Chapter 04: Managerial Decision Making Huber: Leadership & Nursing Care Management, 6th Edition

Chapter 04: Managerial Decision Making Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. What is the definition of the process of making choices that will provide maximum benefit? a. Critical thinking b. Problem solving c. Decision making d. Leading 2. A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. When the nurse recognizes the change and deploys the rapid response team and physician, which skill is being demonstrated? a. Leadership b. Clinical judgment c. Clinical decision making d. Management 3. Which of these concepts is key to refining clinical judgment capabilities? a. Critical judgment b. Reflection c. Management experience d. Nursing expertise 4. A staff RN is leading a quality improvement team on the care of the total hip replacement patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques? a. Decision making b. Evaluating the consequences c. Inclusive judgment d. Problem processing 5. How is decision making at the staff nurse level exemplified? a. The staff nurse adapts to a challenging patient assignment. b. The staff nurse refers issues to the performance improvement committee. c. The staff nurse accepts the status quo. d. The staff nurse questions current practice and refers to unit leadership for change. 6. What is the final step in the clinical reasoning process? a. The right cues b. The right patient c. The right reason d. The right time 7. A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager and they determine that the equipment is urgent for patient safety in the new unit. The manager orders the necessary equipment from another company even though it is slightly more expensive. This is an example of: a. clinical decision making b. prioritization c. triage decision d. clinical reasoning 8. The nurse in a medical-surgical unit is working short-staffed due to a sick call. Which of these is an example of prioritization? a. Charting by exception b. Omitting personal hygiene in favor of timely medication administration c. Timely medication administration without scanning the patient armband d. Deploying a rapid response team when a patient condition changes 9. A family member of a patient files a complaint that her mother’s dentures were lost when the patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used? a. Delegation b. Direct intervention c. Indirect intervention d. Purposeful inaction 10. Which of the following scenarios is an example of clinical reasoning? a. A nurse ignores a client’s requests to stop his dialysis. b. A nurse is scheduled to work over the weekend, and she has a family outing to attend. c. A nurse is counseling a woman with breast cancer about terminating her pregnancy and receiving chemotherapy or completing the pregnancy and possibly not surviving. d. A nurse has been offered an exciting new position with a dramatic increase in salary, but she would have to move out of state, away from her ailing parents. 11. Nurses working on the intermediate care unit have had many hours of overtime in the last 6 months. Before forming a team, the nurse manager gathers data about patient condition severity, staffing ratios, educational levels of staff, and personality mixes on each shift. What level of decision making is this process? a. Establishment of solution evaluation criteria b. Evaluation of the alternative solutions c. Identification of a problem, issue, or situation d. Search for alternative solutions or actions 12. How is SBAR used in decision making? a. Prevents cognitive errors b. Data management tool c. Financial tool d. Effective communication technique 13. The nursing education department is revising its orientation curriculum for nurse externs. The curriculum includes a module on clinical reasoning skills. What is the expected time frame for mastery of clinical reasoning? a. Nurse externs should master clinical reasoning within 6 months. b. Clinical reasoning is mastered in nursing school. c. Clinical reasoning is never mastered. d. Clinical reasoning is a career-long process. 14. The decision support department has been asked to create balanced scorecards for each nursing unit. Nurse managers work with decision support on the data elements which will be useful in assessing financial, quality, and other measures in order to improve what? a. Staff turnover b. Organizational performance c. Physician satisfaction d. Reimbursement 15. An intravenous infusion center is considering switching intravenous pumps to another vendor. A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team votes to determine which pumps to use. The nurses selected the pump which provides them with the most safeguards for safe infusion delivery. Which type of decision- making tool was used in this process? a. Simulation b. Pilot project c. Data analytics d. Evidence informed 16. A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making tool? a. Pilot project b. Simulation c. Shared governance d. Data analytics 17. A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in the emergency medical service system. Questions are asked such as, “Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?” Which of the following decision-making strategies would work best in this situation? a. Fishbone diagram b. Decision tree c. Flowchart d. Data analytics 18. A team consisting of preoperative, operative, and postoperative health care professionals and ancillary staff is examining the turnaround time from the preoperative area to discharge for patients having tonsillectomies. The goal is to decrease waiting times for clients. The team comes up with a solution and wants to test it on a small group of patients before rolling it out to the rest of the department. What type of decision-making tool is exhibited? a. Shared governance b. Evidence informed c. Pilot project d. Trial and error 19. Which of these clinical decisions poses the greatest risk for committing an error? a. Verifying medication dose prior to administration b. Charting by exception c. Prioritizing patient care activities d. Independent interpretation of a medication order 20. .The nurse manager is dealing with a situation between two nurses who disagree on patient assignments. The nurse manager decides to allow the two nurses to work out their differences between themselves because the patient needs and the needs of the unit are being met. After the situation is resolved, the nurse manager praises the two nurses for making autonomous decisions about staffing. What will be the likely outcome of praising the nurses in this situation? a. higher job satisfaction b. Lower job satisfaction c. Lower patient satisfaction d. Increased staff turnover 21. Effective managers utilize a wide array of data in making decision. Which of these techniques is used to build process improvement models? a. Incrementalism b. Scenario planning c. Six Sigma d. Budgetary model MULTIPLE RESPONSE 1. Nurse managers in patient care areas must manage staffing on a daily basis. The degree of work needed for any patient is known as nursing intensity and includes which of these other variables? (Select all that apply.)? 2. Two cognitive processes that nurses use in clinical reasoning include: (Select all that apply.) a. education. b. acuity. c. staffing ratios. d. experience. 3. Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process? (Select all that apply.) a. Develop and implement an action plan for problem solution. b. Establish criteria for what you want to accomplish. c. Define the problem and determine why anything should be done about it. d. Evaluate the decision through monitoring, troubleshooting, and feedback. e. Determine the best choice or alternative. 4. A client becomes confused after surgery. He is in a room farthest away from the nurses’ station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize? (Select all that apply.) a. Clinical judgment b. Clinical decision making c. Autocratic decision d. Financial decision 5. Which of the following are examples of formal decision-making tools? (Select all that apply.) a. Shared governance b. Anchoring c. Pilot projects d. Evidence-informed decision making e. Simulation Chapter 13: Decentralization and Shared Governance Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. Shared governance is a model of organizational structure in which staff nurses are: a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability. c. engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies. 2. Decentralization occurs when: a. equipment is being purchased from approved vendors. b. hiring decisions are made at the executive level. c. power is distributed to those closest to the work of caregiving. d. supplies are distributed from one central supply area in the hospital. .......................................CONTINUED.......................................................