1.
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The nurse manager tells the staff that this year’s budget numbers will not change, even if census drops over the rest of the year. How should the staff interpret this information?
Correct Answer
A. The budget is a fixed one.
Explanation
The staff should interpret this information to mean that the budget for the year is set and will not be adjusted, regardless of any changes in the number of patients admitted (census). This suggests that the hospital operates with a fixed budget, where the allocated funds remain the same regardless of fluctuations in patient volume.
2.
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The nurse manager identified that the census was higher than anticipated and the client acuity level was also high; however, there were fewer nursing hours paid. This variance is an example of which budgetary variance?
Correct Answer
A. Efficiency
Explanation
The correct answer is efficiency. This is because the nurse manager noticed that even though the census and client acuity level were higher than expected, there were fewer nursing hours paid. This suggests that the nursing staff was able to provide the necessary care with fewer resources, indicating a higher level of efficiency.
3.
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As a member of the budgeting committee, the nurse manager reviews the salaries for file clerks in the accounting department. These salaries should be included in which budget item?
Correct Answer
C. The indirect cost
Explanation
The nurse manager, as a member of the budgeting committee, reviews the salaries for file clerks in the accounting department. These salaries should be included in the indirect cost budget item because they are not directly related to the production of goods or services. Indirect costs are expenses that are not directly tied to a specific product or service, but are necessary for the overall operation of the organization. Salaries for file clerks in the accounting department would fall under this category as they support the accounting function but do not directly contribute to the production of goods or services.
4.
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The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added the cost of this supplementary staff to the unit’s operating budget. A colleague informs the manager it should have been added to which budget?
Correct Answer
A. The personnel budget
Explanation
The nurse manager's goal is to adequately staff the unit and minimize the use of supplementary staff. Adding the cost of supplementary staff to the personnel budget would be the appropriate choice, as the personnel budget is specifically allocated for staffing-related expenses. This budget includes salaries, benefits, and other costs associated with the unit's personnel. By adding the cost of supplementary staff to the personnel budget, the manager can accurately track and allocate funds for staffing needs.
5.
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A client’s spouse is concerned about the cost of hospitalization. The nurse says, “Since your spouse is on Medicare, the hospital will be paid according to the DRG.” What does the nurse mean by this statement?
Correct Answer
D. Medicare will pay based on a set amount for the specific condition for which the client was hospitalized.
Explanation
The nurse means that Medicare will pay a fixed amount for the specific condition for which the client was hospitalized. This payment is determined by the Diagnosis-Related Group (DRG) system, which categorizes patients based on their diagnoses and assigns a predetermined payment amount for each category. This means that the hospital will receive a set payment from Medicare for the client's hospitalization, regardless of the actual total cost of care provided.
6.
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During an interview with a potential employee, the nurse manager tells the individual that an additional 10 percent of the hourly rate will be paid for working the 7:00 pm–7:00 am shift. What is another way the manager could have described this difference in pay?
Correct Answer
B. “The night shift differential is 10 percent.”
Explanation
The manager could have described the difference in pay as "The night shift differential is 10 percent." This statement clearly explains that there is a 10 percent increase in pay specifically for working the night shift.
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The nurse manager of a critical care unit creates the operating budget with the knowledge that a minimum of two professional nurses must be paid per shift regardless of the patient census. Which group determines this standard?
Correct Answer
A. Hospital administration
Explanation
The hospital administration is responsible for determining the staffing standards and requirements for the critical care unit. They are the ones who set the minimum number of professional nurses that must be paid per shift, regardless of the patient census. This decision is based on factors such as patient safety, quality of care, and regulatory requirements. The nursing administration of the hospital may also be involved in this decision-making process, but ultimately it is the responsibility of the hospital administration to determine the staffing standards. The Joint Commission is a regulatory body that sets standards for healthcare organizations, but they do not specifically determine the staffing standards for individual units within a hospital. The nursing personnel of the special care units may provide input and feedback on staffing needs, but they do not have the authority to determine the staffing standards.
8.
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A hospital’s budget is incremental. Which statement by the nurse manager reflects use of this type of budget?
Correct Answer(s)
A. “The finance department sent me the budget worksheet with last year’s expenses.”
B. “We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?”
D. “I like this type of budget preparation because it is fairly simple and straightforward.”
Explanation
The correct answer is "The finance department sent me the budget worksheet with last year’s expenses." This statement reflects the use of an incremental budget because it suggests that the budget for the current year is based on the expenses of the previous year. This type of budgeting approach assumes that the expenses will be similar to the previous year and makes adjustments accordingly.
The statement "We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?" also reflects the use of an incremental budget as it implies that there is a predetermined amount of money allocated for education expenses, and it needs to be spent before the year ends.
The statement "I like this type of budget preparation because it is fairly simple and straightforward." suggests that the nurse manager finds the incremental budget preparation process to be simple and straightforward, which is a characteristic of this type of budgeting approach.
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A nurse educator is asked by the chairperson of the department to submit a list of equipment that could be used to meet the department's goals. The list includes projectors, computers, office supplies, and computer-assisted programs. How would the educator categorize the materials?
Correct Answer
C. As part of the capital budget
Explanation
The nurse educator would categorize the materials as part of the capital budget because they are long-term investments in equipment that will be used to meet the department's goals. These items, such as projectors and computers, are considered assets and are expected to provide value to the department over a significant period of time.
10.
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The nurse manager is reviewing the previous month’s budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance?
Correct Answer(s)
C. Understaffing the unit
D. Low client acuity
Explanation
The favorable efficiency variance of the full-time equivalents (FTEs) could be due to understaffing the unit, which means that there were fewer staff members than required to meet the workload. This could result in cost savings as fewer salaries and benefits would need to be paid. Additionally, low client acuity could also contribute to the favorable variance as it indicates that the clients' needs were less complex and required less staff time and resources.
11.
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The nurse manager is creating the budget for the next fiscal year. Because the client census has been higher in the past year, more supplies were used. Which type of cost does this reflect?
Correct Answer
B. Variable costs
Explanation
The higher client census leading to the use of more supplies reflects variable costs. Variable costs are expenses that change in direct proportion to the volume of activity or production. In this case, as the client census increases, the usage of supplies also increases, resulting in higher variable costs.
12.
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With the current health care industry focus on managed care, nurses must be more cost-conscious. Which option is an example of a nurse being cost-conscious?
Correct Answer
B. The nurse’s decision to use fewer supplies when changing a dressing
Explanation
The nurse's decision to use fewer supplies when changing a dressing is an example of a nurse being cost-conscious. By using fewer supplies, the nurse is being mindful of the cost and not wasting resources unnecessarily. This helps to reduce healthcare expenses and ensures that resources are used efficiently.
13.
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A nursing executive is comparing the entire hospital financials for the month and notes that the medical laboratory’s revenue is higher than environmental services. What is a possible explanation?
Correct Answer
B. Environmental services is a non-revenue-producing cost center.
Explanation
Environmental services refers to the department responsible for cleaning and maintaining the hospital's physical environment. Unlike the medical laboratory, which generates revenue through its services, environmental services is considered a non-revenue-producing cost center. This means that it does not directly contribute to the hospital's financial income but is necessary for the overall functioning and cleanliness of the facility. Therefore, it is expected that the laboratory's revenue would be higher than environmental services.
14.
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A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference?
Correct Answer(s)
A. There is a higher turnover rate of nursing staff on the medical unit.
D. The critical care manager is a better manager than the medical unit manager.
E. More staff on the medical unit received premium pay this year.
Explanation
The higher turnover rate of nursing staff on the medical unit could lead to increased costs for recruiting, hiring, and training new staff, resulting in a higher budget. The critical care manager being a better manager than the medical unit manager could mean that they are more effective at controlling costs and managing resources, resulting in a lower budget for the critical care unit. More staff on the medical unit receiving premium pay this year could also contribute to a higher budget, as premium pay rates are typically higher than regular pay rates.
15.
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The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation?
Correct Answer(s)
A. Sick days
C. Vacation days
D. Holidays
E. Bereavement days
Explanation
The CNO should include sick days, vacation days, holidays, and bereavement days in the calculation for allocating benefit hours for the new position. These are all types of days off that employees are entitled to and should be accounted for in the budget planning process. Weekend days, however, should not be included as they are not typically considered as part of an employee's benefit hours allocation.
16.
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The medical–surgical nursing manager notices the education expenditure for the month is over budget. How should the manager deal with this difference?
Correct Answer
B. Complete a variance report for the month’s budget.
Explanation
The correct answer is to complete a variance report for the month's budget. This is the appropriate action for the nursing manager to take when they notice that the education expenditure for the month is over budget. A variance report will provide a detailed analysis of the difference between the actual expenditure and the budgeted amount, allowing the manager to identify the reasons for the variance and take appropriate measures to address it.
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Every month the chief financial officer (CFO) reviews the budget with the hospital’s board of directors. The CFO requests a million dollars to purchase a new MRI (magnetic response imaging) unit for the radiology department. Which category best describes this request?
Correct Answer
B. Capital expense
Explanation
The CFO's request for a million dollars to purchase a new MRI unit for the radiology department falls under the category of "Capital expense." A capital expense refers to a significant investment made by a company or organization to acquire or upgrade long-term assets, such as equipment or property. In this case, the purchase of the MRI unit is a substantial investment that will have a long-term impact on the hospital's operations and services.
18.
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A nurse manager is trying to educate the staff regarding efficiency and how it affects the unit’s costs. Strategies to increase efficiency could include which of the following?
Correct Answer
C. Labeling the cost of each item in the clean supply closet
Explanation
Labeling the cost of each item in the clean supply closet can help increase efficiency by creating awareness among the staff about the cost of supplies. This can encourage them to use supplies judiciously and avoid wastage, ultimately reducing costs for the unit.
19.
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The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included?
Correct Answer(s)
A. The average daily census for the facility over the last year
B. Current community wage ranges for employee classifications
C. Changes in accrediting body or legislative regulations
E. Current staff mix across the hospital
Explanation
The budget committee of a hospital needs statistical information that will help them make informed decisions about the budget for the upcoming year. The average daily census for the facility over the last year is important because it will give an indication of the number of patients the hospital can expect to have on a daily basis, which will impact staffing and resource needs. Current community wage ranges for employee classifications will provide information about the cost of labor, which is a significant expense for the hospital. Changes in accrediting body or legislative regulations are important to consider because they may require additional resources or changes in operations. Finally, knowing the current staff mix across the hospital will help the committee understand the composition of the workforce and any potential gaps or areas of concern.
20.
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A hospital has used capital funds to purchase a new piece of diagnostic equipment. The hospital’s chief financial officer (CFO) says, “The cost of this equipment will be expensed out across all units that use it.” How should the nurse manager interpret this statement?
Correct Answer
B. If clients on the manager’s unit require the use of this equipment, a portion of the cost will be charged to the unit.
Explanation
The nurse manager should interpret the CFO's statement as meaning that if clients on their unit need to use the equipment, the unit will be responsible for paying a portion of the cost. This suggests that the cost of the equipment will be distributed among the units that use it, rather than being jointly owned or rented out. The nurse manager may need to budget for this expense and ensure that it is allocated appropriately within their unit.
21.
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The newly hired nurse manager is involved in the first budgetary cycle since being hired. The manager lists some capital equipment needs and is surprised when they are not available for staff use two months after the request. What is the reason for this?
Correct Answer
B. The budgetary cycle takes up to 1 year to occur.
Explanation
The reason for the capital equipment not being available for staff use two months after the request is that the budgetary cycle takes up to 1 year to occur. This means that it takes a significant amount of time for the budget to be approved and allocated for the purchase of new equipment. Therefore, it is not unusual for the equipment to not be available immediately after the request is made.
22.
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A nurse manager writes the following note: “Over personnel budget by $1,250 in April due to late snowstorm. Nurses unable to get to work. Overtime wages paid.” Why is this note important?
Correct Answer
A. It will help the manager create the budget for the next year.
Explanation
The note is important because it provides an explanation for why the personnel budget was exceeded in April. The late snowstorm prevented nurses from getting to work, resulting in overtime wages being paid. This information is valuable for the nurse manager to understand the specific circumstances that led to the budget variance and can be used to make more accurate budget projections for the next year.
23.
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An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations?
Correct Answer(s)
A. Were any unexpected bonuses awarded?
B. Did agency personnel hours exceed the number predicted in the budget?
Explanation
The nurse manager should look for situations where unexpected bonuses were awarded and where agency personnel hours exceeded the predicted budget. These situations could contribute to an unfavorable rate variance in the salary budget of the unit.
24.
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The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet?
Correct Answer(s)
A. The FTE factor for an LPN hired this month
C. The names of all unit clerks working in the unit
D. The level of licensure of a nurse working on the unit
E. The fact that two RNs have retired this year
Explanation
The nurse manager would include the FTE factor for an LPN hired this month to accurately calculate the budget for staffing. They would also include the names of all unit clerks working in the unit to ensure they are accounted for in the budget. The level of licensure of a nurse working on the unit would also be included to determine the appropriate wage for that nurse. Finally, the fact that two RNs have retired this year would be included to adjust the staffing plan and budget accordingly.
25.
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A nursing assistant tells a nurse, “I am going to have to call in sick tomorrow because I don’t have a babysitter.” How should the nurse respond to this information?
Correct Answer
B. The assistant should use personal time, not sick time for this situation.
Explanation
The nurse should respond by informing the nursing assistant that they should use personal time, not sick time for this situation. This suggests that sick time should be reserved for when the assistant is actually sick, and personal time should be used for other reasons, such as not having a babysitter. This response indicates that the nurse values the appropriate use of sick time and encourages the assistant to make use of their personal time instead.