Federal Nursing Home Administrator Exam Essay

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1) OBRA asserts some separate committees can be folded into the quality improvement/assurance committee. Safety, Pharmacy and which committee below can be added into QA/QI committee?
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Infection Control
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2) Nursing homes are responsible for obtaining and providing dental care for residents. Who usually pays for dental services?
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The resident or a family member
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3) A facility is not allowed to charge a resident who is Medicaid and Medicare eligible except for:
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Co-pays
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4) You calculate the average percent of occupancy by:
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Dividing the total census (occupied bed days) by the total number of days, then multiply by 100
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5) Resident’s rights should be explained to the resident and or family member:
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Prior to admission
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6) In case of an emergency, when no attending or back up physician is available, the decision as to who will attend to the resident is to be made by the:
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Administrator
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7) Federal law states that facilities must retain menus of food actually served for at least:
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30 days
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8) A resident with a living will and DPOA specified she wants to receive heroic measures if necessary. Six months later the resident requires CPR, but is now incompetent and the son request CPR be withheld. What is the right thing to do?
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Provide the CPR
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9) A resident asks to see his chart. The doctor tells the nurse not to allow the resident access to the chart. What do you do?
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Tell the doctor the law gives the resident the right to view the medical records
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10) Medical records belong to:
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Facility
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11) When a resident passes away, the personal funds deposited with the facility must be given to the resident’s estate with a final accounting of the funds within:
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30 days
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12) The suffix “algia” refers to:
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Pain
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13) Physical restraints must be removed:
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Every two hours
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14) Depression is one of many psychological changes related to the aging process. Others include the following except for:
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Hearing loss
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15) “Nosocomal” refers to
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Infection occurring inside the facility (institutionalized)
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17) A capital budget is mostly about:
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Equipment and real estate
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18) Current debts are debts that are:
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Due within one year
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19) A ledger is a complete listing of:
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Accounts payable and receivable
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20) Which resource usually provides the least revenue for a nursing home?
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Insurance
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20) Past due accounts should not exceed:
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5%
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21) All of the following are a cash expense except:
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Depreciation
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22) A pro forma is primarily
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A financial statement or prediction
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23) A function of management is controlling, which means:
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Measuring outcomes against benchmarks, then responding
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24) OBRA requires every facility to have:
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A governing body – The Omnibus Reconciliation Act
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25) Management by objectives means:
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A system that determines goals and objectives
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26) Policies are:
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General and flexible statements that guid thinking
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27) Procedures are:
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Not flexable
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28) Short range (tactical) goals can be accomplished
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In less than one year
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29) Policies should be developed by the:
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Governing body
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30) The charge nurse is considered
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Line level management
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31) McGregor’s Theory X and Theory Y discuss individual’s:
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Employees’s attitudes towards work
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32) Decision making requires all of the following except:
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Controlling behavior
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33) Public relations has been defined as:
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The management of communications
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34) Strategic Planning is:
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Long term plans based on the organizations overall business objectives
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35) Marketing should:
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Increase and maintain census
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36) Keys to success in reducing turnover are all except:
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Scheduling
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37) Which is not a recognized type of management?
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Scalar Chain Management
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38) Unity of Command is:
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Each person reports to one supervisor
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39) Speed is a communication barrier because, on average, a person speaks 180 words per minute, but thinks at:
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300 words per minute
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40) The most overlooked aspect of communication in health facilities is:
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Two way feedback loops
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41) Of the following, the task management performs that contribute most effectively and positively to morale is:
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Discipline consistentlyr and fairly
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42) In a bargaining unit, only ____ need to sign a card to call a union election:
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30 percent
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44) During an interview or on a job application, you may ask for all except:
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Place of Birth
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45) To be eligible for FMLA, an employee must first work
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1250 hours in the last 12 months
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46) If an employee works 52 hours in one week at a rate of $7 per hour, what would be the total gross salary?
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$406
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47) Fire safety regulations come primarily from:
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LSC Life Safety Code
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48) The purpose of an enunciator panel is to:
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Indicate the zone of a fire
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49) Generators must be checked
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montly
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50) Employee’s Right to know refers to
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Hazardous communicatins
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51) The primary fire – defense tools of a nursing home staff are:
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Smoke barriers, corridor walls, and resident rooms
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52) A maintenance program that saves time and money focuses on:
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Preventive maintenance
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53) Class C fires involve:
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Electricity
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PHYSICAL ENVIRONMENT ANT ATMOSPHERE
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PHYSICAL ENVIRONMENT ANT ATMOSPHERE
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54) Indoor temperatures
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71 – 81 degrees ferinhight
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55) Disaster plans
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OBRA requirement for written plan
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56) Life Safety Code
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Reasonably ensure the public protection from fire in public buildings
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57) MSDS
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Information on potentially hazardous material
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58) OSHA
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federal agency overseeing employee safety
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59) NFPA
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establishes LSC
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60) Personnal Protective Equipment
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gloves
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61) Preventative measures
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time for schedules repairs
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62) Offer HBV
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within 10 working days
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63) Smoke compartments
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200 feet or less
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64) Occupant loads for exit requirements:
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one person per 120 sq ft of floor area in sleeping areas and one person per 240 sq ft in treatment areas
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65) Means of Egress Requirements Emergency lighting:
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Mandatory and Automatically available not requiring manual intervention for continuous operation when power is interupted
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66) Means of Egress Requirements Exit Marking:
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clearly marked with signs no more than 100 feet from exit
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67) Emergency Power:
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Check generator weekly, test under full load for 30 minutes monthly
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68) Handrails at bottom of stairs must be:
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extended parallel to floor for 12 inches
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69) Windows must have opening force requirement:
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of no more than 5 lbs.
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70) Generator should provide for full load for
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4 hours, under emergency power need
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71) Resident rooms
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No more than 4 residents per room 80 sq ft per resident in multi-bed rooms 100 sq ft in private room window to outside
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72) OBRA requires housekeeping services necessary to
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maintain a sanitary, orderly, and clean interior
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73) Exposure Control Plan must be updated
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Annually
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HUMAN RESOURCES
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74) Bargaining Unit
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Workers identified by NlRB to form a group to unionize
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75) Construct Validity
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Extent to which a tool measures a trait important to job performance
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76) Line management
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Performs personnel functioned, delegated authority to make decisions
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77) Skill Analysis
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identification of attributes required to
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78) Task Analysis
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review of job description
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79) Employee Handbook
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Policies related to work conditions
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80) Career Path
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Avenues for upward mobility within organization
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81) Progressive Discipline
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Use of specific number and type of warnings
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82) Job description
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list of duties and responsibilities
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83) COLA
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Group of temporary workers
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84) Election for unionization
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Conducted by NLRB
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85) FLSA
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minimum wage
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86) Halo Effect
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One trait colors all performance
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87) In-Out migration
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Movements of workers in and out of geographic area
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88) Pool
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Group of temporary workers
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89) Labor Market
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geographic area of recruitment
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90) Union election
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NLRB conducts; 50% plus 1 potential bargaining unit members VOTING wins
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LEADERSHIP AND MANAGEMENT (23% – 35 questions)
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91) Strategic Planning
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setting long term goals
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92) Case mix
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residents categorized by acuity
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93) Governing body
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legally responsible for management
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94) Tactical planning
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selecting goals for one year
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95) Management
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achieve common goals thru organization
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96) Market segment
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potential users of services
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97) Payor mix
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residents categorized by payment type
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98) Rules
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commands for action or non-action
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99) Procedures
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required methods for handling activities
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100) Risk management
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proactive means of anticipating problems
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101) Staff authority
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advisory relationship with line management
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102) Forecasting
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projects trends and needs which facility management must decide in future economic, social and political environment expected and resources available.
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103) Bench Marking
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improve business by comparing with best practice of others (standards from which you measure)
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104) Upper-Level management
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responsible for the overall functioning of the facility, normally interacting directly with the Board of Directors and/or owners.
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105) Middle-Level management
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report to upper-level while interacting with lower-level (DON)
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106) Lower-level management
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directly supervise the staff who do the actual work
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107) Line Position (Authority):
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empowered by administrator to make decisions for organization (DON can fire, fire, give orders)
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108) Staff Position (Authority)
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not empowered to make decisions; duties are primarily to advise (consultants, pharmacists, accountants, etc.)
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109) Functional Authority
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action outside the normal lines of authority 1. Violates unity of command 2. Necessary due to principle of exception The two often have edges of distinction blurred
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110) Actionable
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conduct giving rise to legal action
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111) Aggrieved party
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one whose rights invaded or who suffered injury
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112) Burden of proof
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obligation of person bringing action
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113) Liable
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written defamation
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114) Slander
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verbal defamation
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115) Malice
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intentional doing of wrongful act
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115) Tort
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a wrong: legal duty owed, breached, and harm occured
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116) Worker Comp:
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responsible for injuries occurring at work
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117) Scope of Employment:
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range of employee activities (resident services by omission or commission)
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118) Governing:
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excersis authority
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119) Advisory:
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not binding
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120) Stewardship:
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accumulation and use of assets
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121) Planning and monitoring:
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goals and progress
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122) Determining Facility Objectives:
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measurable, verifiable, and attainable
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123) Governing Body:
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Approval of P & P Approval of budget Selection and Appraisal of Administrator
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FINANCE (14% – 21 questions)
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124) Accounting Equation
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Assets = Liabilities + Capital
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125) Accounts payable
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Amounts owed by facility
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126) Balance Sheet
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Statement showing solvency
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127) Solvency
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the ability of a corporation to meet its long term fixed expenses and to accomplish long-term expansion and growth
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128) General ledger
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Summaries entries in each journal for accounting period
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129) Cost Center
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Organizational unit whose costs are separately accumulated
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130) Accrual
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Record revenue when entered; expenses when incurred
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131) Functional Accounting
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Recording aggregated data for related activities
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132) Aggregated
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formed by the conjunction or collection of particulars into a whole mass or sum; total; combined
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133) Contractual Discount
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Uncollectible difference between charges and third party payor agreements
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134) Depreciation
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spreading of cost of capital assests over useful life
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135) Operating Statement
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total revenues – total expenses =net income (loss)138)
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136) Working Capital
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Current assets – current liabilities
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137) Entity Concept:
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The facility, its records and monies are separate from owners. Ensuring consistency in accounting through full ownership disclosure.
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138) On-Going Concern:
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The facility will continue to operate INDEFINITLEY
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139) Consistency:
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The accounting reports will be prepared in the same way year to year to allow the facility to compare history to determine risks, and allow for clarity
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140) Full Disclosure:
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All information must be shown in financial records accurately reflecting the financial standing of the facility
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141) Cash Accounting:
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Expenses are recorded when cash disbursed and revenues are recorded when money received. (Recorded money as it flows in and out of facility. Similar to checkbook) A. Advantage: Simplicity B. Disadvantage: Does not recognize depreciation, accounts receivable, or payable
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142) Time period:
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Accounting period (12 months) will be consistent year to year
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143) Objective Evidence:
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Accounting records are prepared with documentable records kept by facility (Audit Trail)
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144) Accrual Accounting:
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Revenues are recognized when they are earned and expenses when they are incurred, regardless of when cash transactions take place. A. Advantage: Measure revenues earnings after expenses incurred; include depreciation, AP and AR B. Disadvantage: Complexity
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145) Chart of accounts:
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list of every account organized into: Assets, Liabilities, Capital, Revenue, Expenses
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146) Assets:
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things the facility OWN
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147) Liabilities:
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things the facility OWES
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148) Capital:
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Net worth or fund balance
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149) Revenues:
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Earnings
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150) Expenses:
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cost of personnel and supplies used in provision of service
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151) Journals:
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books of original entry (the first place transactions are recorded) Cash receipts, billing, accounts payable (purchases), cash disbursements, payroll, general.
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152) General:
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non-repetitive entries. Used to make adjustments to conform to accrual system.
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153) Double entry:
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two entries for each transaction DEBIT and CREDIT
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154) General Ledger:
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summary of all debits and credits contained in all the journals for the time period. 1. Continuous balance for each account monthly 2. Basis for “trail balance”
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156) Financial Statement:
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summary of all transactions made in a particular time period and their effect on the finances of the facility.
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157) Handling Cash
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Two person procedure; one receives by opening mail or taking in person; the other prepares bank deposit
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158) Collections
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policy for deliquent bills. MUST BE CONSISTENT with all payment types; in not facility could be charged with fraud.
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159) Payroll
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largest expense (50-70% of operational) controlled by administration separate bank account
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160) Residents’ Accounts (Trust fund)
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Legally must provide Safe for cash and valuables Separate accounting Interest Bearing – amounts over $50.00
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161) Cost Per Patient Day =
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Total cost/census days
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RESIDENT CARE & QUALITY OF LIFE (35% – 52 questions)
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162) Nursing Assistant Training
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75 hour course and exams plus continuing in service
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164) Excess Disability
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Avoidable Dysfunction
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165) PASAAR
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Insures appropriate treatment for MR/MI population
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166) Function
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Focus of Rehab
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167) Pharmacist
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Monthly drug review/Audits
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168) Basis for Menu
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Basic 4 plus recommended daily allowances
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168) Nursing Assistants
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Provide most direct care
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169) OBRA ^87
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Conditions to participate in Medicare and Medicaid
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170) MDS
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Comprehensive Assessment within 14 days of admission
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171) Physician Extenders
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Nurse Practitioner, Clinical Nurse Specialist or Physician Assistant
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172) Licensed Nurse
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Charge Nurse on each tour of duty
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173) Time between Super and Breakfast
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14 hours
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174) RN Coverage
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8 consecutive hours, 7 days per week
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175) Frequency of Activities
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7 days per week during hours requested
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176) Frequency of Doctor Visits
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Every 30 days for first 90 days, then every 60 days
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177) Access to records
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24 hours of request
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178) Care Plans
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21 days after admissions
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179) Required in service for CENA
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12 hours per year
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180) QA meetings
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Quarterly
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181) Work before NA certified
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4 months
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182) Interest Bearing accounts
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trust funds greater than $50
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183) Involuntary Transfer Notice
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30 days
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184) CVA
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Stroke
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185) COPD
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Emphysema, Asthma, Bronchitis
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186) ac
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before meals
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187) Meal service:
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Key to high resident morale. 3-5 meals per day with no more than 14 hours btw evening meal and next breakfast (16 if HS snack)
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188) Dishwashing
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wash at 150 to 1600 degrees F
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189) Hot food tray
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leave tray line above 140 degrees F
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190) Cold food
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leave tray line at less than 41*F
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191) Freezer
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0* – 20* F
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192) Refrigeration
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32* – 45*F
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193) Storage
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room temperature
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194) RDA
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Recommended Daily Allowance Bread: 4 servings Fruit/veggies 2 cups Meat: 4 oz Milk: 2 cups
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195) Quality Assurance Committe
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DON, a physician, and 3 other staff members A. Care plan B. Infection Control C. Pharmacy Committee D. Safety Committe
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196) Administration
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A. License B. Compliance with standards and regulations C. Governing body D. Nurse Aide Training E. Medical Director F. Laboratory Services G. Radiology Service H. Clinical Services I. Disaster Plan J. Transfer Agreement K. Quality assurance L. Disclosure
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The most likely cause of for series of bankruptcies among larger nursing home chains around the year 2000 was
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Paying too much for acquisitions in 1998 and 1999
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In a chance conversation with the owner of an eight-facility chain, the newly hired administrator for the oldest facility in the chainindicates that, since the mortgage ia fully retired, he will concentrate more on being effective then effecient since his Quality Indicators are all at or above his state’s average. The owner would likely
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Be distressed
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Occupancy of Facility A has been a steady 70% since Prospective Payment System was introduced. Two weeks ago, a new 120-bed equally equipped facility opened several blocks away. The facility A administrator tells the admissions counselor to continue the usual recruitment approach. The chain owners ought to
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Seek a new administrator
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Bankruptsy among larger nursing home chains prior to 2000
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Were highly unusual
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Under the Prospective Payment System, nursing facilities reimbursed costs
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Were never bundled
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In recent years Medicare has
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shifted more cost onto nursing facilities
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The nurse newly promoted to director of nurses (DON) insist on giving four RN hours of patient care each day on the Alzheimer’s wing in the 175-bed facility. The administrator should
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Seek a new DON
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The applicant for the administrator position in a facility near a larger teaching hospital who insists that, if hired, as before with his rural facility, he would not let Medicare reimbursement policies affect his case mix
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Is out of touch
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The newly hired assistant to the administrator insists the organizational chart line btw his position and the Department of Nursing be a solid line. The administrator should
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Be forwarned
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The medical supplies provider tells the administrator of the facility that has not paid bills the past 3 months, but is now operating under bankruptcy juge’s approved plan for restructuring, that no more deliveries will be made until past bills are fully paid. The medical supply provider
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does not understand how bankruptsy works
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An administrator who adopts the management-by-walking-around (MBWA) approach by walking through the facility and intently observing weekly has
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Failed to understand MBWA
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Management-by-walking-around (MBWA)
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style of business management which involves managers wandering around, in an unstructured manner, through the workplace(s), at random, to check with employees, or equipment, about the staus of ongoing work
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The nursing home administrator who, using the management-by-walking-around (MBWA) technique, succeeds in atually making appropriate corrections on the spot during his rounds
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Doesnt understand (MBWA)
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The applicant for administrator of the facility insist that he has succcessfuly used democrate leadership to the exclusion of all other leadership styles. The intervier should
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continue to interview candidates
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The candidate for administrator said she used a variety of administrative styles, but could’t say exactly which she would use in every circumstance. The interviewer should be
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favorable impress
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The candidate for administrator indicated that she consistently choose the charismatic style of leadership. This should __________the interviewer.
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Alert
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The cost of providing subacute care to nursing home residents _________
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Is perhaps triple that of more typical patient
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The nurse supervisor who had just been appointed DON announced at the first department head meeting that she had circulated a memo among the nurses that only formal communications were to be allowed in the nursing department. The administrator should
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Anticipate problems
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The department head was not surprised to learn that the employee had only heard his positive comments to the employee and ignored his criticism. The department head’s grasp of the communicationn process is
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Appropriate
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The administrator routinely accepted as his nearly exclusive information source the director of nursing’s positive reports on how nursing was going well. The administrator is
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Placing him at risk
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Periodic shortage of nurses available for nursing home employment _________
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Is likely to remain for the foreseeable future
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Congress and the Federal rule makers behave as if the facility will run successfully if congress and CMS can write enough rules. They are
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Incorrect
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When the administrator notices the DON seeks to turn many duties as possible over to housekeeping, the administrator should conclude that the DON is
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Behaving normally
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The administrator insist that a timely copy of all reports generated within the facility come across her desk before anyone signs them. The administrator is _______
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Not rationalizing her managemnt information system
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The administrator notices that incident reports are being insufficiently filled out, but does nothing, believing that the situation will likely correct itself. The administrator is ______
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Failing to control effectively
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Corporate sends a directive its flagship facility administrator, directing the administrator’s attention more towards outcome of resident care than cost of resident care during the coming 12 months. Corporate is more concerned with __________than with _________.
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Effectiveness/efficiency
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The long term care sector receiving increased funding and attention from the federal government is the ________________.
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Home health care sector
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The concept that nursing homes should be reimbursed by states for their actual costs was part of the _______
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Hatch Amendment
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The intense health care cost-shifting efforts among providers such as Medicare, Medicaid and local governments is _____________
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Likely to continue
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Worried about the level of actual resident care being achieved in the facility, the administrator directs the nurses to spend less time charting and more time focusing on the effeciveness of care being given to residents. The likely result will be ________
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Better resident care, possible increase in deficiency citations
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The new social worker informs the head of nursing that admissions is all she has time for and that nursing must monitor and document each resident’s socipsychological experience.
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Responding appropriately to priorities
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Attempting to find the right person for each well-defined job is known as the management function of __________
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The administrator who takes steps that insure the goals are accomplished and that each job is done as planned is successfully ______________
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Controlling quality
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The administrators’ job is to assure that the ________employees do the tasks of the organization at an acceptable quality level.
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Appropriate
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The administrator who conducts a national search for a director of nursing position and interviews 20 candidates from 7 different surrounding states by phone is engaged in the managerial function of ______
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Staffing
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Corporate sends a directiveto its flagship facility administrator, directing the administrator’s attention more towards outcome of resident care than cost of resudent care during the coming 12 months. Corporate is more concerned with ______than with _____.
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Effectiveness/efficiency
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The long-term care receiving increased funding and attention from the federal government is the _______.
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Home health care sector
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The concept that nursing homes should be reimbursed by states for their actual cost was part of the _____.
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Hatch Amendment
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The intense health care costshifting efforts among providers such as Medicare, Medicaid, and local governments is ____.
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Likely to continue
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Worried about the level of actual resident care achieved in the facility, the administrator directs the nurse to spend less time charting and more time focusing on the effectiveness of care being given to the residents. The likely result will be___
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Better resident care, but increased deficiency citatons
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The new social worker informs the head of nursing that the admissions is all she has time for and that nursing must monitor and document each resident’s socipsychological experiences. The new social worker is _____
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Responding appropriately to prorities
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Attempting to find the right person for each well-defined job is known as the managementfunction ______
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Staffing
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The administrator who takes steps that assures the goals are accomplished and that each job as planned is successful __
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Controlling quality
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The administrator’s job is to assure that the ____employees do the task of the organization at an acceptable quality level.
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Appropriate
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The administrator who conducts a national serch for a director of nursing position and interviews 20 candidates from 7 different surrounding states by phone is engaged inthe managerial function of ______
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Staffing
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In the end, it can be said that the administrator’s responsiblity to meet resident care needs and facility needs ae ______
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Both are equal
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Superior performance depends on taking exceptional care of residents via superior service and _____
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Constant innovations
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Superior performance for a nursing facility comes through __
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Innovation in ways to serve residents
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The supeb nursingb facility is supurb by virtue of its ____
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Success in serving the residents
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Answering the phones and resident call bells with common courtesy and doing things that work are examples of ______
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A blind flash of the obvious
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Giving every employee the space to innovate at least a little; listening to residents and acting on their ideas; and wandering around with residents, staff, and suppliers are examples of the different-to-achieve ________
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Common sense, obvious
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In a facility of 120 beds, the administrator ____personally performs each of the management tasks.
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Need not
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To assure that all the management tasks are successfully accomplished, the administrator of a 120-bed facility will typically divide management into _____
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Three layers
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A licensed person responsible for formulating and enforcing policies that will be applied to an entire facility is thought of as a/an ____
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Upper-level manager
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The staff member responsible for reporting to upper-level management and at the same time interacting significantly with several lower-level managers is the ______
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Director of Nursing
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The staff person for whom both upward and downward communication skills are most neccessary is the ____
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Director of nursing
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When the director of nursing makes an effective policy decision without consulting the administrator, that impacts all nursing personnel, the administrator should ______
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Be pleased
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In the typical nursing facility, the decision-making process is _______ establishment of lower, middle, and upper levels of management.
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Noticeably more complicated than the simple
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Among the following positions the _____has no authority to make decisions for the facility.
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Assitant to the Administrator
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Decisions made by persons on the staff to whom the administrator has deligated line authority are, in the final analysis, regaurded as decisions by ______.
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The administrator
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When a nurse practitioner, who is more highly qualified than the director of nursing, gives orders in the hallways, the director of nursing should feel _______
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Undermined
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In times of crisis, corporate representatives, who hold a staff or advisory relationship to their counterparts in the local facility, may expect that their advice as staff be _________
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Acted on as carrying line authority
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As a generalization, it can be asserted that management success belongs to those who ____
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success prepared for the future
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Nursing home administrators should anticipate and successfully prepare for ______
answer

Rapid change
question

The long-term care industry entered a period in which _____chang(s) can be expected.
answer

Rapid and far reaching

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