Unit 5 revision, Module 46 Health Care Systems

The nurse is caring for a client who has been placed on a critical pathway for care following hip surgery. The client asks the nurse why there is a need for this type of care model. The best response by the nurse is: "Critical pathways ensure that you will get well." "Critical pathways make you adhere to the program of care." "Critical pathways give direction to the team caring for you." "Critical pathway is just a new term for the nursing care plan."

"Critical pathways make you adhere to the program of care."

The nurse provides information about Medicare to a 65-year-old patient who is on Medicaid. Which patient statement indicates that further information is needed? "I have an appointment with a social worker to help me apply for Medicare." "I understand that Medicare will not cover everything." "I don't want to pay a premium for Medicare every month." "I know I can use the health department for routine care until my Medicare comes through."

"I don't want to pay a premium for Medicare every month." While Medicare Part B does have a monthly premium, a patient who is eligible for Medicaid does not pay a monthly premium. The local health department can provide some services for the patient until the gap in coverage is closed. A social worker can assist the patient with obtaining benefits. Medicare does not cover all services.

The nurse is working at a facility that utilizes primary care nursing as the model for delivering nursing care. Which statement by the nurse best demonstrates an understanding of the role of the primary care nurse? "I have 24/7 authority and responsibility for the patients assigned to my group." "I will be delegating tasks to others, and they will be responsible for the tasks." "I will be providing all the care for my patients and delegate tasks if necessary." "I am responsible for the care of the patients assigned to my team."

"I have 24/7 authority and responsibility for the patients assigned to my group." The statement that best describes the nursing orientees' understanding of primary care nursing is, "I understand that I have 24/7 authority and responsibility for the patients assigned to my group." The primary nurse (PN) cares for the assigned patients during their shift from the time of admission through discharge. The registered nurse who serves as the team leader is accountable for the care provided to the patients assigned to the team. The team leader retains responsibility and authority for the patients' overall well-being but delegates some tasks to unlicensed assistive personnel (UAPs). The statement, "I understand I am responsible for the care of the patients assigned to my team," reflects the model of team nursing.

The nurse manager is providing training on collaboration to a group of nurses. Which comment by a group member indicates that teaching was​ effective? ​"The charge nurse asked me to be on the infection control​ committee, but I​ don't have​ time." ​"The physician keeps ordering physical therapy for my​ client, who ambulates in the hall every​ day." ​"I need to teach my client how important it is to adhere to her treatment​ regimen." ​"I've done my job the same way for 20​ years, and it works well for​ me."

"I need to teach my client how important it is to adhere to her treatment​ regimen." Teaching the client the importance of following the treatment regimen engages the client in​ client-centered care and can lead to improved adherence with the treatment regimen. Effective collaboration eliminates duplication of effort and unnecessary expenses. The nurse needs to inform the physician about the​ client's progress so that the need for physical therapy can be reevaluated. Serving on a committee can improve client outcomes and reduce healthcare​ costs, while improving communication among members. The nurse may find that serving on a committee fosters improved relationships with peers and increased job satisfaction. Performing​ one's job the same way for 20 years overlooks the opportunity to update practice based on the latest​ evidence-based research, which can improve both quality and cost of care.

An older adult patient with some memory difficulty receives care from her daughter. Upon receiving conflicting information about the healthcare provider's visit from the patient and the nurse, the caregiver gets angry and shouts at the nurse. Which response by the nurse will help to diffuse the situation? "You should call the healthcare provider to follow up." "Let's get the healthcare provider on the phone so you can speak with them directly." "You know your mother has memory issues and should not be trusted." "I need you to listen to me. I was present when the healthcare provider saw your mother."

"Let's get the healthcare provider on the phone so you can speak with them directly." By offering to call the healthcare provider, the nurse allows the caregiver to hear directly from the provider for a report. This addresses the issue immediately and considers the caregiver's point of view. The other answer options direct the caregiver, rather than allowing her to collaborate, which may place her on the defensive.

A patient has been prescribed both physical and occupational therapy. The patient asks the nurse, "Why do I need two types of therapy?" Which response by the nurse explains how a physical therapist may complement the activity of the occupational therapist? "Occupational therapy focuses on independence and activities of daily living, while physical therapy treats the injury." "Your healthcare provider must have made a mistake. You do not need two therapies." "Occupational therapy will help you get back to work faster, while physical therapy focuses on helping you to walk again." "Physical therapy addresses your independence and activities of daily living, while occupational therapy aims to treat the injury."

"Occupational therapy focuses on independence and activities of daily living, while physical therapy treats the injury." Both physical therapy and occupational therapy offer many benefits to patients, including maintaining independence, maximizing their function, and leading a healthy and active life. While occupational therapy focuses more on helping people get back their independence and successfully carry out activities of daily living, physical therapy treats the injury itself and helps prevent future injuries.

The nurse is caring for a patient who has managed care insurance. The patient states, "I am not too sure about this new insurance. I have never had this type of coverage before." Which statement by the nurse provides the patient with an accurate response? "The insurance you have allows you to go wherever you want to receive care." "This type of coverage by design promotes receiving high-quality, cost-effective care." "Your new insurance is excellent in decreasing your out-of-pocket expenses." "You will receive patient-focused care with your insurance plan."

"This type of coverage by design promotes receiving high-quality, cost-effective care." The statement made by the nurse that provides the patient with an accurate response is, "This type of coverage by design promotes receiving high-quality, cost-effective care." Managed care is designed to improve outcomes for groups of patients and its framework can be adapted across all healthcare settings. The statement, "Your new insurance is excellent at decreasing your out-of-pocket expenses," is not necessarily accurate. Managed care consists of a HMO or a PPO, with the PPO's direct cost to the patient being higher. The patient may go wherever they choose for care, but in order for the care to be covered, the patient must use the designated healthcare providers and facilities identified by the insurance company. Patient-focused care is not part of managed care, it is a model of care.

A client is enrolled in an HMO, while their previous experience with healthcare coverage was with a PPO. The client asks the occupational health nurse to explain the difference between the HMO and PPO. The best response by the nurse is: "Both the HMO and PPO are covered by your employer, so it's really not your concern." "You really should be happy about the HMO. You'll pay little, if any, out-of-pocket expense." "Your PPO offered you a choice in your healthcare provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care." "You'll have good healthcare benefits, so don't worry."

"Your PPO offered you a choice in your healthcare provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care." Rationale: HMO plans emphasize wellness, and members choose a primary care provider who evaluates their health status and coordinates their care. Clients are limited in their ability to select healthcare providers and services, but available services are at minimal and predetermined cost to the client. PPOs consist of a group of physicians that provides an insurance company or employer with health services at a discounted rate. One advantage of the PPO is that it provides clients with a choice of healthcare providers and services. Telling the client not to worry does not address the client's request, which is to explain the difference. Even though explaining that the client will have little out-of-pocket expense may be truthful, it doesn't answer the request. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse is preparing to provide the parents of a child that is being seen for a well visit some general education. Which statement by the nurse reflects secondary prevention education? "Your child should be seen by the dentist every 6 months." "You child is due for another immunization in 1 year." "It is important to include fresh fruits and vegetables in your child's diet." "It is important that your child get exercise for at least 20 minutes a day."

"Your child should be seen by the dentist every 6 months." The statement made by the nurse that is reflective of secondary care is, "Your child should be seen by the dentist every 6 months." Secondary prevention focuses on the detection and then treatment of identified injuries and diseases early so that they can be cured or their associated symptoms and complications can be prevented or limited. Exercise, immunizations, and nutritional intake reflect primary preventative care.

Which statement by the nurse describes the difference between a nutritionist and a dietitian? A dietitian primarily prescribes therapeutic diets and a nutritionist recommends healthy diets and advisory services. A dietitian recommends vitamins and exercises for weight loss and the nutritionist works in the community to promote healthy diets. A nutritionist helps patients with therapeutic diets and a dietitian recommends healthy diets and advisory services. A nutritionist recommends vitamins and exercises for weight loss and a dietitian suggests diets to accommodate diseases.

A dietitian primarily prescribes therapeutic diets and a nutritionist recommends healthy diets and advisory services. A dietitian is someone who primarily works in a hospital and helps patients with therapeutic diets and a nutritionist is one who works in a community setting and recommends healthy diets and broad advisory services. This statement best explains the difference between a dietitian and a nutritionist. A dietitian has special knowledge about the diets required to maintain health and treat disease but does not work in a community setting. A nutritionist is one who has special knowledge about nutrition and food and works in a community setting.

Which recommendation should the nurse expect a nutritionist to make? Herbal supplements Vitamin and mineral supplements Special diets for hospitalized patients A healthy diet for a pregnant woman

A healthy diet for a pregnant woman A nutritionist is one who has special knowledge about nutrition and food. They promote health and prevent disease by advising families about balanced diets for growing children and pregnant women. They work in a community setting and recommend healthy diets. They also offer broader services about the purchase and selection of foods but not the recommendation of vitamin, mineral, or herbal supplements. A dietitian recommends special diets for hospitalized patients.

Which situation reflects primary sources of​ conflict? (Select all that​ apply.) A nurse who is gossiping about a coworker A nurse assistant who communicates assessment findings with the healthcare provider A nurse and a physical therapist who are collaborating to provide care to an elderly client A physician who does not believe that a nurse practitioner can provide​ "on-call" care to clients A nurse who places blame on the respiratory therapist for not administering a medication on time

A nurse assistant who communicates assessment findings with the healthcare provider A nurse and a physical therapist who are collaborating to provide care to an elderly client A nurse who places blame on the respiratory therapist for not administering a medication on time Primary sources of conflict include role boundary issues like scope of practice and accountability issues. A nursing assistant who communicates nursing assessment findings to the healthcare provider is experiencing role boundary issues. A physician who does not believe a nurse practitioner can provide care to a client is having​ scope-of-practice issues. A nurse who blames a respiratory therapist for not being able to administer a medication on time is having accountability issues. A nurse and physical therapist who collaborate on care are not experiencing conflict. A nurse who is gossiping about a coworker is contributing to horizontal​ violence, which is not a primary source of conflict. Next Question

A nurse is forming an intradisciplinary team to help implement electronic records. Who might be requested to join the team? (Select all that apply.) A hospital records supervisor A nurse supervisor A nurse anesthesiologist An orthopedic surgeon A hospital administrator

A nurse supervisor A nurse anesthesiologist Rationale: Intradisciplinary teams are formed by members of the same profession who work toward achieving a common goal. Only nurses would be part of an intra disciplinary nursing team. A nurse anesthesiologist might be requested to join an intradisciplinary nursing team. A nurse supervisor might be requested to join an intradisciplinary nursing team. Nursing Process: Planning Client Need: Management of Care Cognitive Level: Applying

Which situation should the recognize as an indication of interpersonal conflict on the hospital unit? An unlicensed assistive personnel (UAP) turning down a job at the nursing home for more money The nurse complaining to the nurse manager about healthcare provider orders The registered nurses on the unit complaining to management about their wages A registered nurse and an unlicensed assistive personnel (UAP) arguing over who should ambulate patients

A registered nurse and an unlicensed assistive personnel (UAP) arguing over who should ambulate patients Interpersonal conflict is conflict between two or more individuals due to differences and/or personalities, or due to competition or concern over territory, roles, or responsibilities. The nurse can delegate the duty of taking patients to the bathroom to the UAP; the AP should not argue about the role responsibility. A group of nurses complaining to management about wages and a nurse questioning healthcare provider orders are examples of intergroup conflict. A UAP who decides to take a job for more money may experience intrapersonal conflict.

The nurse manager wants to promote communication skills for successful collaboration among the nursing staff. Which communication style should the nurse​ use? Active listening Parallel communication Dominance in conversation ​Status-based communication

Active listening Active listening is attentive communication that decreases miscommunication. Parallel communication is the lowest level of communication and does not support collaboration like higher levels of information exchange or consultation.​ Status-based communication does not support​ collaboration, but​ team-centered communication does support collaboration. Dominance and argumentative styles of communication do not promote collaboration.

The nurse plans to discuss strategies to recognize and manage conflict. Which strategy should be​ included? (Select all that​ apply.) Calling in sick during conflict Addressing issues as they arise Ignoring each other when angry Treating each other with respect Acknowledging each​ other's accomplishments

Addressing issues as they arise Treating each other with respect Acknowledging each​ other's accomplishments Strategies that may help prevent or reduce conflict include addressing issues when they​ arise, avoiding destructive​ criticism, treating others with​ respect, defusing​ arguments, listening and considering each​ other's point of​ view, fairly allocating​ resources, defining role​ expectations, encouraging​ feedback, and acknowledging each​ other's professional and personal accomplishments and achievements. Ignoring the conflict or calling in sick are not appropriate strategies to manage conflict.

Which activities should the nurse recognize as supporting the building of skills for successful collaboration of interprofessional healthcare​ teams? (Select all that​ apply.) Focusing care delivery on individual groups Advocating for policy change with local legislation Role playing scenarios to practice communication skills Encouraging clinical problem solving through group work Practicing with additional credentials to increase nursing authority

Advocating for policy change with local legislation Role playing scenarios to practice communication skills Encouraging clinical problem solving through group work Practicing with additional credentials to increase nursing authority Nursing collaboration is supported by working in groups and having a voice in the community on health policy through​ advocacy, professional communication​ skills, and increased authority and accountability. Focusing care is an individual task.

The nurse is part of an interdisciplinary team caring for a patient who was prescribed physical therapy, occupational therapy, and a special diet. Which task should the nurse perform in collaboration with the physical therapist of the team? Assessing the home Ambulating the patient Evaluating the diet Implementing swallowing precautions

Ambulating the patient The physical therapist will assess the patient and recommend hip precautions and ambulation guidelines in collaboration with the nursing staff. There is no indication for the services of a speech therapist to provide swallowing guidelines. A dietitian will perform a dietary assessment with the input of the nursing staff. The discharge planner or home health agency will assess the patient's postdischarge needs in the home.

1) A home health nurse manager is planning care for a male client being discharged after hospitalization for complications of diabetes mellitus. This client requires an extensive dressing change twice a day, help with activities of daily living, and comprehensive education. The nurse manager is planning visits from home health nurses, aides, and therapists. The nurse manager is working within the context of which of the following? A) Health education B) Case management C) Collaboration D) Health promotion

Answer: B Explanation: A) Collaboration means a collegial working relationship with other healthcare providers to supply client care. Collaborative practice requires the discussion of diagnoses and management in the delivery of care. Case management involves one or more individuals overseeing the needs and requirements of a particular individual's health. Health promotion activities include disease prevention and healthy lifestyle interventions. Health education would be included in this particular situation, but collaboration is a more inclusive definition of what is occurring with these individuals and the care they require.

2) The nurse and physician are discussing follow-up care with a client who is being discharged home and the client's family. The client and family cross their arms and state angrily that the team's suggestions are not acceptable. What is the best response by the nurse? A) "We will leave you alone to discuss your options." B) "We only want what's best for you." C) "Let's discuss other options that might work well for you and your family." D) "Perhaps you did not understand the recommendations."

Answer: C Explanation: A) The client is the center of the team, and the goal is to facilitate healing. There are always other options to consider to reach that goal. The nurse would discuss other options with the client, which will most likely increase cooperation by the client, who will feel in control as the decision is made. By leaving the room, the nurse and doctor have turned their backs on the client. The client may not understand the recommendations, but pointing that out can be seen as demeaning. Telling the client that the doctor only wants what is best sends the message that the client does not know what is best, when, in fact, a well-informed client does know what is best and should be able to make the correct choice.

The nurse is assigned to an interdisciplinary team caring for a patient. Which is a role the nurse is expected to fulfill in this team? Attending team meetings to discuss the patient's care Prescribing medications that are appropriate for the patient's care Taking full responsibility for providing direct care to the patient Making independent decisions regarding the patient's medical care

Attending team meetings to discuss the patient's care In an interdisciplinary team, decisions are made by the group, and the members collaborate to set patient goals and carry out the treatment plan. The novice nurse would anticipate attending team meetings to discuss the patient's care. It would not be appropriate for the nurse to take full responsibility for providing direct care to the patient as a member of an interdisciplinary team. This occurs with primary nursing. Prescribing medication and making independent decisions regarding medical care is outside the nurse's scope of practice. The nurse can dispense medications and implement orders prescribed by the physician.

Which should the nurse use to explain mindsight? Behaving disruptively in the workplace, manifesting as aggression, bullying, and violence Being self-aware of one's triggers to stress that can result in conflict Using skills to resolve conflicts in a positive manner Using a collaborative approach for gaining insight to the perspectives of others

Being self-aware of one's triggers to stress that can result in conflict Mindsight is a term that describes being self-aware of one's triggers to stress that can result in conflict and purposefully "retraining" the brain to respond differently. Conflict competence includes skills to resolve conflicts in a positive manner. Incivility or disruptive behavior in the workplace can manifest as aggression, bullying, and violence. Collaboration is a collaborative approach that involves gaining insight to the perspectives of others.

The client asks the nurse to explain how Medicare works. Which items should the nurse include in the teaching​ session? ​(Select all that​ apply.) Both hospital and medical insurance are offered by Medicare. Individuals with​ end-stage renal disease are not eligible for Medicare coverage. There are four types of Medicare coverage. Routine eye care is not covered by Medicare. Medicare is a federally funded health insurance program.

Both hospital and medical insurance are offered by Medicare. There are four types of Medicare coverage. Routine eye care is not covered by Medicare. Medicare is a federally funded health insurance program. Learning Objective Describe various types of healthcare reimbursement. Rationale Medicare is a federally funded health insurance program available to people age 65 or​ older, younger people with​ disabilities, and people with​ end-stage renal disease. Certain​ services, including routine eye​ care, are not covered by Medicare. There are four types of Medicare​ coverage: Part A​ (hospital insurance), Part B​ (medical insurance), Part C​ (Medicare advantage plans like an HMO or​ PPO), and Part D​ (Medicare prescription drug​ coverage).

The nurse educator is comparing the roles of the case manager and the primary nurse with a group of students. The educator wants to review similarities of these roles in the rehabilitation facility and in the acute care facility. Which student statements are accurate regarding the similarities between these two​ roles? ​(Select all that​ apply.) Both roles support continuity of care Both roles plan for meeting families​' needs Both roles lead a multidisciplinary team Both roles follow the clients across care settings Both roles plan for meeting clients​' needs

Both roles support continuity of care Both roles plan for meeting families​' needs Both roles plan for meeting clients​' needs Learning Objective Contrast the different frameworks for providing care. Rationale The similarities between a case manager and a primary nurse are that they both support continuity of care and plan for meeting the needs of clients and families. Only the case manager follows clients across care settings or leads a multidisciplinary team.

A patient who is visually impaired and has Parkinson disease is assigned a nurse to coordinate care from a number of specialists. Which type of framework does this care coordination indicate? Managed care Case management Patient-focused care Team nursing

Case management This type of framework in care coordination is an example of case management. Managed care focuses on a group level, not on an individual level. Patient-focused care is a type of care that identifies the patient as the decision maker. Team nursing is model of nursing used in the hospital setting.

A patient requires skilled nursing care after discharge from an acute care hospital. Which member of the collaborative healthcare team should the nurse anticipate will coordinate the discharge? Case manager Social worker Nurse Discharge planner

Case manager The case manager's role is to ensure that patients receive fiscally sound, appropriate care in the best setting. The role is often filled by the member of the healthcare team who is most involved in the patient's care. Depending on the nature of the patient's concerns, the case manager may be a nurse, a social worker, or any other member of the healthcare team. A social worker counsels patients and their support people regarding problems such as finances, marital difficulties, and adoption of children. The nurse is responsible for reporting the patient's needs to the collaborative healthcare team. The discharge planner coordinates the movement of patients between a hospital or skilled nursing facility and a home care or hospice arrangement.

The nurse is planning to participate in a community dialogue regarding healthcare resource allocation. Which discussion activity would be the most appropriate choice for this nurse? Talking with cancer survivors Collaborating with legislators Networking with healthcare providers Speaking with the hospital administration

Collaborating with legislators

The home health nurse has made a visit to a client who is receiving several therapies by health team members in the home for arthritis and postoperative care. Upon return to the home health office, the nurse plans to: Report to the manager. Communicate the client's status to the rest of the team. Review the cases for the next day. Call the client to reinforce teaching.

Communicate the client's status to the rest of the team. Rationale: Since the client is receiving several therapies, the nurse would communicate with team members regarding the client's current status and progress in collaboration. Reviewing the cases for the next day may or may not be necessary. It is not necessary to report to the manager unless there is a system problem. Calling the client is probably not necessary since the nurse would evaluate client understanding of teaching before leaving the home. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

Which activity should the nurse understand is a key competency to effective nursing care? Being able to interact with healthcare providers Knowledge of hospital rules and regulations Medication administration Communication

Communication Communication is a key competency of effective nursing care and means for promoting collaboration. Miscommunication among healthcare providers can lead to serious consequences. This is important for all members of the collaborative healthcare team, including the healthcare provider. Administering medications is required as prescribed by the healthcare provider. Understanding the rules and regulations of a hospital would be necessary if employed in an inpatient facility.

Which technique should the nurse use to prevent and resolve conflicts? Collaboration Avoidance Communication Competition

Communication Communication is the key for preventing and resolving conflict. Five different communication styles have been identified to use during a conflict. They are competing, collaborating, compromising, avoiding, and accommodating.

Nurses are utilizing an approach that involves addressing an issue of conflict with a resolution that satisfies both parties. Which approach is being​ used? Competing Compromising Accommodating Avoiding

Compromising Compromising involves addressing the conflict with a solution that satisfies all parties. Avoiding is purposely not addressing the​ conflict, sometimes done to collect more information. Competing involves an assertive presentation of​ one's side of the issue. Accommodating neglects the desires of one side to allow the other party satisfactory resolution.

The nurse is attending a team meeting regarding the care of a client. During the​ meeting, the nurse has a heated discussion with a peer. Which factors would be likely to impede effective communication and collaboration in this​ situation? ​(Select all that​ apply.) Confusing roles among team members Understanding cultural differences with the peer Trusting the peer to make the right decision Having a lack of respect for the peer Providing feedback to the peer

Confusing roles among team members Having a lack of respect for the peer A lack of respect and role confusion can impede communication and collaboration. Understanding cultural differences enhances communication and collaboration. Trust is an essential aspect of communication and collaboration. Providing feedback enhances communication and collaboration.

The nurse wants to provide collaborative care for a client who has terminal cancer. Which action should the nurse​ include? Providing comfort interventions Assessing the​ client's preferences regarding care Consulting an​ oncology-certified nurse when planning care Giving the physician priority when delivering care

Consulting an​ oncology-certified nurse when planning care Seeking expertise from an​ oncology-certified nurse when planning care for the client with terminal cancer is consistent with providing collaborative care. Assessing the​ client's preferences regarding care and providing comfort interventions are nursing responsibilities that the nurse is required to​ meet, regardless of the care setting or the type of care being provided. It is not appropriate for the nurse to give one team member priority over another when delivering care.

The nurse is coordinating care for a client who requires the removal of an uncomplicated basal cell carcinoma. Based on the robust health of this​ client, which setting would provide the most​ cost-effective care? Emergency department Surgical center Urgent care clinic Dermatologist​'s office

Dermatologist​'s office Learning Objective ​Discuss factors that affect the delivery of health care. Rationale A dermatologist can handle a minor surgical procedure under local anesthesia in the office. A surgical center is a more expensive setting than an office. It would usually not be appropriate to do the procedure in the ED or urgent care clinic.

The primary care physician has recommended to the nurse that the client be discharged to a rehabilitation center for further care. The nurse discusses the recommendation with the family and client, who decide that this is not what they want to do. The nurse's next action is to: Tell the family that this is the physician's order. Discuss available acceptable options with the family. Notify the case manager that the family is noncompliant. Notify the physician about the family's decision.

Discuss available acceptable options with the family. Rationale: The family and client are a part of the collaborative team. If the family does not favor a recommendation, the nurse explores other options open to the client, such as home health care, and then communicates the client's wishes to the team. It is not appropriate to tell the family that this is the doctor's order because clients have a voice in care decisions. The case manager can be notified to help the nurse present other options but not that the family is noncompliant. The physician may be notified of the need for other options as part of the team. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

A nurse is reported to the charge nurse by a physician for ignoring an order that the physician gave regarding patient care. The charge nurse investigates the issue and finds that it appears as if the nurse did ignore the order. The charge nurse would: Ask another nurse to go get the nurse in question. Ask the client if the task was performed. Go to the nurse and request an explanation. Discuss the situation with the nurse in an office.

Discuss the situation with the nurse in an office. Rationale: The best approach would be to ask the nurse in question to describe the conflict in the privacy of the office. It is entirely possible that there is an easy solution to the problem, but the discussion should take place in private. The request for an explanation should not be conducted in the client care setting. The charge nurse would not ask the client about the incident unless there is a complaint by the client. The charge nurse does not involve another nurse in the conflict since this would be a breach of the first nurse's right to confidentiality. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The charge nurse is preparing to discuss plans to improve the unit with the staff. Based on the concept of peer​ collaboration, which plan will she​ discuss? ​(Select all that​ apply.) Discussing starting a journal club for interested staff members to discuss new​ evidence-based practice findings Allowing nurses to volunteer to prepare brief presentations on clinical topics seen on the unit Asking for volunteers to go from the day shift to night shift to cover a temporary staff shortage Encouraging nurses to eat meals at their desks so they will be more accessible to physicians Implementing open visitation hours for families to increase client satisfaction

Discussing starting a journal club for interested staff members to discuss new​ evidence-based practice findings. Allowing nurses to volunteer to prepare brief presentations on clinical topics seen on the unit. Asking for volunteers to go from the day shift to night shift to cover a temporary staff shortage. Encouraging nurses to share their expertise on commonly encountered health topics allows more experienced nurses to share their knowledge and experience with others in order to ensure​ high-quality client care. Allowing staff to participate in schedule changes on a volunteer basis shows mutual respect and may foster improved relationships. A journal club gives interested individuals a chance to improve their clinical knowledge and share with their peers. Open visitation does not address the principles of peer collaboration. Eating at the desk does not foster collaboration and may violate infection control policies.

A nurse is planning to teach a class about preventing workplace bullying. Which behavior should the nurse​ include? (Select all that​ apply.) Encouraging nonthreatening reporting Developing acceptable codes of conduct Isolating the victim to provide a safe environment Educating others about the ramifications of bullying Talking about the abuser to make the victim feel better

Encouraging nonthreatening reporting Developing acceptable codes of conduct Educating others about the ramifications of bullying Nonthreatening reporting that is taken​ seriously, developing acceptable codes of​ conduct, and education on the impact of bullying all support the prevention of bullying in the workplace. The victim may already feel isolated and should be made to feel part of a supported team. Talking about the abuser does not promote professional behaviors.

The collaborative team treating a client includes the​ cardiologist, dietician, social​ services, and a nurse case manager. The team works together to establish a plan of care based on the​ client's goals. Which outcome is likely to result from this type of collaboration for the​ client? Decreased adherence with the plan of care Increased healthcare costs Improved relationship between the physician and the client Enhanced continuity of care

Enhanced continuity of care When effective collaboration​ occurs, quality of care​ improves; effective collaboration directly impacts client outcomes and enhanced continuity of care results. An​ increase, not a​ decrease, in adherence with the care plan is an outcome of collaboration. Healthcare costs will​ decrease, not​ increase, with collaboration. An improved physician-client relationship is not an outcome of​ collaboration; however, improved relationships do occur within the healthcare team as a result of collaboration.

What are some of the benefits of interdisciplinary teams? (Select all that apply.) Physician satisfaction Redundancy Fewer omissions Greater effectiveness Greater emphasis on individual expertise

Fewer omissions Greater effectiveness Rationale: Less redundancy is a benefit of interdisciplinary teams. Some physicians may be opposed to interdisciplinary collaboration and prefer physician led treatment. Interdisciplinary teams emphasize each individual's contribution to the joint planning and accomplishment of client goals, as opposed to placing emphasis on each individual team member's area of professional expertise. Studies suggest that interdisciplinary teams can manage care with less redundancy, more efficiency, and fewer omissions. Nursing Process: Analysis Client Need: Management of Care Cognitive Level: Analyzing

Which description should the nurse use to describe team-centered communication? Focuses on what "we" can do to work with the patient toward successful outcomes Provides the team with status reports in order to direct patient care outcomes Supports cultural bias between members Focuses on individual responsibilities

Focuses on what "we" can do to work with the patient toward successful outcomes Team-centered communication focuses on shared, not individual, responsibilities. Identifying and preventing any potential cultural and language barriers is also critical to ensuring successful collaboration. Status reporting communication is a one-sided approach that is task oriented, such as "give this" or "do that."

Which nursing care model for delivery can be the most cost effective? Functional nursing Team nursing Positive nursing Primary nursing

Functional nursing Functional nursing is the most cost-effective choice. Functional nursing assigns staff to tasks, rather than to patients, and is effective for budgetary constraints. Team nursing and primary nursing require a greater number of nursing staff, which is costlier. A positive nursing system is not a nursing model.

A nurse who is being pulled from one unit to another for a shift is being introduced to the nursing staff. Some of the labels that the nurse hears are open double quote"medication ​nurse,close double quote" open double quote"dressing change ​nurse,close double quote" open double quote"I and O ​aide,close double quote" and open double quote"vital signs aide.close double quote" Based on these​ comments, which nursing care delivery system can the nurse expect to participate in for this​ shift? Functional nursing Team nursing Secondary nursing Primary nursing

Functional nursing Learning Objective Contrast the different frameworks for providing care. Rationale The labels the nurse hears are indicating tasks assigned to that person. This is functional nursing. Team nursing has clients assigned to a group of staff. Primary nursing has clients assigned to one main staff person. There is no secondary nursing system.

A nurse works at a hospital that provides services in all specialty areas (medical, surgical, pediatrics, obstetrics). This hospital is classified as: General hospital Long-term care hospital Specialty hospital Short-term care hospital

General hospital Rationale: Hospitals are classified by the services they provide as well as by their ownership. General hospitals admit clients requiring a variety of services such as medical, surgical, obstetric, pediatric, and psychiatric services. Some hospitals offer only specialty services such as psychiatric or pediatric. Hospitals can also be classified as acute care or chronic care. Acute care hospitals provide assistance to clients whose illness and need for hospitalization are relatively short term, such as several days. Long-term care hospitals provide services for longer periods—sometimes years or for the remainder of the client's life. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Applying

Which act should the nurse recognize as horizontal​ violence? Maltreatment of a housekeeper by the nurse Battery of a client by a nurse Physical threats by a nurse against a nursing assistant Gossiping by one nurse against another nurse

Gossiping by one nurse against another nurse Horizontal violence involves​ acts, like​ gossiping, by one nurse against another nurse. Battery of a client is criminal abuse. Maltreatment and threats to other team members or insubordinates is bullying.

Which should the nurse identify as an effect of interprofessional collaboration? Greater risk of interpersonal conflict Greater sense of autonomy Increased turnover Increased absenteeism

Greater sense of autonomy Interprofessional collaboration has positive psychologic and professional effects. Both patients and nurses perceive a greater sense of autonomy when collaborative strategies are applied. The ability to enact one's professional role contributes to career satisfaction, decreased absenteeism, decreased turnover, and career retention.

The nurse is working in a busy pediatric ICU. Several of the nurses on the unit are interested, at the request of parents, in changing the rules to allow families to be present in a code situation for their child. The nurses are afraid to speak their minds openly because some of the doctors do not support the change and the nurses do not want to cause hard feelings. The nurse manager suggests a meeting of all concerned and might use which of the following to help with decision making? Present both sides of the argument to the group members. Ask the nurses to present their changes. Ask the members to be open minded. Have group members present concerns and questions on paper.

Have group members present concerns and questions on paper. Rationale: Nurses and doctors have to function as a team for the benefit of the client. Using the nominal group technique has the benefit of members submitting their ideas privately, which can help decrease friction in the group as a whole. The nurse manager would not want to take over the meeting since this would discourage dialogue within the group. If the nurses present their changes themselves, there is the chance that those nurses may be subject to the censorship of the group as a whole. This issue is an emotional one and asking group members to be open-minded may not happen since emotions may be high. It is best, to begin with, present concerns anonymously. Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Applying

The nurse has integrated the six principles of the Joint Principles of the Patient-Centered Medical Home into practice. Which statement defines the goal when providing this type of practice? Healthcare is a partnership with the patient and the patient's family. Patient-centered care is delivered in the home setting. The cost of the care provided to the patient using this model is moderate. A team of healthcare providers will be available to care for the patient.

Healthcare is a partnership with the patient and the patient's family. The factor that constitutes a biological agent to be categorized as the highest priority by the CDC includes the fact that the biological agent can cause public panic. Not all biological agents can be eradicated by a vaccine, but some can be treated with antibiotics. Biological agents that have a significant impact on public health or are easily transmitted are factors that place the agents in the highest category by the CDC.

Which statement describes horizontal violence? Horizontal violence is long-term behavior that lasts a minimum of 6 months. Horizontal violence refers to aggressive acts committed against a nurse by one or more nursing colleagues. Horizontal violence is an attack made when a person is in the horizontal recumbent position. Horizontal violence is chronic violence perpetrated by a workplace bully.

Horizontal violence refers to aggressive acts committed against a nurse by one or more nursing colleagues. Horizontal violence is a term used to describe aggressive acts that are committed against a nurse by one or more nursing colleagues. Workplace bullying is long-term behavior that lasts a minimum of 6 months and plays out in a series of verbal attacks, refusal to help or assist others, speaking negatively, or taunting.

An organization has goals to promote mutual respect within the interprofessional team and to improve client outcomes. Which action by the organization supports mutual​ respect? Placing physician leaders for each hospital department Upholding the tradition of patriarchal​ nurse physician relationships Implementing interprofessional rounding Promoting verbal acknowledgment of mutual respect

Implementing interprofessional rounding Interprofessional rounding promotes mutual respect through collaboration on​ client-centered care. Verbal acknowledgement is not meaningful without nonverbal support. Physician leadership should have nursing counterparts to promote mutual understanding of authority. The traditional​ nurse physician relationship must change to allow for mutual trust in collaboration.

The nurse should understand that which outcome is the major advantage of interprofessional collaboration? Working in partnership with other team members Meeting new colleagues Presenting a united front to the patient Improving patient outcomes

Improving patient outcomes According to the World Health Organization (WHO), professional collaboration has system-wide effects, including improvement of patient outcomes and patient safety indicators. The collaborative team does involve colleagues from other teams, but the most important benefits are always patient focused.

A charge nurse has made client assignments for the shift and learns that two of the nurses are arguing over who is really going to care for one particular client. One nurse was directed by the nurse manager to care for the client because the client's family requested that nurse. The other nurse was assigned care of the client by the charge nurse. The cause of this conflict is: Receiving directions from two or more "bosses." Inadequate action plan Lack of trust Inadequate communication

Inadequate communication Rationale: The ultimate cause of this conflict is the lack of communication between the nurse manager and the charge nurse. Receiving directions from two bosses would create an individual conflict. Inadequate action plan is not relevant to this situation because there is no plan in place. Lack of trust implies that the nurses do not trust the charge nurse, which is not in evidence here. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

A 73 year old client is being discharged following knee replacement surgery. The home health care nurse is forming an interdisciplinary collaborative team to provide care for the client. What would be some characteristics of this team? (Select all that apply.) The physical therapist would be the leader. A physician will make all the treatment decisions. There is limited communication among team members. Individual members of the team participate in the overall treatment planning. Decisions are made by the treatment team.

Individual members of the team participate in the overall treatment planning. Decisions are made by the treatment team. Rationale: Members of the multidisciplinary team set goals and develop client treatment plans in a more autonomous fashion. In a multidisciplinary team approach, a single team member-usually a physician-makes the treatment decisions. While the physician interacts with each member of the multidisciplinary team, there is little communication between the other individual professionals on the team. As opposed to placing emphasis on each individual team member's area of professional expertise, interdisciplinary collaboration emphasizes each individual's contribution to the joint planning. On an interdisciplinary or interprofessional team, decisions are made by the group. Nursing Process: Implementation Client Need: Management of Care Cognitive Level: Applying

The nurse has ideas on how to streamline charting in the electronic medical record. Which interprofessional team member should the nurse​ consult? Information technology expert Complementary healthcare provider Unlicensed assistive personnel Paramedical technologist

Information technology expert The information technology expert would be the collaborative partner to explore changes and to enhance the electronic medical record.The paramedical technologist would be consulted for laboratory and imaging issues.The unlicensed assistive personnel can help with delegated tasks of hands on care.The complementary healthcare provider would be consulted for complementary medical therapies such as acupuncture.

The nurse is planning care for a client following a surgical procedure. Which collaborative action should the nurse​ include? (Select all that​ apply.) Changing the medication order after speaking with the client about adverse effects Informing the dietician that the client is on a special diet and needs reteaching about the diet Consulting the pharmacist regarding interactions between medications the client is prescribed Informing the pharmacist that the​ client's blood pressure​ (BP) is low and to hold the BP medication Updating the physical therapist regarding the​ client's physical activity and tolerance earlier in the day

Informing the dietician that the client is on a special diet and needs reteaching about the diet Consulting the pharmacist regarding interactions between medications the client is prescribed Updating the physical therapist regarding the​ client's physical activity and tolerance earlier in the day Collaborative actions that are client centered lead to improved client outcomes. Consulting the​ pharmacist, updating the physical​ therapist, and informing the dietician are all appropriate collaborative actions for the nurse to take. Telling the pharmacist to hold the​ client's medications without consulting the prescribing provider is outside the scope of practice of the​ nurse, as is changing the medication order. The nurse would report adverse effects or changes in the​ client's condition to the prescribing​ provider, who would be responsible for changing the medication order.

Two hospitals in a small town are trying to increase their nursing staff. In the hopes of attracting more​ applicants, one is offering​ sign-on bonuses to entice​ BSN-prepared staff members to join their team. Which type of conflict could occur in this​ situation? Interpersonal conflict Intrapersonal conflict Intergroup conflict Interorganizational conflict

Interorganizational conflict Interorganizational conflict occurs when one organization within the same market is in direct competition with another. If one organization is able to offer​ sign-on bonuses and other benefits that create a competitive​ advantage, this may alter the ability of other organizations to recruit and retain​ staff, creating conflict. Intergroup conflict is conflict between teams that are in competition for rewards or resources. Intrapersonal conflict is conflict that occurs within an individual that causes stress from real or perceived pressure generated by incompatible expectations or goals. Interpersonal conflict is conflict between two or more individuals due to differences​ and/or personalities or due to competition or concern over​ territory, roles, or responsibilities.

The nurse manager is preparing a report of staffing needs. What demographic trends could the nurse describe that are expected to produce a high demand for healthcare​ expertise? ​(Select all that​ apply.) Lack of primary care providers Increasing ethnic diversity Lack of specialists More​ long-term illnesses Increasing racial diversity

Lack of primary care providers More​ long-term illnesses Learning Objective ​Discuss factors that affect the delivery of health care. Rationale More​ long-term illnesses and lack of primary care providers are expected to produce a high demand for healthcare expertise. Although increasing racial and ethnic diversity is​ expected, those factors do not affect the demand for healthcare expertise. There is no predicted lack of specialists.

Which agency would sponsor a program that would meet the needs of a community group deficient in health promotion education ? Local health department Local hospital State health department Federal government

Local health department Rationale: The local health department is responsible for developing programs to meet the health needs of the people. State health organizations are responsible for assisting the local health departments. The U.S. Department of Health and Human Services is a federal agency whose functions include: conducting research and providing training in the health field, providing assistance to communities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel. Local hospitals provide the majority of acute care services in a community. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse explains to a group of clients some of the healthcare policy changes that have been made to improve healthcare to clients. The nurse includes which policy change in the explanation? Meals on Wheels Nursing diagnoses Mandatory wheelchair ramps at health facilities Flu shots given at pharmacies.

Mandatory wheelchair ramps at health facilities Rationale: One factor influencing changes in national policy is access to healthcare. Government agencies and health care agencies are required to provide increased access by installing wheelchair ramps for the handicapped. Meals on Wheels is not part of the healthcare system. Urging clients to get flu shots is a government policy; however, it is not policy to get the shots at pharmacies. Nursing diagnoses are required but not by the government as policy. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Analyzing

Which term should the nurse use that describes being self-aware of one's triggers to stress that may result in conflict? Collaboration Incivility Mindsight Conflict competence

Mindsight Mindsight is a term that describes being self-aware of one's triggers to stress that can result in conflict and purposefully "retraining" the brain to respond differently. Conflict competence includes skills to resolve conflicts in a positive manner. Incivility or disruptive behavior in the workplace can manifest as aggression, bullying, and violence. Collaboration is a collaborative approach that involves gaining insight to the perspectives of others.

Two coworkers feel esteem for one another. The nurse should recognize that the coworkers are demonstrating which behavior? Mutual respect Trust Collaboration Nonverbal communication

Mutual respect Mutual respect occurs when two or more individuals feel honor or esteem for one another. Trust occurs when an individual is confident in the actions of another individual. Nonverbal communication is not related to esteem. Collaboration is working together in a group that benefits the patient. Members who collaborate may or may not have esteem for each other.

The nurse experiences workplace bullying. Which action should the nurse anticipate from the administration to support steps toward successful resolution of this​ issue? Asking the nurse to provide at least three witnesses to the event Encouraging the employee to transfer out of the department Ignoring the report of bullying until it is reported more than once Obtaining details of the event before taking action

Obtaining details of the event before taking action The nurse manager would obtain details on who was​ involved, when the event​ occurred, and details of the event before taking action to resolve the bullying issue. Witnesses would be encouraged to come forward but are not required. The manager would support resolution of the​ bullying, not encourage the employee to change roles or ignore the report.

Which of the following is in alignment with one of the Healthy People 2010 primary prevention goals? Providing free screening to children Opening a wellness clinic Creating new pharmacological treatments Developing better insurance controls

Opening a wellness clinic Rationale: The two primary prevention goals of Healthy People 2010 are to (1) increase quality and years of healthy life and (2) eliminate health disparities. Opening a wellness clinic, which is aimed at primary prevention, focuses on bettering health; this is in line with the primary goal. Free screening to children occurs in most states and is secondary prevention aimed at early detection. Pharmacological treatments are considered tertiary goals. Developing insurance controls was a goal of health care reform during the Clinton administration. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse is caring for a confused patient whose family states they do not know what the healthcare provider is planning. They state they left several messages without a response. Which response by the nurse is appropriate? Paging the healthcare provider to come and speak with the family Advising the family to call again and stress that they need to speak immediately to the healthcare provider Reminding the family that the healthcare provider is busy but will call when time allows Reiterating the plan of care that was communicated at the shift change

Paging the healthcare provider to come and speak with the family By paging the healthcare provider, the nurse is advocating for the family and patient and handling the issue immediately. This portrays the nurse's understanding of effective communication. The other answer options direct the family, rather than allow them to collaborate, which may place them on the defensive.

A patient is given information about the same medication from different members of the healthcare team. Which term should the nurse use to describe this collaboration? Coordination and consultation Parallel functioning Parallel communication Information exchange

Parallel communication Parallel communication occurs when each professional communicates with the patient independently and asks the same or similar questions. This is the lowest level of communication and can cause gaps in communication or wrong information to be conveyed. Parallel functioning occurs when communication may be more coordinated, but each professional has a separate intervention and a separate plan of care. Information exchange involves planned communication, but decision making is unilateral, involving little, if any, congeniality. Coordination and consultation represent a midrange level of collaboration that seeks to maximize the efficiency of resources.

The manager of a small clinic has cross-trained the nurses to perform ECG testing, phlebotomy, and some respiratory therapy interventions. This clinic is an example of which delivery model? Case management Managed care Critical pathways Patient-focused care

Patient-focused care Feedback Rationale: Patient-focused care is a delivery model that brings all services and care providers to the client. Activities provided by auxiliary personnel are moved close to the client, thereby decreasing the number of personnel involved and the number of steps to get the work done. Managed care focuses on cost-effective, quality care which results in decreased costs and improved outcomes. Case management is a way to integrate health care services for individuals or groups and involves multidisciplinary teams that assume collaborative responsibility for planning, assessing, coordinating, implementing, and evaluating care. Critical pathways are used to track the client's progress in case management. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Applying

A client tells the nurse that the pain medication is ineffective and causes too many side effects. Which interprofessional team member should the nurse​ consult? (Select all that​ apply.) Dentist Dietician Physician Pharmacist Complementary healthcare provider

Physician Pharmacist Complementary healthcare provider The physician ordering pain medication is one interprofessional team member to​ involve, as they are aware of the ineffectiveness and adverse effects of the current medication ordered.The pharmacist is another interprofessional team member to assess interaction of all medications currently prescribed and recommend untried therapies.The complementary healthcare provider can provide adjunct therapies for pain like massage and reflexology. A dentist would be consulted for issues of the​ teeth, gums, and oral cavity. A dietician would be consulted for nutrition needs.

A client diagnosed with Alzheimer's disease, whose memory is rapidly declining, has a spouse who must continue to work full time.- Which solution should the nurse recommend? That the spouse consider early retirement Increasing the client's medications to slow the progress of the disease Long-term care placement for the client Placing the client in an adult day-care environment

Placing the client in an adult day-care environment Rationale: Due to economics and the increasing age of the adult population, means other than hospitalization are needed to care for clients who cannot be cared for in the home. Day-care centers provide care and nutrition for adults who cannot be left at home alone but do not need to be in an institution. Moving a client from an independent home situation to long-term care would be more detrimental than a gradual progression of care. Telling the spouse to consider early retirement is neither therapeutic nor realistic. Increasing medications is a decision that needs to be made by the client's primary caregiver, not the nurse. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Analyzing

The nurse case manager is reviewing Medicare coverage rules with a client. Which client statement indicates correct understanding of the​ teaching? The cost of my hearing aids is covered by Medicare Medicare covers my routine dental care. Prescription drug coverage is available through Medicare Medicare covers the costs of​ long-term care.

Prescription drug coverage is available through Medicare Learning Objective Describe various types of healthcare reimbursement. Rationale Medicare Part D offers prescription drug coverage. Services that are not covered by Medicare include​ long-term care, routine dental​ care, and hearing aids and the exams for fitting them.

The novice nurse is trying to remember the different benefits of primary​ prevention, primary​ care, primary​ insurance, and primary nursing. Which two of these activities would the nurse identify as increasing the continuity of​ care? Primary prevention and primary care Primary prevention and primary nursing Primary care and primary nursing Primary prevention and primary insurance

Primary care and primary nursing Learning Objective Identify various types of healthcare agencies and services provided. Rationale Primary care and primary nursing have the benefit of increasing the continuity of care. Primary prevention is about​ wellness, not continuity. Primary insurance happens when the client has more than one insurer.

A nurse is a member of a community team formed to support and treat individuals with serious mental illnesses. Who might also be part of this team? (Select all that apply.) Physical therapist Psychiatrist Paralegal Speech therapist Employment specialist

Psychiatrist Employment specialist Rationale: Although some individuals may require speech services, physical therapy, or paralegal consultation, these are not services expected as a regular part of a community support team for clients with mental illness. Employment specialists can provide vocational guidance and placement services. A psychiatrist can provide medication management to the team's efforts. Nursing Process: Planning Client Need: Management of Care Cognitive Level: Applying

When performing collaborative health care, the nurse must implement which of the following? Rely on the expertise of other health care team members. Assume a leadership role in directing the health care team. Be physically present for the implementation of all aspects of the care plan. Delegate decision-making authority to each health care provider.

Rely on the expertise of other health care team members. Rationale: In collaboration, each member of the team, including the client, participates in sharing ideas and reaching consensus on the best plan of care. The team is generally led by the health care professional most skilled in the client's specific areas of need. Once the plan is established, it may be implemented by any member of the team or a designate at an appropriate time or place. It is not necessarily delegated by the nurse. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

A coworker yells obscenities at a nurse colleague when unhappy. The nurse colleague asks the coworker to stop the behavior, but it continues. Which action should the nurse colleague take to remedy the situation? Ask a colleague to intervene. Wait to see if the coworker stops the behavior. Report the behavior to the immediate supervisor. Do nothing.

Report the behavior to the immediate supervisor. Verbal abuse in the workplace should be reported immediately. Victims of bullying experience adverse emotional effects, including anxiety, depression, and a sense of isolation. Asking another colleague to intervene or doing nothing will not address the situation.

A 73-year-old client is in the hospital for pneumonia for the third time in 6 months. During the nursing history, the nurse discovers that the client has few financial resources, lives alone, and has not received needed immunizations. To provide excellence in care, the nurse should: Tell the client of the need to move to long-term care. Request consultations with other disciplines. Recommend that the client remain in the hospital until well. Request an order from the physician for long-term care.

Request consultations with other disciplines. Rationale: Many older adults choose to remain in their own homes to care for themselves. In today's world, the nurse recognizes that with the proper resources, this is a possibility. The nurse might request a social worker and a nutritionist to help the client with home care resources, and might also ask the physician for the appropriate immunizations. Considering the cost of health care, the client can recuperate at home with the appropriate resources. The client may not want or need long-term care and should be consulted prior to making that decision. The nurse might discuss the advantages of long-term care with the client, but would not tell the client to move to it. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing

The nurse is examining role expectations and boundary issues causing primary sources of conflict within a healthcare unit. Which issue should be addressed by the nursing​ staff? (Select all that​ apply.) Resistance to change Lack of understanding Inaccurate information Consistent cooperation Effective communication

Resistance to change Lack of understanding Inaccurate information Role expectations and boundary issues are a primary source of conflict within a healthcare unit. They may arise from a lack of understanding or awareness of which task each team member is to perform due to​ miscommunication, inaccurate​ information, and resistance of some members to change. Cooperation and effective communication often lead to conflict resolution.

The nurse is designing activities to promote skill building for nursing collaboration. Which activity should be​ included? (Select all that​ apply.) Reviewing scope of practice for nurses Performing a​ self-assessment of strengths Analyzing different communication styles Explaining how authority impacts care delivery Acknowledging that barriers to team building will never change

Reviewing scope of practice for nurses Performing a​ self-assessment of strengths Analyzing different communication styles Explaining how authority impacts care delivery QSEN​ (Quality and Safety Education for​ Nurses) identified characteristics related to teamwork and collaboration that support skill building for the nurse. The nurse should review scope of​ practice, self-assess​ strengths, analyze different communication​ skills, and understand how authority impacts care delivery. Barriers exist to team​ building, but they should not be viewed as insurmountable.

Which factors should the nurse consider a major source of conflict in the healthcare setting? Role boundary issues and accountability Accountability and miscommunication Accountability and cultural issues Miscommunication and role boundary issues

Role boundary issues and accountability Within the healthcare setting, researchers have identified role boundary issues and accountability as the two primary causes of conflict. Miscommunication can cause a problem but has not been identified as a source of conflict. Cultural differences can cause conflicts but they are not the primary cause.

A nurse is caring for three clients who all demand that the nurse meet expectations immediately. The charge nurse asks the nurse to set up a room and take a new admission from the emergency department. The nurse is experiencing: Intergroup conflict Organizational conflict Interpersonal conflict Role conflict

Role conflict Feedback Rationale: The nurse who is overwhelmed on a tour of duty by many obligations that are due simultaneously is experiencing individual or role conflict. Interpersonal conflict is conflict between people. Organizational conflict refers to conflicts that may occur between departments or perhaps agencies. Intergroup conflict is another name for organizational conflict. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

The nurse is teaching an adolescent patient how to perform a thorough breast self-examination using a realistic model of the breast. Which type of prevention activity is the nurse performing with this patient? Primary prevention Secondary prevention Palliative prevention Tertiary prevention

Secondary prevention Secondary prevention is used to detect and then treat identified injuries and diseases early so that they can be cured or their associated symptoms and complications can be prevented or limited. Breast self-examination is a screening tool for breast cancer. Palliative prevention is not an activity for prevention.

The nurse wants to improve collaborative​ decision-making skills. Which action promotes collaboration between nurses and the interprofessional​ team? Delaying feedback on results to ensure that all collected data were reviewed by the team first Removing the client from the​ decision-making process Sharing responsibility of the outcome of the decision Depending on physician leadership to ultimately make the decision for the team

Sharing responsibility of the outcome of the decision Collaboration in decision making results in shared responsibility of the outcome of the decision. The client should be involved in decision making. The physician should hold a​ collaborative, not​ supervisory, position within the team. Feedback should be prompt to evaluate and make changes as needed.

A nurse is forming a team responsible for school based care. Identify some of the disciplines that might be appropriate for this team. (Select all that apply.) Social worker School bus driver Teacher School secretary Nurse Cafeteria supervisor

Social worker Teacher Nurse Rationale: Although information provided by those who have regular contact with students, such as school secretaries, cafeteria supervisors and bus drivers, may be useful in team planning, they do not bring expertise that contributes to a team's planning and treatment process. Social workers can contribute case management and mental health skills to the interdisciplinary team. Teachers can contribute perspective and knowledge about a student's cognitive and social functioning. School nurses can contribute knowledge and skills on physical and mental health issues. Nursing Process: Planning Client Need: Management of Care Cognitive Level: Applying

Which outcome should the nurse understand is an adverse organizational outcome that may occur because of negativity or incivility? Staff turnover Decreased patient errors Increased reports of incivility Decreased absenteeism

Staff turnover Studies on incivility indicate that such negativity can lead to adverse organizational outcomes. This includes staff turnover and decreased job satisfaction, leading to absenteeism, loss of productivity, and patient errors with the potential for adverse outcomes and associated costs.

The home health nurse is visiting an 86-year-old client who weighs 96 pounds to assess the client's postoperative progress. The nurse observes the aide giving a bath and notes that the aide puts powder in the folds of the perineal area. To promote a collaborative setting, the nurse would: Report the aide to the agency. Ask the family to request another aide. Report the aide to the physician. Take the aide aside and teach the appropriate skin care.

Take the aide aside and teach the appropriate skin care. Rationale: The role of the nurse in this instance is one of a teacher. The nurse cannot assume that the aide was or was not taught appropriately, and would take the aide aside and gently explain appropriate care for this client. This action puts the client in the center of the team and promotes collaboration. Telling the family to request another aide is not appropriate and could decrease the family's trust level; it also victimizes the family. If the aide continues with inappropriate care, the nurse would report the aide after informing the aide of the nurse's intentions. There is no reason to involve other team members, including the physician. Nursing Process: Evaluation Client Need: Physiological Integrity Cognitive Level: Applying

The nurse is involved in a situation of hostility with a​ co-worker that is escalating in an open area. Which action should the nurse take to best address the​ situation? Walking away from the employee and ignoring the situation Continuing the interaction in the current location Calling for​ upper-level administration to assist Taking the interaction to a private place

Taking the interaction to a private place Conflict should not take place in open areas. It is best to move the conflict to a private area.​ Upper-level administration may be involved if members of supervision are involved in the conflict. Walking away to establish boundaries may be done if the conflict cannot be moved to a private area but not with the intention of ignoring the situation.

The nurse leading the​ clinic-based support group for individuals with chronic diseases was pleased with the number of individuals who showed up for a lecture on open double quote"Living with Type 2 Diabetes.close double quote" Due to time​ constraints, the nurse planned to limit the talk to describing tertiary prevention activities. Which activities could the nurse​ include? Discussing smoking cessation tips to help smokers quit the habit Talking about the role of exercise to maintain blood sugar control Showing a video on hand washing techniques to prevent infection Encouraging a healthy diet to prevent onset of a diabetic condition

Talking about the role of exercise to maintain blood sugar control Learning Objective Identify various types of healthcare agencies and services provided. Rationale Talking about the role of exercise to maintain blood sugar control is tertiary​ prevention, meant to avoid complications of uncontrolled hyperglycemia. Wellness advice on topics of a healthy​ diet, smoking​ cessation, and hand washing is primary prevention.

The nurse attended a class about preventing horizontal violence in the workplace. Which action by the nurse indicates that learning​ occurred? Teaching others through unit presentations about the ramifications of workplace violence Ignoring negative statements of others about nurses on the unit Allowing nurses who have been victims to approach and humiliate their abusers Encouraging gossip about peers and other staff members

Teaching others through unit presentations about the ramifications of workplace violence Each nurse and nurse manager has a responsibility to act to prevent workplace bullying. One way to prevent this form of aggression and violence is to educate others about the ramifications of bullying. Condoning or encouraging​ gossip, ignoring negative​ comments, and allowing humiliating or hostile behaviors are actions that​ promote, rather than​ discourage, bullying in the workplace.

A nurse educator is explaining the difference between groups and teams. What are some of the specific characteristics of teams that the nurse identifies. (Select all that apply.) Task completion is delegated to individuals. Team members are only individually accountable. Team members have a variety of goals Teams have a flexible hierarchy. A team is a specialized type of group.

Teams have a flexible hierarchy. A team is a specialized type of group. Rationale: In a team, task completion and product creation are collaborative in nature, as opposed to being delegated to individuals. A team comprises individuals who agree to work in tandem to accomplish a common goal. Accountability among team members is both individual and mutual in nature. A team's hierarchy is more flexible than that of a group; members of a team often share the leadership role. In simplest terms, a team comprises individuals who agree to work in tandem to accomplish a common goal. Nursing Process: Analysis Client Need: Management of Care Cognitive Level: Applying

The nurse caring for a patient who is newly diagnosed with diabetes requests a dietary consult. Which type of care is the nurse implementing? Secondary prevention Primary prevention Case management Tertiary prevention

Tertiary prevention The nurse is implementing tertiary prevention in the care for the diabetic patient that requires a dietary consult to help manage the disease. Secondary preventative measures are aimed at detecting and identifying injuries or diseases early. Primary prevention is used to prevent a future disease or illness. Case management is a method of delivering care.

Which statements are true regarding the nurse as a​ collaborator? ​(Select all that ​apply). The ability to independently set goals and objectives for client care The ability to recognize the contributions of team members by virtue of experience The ability to share and receive clinical expertise with other nurses The ability to participate in policy formation to increase knowledge of a clinical problem The ability to seek opportunities to work with and within professional organizations

The ability to recognize the contributions of team members by virtue of experience. The ability to share and receive clinical expertise with other nurses. The ability to seek opportunities to work with and within professional organizations. The nurse helps clients set mutually​ agreed-upon goals and objectives for health​ care, ensuring the​ client's involvement in healthcare decisions. The nurse does not set goals independently without client input. The nurse shares clinical expertise with other nurses and elicits the expertise of others to ensure​ high-quality client care. The nurse participates in collaborative interdisciplinary research to increase knowledge of a clinical problem or situation. The nurse participates in policy formation in order to offer expert opinions on legislative issues related to health care. The nurse would participate in​ health-related research to increase knowledge of a clinical problem. The nurse recognizes the contributions of team members by virtue of experience and view of the situation. The nurse also seeks opportunities to work with and within professional organizations

The nurse is working with a client who will be discharged home in the next few days. The nurse notes that the client has orders for home health and physical therapy after discharge. The nurse plans to notify: The home health agency The physical therapy department The nurse manager The case manager

The case manager Rationale: The case manager is responsible for coordinating the care of the client from admission through discharge. When the client has orders for services beyond the hospital setting, the case manager arranges the care so that continuity of care is maintained. The nurse is no longer responsible for notifying the home health agency or physical therapy, but is responsible for collaborating with the case manager to assure that the services will be in place when the client is discharged. The nurse manager does not need to be notified unless a situation arises that would need a manager's expertise. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The collaborative care team for a​ 44-year-old client admitted two days ago following a diagnosis of diabetic ketoacidosis is reviewing the client​'s progress since admission. The nurse on the team requests a consultation with the dietician for the client. Which is an expected outcome of the​ consultation? The client will have many questions about insulin. The client will have to eat foods she does not like. The client will be more likely to adhere to her treatment regimen. The client will become an informed consumer.

The client will become an informed consumer. Care that is client centered and client directed results in a client who is a more informed healthcare​ consumer, leading to better client outcomes. The client will not necessarily have to eat foods that she does not like following dietary​ teaching: She will learn to choose from a variety of foods that are appropriate. There is no way to predict whether or not the client will be any more or less likely to follow her treatment regimen following the dietary consultation. While the client may have questions about her​ insulin, this not the focus of a dietary consultation.

The nursing student is giving a presentation on the roles of citizens and government in shaping health policy. Which statements should be included in the​ presentation? ​(Select all that​ apply.) The citizen who reports the concern is responsible for choosing the best solution. The government official is responsible for identifying political considerations related to each solution. The citizen​'s responsibilities include evaluating safety concerns of proposed solutions. Citizens will evaluate the outcomes of newly implemented laws. One role of government officials is hearing citizens​' concerns.

The government official is responsible for identifying political considerations related to each solution. One role of government officials is hearing citizens​' concerns. Learning Objective Identify societal and governmental influences of the development of health policy. Rationale Government​ officials' roles include hearing​ citizens' concerns about healthcare​ needs, evaluating safety concerns related to potential​ solutions, identifying political considerations related to each​ solution, and choosing the best solution. Federal agencies or departments who are responsible for implementing the new law will evaluate outcomes.

The nurse manager for the acute care wing of an assisted living center has several meetings with different groups of people. Which group would be considered an intradisciplinary​ team? The​ respiratory, occupational,​ speech, and physical therapy managers The facility physician and pharmacy manager The social worker and the nurse manager for the chronic care wing The nurse managers for the memory care wing and the chronic care wing.

The nurse managers for the memory care wing and the chronic care wing. Intradisciplinary teams are made up of members of the SAME profession. The therapy​ managers, physician, pharmacy​ manager, and social worker all are from different professions. Meetings with them would be considered interdisciplinary.

The unit nurse manager is preparing to give a performance review to a new nurse who has performed below expectations in multiple areas. Which factor does the nurse manager anticipate will impact the way that this employee receives the​ feedback? The nurse​'s ​self-esteem The nurse​'s lack of time management skills The nurse​'s lack of experience The nurse​'s religious beliefs

The nurse​'s ​self-esteem ​Self-esteem is one factor that affects how an individual perceives feedback. If the nurse has low​ self-esteem, a poor review can cause feelings of failure in other areas of​ life, not just on the job. While the​ nurse's lack of job experience can impact​ performance, it does not influence how well or how poorly the nurse receives feedback. The​ nurse's religious beliefs are not a factor in determining how feedback is received. Poor time management skills can adversely affect job​ performance, but are not a factor in how effectively feedback is received.

The nurse is caring for an older adult patient who takes many medications due to complex healthcare needs. Which statement describes the risk for the patient for prescription drug expenses when hitting the "donut hole" of Medicare? The patient is able to get a free year's worth of drugs to use before the next calendar year. The patient can only qualify for generic medications using Medicare payment. The patient is given low-cost medications paid for with government funding. The patient may be forced to purchase fewer prescription drugs.

The patient may be forced to purchase fewer prescription drugs. The government rations healthcare resources, such as inclusion of the coverage gap in Medicare Plan D (known as the "donut hole") that sometimes forces beneficiaries to purchase fewer prescriptions. The "donut hole" means that the patient pays a higher price for a time, until drug expenses hit a preset higher level. There are no Medicare drug discounts or free medications, and the patient is not restricted to generic medications.

A patient tells the nurse, "I work full-time at a large company but I do not have any health insurance." Which statement best describes the nurse's understanding of why the patient may have no health insurance? The patient does not understand the importance of caring for health. The patient may not be able to get insurance due to preexisting conditions. The employer may not offer health insurance due to the employee's job description. The patient may not be able to afford the health insurance the employer offers.

The patient may not be able to afford the health insurance the employer offers. The patient may not be able to afford the health insurance the employer offers. A job description does not exclude a full-time employee from obtaining health insurance benefits. The Affordable Care Act prevents insurance companies from denying individuals insurance coverage based on preexisting conditions. The patient understands the importance of care for their health, because the patient presents to the clinic with concerns about high blood sugar levels.

The nurse is caring for a patient who lives 50 miles from the clinic and is often unable to obtain transportation for follow-up care. Which barrier to healthcare is most likely responsible for the patient's noncompliance with follow-up clinic visits? Uneven distribution of services Perception of need Lack of a usual source of care Lack of healthcare insurance

Uneven distribution of services The barrier to healthcare that is most likely responsible for the patient's noncompliance with follow-up care in the clinic is the uneven distribution of services (for example, the nearest clinic is 50 miles away). The perception of need, lack of healthcare insurance, or lack of a usual source of care are not identified as primary factors for the noncompliance in care.

Which situation is representative of workplace bullying? The public health nurse's role is to educate the public on sexually transmitted infections. When assignments are posted, a nurse loudly insists on choosing their own patients. The young nurse loves to talk about personal life quite often. The nurse who works in a long-term care facility is eager to help teammates.

When assignments are posted, a nurse loudly insists on choosing their own patients. Workplace bullying is long-term behavior that lasts a minimum of 6 months and plays out in a series of verbal attacks, refusal to help or assist others, speaking negatively, or taunting. Each day, the nurse insisting on choosing their own patients indicates bullying of the team leader and undermining the team leader's authority. This is not fair to the rest of the team. Although it may be annoying, a coworker talking about personal life is not a form of bullying. A helpful nurse and one who provides education about sexually transmitted infections are not bullies.

The nurse manager is establishing a team of nurses to explore ways to reduce sharps exposure among staff on the unit. Which is an example of using collaboration when coaching staff members on the​ unit? Designating a single team leader Working toward a common goal Following a stringent chain of command Delegating tasks to specific individuals

Working toward a common goal. Individuals on a team work together toward a common goal. Teams complete tasks in a collaborative​ manner, not by delegating to individuals. Team members often share leadership roles. Teams have a flexible hierarchy or chain of command.

The nurse is discussing care with an adult client. Which action by the nurse is the most appropriate for providing collaborative​ care? Asking the​ client's husband to wait outside Working with the client to determine care objectives Your answer is correct. Encouraging the client to request more aggressive treatment Sharing the​ physician's treatment goals with the client

Working with the client to determine care objectives. Setting​ mutually-agreed upon goals and objectives illustrates collaborative care. Asking the​ client's husband to wait outside is not collaborative and is only appropriate if the client requests it. Sharing the​ physician's treatment goals with the client does not indicate collaboration. Encouraging the client to request more aggressive treatment is considered to be offering advice and is not indicative of collaborative care.