Chapter 21 - Managing Patient Care

Your nurse manager distributes biweekly newsletters of ongoing unit or healthcare agency activities and posts minutes of committee meetings on a bulletin board in the staff break room. Of what is this an example? Staff communication Problem-solving committees Interdisciplinary collaboration Nurse-physician collaborative practice

1 Rationale A manager's greatest challenge, especially if a work group is large, is communicating with staff. Posting minutes in an accessible place for all staff ensures that all staff members receive the same message: the correct message. Minutes of committee meetings are usually in an accessible location for all staff to read. p. 284

Primary nursing is a nursing care delivery model. When was this model of care adopted? During the 1970s During World War I During World War II During the 2000s

1 Rationale The primary nursing model was more popular in the 1970s. The total patient care model was developed during World War I. Team nursing was developed in response to the severe nursing shortage following World War II. The interdisciplinary model became popular during the 2000s. p. 281

The nurse, who has experience working in a non-Magnet hospital, has found a new job in a Magnet hospital. What differences would the nurse expect to find in the new hospital? Select all that apply. The staff feels valued. There is increased job satisfaction. There is increased dependence on other staff members. Solo work is preferred to working in a team. It empowers nurses to be innovative.

1, 2, 5 Rationale A Magnet hospital empowers a nursing team to make changes and be innovative. Professional nurse councils at the organizational and unit levels are one way to create an empowerment model. An effective empowerment model leads to a staff that feels valued, has increased autonomy, and a work environment that promotes job satisfaction. This culture and empowerment combine to produce strong collaborative relationships among team members and improve patient quality outcomes. Autonomy and working in teams is encouraged in a Magnet hospital. p. 279

The nurse is assessing a patient who has diarrhea. While inserting the intravenous catheter, the nurse asks the nursing assistant to help stabilize the patient's hand. Which type of clinical care coordination is the nurse following? Priority setting Use of resources Time management Clinical decision making

2 Rationale Appropriate use of resources is an important aspect of clinical care coordination and is useful for effective patient care. Priority setting is helpful in sequencing nursing interventions to solve collaborative problems. Time management skills are helpful in reducing work-related stress. Clinical decision making is helpful in determining the proper course of action. p. 285

Nursing models provide faster diagnosis and intervention. Which nursing model focuses on improving the accountability of nursing for patient outcomes? Team nursing Primary nursing Total care Secondary nursing

2 Rationale The primary nursing model of care delivery was developed to improve the accountability of nursing for patient outcomes. Team nursing was developed in response to the severe nursing shortage following World War II. Total patient care delivery was the original care delivery model developed during Florence Nightingale's time. Secondary nursing is not a type of nursing care delivery model. STUDY TIP: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say aloud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces test anxiety. p. 281

The nurse asks the nursing assistant to hold the legs of a female patient during an indwelling catheter insertion. Of what is this an example? Organizational skills Use of resources Time management Evaluation

2 Rationale Appropriate use of resources is an important aspect of clinical care coordination. Resources in this case include members of the healthcare team. In any setting, the patient's care is administered more smoothly when staff members work together. The staff needs to ask for assistance, especially when there is an opportunity to make a procedure or activity more comfortable and safer for the patient. p. 285

There are three models of nursing care delivery. Which statement is true about the primary nursing model? The model has no hierarchy of communication. The model allows lateral communication from nurse to nurse. The model allows a mix of communication channels. The model allows every staff member to communicate with everyone else.

2 Rationale The primary nursing model of care delivery was developed to place registered nurses (RNs) at the bedside and improve the accountability of nursing for patient outcomes. This model involves lateral communication from nurse to nurse. The model has a hierarchy, but the nurse can communicate with other nurses, and the caregiver can communicate with other caregivers. The model does not allow a mix of communication channels. If every team member communicated with everyone else, there would likely be miscommunication. STUDY TIP: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the previous material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. p. 281

The nurse works in a medical unit. Which patients should the nurse consider at a high-priority level for nursing care? Select all that apply. A patient who has a fractured bone in his leg A patient who lost consciousness A patient who has impaired oxygenation A patient whose cardiac output is decreased A patient who has pressure ulcers

2, 3, 4 Rationale A high-priority level problem poses an immediate threat to a patient's survival. It is considered an emergency and is a life-threatening condition. If left untreated, it can have fatal consequences. Loss of consciousness, impaired oxygenation and decreased cardiac output are high-priority problems. These conditions may be life-threatening if not treated in a timely manner. A fracture of the leg or presence of pressure ulcers does not pose immediate danger to life. Therefore, these are intermediate-priority problems. p. 284

A registered nurse (RN) is delegating a task to one of the the nursing assistive personnel (NAP). The RN tells her to measure the blood pressure of room 32. Which statement is true about the nurse's delegation skill? The nurse has not provided the right supervision. The nurse has not delegated the task to the right person. The nurse has not delegated the right task to the person. The nurse has violated the principle of right communication.

4 Rationale The RN has violated the principle of right communication. The nurse should not address the patient by disease condition or by room number. This can create confusion. The other principles of delegation include right supervision, right person, and right task. p. 287

The nurse is reviewing the work of nursing assistive personnel (NAP) and notices that one of them is consistently delivering a dissatisfactory performance. What should the nurse do? Select all that apply. Assign another task. Give constructive and appropriate feedback. Schedule additional training with the educational department. Focus on things that can be changed and give specific detail. Involve other colleagues while giving the feedback to the person so that others do not make the same mistake.

2, 3, 4 Rationale When a nursing assistant does not perform the given tasks appropriately, the nurse should give appropriate feedback in a constructive way. The alternate ways to handle the situation and a better way to perform the task should be explained. If there is any deficiency in training and education, additional training sessions should be arranged with educational departments. One issue should be discussed at a time, and specific details should be given. If the performance is not satisfactory, it indicates that either the training is inadequate or the assistant has been assigned too many tasks. Assigning the assistant another task may not solve the issue. The feedback should be provided in private to maintain the assistant's self-esteem. Involving others in the feedback process may embarrass the him or her. pp. 287-288

While administering medications, the nurse realizes that she has given the wrong dose of medication to a patient. She completes an incident report and notifies the patient's healthcare provider. What characteristic is the nurse demonstrating? Authority Responsibility Accountability Decision making

3 Rationale Accountability means that nurses are answerable for their actions. It means that they accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing it. Following institutional policy for reporting errors demonstrates the nurse's commitment to safe patient care. p. 282

Which example demonstrates the nurse performing the skill of evaluation? The nurse explains the side effects of the new blood pressure medication ordered for the patient. The nurse asks the patient to rate pain on a scale of 0 to 10 before administering the pain medication. After completing the teaching, the nurse observes the patient draw up and administer an insulin injection. The nurse changes the patient's leg ulcer dressing using the aseptic technique.

3 Rationale Evaluation is one of the most important aspects of clinical care coordination; it involves the determination of patient outcomes. Observing a patient demonstrate teaching is evaluation to ensure that he or she has understood teaching. Asking the patient to rate pain is not an evaluation because it occurs before administering a pain medication. The other options are interventions. Test-Taking Tip: Do not read too much into the question or worry that it is a trick. If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. p. 286

When unit staffing includes nursing assistive personnel (NAP), which scenario is characteristic? The NAP have formal training and are able to function independently. The NAP do not have clinical duties on a patient care unit. The registered nurse (RN) is accountable for the tasks delegated to the NAP. Delegating tasks to the NAP is not in the scope of the RN's practice.

3 Rationale Nurses remain accountable for patient outcomes whether or not the specific tasks are performed by nurses or nurse extenders. Accountability implies being responsible and answerable for actions or inactions of the self or others in the context of delegation. The NAP do not function independently but can have clinical duties on a patient care unit. Delegation of tasks is within the scope of the RN's practice. p. 287

You are the charge nurse on a surgical unit. You are doing staff assignments for the 3:00 PM to 11:00 PM shift. Which patient do you assign to the licensed practical nurse (LPN)? The patient who transferred out of intensive care an hour ago The patient who requires teaching on new medications before discharge The patient who had a vaginal hysterectomy 2 days ago and is being discharged tomorrow The patient who is experiencing some bleeding problems following surgery earlier today

3 Rationale The patient with the vaginal hysterectomy is stable and requires care that is within the scope of the LPN. The other three patients need a higher level of care requiring assessment, support, and teaching that are the responsibilities of the registered nurse. p. 287

A registered nurse (RN) delegates the duty of oral care of a patient to one of the nursing assistive personnel (NAP). The RN provides instructions for the procedure and supervises the assistant when the procedure is being done. Which right of delegation is the RN applying? Right task Right direction Right supervision Right circumstances

3 Rationale The registered nurse is following the principle of right supervision for delegation. Right supervision refers to the act of providing appropriate monitoring, evaluation, intervention, and feedback for improvement. The principle of right task is related to the delegation of patient care activities based on the skill of the staff. Tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk should be delegated. The principle of right direction gives a clear, concise description of the task, including its objective, limits, and expectations. The principle of right circumstances considers the appropriate setting, available resources, and other relevant factors. p. 287

The nurse has just given a patient a narcotic for pain relief and must now leave the unit. To whom should the nurse delegate the task of evaluating the client's response to the pain medication? A unit clerk A student nurse Another registered nurse (RN) A patient care aide

3 Rationale Assessment and management of pain belongs only to the RN's scope of practice The unit clerk is not responsible for the patient's care. The student nurse may participate in the patient's care but the accountability remains with the RN. The patient care aide is not accountable for the patient's assessment and management of pain. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX ® item writers (those who write the questions) are also aware of this and attempt to avoid offering you such helpful hints. p. 287

The nurse is assisting the patient with coughing and deep-breathing exercises following abdominal surgery. This is which priority nursing need for this patient? Low priority High priority Intermediate priority Nonemergency priority

3 Rationale Assisting the patient with coughing and deep breathing is an intermediate priority. Intermediate priorities are not emergency, life-threatening actual or potential needs that the patient and family members are experiencing. Anticipating teaching needs of patients related to a new drug or taking measures to decrease postoperative complications are examples of intermediate priorities. p. 284

Building an empowered nursing team starts with the nurse executive. What is the responsibility of the nurse executive in this process? Provide training to the nursing staff. Maintain the patient's record in a systematic way. Teach the patients about health and well-being. Establish a philosophy for nursing staff to provide quality nursing care.

4 Rationale The executive's position is critical in uniting the strategic direction of an organization with the philosophical values and goals of nursing. The main responsibility of the nurse executive is to establish a philosophy for the nursing staff to provide quality nursing care. The nurse executive is not responsible for providing training to the nursing staff or maintaining the patient's record in a systematic way. Teaching the patients about health and well-being is not the responsibility of the nurse executive. This is done by the nursing staff. Test-Taking Tip: If you are confused about the question, read the choices and label them true or false. Then reread the question and make your decision. p. 287

Which task is appropriate for a registered nurse (RN) to delegate to the nursing assistant? Explaining to the patient the preoperative preparation before the surgery in the morning Administering the ordered antibiotic to the patient before surgery Obtaining the patient's signature on the surgical informed consent Assisting the patient to the bathroom before leaving for the operating room

4 Rationale Assisting the patient to the bathroom is a skill and task within the knowledge level and tasks appropriate for a nursing assistant. The other tasks are the responsibility of the RN. The RN is responsible for patient teaching, medication administration, and surgical consents. p. 287

The registered nurse (RN) checks on a patient who was admitted to the hospital with pneumonia. The patient is coughing profusely and requires nasotracheal suctioning. Orders include an intravenous (IV) infusion of antibiotics. The patient is febrile and asks the RN if he can have a bath because he has been perspiring profusely. Which task is appropriate to delegate to the nursing assistant? Assessing vital signs Changing IV dressing Nasotracheal suctioning Administering a bed bath

4 Rationale The bed bath is a skill and task within the knowledge level and tasks appropriate for a nursing assistant. The other tasks are the responsibility of the RN. Assessment, dressing change, and suctioning require assessment and skill that are within the scope of practice of the RN. p. 287

A registered nurse (RN) is delegating patient care to nursing assistive personnel (NAP). Which tips would help the RN appropriately delegate patient care? Select all that apply. Listen attentively to the NAP. Communicate clearly with the NAP. Let the NAP perform tasks independently. Assign tasks a little higher than the NAP's skills. Assess the knowledge and skills of the NAP.

1, 2, 5

The nurse is learning about a decentralized nursing unit that supports decision making. Which elements of decision making should the nurse practice? Select all that apply. Authority Autonomy Negligence Dependence Responsibility

1, 2, 5 p. 282

A group of registered nurses in a 75-bed, pediatric healthcare facility are planning to apply for Magnet status for the hospital. The nurses discuss the various nursing care models and unanimously decide to adopt the primary nursing model of nursing care delivery. What are the characteristics of this care delivery system? Select all that apply. One primary registered nurse (RN) is responsible for a set of patients. The registered nurse does not directly provide care to the patient. The registered nurse does not communicate with the nursing assistive personnel. The registered nurse develops the care plan and delivers appropriate nursing care.

1, 4 A group of registered nurses in a 75-bed, pediatric healthcare facility are planning to apply for Magnet status for the hospital. The nurses discuss the various nursing care models and unanimously decide to adopt the primary nursing model of nursing care delivery. What are the characteristics of this care delivery system? Select all that apply. <p>A group of registered nurses in a 75-bed, pediatric healthcare facility are planning to apply for Magnet status for the hospital. The nurses discuss the various nursing care models and unanimously decide to adopt the primary nursing model of nursing care delivery. What are the characteristics of this care delivery system? <b>Select all that apply.</b> </p> One primary registered nurse (RN) is responsible for a set of patients. The registered nurse does not directly provide care to the patient. The registered nurse does not communicate with the nursing assistive personnel. The registered nurse develops the care plan and delivers appropriate nursing care. p. 281

When performing a hospital duty, which actions should the nurse perform to appropriately delegate tasks in accordance with the five rights of delegation? Select all that apply. Delegate tasks in any clinical setting. Provide appropriate supervision and evaluation. Delegate tasks that have minimal potential risk. Provide a clear, concise description of the delegated task. Provide feedback in front of everybody.

2, 3, 4 Rationale It is important to provide appropriate monitoring, evaluation, intervention, and feedback to make the nursing assistive personnel (NAP) feel comfortable enough to ask questions and seek assistance. The right tasks to delegate are those that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk. The nurse should provide a clear, concise description of the delegated task to make sure the information and instructions are clearly understood by the NAP. The nurse should consider appropriate settings when delegating tasks; for example, in acute care settings the patient's condition may often change. The nurse should provide feedback in a private place, and discuss the issues in a constructive manner. Test-Taking Tip: Do not spend too much time on one question because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass. p. 287

What are the characteristics of an effective team? Select all that apply. Different purposes Effective communication Trust The ability to keep feedback to oneself Effective conflict management

2, 3, 5 Rationale A good team is important to effective nursing care. The team should be able to communicate properly and avoid miscommunication. The team members should be able to trust each other. Conflicts may arise among team members; the team should be able to manage them amicably. All the team members should have a common purpose so that their efforts are focused. Providing feedback to each other helps improve patient care. Test-Taking Tip: Trust your training! Your nursing judgment and common sense both are valuable when answering this question. As you read the choice, you can eliminate the incorrect choices by asking yourself if it makes sense. Clearly, a team needs to have a united purpose and team members need to be able to give each feedback. The other choices will seem right to you because of your training and good judgment. p. 286

The nursing student is learning that accountability is one of the four key elements in decision making. Which actions indicate that the nursing student displays an understanding of accountable nursing care? Select all that apply. Suspend care after discharge. Be committed to providing excellent patient care. Inform clients about ways to improve self-care. Deny the responsibility of the patient care outcomes. Check with the patient about his or her health status after discharge.

2, 3, 5 Rationale Accountability means the nurse is answerable for the actions performed and that he or she should accept the commitment to provide excellent patient care. The nurse is accountable for ensuring that each patient learns the information necessary to improve self-care. Checking with the patient about his or her health status after discharge shows the accountability of the nurse and the nurse's commitment to providing quality care to the patient. Suspending patient care after discharge shows poor involvement. The nurse is accountable for the patient's outcomes and should ensure that each patient learns the information necessary to improve self-care. Test-Taking Tip: Eliminate answers that would not be appropriate in any setting. For this question, the choice to "Deny the responsibility of the patient care outcomes" can easily be eliminated because it does not reflect ethical, professional behavior. p. 282