Final - Ch 4, 14, 15 - Budget, Staffing, Managed Care & Utilization

A department manager's budget concerned with the income and expenses associated with day-to-day activities of the unit is a(n): a. operational budget. b. capital budget. c. construction budget. d. balanced budget.

A

A hospital administrator is trying to determine whether a new piece of equipment should be ordered for the Intensive Care Unit (ICU). Because the hospital has been experiencing some financial problems, a good approach for the administrator to use would be to do which of the following? a. Examine the break-even point b. Terminate several employees and use the extra salaries to purchase the equipment c. Purchase the equipment and hope for the best d. Ask the employees to donate a day's pay toward the purchase price

A

A nurse manager is listing the number and type of staff needed for a procedure, otherwise known as which of the following? a. Staffing model b. Direct patient preparation c. Pre-procedure care d. Post-procedure care

A

A nurse manager is preparing a budget that outlines anticipated revenue and expenses over the next fiscal year. This is an example of which of the following? a. Operational budget b. Capital budget c. Construction budget d. Accounting

A

A nurse manager, giving a presentation to subordinates, details an issue associated with registered nurses known as "failure to rescue." Research has shown that "failure to rescue" is linked to which of the following? a. Lower proportion of hours of care at the bedside b. Weak cardiopulmonary resuscitation skills c. Inappropriate budgeting by the manager d. Inadequate equipment and resources

A

An accountant at the local hospital would understand that which of the following government organizations is responsible for the administration of Medicare and Medicaid? a. Health Care Financing Administration (HCFA) b. Social Security Department c. Tax Equity and Fiscal Responsibility Act (TEFRA) d. Congress

A

An advantage of primary nursing is: a. accountability. b. cost. c. geographic boundaries. d. performing all interventions.

A

An advantage of the prototype patient classification system is: a. reduction of work. b. ongoing data to monitor accuracy of the nursing requirements. c. ongoing measure of the actual nursing work required. d. commonly used system.

A

As the nurse manager of a pediatric unit, your daily staff assignments would be based on which of the following? a. Patient acuity and nursing care hours needed b. Number of nurses that are available c. Patient acuity and cost of care d. Staff preference and patient difficulty

A

Some methods of identifying nursing costs such as direct patient care, indirect patient care, coordinating discharges, documentation, and critical problem solving are: a. patient classification systems (PCS). b. relative value models (RVM). c. quality measurement (QM). d. process improvement (PI).

A

The concept of _____ does not work well when applied to health care because the general rule that when the price of an item or service goes up, the demand goes down does not necessarily impact the public's demand for (or belief in their right to obtain) this item or service. a. Price elasticity b. Scarcity c. Economics d. Cost maximization

A

The nurse manager understands that the cost in a budget that exists regardless of the number of patients for whom care is provided would be considered which of the following? a. Fixed costs b. Variable costs c. Annual costs d. Supplemental costs

A

The nurses in the hospital received a letter stating that they would each be receiving a small raise. The letter stated that the previous year's income was higher than the expenses. This situation is known as which of the following? a. Profitability b. Stability c. Accountability d. Responsibility

A

When planning the budget for the unit, the nurse manager recognizes that equipment depreciation, utilities, fringe benefits, and salaries are considered: a. fixed costs. b. variable costs. c. direct expenses. d. indirect expenses.

A

Which of the following are tools the nurse manager can use when developing a budget? a. High-low cost estimation, regression analysis, and break-even analysis b. Regression analysis, break-even analysis, and t-test c. Break-even analysis, high-low cost estimation, and balanced scorecard d. T-test, balanced scorecard, and regression analysis

A

Which of the following patient care units would require the largest number of nurses if the scale used to measure acuity ranged from 1-5, with the highest acuity being 5? a. A unit with10 patients, all ranked acuity level 5 b. A unit with 15 patients, 5 with acuity level 4 and 10 with acuity level 2 c. A unit with 20 patients , 2 ranked acuity level 5, 2 ranked acuity level 3, and 17 ranked acuity level 1-2 d. A unit with 25 patients, all ranked as acuity level 1-2

A

Which of the following was initiated to help ensure that the quality and safety of care was not compromised? a. CQI b. HSA c. TEFRA d. PPO

A

You recently hired a new staff nurse to work from 12 Noon until 8 P.M., 4 days per week. This new staff nurse would add how many additional FTEs to your unit? a. 0.8 FTEs b. 0.9 FTEs c. 1.6 FTEs d. 2.5 FTEs

A

The nurse manager is preparing the budget. Which of the following would be considered direct costs? Select all that apply. a. Syringes and needles b. Dressing trays c. Phone bills d. Medications e. Housekeeping service f. Catheters

A B D F

The hospital in your local community is considering expanding their pediatric services. Which of the following pieces of demographic data would be important? Select all that apply. a. Age of residents b. Availability of pediatric services offered by other agencies in the area c. Number of elderly residents d. Incidence of prostate cancer e. Number of women of childbearing age f. Crime statistics for the area

A B E

A client is to have a central line inserted. According to the Institute for Health Improvement, which of the following are required? Select all that apply. a. Cap b. Mask c. Clean gloves d. Shoe covers e. Suction equipment f. Large sterile drape

A B F

Which of the following would be considered direct costs in a nurse manager's budget? Select all that apply. a. Nurses' salaries b. Maintenance costs c. Patient care supplies d. Heating cost e. Cost for air conditioning f. Utility costs such as electricity

A C

The local hospital has just changed its patient care delivery model from Team Nursing to Total Patient Care. Some of the advantages for this change include which of the following with Total Patient Care? Select all that apply. a. Consistency of one individual caring for patients for an entire shift b. Less costly than other models of delivery c. Works well in a specialized unit such as hospice d. Requires fewer RNs to provide patient care e. Patient, nurse, and family are able to develop a relationship based on trust f. Nurse has more opportunity to observe and monitor the progress of the patient

A C E F

When preparing a hospital's budget, which of the following would be included in the fixed costs? Select all that apply. a. Utilities b. Medical and surgical supplies c. Equipment depreciation d. Laundry and food e. Fringe benefits f. Administrative salaries

A C E F

Value added refers to activities that are characterized by which of the following? Select all that apply. a. The customer will pay for this activity. b. The activity must be performed by a registered nurse. c. The activity must be done right the first time. d. The activity must be completed in half the time. e. The activity must be completed by both the client and the nurse. f. The activity must somehow change the product or service in some desirable manner.

A C F

In preventing infection of a central line, the nurse must perform which of the following hand hygiene protocols? Select all that apply. a. Between each patient b. Before, but not after, palpating catheter insertion site c. Only when hands are obviously soiled d. After using the bathroom e. Before and after palpating catheter insertion site f. Before and after invasive procedures

A D E F

The nurses on your unit want to change the patient care delivery model from functional nursing to primary care nursing. They are concerned about the disadvantages of functional nursing, which include which of the following? Select all that apply. a. Patients feel disjointed. b. Care can be delivered to a large number of patients. c. LPNs are forced to work outside their scope of practice. d. Patients become the sum of the tasks rather than an integrated whole. e. Other types of health care workers are used when there is a shortage of RNs. f. Technical, rather than professional, nursing care often results.

A D F

A client is seen at the local health center where a flat rate of payment up front is required, instead of reimbursing the health care provider's cost. The client is most likely using which form of payment? a.Pay for performance b. Prospective payment system c. Cost plus d. Selective payment

B

A full-time employee works how many hours per year? a. 1,040 b. 2,080 c. 1,664 d. 1,872

B

A local hospital has no stockholders. This type of organization is most likely: a. for-profit. b. not-for-profit. c. monopoly. d. fiefdom.

B

A model of care delivery that consists of a group of patients who are being cared for by an RN, an LPN, and a UAP is called: a. functional nursing. b. team nursing. c. total patient care. d. primary nursing.

B

A newly hired staff nurse understands that the organization's vision statement provides which goals for the organization? a. Short-term b. Long-term c. Short-term and long-term d. Anticipated, short-term, and long-term

B

A nurse researcher is collecting data on the average income of residents in her community. The purpose of the study is to determine if there is a correlation between income, educational level, and health beliefs. The data related to average income is considered: a. competitive analysis. b. demographic information. c. strategic initiatives. d. regulatory influences.

B

A nursing student questions the instructor regarding the acronym DRGs. The most appropriate response by the instructor is to inform the student that the acronym DRGs stands for which of the following? a. Debt ratio gain b. Diagnosis-related groups c. Disease recovery groups d. Debt resource generator

B

A strategy to improve patient care and reduce hospital costs through coordination of care is termed: a. clinical pathways. b. case management. c. primary nursing. d. utilization review.

B

A student in an economics course is aware that the three premises that the study of economics is based upon would involve which of the following? a. Price elasticity, choice, and scarcity b. Scarcity, choice, and preference c. Choice, price elasticity, and preference d. Price elasticity, scarcity, and cost maximization

B

Acuity data and nursing hours per patient day (NHPPD) are concrete data parameters that are primarily used to: a. benchmark. b. adjust staffing levels. c. develop a nursing budget. d. review patient care outcomes.

B

California was the first state to mandate nurse-to-patient staffing: a. plans. b. ratios. c. patterns. d. departments.

B

During the budget process, the nurse manager wants to drill down into expenses and detail the cost of every supply item and quantity of times it is typically used. This is called: a. accountable budgeting. b. zero-based budgeting. c. operating budget. d. capital budget.

B

How many FTEs per day would you need if your target NHPPD was 8, and you expected to have 22 patients on your 24-bed unit? a. 20 b. 22 c. 24 d. 26

B

If an organization takes donations, this money is considered a: a. profit. b. revenue. c. dashboard. d. variance.

B

In which model of care delivery does the nurse have responsibility for the total care for the patient assignment during the shift? a. Case method b. Total patient care c. Functional nursing d. Team nursing

B

In which model of care delivery is the focus on patient needs rather than on staff needs? a. Primary b. Patient-centered c. Differentiated practice d. Modular

B

Medical and surgical supplies, drugs, laundry, and food are considered: a. fixed costs. b. variable costs. c. direct expenses. d. indirect expenses.

B

Obtaining information on Medicare services is considered: a. demographic information. b. regulatory information. c. strategic information. d. competitive information.

B

The nurse manager plans to develop a picture of a moment in time that depicts whether the unit is achieving its goals. This can be done by developing which of the following? a. Storyboard b. Dashboard c. Album with patients' pictures d. Photographs of the unit

B

The radiology department has requested that the hospital purchase a new mammogram machine. This equipment would be included in which of the following budgets? a. Operational budget b. Capital budget c. Construction budget d. Balanced budget

B

When completing the staffing assignment, the nurse manager must include holiday time for the staff members. In terms of financial budgeting, holiday time is considered which of the following? a. Productive time b. Nonproductive time c. Direct care d. Indirect care

B

When developing a budget that meets the needs of the department, the nurse manager understands that sick time, vacation time, and holiday time are considered which of the following? a. Productive time b. Unproductive time c. Direct expenses d. Variable costs

B

When evaluating the organization, the nurse manager realizes that overall organizational performance is dependent on which of the following? a. Managers' insight into financial outcomes b. Staff's insight into quality and financial outcomes c. Organization's strategic plan d. Administration's insight into financial outcomes

B

Your unit is staffed by 4 nurses who work 12-hour shifts, 6 nurses who work 8-hour shifts, and 6 nurses who work 5-hour shifts. How many FTEs do these nurses represent? a. 11 FTEs b. 12.6 FTEs c. 14.5 FTEs d. 16 FTEs

B

A disadvantage of functional nursing is: a. it serves a large number of patients. b. it utilizes different skill levels to deliver care. c. the patient receives task-focused care. d. the patient receives care from several staff members.

C

A new nurse is receiving training on a payment classification system used for reimbursement of health care costs by Medicare. The nurse is most likely learning about which of the following? a. Managed care contracts b. Penetration rate revenue c. Diagnosis-related groups d. Length-of-stay records

C

A nurse educator evaluates the students' understanding of the current factors influencing health care reform. Which response by a student would indicate that further teaching is required? a. Interest groups b. Political ideology c. Altruism d. Policy entrepreneurs

C

A nurse manager recognizes that methods used to account for the cost of health care expenditure include which of the following? a. Regression analysis, flowcharts, and relative value points b. Patient classification systems, regression analysis, and flowcharts c. Relative value units, regression analysis, and patient classification systems d. Relative value points, process improvement, and quality management

C

A patient classification system that uses units of measure that equate to nursing time is called: a. prototype b. seven domain. c. factor system. d. scorecard.

C

An advantage of the factor-type patient classification system is: a. ongoing workload for nurses to classify patients. b. capturing holistic patient needs. c. data are readily available. d. capturing typical nursing time.

C

An expense that is associated with patient care is: a. fixed. b. indirect. c. direct. d. variable.

C

An instructor wants to determine whether a nursing student knows during which era the cost of health care began to be questioned. Which response by the student would indicate that the student knows? a. 1940s b. 1950s c. 1960s d. 1990s

C

At the end of the shift, nurses document the care provided each of the clients. The time spent on this type of accounting activity would be considered which of the following? a. Direct care b. Productive time c. Indirect care d. Nonproductive time

C

During an in-service training, the speaker evaluates the attendees' knowledge of the term cost plus. Which response by the attendees indicates they understand? a. An international discount store b. The amount of monies spent on health care plus the current inflation factor c. The cost to the provider plus a profit incentive for being in business d. The expenditure for being in the health care business plus benefits from pharmaceutical companies

C

Each nurse on your unit receives a benefits package that includes a 2-week vacation, 1 sick day each month, 6 holidays, and 2 days to attend an educational conference. How many nonproductive hours would each nurse on your unit represent? a. 60 hours b. 120 hours c. 240 hours d. 360 hours

C

Nurses should be familiar with the concept of ethics and understand that it represents the concern for which of the following? a. Others instead of oneself b. Oneself instead of others c. The general welfare of society as the proper goal of actions d. The welfare of the individual as opposed to groups as the proper goal of actions

C

One of the laboratories in your hospital budgeted $24,000 for procedure activity. However, when reviewing the data, the head of the department realized that the actual cost was $26,250. What was the variance? a. 9.1% b. 9.4% c. 10.4% d. 110%

C

Prompt access to diagnostic and treatment services, ready availability of state-of-the-art and cutting-edge technology, and participation in health care decisions are examples of American: a. rights. b. entitlements. c. qualities of life. d. values.

C

The intensification of the focus on cost and quality improvement and the expansion from hospitals to diverse ambulatory and home care sites is being referred to as which of the following? a. 20th century revolution b. Internet revolution c. Q-revolution d. Transition revolution

C

The nurse manager must take into account which of the following when scheduling staff? a. Staffing pattern b. Volume of staff c. Volume of patients d. Staff needs

C

The nurse understands that the term Failure to Rescue refers to which of the following? a. An organization's inability to avoid bankruptcy due to lack of funds b. The physician's inability to provide adequate support to nurses experiencing burnout c. The clinician's inability to save a patient's life when the patient experiences complications d. The nurse's inability to provide overtime services when the ward is short-staffed

C

Three of the six interventions to help reduce morbidity and mortality in the United States developed by the Institute for Healthcare Improvement (IHI) are: a. deploying rapid response teams, improving the care for myocardial infarctions, and employing time outs. b. promoting medication reconciliation, preventing central line infections, and using the SBAR technique. c. preventing ventilator-assisted pneumonia, deploying rapid response teams, and promoting medication reconciliation. d. preventing surgical site infections, using the SBAR technique, and deploying rapid response teams.

C

When developing the budget, the nurse manager knows that a variance analysis that must be explained is which of the following? a. Actual = budget b. Actual < budget c. Actual > budget d. Projected = budget

C

When examining the budget, the nurse manager knows that approximately 50 percent to 60 percent of the operational expenses are for which of the following? a. Supplies b. Equipment c. Salaries and benefits d. Pharmaceuticals

C

Which of the following emerged as the answer to cost-efficient quality care? a. Health care savings plan b. Evidence-based care c. Managed care d. Planned parenthood

C

Whose responsibility is it to schedule staff? a. Staff members themselves b. Nursing scheduling office c. Nurse manager d. Director of Nursing

C

A disadvantage of clinical pathways is the: a. ability to manage care. b. ability to shorten length of stay. c. ability to collect variances. d. template for care.

D

A for-profit brokerage company that acts as an agent who negotiates for a contract regarding how and when the provision of health care services will be accomplished is called: a. Medicare. b. health service organization. c. integrated health care system. d. managed care.

D

A measurement tool to articulate the nursing workload for a specific patient or group of patients over a specific period of time is called: a. benchmarking. b. skill mix. c. staffing pattern. d. patient classification.

D

A new staff nurse is hired as a full-time employee who works 40 hours a week. The nurse would be referred to as which of the following? a. .5 FTE b. .8 FTE c. .9 FTE d. 1.0 FTE

D

A nurse manager wishing to positively affect the budget could employ which of the following strategies? a. Increase patient charge items b. Maintain patient length of stay c. Maintain productivity d. Evaluate staff downtime

D

A nursing unit schedule has one RN on admission assessments and discharges; an LPN assigned to pass medications to all patients; one RN for IVs, IV meds, and blood administration; two NAPs for baths; and two NAPs for assisting with patient feeding. This unit most likely uses which form of patient care delivery? a. Team nursing b. Primary nursing c. Managed care d. Functional nursing

D

An advantage of the total patient care and the case method model of care delivery is: a. cost. b. same patients. c. continuum of care. d. consistency of care.

D

As the nurse manager of the unit, you are responsible for monitoring the unit's budget. You perform these activities in order to do which of the following? a. Demonstrate your expertise in budgeting b. Keep expenses above the amount of revenues collected in previous years c. Identify areas that may cause patient safety concerns d. Ensure that revenue is generated consistent with projected productivity and standards

D

During an in-service on budgeting, the staff developer asks the participants, "Who is responsible for ensuring that expenses are kept within the budget?" The participants would be correct if they gave which of the following responses? a. Chief financial officer b. Unit manager of department c. Staff nurse using supplies d. Entire health care team

D

Gas, electricity, and phones are considered: a. fixed costs. b. variable costs. c. direct expenses. d. indirect expenses.

D

High Risk Pool plans are: a. a way to save money and get a tax deduction. b. an incentive to shop for cost-effective health care services. c. a branch of the U.S. government that deals with health and health services. d. plans for patients previously refused insurance due to preexisting health care conditions.

D

In the budget preparation phase, obtaining information regarding other hospitals' performance is considered: a. demographic information. b. regulatory influences c. strategic initiatives. d. competitive analysis.

D

When doing self-scheduling, one of the guidelines should include: a. nurse manager outcomes. b. patient outcomes. c. staff outcomes. d. scheduling period.

D