NCLEX Questions for Leadership and Management with Rationale

The nurse manager has asked that all staff nurses develop effective leadership competencies. How should the staff nurses interpret this request?

1. This is an unrealistic expectation, because only managers are leaders.
2. If the nurses learn about and use relevant leadership and management theories and styles this is possible.
3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done.
4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

Answer:
2. If the nurses learn about and use relevant leadership and management theories and styles this is possible.

Rationale:
1: A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders.
2: In today’s health care environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices.
3: Control, competition, and getting the job done are past theories and styles and are not as useful in today’s environment.
4: Leadership is a skill that can be learned.

Peter Drucker’s view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization?
1. The control of the organization is centralized, and decisions are made by upper-level management.
2. Staff nurses are expected to provide support and nurturing for management’s decisions.
3. The organization’s approach to leadership is autocratic and bureaucratic.
4. Staff nurses provide input into planning and changes for their own unit.
Answer:
4. Staff nurses provide input into planning and changes for their own unit.

Rationale:
1: In participatory organizations, the control of the organization is decentralized and many decisions are made by those “on the front lines” of the organization.
2: The theory is that the staff should be nurtured to promote greater leadership competency.
3: According to Drucker, when staff participate in the core functions of management, the organization is more effective.
4: According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

Which behavior demonstrates the nurse’s competency as an emotionally intelligent leader?
1. The nurse is proficient in technical skills.
2. The nurse relies on policies, not options.
3. The nurse supports team members.
4. Productivity is not a major concern.
Answer:
3. The nurse supports team members.

Rationale:
1: While technical skill is important for all nurses, it is not a hallmark of a competent leader.
2: Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered.
3: In Emotional Intelligent theory, team members support each other and feel supported by the team leader.
4: This statement reflects the country club leadership style.

Describe the primary focus of a manager in a knowledge work environment.
1. Developing the most effective teams.
2. Taking risks.
3. Routine work.
4. Understanding the history of the organization.
Answer:
1. Developing the most effective teams.

Rationale:
1: The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many.
2: Risk taking is a part of knowledge work, but is not the most important of this manager’s tasks.
3: Knowledge work is a combination of routine and non-routine work, so the manager will have focus on the routine. This is not the manager’s most important focus.
4: Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus.

A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager’s authority because of the age difference. How can this nurse manager best exercise authority?
1. Use critical thinking to solve problems on the unit.
2. Give assignments clearly, taking staff expertise into consideration.
3. Understand complex health care environments.
4. Maintain an autocratic approach to influence results.
Answer:
2. Give assignments clearly, taking staff expertise into consideration.

Rationale:
1: Critical thinking is important for every RN, not just a manager 2: Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group.
3: Nurse managers do work in complex health care environments but must create an appropriate organizational environment as a way of exercising authority.
4: In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit?
1. “I know I told you that you could have the weekend off, but I really need you to work.”
2. “The others work many extra shifts, why can’t you?”
3. “I’m sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs.”
4. “I can’t believe you need help with such a simple task. Didn’t you learn that in school?”
Answer:
3. “I’m sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs.”

Rationale:
1: To develop trust, managers who make promises to staff must keep the promise.
2: This statement implies that the staff nurse is not a team player. It also sets up one nurse against the remainder of the staff. Effective managers must be fair and supportive with all staff.
3: This manager is standing up for staff by not allowing another unit to take a nurse today.
4: This statement is belittling to the staff nurse. This attitude does not demonstrate trust that staff performances will be effective.

The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role?
1. “If you make a mistake with your staff, admit it, apologize, and correct the error if possible.”
2. “Don’t be too soft on the staff. If they make a mistake, be certain to reprimand them immediately.”
3. “Give your best nurses extra attention and rewards for their help.”
4. “Never get into a disagreement with a staff member.”
Answer:
1. “If you make a mistake with your staff, admit it, apologize, and correct the error if possible.”

Rationale:
1: Managers need to be honest and forthcoming with staff, which includes taking responsibility for one’s own actions and errors. This also provides a positive role model for the staff.
2: When errors occur, the manager should use the opportunity for improvement, not punishment.
3: When staff feel some staff are given extra credit, staff will feel uncomfortable with the manager and resentment will build.
4: Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

The nurse wishes to improve personal Emotional Intelligence (EI) in hopes of a promotion to nurse manager. Which skills are important for this nurse to improve? Select all that apply.
1. Self-confidence.
2. Knowledge base of nursing.
3. Proficiency in technical skills.
4. Empathy.
5. Ability to initiate change.
Answer:
1. Self-confidence.
4. Empathy.
5. Ability to initiate change.

Rationale:
1: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.
2: While this is an important aspect of professional nursing, it is not a competency of EI.
3: While this is an important aspect of professional nursing, it is not a competency of EI.
4: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.
5: EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.

Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply.
1. Focus is change.
2. Have the ability to influence others.
3. Control the environment.
4. Focus is on people.
5. Focus on efficiency.
Answer:
3. Control the environment.
5. Focus on efficiency.

Rationale:
1: The manager accepts the status quo, while the leader challenges it.
2: The manager controls people, while the leader influences
3: The manager controls the environment, patient care, and the staff that deliver that care.
4: The leader focuses on people while the manager focuses on systems and structure.
5: Managers focus on efficiency, while leaders focus on effectiveness.

Typically the nurse manager of a unit uses a participatory style of leadership. Today a patient suffered a cardiac arrest; the manager took over the patient’s care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply.
1. Bureaucratic.
2. Autocratic.
3. Permissive.
4. Directive.
5. Authoritarian.
Answer:
2. Autocratic.
4. Directive.
5. Authoritarian.

Rationale:
1: This style is focused on organizational rules and policies.
2: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.
3: This is a “hands-off” approach.
4: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.
5: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

There have been several patient complaints that the staff members of the unit are disorganized and that “no one seems to know what to do or when to do it.” The staff members concur that they don’t have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing?
1. Autocratic.
2. Bureaucratic.
3. Laissez-faire.
4. Authoritarian.
Answer:
3. Laissez-faire.

Rationale:
1: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur.
2: Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur.
3: This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients.
4: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is likely the complaints in this scenario would occur.

The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model can these students most usually expect to follow?
1. Total patient care model.
2. Functional nursing model.
3. Primary nursing model.
4. Care management model.
Answer:
1. Total patient care model.

Rationale 1: Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student’s progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving IV meds.
Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as wound care.
Rationale 3: In primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care, from admission to discharge.
Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

This morning, the RN is assigned to administer medications to all of the patients on the medical-surgical unit. From this assignment, the RN knows that this organization adheres to which type of patient care delivery model?
1. Total patient care model.
2. Functional nursing model.
3. Primary nursing model.
4. Care management model.
Answer:
2. Functional nursing model.

Rationale 1: The staff working for an organization that uses the total patient care model are assigned to provide all of the care for a patient while in the clinical area.
Rationale 2: Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as passing out medications for the unit.
Rationale 3: IN primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care, from admission to discharge.
Rationale 4: The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

What is a disadvantage of using the team approach for care delivery?
1. The team leader might not have the necessary leadership skills required to successfully lead the team.
2. There is a risk that care will be fragmented.
3. This approach often leads to greater staff dissatisfaction, with staff members feeling they are just grinding out tasks.
4. This approach may lead to decreased collaboration and redundancy in patient care.
Answer:
1. The team leader might not have the necessary leadership skills required to successfully lead the team.

Rationale 1: Using the team approach requires that the team leader have the necessary leadership skills to coordinate and delegate patient care.
Rationale 2: The team approach helps keep care from becoming fragmented.
Rationale 3: In this approach, each team member can contribute his or her own special expertise or skill in caring for the patient.
Rationale 4: There is generally a greater amount of collaboration and less redundancy or care.

The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model?
1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest-ranking member.
2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.
3. The mission statement of the hospital describes centralized power.
4. A staff nurse mentions that each individual staff member has complete autonomy.
Answer:
2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.

Rationale 1: This documents that the hospital follows the classical theory of organization.
Rationale 2: Shared governance increases each nurse’s influence over the organization, empowering staff.
Rationale 3: This is a classical organizational model.
Rationale 4: Although the shared governance model does provide some autonomy, there is also an understanding that staff are expected to collaborate and function cooperatively with both management and colleagues.

Which factor would least likely be included in the analysis of an organization?
1. Whether the organization’s mission and vision match staff performance.
2. Results from a staff opinion survey regarding the organization’s decision-making processes.
3. How the organization’s communication patterns have affected the change process.
4. The turnover rate of nursing personnel in a given unit.
Answer:
4. The turnover rate of nursing personnel in a given unit.

Rationale 1: The vision and mission statements are the driving forces behind all decision, and provide critical information about the organization’s values and philosophy.
Rationale 2: It is important to analyze how staff members believe decisions are made.
Rationale 3: It is essential to analyze communication patterns because communication runs an organizations and its ability to function effectively.
Rationale 4: Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient’s IV rate while a colleague contacts the patient’s physician. Which critical element of nursing is this nurse demonstrating?
Standard Text: Select all that apply.
1. Autonomy.
2. Responsibility.
3. Delegation.
4. Accountability.
5. Relevance.
Answer:
1. Autonomy.
2. Responsibility.
4. Accountability.

Rationale 1: Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them.
Rationale 2: This nurse was entrusted with a particular function, in this case, caring for a post-op patient.
Rationale 3: There is no indication that the nurse delegated care of this patient to anyone.
Rationale 4: Accountability is the acceptance of responsibility of the outcomes of care.
Rationale 5: This term is not one of the critical elements of nursing.

What is the oldest of the nursing care models?
1. Total patient care.
2. Functional nursing.
3. Team nursing.
4. Primary nursing.
Answer:
1. Total patient care.

Rationale 1: This is the oldest of the models. Nurses have provided this type of care for generations.
Rationale 2: This model is not as old as total patient care.
Rationale 3: This model is not as old as total patient care.
Rationale 4: This model is not as old as total patient care.

Which options are included in the six dimensions of shared governance?
Standard Text: Select all that apply.
1. Informal authority base.
2. Access to information about the organization.
3. Delegation of care to others.
4. Ability to set goals and negotiate conflict.
5. Control over professional practice.
Answer:
2. Access to information about the organization.
4. Ability to set goals and negotiate conflict.
5. Control over professional practice.

Rationale 1: Shared governance requires formal authority granted by the organization.
Rationale 2: This is a part of shared governance.
Rationale 3: This is not a part of shared governance though it occurs in a shared governance organization.
Rationale 4: This is a part of shared governance.
Rationale 5: This is a part of shared governance.

What are the responsibilities of the nurse manager in most shared governance models?
Standard Text: Select all that apply.
1. Staffing.
2. Direct patient care.
3. Program evaluation.
4. Allocation of resources.
5. Long-range planning.
Answer:
1. Staffing.
3. Program evaluation.
4. Allocation of resources.
5. Long-range planning.

Rationale 1: This is a responsibility of the nurse manager in most shared governance models.
Rationale 2: In most shared governance models, the nurse manager is not responsible for providing direct patient care.
Rationale 3: This is a responsibility of the nurse manager in most shared governance models.
Rationale 4: This is a responsibility of the nurse manager in most shared governance models.
Rationale 5: This is a responsibility of the nurse manager in most shared governance models.

The nurse manager is making patient assignments for the shift. What should be the primary guiding factor in these assignments?
1. Number of staff available.
2. Skill mix of the staff.
3. Patient needs.
4. Physical layout of the unit.
Answer:
3. Patient needs.

Rationale 1: This is an important determinant of staff assignments, but is not the most important factor.
Rationale 2: This is an important determinant of staff assignments, but is not the most important factor.
Rationale 3: The most important factor in any decision made by any health care provider should be patient needs.
Rationale 4: This is an important determinant of staff assignments, but is not the most important factor.

What is the primary focus of disease management programs?
1. Curing the disease.
2. Reducing the need for medications.
3. The whole patient.
4. Learning more about the disease.
Answer:
3. The whole patient.

Rationale 1: This can be a focus, depending upon the disease, but is not the primary focus.
Rationale 2: This can be a focus, depending upon the disease, but is not the primary focus.
Rationale 3: The primary focus is caring for the whole patient.
Rationale 4: This can be a focus, but is not the primary focus.

The nurse who works for an insurance company has been asked to develop an initial set of disease management programs. What factors should this nurse consider when choosing the diseases? Select all that apply.
1. High cost problems.
2. Those with high numbers of hospitalizations.
3. Those with high risk for complications.
4. Long-term problems.
5. Those with a longer length of stay when hospitalization is required.
Answer:
1. High cost problems.
2. Those with high numbers of hospitalizations.
3. Those with high risk for complications.
4. Long-term problems.
5. Those with a longer length of stay when hospitalization is required.

Rationale 1: High cost, high volume, high risk diseases are typically considered for management programs.
Rationale 2: High cost, high volume, high risk diseases are typically considered for management programs.
Rationale 3: High cost, high volume, high risk diseases are typically considered for management programs.
Rationale 4: Long-term problems incur high costs.
Rationale 5: Longer length of stay increases costs.

Which description of a clinical pathway provided by a nursing student would indicate the best understanding of the concept?
1. Clinical pathways are tools to measure patient outcomes.
2. Clinical pathways are the same as nursing care plans.
3. Clinical pathways are developed to use in acute care settings and guide the nursing care of patients as they are admitted, treated, and discharged.
4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.
Answer:
4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.

Rationale 1: This statement only describes a portion of the use of clinical pathways.
Rationale 2: While the clinical pathway does include nursing care, they are interprofesssional.
Rationale 3: This option does not take into account the interprofessional nature of clinical pathways, nor does it take into account the fact that they are used in areas other than acute care.
Rationale 4: This statement is the clearest and most complete description of a clinical pathway.

The staff nurse has been asked to work on a committee whose task is to develop clinical pathways for the facility. What is the purpose of these pathways?
1. To provide quality health care with the efficient use of resources while controlling costs.
2. To provide practice guidelines for the general treatment of a specific diagnosis.
3. To reduce patient length of stay.
4. To justify alternative treatment methods.
Answer:
1. To provide quality health care with the efficient use of resources while controlling costs.

Rationale 1: Clinical pathways were developed in response to the need to identify quality, cost-effective health care within a specific time frame.
Rationale 2: Clinical pathways are specific and unique to the health care agency or managed care organization in which they are used.
Rationale 3: One of the purposes for developing clinical pathways is to reduce the cost of health care. This can occur as a result of reduced length of stay, but reducing length of stay is not the primary goal.
Rationale 4: Clinical pathways often are used to demonstrate compliance with standards of care, accreditation, and regulatory requirements.

The health care providers in an organization have chosen not to adopt the use of clinical pathways. What are reasons to justify this decision? Select all that apply.
1. Clinical pathways development and implementation takes time and can be costly.
2. The pathway content has to be evaluated each time it is used.
3. Some believe that clinical pathways result in excessive paperwork and redundant documentation.
4. There is fear that pathways will be used in evaluating staff performance.
5. The use of clinical pathways has not been proven to make a difference in patient care.
Answer:
1. Clinical pathways development and implementation takes time and can be costly.
2. The pathway content has to be evaluated each time it is used.
3. Some believe that clinical pathways result in excessive paperwork and redundant documentation.
4. There is fear that pathways will be used in evaluating staff performance.

Rationale 1: These pathways are developed for each facility and can be costly to develop and implement.
Rationale 2: Since the content contains the general care of the patient with a specific disease, the content must be reviewed and individualized to each patient each time it is used.
Rationale 3: New forms and paperwork often cause health care providers to be concerned about new methods of providing care.
Rationale 4: Some health care providers fear the interprofessional aspects of these tools. Others resent the requirement to follow the instructions of the critical pathway and fear they will be criticized if their general care does not match that required by the critical pathway.
Rationale 5: These pathways do change patient care and can support interprofessional care.

Which statement is true regarding implementation of clinical pathways?
1. Pathways replace physician orders.
2. Pathways cannot be used for patients with more than one illness or condition.
3. Using pathways is the best way to assess length of stay (LOS).
4. Disclaimers may be used with clinical pathways to convey that treatment is standardized.
Answer:
3. Using pathways is the best way to assess length of stay (LOS).

Rationale 1: Pathways do not replace physician orders.
Rationale 2: Pathways can be used for patients with more than one illness or condition by developing co-paths.
Rationale 3: Using pathways is the best way to assess the LOS, and their use helps to determine the best expected LOS.
Rationale 4: Disclaimers are a way to indicate that care will be provided to meet the individual needs of the patient, which may require variance from a clinical pathway.

Differentiate between disease management programs and clinical guidelines by choosing the option that describes disease management programs.
1. The major goal is to prepare the patient to understand the disease and to increase self-management of the disease.
2. They establish standards that focus on health maintenance.
3. They have been adopted to control costs.
4. They are also called medical review criteria.
Answer:
1. The major goal is to prepare the patient to understand the disease and to increase self-management of the disease.

Rationale 1: The purpose of disease management programs is to provide patients with education and preventive care that improves quality of life.
Rationale 2: This is true of clinical guidelines.
Rationale 3: This is true of clinical guidelines.
Rationale 4: This is true of clinical guidelines.

The Governing Board of the hospital has completed an assessment of the organization’s culture. Which findings would lead the Board to determine that the culture is healthy?
Standard Text: Select all that apply.
1. There is wide variation in the expectations of individual employees and departments.
2. The decisions made about care are staff-centered.
3. There is evidence that the values of the organization and the health professionals working there are similar.
4. The organization is designed to serve its health professionals.
5. New people who come into the organization learn about the culture by connecting behaviors and consequences.
Answer:
3. There is evidence that the values of the organization and the health professionals working there are similar.
5. New people who come into the organization learn about the culture by connecting behaviors and consequences.

Rationale 1: Separate approaches to expectations, caring, and values among departments would not be present.
Rationale 2: The decisions should be patient-centered.
Rationale 3: A hallmark of a healthy organization is a close match of values between the organization and its health professionals.
Rationale 4: The organization should be designed to serve the patients.
Rationale 5: This is the way new people learn the values of the organization.

The staff nurse has been asked to assume leadership of a work team. Which strategies should this nurse use to increase the team members’ trust? Select all that apply.
1. Keep promises that are made.
2. Give honest feedback.
3. Create a logical excuse for not keeping promises made.
4. Reward followers.
5. Ask followers to defer feedback until the end of the project.
Answer:
1. Keep promises that are made.
2. Give honest feedback.
4. Reward followers.

Rationale 1: If the leader does not keep promises, trust is lost.
Rationale 2: Feedback should be honest and formulated to help the follower do a better job.
Rationale 3: The leader can explain why a promise was not kept, but should not “create” excuses.
Rationale 4: Followers appreciate rewards when they are earned.
Rationale 5: Followers should be encouraged to provide feedback to the leader throughout the project.

The manager has asked the staff to participate in the selection of new intravenous pumps for the unit. The manger has provided a list of choices and budget guidelines. This is an example of use of which management strategy?
1. Use of expert power.
2. Use of legitimate power.
3. Empowerment of staff.
4. Management persuasiveness.
Answer:
3. Empowerment of staff.

Rationale 1: This manager has used expert opinion, not expert power.
Rationale 2: Legitimate power is the type of power that is “awarded” with a position.
Rationale 3: This action enables others to act and provides others with the opportunity to participate and influence decisions.
Rationale 4: The manger would have used persuasiveness to convince the staff to adopt a particular kind of pump that the manager chose.