Managing Care
d (Rationale When delegating a task, the nurse should match the task to the individual. To decide on the delegate, the nurse needs to analyze skill levels and abilities in order to determine if a person is able to complete a task. Availability of the delegate is another consideration. In this situation, the nurse will need to find another qualified individual to serve as delegate. The client is being prepared for emergency surgery, so the task needs to be completed quickly. Waiting on an assistant to complete another task or informing the surgical suite of a delay are not appropriate. The nurse should not reassign a task that another nurse has delegated.)
A client scheduled for emergency surgery needs a bowel preparation. The assistant with the necessary experience to complete this task is currently working with another client. Which nursing action is the most appropriate? a Reassign the task that the assistant is completing to someone else b Assign the task to the assistant to complete as soon as possible c Notify the surgical suite that the client will be delayed d Ask if other assistants have experience in the bowel preparation
d (Rationale When the demand for a product or item increases, the cost increases. One way to address this client's issue would be to discuss comparable medications with the healthcare provider; those in less demand may be less expensive. Suggesting ways to increase the client's income will not support the client's healthcare needs. Documenting non-adherence does not support the client's healthcare needs. Explaining the long-term effects of medication non-adherence will not be effective if the client's financial resources are insufficient.)
A client who has not been taking medication explains that the price of the medication has increased and become unaffordable. Which action should the nurse consider to support this client's healthcare needs? a Document the client's non-adherence to prescribed medication regimen b Explain the long-term effects of medication non-adherence to the client c Suggest ways to increase income to have resources to purchase the medication d Discuss comparable medications with the healthcare provider that have less of a demand
d (Rationale In the 1970s, changes were made to allow healthcare organizations and insurance companies to permit competition. Hospitals and other entities sought new ways to compete for clients' healthcare dollars. These changes and efforts resulted in the rise of walk-in clinics, urgent care clinics, and increased use of alternate healthcare providers. Collaboration, managed care, and price control efforts are not directly related to the emergence of walk-in clinics, urgent care centers, or alternate healthcare providers.)
A client who is waiting to be seen in the emergency department tells the nurse that a walk-in clinic is the primary source for health care. The popularity of walk-in clinics is partly a result of which factor? a Diagnosis-related groups b Collaboration c Price controls d Competition
a,b,e (Rationale In Canada, all medically necessary services are covered under a government-funded insurance plan, including physician care, hospitalization, and some prescription medications. Mandatory health insurance uses the approach of a sickness fund. This is used in Germany and Japan. Although the client may be able to continue to receive health insurance through her employer, the nurse cannot be certain of this and this does not answer the client's question.)
A client whose employer is transferring her to Canada asks if there are many differences between health care in the United States and Canada. What characteristics of the Canadian healthcare industry should the nurse review with this client? (Select all that apply.) a Physician care is covered under a government-funded insurance plan. b Some prescription medications are covered under a government-funded insurance plan. c The client will continue to receive health insurance through her employer. d Healthcare needs will be paid through a sickness fund. e Hospitalization is covered under a government-funded insurance plan.
c (The nurse is meeting with the client's therapists to evaluate the care they have provided in relation to the client's outcomes. Assessment, care coordination, and provision of interventions are a part of the case management model, but these are not occurring at this time.)
Abigail, the registered nurse, is meeting with the physical and occupational therapists to discuss outcome achievement for a client recovering from a stroke. Which case management behavior is the nurse demonstrating at this time? a Providing interventions b Assessing client needs c Evaluating care provided d Coordinating care
c (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 assistant to complete morning care on four clients without following all the steps of delegation, including providing any information and resources the assistant might need. The nurse did not "dump" the morning care of four clients to the assistant. 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 nursing assistant on the care of the clients, as the nurse did not work with the assistant to complete the task. In partnering, nurses and UAPs are consistently assigned to work together on a unit in order to foster team building and consistency in client care. There is no evidence of partnering in this scenario.)
After shift report, the registered nurse directs a nursing assistant to provide morning care to four clients. What behavior did the nurse demonstrate with the nursing assistant? a Collaborating b Delegating c Assigning d Dumping
c,e (Rationale When the supply cannot meet the demand, rationing can occur. One way to keep costs low is to restrict access to services. Another way is for the client to pay more out of pocket for the scarce service. Rationing of healthcare is not being performed throughout the US. Seeing another healthcare provider will not cut the waiting time if the client does not meet the criteria for eligibility. The client's level of need may be such that the client truly needs the service before the next available appointment; the nurse may need to assess and advocate for the client.)
An older adult client asks the nurse why a needed total hip replacement cannot be performed for six months. What should the nurse include when responding to this client? (Select all that apply.) a Health care is provided according to need, and the client's need is not great at this time. b Rationing of expensive health care surgeries is being done in the United States. c The waiting list may be shorter if the client is willing to pay more out of pocket. d Being evaluated by another healthcare provider would cut the waiting time. e Reducing availability of some procedures helps reduce healthcare costs.
c (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. Reassigning the UAP to complete other tasks interferes with the delegation process between the nurse and UAP. Directing all nurses to complete individual tasks is an example of a non-supportive environment, which can lead to poor job satisfaction, mistrust, and poor tolerance for mistakes.)
Anita is the nurse manager for an oncology unit. She is concerned that a staff nurse, Marc, is overdelegating tasks to an unlicensed assistive personnel (UAP). What is the most appropriate action for Anita at this time? a Direct all nurses to complete individual tasks b Reassign the UAP to complete other tasks c Discuss the delegated tasks with the nurse d Tell UAP to stop performing the tasks
a,e (Rationale The case method is also termed total care and involves one nurse being assigned and responsible for the care of a group of clients over an 8 or 12 hour shift. Nursing responsibilities in the case method include assessing, diagnosing, planning, implementing and evaluating the effectiveness of care. Providing medications to clients for an entire team would be performed in functional nursing. Delegating the completion of morning care to unlicensed assistive personnel is an action within team nursing. In primary nursing, the nurse oversees the total care for a number of clients 24 hours a day, 7 days a week.)
A medical-surgical unit utilizes the case method for providing client care. Which actions will the nurse perform when caring for clients using this approach? (Select all that apply.) a Providing total care to assigned clients for the entire shift b Delegating the completion of morning care to unlicensed assistive personnel c Providing medications to clients for an entire team d Overseeing the total care for a number of clients 24 hours a day, 7 days a week e Assessing, planning, implementing, and evaluating care provided
b (Client teaching is a role of the primary nurse. 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.)
Jennifer Calper, the primary nurse, is assigned a client with newly diagnosed type 2 diabetes mellitus. Which nursing action is most appropriate when caring for this client? a 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 c Providing direct care to the client during the scheduled shift d Participating on a task force to identify glucometers for use during care
b (Initiating consultations, identifying the need for referrals, and obtaining orders are all actions the nurse will take when implementing care coordination. However, ensuring the client's ability to maintain adequate perfusion and oxygenation following discharge by obtaining an order and organizing oxygen delivery takes priority over other actions. Discussing the client's medications with the pharmacist, meeting with the dietician to review the client's nutritional needs, and responding to family members' questions are collaborative actions.)
Katrina Simons is a nurse who is coordinating the discharge for a client with chronic lung disease. Which nursing action is the priority when coordinating this client's care? a Reviewing the client's nutritional needs with the dietician b Obtaining an order and organizing the delivery of oxygen to the client's home c Responding to family members' questions about the client's needs d Discussing the client's medications with the pharmacist
c (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.)
Kevin is the nurse manager for a long-term care unit. He wants to share the management function of controlling with the staff nurses. Which action should Kevin take to share this function? a Divide client care assignments among the staff b Explain the contingency plan to the staff nurses c Assign staff to peer review groups d Coach the staff on ways to achieve the organization's objectives
a (The nurse must delegate the responsibility and authority for the task to be completed. The UAP might have instructed the client to call the nurse if assistance was required. The nurse has no way of knowing this. The nurse should not ask another UAP to complete a task once it is delegated. By responding to the call and helping the client, the nurse would not be permitting the UAP to complete the task. This would not be the best use of the nurse's time and would not assist the UAP to better understand the delegation process or to take responsibility and authority for the task the UAP accepted. It would be inappropriate for the nurse to reprimand the UAP prior to the task being completed.)
Kim is a nurse working on a medical-surgical unit. Kim delegates a task to Mitchell, the unlicensed assistive personnel (UAP). After Kim delegates the task to Mitchell, she receives a call from the client requesting assistance related to the task that Kim delegated. What is the most appropriate action for Kim at this time? a Alert the UAP that the client is asking for assistance b Ask another UAP to assist the client c Respond to the call and assist the client d Reprimand the UAP for not assisting the client
b (In the third step of the delegation process, the nurse should specifically review with the delegate the importance of the task to the client. Checking the medical record for documentation of a client's urine output is performed in the fifth step of the delegation process. Deciding a task that needs to be completed is performed in the first step of the delegation process. Determining the delegate is sufficient for the task is performed in the second step of the delegation process.)
Mary is a nurse working with unlicensed assistive personnel (UAP) during a busy shift on a medical-surgical unit. Mary has delegated certain aspects of care for her clients to the UAP. During the third step of the delegation process, what is the most appropriate action for Mary to complete? a Decide that help is needed to measure a client's urine output b Explain the importance of correctly measuring a client's urine output c Determine that one UAP is qualified to measure urine output d Check the medical record for documentation of a client's urine output
a,b,e (Rationale If the assistant was unable to recognize a change in the client's condition, it is possible the nurse did not provide sufficient information when delegating the task, or 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 assistant regarding task completion. If the assistant asked another nurse for assistance on completing a task, the task might have been too complicated or the assistant 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 charge nurse observes a registered nurse delegate tasks to a nursing assistant. What did the charge nurse observe that indicates additional information about delegation is required? (Select all that apply.) a The assistant asked another nurse to assist with the delegated task. b The assistant was unable to recognize a change in a client's condition. c The assistant and nurse discussed completion of delegated tasks. 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,b,d,e (Rationale Strategies to improve time management include identifying priorities, prioritizing urgent tasks, eliminating workspace clutter, increasing the use of automation, and learning to say no and avoiding interruptions. Returning phone calls and emails before attending change of shift report does not indicate an ability to identify priorities and complete urgent tasks first.)
The director evaluates a nurse manager's time management skills as being "outstanding." Which actions by the manager would the nursing director identify as being worthy of an outstanding rating? (Select all that apply.) Declined participation in a newly formed task force Used the software program to run a productivity report Returned phone calls and emails before attending change of shift report Cleared off the desk and focused on one project at a time Closed the office door when discussing performance appraisals
b,c,d,e (Rationale An increase in applications for a nurse leadership program indicates nurses are experiencing greater job satisfaction and taking an interest in the success of the organization. A decrease in transfer requests indicates that nurses are experiencing greater satisfaction working on their units. A reduction in safety errors indicates improvements in client care. All of these suggest that delegation is benefiting nurses. A decrease in expenses may or may not relate to the changes made in delegation. Client perceptions of services benefit the organization.)
The director of nursing is reviewing the impact of increased delegation within the organization. Which observations indicate that delegation is benefitting nurses? (Select all that apply.) a Overall expenses have decreased 5%. b Safety errors have decreased by 8%. c Requests from nurses to transfer units have decreased by 20%. d Client satisfaction with services as reflected on post discharge surveys has increased by 18%. e Applications to the organization's o "nurse as leader " program have increased by 20%.
c,d,e (Rationale The third step in delegation is to describe clearly to the delegate what needs to be done. The nurse should specifically review the importance of the task to the client, the expected outcome and the timeline for completion, and how closely the assignment will be supervised. Completing a task when possible is not specific enough when delegating. Presence or absence of family members is not relevant to the description of the task.)
The nurse is delegating a task to an assistant. Which factors should the nurse include when describing the task to be completed? (Select all that apply.) a The fact that the client's family is not local b The need to complete the task when possible c Location of the nurse if there are any issues with completing the task d Expectation that the task is completed within 1 hour e The need to complete the task before the client attends physical therapy
a (Rationale Organizing is the process of coordinating work that needs to be done. Organizing may require reviewing the staff and material resources available. Directing is the process of getting the organization's work done. An example of this would be telling assistants to prepare bed spaces with blankets and dressing materials. Controlling is comparing projected results with actual results, such as reviewing staff performance during a previous disaster. Strategic planning is the process assessment, planning, and evaluation to guide the future, such as identifying the need for nursing staff for the next day.)
The emergency department manager is notified that victims of a train derailment are due to arrive in 30 minutes. Which action should the manager take when organizing for this influx of clients? a Identifying staff available to triage the victims as they arrive b Telling assistants to place extra blankets and dressing supplies in each bed space c Reviewing staff performance of care provided during last month's hurricane d Notifying human resources of the need for additional staff during the next 24 hours
a (Rationale The measure used to determine if a shortage exists is the vacancy rate, or the percentage of unfilled positions, within a healthcare organization. If the vacancy rate is high, the nurse has a higher chance of gaining employment. If the vacancy rate is low, fewer positions are available. Organizations that provide a higher hourly wage will have fewer vacancies. Community organizations would be within the nurse's local area. The nurse has not been successful in finding a position with a local organization.)
The graduate nurse is unable to find employment within local healthcare organizations despite being informed of a nursing shortage in the area. On which type of organization should the nurse focus the search to help secure employment? a Organizations with high vacancy rates b Organizations that provide a higher hourly wage for nurses c Organizations with low vacancy rates d Community organizations
b (Rationale Because care coordination can be a helpful strategy in reducing readmission rates, the Centers for Medicare and Medicaid Services now reimburses clinical nurse specialists if specific criteria are met, such as visiting the client in person within 30 days of discharge. The nurse specialist may or may not need to notify the case manager of the visit. The client's needs may or may not need to be discussed with the health care provider. The visit does not need to be discussed with the primary nurse.)
The neurological clinical nurse specialist (CNS) visits a client at home one week after the client was discharged from the hospital after a stroke. What can the CNS do after this care visit is complete? a Discuss the client's care needs with the health care provider b Reimbursed by CMS for the care visit c Notify the case manager of the visit d Discuss the visit with the primary nurse
a (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.)
The nurse educator is presenting information to a group of students related to sources of payment for healthcare services. The educator wants to highlight differences between the values of the United States versus other countries. Which statement by the educator is appropriate to include in the presentation? a "The United States values individual accountability for retaining and paying for health care. b "The United States has global budgets to pay for the health care of citizens. c "The United States values universality in providing health care to citizens, which lowers costs. d "The United States rations care in order to control costs
b (Rationale The nurse needs to determine the right person to whom to delegate this task. If an assistant has a good safety record, then the nurse knows the individual is capable of the task. An assistant whose own father recently died might find sitting with this client emotionally draining if she has not yet processed her own grief. An assistant who normally works with young children may not have experience working with clients who have dementia. The nursing assistant who is completing morning care does not have time to take on the assigned task.)
The nurse in the emergency department (ED) has several tasks that can be delegated to unlicensed assistive personnel (UAP). One of these tasks involves sitting with an older adult client who has dementia. The client was found wandering out of doors, and law enforcement transported him to the ED for a medical evaluation while they located his family, who are on their way to pick up the client. To which employee should the nurse delegate this assignment? a Nursing assistant who is helping another complete morning care b Nursing assistant with a good safety record c Nursing assistant whose father recently passed away d Nursing assistant who is floating from the pediatrics department
d,e (Rationale When functioning in the role of coordinator, the nurse will facilitate team and group activities and use verbal communication skills with other disciplines to ensure completion of the client's care. Delegation is a skill used in team nursing. Documentation is a basic nursing skill performed by all nurses regardless of the care delivery method used. Discussing the client's need for a medication with the insurance provider is a skill within the role of advocacy.)
The nurse is coordinating the care for a client recovering from a stroke. Which skills are appropriate for the nurse to use when coordinating care for this client? (Select all that apply.) a Discuss the client's need for a prescribed medication with the insurance company b Document the client's responses to care c Delegate morning care to unlicensed assistive personnel d Communicate with other disciplines regarding the provision of care e Facilitate team and group activities to avoid scheduling conflicts
a,b,e (Rationale It is difficult to calculate the cost of nursing care; however, some resources that can be used include the number of nursing care hours required for each DRG, the ratio of RNs to LPNs and to UAPs on the unit, and the cost of using a care delivery system that provides the best outcomes while using the fewest nursing hours. The number of attending health care providers who admit clients to the care area and the location of pharmacies used by clients will not help the manager calculate the cost for nursing care.)
The nurse manager has been tasked to determine the cost of providing nursing care to clients on a 10-bed transitional care unit. What resources should the manager use to make this calculation? (Select all that apply.) a Care delivery system that provides the best quality and uses the fewest nursing hours b The number of nursing care hours for each diagnosis-related group c Location of the pharmacies where the clients have prescriptions filled upon discharge d Number of attending healthcare providers that admit clients to the care area e Ratio of RNs to licensed and unlicensed assistive personnel
c (Rationale Contingency planning is conducted in anticipation of or in response to an unplanned event. An example of a contingency plan would be one that examines staffing options in the event adverse weather conditions prevented staff from arriving to work as scheduled. Strategic planning is the process of continual assessment, planning, and evaluation to guide the future. Examples of strategic planning include preparing for nurses to attend charge nurse classes, plans to replace outdated computers, and renovation plans.)
The nurse manager is completing a contingency plan that is due to the director of nursing before the end of the business day. Which plan is appropriate for the nurse manager to submit? a Cost analysis to replace older computers in advance of software upgrades b Schedule to renovate four step-down bays on the unit c Approach to staffing if adverse weather conditions prevent staff from arriving for scheduled shifts d Preparation of staff nurses to attend charge nurse classes
a,b,c,d (Rationale Care that is not coordinated can lead to fragmented services, medical errors, and unnecessary duplication of tests, services, and treatments, as well as to omission of necessary services. Collaboration can be initiated by the client, family member, or a member of the health care team.)
The nurse manager is concerned that client care coordination was not successful. On which observations did the nurse manager base this concern? (Select all that apply.) a The client's abdominal wound dressing was changed twice in one shift. b The client's fasting blood glucose level was drawn twice in one day. c The client received two doses of a prescribed pain medication. d Referral for home care has been delayed by two days. e The family is requesting to discuss home care needs.
a,b,d,e (Rationale When nurses embrace the expectations of care coordination, care will be provided that is reliable, accessible, of the highest quality, and at the lowest cost. Rationing of care is not an expectation of care coordination.)
The nurse manager is evaluating care coordination actions performed by the nursing staff. Which outcomes indicate that the nursing staff's actions have been effective? (Select all that apply.) a Care is reliable. b Care is of the highest quality. c Care is being rationed. d Care is being provided at the lowest cost. e Care is readily accessible.
b,c,d (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 nurse manager is performing responsible actions associated with a delicate client care situation. Which actions are appropriate for the nurse manager to complete? (Select all that apply.) a Directing nursing staff to check expiration dates before using intravenous fluids b Notifying central storage of stock items no longer needed for the care area c Ensuring paper work is completed and submitted to the security department as required d Meeting with staff about the need to maintain client confidentiality e Referring to the nurse practice act before delegating a task to a nurse
a,b (Rationale Partnering is an approach to delegation in which teams of workers, such as an RN, LPN, and UAP, work together consistently. Scheduling the same staff to work the same shifts and sending them to training sessions together supports partnering as a delegation strategy. Preparing a task list is a unit-based approach to delegation. Assigning a nurse to an assistant for each shift exemplifies the pairing approach to delegation. Nurses should always ask for help when necessary.)
The nurse manager is planning to implement partnering in the medical-surgical care area. Which actions should the manager perform to support this approach to delegation? (Select all that apply.) a Schedule nurses and assistants to work the same shifts b Assign a designated group of nurses and assistants to attend a training session together c Prepare a task list for each shift d Assign a nurse to an assistant for every shift e Direct nurses to ask for help when necessary
a,b (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 pre-determined amount of money paid to the hospital based upon 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 manager plans to inform the staff that the organization is going to provide a group self-insurance health plan for all employees effective in the new year. What 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 Coverage will cost the organization less because of lower fees and tax exemptions. It is a prospective payment system that determines costs before care is provided. A pre-determined amount of money will be paid to the hospital based upon a diagnosis. Rates for care are set in advance of the year in which they apply.
c (Rationale To overcome the barrier of limited resources, the nurse may discuss covering the resource with the client's insurance carrier. A strategy to overcome non-adherence to the plan of care would be to identify alternatives to overcome reasons for not following the plan of care. The health insurance carrier would not be involved in this process. To address a knowledge deficit, the nurse would provide additional teaching to help the client comprehend instructions. Caregiver reluctance may impact care delivery, but it is not a barrier to care coordination.)
The nurse telephones a health insurance carrier to discuss covering an electric wheelchair for a client with a spinal cord injury. Which barrier of care coordination is the nurse attempting to overcome? a Caregiver reluctance b Non-adherence to the plan of care c Limited resources d Knowledge deficit
a,e (Rationale In the planning phase of care coordination, the nurse should utilize standard protocols, or 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 health care provider are actions that occur during the implementation phase of care coordination.)
The primary nurse is coordinating care for a newly admitted client. Which nursing actions are appropriate when planning this client's care? (Select all that apply.) a Select appropriate critical pathways for the client b Obtain orders for referrals and consultations from the health care provider c Initiate consultations with other health care providers d Suggest appropriate referrals for the client's care e Identify applicable evidence-based practice guidelines for the client's care
b,c,d (Rationale When assigning tasks to delegate, the nurse needs to determine if the task involves technical skills or cognitive abilities, specific qualifications, licensure, scope of practice, job description, complexity, education, or training. Tasks that should never be delegated include disciplining other employees, highly technical tasks, complex client care tasks that require specific levels of licensure, certification, or training, and any situation that involves confidentiality or controversy. Assessing limb pulses is a complex task that requires nursing licensure. Discussing errors made by another employee is likely to violate the organization's personnel policies related to employee confidentiality. The other tasks are within the scope of practice for unlicensed assistive personnel.)
The primary nurse is reviewing a list of tasks to delegate to a nursing assistant. Which tasks should the nurse avoid delegating to this level of personnel? (Select all that apply.) a Removing limb restraints in order to ambulate a client with confusion b Suctioning a client recovering from radical neck surgery c Assessing limb pulses on a client recovering from a cardiac catheterization d Discussing a care error made by another nursing assistant e Applying dry gauze dressings over a client's skin tears after morning care
d (Rationale Team nursing is not as effective when caring for clients who are acutely ill because the nurse is needed for direct care and will not have time to delegate many tasks. Teaching, identifying nursing diagnoses, and decision-making are skills used within primary nursing and would be required when caring for this client.)
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 as the team leader? Client teaching Decision-making Identifying nursing diagnoses Delegation
a,c,d,e (Rationale Learning to manage care takes time because it requires strong communication, assessment, and time management skills. Managing care also requires the ability to appropriately delegate to unlicensed staff. The skill of medication administration is necessary for direct client care, not managed care.)
The staff development educator is preparing a seminar for staff nurses prior to implementing managed care. Which skills should the educator include as necessary when implementing this care delivery system? (Select all that apply.) a Assessment b Medication administration c Communication d Time management e Delegation
b,d (Shared governance is an organizational model that encourages nurse participation in decision-making at all levels within an organization. It can be used with other care delivery models. Client and family participation in care delivery is a characteristic of client-focused care. Differentiated practice is based upon competencies needed to provide client care. The case method of care delivery is believed to be a precursor to primary nursing.)
What are characteristics of shared governance? (Select all that apply.) a Based upon competencies needed to provide client care b Encourages decision-making at all organization levels c Client and family participation in care delivery process d Can be used with other care delivery methods e Is a precursor to primary nursing
b,c,d (Delegation benefits the nurse by providing more time to complete tasks that cannot be delegated, such as complex client care, by improving client care, and by increasing the nurse's job satisfaction. Delegation benefits the delegate by building self-esteem and confidence and by increasing cooperation and teamwork.)
What are the benefits of delegation to the nurse? (Select all that apply.) a Helps build self-esteem and confidence b Improves client care c Provides more time to complete complicated tasks d Increases job satisfaction e Increases cooperation and enhances teamwork
a,b,c,e (Planning is a four-stage process that includes: establishing objectives and goals, evaluating the present situation and predicting future trends and events, formulating a planning statement, and converting the plan into an action statement. Organizing is coordinating the work to be done.)
What are the steps that a nurse manager uses when planning? (Select all that apply.) a Evaluating the present situation and predicting future trends and events b Formulating a planning statement c Converting the plan into an action statement d Coordinating the work to be done e Establishing objectives and goals
b (Care coordination is always initiated by the nurse. Care coordination does not necessarily involve direct client care. Collaboration is defined as two or more people working towards a common goal, and may occur in a number of models and settings. In collaboration, a client, family member, or any member of the healthcare team may initiate action. Direct interaction with the client or other individual is a characteristic of collaboration.)
What is a defining characteristic of care coordination? a Direct interaction with other members of the care team b Initiation by the nurse c Direct client care is delivered d Initiation by a family member
a (Institutional accountability is a reflection of the philosophy and objectives of the nursing department. Individual or client accountability is reflected in ethical integrity. Professional accountability is reflected by standards of practice. Societal accountability is reflected in legislated nurse practice acts.)
What is used as a reflection of institutional accountability? a Philosophy and objectives of the nursing department b Ethical integrity c Legislated nurse practice acts d Standards of practice
b.c (The Centers for Medicare and Medicaid Services (CMS) and the American Nurses Association (ANA) have both embraced the use of care coordination. The CMS considers care coordination as reimbursable due to its ability to reduce rehospitalization rates, and the ANA identifies several positive results related to the implementation of care coordination. The American Medical Association, the National League of Nurses, and La Leche League have not specifically embraced the use of care coordination.)
What organizations have embraced the use of care coordination? (Select all that apply.) a La Leche League b American Nurses Association c Centers for Medicare and Medicaid Services d American Medical Association e National League of Nurses
a,c,d,e (SBAR: The SBAR approach can be used to support communication between disciplines and includes situation, background, assessment, and recommendation. Efficiency is not a step to support communication between disciplines but rather is a technique used when evaluating performance.)
What steps are used to support communication between disciplines? (Select all that apply.) a Recommendation b Efficiency c Situation d Assessment e Background
b (In the planning care phase of care coordination, the nurse will utilize standard protocols or critical pathways and evidence-based guidelines. Determining the need for consultation with other healthcare providers is a part of the assessment phase of care coordination. Identifying potential challenges is a part of the problem identification phase when coordinating care. Adjusting the plan in response to a change in the client's condition is an action taken when evaluating care coordination.)
Which action is characteristic of the "planning care" phase of the care coordination process? a Determine the need for consultation with other healthcare providers b Utilize standard protocols or critical pathways and evidence-based guidelines c Adjust the plan in response to changes in the client's condition d Identify potential challenges
b (The fourth step of delegation includes reaching an agreement with the delegate regarding completing the task. Identifying routine, low priority tasks occurs in the first step as the nurse determines what tasks are appropriate for delegation. The second step of delegation includes matching the task to an individual. In the third step, the nurse reviews expected outcomes and the timeline for completion.)
Which action will the nurse perform in the fourth step of the delegation process? a Identify routine, low priority tasks b Reach an agreement regarding the task that will be performed c Review the expected outcome and the timeline for completion d Match the task to an individual
a,b,c,e (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.)
Which activity is required of the delegate who accepts a task? (Select all that apply.) a Report concerns b Clarify how to report completion of the task c Keep the delegator informed of progress d Define the task e Clarify the time frame to complete the task
b (Partnering is the ideal approach to delegation because it ensures that a set team of healthcare workers, such as an RN, LPN, and UAP, always work together. This creates healthy interpersonal relationships, increases trust, and helps each partner anticipate the others' needs and expectations. The unit-based approach is the least effective method of delegation. Pairing is an effective method but typically is limited to the current shift. Functional is not an assignment pattern for delegation.)
Which assignment pattern is the ideal approach to delegation? a Functional b Partnering c Unit-based d Pairing
d (The functional method uses a task-oriented approach. In the case method, one nurse is assigned and responsible for the care of a group of clients over the course of a shift. In the team method, the 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.)
Which care delivery method uses a task-oriented approach? a Team b Primary c Case d Functional
d (Clients who receive the greatest benefit from managed care usually are those with chronic health alterations, such as chronic lung, heart, or neurological health conditions. Minor orthopedic surgery, peptic ulcer, and limb fractures are not considered chronic health conditions.)
Which client health problem would benefit the most from case management? a Peptic ulcer b Minor orthopedic surgery c Fractured leg d Chronic lung disease
d (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.)
Which client should the nurse refer to the case manager for ongoing care? a Client being treated for deep vein thrombosis b Client being discharged after a total hip replacement c Client with hepatitis B d Client with exacerbation of multiple sclerosis
d (Limited access to resources such as a lack of transportation is a barrier to care coordination. A change in a client's condition, a staff member calling out sick, or a delay in medication administration are not barriers to care coordination.)
Which is a barrier to care coordination? a Client's abdominal wound becomes infected after surgery b Nursing assistant scheduled for afternoon shift calls off from work c Prescribed dose of medication delayed in arriving from the pharmacy d Client does not have transportation to attend out-patient physical therapy
b,c,d,e (The five rights of delegating include the right task, the right person, the right circumstance, the right direction, and the right supervision. Documentation is not a part of the five rights of delegation.)
Which rights should the nurse follow when delegating a task to unlicensed assistive personnel (UAP)? (Select all that apply.) a Right documentation b Right supervision c Right task d Right person e Right direction
a,b,c,d (Managed care is a delivery system that focuses on decreasing costs and improving client outcomes. It emphasizes preventing inappropriate and unnecessary costs, increasing customer satisfaction, promoting health, and delivering preventive services. Adhering to ethical values is a nursing action essential to all aspects of nursing care but is not a strategy or goal of managed care.)
Which strategies are emphasized in managed care? (Select all that apply.) a Preventing inappropriate and unnecessary costs b Promoting health c Delivering preventive services d Increasing customer satisfaction e Adhering to ethical values
c (One way to overcome a barrier to care coordination is to address knowledge deficits by providing additional teaching to ensure that the client comprehends discharge instructions. Changing assignments to maximize the use of personnel is an approach for differentiated practice. Task force meetings are a characteristic of shared governance. Organizing a client's care needs for a 12 hour shift is a characteristic of the case method of care delivery.)
Which strategy is useful to overcome barriers related to care coordination? a Organize a client's care needs for a 12 hour shift b Discuss a client care issue during a task force meeting c Review the steps in self-administration of insulin with the client before discharge d Change the client assignment so that licensed personnel will be utilized more effectively
c (Flushing an arterial line is a skill within the nurse's scope of practice and cannot be safely delegated to UAP to complete. Providing gastrostomy feedings, measuring intake and output, and ambulating a client with a walker are all tasks that can be safely delegated.)
Which task should the nurse question before delegating it to unlicensed assistive personnel (UAP)? a Measuring intake and output b Ambulating a client with a walker c Flushing an arterial line d Providing a gastrostomy feeding
a,c (Rationale When discussing responses to treatment with the client's other healthcare providers, the nurse is engaging in collaboration. When explaining the client's issues with medication side effects the nurse is engaging in advocacy. The nurse is engaged with healthcare systems when working within the federal, state, local and healthcare organization regulations and requirements. Clinical decision making is prioritizing and providing care. Ethics is adhering to the nursing code of ethics when providing care.)
While caring for a client, the nurse meets with the healthcare provider to discuss responses to treatment and explain the client's issues with medication side effects. Which associated concepts of managed care is this nurse demonstrating? (Select all that apply.) a Collaboration b Clinical decision-making c Advocacy d Ethics e Healthcare systems
c (When resources are lacking, the nurse can network with another provider to obtain the resource for the client. Explaining to the physician why the equipment is not available, teaching the client to monitor his weight, and helping him understand the need for monitoring at home are important nursing actions but will not help overcome the existing barrier of limited resources.)
While coordinating the care for Mr. Obertone, an adult client with heart failure, the nurse discovers that home monitoring equipment is not available for several days. Which nursing action is most appropriate to overcome this care coordination barrier? a Help the client understand the purpose of monitoring at home b each the client to monitor weight every day at home c Contact another company to obtain the needed resource d Explain to the physician why the equipment is not available
b (Rationale In the event of a problem, the nurse should privately investigate the issue and discuss any findings with the delegate. The nurse should encourage the delegate to explain or provide feedback about the issue before deciding on how to address the issue. The nurse needs to investigate the reasons for the task not being completed before providing any follow up instruction, disciplining the assistant, or discussing disciplinary action with the nurse manager.)
While following up on a delegated task, the nurse observes the task was not completed as required and agreed. Which is the priority nursing action in this situation? a Discipline the assistant for failing to complete the agreed upon task b Inquire as to why the task was not be completed as planned c Discuss disciplinary action for the assistant with the nurse manager d Instruct the assistant on ways to avoid similar situations in the future
b (Rationale Irrigating the nasogastric tube of a client recovering from surgery is beyond the scope of practice of unlicensed assistive personnel. The charge nurse needs to intervene and complete the irrigation of the tube. The charge nurse can discuss over delegation with the nurse at a later time. The charge nurse needs to do more than ask the assistant for the location of the nurse or ask if help is needed. Permitting the assistant to perform a task could result in liability for the nurse, charge nurse, and assistant.)
While making morning rounds, the charge nurse observes an assistant irrigating a nasogastric tube of a client recovering from gastric surgery. What is the most appropriate action by the charge nurse at this time? a Ask the assistant if help is needed b Intervene and complete the irrigation of the tube for the assistant c Ask the assistant of the location of the nurse d Discuss the issue of over delegation with the nurse
b,c,d,e (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.)
Why would a nurse hesitate to delegate a task to another member of the healthcare team? (Select all that apply.) a Fear of making mistakes b Fear of competition and criticism c Fear of loss of control d Fear of liability or being blamed for the delegate's mistakes e Fear of overburdening others
4 As charge nurse, you must assess the performance and attitude of the staff in relation to this client. After data are gathered from the nurses, additional information can be obtained from the records and the client as necessary. The educator may be of assistance if a knowledge deficit or need for performance improvement is the problem. Focus: Supervision, prioritization; QSEN: PCC, TC, QI; Concept: Pain
You are the charge nurse. A client with chronic pain reports to you that the nurses have not been responding to requests for pain medication. What is your initial action? 1. Check the medication administration records (MARs) for the past several days. 2. Ask the nurse educator to provide in-service training about pain management. 3. Perform a complete pain assessment on the client and take a pain history. 4. Have a conference with the nurses responsible for the care of this client.
