(Test Bank) Nursing Delegation and Management of Patient Care

Motacki, 2

Nursing

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2nd Edition

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Author(s): Motacki

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TEST BANK FOR NURSING DELEGATION AND MANAGEMENT OF PATIENT CARE 2ND EDITION BY Motacki RN MSN, Kathleen, Burke RN PhD, Kathleen 2nd Edition TEST BANK FOR NURSING DELEGATION AND MANAGEMENT OF PATIENT CARE 2ND EDITION BY Motacki RN MSN, Kathleen, Burke RN PhD, Kathleen 2nd Edition TEST BANK FOR NURSING DELEGATION AND MANAGEMENT OF PATIENT CARE 2ND EDITION BY Motacki RN MSN, Kathleen, Burke RN PhD, Kathleen Table of Contents Section 1: TRANSFORMATIONAL LEADERSHIP 1. Leadership and Management 2. Organizational Structure of Health Care 3. Strategic Management and Planning 4. Financial Management in Health Care 5. Health Care Regulatory and Certifying Agencies Section 2: STRUCTURAL EMPOWERMENT 6. Organizational Decision Making and Shared Governance 7. Professional Decision Making and Advocacy 8. Communication in the Work Environment 9. Personnel Policies and Programs in the Workplace Section 3: EXEMPLARY PROFESSIONAL PRACTICE 10. Professional Development 11. Professional Practice and Care Delivery Models and Emerging Practice Models 12. Staffing and Scheduling TEST BANK FOR NURSING DELEGATION AND MANAGEMENT OF PATIENT CARE 2ND EDITION BY Motacki RN MSN, Kathleen, Burke RN PhD, Kathleen 2nd Edition 13. Delegation of Nursing Tasks 14. Providing Competent Staff 15. Group Management for Effective Outcomes 16. Hospital Information Systems 17. Organizational Structure of Health Care Section 4: NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS 18. Improving Organizational Performance 19. Evidence -Based Practice 20. Monitoring Outcomes and the Use of Data for Improvement Section 5: CONGRATULATIONS 21. The Immediate Future: Job Interviewing, NCLEX, and Continuing Education 2nd Edition Chapter 01: Leadership and Management Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Nurses can be leaders without being managers. Which nursing actions demonstrate leadership? a. Assisting a new nurse with enteral tube feedings b. Counseling a new nurse regarding attendance c. Adjusting assignments after a staff member calls in sick d. Calling a physician for new order clarification ANS: A Leaders act as role models and mentor new staff. The other options are incorrect because they are management responsibilities and not leadership roles. DIF: Cognitive Level: Application REF: page 6 2. Which nursing actions demonstrate the role of management in nursing? a. Encouraging autonomous decision making b. Observing the documentation of appropriate charges to patients c. Assisting in a code d. Asking the patient/family about advance directives ANS: B Managers are responsible for the budget of their units. The other options are incorrect because those are leadership or mentoNriUngRrSolIesN. GTB.COM DIF: Cognitive Level: Application REF: page 6 3. Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities? a. A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A staff nurse acts quickly when a cardiac arrest is called on her patient. c. A staff nurse notifies another staff member that she is being “pulled” today. d. A new nurse volunteers to work when another staff member must leave work because her child is ill. ANS: A Nurse leaders are interested in changing practice based on evidence. Options B and D are incorrect because they are actions taken by nurses as part of the functional structure of the unit. Option C is incorrect because it is an action taken by a manager. DIF: Cognitive Level: Analysis REF: page 6 4. A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager? a. A nurse becomes aware of increased infection rates following cardiac surgery. The 2nd Edition nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A nurse acts quickly when a cardiac arrest is called on her patient. c. A nurse notifies another staff member that she is being “pulled” today. d. A nurse volunteers to work when another staff member must leave work because her child is ill. ANS: C Determining who gets “pulled” is a management decision. Option A is incorrect because it is a role taken by a nurse leader. Option B is incorrect because it is an action taken by staff as part of the functional structure of the unit. Option D is incorrect because it is an action taken by staff as part of the functional structure of the unit. DIF: Cognitive Level: Analysis REF: page 6 5. A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice. ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision maki ng. Opt ion BNiUs RinScoIrrNecGt TbeBca.uCseOiMt should be seen in all environm ents regardless of autonomy. Option D is incorrect because excellence in practice is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 6 6. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation. ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because it is not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 10 7. The student nurse, shadowing on a medical -surgical unit, observes the charge nurse. Which action would the student identify as a leadership quality in the nurse’s actions? a. Making patient care assignments distributed equally to staff b. Sitting with a confused combative patient c. Calling the nursing office for extra staff when an RN calls in sick 2nd Edition d. Assisting in a code ANS: B Leaders act as role models and do what is right for the patient. The other options are incorrect because these actions are expected as part of the functioning of the unit. DIF: Cognitive Level: Analysis REF: page 5 8. Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business? a. Ability to pressure staff to do what you want b. Resource utilization c. Cutting corners to make money d. Providing bonuses to staff members who help the organization to save money ANS: B The ability to manage a budget is essential to being a manager in health care today. The other options are incorrect because they are only a perception of the public regarding successful managers. DIF: Cognitive Level: Application REF: page 3 | page 7 9. The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict? a. Coordinating institutional goals with the immediate demands of the clinical area b. Determining which of the staff members should get better raises than other members NURSINGTB.COM c. Deciding which employees should be recommended for promotion d. Determining which staff members get Christmas day off ANS: A Many times the goals of the institution conflict with the goals of the individual employees of a particular clinical area and the nurse manager must implement institutional changes regardless of the nurse’s personal opinion. The other options are incorrect because those roles should not provoke as much conflict. DIF: Cognitive Level: Application REF: pages 7-8 10. Nurse managers can best be described as people who a. develop institutional goals based on staff suggestions. b. develop institutional goals based on a personal theory. c. motivate staff to meet institutional goals through positional power. d. inspire staff to meet institutional goals through personal power. ANS: C Managers motivate staff to make changes. Options A and B are incorrect because n urse managers usually do not make institutional goals. Option C is incorrect because leaders inspire, not managers. DIF: Cognitive Level: Application REF: page 6 2nd Edition 11. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first -line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A The first -line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle -level managers set short - and long -term goals. Option C is incorrect because reevaluating the nursing policy permitting IV push of certain medications by RNs is a responsibility of upper -level management to forecast trends in nursing. Option D is incorrect because designating assignmen t of new admissions would be the responsibility of the charge nurse. DIF: Cognitive Level: Analysis REF: page 7 12. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A Establishing objectives should be seen in the planning step following identification of the problem. Option B is the organizing step. Option C is the directing step. Option D is the controlling step. NURSINGTB.COM DIF: Cognitive Level: Application REF: page 7 13. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision - making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step -down unit ANS: D Decision making is a result of the other steps. The other options are different steps in the management process. DIF: Cognitive Level: Application REF: page 7 14. First -level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first -level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds ANS: B 2nd Edition U S N T O Managing the unit budget is the sole responsibility of the nurse manager and first -level manager. The other activities are not specific to first -level managers. DIF: Cognitive Level: Application REF: page 7 15. Middle -level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle -level manager? a. Maintaining currency in profession b. Planning for changes with in the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B The middle -level manager is solely responsible for planning changes and presenting them to upper -level managers. The other activities are not the exclusive responsibility of the middle -level manager. DIF: Cognitive Level: Application REF: pages 8-9 16. Upper -level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper -level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B Upper-level managers are resNponRsiblIe foGr foBrm.iCng sMtrategic plans. The other activities are responsibilities shared by all levels. DIF: Cognitive Level: Application REF: page 9 17. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff. ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other actions may correct the immediate problem that day but will not change the care provided over a length o f time if RNs are lacking prioritization skills. DIF: Cognitive Level: Application REF: page 9 MULTIPLE RESPONSE 1. To become a leader, one must develop certain personal aspects. Which of the following can be identified as competencies expected in creating leadership in oneself? (Select all that apply. ) 2nd Edition a. Asking for overtime b. Asking for certain patient assignments c. Personal and professional accountability d. Acquiring advanced degrees e. Personal discipline ANS: C, D, E Options C, D, and E are competencies identified in the text for developing leadership in oneself. Although they may be associated with a good work ethic, the other options do not apply to the development of leadership competencies. DIF: Cognitive Level: Analysis REF: page 11 2. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply. ) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D Options A, B, and D are correct because the text lists these as fundamental elements of any patient care delivery system. Options C, E, and F are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: ApplicNatUionRSINGRTEBF:.CpaOgeM7 3. A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which ( Select all that apply. ) a. a staff nurse provides advice and guidance to new nurses. b. a clinical ladder is used for advancement. c. a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them. d. annual performance appraisals are provided with competitive raises. e. decisions are made from the top down. ANS: A, B, C Options A, B, and C are correct because a transformational leadership environment encourages consultation and collaboration, empowering and motivating staff. The other options are examples of transactional leadership. DIF: Cognitive Level: Analysis REF: page 5 4. A nurse leader, according to the American Organization of Nurse Executives (AONE), is competent in the areas of (Select all that apply. ) a. knowledge of the health care environment. b. communication. c. business management. 2nd Edition d. demanding participation by the staff. e. providing a financial incentive. ANS: A, B, C Options A, B, and C are identified by AOEN as a competencies of nurse leaders. The other options are not competencies recommended by the AOEN. DIF: Cognitive Level: Analysis REF: pages 8-9 5. The organizational hierarchy is used in which of the following situations? ( Select all that apply .) a. A staff member is observed taking money from a patient’s bedside table. b. A staff member is found to be drinking alcohol while at work. c. A nurse refuses to care for a patient receiving peritoneal dialysis because he has not been trained on this procedure. d. A nurse refuses to be floated to the ICU while still in orientation. e. A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient. ANS: A, B, E Options A, B, and E are correct because inappropriate actions by staff are managed by the hierarchy of any organization. Options C and D are incorrect because they are sce narios requiring actions not relegated to the hierarchy of the organization. DIF: Cognitive Level: Analysis REF: page 5 NURSINGTB.COM 2nd Edition N R I G B.C Chapter 02: Organizational Structure of Health Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent “floating.” b. self-scheduling. c. cover of another nurse’s assignment while she or he is on break. d. hourly pay differential for the night shift. ANS: B In a self -governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are p racticed throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization. DIF: Cognitive Level: Application REF: page 16 2. The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies. b. the financial environm ent oUf thSe paNtienTt popu lOation. c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit. ANS: A Patient delivery models are instituted based on various elements including clinical decision -making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options do not describe a fundamental eleme nt used in the decision -making process for delivery mode. DIF: Cognitive Level: Application REF: page 19 3. An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths b. RN taking vital signs and giving baths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery ANS: C In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models. 2nd Edition U S N T DIF: Cognitive Level: Application REF: page 20 4. In which health care delivery model would the nurse expect to see “point -of-care” decision making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing ANS: A Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options are incorrect because they may not allow for the autonomy required for “point -of-care” decisions. DIF: Cognitive Level: Application REF: page 21 5. A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice. ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committe es so that sNtaffRmayIbeGcomBe.inCvolMved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 16 6. Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Change s can be made rapidly based on immediate needs. c. Nurses must work under a dual -authority structure. d. Decisions can be made at the “point of care.” ANS: A In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed. DIF: Cognitive Level: Application REF: page 16 7. What should the nurse expect when working in a product -line leadership structured environment? 2nd Edition a. Coordination of all services within the specialty b. Slow organizational response to environmental changes c. Individual service goals d. Each service area autonomous to the others ANS: A In product - or service -line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product -line leadership and is an example of leadership without coordination. DIF: Cognitive Level: Application REF : page 17 8. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation. ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 19 9. A nurse who is interested in developing clinical decision -making skills would look for a unit that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management ANS: A NURSINGTB.COM Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other options do not necessarily promote the development of decision -making skills. DIF: Cognitive Level: Application REF: page 21 10. A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway. ANS: B The nurse delegates and works collaboratively with the members of the team in team nursing. Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing. DIF: Cognitive Level: Application REF: page 10 2nd Edition 11. A nurse working on a unit using the primary care delivery model would expect to observe which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. b. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morning dose of insulin for a patient scheduled for surgery later that day. ANS: D In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models. DIF: Cognitive Level: Analysis REF: page 21 12. Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments. ANS: A The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models. DIF: Cognitive Level: AnalysNisURSINGRTEBF:.CpaOgeM21 13. In a team nursing health care delivery model environment, the nurse would observe for which action by the staff? a. The UAPs answer all call lights. b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients’ call lights. d. The RN is notified when there are patient care complaints. ANS: D Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing. DIF: Cognitive Level: Analysis REF: page 21 MULTIPLE RESPONSE 1. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply. ) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement 2nd Edition e. Leadership style f. Cultural diversity of patients ANS: A, B, D According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: Applicati on REF: pages 18 -19 NURSINGTB.COM 2nd Edition Chapter 03: Strategic Management and Planning Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. When applying for a management position, the nurse should ask about the goals and plans of the hospital. Strategic plans must be developed around a. the mission statement. b. patient population. c. staff input. d. infection rates. ANS: A The strategic plan of an organization must comply with the mission statement. The other factors are incorrect because although they may influence the overall plan, the plan can never stray from the mission statement. DIF: Cognitive Level: Application REF: page 28 2. The strategic plan of an organization includes all stakeholders of the organization, including nurse managers. Which explains the benefit of including nurse managers in developing plans for the organization? a. Nurse managers own stock in the business. b. Nurse managers understand the clinical areas. c. Nurse managers will be involved in implementing the changes. d. Nurse managers have hadNbuRsineIss cGoursBe.s.C M U S N T O ANS: C Nurse managers will be important in the implementation of the plan at the unit level. Option A is not true. Option B is not a reason for including nurse managers. Option D is not a reason for including nurse managers. DIF: Cognitive Level: Analysis REF: page 28 3. Nurse managers are included in strategic planning for the institution because of which principle? a. Nurse managers have the authority to terminate employees. b. Nurse managers encourage “buy -in” from staff. c. Nurse managers understand the need for the plan. d. Nurse managers understand the financial aspects of the organization. ANS: B Nurse managers ensure “buy -in” of the project from staff. The other options are not the reason for including nurse managers in the planni ng. DIF: Cognitive Level: Analysis REF: page 28 4. When interviewing for a position at a new facility, the nurse managers ask to review the mission, vision, and values statements because they understand that these statements provide information about the organization’s 2nd Edition a. fiscal responsibility. b. direction and purpose. c. concern for uninsured. d. specific actions to be taken. ANS: B These statements are usually generalized around the direction and purpose of the organization. Mission, vision, and value statements do not address specific areas listed in the other options. DIF: Cognitive Level: Analysis REF: page 28 5. A health care organization incorporates information from which group into their strategic plan? a. Local community b. Nursing research c. Pharmaceutical research d. Insurance companies ANS: A Information from stakeholders, which would include the members of the local community, should be incorporated into their strategic plan. The other groups are not generally a source for direction that is incorporated into the strategic plan. DIF: Cognitive Level: Application REF: page 28 6. In developing mission and values statements, health c are facilities incorporate tools to describe desirable behaviors of the organization. These tools describe behaviors such as a. patient risks. b. nurse/patient ratios. c. organizational direction. d. desired outcomes. ANS: C NURSINGTB.COM Most tools used to describe mission and values incorporate actions that are measurable. The other behaviors are not included in organizational statements. DIF: Cognitive Level: Application REF: page 28 7. Sometimes organizations use measurable critical success factors (CSFs) when developing their strategic plan. The CSFs include People, Service, Quality, Financial, Growth , and sometimes Community . Which of the definitions indicates the meaning of the term People ? a. The term People represents the patients served. b. The term People represents the nurses and physicians who provide the care. c. The term People represents the community served. d. The term People represents the upper -level management. ANS: B The term People , when used as a CSF, represents those who are attracted to an environment conducive for nurturing the best in their practice. The other definitions do not represent the meaning of the term People as a CSF. DIF: Cognitive Level: Analysis REF: page 32 2nd Edition U S N T O 8. Strategic goals are developed as a result of which information source? a. Environmental scan b. Electronic medical record c. Changes in nursing practice d. Changes in staff ratios ANS: A The environmental scan is a major source for developing strategic goals and includes the competition, economic trends, etc. The other goals do not impact strategic goal development. DIF: Cognitive Level: Analysis REF: page 28 9. When referring to the critic al success factors (CSFs) that organizations use for developing their strategic plans, the term Quality best describes which characteristic? a. Quality is a measurement of the product produced. b. Quality is the value of the service. c. Quality is the outcome provided when the best people are providing the best service. d. Quality is a characteristic of the service. ANS: C Quality represents the outcome of the care being provided by the best people in an institution with the best service. The other characteristics can be a definition of the term Quality but do not apply when used as a CSF. 10.1 DIF: Cognitive Level : Analysis REF: page 32 N R I G B.C M When referring to the critical success factors (CSFs) that organizations use for developing 0 their strategic plans, the term Financial best describes which characteristic? . a. Financial indicates the economic benefits achieved. b. Financial indicates the expertise of the financial manager. c. Financial indicates the cost to the patient. d. Financial indicates the cost to the community. ANS: A The term Financial when used as a CSF indicates the economic benefits derived from the quality of the service provided by the best people. The other options do not represent the meaning of the term Financial when used as a CSF. DIF: Cognitive Level: Analysis REF: page 32 11. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Growth best describes which characteristic? a. Growth is the expansion of the specific disease. b. Growth is the aging of the population served. c. Growth is difficult -to-access health care. d. Growth is the expansion of the organization. ANS: D 2nd Edition U S N T Growth refers to the expansion of the organization as a result of the financial benefits received from the quality outcome resulting from the service provided by the best people. The other options do not represent the meaning of the term Growth when used as a CSF. DIF: Cognitive Level: Analysis REF: page 32 12. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Community best describes which characteristic? a. Community is society. b. Community is the neighborhood surrounding the organization. c. Community identifies the people served. d. Community is the group of people working within the organization. ANS: C The Community is the end beneficiary of the growth from the financial benefits due to the quality outcomes from the service provided by the best people. The other options represent the meaning of the term Community when used as a CSF. DIF: Cognitive Level: Analysis REF: page 32 13. Which of the following could have an impact on strategic planning for a community hospital? a. Change in primary orthopedic surgeon b. Increased availability of flu shots c. Health promotion by the local nursing school d. Community health fairs ANS: A Each surgeon has their own pNatieRnt lIoadGin tBhe.irCpraMctice and th is would change the strategic plan. The other options reduce admissions to the hospital by reducing patient illnesses or aid in identifying diseases early. DIF: Cognitive Level: Application REF: page 29 14. A community hospital has assessed the need for an automatic internal cardiac defibrillator for special procedures. Because of the reimbursement allowed from Medicare, which of the following best explains the decision made? a. An environmental scan showed no interest in the community for having these placed. b. An environmental scan showed the need for this procedure in only a few patients in the community. c. An environmental scan showed that the cost to the patient was prohibitive. d. An environmental scan showed the device has a high malfunction rate. ANS: B This hospital determined that the cost -benefit to the hospital did not make it financially beneficial to perform these procedures. The other options would not have been determined by an environmental scan. DIF: Cognitive Level: Analysis REF: page 29 15. Whic h of the following represents a short -term goal for an organization? a. Health education to prevent the incidence of accidents due to drunk drivers 2nd Edition U S N T O b. Heart failure education provided to every patient admitted with that diagnosis -related group c. Building a new emergency department d. Renovation of the intensive care unit ANS: B Providing education to a specific population is achievable as a short -term goal. The other options are long -term goals. DIF: Cognitive Level: Application REF: page 30 16. Action planning is a process by which organizations develop and implement both short -term and long -term goals. What would be expected in these plans? a. Identification of the strengths and weaknesses for each objective b. Identification of the impact on the community c. Specific responsibilities and timelines for each objective d. Specific patient population for each objective ANS: C Responsibilities and timelines are set for each objective. Options A and B are incorrect because they are not part of the action planning process. Option D is incorrect because action planning usually has a more global focus. DIF: Cognitive Level: Application REF: page 30 17. When identifying the objectives in an organization’s action plan, what would be an essential tool to use to improve performance? a. Benchmarking to “best inNclaRss pIerfoGrmeBrs.”C M b. Patient satisfaction survey results c. Employee satisfaction survey results d. Patient population ANS: A Most objectives will identify benchmarks that they want to reach. The other options may be used but not for every objective and therefore is not essential. DIF: Cognitive Level: Analysis REF: page 30 18. Nurse managers involved in the development of the action plan for a unit understand that each objective is individualized such that a. each objective has an identified population. b. each objective has an identified resource. c. each objective has an identified goal. d. each objective has been identified by the CEO. ANS: C Each objective has a target goal or benchmark. The other options do not apply. DIF: Cognitive Level: Application REF: page 30 19. When establishing a unit action plan, the nurse manager identifies steps to be taken to accomplish the goal. What is most important for achieving the goal? 2nd Edition a. Regularly scheduled meetings b. Administration attendance at meetings c. Staff involvement in decisions and actions d. Involvement of other departments ANS: C Without “buy -in” from staff, the likelihood of success in the plan is remote. The other options may be necessary for success but are not the most important factors. DIF: Cognitive Level: Application REF: page 30 20. When developing a unit -based action plan, what would the nurse manager need to do first? a. Identify the purpose of the plan b. Identify specific plans for each strategy c. Monitor and update the plan d. Identify the responsibility of each person in achieving the goal ANS: A The first thing to be accomplished is identification of the purpose or mission. The other actions are incorrect because they are one of the steps taken in the process but not the first. DIF: Cognitive Level: Application REF: page 30 21. When developing a unit -based action plan, the nurse manager would need to include which factor in making decisions for implementation? a. Patient acuity statistics b. Patient satisfaction survey c. Budget d. Staff holiday schedule ANS: C NURSINGTB.COM Implementation must be made within the budgetary constraints of the unit. The other factors may be involved, depending on the purpose and goal established, but not in every action plan. DIF: Cognitive Level: Analysis REF: page 32 22. Organize the following steps in developing a strategic unit -based action plan. 1. Determine specific strategies for each goal. 2. Select goals to be achieved. 3. Define the purpose or mission. 4. Monitor and update the plan 5. Identify resources for accomplishing goals. a. 3, 2, 1, 5, 4 b. 2, 1, 3, 4, 5 c. 1, 2, 3, 4, 5 d. 1, 2, 5, 4, 3 ANS: A These are the correct steps for developing a strategic unit -based action plan. The other options are not the correct steps for developing a strategic unit -based action plan. DIF: Cognitive Level: Application REF: page 32 2nd Edition N R I G B.C 23. The overall purpose for strategic planning in an organization includes which of the following? a. Increases the chance of success b. Frees the nurse manager from day-to-day supervision c. Shows interest in the success of the organization d. Avoids crisis management ANS: A Planning for changes using a strategy increases the chance of success. Options B and C are not a purpose for planning. Avoiding crisis management is a purpose but it can be incorporated into the success strategy. DIF: Cognitive Level: Application REF: page 33 MULTIPLE RESPONSE 1. When an organization performs a strategic analysis, it is looking for ways to address the competition. Which environmental factor influences their decision making? (Select all that apply. ) a. Transfer of patients to a Level I trauma center b. Changing demographics c. Political climate d. Economic considerations e. Transfer of patients to an extended -care facility (ECF) ANS: B, C, D An environmental scan can expose changes within the community population, changes in acce ss to federal fundi ng and toUacScessNibilTity to mOoney available for growth, and changes in access to money available for growth. Options A and E are incorrect because these conditions do not change significantly and should not affect the overall strategic plan. DIF: Cognitive Level: Analysis REF: page 28 2. The patient satisfaction survey can influence strategic planning by using which factors? (Select all that apply. ) a. Strengths and weaknesses b. Medication errors c. Threats d. Staffing shortages e. Opportunities ANS: A, C, E SWOT (Strengths, Weaknesses, Opportunities, Threats) is an acronym that can be used when performing environmental scans for the purposes of strategic planning. The other options are incorrect because they may impact planning at the unit level but not at the organizational level. DIF: Cognitive Level: Application REF: page 28 2nd Edition Chapter 04: Financial Management in Health Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. When developing a zero -based budget, nurse managers understand a. the previous year’s monies are applied to the current one. b. all budget needs are justified annually. c. no changes to patient care delivery can occur. d. it does not reflect actual changes of the unit. ANS: B Zero -based budgets have to be re -created annually starting from zero and every request must be justified. Options A and D are a factor seen in the incremental type budget. Option C is the zero -based type budget allows for changes in delivery of the service. DIF: Cognitive Level: Application REF: page 46 2. When developing an incremental type budget, the nurse manager understands a. yearly budgets are dependent on the previous year’s budget. The budget must be recreated every year. b. anticipated changes are allowed. c. all changes must be justified. d. the yearly budget for the upcoming year will be less than for the present year. ANS: A Each year’s budget is based oNnUthReSaImNouGnTt sBp.enCt iOnMthe previous year’s budget. The other options refer to the zero -based budget. DIF: Cognitive Level: Application REF: page 46 3. When using the gathering and planning phase of developing a budget, the nurse manager would expect to find a. financial objectives of the organization. b. environmental assessment. c. scheduled budget items. d. monitoring of progress. ANS: B An environmental survey should be done as the first step in the budget process. The other options are part of another phase. DIF: Cognitive Level: Application REF: page 47 4. When evaluating the performance of a budget, the nurse manager can use a variance analysis to explain a. an increased cost due to market changes. b. a change in availability of materials. c. differences between budget and cost. d. one-time event. 2nd Edition U S N T ANS: C A variance analysis can explain the reason for a difference between what is budgeted and what was spent. The other options do not address variance analysis. DIF: Cognitive Level: Analysis REF: page 48 5. Unit yearly budgets may change based on variances. What does the nurse manager understand to be the cause of budget variances? a. A change in patient census b. An increase in staffing c. Implementation of new responsibilities d. New manag ement ANS: B Changes in staffing will cause a budget variance. A change in the patient census can cause a change but only in its relationship to staffing. The other options do not affect the budget. DIF: Cognitive Level: Analysis REF: page 48 6. A positive budget variance can be identified by which situation? a. A decrease in the budgeted expenditures b. An increase in the budgeted expenditures c. An increase in RN salaries d. A decrease in patient ratios ANS: A Positive budget variances are those that show a decrease in expenditures from what was budgeted. An increase in theNbudRgeteId eGxpenBd.itCuresMreflects a negative variance. An increase in RN salaries and decrease in patient ratios would apply only if it had been incorporated into the budget and then a change occurred. DIF: Cognitive Level: Analysis REF: page 48 7. A nurse consistently remains past her shift for report or charting. The amount of overtime accumulated is equivalent to a full -time nurse’s salary for 1 month. The nurse manager counsels the nurse and emphasizes that one of the responsibilities to the institution is a. quality patient care. b. fiscal accountability. c. accurate documentation. d. accurate medication administration. ANS: B This particular nurse appears to have no sense of fiscal accountability to the institution. Fiscal responsibility is as vital to the success of the institution as is quality patient care. The other options describe important responsibilities, but the question is not about the nurse’s care that is provided but about the organization of her time. DIF: Cognitive Level: Analysis REF: page 48 8. A proactive budget should incorporate which situation? a. Patient acuity changes b. Patient/nurse ratio changes 2nd Edition c. Projection of sick time d. Equipment maintenance ANS: C Projection of increased sick time during the flu season into the budget is a proactive example. The other options are not examples of a proactive budget that anticipates changes based on past years and includes them into the budget. DIF: Cognitive Level: Application REF: page 48 9. In addition to determining the number of patient care hours needed, the nurse manager must also include which other labor costs? a. Loss of staff positions b. Vacations and holiday pay c. Breaks d. Changes in management ANS: B Vacations, holiday pay, shift differential, etc. impact the overall personnel budget. The other costs are not usually calculated into the personnel budget. DIF: Cognitive Level: Application REF: page 49 10. Indirect costs in a nurse manager’s budget would include a. benefits. b. expected raises. c. shift differential. d. travel . ANS: D NURSINGTB.COM Travel is determined as an indirect cost to the budget because there is no direct connection to patient care. The other options have a direct connection to patient care. DIF: Cognitive Level: Application REF: page 50 11. When planning the purchase of new equipment, the nurse manager should include these items into which type of budget? a. Capital budget b. Personnel budget c. Cash budget d. Operating budget ANS: A The capital budget includes expensive equipment, land, etc. The other items do not apply. DIF: Cognitive Level: Application REF: page 50 12. The nurse manager understands that when there is a negative variance of the budget report, it is necessary to establish the cause. Which of the following might best explain a negative variance? a. Decreased patient acuity b. Increase in staff sick days