Chapter 04: Managerial Decision Making
Huber: Leadership & Nursing Care Management, 6th Edition
MULTIPLE CHOICE
1. What is the definition of the
... [Show More] process of making choices that will provide maximum benefit?
a. Critical thinking
b. Problem solving
c. Decision making
d. Leading
ANS: C
Decision making is the process of making choices that will provide maximum benefits.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
The competent nurse uses the information about head injury, change in mental status from
talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to
deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial
pressure. The nurse is demonstrating clinical judgment, which is the interpretation of the
information of patient problems and needs.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. Which of these concepts is key to refining clinical judgment capabilities?
a. Critical judgment
b. Reflection
c. Management experience
d. Nursing expertise
ANS: B
Reflection is key to refining the capabilities of clinical judgment. As a nurse gets more
experience, the intuitive component of judgment follows. Nurses do not require management
experience or nursing expertise to refine clinical judgment.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: A
Decisions are made following the basic problem-solving process but also involve an evaluation
of the effectiveness of outcomes that result from the decision-making process itself.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.
ANS: A
Decision making is the process of making choices from several courses of action in order to
solve problems. The process of selecting one course of action from alternatives forms the basic
core of the definition of decision making. The staff nurse who adapts to a challenging patient
assignment is using decision making to affect the quality of patient care delivered.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: C
There are five steps for clinical reasoning, which involves five rights: the right cues or clinical
data, the right patient or setting priorities, the right time or capability of identifying high risk
patients, the right action or clinical decision that results from the clinical reasoning process, and
the right reason. The right reason incorporates legal and ethical considerations.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
Prioritization occurs not only in triage situations, but also across the care spectrum. Thus
decisions have to be made regarding what care has to be delivered and when the care is to be
delivered. All nurse managers and leaders need to consider the implications of their decisions.
Each decision made involves financial, ethical, and human resources. Furthermore,
reimbursement and other regulations must be taken into account.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
Prioritization occurs not only in triage situations, but also across the care spectrum. Thus
decisions have to be made regarding what care has to be delivered and when the care is to be
delivered. For example, nurses implicitly make decisions to ration care when time and staffing
are short (Jones, 2015). On a day-to-day basis nurses must decide if such things as routine
hygiene activities are omitted in favor of administering critical treatments, including medications
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
The focus of leadership and management decision making is more closely related to the nurse’s
role as care coordinator and systems problem solver. Some decisions, such as those requiring
disciplinary action, do require the manager’s direct intervention.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Basic Care and Comfort
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.
ANS: C
Clinical reasoning is the process of analyzing and synthesizing both objective and subjective
cues about patients. Levett-Jones and colleagues (2010) defined five steps for clinical reasoning.
They stated that clinical reasoning involved five rights: the right cues or clinical data, the right
patient or setting priorities, the right time or capability of identifying high risk patients, the right
action or clinical decision that results from the clinical reasoning process, and the right reason.
The right reason incorporates legal and ethical considerations. For example, the clinical process
may lead a nurse to recommend that a patient needs respiratory support in the form of a
ventilator. However, the patient may have an advance directive that would cause the clinician to
make a different decision.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: C
Data should be collected to identify properly the actual problem, issue, or situation. The five core
elements to decision making are the following: (1) identification of a problem, issue, or situation;
(2) establishment of the criteria to be used to evaluate potential solutions; (3) search for
alternative solution or actions; (4) evaluation of the alternative; and (5) selection of a specific
alternative.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. How is SBAR used in decision making?
a. Prevents cognitive errors
b. Data management tool
c. Financial tool
d. Effective communication technique
ANS: D
SBAR is a communication technique that helps members of the health team communicate
effectively so that appropriate decisions can be made. Because hands-off communication is so
crucial to decision making about patient care, SBAR is used to clarify and organize essential but
complex patient care information.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.
ANS: D
Clinical reasoning is a career-long development process. This process must carry over from skills
learned during a nurse’s education to the workplace. Nurse residency programs are one way to
help newly licensed nurses develop their clinical decision-making abilities.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
Managers in particular can use the data to develop a balanced scorecard that assesses financial,
quality, and other operational performance measures. This scorecard should be available to all
staff so that organizational performance can improve.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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 decisionmaking tool was used in this process?
a. Simulation
b. Pilot project
c. Data analytics
d. Evidence informed
ANS: D
All nurses are familiar with evidence-based practice for clinical standards of practice. In the
management realm, using evidence to make decisions is as important as is using evidence for
clinical decisions.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
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
ANS: C
Shared governance is an organizational structure that promotes empowerment and autonomous
decision making at the point of care, accountability that is shared among all parties in a decision,
and organizational processes that promote an egalitarian environment in decision-making
processes.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: B
Diagrams such as decision trees can be invaluable in understanding complicated alternative
solutions. These diagrams are useful in assessment and problem definition and in considering the
available alternatives for dealing with a problem. Once the alternative is chosen, a plan must be
formulated for implementing the approach chosen. The choice implemented must be evaluated.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: C
Pilot projects are critical for implementation for evidence-informed decision making. Pilot
projects or carefully defined trials are used to experiment by trying out a solution alternative on a
small or restricted basis to reduce risk and to see whether major problems will occur. Pilot
project strategies may resemble research projects, and these projects may also be linked to
quality improvement initiatives.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: D
Medication administration involves many decisions. In order to protect the patient, the nurse
must deliver medications safely while managing the environment in order to preserve safe
medication administration (Dickson & Flynn, 2012). According to Dickson and Flynn’s study,
medication administration involves decisions regarding managing distractions, interpreting
orders, and documenting errors and near-misses. In addition, Sitterding and colleagues (2012)
found that work-flow interruptions can interrupt the cognitive processes necessary for decision
making.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: A
A nurse manager’s leadership style may affect how decisions are made throughout the
organization. Decisions about the safety culture are a part of a nurse manager’s role. Merrill
(2015) found that a transformational leadership style contributed to a positive safety culture.
Praising employees affects a nurse’s job satisfaction.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: C
Six Sigma is a quality and decision support technique that uses data to build process
improvement models. The goal is to eliminate defects in safety and quality in health care
delivery (American Society for Quality Improvement, n.d.). Essentially Six Sigma is a variant of
the plan-do-study-act (PDSA) cycle promoted by the Institute for Healthcare Improvement.
DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.)?
a. Severity of illness
b. Complexity of patient’s condition
c. Amount of time needed with patient
d. Complexity of care
e. Patient’s dependency
ANS: A, C, D, E
The degree of work needed for any patient is called nursing intensity and is a combination of the
severity of illness, the patient’s dependency, the complexity of care, and the amount of time
needed. The need-severity (physical and psychological) is called patient acuity, which is a rating
of the complexity of the patient’s condition.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Two cognitive processes that nurses use in clinical reasoning include: (Select all that apply.)
a. education.
b. acuity.
c. staffing ratios.
d. experience.
ANS: A, D
Clinical reasoning is the process of analyzing and synthesizing both objective and subjective
cues about patients (Johansen & O’Brien, 2015). The nurse’s level of analysis is influenced by
experience and education.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.
ANS: C, D
The first step in the decision-making process using DECIDE is to define the problem and
determine why anything should be done about it and explore what could be happening. The final
step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.
DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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
ANS: A, B
Clinical judgment and clinical decision making were utilized in determining the measures that
would promote patient safety and prevent a fall.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
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
ANS: A, C, D, E
Examples of formal decision-making strategies include shared governance, the use of pilot
projects, evidence-informed decision making, and the use of simulation.
DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.
ANS: B
Shared governance is a model of organizational structure in which staff nurses are empowered
through autonomy and accountability.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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.
ANS: C
Decision-making authority rests at lower levels in the organizational framework, closer to the
point of care, rather than being passed up through the chain of command to an executive.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. Which of the following statements best describes an organizational chart?
a. All job positions are displayed clearly in a two-dimensional drawing.
b. All outside organizations with relationships to the hospital are depicted.
c. Informal and formal structures within the organization are outlined.
d. It shows organizational positions and relationships in a visual representation.
ANS: D
The organizational chart is a diagrammatic representation that displays “the flow of authority,
chain of command, titles, and functions.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. Nurses’ involvement in shared governance is an important component of:
a. practice models.
b. Magnet recognition.
c. increased reimbursement.
d. physician satisfaction.
ANS: B
Nurses’ involvement in governance is an important component of the American Nurses
Credentialing Center’s Magnet Recognition Program®
.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment [Show Less]