Nursing Delegation And Management Of Patient Care 2nd Edition By Kathleen Motacki. Kathleen Burke – Test Bank
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Sample Test
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 had
business courses. |
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 planning.
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
|
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 care 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
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
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 critical 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.
DIF: Cognitive Level:
Analysis
REF: page 32
10. When
referring to the critical success factors (CSFs) that organizations use for
developing 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
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 patient load in their practice and
this 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. Which
of the following represents a short-term goal for an organization?
|
a. |
Health education to prevent
the incidence of accidents due to drunk drivers |
|
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 in
class performers” |
|
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?
|
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
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.
23. Determine
specific strategies for each goal.
24. Select
goals to be achieved.
25. Define
the purpose or mission.
26. Monitor
and update the plan
27. 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
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 access to federal funding and to accessibility to money
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
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 on the amount spent in the 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. |
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 management |
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 the budgeted expenditures
reflects 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 |
|
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
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 |
|
c. |
Increased benefits |
|
d. |
Decreased census |
ANS: B
An increased use of sick time requires additional nurse hours to
staff the unit and so the manager is essentially paying twice for the same
hours, which would lead to a negative variance. The other options would not
affect the budget negatively.
DIF: Cognitive Level: Application
REF: page 48
13. To
determine staffing needs, the nurse manager needs to
|
a. |
determine supplies needed. |
|
b. |
determine shift
differential. |
|
c. |
determine the daily census. |
|
d. |
determine overtime needed. |
ANS: C
To know the number of staff needed, it is necessary to know the
daily census. The other options are not required to determine staffing needs.
DIF: Cognitive Level:
Analysis
REF: page 48
14. A
community health center leases space from the owner of the building. As the
manager develops the budget, they understand this to be a fixed cost. From
which of the following would the lease payment be paid?
|
a. |
Operating budget |
|
b. |
Personnel budget |
|
c. |
Capital budget |
|
d. |
Cash budget |
ANS: A
A fixed cost such as a lease will come from the operating
budget. The other options do not apply.
DIF: Cognitive Level:
Application
REF: page 48
15. When
assessing the staffing needs, the nurse manager must consider which of the
following in addition to the patient care hours?
|
a. |
Anticipated retirements |
|
b. |
Cash budget |
|
c. |
Staff mix required |
|
d. |
Scheduled breaks |
ANS: C
The staff mix must be considered when assessing the required
staffing needs. The patient acuity may allow for fewer RNs and more UAPs. The
other options are not assessed when deciding the staffing needs of the unit.
DIF: Cognitive Level:
Application
REF: page 49
16. A new
drug reference book is needed for a unit. The nurse manager would plan to pay
for this from which budget?
|
a. |
Cash budget |
|
b. |
Operating budget |
|
c. |
Personnel budget |
|
d. |
Capital budget |
ANS: A
Small expenditures will come from the cash budget. The other
budgets do not apply.
DIF: Cognitive Level:
Application
REF: page 48
17. Which
of the following would explain a nurse manager’s use of position control in
monitoring the budget?
|
a. |
Comparison of this year’s
turnover rate with last year’s |
|
b. |
Premium pay |
|
c. |
Comparison of actual
full-time employees and the number that was budgeted |
|
d. |
Control of nurse manager to
allocate pay raises |
ANS: C
Position control is managed by the nurse manager and provides
visualization of positions filled or not filled. The other options do not
apply.
DIF: Cognitive Level: Application
REF: page 49
18. From
which of the following would a nurse manager expect to receive revenue?
|
a. |
Failure of the nurse to
correctly check in |
|
b. |
Staff turnover |
|
c. |
Unused sick time |
|
d. |
Medicare |
ANS: D
Third party payers and investments are the source of revenue for
hospitals. The other factors do not provide revenue for a nursing unit.
DIF: Cognitive Level:
Application
REF: page 43
19. Support
costs must be included in the budget. Which employee position would be included
in the support or indirect costs part of the operating budget?
|
a. |
Waiting room secretary |
|
b. |
UAPs |
|
c. |
Physical therapists |
|
d. |
Case managers |
ANS: A
Support staff (housekeeping) who do not provide direct care to
patients are considered indirect costs and come from the operating budget and
not the personnel budget. The other employee positions will have direct care
responsibilities to the patient.
DIF: Cognitive Level:
Application
REF: page 50
MULTIPLE RESPONSE
1. The
personnel budget is based on the calculations of which factors? (Select all that apply.)
|
a. |
Average daily census |
|
b. |
Patient safety factors |
|
c. |
Hours per patient day |
|
d. |
Number of staff |
|
e. |
Nurse/patient ratios |
ANS: A, C, D
The personnel budget is made up of factors around number of
staff and patient care needs. Patient safety factors and nurse/patient rations
are not part of the personnel budget.
DIF: Cognitive Level:
Application
REF: page 48
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