Part 1: NAB Domain: Management, Governance, and Leadership

Question 1

The most likely single cause for the series of bankruptcies among larger nursing home chains around the year 2000 was _____.

1. Too small increases in government reimbursement rates
2. Paying too much for acquisitions in 1998 and 1999
3. Not taking advantage of falling interest rates
4. Thinking too small

Answer 1

2. Paying too much for acquisitions in 1998 and 1999

Question 2

In a chance conversation with the owner of an eight-facility chain, the newly hired administrator for the oldest facility in the chain indicates that, because the mortgage is fully retired, the administrator will concentrate more on being effective than efficient since the Quality Indicators are all at or above the state’s average. The owner would likely ______.

1. Be pleased
2. Be distressed
3. Be content
4. Praise the newly hired administrator

Answer 2

2. Be distressed

Question 3

Occupancy of Facility A has been a steady 70% since the 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 ______.

1. Rest comfortably
2. Seek a new administrator
3. Appoint a new admissions counselor
4. Take no action

Answer 3

2. Seek a new administrator

Question 4

Bankruptcies among larger nursing home chains prior to 2000 ______.

1. Were frequent
2. Were ubiquitous
3. Were highly unusual
4. Were routinely declared to avoid too much accumulated debt

Answer 4

3. Were highly unusual

Question 5

Under the Prospective Payment System, nursing facilities’ reimbursed costs ______.

1. Were about the same as previously
2. Were more bundled
3. Used an unbundled cost structure
4. Were reimbursement for actual costs

Answer 5

2. Were more bundled

Question 6

In recent years, Medicare has _____.

1. Allowed facilities to make a modest profit
2. Shifted more costs onto nursing facilities
3. Eased up on economic pressures previously placed on facilities
4. Remained relatively unchanged in its reimbursement structure

Answer 6

2. Shifted more costs onto nursing facilities

Question 7

The nurse newly promoted to director of nursing insists on giving four RN hours of patient care each day on the Alzheimer’s wing in the 175-bed facility. The administrator should ______.

1. Praise the new director of nursing for her resident centeredness
2. Appoint an assistant director of nursing
3. Adapt the job description to her pattern
4. Seek a new director of nursing

Answer 7

4. Seek a new director of nursing

Question 8

The applicant for the administrator position in a facility near a large teaching hospital insists that, as before in his rural facility, if hired he would not let the Medicare reimbursement policies affect his case mix. This applicant _____.

1. Should be hired
2. Is likely to succeed in his goals
3. Can likely succeed in his goal
4. Is out of touch

Answer 8

4. Is out of touch

Question 9

The newly hired assistant to the administrator insists that the organization chart dotted between this position and the Department of Nursing be a solid line. The administrator should _____.

1. Agree in general
2. Agree to this special case
3. Ask the director of nursing for his or her opinion
4. Be forewarned

Answer 9

4. Be forewarned

Question 10

The medical supplies provider tells the administrator of a facility that has not paid bills for the past 3 months but is not operating under a bankruptcy judge’s approved plan for restructuring, that no more deliveries will be made until past bills are fully paid. The medical supplies provider ______.

1. Is smart to cut losses at that point
2. Does not understand how bankruptcy works
3. Will now likely get his past due bills paid
4. Is farsighted

Answer 10

2. Does not understand how bankruptcy works

Question 11

An administrator who adopts the leadership-by-walking-around (LBWA) approach by walking through the facility weekly and intently observing has _____.

1. Become an effective leader
2. Chosen a good management style
3. Failed to understand LBWA
4. Implemented a useful strategy

Answer 11

3. Failed to understand LBWA

Question 12

The nursing facility administrator who, using the LBWA technique, succeeds in actually making appropriate corrections on the spot during her rounds _____.

1. Is effectively implementing the concept
2. Gains additional power through the process
3. Exhibits appropriate leadership
4. Does not understand LBWA

Answer 12

4. Does not understand LBWA

Question 13

The rate of increase in the total number of nursing facilities in the US during the years 2008 to 2012 is _____.

1. Likely to be about level
2. Likely to double
3. Likely to triple to accommodate the baby boomer generation
4. Likely to decrease markedly

Answer 13

1. Likely to be about level

Question 14

The applicant for administrator of the facility insists that he has successfully used democratic leadership to the exclusion of all other leadership styles. The interviewer should ______.

1. Recommend hiring this candidate
2. Praise the candidate
3. Be favorably impressed
4. Continue to interview candidates

Answer 14

4. Continue to interview candidates

Question 15

The candidate for administrator said that she used a variety of administrative styles, but could not say exactly which she would use in every circumstance. The interviewer should be _____.

1. Favorably impressed
2. Unfavorably impressed
3. Concerned about possible indecisiveness
4. Looking for one leadership style

Answer 15

1. Favorably impressed

Question 16

The candidate for administrator indicated that he consistently chose the charismatic style of leadership. This should _______ the interviewer.

1. Reassure
2. Alert
3. Confirm the candidate’s qualifications to
4. Please

Answer 16

2. Alert

Question 17

The costs of providing subacute care to nursing home residents _______.

1. Is perhaps triple that of the more typical patient
2. Covered by Medicare
3. Absorbed by Medicaid if Medicare coverage is inadequate
4. Mostly covered by private insurance

Answer 17

1. Is perhaps triple that of the more typical patient

Question 18

The nurse supervisor who had just been appointed director of nursing announced that only formal communications were to be allowed in the nursing department. The administrator should ______.

1. Be relieved
2. Confirm the decision
3. Be supportive
4. Anticipate problems

Answer 18

4. Anticipate problems

Question 19

The department head was not surprised to learn that an employee had heard only the positive comments to the employee and ignored the criticisms. The department head’s grasp of the communication process is ______.

1. Deficient
2. Appropriate
3. Out of focus
4. Inadequate

Answer 19

2. Appropriate

Question 20

The administrator routinely accepted as a nearly exclusive information the director of nursing’s positive reports that nursing was going well. The administrator is ______.

1. Showing appropriate confidence in the DON
2. Utilizing the DON properly
3. Realizing a successful appointment has been made
4. Placing himself at risk.

Answer 20

4. Placing himself at risk

Question 21

Periodic shortage of nurses available for nursing home employment ______.

1. Is being solved by community college programs
2. Is decreasing
3. Can be readily solved by hiring temporary nurses
4. Is likely to remain for the foreseeable future

Answer 21

4. Is likely to remain for the foreseeable future

Question 22

Congress and the federal rule makers behave as if the facility will run successfully if Congress and CMS can write enough rules. They are ______.

1. Incorrect
2. Correct, according to behavior theory
3. Pessimistic about the need for rules
4. Correct, according to emerging management theory

Answer 22

1. Incorrect

Question 23

When the administrator notices that the DON seeks to turn as many duties as possible over to housekeeping, the administrator should conclude that the director of nursing is _______.

1. Behaving normally
2. Holding a grudge against housekeeping
3. Unwilling to be cooperative
4. Wielding power desirably

Answer 23

1. Behaving normally

Question 24

The administrator insists that a timely copy of all reports generated within the facility come across her desk before anyone signs them. The administrator is ______.

1. Not rationalizing her management information system
2. Making appropriate and desirable requests
3. Exercising good judgement
4. Initiating an appropriate management information system

Answer 24

1. Not rationalizing her management information system

Question 25

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 ______.

1. Practicing effective control
2. Likely to be correct
3. Failing to control effectively
4. Right to monitor the situation for a period of time

Answer 25

3. Failing to control effectively

Question 26

Corporate sent a directive to its flagship facility administrator that more attention should be given toward the outcome of resident care than the cost of resident care during the coming 12 months. Corporate is more concerned with ______ than with ______.

1. Effectiveness; efficiency
2. Efficiency; effectiveness
3. Expenses/inputs
4. Expenses/throughput

Answer 26

1. Effectiveness; efficiency

Question 27

The long-term care sector receiving increased funding and attention from the federal government is the ______.

1. Home health care sector
2. Volunteer hospice group association
3. Long-term care hospital sector
4. Private insurance industry

Answer 27

1. Home health care sector

Question 28

The concept that nursing homes should be reimbursed by states for their actual costs was part of the ______.

1. Emerging Medicare approach
2. Federal administration’s goal as seen in new budgetary appropriations
3. Hatch Amendment
4. Goal statements of most state governments

Answer 28

3. Hatch Amendment

Question 29

The intense healthcare cost-shifting efforts among providers such as Medicare, Medicaid, and local governments are ______.

1. On the wane
2. Likely to continue
3. Leading to increased reimbursements
4. Good for the nursing home profession

Answer 29

2. Likely to continue

Question 30

Worried about the level of actual resident care being achieved, the admin directs nurses to spend less time charting and more time focusing on the effectiveness of care being given to residents. The likely result will be _____.

1. Better resident care, possibly increased deficiency citations
2. Better resident care, decreased deficiency citations
3. No real improvement in resident care, decreased charting
4. Greater sensitivity to residents’ needs and better documentation

Answer 30

1. Better resident care, possibly increased deficiency citations

Question 31

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 socio-psychological experiences. The new social worker is _____.

1. Responding appropriately to priorities
2. Achieving a better balance of assignment within the facility
3. Responding inappropriately
4. Likely to improve the case mix dramatically

Answer 31

3. Responding inappropriately