Question 1

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?

Accepted Answer

A)  Flexibility 
B)  Strict adherence 
C)  Persistence 
D)  Resistance to change 
A)  Flexibility 
B)  Strict adherence 
C)  Persistence 
D)  Resistance to change A

Question 2

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  Continuity of care may suffer. 
B)  Client/staff communication may be an issue. 
C)  There is little cost savings to the institution. 
D)  Delegation is necessary. 
E)  Not as many professional staff are required. 
A)  Continuity of care may suffer. 
B)  Client/staff communication may be an issue. 
C)  There is little cost savings to the institution. 
D)  Delegation is necessary. 
E)  Not as many professional staff are required. A,B,D

Question 3

A long-term care facility is considering implementing total client care. Prior to implementing this system, what must be available?

Accepted Answer

A)  Enough RN staff to provide all the care to the residents 
B)  A group of licensed assistants who are good at taking direction 
C)  A strong nurse manager 
D)  RNs willing to assume 24-hour accountability for the care provided to residents 
A)  Enough RN staff to provide all the care to the residents 
B)  A group of licensed assistants who are good at taking direction 
C)  A strong nurse manager 
D)  RNs willing to assume 24-hour accountability for the care provided to residents A

Question 4

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?

Accepted Answer

A)  Team nursing 
B)  Functional nursing 
C)  Total client care 
D)  Primary care 
A)  Team nursing 
B)  Functional nursing 
C)  Total client care 
D)  Primary care

Question 5

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 
B)  "If a client is not able to follow the critical pathway, a variance will be written." 
C)  "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 
D)  "Once the client is on a critical pathway, we must follow it until discharge." 
E)  "Using critical pathways will help us reduce length of stay and costs to the client." 
A)  "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 
B)  "If a client is not able to follow the critical pathway, a variance will be written." 
C)  "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 
D)  "Once the client is on a critical pathway, we must follow it until discharge." 
E)  "Using critical pathways will help us reduce length of stay and costs to the client."

Question 6

The RN leader of a team overhears one of the UAP on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?

Accepted Answer

A)  As a need to be more involved in direct client care when this UAP is on the team 
B)  As a common disadvantage of the team approach to nursing 
C)  As an indication that this UAP should be reported for unprofessional behavior 
D)  As confirmation that UAP are poorly educated and do not work well on teams 
A)  As a need to be more involved in direct client care when this UAP is on the team 
B)  As a common disadvantage of the team approach to nursing 
C)  As an indication that this UAP should be reported for unprofessional behavior 
D)  As confirmation that UAP are poorly educated and do not work well on teams

Question 7

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?

Accepted Answer

A)  Diagnoses given to only a few clients 
B)  Diagnoses that carry high risk for the client and the provider 
C)  Diagnoses that have low reimbursement rates 
D)  Diagnoses that involve as few providers as possible 
A)  Diagnoses given to only a few clients 
B)  Diagnoses that carry high risk for the client and the provider 
C)  Diagnoses that have low reimbursement rates 
D)  Diagnoses that involve as few providers as possible

Question 8

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

Accepted Answer

A)  One nurse has responsibility for all the medications on the unit. 
B)  One nurse has responsibility for all the needs of three clients. 
C)  One charge nurse and one respiratory therapist have responsibility for all clients. 
D)  One nurse and one nursing assistant have responsibility for 10 clients. 
A)  One nurse has responsibility for all the medications on the unit. 
B)  One nurse has responsibility for all the needs of three clients. 
C)  One charge nurse and one respiratory therapist have responsibility for all clients. 
D)  One nurse and one nursing assistant have responsibility for 10 clients.

Question 9

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?

Accepted Answer

A)  Instruct physical therapy to increase treatments to four times daily. 
B)  Contact the family to discuss preoperative mobility problems. 
C)  Inform the case manager of variance in the critical pathway. 
D)  Discuss the problem with the client's surgeon. 
A)  Instruct physical therapy to increase treatments to four times daily. 
B)  Contact the family to discuss preoperative mobility problems. 
C)  Inform the case manager of variance in the critical pathway. 
D)  Discuss the problem with the client's surgeon.

Question 10

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  It is the most cost-effective way to manage a hospital. 
B)  An environment that is better for nurses is associated with lower mortality rates. 
C)  Nurses are more satisfied working in an environment that is better for nursing. 
D)  When the environment is better for nursing, it is also better for other disciplines. 
E)  Most of the strategies that improve the environment for nursing do not cost anything. 
A)  It is the most cost-effective way to manage a hospital. 
B)  An environment that is better for nurses is associated with lower mortality rates. 
C)  Nurses are more satisfied working in an environment that is better for nursing. 
D)  When the environment is better for nursing, it is also better for other disciplines. 
E)  Most of the strategies that improve the environment for nursing do not cost anything.

Question 11

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Which of the following are disadvantages of this method? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  The client may have multiple primary nurses if transfers within the facility are necessary. 
B)  Physician satisfaction is decreased. 
C)  Staff nurses cannot be held legally liable for care provided outside their work hours. 
D)  It requires a knowledge-based nursing practice model. 
E)  All individuals caring for the client must have excellent communication skills. 
A)  The client may have multiple primary nurses if transfers within the facility are necessary. 
B)  Physician satisfaction is decreased. 
C)  Staff nurses cannot be held legally liable for care provided outside their work hours. 
D)  It requires a knowledge-based nursing practice model. 
E)  All individuals caring for the client must have excellent communication skills.

Question 12

At a strategic planning meeting the nurse executive recommends instituting client-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?

Accepted Answer

A)  "We have always had the client at the center of everything we do." 
B)  "We can't afford to hire more RNs." 
C)  "I'm concerned about the increased time and leadership our nurse managers will have to provide." 
D)  "I like the idea of centralizing all our care." 
A)  "We have always had the client at the center of everything we do." 
B)  "We can't afford to hire more RNs." 
C)  "I'm concerned about the increased time and leadership our nurse managers will have to provide." 
D)  "I like the idea of centralizing all our care."

Question 13

The nurse just left a healthcare agency that utilized the practice partnership model of care. When compared to team nursing, practice partnership offers which attributes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  Working alone 
B)  Continuity of care 
C)  Less expensive for the organization 
D)  Accountability for client care 
E)  Coordinating implementation of care 
A)  Working alone 
B)  Continuity of care 
C)  Less expensive for the organization 
D)  Accountability for client care 
E)  Coordinating implementation of care

Question 14

Which is the most important consideration in choosing a structure for nursing care?

Accepted Answer

A)  Client need 
B)  Efficiency 
C)  Cost 
D)  Timeliness 
A)  Client need 
B)  Efficiency 
C)  Cost 
D)  Timeliness

Question 15

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?

Accepted Answer

A)  "There has been little change in nursing care delivery over the last few years." 
B)  "We must look to the nursing process for guidance in nursing care." 
C)  "Too much time is spent deciding on a system of care." 
D)  "Any system is okay, as long as the nurses follow it." 
A)  "There has been little change in nursing care delivery over the last few years." 
B)  "We must look to the nursing process for guidance in nursing care." 
C)  "Too much time is spent deciding on a system of care." 
D)  "Any system is okay, as long as the nurses follow it."

Question 16

Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 
B)  The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease. 
C)  The nurse advocates for the client who has decided to forego further dialysis. 
D)  Client information is entered into an electronic medical record. 
E)  Information about the operating hours of a community recreation center is provided to the client with coronary artery disease. 
A)  Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 
B)  The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease. 
C)  The nurse advocates for the client who has decided to forego further dialysis. 
D)  Client information is entered into an electronic medical record. 
E)  Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Question 17

A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons that team nursing is not successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  There are problems with delegation. 
B)  There are problems with the skill set of the UAP on the teams. 
C)  The LPNs on the team do not accept their position of being "in the middle." 
D)  Communication on the team or with the nurse manager is flawed. 
E)  RNs and LPNs struggle with who is in control and has the power on the team. 
A)  There are problems with delegation. 
B)  There are problems with the skill set of the UAP on the teams. 
C)  The LPNs on the team do not accept their position of being "in the middle." 
D)  Communication on the team or with the nurse manager is flawed. 
E)  RNs and LPNs struggle with who is in control and has the power on the team.

Question 18

A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  The nurse will determine interventions for all the disciplines needed as part of the clients' care. 
B)  The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 
C)  The nurse will work to build consensus with the physicians caring for the clients on the team. 
D)  The nurse will define the expected nursing outcomes for the clients on the team. 
E)  The nurse will collect and analyze data regarding the clients on the team. 
A)  The nurse will determine interventions for all the disciplines needed as part of the clients' care. 
B)  The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 
C)  The nurse will work to build consensus with the physicians caring for the clients on the team. 
D)  The nurse will define the expected nursing outcomes for the clients on the team. 
E)  The nurse will collect and analyze data regarding the clients on the team.

Question 19

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?

Accepted Answer

A)  Those who deliver the nursing care make the most educated decisions for a particular unit. 
B)  Clinical decisions are best made by the clients who are served by a particular unit. 
C)  Clinical decisions are best made by nursing leaders for all units within that particular hospital. 
D)  Nurses working in a particular service area are best suited to make decisions for the clients in that area. 
A)  Those who deliver the nursing care make the most educated decisions for a particular unit. 
B)  Clinical decisions are best made by the clients who are served by a particular unit. 
C)  Clinical decisions are best made by nursing leaders for all units within that particular hospital. 
D)  Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Question 20

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

A)  "It helps to coordinate care to a group of clients." 
B)  "It organizes care responsibilities." 
C)  "It ensures that the staff doesn't get overtime." 
D)  "It improves physician efficiency." 
E)  "It provides skilled care by skilled staff." 
A)  "It helps to coordinate care to a group of clients." 
B)  "It organizes care responsibilities." 
C)  "It ensures that the staff doesn't get overtime." 
D)  "It improves physician efficiency." 
E)  "It provides skilled care by skilled staff."

Exam 3: Delivering Nursing Care

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A long-term care facility is considering implementing total client care. Prior to implementing this system, what must be available?

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?

The RN leader of a team overhears one of the UAP on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Which of the following are disadvantages of this method? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

At a strategic planning meeting the nurse executive recommends instituting client-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?

The nurse just left a healthcare agency that utilized the practice partnership model of care. When compared to team nursing, practice partnership offers which attributes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Which is the most important consideration in choosing a structure for nursing care?

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?

Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Introducing Nursing Management

Designing Organizations

Leading, Managing, Following

Initiating and Managing Change

Managing and Improving Quality

Understanding Legal and Ethical Issues

Understanding Power and Politics

Thinking Critically, Making Decisions, Solving Problems

Communicating Effectively

Delegating Successfully

Building and Managing Teams

Handling Conflict

Managing Time

Budgeting and Managing Fiscal Resources

Recruiting and Selecting Staff

Staffing and Scheduling

Motivating and Developing Staff

Evaluating Staff Performance

Feedback and Coaching, Disciplining, and Terminating Staff

Managing Absenteeism, Reducing Turnover, Retaining Staff

Dealing With Disruptive Staff Problems

Preparing for Emergencies

Preventing Workplace Violence

Handling Collective Bargaining Issues

Managing Stress

Advancing Your Career

Imagining the Future

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