Ch. 39 Managing Care/UAP

In a team approach to nursing​ care, which function or task would most likely be delegated to unlicensed assistive personnel​ (UAP)? (Select all that​ apply.) A. Collecting specimens B. Assisting with feeding C. Client bathing D. Client assessment E. Identification of health problems

A. Collecting specimens B. Assisting with feeding C. Client bathing Rationale: In a team nursing​ approach, delivery of care to clients is done by a team that is led by the professional nurse. UAPs assume delegated aspects of​ care, including​ bathing, collecting​ specimens, and assisting with feeding. Registered nurses are responsible for client assessment and identification of health problems.

The nurse manager for an oncology unit is concerned that a staff nurse is overdelegating tasks to an unlicensed assistive personnel​ (UAP). Which is the most appropriate action for the nurse manager at this​ time? A. Discussing the delegated tasks with the nurse B. Telling the UAP to stop performing the tasks C. Reassigning the UAP to complete other tasks D. Directing all nurses to complete individual tasks

A. Discussing the delegated tasks with the nurse Rationale: The nurse manager should discuss with the nurse the appropriateness of the tasks in question in order to support the activity of delegation. Telling the UAP to stop performing the task interferes with the delegation process between the nurse and the​ UAP, as does reassigning the UAP to complete other tasks. Directing all nurses to complete individual tasks is an example of a nonsupportive​ environment, which can lead to poor job​ satisfaction, mistrust, and poor tolerance for mistakes.

The new nurse asks to speak to the nurse preceptor regarding fears and concerns related to the process of delegation. Which reason common to new nurses may be interfering with the​ nurse's ability to delegate tasks to other members of the healthcare​ team? (Select all that​ apply.) A. Fear of competition and criticism B. Fear of overburdening others C. Fear of loss of control D. Fear of liability or being blamed for the​ delegate's mistakes E. Fear of making mistakes

A. Fear of competition and criticism B. Fear of overburdening others C. Fear of loss of control D. Fear of liability or being blamed for the​ delegate's mistakes Rationale: Reasons that delegators do not delegate include the fear of competition and​ criticism, the fear of liability or being blamed for the​ delegate's mistakes, the fear of overburdening​ others, and the fear of losing control. The fear of making a mistake is a reason a delegate may be unwilling to accept a delegated​ task, not a reason the nurse hesitates to delegate.

The nurse is preparing a presentation related to sources of payment for healthcare services. The nurse wants to highlight differences between the values of the United States versus other countries. Which statement by the nurse is appropriate to include in the​ presentation? A. ​"The United States values individual accountability for retaining and paying for​ healthcare." B. ​"The United States values universality in providing healthcare to​ citizens, which lowers​ costs." C. ​"The United States has global budgets to pay for the healthcare of​ citizens." D. ​"The United States rations care in order to control​ costs."

A. ​"The United States values individual accountability for retaining and paying for​ healthcare." Rationale: The United States values individual accountability for retaining and paying for healthcare. This has led to citizens being underinsured or​ uninsured, which increases healthcare costs. The United States values pluralism and​ choice, not universality. The United States also values volunteerism and​ communitarianism, not global budgets. At this​ time, there is no nationwide rationing to control costs.

After shift​ report, the registered nurse directs an unlicensed assistive personnel​ (UAP) to provide morning care to four clients. Which behavior did the nurse demonstrate with the​ UAP? A. Collaborating B. Assigning C. Delegating D. Dumping

Assigning ​Rationale: Delegation is not the same as assignment. An assignment is a direction to an individual to complete work based on position descriptions or other organizational goals or functions. The nurse assigned the UAP to complete morning care on four clients without following all the steps of​ delegation, including providing any information and resources that the UAP might need. The nurse did not​ "dump" the morning care of four clients on the UAP. Dumping is pushing undesirable tasks onto someone else to​ complete; morning care of four clients is a reasonable task for delegation. The nurse did not collaborate with the UAP on the care of the clients because the nurse did not work with the UAP to complete the task.

Which client should the nurse refer to the case manager for ongoing​ care? A. A client who is being discharged after a total hip replacement B. A client with exacerbation of multiple sclerosis C. A client with hepatitis B D. A client who is being treated for deep vein thrombosis

B. A client with exacerbation of multiple sclerosis Rationale: To maximize​ effectiveness, clients who benefit the most from case management are those with chronic health​ problems, such as chronic alterations in​ lung, heart, or neurological health. The client with an exacerbation of multiple sclerosis would benefit the most from case management. Hepatitis​ B, deep vein​ thrombosis, and total hip replacement are all acute problems with minimal risk for developing into a chronic disorder.

The nurse manager for a​ long-term care unit wants to share the management function of controlling with the staff nurses. Which action should the manager take to share this​ function? A. Explaining the contingency plan to the staff nurses B. Assigning staff to​ peer-review groups C. Dividing client care assignments among the staff D. Coaching the staff on ways to achieve the​ organization's objectives

B. Assigning staff to​ peer-review groups ​Rationale: The management function of controlling may be shared with staff through the use of peer review. Coaching the staff on ways to achieve the​ organization's objectives is an action within the management function of directing. Dividing the​ work, such as client care​ assignments, among the staff is an action within the management function of organizing. Contingency planning is a part of the management function of planning.

The nurse is interviewing for a leadership position in an acute care facility. When asked to describe the​ nurse's approach to​ leadership, the nurse explains an overall belief that​ people, especially​ nurses, are externally motivated and often have difficulty making independent decisions. Which leadership style would the interviewer most likely expect this nurse to​ practice? A. Bureaucratic B. ​Laissez-faire C. Autocratic D. Democratic

C. Autocratic Rationale: Autocratic leaders believe that individuals are externally motivated and incapable of independent decision​ making; thus, the interviewer would suspect that this nurse would be an autocratic leader. A​ laissez-faire leader recognizes the​ group's need for autonomy and​ self-regulation, taking a​ hands-off approach. A democratic leader encourages group discussion and decision making. A bureaucratic leader relies on the​ organization's rules,​ policies, and procedures to direct the​ group's work efforts.

Which activity completed by the nurse manager characterizes the management function of​ controlling? A. Creating​ unit-level goals to achieve the best possible client outcomes B. Determining the chain of command for nurses and other healthcare team members to use when issues occur C. Developing performance standards for a newly created nursing position D. Developing a plan to respond to unanticipated​ mass-casualty events

C. Developing performance standards for a newly created nursing position Rationale: Developing performance standards for a newly created nursing position best reflects the function of controlling. Developing a plan to respond to unanticipated​ mass-casualty events and creating​ unit-level goals to achieve the best possible client outcomes reflect the management function of planning. Determining the chain of command for nurses and other healthcare team members to use when issues occur reflects the management function of organizing.

Two veteran staff nurses on a care area have resigned their positions to begin employment elsewhere. Which action should the nurse manager take to best address the vacancies created by their​ resignations? A. Holding a staff meeting to announce the resignations of the staff nurses B. Encouraging the nurses to reconsider their decision to leave C. Posting the open positions within the organization D. Meeting with human resources to discuss nursing retention strategies

D. Meeting with human resources to discuss nursing retention strategies

The registered nurse team leader is performing gastric lavage for a client who is experiencing an acute gastrointestinal bleed. Which function will the nurse most likely have difficulty completing when the team nursing approach is​ used? A. Client teaching B. Delegation C. Decision making D. Identifying nursing diagnoses

Delegation ​Rationale: Team nursing is not as effective when caring for clients who are acutely ill because the nurse is needed for direct care and little time is allowed for delegation of many tasks.​ Teaching, identifying nursing​ diagnoses, and decision making are skills that are used in primary nursing and would be required when caring for this client.

The nurse chief executive officer​ (CEO) of a large nonprofit hospital is motivated more by a desire to serve rather than to lead. The nurse CEO notes that this has been a very effective leadership style because it helps others to grow and become empowered in their roles. Which type of leader is this nurse​ CEO? A. Transactional B. Transformational C. Servant D. Charismatic

Servant Servant leaders are motivated primarily by a desire to serve rather than a desire to​ lead, placing​ others' needs before their own. They inspire their followers to grow and become more​ self-directed. A charismatic leader is characterized by the ability to cultivate an emotional relationship with group members. A transactional leader has a relationship with group members based on an exchange for some resource valued by the members. A transformational leader fosters​ creativity, risk​ taking, commitment, and collaboration by empowering the group to share in the​ organization's vision.

The nurse works in a facility where the focus is on the jobs necessary to provide client​ care, using different members of the healthcare team to perform​ baths, vital​ signs, and so on. Which care delivery model is being used in this​ facility? A. Functional B. Case C. Primary D. Team

​ Functional Rationale: The functional method uses a​ task-oriented approach, focusing on the jobs to be completed as part of client care. In the case​ method, one nurse is assigned to and responsible for the care of a group of clients over the course of a shift. In the team​ method, the registered nurse​ (RN) has the responsibility and authority for client care but delegates tasks to other team members as appropriate. In primary​ nursing, one nurse is responsible for overseeing the total care for a number of clients 24 hours a​ day, 7 days a week.

The nurse is delegating a task to an unlicensed assistive personnel​ (UAP). After the nurse has explained the​ task, which activity is required of the delegate who accepts the​ task? (Select all that​ apply.) A. Clarifying how to report completion of the task B. Defining the task C. Reporting concerns D. Clarifying the time frame to complete the task E. Keeping the delegator informed of progress

​A. Clarifying how to report completion of the task C. Reporting concerns D. Clarifying the time frame to complete the task E. Keeping the delegator informed of progress Rationale: The nurse is responsible for defining the​ task, which helps determine if the task can be delegated. The delegate is responsible for clarifying the time frame to complete the​ task, reporting progress toward​ completion, reporting any concerns about the​ task, and clarifying how to report completion of the​ task, including what information the nurse wants reported.

The primary nurse is coordinating care for a newly admitted client. Which nursing action is appropriate when planning this​ client's care?​ (Select all that​ apply.) A. Identifying applicable​ evidence-based practice guidelines for the​ client's care B. Obtaining orders for referrals and consultations from the healthcare provider C. Selecting appropriate critical pathways for the client D. Suggesting appropriate referrals for the​ client's care E. Initiating consultations with other healthcare providers

​A. Identifying applicable​ evidence-based practice guidelines for the​ client's care C. Selecting appropriate critical pathways for the client Rationale: In the planning phase of care​ coordination, the nurse should utilize standard​ protocols, critical​ pathways, and​ evidence-based guidelines; prepare the care plan in consultation with the​ client; and make the care plan the framework for care coordination. Initiating​ consultations, suggesting​ referrals, and obtaining orders for consultations and referrals from the healthcare provider are actions that occur during the implementation phase of care coordination.

The nurse manager is performing actions associated with a delicate client care situation. Which action indicates a responsibility appropriate for the nurse​ manager? (Select all that​ apply.) A. Notifying central storage of stock items that are no longer needed for the client care area B. Referring to the nurse practice act before delegating a task to a nurse C. Meeting with staff about the need to maintain client confidentiality D. Ensuring that paperwork is completed and submitted to the security department as required E. Directing nursing staff to check expiration dates before using intravenous fluids

​A. Notifying central storage of stock items that are no longer needed for the client care area C. Meeting with staff about the need to maintain client confidentiality D. Ensuring that paperwork is completed and submitted to the security department as required Rationale: Responsibility is an obligation to meet objectives and perform tasks. The focus is on the use of​ resources, communication to​ subordinates, and implementation of organizational goals and objectives. Directing​ others' actions is a characteristic of authority. Referring to the nurse practice act is an action within accountability.

The charge nurse observes a registered nurse delegate tasks to an unlicensed assistive personnel​ (UAP). Which observation by the charge nurse indicates that​ follow-up is​ required? (Select all that​ apply.) A. The UAP asked another nurse to assist with the delegated task. B. The UAP and nurse discussed completion of delegated tasks. C. The UAP was unable to recognize a change in a​ client's condition. D. The nurse provided direction and feedback on task progress and completion. E. The nurse did not have complete information about the status of delegated tasks at the​ change-of-shift report.

​A. The UAP asked another nurse to assist with the delegated task. C. The UAP was unable to recognize a change in a​ client's condition. E. The nurse did not have complete information about the status of delegated tasks at the​ change-of-shift report. Rationale: If the UAP was unable to recognize a change in the​ client's condition, it is possible that the nurse did not provide sufficient information when delegating the task or that the nurse selected the wrong delegate for the task. If the nurse is not prepared for report because tasks were not​ completed, the nurse did not adequately follow up with the UAP regarding task completion. If the UAP asked another nurse for assistance in completing a​ task, the task might have been too​ complicated, or the UAP did not possess the required skills to complete the task. Discussing the completion of tasks and providing direction and feedback on task progress are expected actions when delegating.

The nurse manager plans to inform the staff that the organization is going to provide a group​ self-insurance health plan for all employees. Which information should the manager include when explaining this health​ plan? (Select all that​ apply.) A. The group will assume all or part of the costs of healthcare for the employees. B. A predetermined amount of money will be paid to the hospital based on a diagnosis. C. It is a prospective payment system that determines costs before care is provided. D. Rates for care are set in advance of the year in which they apply. E. Coverage will cost the organization less because of lower fees and tax exemptions.

​A. The group will assume all or part of the costs of healthcare for the employees. E. Coverage will cost the organization less because of lower fees and tax exemptions. Rationale: With a group​ self-insurance health​ plan, the group assumes all or part of the costs of health care for the​ members, and coverage is provided at rates lower than health insurance plans because of lower fees and tax exemptions. A predetermined amount of money that is paid to the hospital based on a diagnosis describes​ diagnosis-related groups. Setting the rates for care in advance of the year in which they apply also is a characteristic of​ diagnosis-related groups.​ Diagnosis-related groups typically use a prospective payment system that determines costs before care is provided.

The nurse who is working on a unit that uses a primary nursing care delivery model is assigned a client with newly diagnosed type 2 diabetes mellitus. Which nursing action is most appropriate when caring for this​ client? A. Participating on a task force to identify glucometers for use during care B. Instructing the client on the role of medications to control the disease process C. Providing direct care to the client during the scheduled shift D. Directing nursing assistants to complete morning care on a group of clients

​B. Instructing the client on the role of medications to control the disease process Rationale: Client teaching is a role of the nurse in the primary nursing delivery model. Participation in a task force is an activity within shared governance. Delegating tasks related to a group of clients is not the same as providing direct client care. In this​ scenario, the nurse is working within the primary nursing​ method; providing direct care during a scheduled shift is a characteristic of the case method.

The nurse preceptor is discussing the aspects of a prospective payment system with a newly hired home care nurse. Which statement most accurately describes this​ system? A. Prospective payment limits the reimbursement paid to healthcare providers for services provided for Medicaid and Medicare clients. B. Under prospective​ payment, billing is determined before the client is admitted based on diagnosis. C. In a prospective payment​ system, billing is based on​ clients' progression during their​ care, allowing for extra costs due to complications. D. Prospective payment provides general ranges of payment allowed for specific diagnoses depending on client comorbidities.

​B. Under prospective​ payment, billing is determined before the client is admitted based on diagnosis. Rationale: With a prospective payment system​ (PPS), billing is determined before the client is ever admitted to the hospital. It sets a specific​ amount, not a range. It does not limit reimbursement to healthcare​ providers, nor does it determine payment as clients progress through their illness.