Chapter 21: Managing Patient Care Nursing School Test Banks

Test Bank

MULTIPLE CHOICE

1. In which nursing care model is the RN usually appointed the position of group leader?

a.

Total patient care

b.

Primary nursing

c.

Team nursing

d.

Case management

ANS: C

In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs.

DIF: Remember REF: 276

OBJ: Differentiate among the types of nursing care delivery models.

TOP: Planning MSC: Safe and Effective Care Environment

2. In which nursing care delivery model are clinicians held accountable for some standard of cost-effectiveness and quality of care?

a.

Total patient care

b.

Primary nursing

c.

Team nursing

d.

Case management

ANS: D

What is unique about case management is that clinicians, as individuals or as part of a collaborative group, oversee the management of patient groups with specific case types and usually are held accountable for some standard of cost management and quality. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care.

DIF: Remember REF: 276

OBJ: Differentiate among the types of nursing care delivery models.

TOP: Planning MSC: Safe and Effective Care Environment

3. With the current shortage of nursing faculty and nursing programs, which nursing care delivery model is least feasible in many agencies?

a.

Total patient care

b.

Primary nursing

c.

Team nursing

d.

Case management

ANS: A

Patient satisfaction with the total patient care model is high, but total patient care is not cost-effective because it requires a large number of RNs to provide care. Total patient care involves an RN being responsible for all aspects of care for one or more patients. With the current shortage of nursing faculty and retirement of many practicing RNs, staffing enough RNs is a problem in many agencies. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs.

DIF: Understand REF: 276

OBJ: Differentiate among the types of nursing care delivery models.

TOP: Planning MSC: Safe and Effective Care Environment

4. A nurse manager is evaluating patient outcomes on the hospital unit. The nurse manager discovers that the re-admission rate of hospitalized patients is very high on this unit. The nurse manager desires improved coordination of care and accountability for cost-effective quality care. The nursing care delivery model best suited to these needs is

a.

Total patient care.

b.

Primary nursing.

c.

Team nursing.

d.

Case management.

ANS: D

What is unique about case management is that clinicians, as individuals or as part of a collaborative group, oversee the management of patient groups with specific case types and usually are held accountable for some standard of cost management and quality. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care.

DIF: Apply REF: 303-304

OBJ: Differentiate among the types of nursing care delivery models.

TOP: Planning MSC: Safe and Effective Care Environment

5. Which organizational structure approach has fewer directors with managers accountable 24 hours for staff, budget, and day-to-day management?

a.

Centralized management

b.

Decentralized management

c.

Business unit management

d.

Matrix

ANS: B

The decentralized management structure often has fewer directors, and managers are accountable around the clock for the operation of the unit. Centralized management involves having a single administrator and managers with minimal accountability for the unit operation. The matrix approach involves reorganization of hospital departments into business units.

DIF: Remember REF: 277

OBJ: Describe the elements of decentralized decision making. TOP: Planning

MSC: Safe and Effective Care Environment

6. A staff member verbalizes his satisfaction in working on a particular nursing unit because he appreciates the freedom of choice and responsibility for the choices. This nurse highly values which element of decentralized decision making?

a.

Responsibility

b.

Autonomy

c.

Accountability

d.

Authority

ANS: B

Autonomy is freedom of choice and responsibility for the choices. Responsibility refers to the duties and activities that an individual is employed to perform. Accountability refers to individuals being answerable for their actions. Authority refers to legitimate power to give commands and make final decisions specific to a given position.

DIF: Understand REF: 277

OBJ: Describe the elements of decentralized decision making. TOP: Planning

MSC: Safe and Effective Care Environment

7. A staff nurse delegates a task to a nursing assistant, knowing that the assistant has never performed the task before. As a result, the patient is injured, and the nurse defensively states that the nursing assistant should have known how to perform such a simple task. This nurse is demonstrating lack of

a.

Responsibility.

b.

Autonomy.

c.

Authority.

d.

Accountability.

ANS: D

Accountability refers to individuals being answerable for their actions. The nurse in this situation is not taking ownership of the inappropriate delegation of a task. Autonomy is freedom of choice and responsibility for the choices. Responsibility refers to the duties and activities that an individual is employed to perform. Authority refers to legitimate power to give commands and make final decisions specific to a given position.

DIF: Apply REF: 277

OBJ: Describe the elements of decentralized decision making. TOP: Planning

MSC: Safe and Effective Care Environment

8. A nurse manager sent one of the staff nurses on the unit to a conference about new, evidence-based wound care techniques. The nurse manager asks the staff nurse to prepare a poster to present at the next unit meeting, which will be mandatory for all nursing staff on the unit. The nurse manager is providing a learning opportunity in this situation through

a.

Nurse/physician collaborative practice.

b.

Interdisciplinary collaboration.

c.

Staff education.

d.

Establishing a nursing practice committee.

ANS: C

The nurse manager is planning a staff education opportunity in the given example. Staff education is one way the nurse manager supports staff involvement in a decentralized decision-making model. This nurse is providing staff education to other staff nurses on the unit, not to physicians. Interdisciplinary collaboration involves working with other disciplines such as medicine, physical therapy, respiratory therapy, etc. The question does not state that the nurse is establishing a practice committee. A poster presentation is a common teaching method.

DIF: Understand REF: 279-280

OBJ: Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model. TOP: Planning

MSC: Safe and Effective Care Environment

9. A nurse is making a home visit and discovers that a patients wound infection has gotten worse. After cleaning and re-dressing the wound, what should the nurse do?

a.

Ask the home health agency nurse manager to contact the health care provider.

b.

Document the findings and confirm with the patient the date of the next home visit.

c.

Notify the health care provider of the findings before leaving the home.

d.

Tell the patient that the health care provider will be notified before the next visit.

ANS: C

The nurse should notify the health care provider before leaving the home. Nurse/health care provider collaboration and open communication are important in fostering trust and respect. The manager should avoid taking care of problems for staff. The staff nurse needs to learn how to professionally communicate with other members of the health care team and demonstrate interdisciplinary collaboration.

DIF: Apply REF: 278

OBJ: Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model. TOP: Intervention

MSC: Safe and Effective Care Environment

10. A nurse manager conducts rounds on the unit and discovers that expired stock medicine is still in the cabinet despite the e-mail she sent stating that it had to be discarded. The staff nurse dress code is not being adhered to, and the staff lounge is not kept neat and tidy as she requested in the same e-mail. Several staff nurses deny having received the e-mail. After evaluating this situation, one way the nurse manager could resolve the issue is to

a.

Include the findings on each staff members annual evaluation.

b.

Close the staff lounge.

c.

Enforce a stricter dress code.

d.

Place a hard copy of announcements and unit policies in each staff members mailbox.

ANS: D

The identified problem is lack of staff communication. Therefore, the answer pertaining to communication is the correct answer. Staff communication is a challenge for managers, but using a variety of approaches can help. Sending an e-mail was not effective; therefore, giving each staff member a hard copy along with e-mailing is another approach the manager can take. Including the findings on evaluations, closing the lounge, and enforcing stricter dress codes do not address the problem and offer a proposed solution. An effective nurse manager uses a variety of approaches to communicate quickly and accurately with all staff.

DIF: Evaluate REF: 278

OBJ: Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model. TOP: Evaluation

MSC: Safe and Effective Care Environment

11. A new nurse expresses frustration at not being to complete all interventions for a group of patients in a timely manner. The nurse leaves the rounds report sheets at the nurses station when caring for patients and reports having to go back and forth between rooms several times looking for equipment and supplies. This nurse could benefit from practicing better _____ skills.

a.

Clinical decision-making

b.

Organizational

c.

Evaluation

d.

Interpersonal communication

ANS: B

The clinical care coordination skill this nurse needs to improve on is organization. This nurse needs to keep the patient report sheets in hand to anticipate what equipment and supplies a patient is going to need. Then the nurse may not have to leave the room so often; this will save time. The nurse in this example does not voice concern about decision-making skills, evaluation skills, or communication skills.

DIF: Understand REF: 279-280

OBJ: Discuss ways to apply clinical care coordination skills in nursing practice.

TOP: Evaluation MSC: Safe and Effective Care Environment

12. Which of these approaches would be most appropriate for a nurse to take when faced with the challenge of performing many tasks in one shift?

a.

Evaluate the effectiveness of all tasks when all tasks are completed.

b.

Delegate tasks the nurse does not like doing.

c.

Do as much as possible by oneself before seeking assistance from others.

d.

Complete one task before starting another task.

ANS: D

The appropriate clinical care coordination skill in these options is to complete one task before starting another task. Evaluation is ongoing and should not be completed just at the end of task completion. The nurse should not delegate tasks simply because the nurse does not like doing them. The nurse should use delegation skills and time management skills instead of trying to do as much as possible by herself. The nurse needs to complete many tasks and treatments on each shift. Some tasks need to be delegated so patients receive the care they need in a timely manner. Good time management involves setting goals to help the nurse complete one task before starting another task.

DIF: Understand REF: 280

OBJ: Discuss ways to apply clinical care coordination skills in nursing practice.

TOP: Planning MSC: Safe and Effective Care Environment

13. Which of these assessments of a patient who is 1 day post surgery to repair a hip fracture requires immediate nursing intervention?

a.

Patient ate 30% of clear liquid breakfast.

b.

Oral temperature is 99.2 Fahrenheit.

c.

Patient states, Boy, I did not realize I would be so tired after this surgery.

d.

Patient reports severe pain 30 minutes after receiving pain medication.

ANS: D

The nurse needs to recognize and differentiate normal from abnormal findings and set priorities. The nurse needs to report severe pain that is unrelieved by pain medication to the health care provider. Eating 30% of breakfast, having a slightly elevated temperature, and being tired the day after surgery are expected findings following surgery and do not require immediate intervention.

DIF: Apply REF: 280

OBJ: Discuss ways to apply clinical care coordination skills in nursing practice.

TOP: Evaluation MSC: Safe and Effective Care Environment

14. A charge nurse should instruct a new nurse taking care of a patient with hypercholesterolemia to make which of these lifestyle modifications?

a.

High-protein, high-fat diet

b.

Decreased walking frequency from three times to two times a week

c.

Discontinuation of antihypertensive medications

d.

Smoking cessation

ANS: D

The only appropriate lifestyle modification among these options is smoking cessation. Hypercholesterolemia can be caused by a high-fat diet; therefore, a high-fat diet should be avoided. Exercise is usually recommended, not contraindicated. The patient should continue blood pressure medications. In this question, the nurse is using the aspect of evaluation in clinical care coordination.

DIF: Apply REF: 280-281

OBJ: Discuss ways to apply clinical care coordination skills in nursing practice.

TOP: Intervention MSC: Safe and Effective Care Environment

15. A patient with an indwelling urinary catheter has been given a bed bath by a new nursing assistant. The nurse evaluating the cleanliness of the patient notices crusting at the urinary meatus. The best next action of this nurse is to

a.

Ask the nursing assistant to observe while the nurse performs catheter care.

b.

Leave the room and ask the nursing assistant to go back and perform proper catheter care.

c.

Discontinue the catheter.

d.

Document the incident in the patients chart.

ANS: A

Because the nursing assistant is new, it is best for the nurse to perform catheter care while the assistant observes. This action will ensure that the assistant has been shown the proper way to perform the task and fosters collaboration rather than leaving the room just to tell the assistant to come back. While the nurse is in the room, the nursing assistant should perform the task. Discontinuing the catheter is not warranted and requires a physicians order. This occurrence does not need to be documented in the patients chart, granted no harm has come to the patient.

DIF: Evaluate REF: 281-283

OBJ: Discuss ways to apply clinical care coordination skills in nursing practice.

TOP: Evaluation MSC: Safe and Effective Care Environment

16. A nurse observes a patient care technician using all these measures when taking vital signs. Which measure requires the nurse to intervene?

a.

Palpates brachial artery before inflating blood pressure cuff

b.

Counts respirations while palpating radial pulse

c.

Inserts thermometer into sublingual pocket after patient sips water

d.

Asks patient to relax arm before taking blood pressure

ANS: C

The nurse needs to intervene if observing the technician taking an oral temperature after consuming any type of beverage because of the potential for a temperature difference in the liquid that may affect the patients measured temperature. The other options are appropriate.

DIF: Apply REF: 280-281

OBJ: Discuss principles to follow in the appropriate delegation of patient care activities.

TOP: Evaluation MSC: Safe and Effective Care Environment

17. A nursing assistant reports seeing a reddened area on the patients hip while bathing the patient. The nurse should

a.

Go to the patients room to assess the patients skin.

b.

Document the finding per the nursing assistants report.

c.

Request a wound nurse consult.

d.

Ask the nursing assistant to apply a dressing over the reddened area.

ANS: A

The nurse needs to assess the patients skin. Assessment should not be delegated; it is the responsibility of the licensed professional nurse. The nurse needs to document the assessment findings objectively, not subjectively per the nursing assistant. Before requesting a consult or determining treatment, the nurse needs to assess the skin.

DIF: Apply REF: 281

OBJ: Discuss principles to follow in the appropriate delegation of patient care activities.

TOP: Assessment MSC: Safe and Effective Care Environment

18. A nurse is assigned to care for the following patients who all need vital signs taken right now. Which of these patients is most appropriate for the nurse to delegate vital sign measurement to nursing assistive personnel (NAP)?

a.

Patient scheduled for a procedure in the nuclear medicine department

b.

Patient transferring from the intensive care unit (ICU)

c.

Patient returning from cardiac catheterization

d.

Patient returning from hip replacement surgery

ANS: A

The nurse does not assign vital sign measurement or other tasks to NAP when patients are experiencing a change in level of care. The patient awaiting the procedure in nuclear medicine is the only patient who has not experienced a change in level of care. According to the rights of delegation, tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have minimal risk can be delegated to assistive personnel. The patient in this question with the most predictable condition is the patient awaiting the nuclear medicine procedure. Once the nurse determines that the other patients are stable, the nurse could delegate their future vital sign measurement to the NAP. However, it is important for the nurse to assess patients coming from the ICU, the cardiac cath lab, and surgery when they first arrive on the unit.

DIF: Apply REF: 282

OBJ: Discuss principles to follow in the appropriate delegation of patient care activities.

TOP: Planning MSC: Safe and Effective Care Environment

19. Which of these staff members does the staff nurse assign to provide morning care for an older adult patient who requires assistance with activities of daily living?

a.

Licensed vocational nurse

b.

Cardiac monitor technician

c.

Nursing assistive personnel (NAP)

d.

None of the above; the nurse needs to provide morning care to this patient.

ANS: C

The NAP is capable of caring for this patient and is the most cost-effective choice. The cardiac monitor technicians role is to watch the cardiac monitors for patients on the floor. The nurse and the licensed vocational nurse are not the most cost-effective options in this case, even though each could assist with activities of daily living. These nurses would be better used to administer medications, perform assessments, etc.

DIF: Apply REF: 281-283

OBJ: Discuss principles to follow in the appropriate delegation of patient care activities.

TOP: Planning MSC: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. The five rights of delegation include (Select all that apply.)

a.

Right task.

b.

Right circumstances.

c.

Right monetary compensation.

d.

Right person.

e.

Right direction.

f.

Right opinion.

g.

Right supervision.

ANS: A, B, D, E, G

The five rights of delegation are right task, circumstances, person, direction, and supervision.

DIF: Remember REF: 282

OBJ: Discuss principles to follow in the appropriate delegation of patient care activities.

TOP: Planning | Implementation MSC: Safe and Effective Care Environment

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