TV is permissible because the eye does not need to move rapidly with this activity,
and it does not increase intraocular pressure.
16. A. Common signs and symptoms of fracture include pain, deformity, shortening of the extremity,
crepitus and swelling.
17. C. The dropper should not touch any object or any part of the clients ear.
18. A. Sudden decrease in drainage or onset of severe abdominal pain should be reported immediately
to the physician because it could mean that obstruction has been developed.
19. B. Complications of acute appendicitis are peritonitis, perforation and abscess development.
20. D. A client with acute pancreatitis is prone to complications associated with respiratory system.

D. NURSING RESEARCH:
1.Patients refusal to divulge information is a limitation because it is beyond the control of Tifanny.
What type of research is appropriate for this study?
a. Descriptive- correlational
b. Experiment
c. Quasi-experiment
d. Historical

2.Nurse Ronald is aware that the best tool for data gathering is?
a. Interview schedule
b. Questionnaire
c. Use of laboratory data
d. Observation

3.Monica is aware that there are times when only manipulation of study variables is possible and the
elements of control or randomization are not attendant. Which type of research is referred to this?
a. Field study
b. Quasi-experiment
c. Solomon-Four group design
d. Post-test only design

4.Cherry notes down ideas that were derived from the description of an investigation written by the
person who conducted it. Which type of reference source refers to this?
a. Footnote
b. Bibliography
c. Primary source
d. Endnotes

5.Ronald plans to conduct a research on the use of a new method of pain assessment scale. Which of
the following is the second step in the conceptualizing phase of the research process?
a. Formulating the research hypothesis
b. Review related literature
c. Formulating and delimiting the research problem
d. Design the theoretical and conceptual framework

6. The leader of the study knows that certain patients who are in a specialized research setting tend to
respond psychologically to the conditions of the study. This referred to as :
a. Cause and effect
b. Hawthorne effect
c. Halo effect
d. Horns effect

7.Mary finally decides to use judgment sampling on her research. Which of the following actions of is
correct?
a. Plans to include whoever is there during his study.
b. Determines the different nationality of patients frequently admitted and decides to get
representations samples from each.
c. Assigns numbers for each of the patients, place these in a fishbowl and draw 10 from it.
d. Decides to get 20 samples from the admitted patients

8.Marion is aware that the sampling method that gives equal chance to all units in the population to
get picked is:
a. Random
b. Accidental
c. Quota
d. Judgment

ANSWERS WITH RATIONALE :
1. Answer: (A) Descriptive- correlational
Rationale: Descriptive- correlational study is the most appropriate for this study because it studies the
variables that could be the antecedents of the increased incidence of nosocomial infection.
2. Answer: (C) Use of laboratory data
Rationale: Incidence of nosocomial infection is best collected through the use of biophysiologic
measures, particularly in vitro measurements, hence laboratory data is essential.
3. Answer: (B) Quasi-experiment
Rationale: Quasi-experiment is done when randomization and control of the variables are not possible.
4. Answer: (C) Primary source
Rationale: This refers to a primary source which is a direct account of the investigation done by the
investigator. In contrast to this is a secondary source, which is written by someone other than the
original researcher.

5. Answer: (B) Review related literature
Rationale: After formulating and delimiting the research problem, the researcher conducts a review of
related literature to determine the extent of what has been done on the study by previous
researchers.
6. Answer: (B) Hawthorne effect
Rationale: Hawthorne effect is based on the study of Elton Mayo and company about the effect of an
intervention done to improve the working conditions of the workers on their productivity. It resulted to
an increased productivity but not due to the intervention but due to the psychological effects of being
observed. They performed differently because they were under observation.
7. Answer: (B) Determines the different nationality of patients frequently admitted and decides to get
representations samples from each.
Rationale: Judgment sampling involves including samples according to the knowledge of the
investigator about the participants in the study.

8. Answer: (A) Random
Rationale: Random sampling gives equal chance for all the elements in the population to be picked as
part of the sample.