The concept of Managing Care & Exemplars

During the orientation of new nurses to an acute care facility, diagnosis-related groups (DRGs) are discussed. Which statement by one of the orientees indicates accurate understanding of DRGs? A. "DRGs determine what will be paid for care by the insurer before the patient is admitted." B. "DRG rates are fixed, regardless of the occurrence of major uncontrollable events." C. "DRG rates are grouped by body system, with predetermined pay determined by system." D. "DRG rates are revised quarterly to reflect the constant changes that occur in the healthcare system."

A

The nurse case manager has been assigned a 3-year-old patient with cystic fibrosis. As the nurse initiates care, which resource should they use to guide care? A. Critical pathway B. Cystic fibrosis concept map C. Nursing standards of care D. Cystic Fibrosis Foundation Age-Specific Guidelines

A

The nurse delegated a task to the unlicensed assistive personnel (UAP). A few minutes later, the UAP returns and tells the nurse that the patient wants to speak to her before the task is done. When the nurse speaks with the patient, the patient shares that they thought only nurses could do the task. How should the nurse best respond to the patient's comment? A. "This is something that they are allowed to do. They reviewed the task with me and demonstrated they could do it safely." B. "They are allowed to do these tasks if we are busy, so please allow them to come back and complete it." C. "There are many things that UAPs can do but normally don't if we have time to do them ourselves." D. "It made the UAP feel bad when you questioned their ability. Do you have a problem with the UAP taking care of you?"

A

The nurse is reviewing dietary limitations with a patient, when the patient states that they will not follow the recommendations. How should the nurse initially address this situation using a patient-focused approach? A. Inform the patient of the risks associated with not following the dietary restrictions. B. Acknowledge the patient's comments and inform the healthcare provider. C. Enlist the help of the patient's family to help persuade the patient to follow the dietary restrictions. D. Inform the patient that, if they are noncompliant, they will immediately be discharged.

A

The nurse leader is trying to identify the why, where, when, how, and by whom during unit budget development. Which management function is the nurse completing? A. Planning B. Organizing C. Directing D. Controlling

A

The nurse manager is discussing issues on the unit with extended stays for Medicare patients due to possible infection control issues. One staff nurse asks why it matters since insurance providers cover the cost of the care and therefore the financial aspects are not really that important. Which response by the nurse manager best addresses this statement? A. "Unless there is a major uncontrollable event for the patient, we only get reimbursed a specified predetermined amount for care, regardless of how long they are here." B. "While that may be true, it is prudent for us to try to control costs to keep the healthcare system functional." C. "Depending on which Medicare plan they have, they may not have coverage that will cover these extended stays, thus placing a financial obligation on the patient." D. "The things that are happening are a direct result of improper infection control practices; it's not fair for the patient or the insurance company to shoulder costs for our errors."

A

The nursing unit director at a large acute care facility is reviewing possible care delivery models. Which factor should the nurse identify as a strong advantage of the functional approach to care delivery? A. Allows centralized direction and control, increasing efficiency B. Allows all care to be provided by nurses, supporting more consistent care C. Maximizes the time and skill of individual staff members D. Includes nursing staff in decision making regarding patient care policies

A

The registered nurse (RN) has asked a licensed practical nurse (LPN) to complete a dressing change for one of the RN's assigned patients. Which is the responsibility of the delegate after the RN explains how to do the dressing change? A. Communicating understanding of the dressing change B. Informing the patient when performing the task that it is being done on behalf of the RN C. Reviewing provider orders to make sure that the dressing change has been prescribed D. Ensuring that the nurse will be in the room during the dressing change to supervise the process

A

A managed care facility is attempting to increase participation by nursing staff in decision making throughout the organization. Which model should the facility leadership select to best achieve this outcome? A. Managed care B. Case management C. Team nursing D. Shared governance

D

A nurse who works at a facility that uses a primary nursing approach to patient care explains to a colleague the benefits of this approach. Which benefit of primary nursing should the nurse include? A. "Primary nursing requires 24-hour responsibility for a patient thereby increasing costs." B. "Primary nursing makes it difficult to focus on acutely ill patients because the nurse just oversees and does not personally deliver all care." C. "Primary nursing delinealtes the roles of all personnel." D. "Primary nursing is focused on consistency of care."

D

A nurse who has been hired to fill a case management role begins working with other healthcare team members to provide care for older patients who are diagnosed with heart failure. Which should the nurse do initially after establishing a collaborative practice team? A. Determine specific interventions to be achieved within specified time frames. B. Define expected outcomes of care for this population within specified time frames. C. Determine the responsibilities of each collaborative practice team member. D. Identify potential variances that may occur for patients with heart failure.

B

A nursing unit manager is looking at historical nursing staff costs as she creates a budget for the next fiscal year. Which issue related to a recent nursing shortage makes it difficult to determine the actual costs of nursing staff? A. Increases in labor union participation B. Increased salary fluctuations C. Increased number of nurses with less than a baccalaureate degree D. Increased use of unlicensed assistive personnel and decreased number of nurses

B

An elderly adult patient with diabetes, obesity, and peripheral vascular disease has been admitted for a left below-the-knee amputation. Which service should the nurse initiate to best meet the needs of this patient as they transition in and out of the hospital setting? A. Primary nursing B. Case management C. Managed care D. Long-term care

B

The home care nurse manager is reviewing applications received from nurses for a case manager role. Which applicant should the nurse manager initially identify as the best fit for the position? A. A nurse with an associate's degree (AD) and 20 years of experience that includes managerial experience B. A baccalaureate (BSN) prepared nurse with 15 years of experience in acute and community-based care. C. A newly graduated advanced practice nurse (APN) who recently completed a direct baccalaureate (BSN) to APN program D. A nurse with 25 years of experience who is returning to practice after teaching fundamentals of nursing at a local community college for the past 10 years

B

The nurse manager encourages the nurses on the unit to attend educational offerings to stay current by providing a small stipend and time off to attend one offering a year. Which management responsibility is the nurse manager best fulfilling through provision? A. Managing resources B. Enhancing employee performance C. Holding nursing staff accountable D. Managing time

B

The nurse manager is preparing to create tools to measure the performance of the emergency department staff when responding to cardiac emergencies. Which function is the nurse manager carrying out? A. Planning B. Controlling C. Organizing D. Directing

B

A participant at a healthcare reform discussion states that the best approach to healthcare would allow continued use of public and private providers with all necessary medical services covered by the government. This type of approach would best fit which category of healthcare systems? A. Mandatory health insurance B. Socialized medicine C. Multipayer systems D. Socialized insurance

D

A facility has decided to use the case management process to manage the care of patients with juvenile diabetes in the primary care clinic. Using the case management approach, when should identification of expected outcomes occur? A. After potential interventions have been identified B. Once all potential patient variations have been discussed C. After a collaborative practice team is established D. After development of the critical pathway to guide care

C

A nursing work group is tasked with finding cost-effective ways to enhance care provision. The group is pulling together a proposal for administrative review that includes hiring more unlicensed assistive personnel (UAPs). Which benefit of delegation should the working group include in their proposal to best enhance potential support for the proposal? A. The availability of more UAPs to whom tasks can be delegated requires fewer nurses, decreasing overall staffing costs. B. A better mix of nurses and UAPs allows the organization more flexibility to respond to ever-changing patient needs. C. Use of delegation increases efficiency of care and productivity, which can improve the organization's financial position. D. It allows delegates (the UAPs) to gain new skills and abilities.

C

A recently graduated nurse has begun working at a facility that uses the team nursing approach. The nurse asks if there are any resources available that can help nurses better understand how to safely delegate tasks to the other members of the healthcare team. Which resource would be most helpful to the nurse? A. Nursing scope and standards for medical-surgical nursing B. Job description for unlicensed assistive personnel at the facility C. The ANA's Five Rights of Delegation D. Clinical practice guidelines for registered nurses

C

The nurse delegates a task to the unlicensed assistive personnel (UAP). After delegating, the nurse receives a call from the patient requesting assistance related to the task that has been delegated. Which is the most appropriate action for the nurse at this time? A. Asking another UAP to assist the patient B. Responding to the call and assisting the patient C. Alerting the UAP that the patient is asking for assistance D. Reprimanding the UAP for not assisting the patient

C

The nurse is working at a facility that uses a case method delivery model of care. Which statement by the nurse best describes this model? A. Unlicensed assistive personnel (UAPs) provide less complex care. B. It uses specific job descriptions to differentiate the practice of each nurse who may provide care. C. The patient has consistent contact with one nurse during the shift. D. One nurse oversees a group of patients 24 hours a day.

C

The nurse is working on a unit where the unit manager has indicated that they want to enhance the delivery of care through shared governance. Which action by the unit manager would best exemplify implementation of shared governance? A. Development of specific job descriptions for nurses according to their education or training to maximize use of staff B. Creation of interprofessional teams that have full responsibility for planning and assessing the needs of patients C. Creation of a group, including staff nurses, to make decisions concerning long-range planning for the unit D. Development of guidelines to support delivery of care by teams led by a professional nurse

C

The nurse manager is meeting with nurses who have recently been promoted to the managerial level. The manager encourages the nurses to review the nursing standards of practice and the state nurse practice act. Which principle of management is reflected in these documents? A. Authority B. Responsibility C. Accountability D. Influence

C

The unit nurses describe the unit nurse manager as someone who encourages them to be involved in decision making and discussions about matters concerning the unit. Which types of leadership style is the nurse manager exhibiting? A. Bureaucratic and democratic B. Laissez-faire and autocratic C. Democratic and laissez-faire D. Authoritarian and participative

C

The nurse has delegated certain aspects of care to an unlicensed assistive personnel (UAP) during a busy shift. During the second step of the delegation process, which is the most appropriate action for the nurse to complete? A. Checking the medical record for documentation of a patient's urine output B. Deciding that help is needed to measure a patient's urine output C. Determining that the UAP is qualified to measure urine output D. Explaining the importance of correctly measuring a patient's urine output

D

The nurse is temporarily assigned to a unit that is receiving multiple admissions secondary to a mass casualty event. The unit's nurses are busy, but an unlicensed assistive personnel (UAP) states to the nurse, "Help complete vital signs on the rest of the patients in the unit." What type of delegation is best reflected by this request? A. Overdelegation B. Unnecessary delegation C. Ineffective delegation D. Reverse delegation

D

The nurse manager is discussing the principles of accountability versus responsibility with nursing staff during a continuing education session. Which information provided by the nurse manager best clarifies the differences between the two? A. Responsibility is reflected in national standards of practice, while accountability is determined facility by facility. B. Responsibility is clearly reflected in an institution's mission and philosophy, while accountability is reflected at the individual level. C. Accountability helps nurses to feel empowered and confident in their abilities, while responsibilities tend to be more task oriented and routine. D. Accountability is being willing to accept the consequences of one's behavior, while responsibility is an obligation to perform tasks.

D

The nurse manager notes that a new nurse is overwhelmed with patient care tasks and rarely asks other team members, including unlicensed assistive personnel (UAPs), for assistance. When the manager asks the new nurse why they are not using the UAPs, the nurse replies, "I don't feel that I should since I'm still accountable for the task they do; that frightens me." How should the nurse manager best respond to the new nurse? A. "It's okay, I was kind of the same way myself. When you're ready let me know and I can help you learn how to effectively delegate." B. "You will burn out if you don't start delegating, so it's important that you deal with your fears concerning it." C. "By not delegating, you might be missing some things which actually jeopardizes the patients more than if you did delegate." D. "I understand. Let's review the state practice act and the ANA's Five Rights of Delegation to help you understand how to address your fears."

D

Two nurses who work at different facilities are discussing their unit managers. One nurse shares that their manager is truly concerned about how they feel. The second nurse shares that they feel very loyal because the nurse manager provides incentives when extra effort is required. Which leadership comparison would refer to the first leader described as compared with the second leader? A. Transactional versus transformational B. Transformational versus servant C. Servant versus charismatic D. Charismatic versus transactional

D