Test Bank For Nursing Delegation And Management of Patient Care 2nd Edition By Motacki RN MSN

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Test Bank For Nursing Delegation And Management of Patient Care 2nd Edition By Motacki RN MSN

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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