In zero-based budgeting, the nurse manager:

Justifies every expense afresh, as if starting from nothing

Lets the budget change with the patient census

Adds a fixed percentage to last year's figures

Plans only for the purchase of major equipment

A staff nurse with five years' ICU experience can run the new dialysis machine well but is anxious and unsure about taking charge of it alone. Using Hersey and Blanchard's model, which style should the ICU in-charge use?

Participating: low direction, high support

Delegating: low direction, low support

Telling: high direction, low support

Selling: high direction, high support

Nursing management, leadership and quality

35 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Nursing management, leadership and quality, part of Nursing Management and Education. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
In zero-based budgeting, the nurse manager:
1. AJustifies every expense afresh, as if starting from nothing
2. BLets the budget change with the patient census
3. CAdds a fixed percentage to last year's figures
4. DPlans only for the purchase of major equipment
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Answer: A · Justifies every expense afresh, as if starting from nothing
Zero-based budgeting starts each budget period from zero, and every programme and expense must be justified again before money is given. It stops old, unneeded spending from carrying forward year after year. It takes more time to prepare than incremental budgeting. It is useful when funds are tight and priorities must be reviewed.
- B: A budget that changes with census or volume is a flexible budget.
- C: Adding a percentage to last year's figures is incremental budgeting.
- D: Planning for major equipment is the capital budget.
Question 2 · Hard
A unit needs 14,000 hours of nursing care a year. Each full-time post provides 2,000 paid hours a year, of which 20% is leave and other non-productive time. How many full-time equivalents (FTE) does the unit need?
1. A5.60 FTE
2. B8.75 FTE
3. C7.00 FTE
4. D8.40 FTE
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Answer: B · 8.75 FTE
Productive hours per FTE = 2,000 x 0.80 = 1,600 hours. FTE needed = 14,000 / 1,600 = 8.75. Dividing by all 2,000 paid hours gives 7.0, which ignores leave. Multiplying 7.0 by 0.8 gives 5.6 (the wrong direction), and adding 20% to 7.0 gives 8.4, which understates the need because the reserve must be calculated on productive hours.
- A: 5.6 multiplies by 0.8 instead of dividing, reducing staff instead of adding.
- C: 7.0 uses paid hours and ignores the 20% non-productive time.
- D: 8.4 adds 20% to 7.0 instead of dividing by the 80% productive time.
Question 3 · Hard
A 30-bed medical ward runs three 8-hour shifts. Hospital policy is one staff nurse to 6 patients in each shift, and a 30% leave reserve is added. How many staff nurse posts does the ward need?
1. A20
2. B24
3. C15
4. D7
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Answer: A · 20
Nurses needed per shift = 30 / 6 = 5. For three shifts, 5 x 3 = 15 nurses on duty in 24 hours. Leave reserve = 30% of 15 = 4.5, so the total is 19.5, rounded up to 20 posts. Forgetting the reserve gives 15, forgetting the shifts gives 7, and taking 30% of the beds instead of the nurses gives 24.
- B: 24 adds 30% of the beds (9) instead of 30% of the nurses.
- C: 15 is the on-duty number only, without the leave reserve.
- D: 7 comes from adding the reserve to one shift's nurses (5 x 1.3) and ignoring the other shifts.
Question 4 · Hard
A nurse manager wants staff to adopt a new hand-hygiene audit. She holds group discussions, lets the staff reshape the plan, and works on their attitudes and group norms so that they own the change. Which change strategy is she using?
1. APower-coercive
2. BEmpirical-rational
3. CNormative-re-educative
4. DEnvironmental-adaptive
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Answer: C · Normative-re-educative
Chin and Benne described three main change strategies. The normative-re-educative strategy assumes that people act on their values and group norms, so change comes through participation, discussion and re-education. The empirical-rational strategy assumes people will change once they are shown facts that the change is in their interest. Power-coercive change relies on authority, rules and sanctions.
- A: Power-coercive change is imposed through authority or sanctions.
- B: Empirical-rational change relies on giving information and evidence, not on reshaping group norms.
- D: Environmental-adaptive change alters the setting around people rather than working through the group.
Question 5 · Hard
A staff nurse with five years' ICU experience can run the new dialysis machine well but is anxious and unsure about taking charge of it alone. Using Hersey and Blanchard's model, which style should the ICU in-charge use?
1. AParticipating: low direction, high support
2. BDelegating: low direction, low support
3. CTelling: high direction, low support
4. DSelling: high direction, high support
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Answer: A · Participating: low direction, high support
Hersey and Blanchard match style to the follower's readiness: ability plus willingness or confidence. This nurse is able but insecure, which is moderate-to-high readiness (R3). She needs little instruction but much encouragement, which is the participating style (S3). Telling or selling would give unneeded instruction, and delegating would leave her without the support she lacks.
- B: Delegating suits a nurse who is both able and confident.
- C: Telling suits a follower who is unable and insecure, not a skilled nurse.
- D: Selling suits a willing follower who still lacks skill.
Question 6 · Medium
A nurse in a hospital project team reports both to her ward's nursing superintendent and to the project manager. This structure is a:
1. ALine organisation
2. BMatrix organisation
3. CFunctional organisation
4. DLine and staff organisation
Answer and explanation in LearnFree account
Question 7 · Medium
A doctor's written order is for digoxin 2.5 mg orally, ten times the usual dose. If the nurse gives it without question and the patient is harmed, the legal position is that:
1. ANo one is liable, because a written order was followed
2. BOnly the doctor is liable, because he wrote the order
3. COnly the hospital is liable, under vicarious liability
4. DThe nurse is also liable, as she should have questioned the order
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Question 8 · Hard
A ward plots its monthly fall rate per 1,000 patient days on a control chart: mean 3.0, upper control limit 5.4, lower control limit 0.6. Eleven months lie between 1.8 and 4.2, scattered evenly about the mean; June is 6.1. What is the best interpretation?
1. AAll months show only common-cause variation
2. BJune shows special-cause variation to be investigated
3. CThe whole process must be redesigned at once
4. DThe limits should be widened to include June
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Question 9 · Easy
What best describes accreditation of a hospital by NABH?
1. AA voluntary external assessment against set standards
2. BAn internal audit done by the hospital's own staff
3. CA one-time inspection with no need for renewal
4. DA compulsory licence issued by the state government
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Question 10 · Hard
On night duty, the nursing supervisor asks a staff nurse to care for 18 post-operative patients alone because two colleagues are on sick leave. The nurse believes this is unsafe. What is her most appropriate action?
1. ARefuse the assignment and go home at the end of her shift
2. BLeave some patients to the ward aide without supervision
3. CAccept, record her objection in writing and inform the supervisor
4. DAccept silently and give only the essential medicines
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Question 11 · Medium
A district committee spends its limited budget on immunisation for the whole district rather than on one costly transplant, because this does the greatest good for the greatest number. This reasoning is:
1. ADeontology
2. BVirtue ethics
3. CUtilitarianism
4. DEthical egoism
Answer and explanation in LearnFree account
Question 12 · Medium
A nursing auditor checks the care of patients who are still on the ward by reviewing their charts and talking to them and to staff. The main advantage of this concurrent audit over a retrospective audit is that:
1. AIt needs no access to the patient's records
2. BIt can be done only after the patient's death
3. CIt measures long-term outcomes after discharge
4. DFaults can be corrected while the patient is still in care
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Question 13 · Hard
A surgical ward tracks: the number of trained nurses on each shift; the percentage of patients given antibiotic prophylaxis within 60 minutes before incision; and the surgical site infection rate. Using Donabedian's model, how are these classified, in that order?
1. AStructure, outcome, process
2. BStructure, process, outcome
3. CProcess, structure, outcome
4. DOutcome, process, structure
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Question 14 · Medium
A terminally ill cancer patient is given morphine in doses large enough to control his pain, knowing that it may slightly shorten his life. Which ethical principle supports this?
1. ADouble effect
2. BPaternalism
3. CActive euthanasia
4. DDistributive justice
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Question 15 · Easy
Fayol's principle of 'esprit de corps' asks a nurse manager to:
1. AKeep every resource in its proper place
2. BPass communication through the chain of command
3. CBuild team spirit and harmony among her staff
4. DGive each nurse orders from only one superior
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Question 16 · Medium
PERT, used to plan the opening of a new cardiac unit, differs from a simple Gantt chart because PERT:
1. AShows activities only as bars on a calendar
2. BIgnores the order in which tasks depend on each other
3. CIs limited to controlling the unit's budget
4. DUses three time estimates for each activity
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Question 17 · Medium
In the NABH accreditation standards for hospitals, the procurement, storage, prescription and administration of drugs are covered by the chapter:
1. ACare of Patients (COP)
2. BFacility Management and Safety (FMS)
3. CInfection Prevention and Control (IPC)
4. DManagement of Medication (MOM)
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Question 18 · Hard
Workload record for one day: category I (minimal care) 8 x 2 h; category II (intermediate care) 10 x 4 h; category III (intensive care) 4 x 7 h. Productive time per nurse shift is 6 h. How many nurse shifts are required for the 24 hours, before leave reserve?
1. A11
2. B14
3. C10
4. D16
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Question 19 · Medium
Failure mode and effects analysis (FMEA) differs from root cause analysis (RCA) in that FMEA:
1. AInvestigates an event after a patient has been harmed
2. BIs used only for faults in medical equipment
3. CAssigns blame to the staff member who made the error
4. DLooks for possible failures before a process causes harm
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Question 20 · Easy
The Japanese quality philosophy that seeks continuous improvement through many small, everyday changes suggested by all staff is called:
1. ABenchmarking
2. BKaizen
3. CKanban
4. DBrainstorming
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Question 21 · Medium
Staff on a ward follow the advice of a nurse who is not their senior, because she is the unit's acknowledged wound-care specialist. Which type of power does she hold?
1. ALegitimate power
2. BExpert power
3. CReferent power
4. DCoercive power
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Question 22 · Easy
An unexpected occurrence in hospital that causes a patient's death or serious permanent harm, and that calls for an immediate root cause analysis, is termed a:
1. ANear miss
2. BNo-harm incident
3. CSentinel event
4. DAdverse drug reaction
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Question 23 · Medium
A hospital quality programme aims for 'Six Sigma' performance in its medication process. This target means no more than about:
1. A1 defect per hundred opportunities
2. B34 defects per million opportunities
3. C3.4 defects per million opportunities
4. D6 defects per thousand opportunities
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Question 24 · Medium
Elton Mayo's Hawthorne studies found that workers' output rose whether lighting was improved or reduced. What did the researchers conclude?
1. ABetter lighting is the key to productivity
2. BAttention and group relations affect productivity
3. CStrict supervision raises output most
4. DMoney is the only real motivator of workers
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Question 25 · Hard
In an FMEA of the transfusion process, four failure modes are scored for severity, occurrence and detection (each 1-10): A 9, 2, 2; B 5, 5, 4; C 7, 3, 1; D 4, 4, 4. Which failure mode should the team address first by risk priority number?
1. AB, with an RPN of 100
2. BD, because all its scores are equal
3. CC, because it is hardest to miss
4. DA, because its severity is highest
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Nursing management, leadership and quality

In zero-based budgeting, the nurse manager:

A unit needs 14,000 hours of nursing care a year. Each full-time post provides 2,000 paid hours a year, of which 20% is leave and other non-productive time. How many full-time equivalents (FTE) does the unit need?

A 30-bed medical ward runs three 8-hour shifts. Hospital policy is one staff nurse to 6 patients in each shift, and a 30% leave reserve is added. How many staff nurse posts does the ward need?

A nurse manager wants staff to adopt a new hand-hygiene audit. She holds group discussions, lets the staff reshape the plan, and works on their attitudes and group norms so that they own the change. Which change strategy is she using?

A staff nurse with five years' ICU experience can run the new dialysis machine well but is anxious and unsure about taking charge of it alone. Using Hersey and Blanchard's model, which style should the ICU in-charge use?

A nurse in a hospital project team reports both to her ward's nursing superintendent and to the project manager. This structure is a:

A doctor's written order is for digoxin 2.5 mg orally, ten times the usual dose. If the nurse gives it without question and the patient is harmed, the legal position is that:

A ward plots its monthly fall rate per 1,000 patient days on a control chart: mean 3.0, upper control limit 5.4, lower control limit 0.6. Eleven months lie between 1.8 and 4.2, scattered evenly about the mean; June is 6.1. What is the best interpretation?

What best describes accreditation of a hospital by NABH?

On night duty, the nursing supervisor asks a staff nurse to care for 18 post-operative patients alone because two colleagues are on sick leave. The nurse believes this is unsafe. What is her most appropriate action?

A district committee spends its limited budget on immunisation for the whole district rather than on one costly transplant, because this does the greatest good for the greatest number. This reasoning is:

A nursing auditor checks the care of patients who are still on the ward by reviewing their charts and talking to them and to staff. The main advantage of this concurrent audit over a retrospective audit is that:

A surgical ward tracks: the number of trained nurses on each shift; the percentage of patients given antibiotic prophylaxis within 60 minutes before incision; and the surgical site infection rate. Using Donabedian's model, how are these classified, in that order?

A terminally ill cancer patient is given morphine in doses large enough to control his pain, knowing that it may slightly shorten his life. Which ethical principle supports this?

Fayol's principle of 'esprit de corps' asks a nurse manager to:

PERT, used to plan the opening of a new cardiac unit, differs from a simple Gantt chart because PERT:

In the NABH accreditation standards for hospitals, the procurement, storage, prescription and administration of drugs are covered by the chapter:

Workload record for one day: category I (minimal care) 8 x 2 h; category II (intermediate care) 10 x 4 h; category III (intensive care) 4 x 7 h. Productive time per nurse shift is 6 h. How many nurse shifts are required for the 24 hours, before leave reserve?

Failure mode and effects analysis (FMEA) differs from root cause analysis (RCA) in that FMEA:

The Japanese quality philosophy that seeks continuous improvement through many small, everyday changes suggested by all staff is called:

Staff on a ward follow the advice of a nurse who is not their senior, because she is the unit's acknowledged wound-care specialist. Which type of power does she hold?

An unexpected occurrence in hospital that causes a patient's death or serious permanent harm, and that calls for an immediate root cause analysis, is termed a:

A hospital quality programme aims for 'Six Sigma' performance in its medication process. This target means no more than about:

Elton Mayo's Hawthorne studies found that workers' output rose whether lighting was improved or reduced. What did the researchers conclude?

In an FMEA of the transfusion process, four failure modes are scored for severity, occurrence and detection (each 1-10): A 9, 2, 2; B 5, 5, 4; C 7, 3, 1; D 4, 4, 4. Which failure mode should the team address first by risk priority number?