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LEADERSHIP AND NURSING CARE MANAGEMENT 5TH
EDITION HUBER TEST BANK
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Leadership and Nursing Care Management 5th Edition Huber Test Bank
Chapter 02: Change and Innovation

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MULTIPLE CHOICE
1. A hospital system is implementing an electronic health record. The facility conducts education
and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This
is an example of:
a. emergent change.
b. planned change.
c. transformation.
d. innovation.
ANS: B
Planned change is a decision to make a deliberate effort to improve a system.
DIF: Cognitive Level: Apply (Application) REF: Page 38

TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. The use of a new idea or method is the definition of:

a. change.
b. innovation.
c. resistance.
d. stereotyping.
ANS: B NURSINGTB.COM
Innovation is the use of a new idea or method.
DIF: Cognitive Level: Remember (Knowledge) REF: Page 38

TOP: Nursing Process: Assessment
3. The chief nursing officer (CNO) of a hospital system works with senior leadership for
approval to initiate an electronic health system. He recruits a nursing informaticist and a chief
medical informatics officer to begin the process of planning the education and roll-out of the
new electronic system. The CNO could be viewed as the:
a. resistor.
b. innovator.
c. change agent.
d. strategist.
ANS: C
The change agent is a person or thing that produces a particular effect or change. The change
agent can be a person who functions as a change facilitator.

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4. A small critical care unit forms a team of nurses to implement bedside rounds at shift change.
The nurses have researched the efficacy of bedside rounds and have determined that this
evidence-based practice will lead to improved communication of patient status. Which type of
change does this demonstrate?
a. First-order change
b. Second-order change
c. Emergent change
d. Organizational change
ANS: A
First-order change occurs in a stable system and is characterized by rational stepwise
processes. It is useful for smaller scale changes at a unit-based level. Adaptation and
adjustment occurs when nursing uses a new evidence-based protocol and puts it into practice.

TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiological Adaptation
5. How is the refreezing stage of change similar to the nursing process?

a. Refreezing is similar to the assessment phase of the nursing process.
b. Refreezing is similar to the problem identification phase of the nursing process.
c. Refreezing is like the planning and implementation phase of the nursing process.
d. Refreezing is like evaluation in the nursing process.
ANS: D
Refreezing is like evaluation in the nursing process.
DIF: Cognitive Level: Remember

NUR(Knowledge) REF: Page 41
TOP: Nursing Process: Evaluation SINGTB.COM
6. Which of the following factors is used to describe the degree to which successful planned
change is thought to be better than the status quo?
a. Complexity
b. Compatibility
c. Trialability
d. Relative advantage
ANS: D
Relative advantage is one of the factors that helps determine successful planned change. It is
the degree to which the change is thought to be better than the status quo.

7. The _____ is a tool which is useful in assessing the readiness for organizational change.
a. Organizational Change-Readiness Scale (OCRS)
b. five-dimensional scale
c. Rapid Cycle Change
d. plan-do-study-act model
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ANS: A
The OCRS is a 76-item inventory that is used to analyze the ability of an organization to
manage change effectively. There are five dimensions that are a part of this assessment tool.

8. A medical-surgical unit utilizes a group of nurses and patient care assistants to determine
ways to reduce the number of falls in the unit. They conduct Internet research to locate best
practice interventions. They create fall risk alerts in the unit, and they implement hourly
rounding to assess the need for toileting. After putting these small changes into place, they
will evaluate the data to determine effectiveness. This project is an example of:
a. rapid response teams.
b. Failure Modes and Effects Analysis.
c. root cause analysis.
d. Rapid Cycle Change.
ANS: D
Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on
the idea that changes are tried on a small scale to see how they work.

TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
9. An organization has encountered a serious patient safety event that was reported to the state,
The Joint Commission, and the NUCenters
RSING B.COM & Medicaid Services (CMS). An
forTMedicare
extensive plan of correction was received, and the organization had to make some immediate
changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best
method of educating staff about the practice changes that were issued?
a. “These changes need to be made because the state and CMS require it.”
b. “We understand this is a knee-jerk reaction, but please change the practice while
the surveyors are in the building.”
c. “We need to make this change because it will help our lawsuit.”
d. “This change is being made so that there is no further harm to another patient.”
ANS: D
Rapid Cycle Changes or those that are emergent are put into place to improve patient care,
with the emphasis on patient safety and quality goals. Staff should not be educated that the
changes are made based upon regulatory requirements or the avoidance of litigation.
Misconceptions or inaccurate information can create resistance to change.

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
10. _____ is an expected part of change and is often related to fear and anxiety.
a. Depression
b. Resistance
c. Acceptance
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d. Denial
ANS: B
Resistance to change should be expected as integral to the process of change. It may be rooted
in anxiety or fear.

11. Individual members of a group will adapt to change at different rates. Which of the following
groups would take the longest to accept change?
a. Early adopters
b. Late majority
c. Innovators
d. Laggards
ANS: D
Nurse leaders need to recognize that change will be accepted at varying rates and target
interventions accordingly. The five categories in order are innovators, early adopters, early
majority, late majority, and laggards.

12. A process of intentional intervention to create something new is called:

a. altered direction.
b. organizational flux.
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c. planned change.
d. status revision.
ANS: C
Planned change is defined as a process of intentional intervention to create something new.
From an organizational perspective, planned change is a decision to make a deliberate effort
to improve the system.

13. The most difficult to change is:

a. attitudes.
b. group behavior.
c. knowledge.
d. individual behavior.
ANS: B
Group behavior and performance changes are the most difficult to change and take the longest
time.

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14. The charge nurse of a small nursing unit would like to gain staff acceptance of a
time-intensive, budget-imposed change required by the hospital administration. She plans to
emphasize several evidence-based research projects that have shown improved patient health
outcomes as a result of implementing this change. This is an example of which of the
following organizational change concepts?
a. Budget-oriented change
b. Transformation
c. Resistance
d. Emergent change
ANS: B
Transformation is the use of new ideas, innovation, and creativity to change fundamental
properties of the state of a system.

15. The first stage of planned change involves:

a. accepting the need for change.
b. cognitive redefinition.
c. integration and stabilization.
d. problem solving.
ANS: A
Change must begin with an awareness
NURSINofGthe need for
acceptance of the necessity of change. TB.C OM change, and end with a general
16. The identification of forces that drive and restrain change is called a(n):
a. equilibrium evaluation.
b. force field analysis.
c. status quo analysis.
d. refreezing system.
ANS: B
Driving and restraining forces influence any situation. A force field analysis facilitates the
identification and analysis of driving and restraining forces in any situation.

17. A nursing manager recognizes that the changes that she is expected by administration to
implement will be met with staff resistance. She is committed to determining the root of the
resistance and communicating positively with her staff. The nurse manager’s actions
characterize her as a(n):
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a. change agent.
b. implementation expert.
c. restructuring motivator.
d. supervisory threat.
ANS: A
The change agent needs to anticipate resistance, determine why it is occurring, and try to
determine what the person who is resisting is trying to protect.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 43

18. A nurse manager recognizes that her staff’s emotional responses to organizational change are
similar to:
a. adaptation techniques.
b. integrative tactics.
c. symptoms of mental illness.
d. the grief model.
ANS: D
The grief model is the most accurate, because change produces a longing for what is familiar,
even if it is not what is best or realistic.

19. A memo sent to the unit nurse U

N R I G B.C M
S Nreads
manager T thatObeginning next week, all nursing staff will
be expected to conform to a new dress code selected by the hospital board of directors. The
nurse manager understands that she needs to use her positional power to trigger a(n) _____
change cycle.
a. automatic
b. directive
c. participative
d. positional
ANS: B
A directive change cycle occurs when a change is imposed by some external force.
DIF: Cognitive Level: Understand (Comprehension) REF: Page 48

20. An experienced nurse has recently taken a position on a telemetry unit in the local hospital.
After 2 weeks on the job, he finds that the staffing is not what was discussed during his
employment interview with the nurse manager. Which approach would be most appropriate
for the nurse to take?
a. Give 2 weeks’ notice and begin seeking employment at another hospital.
b. Discuss the situation with the nursing manager who interviewed him.
c. Talk to other employees about the staffing situation.
d. Notify the charge nurse that this was not what was explained to him prior to
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employment.
ANS: B
The nurse should discuss the situation with the nursing manager who interviewed him before
quitting. Perhaps there is a temporary problem affecting staffing that could explain the
situation. If after this discussion it is believed that the staffing is not now or ever will be as it
was relayed to him in the interview, then he should seek employment elsewhere.
DIF: Cognitive Level: Apply (Application) REF: Pages 46-48

21. The nurse manager on a medical-surgical unit wants to change to “walking rounds” in the
patients’ rooms for change of shift report. In the past, it has been “face to face” at the nurses’
station. The nurse manager is meeting resistance from the staff, because they think that it will
take longer, and the nurses will not finish their shift on time. What could the manager do to
increase the nurses’ acceptance of this change?
a. Inform all shifts that there have been some lapses in communication regarding
patient needs and that involving the patient in the report will help alleviate this.
b. Inform all nurses that to reach Magnet status, this type of change of shift report is
required.
c. Ask the nurses to participate in the planning and implementation of the change.
d. Ask the nurses to try this type of change of shift report for 1 week and then have
them evaluate it.
ANS: C
Change is always difficult, especially when it has been forced on people, threatens their
NUChange
security, or seems unnecessary. RSINGisTmore
B.Cpalatable
OM when nurses participate in the
planning and implementation and see that it is worthwhile.
DIF: Cognitive Level: Analyze (Analysis) REF: Pages 37-38

MULTIPLE RESPONSE
1. Which of the following statements are accurate descriptors regarding change (select all that
apply)?
a. Organization-wide change is more sustainable when leadership imposes the
change.
b. Change within an organization is often externally imposed.
c. Change within an organization may originate internally.
d. Nurses do not need to participate actively in the organizational changes.
e. Change is often complex and irrational.
ANS: B, C, E
Changes within an organization may be necessary due to external or internal demands.
Change is seldom easy and may be complex and irrational.
DIF: Cognitive Level: Remember (Knowledge) REF: Pages 37-38

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2. Learning organizations adapt to change through their ability to be open, dynamic, and
responsive to changes in the environment. Which of the following learning disciplines are true
of these types of organizations (select all that apply)?
a. Learning is conducted in individual parts rather than in groups.
b. Viewing the organization as an interrelated system is known as systems thinking.
c. Individuals utilize mental models to understand how their vision affects their
decisions and actions.
d. Shared vision is conducted within a group to determine plans to get to the
preferred future.
e. Personal mastery encourages individuals to create results as they see fit.
ANS: B, C, D
Mental models allow individuals to develop, create, and project a personal vision and
understand how these views affect their decisions and actions. Shared vision is encouraged
within a group for development of plans. A sharing of learning skills is encouraged as a group
so that learning can occur as a group. The organization is viewed as an interrelated system,
rather than in unrelated parts, in systems thinking.

3. During periods of stress and change, which of the following strategies should managers use to
provide emotional support to staff members (select all that apply)?
a. Reframe difficult questions.
b. Communicate facts through NUe-mail.
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c. Provide active listening.
d. Promote action steps and solutions.
e. Keep staff informed of decisions.
f. Communicate with participation.
ANS: A, C, D, E, F
Emotional responses are an expected part of change, and managers need to be able to provide
emotional support to staff during periods of stress. Some of the effective strategies are: active
listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting
input, encouraging participation, and reframing difficult questions.

4. The probability of effectiveness of the change process can be increased through several
techniques. Which of the following actions will likely increase effectiveness (select all that
apply)?
a. Explain the rationale for a change so that individuals understand it.
b. Simply announce the change without laying a foundation.
c. Give participants all the information they need.
d. Rely only on formal authority in implementing change.
e. Help individuals cope with change.
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ANS: A, B, E
Announcing the change without laying a foundation and relying only on formal authority in
implementing change are actions to be avoided when implementing change within an
organization.

5. A group of nurses is showing resistance to changes the manager is making with regards to
staffing. Which of the following ways can the manager deal with the emotionality of the
situation (select all that apply)?
a. Use persuasion.
b. Give the nurses adequate notice of change.
c. Avoid discussion.
d. Explain the rationale and patient impact.
e. Inform staff that senior leadership made the decision.
ANS: B, D
A factor in determining how change is accepted depends upon how it is managed. The way to
deal with emotionality is to avoid persuasion and to allow people to express their feelings.
Staff should be given as much notice as possible when making changes in staffing or
scheduling, and discussion is encouraged. Staff should be informed about the rationale for the
decision as well as patient impact. Effective managers possess self-confidence to explain the
change without blaming.
DIF: Cognitive Level: Apply N

(Application) REF: Page 48
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LEADERSHIP AND NURSING CARE MANAGEMENT 5TH

EDITION HUBER TEST BANK

Chapter 02: Change and Innovation

DIF: Cognitive Level: Apply (Application) REF: Page 38

2. The use of a new idea or method is the definition of:

DIF: Cognitive Level: Remember (Knowledge) REF: Page 38

DIF: Cognitive Level: Apply (Application) REF: Page 38

DIF: Cognitive Level: Apply (Application) REF: Page 39

5. How is the refreezing stage of change similar to the nursing process?

DIF: Cognitive Level: Remember

DIF: Cognitive Level: Remember (Knowledge) REF: Page 43

DIF: Cognitive Level: Remember (Knowledge) REF: Page 46

DIF: Cognitive Level: Apply (Application) REF: Page 46

DIF: Cognitive Level: Apply (Application) REF: Page 46

DIF: Cognitive Level: Remember (Knowledge) REF: Page 46

DIF: Cognitive Level: Remember (Knowledge) REF: Page 43

12. A process of intentional intervention to create something new is called:

DIF: Cognitive Level: Remember (Knowledge) REF: Page 45

13. The most difficult to change is:

DIF: Cognitive Level: Apply (Application) REF: Page 48

DIF: Cognitive Level: Apply (Application) REF: Page 38

15. The first stage of planned change involves:

DIF: Cognitive Level: Remember (Knowledge) REF: Page 42

DIF: Cognitive Level: Understand (Comprehension) REF: Page 43

DIF: Cognitive Level: Apply (Application) REF: Page 47

19. A memo sent to the unit nurse U

DIF: Cognitive Level: Understand (Comprehension) REF: Page 48

DIF: Cognitive Level: Apply (Application) REF: Pages 46-48

DIF: Cognitive Level: Analyze (Analysis) REF: Pages 37-38

DIF: Cognitive Level: Remember (Knowledge) REF: Pages 37-38

DIF: Cognitive Level: Apply (Application) REF: Page 40

DIF: Cognitive Level: Remember (Knowledge) REF: Page 47

DIF: Cognitive Level: Remember (Knowledge) REF: Page 48

DIF: Cognitive Level: Apply N

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