Chapter 20: Managing Client Care Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. It is necessary for the new nurse manager to delegate tasks to the staff. What is a requirement for the nurse manager in this delegation process?

a.

Obtaining the employees voluntary acceptance of the task

b.

Communicating the work assignment in understandable terms

c.

Functioning from a laissez-faire style of leadership

d.

Working alongside the staff to evaluate their care

ANS: b

b. When delegating, the nurse should always provide unambiguous and clear directions by describing a task, the desired outcome, and the period within which the task should be competed.

a. Tasks should be delegated to those who are capable, not necessarily to those who are willing.

c. A laissez-faire style of leadership is not a requirement for delegation.

d. The nurse manager does not necessarily have to work alongside staff to evaluate their care. The nurse manager can often evaluate staff performance in client outcomes.

REF: Text Reference: p. 380

2. To be able to meet the needs of assigned clients and the responsibilities associated with the position, nurses must be aware of time-management techniques. The time-management skills for the nurse include:

a.

Meeting all of the clients needs in the early morning hours

b.

Anticipating possible interruptions by therapists and visitors

c.

Doing each of the clients assessments and treatments individually at separate times throughout the day

d.

Leaving each day unplanned to allow for adaptations in treatments

ANS: b

b. To manage time, the nurse must anticipate when care will be interrupted for medication administration, any diagnostic testing, and when is the best time for planned therapies such as dressing changes, client education, and client ambulation.

a. This would be an unrealistic. Some activities have specific time limits in terms of addressing client needs, and some activities follow scheduled routines according to hospital policy. The nurse also may have to work around other schedules, such as if the client had a test ordered for the morning. Therefore the nurse cannot expect to meet all of the clients needs at a specified time of day.

c. Time management involves using client goals as a way to identify priorities. The nurse. in reviewing the care requirements, organizes his or her time so the activities of care and client goals can be achieved. A nurse should complete the activities started with one client before moving on to another.

d. Because the nurse has a limited amount of time with clients, it is essential to remain goal oriented and make a plan for using time wisely.

REF: Text Reference: p. 377

3. In anticipation of a nursing shortage, the nursing management in a facility is investigating a nursing care delivery model that involves the division of tasks, with one nurse assuming the responsibility for particular tasks. This model is called

a.

Total patient care

b.

Functional nursing

c.

Team nursing

d.

Primary nursing

ANS: b

b. Functional nursing is task focused, not client focused. In this model, tasks are divided, with one nurse assuming responsibility for specific tasks.

a. Total patient care is a model of care where an RN is responsible for all aspects of care for one or more clients. The RN may delegate aspects of care, but retains accountability for care of all assigned clients.

c. In team nursing, an RN leads a team that is composed of other RNs, LPNs or LVNs, and nurse assistants or technicians. The team members provide direct client care to groups of clients, under the direction of the RN team leader. Nurse assistants are given client assignments rather than being assigned particular tasks.

d. Primary nursing is a model of care delivery whereby an RN assumes responsibility for a caseload of clients over time. Typically the RN selects the clients for his or her caseload and cares for the same clients during their hospitalization or stay in the health care setting.

REF: Text Reference: p. 372

4. The medical center has changed its overall management philosophy from centralized to decentralized management. One advantage of a decentralized management structure for the nursing units over a centralized structure is that:

a.

Staff is not responsible for defining their roles.

b.

Managers handle the difficult decisions.

c.

Communication pathways are simplified.

d.

Each staff member is accountable for evaluating the plan of care.

ANS: d

d. In decentralized management, decision making is moved down to the level of staff. It requires workers to be empowered to accept greater responsibility for the quality of client care provided. This means that each staff member is accountable for evaluating the plan of care.

a. If decentralized decision making is in place, professional staff has a voice in identifying the RN role. Each RN on the work team is responsible for knowing his or her role and how it is to be implemented on the nursing unit.

b. In decentralized management, autonomy exists (freedom to decide and act). The nurse manager does not necessarily handle the difficult decisions. Those staff members who are best informed about a problem or issue make decisions on the basis of knowledge.

c. Communication pathways are not simplified.

REF: Text Reference: p. 374

5. The determination of indicators in a Quality Improvement program that evaluate the manner in which care is delivered are:

a.

Structure indicators

b.

Team indicators

c.

Process indicators

d.

Client indicators

ANS: c

c. A quality indicator for evaluating the manner in which care is delivered is a process indicator.

a. Structure indicators evaluate the structure or systems for delivering care; an example is adherence in checking whether emergency carts are adequately stocked.

b. There is no team indicator.

d. Client indicators would actually be outcome indicators. Outcome indicators evaluate the result of care delivered.

REF: Text Reference: p. 384

6. A threshold of 90% is identified for an outcome indicator in the Quality Improvement program. Which of the following situations indicates a need for further review of the quality improvement plan?

a.

The waiting time for clinic appointments has decreased 96%.

b.

Clients with renal dialysis expressed a 95% satisfaction with their care.

c.

In 93% of clients, subjective expressions of postoperative pain have decreased.

d.

Wound infections are evident in 92% of clients after care of intravenous (IV) access ports.

ANS: d

d. Wound infections are exceeding the designated threshold, indicating a need for further review of the quality improvement plan.

a. Waiting time for clinic appointments has decreased, meeting the threshold.

b. Satisfaction with care meets the threshold.

c. Expressions of pain have decreased, meeting the threshold.

REF: Text Reference: p. 384

7. In anticipation of a nursing shortage, the nursing management in a facility is investigating a nursing care delivery model that involves staff members working under the direction of a registered nurse leader. This model is called

a.

Team nursing

b.

Primary nursing

c.

Functional nursing

d.

Total patient care

ANS: a

a. In team nursing, an RN leads a team that is composed of other RNs, LPNs or LVNs, and nurse assistants or technicians. The team members provide direct client care to groups of clients, under the direction of the RN team leader. Nurse assistants are given client assignments rather than being assigned particular tasks.

b. Primary nursing is a model of care delivery whereby an RN assumes responsibility for a caseload of clients over time. Typically the RN selects the clients for his or her caseload and cares for the same clients during their hospitalization or stay in the health care setting.

c. Functional nursing is task focused, not client focused. In this model, tasks are divided, with one nurse assuming responsibility for specific tasks.

d. Total patient care is a model of care in which an RN is responsible for all aspects of care for one or more clients. The RN may delegate aspects of care, but retains accountability for care of all assigned clients.

REF: Text Reference: p. 373

8. Accountability is a critical aspect of nursing care. An example of a specific decision-making process of accountability is demonstrated by:

a.

Selecting the medication schedule for the client

b.

Implementing discharge teaching plans that meet individual needs

c.

Evaluating the clients outcomes after implementation of care

d.

Promoting participation of all staff members in unit meetings

ANS: c

c. Accountability refers to individuals being answerable for their actions. It involves follow-up and a reflective analysis of ones decisions to evaluate their effectiveness.

a. Selecting the medication schedule for the client is an example of taking responsibility.

b. Implementing discharge-teaching plans that meet individual needs is an example of autonomy.

d. Promoting participation of all staff members in unit meetings is an example of decentralized management and of promoting authority.

REF: Text Reference: p. 375

9. The student nurse is seeking to learn skills associated with priority setting. In discussing different priorities of care, an example of a second-order priority is:

a.

An obstructed airway

b.

The need to urinate

c.

The side effects of a medication

d.

Activities of daily living in the home environment

ANS: b

b. Second-order priority needs are actual problems for which the client or family has requested immediate help, such as a full bladder.

a. An obstructed airway is a first-order priority need because it is an immediate threat to a clients survival or safety.

c. Side effects of a medication are an example of a third-order priority need. It is a relatively urgent actual or potential problem that the client or family does not recognize.

d. Activities of daily living in the home environment are a fourth-order priority need. It is an actual or potential problem with which the client or family may need help in the future.

REF: Text Reference: p. 376

10. The nurse on the unit is determining what activities may be delegated to assistive personnel. A number of factors are included in the nurses decision. Assuming that the nurse assistant is competent, which one of the following activities may be safely delegated by the registered nurse?

a.

Vital signs on a stable client

b.

An admission history on a new client

c.

Initial transfer of a postoperative client

d.

Administration of medications prepared by the nurse

ANS: a

a. An institutions policies and procedures and job description for assistive personnel provide specific guidelines in regard to what tasks or activities can be delegated. The nurse should match tasks to the delegates skills, such as delegating vital signs to a nurse assistant.

b. It would not be appropriate to delegate an admission history on a new client to a nurse assistant. The RN should perform this task.

c. Initial transfer of a postoperative client should not be delegated to a nurse assistant, as the client would be considered unstable. The RN should perform this task.

d. The nurse should not delegate medication administration to a nurse assistant, even if the nurse prepared it. The nurse assistant is not licensed to administer medication.

REF: Text Reference: p. 380

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