Nursing: A Concept-Based Approach to Learning, 2e (Pearson) Module 37 Collaboration
4) Which of the following statements about case management and case managers is not true? A) Case managers can only be licensed professional nurses who have extensive patient care experience. B) The collection of baseline data for conditions or diagnoses that will be managed is an essential component of case management. C) Case managers usually do not provide direct client care; instead, they coordinate and monitor others providing direct client care. D) A case manager's typical caseload is 10-15 clients, mostly representing high-volume, high-cost, and high-risk diagnoses for the hospital.
Answer: A Explanation: A) Although case managers are often licensed professional nurses with advanced degrees and extensive patient care experience, social workers, nurses without advanced degrees, and other healthcare-related professionals also serve in this role. Case managers typically do not provide direct patient care, but are responsible for a caseload of 10-15 clients for whom they will coordinate care during the clients' hospitalization while also assisting with discharge planning. It is critical to collect and document baseline data for those conditions in the client population selected by the facility for case management.
5) A nurse is working as the designated leader of a group of healthcare providers in a community clinic setting. The team members are working to decrease the number of teenage pregnancies in the community. They have defined the problem and are now focusing on objectives and considering various viewpoints presented by the group. The nurse is tasked with helping the team to stay focused in order to address the defined problem. Which of the competencies of collaboration does this describe? A) Decision making B) Mutual respect C) Trust D) Communication
Answer: A Explanation: A) Decision making involves shared responsibility for the outcome. The team must follow specific steps of the decision-making process, beginning with a clear definition of the problem. Team decision making must be directed at the objectives of the effort and requires full consideration and respect for various and diverse viewpoints, and often requires guidance and direction from a group leader. Mutual respect occurs when two or more people show or feel honor or esteem toward one another. Trust occurs when an individual is confident in the actions of another individual. Both mutual respect and trust imply mutual process and outcome and may be expressed verbally or nonverbally. Communication is necessary in effective collaboration; it occurs only if the involved parties are committed to understanding each other's professional roles and appreciating each other as individuals.
1) A young female surfer is admitted with traumatic amputation of the lower left arm secondary to shark attack. The nurse realizes that many different types of healthcare professionals will be needed to help the client survive the injury and regain as much upper extremity function as possible. The nurse advises that a healthcare team be assembled based on which description? A) Healthcare teams utilize collaborative delivery of high-quality, interdisciplinary health services in a shared leadership role, where accountability is both individual and mutual in nature. B) Healthcare teams are made up of members of the same profession who work under one leader to achieve one goal. C) Healthcare teams exist only to make decisions for clients. D) Healthcare teams are assembled only to manage the care of extremely ill clients.
Answer: A Explanation: A) Healthcare teams are made up of professionals from different areas of expertise, each with equal input and accountability, with the shared goal of delivering comprehensive, high-quality care to clients. Healthcare groups are made up of members of the same profession, and have one leader. Clients and families are included in the healthcare team's decision-making process. Healthcare teams are utilized anywhere in health care where multiple areas of expertise are needed, and not only for extremely ill clients.
5) In arranging community services for a client who is schizophrenic, the nurse case manager discusses options with the Assertive Community Treatment (ACT) team. Which team disciplines should the nurse expect will be part of the client's ACT interdisciplinary team? A) Psychiatrists, nurses, social workers, employment specialists, substance abuse specialists B) Speech pathology, occupational therapy C) Teachers, school administrators D) Handi-Cab drivers
Answer: A Explanation: A) The ACT program supports and treats individuals with serious mental illnesses and provides psychiatrists, nurses, social workers, employment specialists, and substance abuse specialists. The schizophrenic patient would not require speech pathology remediation or occupational therapy. The schizophrenic patient would not require teacher assistance or school administration intervention. Handi-Cab drivers may be utilized for transportation, but are not part of the healthcare team.
3) A staff nurse learns before reporting to work that a close family member has been diagnosed with terminal cancer. The nurse is receiving the shift report and finds the family member has been assigned as a client. The nurse reporting off duty states that the client is very demanding and complains a lot. What is the appropriate next action by the oncoming nurse? A) Discuss the situation with the charge nurse. B) Resolve to refrain from reacting negatively to the client. C) Tell the client to change the behavior. D) Ask the doctor to help control the client.
Answer: A Explanation: A) The best action to prevent conflict would be to explain the personal situation to the charge nurse and ask for a reassignment. The nurse can resolve to not react to the client, but the nurse should have the presence of mind to understand that personal ability to cope is impaired. It would not be appropriate to confront the client at this time. The nurse should not ask anyone other than the charge nurse to intervene and help control the client.
8) Nurse leaders in a local hospital created a neurotrauma (NT) unit healthcare team focused on improving outcomes for their stroke clients. This team includes acute care nurses, physicians, other care partners (e.g., physical therapists, social workers, case managers, dieticians), and representatives from the NT outpatient clinic. This team is led by a physician who makes treatment decisions based on the treatment plans developed by individual team members who each communicate with the clients, asking the same or similar questions to obtain data needed for their treatment plan. What type of communication and action is represented in the scenario described? A) Parallel communication B) Parallel functioning C) Information exchange D) Coordination and consultation E) Co-management and referral
Answer: A Explanation: A) The type of communication and action used by this healthcare team is parallel communication. It is at the lowest level along the continuum of communication and collaboration among health team members and is characterized by each professional communicating with the client independently, asking the same or similar questions needed to develop their plan of care. The next level up on the continuum of communication and collaboration, but not described in this scenario, is parallel functioning. Here, communication is more coordinated, but each professional still develops separate interventions and care plans. In parallel functioning, the exchange of information among team members is more structured and planned, but decision making is unilateral and does not involve much collegiality. The actions of this NT team do not demonstrate coordination and consultation or co-management and referral, the two highest levels of communication and collaborative action. The higher levels of communication and collaboration characterize interdisciplinary and interprofessional teams; the lower level of communication characterizes multidisciplinary teams.
7) The hospital's nurse case manager has been extensively involved with a shooting victim and his family in coordinating care of providers from many disciplines as the client progressed from the Emergency Department (ED) to the intensive care unit (ICU) and then onto the unit. After 3 weeks of hospitalization, the case manager is helping to prepare him for discharge to a rehabilitation center where he will continue treatment for his injury. Which outcomes have been documented in the literature as benefits of such collaboration? Select all that apply. A) Improved client outcomes B) Reduction in duplication of healthcare services C) Increased overall cost of health care services D) Decreased client morbidity and mortality E) Diminished sense of autonomy felt by nurses F) Higher level of job satisfaction
Answer: A, B, D, F Explanation: A) Research findings suggest that collaboration in health care among clients, family members, caregivers, and communities leads to improved client outcomes, a reduction in duplicated healthcare services, and a decrease in client morbidity and mortality. Collaborative efforts have also been found to decrease, rather than increase, the overall cost of healthcare services, and to contribute to an enhanced, rather than diminished, sense of autonomy. This increase in sense of autonomy has been linked to nurses' greater job satisfaction.
6) Years after the practice of having newborns "room in" with mothers was widely established in this country, some the nurses on the labor and delivery unit and on the newborn nursery unit at a rural community hospital strongly resisted the implementation of an integrated mother/baby unit. The nurses were concerned that after years of experience in working with only birthing mothers or only with newborns, they might not be able to adequately care for pairs of mothers and infants. Many felt that they had a limited skill set in the area where they had not previously worked and did not want this change. They also felt that if they spoke up about their opposition they might lose their jobs. Others felt the units were "behind the times," were eager for the transition, and were angry at the other nurses' hostility toward the head nurse promoting the change. The head nurse pushing for the integrated unit clearly stated her expectations, reported that jobs would not be lost, involved the team members in planning, posted frequent updates about the planning process, and discussed her plan for how nurses in each unit would be cross-trained for the other unit. Based on the information presented, what were the likely causes of the conflict that occurred in spite of the head nurse's efforts for this transition? Select all that apply. A) Mistrust B) Miscommunication C) Ambiguous role expectations D) Resistance to change E) Ineffective leadership F) Inadequate project planning
Answer: A, D Explanation: A) The likely sources of conflict in this scenario are mistrust and resistance to change. From the information presented, the head nurse applied several principles of effective management to avoid conflict among her staff, yet some nurses continued to resist the change and demonstrated mistrust. Miscommunication, ambiguous role expectations, ineffective leadership, and inadequate project planning appear not to have been issues because the head nurse took several actions to smooth the transition and reassure the staff. These included involving them in planning, reassuring them that they would retain employment, explaining the cross-training they would be provided, as well as a number of other activities to avoid conflict.
8) Which statement is a primary and historical barrier to effective nurse-physician collaboration that has tended to persist over time? A) The view among the general population that that nurses' contributions to clients' care is less important to their health and well-being compared to the contribution of physicians B) The nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and physicians assuming leadership and superior role in healthcare settings C) A general lack of education provided in schools for health professionals about the benefits on healthcare quality linked to nurse-physician collaboration D) A lack of published evidence about the effectiveness of collaborative efforts among and between nurses and physicians E) The lack support at the federal level for efforts to improve health care among the general population through increased nurse-physician-client collaboration.
Answer: B Explanation: A) A primary and historical barrier to effective nurse-physician collaboration has been nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and medical providers perceiving their role to be superior in the provision of healthcare services. Evidence does not suggest that the general population views nurses' contributions to the care of clients as less important, thus this is not considered a primary barrier to nurse-physician collaboration. Likewise, because health professional students are in fact educated about the benefits of collaborative practice and published evidence has documented the effectiveness of collaboration in improving client outcomes, these are not barriers to collaboration. In addition, the federal government, as evidenced in particular by the Healthy People initiative, has promoted collaborative efforts among clients, nurses, physicians, other healthcare providers, and the larger community to improve the health of the U.S. population.
7) The Chief Nursing Officer and Chief Medical Officer in an urban teaching hospital are leading a series of meetings with nurses, physicians, hospital lawyers, and risk managers to review and update hospital privileging procedures and requirements for advanced practice RNs and physicians new to the hospital. This is an example of what type of collaborative team? A) Intradisciplinary B) Interdisciplinary C) Multidisciplinary D) Complementary
Answer: B Explanation: A) A team comprised of members from different disciplines that is focused on achieving a common goal is an interdisciplinary team. Their varying professional backgrounds helps to ensure that other perspectives are represented as the issue is considered. Intradisciplinary teams are comprised of members of the same profession working to achieve a common goal, and multidisciplinary teams are more commonly teams whose members work more autonomously toward the common goal. Complementary is not a type of team, although team members' efforts can be complementary and provide a broader perspective of issues.
4) A group of nurses are in a staff meeting on a medical-surgical unit headed by the new unit nurse manager. The manager announces that nurses should not criticize and make fun of other nurses or there will be repercussions. Several nurses at the meeting tell the manager that this type of situation should be handled by the individual nurses. Which statement describes how the new manager could best develop an understanding of the group's dynamic? A) Insist that this is an appropriate new policy. B) Recognize that the group has already defined behavioral norms. C) Discipline the staff nurses who spoke out. D) Request a transfer to another unit.
Answer: B Explanation: A) Behavioral norms are established by the group or the leader of the group. In this case, the manager should recognize that the group does not see this as an issue because it has already established behavioral norms for it. The new manager should simply offer support for any nurse who is unable to resolve such interpersonal conflicts. Insisting on initiating the new policy could be harmful to the goals of the group as a whole. Rather than transfer, the manager could observe the dynamics of the group and adapt to the findings. Disciplining those who spoke out would negatively affect the cohesiveness of the entire group.
2) A client who has been in the intensive care unit (ICU) for 2 days is placed on a care map for extended care following a coronary artery bypass. Which statement by the client indicates to the nurse that there is understanding of the care map? A) "I cannot alter the care map plan." B) "The chosen care map can be altered to meet my needs." C) "My insurance plan can deny payment if I do not meet goals." D) "I must be able to meet goals that are set for me."
Answer: B Explanation: A) Care maps, or critical pathways, are flexible enough to be adjusted and tailored to the client's needs and wishes. The client is included in the discussion of meeting goals. It is possible to have variances in a critical pathway that, if documented properly, should be paid for by insurance. The case manager monitors and works with the client to alter the pathway as needed during the recovery process.
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.
4) A 10-year-old boy is in the intensive care unit (ICU), unconscious and with multiple traumatic injuries, after a skateboard accident that included closed head injury. Many health professionals are involved in his care and the scene is chaotic. The parents are extremely anxious and want to know what's happening. The nurse case manager realizes that an interdisciplinary team meeting would be of great benefit in managing the client's care, based upon which of the following statements? A) An interdisciplinary team would not be needed for a multiple-trauma patient. Each healthcare professional should practice independently. B) An interdisciplinary team could more efficiently share and evaluate information for care planning and implementation, and prevent priority conflicts, redundancy, and omissions in care. C) The team should be multidisciplinary, with one physician making all of the decisions. D) Forming an interdisciplinary team would prevent the parents from trying to change the plan of care.
Answer: B Explanation: A) Interdisciplinary collaboration engages each professional's contribution to joint care planning, implementation, and accomplishment of client goals, with possibly less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making.
1) A client with type 1 diabetes mellitus has developed an open sore on the shin and is having trouble meeting daily goals for exercising. After the client spends a week in the hospital receiving wound care and antibiotics, the nurse decides to notify which of the following healthcare team members for follow-up care? A) The pharmacy B) The case manager C) The occupational therapist D) The physical therapist
Answer: B Explanation: A) The client's needs and progress have changed. The nurse notifies the case manager to coordinate changes in care needed after discharge. A physical therapist may be needed, but the nurse would coordinate care best by notifying the case manager. The pharmacy is not needed as part of the team at this time. The occupational therapist mainly deals with the upper body areas needing rehabilitation. This client's exercise program needs to be revamped, and the case manager is the individual to coordinate this change.
9) What does research reveal about the greatest benefit of engaging an interdisciplinary team in planning and implementing client care? A) Team members feel a greater sense of commitment and contribution to the organization. B) Team members report feeling more respected and valued within and across professional disciplines. C) Pooling resources and ideas results in greater efficiency in providing care to clients. D) Organizations can report greater compliance with the 2010 Patient Protection and Affordable Care Act.
Answer: C Explanation: A) The greatest benefit of increased interdisciplinary collaboration among health team members is greater efficiency in providing care to clients from pooling resources and ideas to help clients meet their healthcare goals.
2) The nurse case manager assembles a team of healthcare professionals, including the client's physician, physical therapist, and social worker, for the purpose of collaborative discharge planning and decision making. What type of team does this represent? Select all that apply. A) Intradisciplinary team B) Interdisciplinary team C) Interprofessional team D) Management team
Answer: B, C Explanation: A) Interdisciplinary teams include professionals of varied backgrounds who share decision making. The terms interprofessional team and interdisciplinary team are synonymous. Intradisciplinary teams include members of the same profession. Multidisciplinary teams include members of varied backgrounds, but treatment decisions are made by one team member-usually the physician. Management teams are executive-level teams that run the day-to-day operations of a corporation.
5) The nurses in the Emergency Department (ED) and the staff nurses on the neurological unit are experiencing conflict. The ED nurses are concerned that individuals discharged from the ED with orders for admission to the neurological unit are experiencing prolonged wait times as they wait for the neurological unit's admitting nurse to come down to the ED to receive a face-to-face report about the client and to then assist with the client's transfer to the floor. The neurological unit is currently short-staffed, and the nurses want to make sure that their patients are adequately cared for before they leave the unit to go to the ED. The neurological unit nurses also have said that once they arrive in the ED after being called to come down for the report and transfer, required paperwork isn't always completed, and the nurse ends up having to wait while this task is finished. What type of conflict are the nurses in these two service areas experiencing? A) Intrapersonal conflict B) Interpersonal conflict C) Intergroup conflict D) Interorganizational conflict E) Covert conflict
Answer: C Explanation: A) Because the inter-unit conflict described is occurring between two teams of nurses, this scenario is describing intergroup conflict. It is likely driven by each team's wish to provide quality care for their patients in a context of limited resources or lack of role clarity. Intrapersonal conflict describes stress or tension within the individual that results from real or perceived pressure associated with incompatible expectations. Interpersonal conflict is characterized by conflict between individuals (rather than service areas as in this situation). Interorganizational conflict typically involves competition between two organizations existing in one market. Without a further description of how the conflict is being manifested and managed by the two teams, the conflict can't be identified as covert (or overt) at this time.
7) A group of nurses were having lunch together at a community table in the hospital cafeteria. One individual made an unflattering comment in front of several other nurses about one a nurse on the unit who was off that day. The nursing director present quietly said to the offending nurse, "This behavior isn't OK, especially in a hospital like ours with a 'zero-tolerance policy.' Please take your issue directly to him and have a discussion if there is something that is bothering you. If you'd like me to help you with this, please let me know, and the three of us can meet." This nursing director was modeling appropriate behavior for addressing which work-related issue? A) Workplace stress B) Sexual harassment C) Horizontal violence D) Intrapersonal conflict
Answer: C Explanation: A) In quietly and respectfully calling out the nurse about her disparaging comments directed at an absent coworker, the nursing director modeled strategies to address horizontal violence (HV), a form of workplace bullying. HV is described as aggressive acts committed against a nurse by one or more nursing colleagues and can be verbal or physical. The director's positive steps to address HV included: reminding the nurse about the hospital's "zero-tolerance" attitude toward bullying; reinforcing the code of conduct that identified the nurses' behavior as bullying; demonstrating to other nurses that she took the issue of bullying seriously; and offering to help the nurse appropriately address with her colleague the behavior that had prompted the disparaging comment. There is not enough information presented to know if workplace stress or sexual harassment were issues, and intrapersonal conflict refers to conflict within an individual, which is not necessarily evident in this scenario.
3) The client's nurse case manager, diabetes educator, and nutritionist met to discuss the client's needs in preparation for discharge to home. The client's physician arrived and stated that he would be making all decisions regarding the client's discharge care. With the physician's decision to lead the team, the dynamic has shifted between what two types of teams? A) Intradisciplinary to interdisciplinary team B) Multidisciplinary to intradisciplinary team C) Interdisciplinary to multidisciplinary team D) Interprofessional to interdisciplinary team
Answer: C Explanation: A) Interdisciplinary teams include professionals of varied backgrounds who share in decision making. Multidisciplinary teams include members of varied backgrounds, but treatment decisions are made by one member-usually the physician. Intradisciplinary teams include members of the same profession. The term interprofessional team is synonymous with interdisciplinary team.
6) The nurse managers in a community hospital have been charged with reviewing job descriptions of unlicensed assistive personnel (UAPs) and have questions about the delegation of certain client care activities to UAPs by nurses. To which group, organization, or individual would committee members direct their questions to obtain definitive answers about the parameters of nurse delegation to UAPs? A) The hospital's Chief Nursing Officer B) The hospital's Chief Executive Officer C) The state board of nursing D) The American Nurses Association
Answer: C Explanation: A) Parameters for the delegation of client care tasks by nurses to UAPs are established by each state's board of nursing.
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.
1) A nurse is discussing the plan of care with a client who is preparing for discharge. The client has a strong objection to portions of the plan of care. The nurse recognizes that there is a conflict. Which response by the nurse indicates an understanding of the client's position and a willingness to collaborate regarding the discharge plan? A) "You are not being cooperative in your plan of care." B) "This plan of care was ordered by the physician." C) "Let's talk about what your objections are and possible solutions or alternatives." D) "I will ask your family to convince you that this plan of care is best."
Answer: C Explanation: A) The nurse attempts to resolve the conflict with the client by listening to the client's concerns and then negotiating with the client. This action helps build the client's trust in the medical team. Telling the client that these orders were made by the physician continues the conflict and brings the physician into it. The nurse would not want to include the client's family in the conflict and cause problems between family members. The nurse might consult with the physician after a resolution has been reached with the client, but the conflict is the nurse's to solve.
3) The nurse and physician are preparing a client for discharge who will be requiring physical therapy (PT) to rehabilitate after a total knee replacement. After reading the physician order for PT, which would be the nurse's initial action? A) Set up appointments according to the order with the hospital PT department. B) Call home health and schedule a therapist to visit the home for therapy. C) Discuss the various types of settings for therapy and have the client choose the venue. D) Teach the family the exercises needed for the client.
Answer: C Explanation: A) The nurse best exhibits the characteristic that the client has a right to self-determination by presenting the methods available for PT and answering the client's questions about each so the client can make an informed decision. The nurse would not refer the client for outpatient therapy unless the client requests that form of therapy. Scheduling home PT is leaving the client out of the decision-making process. The therapy that the client requires must be performed by a professional physical therapist. To teach the family exercises encroaches upon the expertise of the professional who will be performing the service.
6) An 86-year-old client has been referred for home health nurse case management. The nurse realizes that an outpatient interdisciplinary team may best serve the client's needs in terms of planning for increased mobility, socialization, transportation, and home-based care. The nurse knows that the elderly client may best be supported by which interdisciplinary teams? Select all that apply. A) Assertive Community Treatment (ACT) B) YMCA C) Programs of All-Inclusive Care for the Elderly (PACE) D) Outpatient clinic E) Meals on Wheels
Answer: C, D Explanation: A) Interdisciplinary teams are used in many settings outside the hospital, including schools, the workplace, and long-term care facilities. PACE supports and facilitates the provision of all services and care for the elderly. Outpatient clinics coordinate medical care, supplies, and social services referrals. ACT is a mental health support and treatment program. The YMCA is a fitness facility. Meals on Wheels provides a service but is not an interdisciplinary program.
3) The nurse case manager has interviewed an elderly client with a recent hip replacement and her family. The case manager began the process for discharge planning soon after the client's admission to the orthopedic floor for planned surgery and has followed her progress through the client's hospitalization. A joint decision has been made that the client will not be able to return to her apartment until her rehabilitation is completed. Toward this end, the case manager has worked with the hospital nursing staff, the rehabilitation center, family members, and other care providers to assist with a smooth transition. Which is the primary goal of the care management model described here? A) To provide greater peace of mind for the client and his or her family members B) To help manage concerns that are related to the client's medical care and treatment regimen only C) To track a client's progress to ensure that appropriate care is provided until the time of discharge D) To provide a continuum of clinical services in order to help contain costs and improve client outcomes
Answer: D Explanation: A) Case managers coordinate client care to help ensure that a continuum of clinical services is provided. The goal of case management is to improve client outcomes and to help contain costs. Toward this end, case managers not only with help to coordinate care and treatment during hospitalization, but also assist with planning for care following discharge. Their focus includes not only medical care, but issues related to health promotion and disease prevention, the cost of health care received, and planning for the efficient use of resources. Although the involvement of case managers in care typically provides greater peace of mind for clients and family members, this is not the primary goal of this service.
5) Identify the primary purpose of critical pathways used by nurse case managers. A) evaluate care provided to clients with certain medical conditions. B) direct care provided to clients with certain medical conditions. C) track care provided to clients with certain medical conditions. D) direct, track, and evaluate care provided to clients with certain medical conditions.
Answer: D Explanation: A) Critical pathways are a disease-specific or diagnosis-specific tool used by case managers to direct, track, and evaluate expected client outcomes and care strategies.
4) The nurse is caring for a client with rheumatoid arthritis who expresses the desire to remain active as long as possible. In order for the client to meet this goal, what should the nurse prepare to do? A) Teach the client nutrition and joint exercises. B) Ask the client the reason for the decision. C) Tell the client there is no hope. D) Refer the client to the appropriate professionals.
Answer: D Explanation: A) The number of clients with chronic diseases with healthcare needs is increasing rapidly, and nurses and physicians cannot meet all of these clients' needs. When a client expresses the desire to live as normally as possible, the nurse should refer the client to professionals who can help the client meet that goal. The nurse can teach some nutrition and exercise but cannot go into the depth that this client would need. The client with a chronic disease should not be told there is no hope but should be helped toward reaching desired goals. Asking the client the reason for the decision is irrelevant to the situation.
2) The nurse caring for an adult client in the intensive care unit (ICU) is given a verbal order by a first-year medical resident. The nurse determines that the best course of action is to check with the attending physician before implementing the order. Which of the following statements best describes the nurse's Rationale for her decision? A) The resident seems unsure of the order. B) The nurse only takes orders from attending physicians. C) The nurse does not like first-year residents. D) The nurse may not trust the resident to make the best care decisions.
Answer: D Explanation: A) This type of conflict is most likely caused by a lack of trust in the resident on the part of the nurse. Nurses who work in critical care learn to validate orders given by a resident because a mistake can mean the client's life. The nurse may not like residents, but that is not a reason to question their orders. There is no evidence here that the resident is unsure of the order given. Residents can give orders, preferably written, but the nurse is wise to confirm the order with the managing physician.
