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15. The case method of care delivery is used on the surgical unit. The LPN/LVN asks what this means regarding work assignments. The best answer would be a. "You will be assigned to provide care for two or three relatively stable patients with predictable care outcomes." b. "You will be assigned to perform specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on." c. "You will be assigned to provide daily total care for several patients from admission to discharge." d. "You will receive cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties."

ANS: A Case method calls for a nurse to provide complete care to several patients. Stable patients are generally assigned to LPN/LVNs. Performance of specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on, describes the team method of care delivery. Provision of daily total care for several patients from admission to discharge describes primary care nursing that utilizes only RN staff. Cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties describes patient-focused nursing. DIF: Cognitive Level: Application REF: p. 187 OBJ: 6 TOP: Case method of nursing care delivery KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

13. A nurse describes the method of care delivery on a unit as "using nursing staff in varying ratios to meet patient needs and coordinating care using care pathways." This best describes a. nursing case management. b. primary nursing. c. team nursing. d. the skill mix method.

ANS: A Nursing case management care delivery uses critical paths to coordinate cost-effective care provided by nursing team members from a variety of educational backgrounds. The description of the care delivery method does not match any of the other care delivery methods mentioned in the options. DIF: Cognitive Level: Comprehension REF: p. 188 OBJ: 5 TOP: Nursing case management KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

1. Which groups are members of a nursing team? a. RNs, LPN/LVNs, nursing assistants b. Radiologists, dietitians, respiratory therapists c. Occupational therapists, physical therapists, pharmacists d. Physicians, pharmacists, dietitians, physical therapists

ANS: A RNs, LPN/LVNs, and nursing assistants are members of the nursing team who have been cross-trained to perform selected nursing tasks. The groups listed in the other options are not considered part of the nursing team. DIF: Cognitive Level: Comprehension REF: p. 181 OBJ: 3 TOP: Nursing team KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

9. The goal of the health care team is best described as a. restoring optimal physical, emotional, and spiritual health to patients. b. preventing communicable diseases. c. selecting health care professionals who serve people with health care needs. d. attaining personal satisfaction of the need to help others.

ANS: A Restoring optimal physical, emotional, and spiritual health to patients is a frequently used statement that describes the goal of health care. Prevention of communicable diseases is a narrow statement and does not best describe the goal of the health care team. The remaining options are not goals of the health care team. DIF: Cognitive Level: Knowledge REF: pp. 179-180 OBJ: 1 TOP: Goal of health care team KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

10. The most important reason for a student nurse to prepare adequately before providing patient care is to a. be able to give the same safe care as a nurse. b. avoid arousing the anger of the instructor. c. maintain self-esteem by performing well. d. make a favorable impression on unit staff.

ANS: A Student nurses are legally and ethically responsible for giving the same safe nursing care that nurses provide. Avoidance of arousing the anger of the instructor is not a valid reason. The remaining options are not the most important reasons. DIF: Cognitive Level: Analysis REF: p. 184 OBJ: 3 TOP: Student nurses KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

7. Which member of the health care team is responsible for initially teaching a patient about medication side effects? a. Registered nurse b. LPN/LVN c. Occupational therapist d. Patient care technician

ANS: A The RN initiates all health teaching. This would include education about medication effects and side effects. The LPN/LVN is able to initiate health teaching only for basic health habits, such as cleanliness. Occupational therapists and patient care technicians are not qualified to undertake medication teaching. DIF: Cognitive Level: Comprehension REF: pp. 182-185, Table 15-1 OBJ: 3 TOP: Patient teaching KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

2. Nursing management and executive roles include which of the following? (Select all that apply.) a. Supervisor b. Nurse manager c. Director d. Chief nursing officer e. Charge nurse

ANS: A, B, C, D The four levels of nursing management include supervisor, nurse manager, director, and chief nursing officer (CNO). Charge nurse is not considered a level of nursing management. DIF: Cognitive Level: Comprehension REF: p. 184, Box 15-1 OBJ: 3 TOP: Health care team KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

12. A student nurse asks, "What determines the LPN/LVN's role and responsibilities in the practice setting?" The best answer is a. "The job analysis performed by the National Council of State Boards of Nursing." b. "The Nurse Practice Act of the state in which the LPN/LVN is employed." c. "The skill mix of the agency unit to which the nurse is assigned." d. "The degree of centralization of the unit on which the LPN/LVN works."

ANS: B The LPN/LVN's role is determined by the Nurse Practice Act of the state in which the nurse is working. The Nurse Practice Act differs from state to state but generally allows LPN/LVNs to provide care in basic and complex patient situations under the general supervision of an RN, physician, podiatrist, or dentist. The other options are not determinants of scope of practice. DIF: Cognitive Level: Application REF: p. 185 OBJ: 3 TOP: Scope of practice KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

17. The LPN/LVN describes herself as "working in an expanded role in a long-term care facility." What is the most correct interpretation of this statement? a. The LPN/LVN is able to administer oral medications. b. The LPN/LVN is a first-line manager responsible to the RN. c. The LPN/LVN formulates nursing diagnoses and care plans. d. The LPN/LVN interprets and implements research findings.

ANS: B The expanded role of the LPN/LVN in long-term care occurs in the role of manager of care. The LPN/LVN may be a first-line manager, supervising care given by LPN/LVNs and unlicensed assistive personnel while being directly responsible to the RN nurse manager. Oral medication administration is part of the traditional role. Formulation of nursing diagnoses and care plans and interpreting and implementing research findings are outside the LPN/LVN role. The LPN/LVN assists in implementing research findings. DIF: Cognitive Level: Analysis REF: p. 185 OBJ: 3 TOP: LPN/LVN expanded role KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

2. How should the nurse accurately describe a nurse practitioner to a student nurse? a. "The nurse practitioner is a student nurse who is near graduation from a basic program." b. "The nurse practitioner is a registered nurse with a master's degree in nursing and specialty certification." c. "The nurse practitioner is a registered nurse with doctoral preparation in research methodology." d. "The nurse practitioner is a nurse who practices exclusively in a university medical center."

ANS: B The nurse practitioner has a minimum of a master's degree in nursing and certification in an area of specialization, such as primary care, geriatrics, pediatrics, and so on. The other options do not accurately describe the nurse practitioner's education or role. DIF: Cognitive Level: Application REF: p. 183 OBJ: 3 TOP: Nurse practitioner KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

14. An LPN/LVN offers input to the RN about the effectiveness of the patient's care plan. By doing this, the LPN/LVN is functioning in an a. entrepreneurial role. b. expanded role. c. interdependent role. d. independent role.

ANS: C Interdependence calls for the LPN/LVN to provide input and feedback to the RN planning and evaluating care for a specific patient. DIF: Cognitive Level: Application REF: p. 185 OBJ: 3 TOP: Interdependent role of LPN/LVN KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

6. The member of the health care team responsible for performing treatments to assist the patient to breathe more efficiently and effectively is the a. occupational therapist. b. physical therapist. c. respiratory therapist. d. psychotherapist.

ANS: C Respiratory therapists are responsible for evaluating patient respiratory status and suggesting treatment to prevent or treat respiratory problems. The health care team members mentioned in the other options do not focus on patient breathing. DIF: Cognitive Level: Comprehension REF: p. 179 OBJ: 2 TOP: Health care team KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

3. Which statement best describes the relationship between the student nurse assigned to a hospital unit for clinical experience and the unit staff? a. The student is under direct supervision of the nurse manager of the unit at all times. b. Students are on the clinical unit to give service to the hospital as they care for patients. c. The student applies classroom learning under the supervision of faculty members during clinical training. d. Practical nursing students form a nursing team of their own and are not a part of the larger unit team.

ANS: C Student nurses are not counted as clinical staff when receiving clinical experience on a unit. They are supervised by instructors, and their objective is to apply classroom theory in selected clinical situations. It is not an expectation that a student be under direct supervision of the nurse manager. Students are not unit employees. It is not a usual practice for practical nursing students to form a nursing team of their own and not be a part of the larger unit team on the clinical unit. DIF: Cognitive Level: Analysis REF: p. 185 OBJ: 3 TOP: Student role KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

8. The role of the LPN/LVN in the health care team is best described as a. independent. b. advanced practice. c. interdependent. d. decentralized.

ANS: C The LPN/LVN functions interdependently by providing care according to the established plan, collecting data, and offering input to the RN about the effectiveness of care and suggestions for care improvement. Only the RN provides care independently. Advanced practice refers to a nurse with specialized education, skills, and certification. Decentralized is not a term used to describe the LPN/LVN role. DIF: Cognitive Level: Knowledge REF: p. 185 OBJ: 3 TOP: LPN/LVN role KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

16. Which care delivery method has the greatest potential for fragmenting patient care? a. Primary nursing b. Case method c. Functional method d. Patient-focused care

ANS: C The functional method of care delivery assigns various nursing team members to provide specific aspects of care to the patient. The RN might give medications and provide health teaching, the unlicensed assistive personnel (UAP) might provide hygiene, the LPN/LVN might take vital signs and change a dressing, lab personnel might draw blood specimens, and so on. Primary nursing provides the least fragmentation. With the case method, one nurse is responsible for most of the patient care. Patient-focused care attempts to limit fragmentation by using cross-trained personnel. DIF: Cognitive Level: Evaluation REF: p. 187 OBJ: 5 TOP: Care delivery methods KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

MULTIPLE RESPONSE 1. Select the person or persons who may be included on the physical therapy team. (Select all that apply.) a. RN b. LPN/LVN c. Physical therapists d. Physical therapy assistants

ANS: C, D Strictly speaking, the physical therapy team includes only those individuals who have education in physical therapy. Nurses may assist the patient to perform exercises to provide continuity of care when members of the physical therapy team are not present. DIF: Cognitive Level: Comprehension REF: p. 179 OBJ: 3 TOP: Health care team KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity

18. The role of the LPN/LVN can best be described as which of the following? a. Initiates all health teaching b. Works in an independent role c. Initiates all phases of the nursing process d. Assists with all phases of the nursing process

ANS: D Initiating health teaching, working in an independent role, and initiating all phases of the nursing process are roles of the RN. An RN initiates all health teaching

11. The aspect of functioning that distinguishes RNs from LPN/LVNs is that only RNs a. plan and organize daily care for groups of patients. b. implement measures ordered to prevent complications. c. provide health information to patients and families. d. initiate independent nursing actions based on nursing diagnoses.

ANS: D LPN/LVNs function interdependently rather than independently. The LPN/LVN functions under the supervision of the RN. The LPN/LVN is able to perform the remaining options. DIF: Cognitive Level: Knowledge REF: p. 185 OBJ: 3 TOP: LPN/LVN role vs. RN role KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. The member of the health care team responsible for assisting patients to arrange for community agencies to provide services after discharge is the a. nurse. b. physician. c. physical therapist. d. social worker.

ANS: D The social worker explores needs identified by discharge plans and works with community agencies to meet these patient needs. DIF: Cognitive Level: Comprehension REF: p. 179 OBJ: 2 TOP: Social work KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity|NCLEX: Physiological Integrity

4. Select the method of delivering nursing care that facilitates continuity of care, individualizes care, and fosters 24-hour accountability for patient care. a. Case nursing b. Team nursing c. Functional nursing d. Primary care nursing

ANS: D This care delivery method utilizes RNs only. Each primary nurse cares for six patients from admission to discharge, developing the nursing diagnoses and plans of care and assuming ultimate responsibility for 24-hour care, although associate nurses may actually provide care when the primary nurse is not on duty. DIF: Cognitive Level: Analysis REF: p. 188 OBJ: 5 TOP: Primary nursing KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment