Chapter 30: Thriving for the Future Nursing School Test Banks

Chapter 30: Thriving for the Future
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. Nursing professionals in the twenty-first century will accomplish most of their work:
a. Through teams of internationally prepared professionals.
b. In teams and through group work.
c. Through long-term, secure jobs.
d. In competitive environments and work groups.
ANS: B
The future is about teams and group work. Competition will be out and collaboration will be in. Job security will be out and career options will be in. Our brightest and best may leave more often than they do at present to pursue career options internationally.

REF: Page 567 | Page 572
TOP: AONE competency: Knowledge of the Health Care Environment

2. Based on studies of workplace environments for nurses and future projections, the workplace of the future will be:
a. Less intense because of more technology.
b. About the same as it is now.
c. More intense because of more technology.
d. Fluctuating between intense periods and less intense periods.
ANS: C
Technology will continue to revolutionize health care and contribute to complexity compression. In addition to access to knowledge, electronic records, and current applications of technology, technology will include robotics, which will change how chronic disease can be managed, and bioengineering will make possible interventions that do not yet exist.

REF: Page 572 TOP: AONE competency: Business Skills

3. Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you:
a. Refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective.
b. Work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health care and prescriptions for immediate needs.
c. Ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery.
d. Address the health of those who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying.
ANS: A
Referral to a food bank addresses the needs of a specific population, while exemplifying an important leadership strength: thinking long-term, acting short-term. The project that involves mothers will teach mothers about nutrition and engage them in preparation of low-cost, healthy meals while promoting longer-term changes in healthy eating.

REF: Page 567 | Page 568 | Page 572 TOP: AONE competency: Leadership

4. You notice that wait times in your Emergency Department are growing longer, because of factors such as increases in the numbers of persons with chronic disorders, discharge of patients into the community at a higher level of acuity, and limited resources for transfer of inpatients. You begin to think about an application that would use your knowledge of the Emergency Department but also software and business applications and wonder if this would reduce wait times. You have not encountered anything similar to this idea. According to the Wise Forecast Model, you are in what phase?
a. Wild thinking
b. Act widely
c. Think wildly
d. Learn widely
ANS: C
The second step in the Wise Forecast Model is to think wildly. Step two is designed to create connections among disparate thoughts. This thinking might be seen as the start of innovations.

REF: Page 570 TOP: AONE competency: Knowledge of the Health Care Environment

5. Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. What would be a healthy response to this situation?
a. Salvage as much of the original planning as possible so as to reduce expenditures.
b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions.
c. Abandon the current planning in favor of addressing the new trends.
d. Continue with the current planning because trends come and go.
ANS: B
Stability and total chaos are the ends of a continuum. Moving in some way between those two ends suggests that we live in a constant state of disequilibrium in which we strive toward stability while recognizing we experience chaos. As we continue to move from traditional practices to evidence-based ones and from a heavy focus on tertiary care to one that values primary care, we can assume that we might experience more chaos. Chaos can lead to new learning and new, innovative solutions. As nurses, it is important to be able to function in an evolving environment.

REF: Page 571 TOP: AONE competency: Leadership

6. Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. As a manager in this situation, your staff experience a gap between what they expected (the original re-design of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what?
a. Eustress
b. Distress
c. Stress
d. Compression
ANS: C
Selye described stress as being on a continuum between stress that is positive (eustress) and stress that is negative (distress). Because individuals perceive the same event differently, from the information that is given, it is not possible to determine whether the nurses experience the events as eustress or distress; what is most likely is that the nurses are experiencing stress, which is what occurs when there is a gap between expectations and what is actually occurring.

REF: Page 571 TOP: AONE competency: Leadership

7. As a nurse manager, it is important to become a future thinker. Which is an example of a future thinker?
a. Keeping traditional practices
b. Moving toward evidence-based practices
c. Finding less need for more knowledge
d. Believing that macromarketing will be a necessity
ANS: B
Future forecasts include evolutions in power, structure, and knowledge; rapid change in the healthcare system; the demise of macromarketing; and increased evidence-based practice.

REF: Page 571 TOP: AONE competency: Leadership

8. As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed the questions that you would like addressed and searched the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing?
a. Compression complexity
b. Distress
c. Information lag
d. Technology advancement
ANS: A
This situation exemplifies complexity compression, a term that means many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other new change. This compression can be distracting or useful.

REF: Page 572 TOP: AONE competency: Leadership

9. Nursing research has indicated that the foundation for becoming a nursing leader is the ability to:
a. Write effectively.
b. Speak two or three languages.
c. Focus on day-to-day priorities.
d. Think futuristically.
ANS: D
Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is becomes a critical strategy. A vision can range from that of an individual to that of a group or to a whole organization.

REF: Page 569 TOP: AONE competency: Leadership

10. The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling?
a. Her clinical expertise
b. Affection for tradition
c. Her employability
d. Her busy professional life
ANS: C
Being employed is no longer sufficient; we must be employable. A portfolio outlines achievements and experiences that communicate employability.

REF: Page 569 TOP: AONE competency: Leadership

11. Your unit has a number of patients who have undergone limb amputation. In working with the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to amass information in a number of areas with which you previously had little familiarity. According to the Wise Forecast Model, you are
a. Acting wildly.
b. Learning wildly.
c. Engaging in interprofessional care.
d. Increasing your complexity compression.
ANS: B
The first step, learn widely, means that we must extend our sources of knowledge beyond our role and clinical areas of interest. In fact we must extend our learning beyond nursing and health care. Widely might encompass another discipline such as architecture or engineering.

REF: Page 570 TOP: AONE competency: Leadership

12. The starfish analogy is exemplified in which of the following?
a. A unit manager resigns after continued tension between the administration and her regarding implementation of primary nursing. The primary nursing project dies.
b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers.
c. Alana, a new graduate, promotes continence care based on evidence. When she presents her ideas, senior staff refuses to consider it.
d. The head of a community health service moves on to another position. Programs are disbanded.
ANS: B
The starfish analogy points to the connectivity that we have with one another and how we influence and are influenced by others all the time. This affords many opportunities for leadership that are dependent not on formal titles but on opportunities to shape the work at hand.

REF: Page 568 TOP: AONE competency: Leadership

13. Which of the following will require greater attention in the future?
a. Chronic disorders
b. Obstetrical outcomes
c. Prevention of hospital-based errors
d. Team conflict resolution strategies
ANS: A
Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on prevention, personal accountability, and innovations such as robotics in the management of chronic illnesses.

REF: Page 572 TOP: AONE competency: Knowledge of the Health Care Environment

14. Which of the following strategies is most important in developing a strong vision?
a. Seeking out evidence to support trends and out-of-the-box thinking
b. Spending time with others with whom we discuss ideas
c. Setting up focus groups to provide information on current realities
d. Being honest and open about what we think for the future
ANS: D
Regardless of how we go about developing our vision (gathering evidence, testing ideas with others), honesty and openness are foundational to a strong vision.

REF: Page 569 TOP: AONE competency: Leadership

15. To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most consistent with thinking wildly in the Wise Forecast Model?
a. Listing everything that we know about our current situation
b. Defining which practices will remain unchanged and which will change
c. Asking someone with a great deal of experience to share ideas about best practice
d. Challenging current and future practices with questions of what if?
ANS: D
Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild idea.

REF: Page 570 TOP: AONE competency: Leadership

16. Which aspect of our tradition and history in nursing may impede our movement towards future-oriented thinking?
a. Lack of confidence
b. Focus on the discipline of nursing
c. Focus on details in the everyday practice
d. Mistrust of trends and new evidence
ANS: C
Because of our history of attention to details, we may need to challenge ourselves in developing our ability for leadership. Moving from micromanaging to focusing on setting expectations for those for whom we are accountable may feel uncomfortable. However, that movement reinforces our ability to deal with longer-term issues.

REF: Page 569 TOP: AONE competency: Knowledge of the Health Care Environment

17. A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies:
a. A poor relationship between leaders and staff.
b. Lack of knowledge regarding the importance of changes.
c. Striving to achieve stability in the midst of great disequilibrium.
d. The importance of chaos in promoting adherence with established practices.
ANS: C
Stability and chaos are at opposite ends of a continuum. When chaos is present, change occurs but life may seem uncontrollable. Resisting further change is a move toward establishment of equilibrium.

REF: Page 571 TOP: AONE competency: Leadership

18. A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. The phenomenon experienced by the staff is termed:
a. Eustress.
b. Care process.
c. Stereotypical thinking.
d. Complexity compression.
ANS: D
Complexity compression refers to many changes occurring simultaneously before time is sufficient to assimilate the change.

REF: Page 572 TOP: AONE competency: Leadership

19. A business condition that may assist forecasting but add to the complexity of change is:
a. Consulting with professional groups about change.
b. Researching about trends on futuristic sites.
c. Asking patients to examine options for change.
d. Building profit projects and sustainability into planning.
ANS: C
Stalk and Butman suggests that asking the customer for feedback on options may assist with forecasting. Adopting this strategy runs counter to current practice and would increase the complexity of healthcare planning and forecasting.

REF: Page 572 TOP: AONE competency: Knowledge of the Health Care Environment

20. A number of changes are introduced to a unit, including changes to familiar clinical procedures and the use of PDAs to enable bedside documentation. You, as unit manager, anticipate which of the following will contribute most to complexity compression?
a. Meaning of the change
b. Pace of changes
c. Previous experiences with change
d. Confidence of the leader in the value of the change
ANS: B
Complexity compression is a term that means that many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other change

REF: Page 572 TOP: AONE competency: Leadership

21. In order to plan long term, you consider what the client of the future will look like. Which of the following client profiles would best capture shifting demographics and trends in health care?
a. Younger, knowledgeable about health options
b. Female, uses emergency care services for parents and children
c. Older, one or more chronic disorders, diverse background
d. Male, various occupationally generated disorders, diverse ethnic background
ANS: C
The client base is aging and more people will be living with chronic disorders. Persons will travel more and there will be increased need to speak two or more languages to address the needs of a mobile global population.

REF: Page 572 TOP: AONE competency: Leadership

22. You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given, as well as with the idea that working means no more essays, tests, or assignments! She indicates that she has no intention of touching a book, journal, or health information Website for a long time. Which of the following would be your best response?
a. The expectations and design of educational programs means that new graduates are better prepared for the workforce.
b. The new graduate will still have to learn, but it will be job-specific learning.
c. An ideal learning plan for nurses emphasizes followership.
d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.
ANS: D
Knowledge will change dramatically, requiring that we all be dedicated learners. With or without state law, continuing education will be mandatory and essential.
Knowledge will evolve from the intensity of the current information evolution so that we will access content with meaning and applicability for our work.

REF: Page 572 TOP: AONE competency: Professionalism

23. A necessary leadership strength for nurses of the future is:
a. Inspiring others to work their best to create the future.
b. Understanding the nuances of fundraising to make up funding shortfall.
c. Guarding the tendency of other professions to encroach on nursing roles.
d. Adapting work life to an aging nursing workforce.
ANS: A
Senge said that all leadership is really about is people working at their best to create the future. Predictions of the future highlight the importance of interprofessional teams and of a shift towards understanding the importance of health care.

REF: Page 569 | Page 572 TOP: AONE competency: Leadership

24. Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is:
a. With many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of the nursing employment market.
b. The job market for nurses will be diminished with funding cuts to hospitals.
c. The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security.
d. It is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors.
ANS: C
Employment for nurses continues to be positive, although roles will change in a rapidly changing environment, which will increase options. With the number of options available and sporadic work opportunities, nurses will need to be flexible and able to adapt rapidly. Job security will be out; career options will be in.

REF: Page 572 TOP: AONE competency: Business Skills

MULTIPLE RESPONSE

1. In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate (select all that apply):
a. Prevention strategies.
b. Leadership skills and knowledge.
c. Violence de-escalation strategies.
d. Strategies for job security.
ANS: A, B, C
Future forecasts suggest that health factors such as obesity that are implicated in the development of chronic disorders will increase, as will chronic disease. Leadership skills have been identified as a key competence for nurses of tomorrow, and competence with technology will be needed as technology continues to revolutionize health care. Rather than emphasizing job security, nurses will need to be prepared to be in an environment with many options and episodic employment.

REF: Page 571 | Page 572
TOP: AONE competency: Knowledge of the Health Care Environment

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