Practice Questions

1. Process Audit

Question: The Chief Nursing Officer asks a nurse manager to complete an audit to prepare for the next Joint Commission accreditation visit. What information would be collected for a process audit?

Choices:

A. How satisfied patients were with their care as reflected by Patient Satisfaction scores.

B. The percentage of patients diagnosed with a heart attack who were readmitted within 30 days of discharge from the hospital.

C. The number of nurses who can correctly demonstrate sterile technique when placing an indwelling urinary catheter.

D. The number of patients assigned to each registered nurse on the telemetry unit.

Answer: C. The number of nurses who can correctly demonstrate sterile technique when placing an indwelling urinary catheter.

Rationale: A process audit evaluates how care is provided, focusing on whether procedures and policies are followed. Options A and B are outcome audits (results of care), while D is a structure audit (environment/resources) .

2. Planning Type

Question: After a patient fell and sustained multiple injuries on the medical-surgical unit. This is the third patient fall with injuries this month. The nurse manager implemented mandatory overtime. This would be an example of what type of planning?

Choices:

A. Proactive planning

B. Inactive planning

C. Preactive planning

D. Reactive planning

Answer: D. Reactive planning

Rationale: Reactive planning occurs after a problem exists and the leader responds to it. Proactive planning anticipates future needs, inactivists resist change, and preactive planners focus only on the future .

3. Active Failures – Swiss Cheese Model

Question: The Swiss Cheese Model explores latent and active failures. Which are active failures? (Select all that apply)

Choices:

A. The nurse did not scan the patient’s ID band.

B. Each nurse was assigned 6 patients.

C. The nurse correctly identified the patient using two patient identifiers.

D. All the morning medication were scheduled for 0900.

E. The unit was staffed with 5 new graduate nurses.

F. The nurse did not dilute the medication properly.

Answer: A and F

Rationale: Active failures are direct errors by frontline staff (e.g., not scanning ID band, improper dilution). The others represent latent conditions—system-level factors (staffing, scheduling, skill mix) .

4. Lewin’s Change Theory

Question: A cardiac stepdown unit struggles with discharges. The manager changes staffing to add a nurse for admissions/discharges. In what stage of Lewin’s Change Theory would this be?

Choices:

A. Movement stage

B. Planning stage

C. Unfreezing stage

D. Reframing stage

E. Refreezing stage

Answer: A. Movement stage

Rationale: In Movement, the change is implemented. Unfreezing = creating recognition of the need for change, Refreezing = stabilizing after change. Planning/Reframing are not part of Lewin’s model .

5. PDSA Cycle

Question: Which statement indicates an incorrect understanding of PDSA?

Choices:

A. The team makes predictions in the Plan stage.

B. The decision to adopt, adapt, or abandon occurs in the Act stage.

C. Implementation occurs in the Act stage.

D. Data is analyzed in the Study stage.

Answer: C. Implementation occurs in the Act stage.

Rationale: Implementation happens in the Do stage, not Act. The Act stage is about adapting/adopting/abandoning the change .

6. Change Strategy

Question: The nurse manager tells staff that not following the new attendance policy will result in termination. What strategy is this?

Choices:

A. Rational-empirical strategy

B. Offensive-defensive strategy

C. Normative-reeducative strategy

D. Driving-restraining strategy

E. Power-coercive strategy

Answer: E. Power-coercive strategy

Rationale: Power-coercive uses authority, power, or fear to enforce compliance. Rational-empirical relies on education, normative-reeducative relies on peer influence .

7. Planning Hierarchy

Question: Which statement shows correct understanding of the Planning Hierarchy?

Choices:

A. The mission statement is the desired result that everyone is working towards.

B. Policies are the step-by-step processes nurses use to complete patient care.

C. A procedure is the plan that defines an acceptable action.

D. The philosophy defines the values and beliefs of the organization.

Answer: D. The philosophy defines the values and beliefs of the organization.

Rationale: Philosophy = values/beliefs guiding actions. Mission = why the organization exists. Policies = general plans reduced to statements. Procedures = step-by-step directions .

8. External Stakeholders

Question: Which is an external stakeholder?

Choices:

A. Nurses

B. Patient

C. Nursing professors

D. Board of Directors

E. The manager of Dietary Services

F. Physicians

Answer: C. Nursing professors

Rationale: External stakeholders include groups outside the organization (universities, unions, community leaders, insurers). Patients and staff are internal stakeholders .

9. Organizational Culture

Question: Which statement reflects a clear understanding of organizational culture?

Choices:

A. Organizational culture is how employees perceive the organization.

B. Organizational culture reflects the values and history of the organization.

C. Only the nurse leaders influence the organizational culture.

D. Different people may view the organizational culture differently.

Answer: B. Organizational culture reflects the values and history of the organization.

Rationale: Culture = shared values, history, rituals. Climate = how staff perceive the workplace (can vary). Leaders aren’t the only influence .

10. True Statement About Change

Question: Which statement about change is true?

Choices:

A. Restraining forces should be greater than driving forces.

B. Change should be rapid.

C. Everyone impacted should be involved in planning.

D. A change agent should not be involved in implementation.

E. A clear rationale is not needed.

Answer: C. Everyone impacted should be involved in planning.

Rationale: Involving everyone improves buy-in. Driving forces should outweigh restraining forces, change should be gradual, rationale must always be clear, and change agents help manage emotions.

Question 11

A nursing student is studying for the first test in Leadership with a group of friends. The group is testing one another about the influences on quality. Which statement by a student indicates a correct understanding of the different influences on quality?

The Leapfrog group monitors sentinel events nationally.
The Centers for Medicare and Medicaid Services (CMS) determine the National Patient Safety Goals annually.
Health Grades tracks patient satisfaction scores after hospital discharge.
ORYX, a division of CMS, is responsible for accreditation of healthcare facilities.
The National Database of Nursing Quality Indicators provides unit level data to help organizations evaluate nursing care compared to other similar units around the country.

Correct Answer: E

Rationale: The National Database of Nursing Quality Indicators (NDNQI) provides unit-level nursing data to help organizations evaluate quality compared to benchmarks. The Leapfrog Group actually monitors hospital safety practices, not sentinel events. CMS does not determine National Patient Safety Goals (the Joint Commission does). Health Grades focuses on patient outcomes, not satisfaction scores. ORYX is part of The Joint Commission, not CMS .

Question 12

A nurse leader is concerned about how long it is taking for the phlebotomists from the lab to come to the unit to draw labs when a patient complains of chest pain. The nurse leader implements a plan that includes calling the lab right after the order is put in the computer. This plan addresses which of the Six (6) Dimensions of Quality Health Care outlined by the IHI?

Efficient
Timely
Safe
Effective
Equitable
Patient-centered

Correct Answer: B. Timely

Rationale: Timely care means avoiding unnecessary delays in providing care. Calling the lab immediately ensures care is delivered quickly. Efficient care focuses on avoiding waste, safe care prevents harm, effective care links practice to evidence, equitable care ensures fairness, and patient-centered care involves respecting patient preferences .

Question 13

A nurse leader is completing a SWOT analysis to better understand the unit and organization before implementing a change to address an issue. Chances for growth and change on the unit would be identified in which part of the SWOT analysis?

Correct Answer: O

Rationale: In SWOT, Opportunities are external chances for growth or improvement. Strengths and weaknesses are internal factors, while threats are external risks .

Question 14

Identify the benefits of nurse leaders understanding elements of an organizational chart. Select all that apply.

Informal structures/relationships are clearly identified in an organizational chart.
Organizational charts depict who makes decisions in the organization.
Organizational charts outline who to contact (communicate with) about a concern or issue.
Clearly shows how the organization is run on a day-to-day basis.

Correct Answers: B & C

Rationale: Organizational charts show formal decision-making authority and lines of communication. They do not depict informal relationships (those are not visible on charts) and they don’t truly show daily workflow .

Question 15

In response to a sentinel event, the nurse leader would anticipate completing what?

Swiss Cheese outline
National Patient Safety Goals report
Benchmarking rates of the event
Root Cause Analysis (RCA)

Correct Answer: D

Rationale: A Root Cause Analysis is always completed after a sentinel event to determine what happened, why it happened, and how to prevent recurrence. It focuses on processes, not individual blame .

Question 16

Identify the characteristics of a transformational leader. Select all that apply.

Inspires a vision for the organization
Manages employees’ pay each week
Concerned with empowering others
Assures safe staffing for each shift
Believes community involvement is necessary for nurse growth

Correct Answers: A & C

Rationale: Transformational leaders inspire vision and empower others. They focus less on transactional duties (like payroll or scheduling) and more on long-term growth and motivation. Community involvement is valuable but not a defining trait of transformational leadership .