New nursing -managerial decision making exam questions with
answers 2022 update
MULTIPLE CHOICE
1. 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.
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
,New nursing -managerial decision making exam questions with
answers 2022 update
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 definition of the 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
,New nursing -managerial decision making exam questions with
answers 2022 update
7. 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
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
, New nursing -managerial decision making exam questions with
answers 2022 update
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
answers 2022 update
MULTIPLE CHOICE
1. 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.
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
,New nursing -managerial decision making exam questions with
answers 2022 update
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 definition of the 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
,New nursing -managerial decision making exam questions with
answers 2022 update
7. 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
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
, New nursing -managerial decision making exam questions with
answers 2022 update
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
