Deck 39: Managing Care

Question 1

A nurse is responsible for the care coordination of a client with multiple sclerosis who is being treated at a multiservice outpatient clinic.The nurse is informed by the occupational therapist that the client needs specialized assistive devices in order to prepare meals but does not have the money to purchase them.The client's insurance company has denied approval to cover the devices.Which is the appropriate action by the nurse?

A) Tell the occupational therapist that she will have to come up with another plan to meet the client's needs.
B) Advocate with the insurance company to provide the appropriate coverage.
C) Explain to the client that she will have to get family members or friends to prepare her meals.
D) Explain to the client that she will have to find other methods to pay for the devices.

Answer 1

Advocate with the insurance company to provide the appropriate coverage.

Question 2

A nurse,who works in a clinic environment,places great emphasis on cost control,customer satisfaction,health promotion,and preventive services.The primary focus of this nurse is representative of which type of healthcare system?

A) Functional method
B) Client-focused care
C) Case method
D) Managed care

Answer 2

Managed care

Question 3

The nurse is caring for a preschool-age client who suffered brain damage following a car accident.The client has a tracheostomy,is ventilator-dependent,and will be discharged from the hospital into the family's care.The family wants to care for the child at home but does not have the resources for 24-hour care.Which action by the care manager is appropriate?

A) Making referrals to a variety of community-based agencies that can meet the family's needs
B) Telling the family that it is impossible to provide care at home
C) Arranging for the child to be sent to a long-term healthcare facility
D) Contacting local nurses in the community to provide the assistance that the family needs to provide care for the client

Answer 3

Making referrals to a variety of community-based agencies that can meet the family's needs

Question 4

An instructor is teaching the class about cost-conscious nursing practice.The instructor knows that the students understand this concept when the students make which statements? Select all that apply.

A) "Nurses must search for more efficient ways to deliver nursing care."
B) "Careful use of supplies will reduce waste and save money."
C) "I do have to take short cuts every now and then."
D) "There are insufficient healthcare workers to meet the need right now."
E) "A new emphasis has been placed on health promotion and disease prevention."

Question 5

A nurse is applying for a job as a case manager for a managed care insurance organization.Which responsibility is associated with this role?

A) Providing home visits to clients
B) Independent treatment planning
C) Coordinating client care through all stages of treatment
D) Approving treatment decisions

Question 6

A client who is experiencing an exacerbation of rheumatoid arthritis (RA)will be discharged after a week's stay in the hospital.The client tells the nurse,"I can't believe how much better I am feeling now." Which is the rationale for why the client is feeling better?

A) The client appreciates the various levels of care given.
B) Appropriate scheduling of the client's care by all disciplines allowed the client to rest.
C) The client was kept busy each day.
D) The client's disease process having been stopped.

Question 7

A nurse is caring for a client who had a total hip replacement 14 days ago.The client is preparing for discharge in a few days.The nurse facilitates a care conference with the primary healthcare provider,occupational therapist,physical therapist,and the client and family to develop a plan of care for the client prior to discharge.Which roles are being demonstrated by this nurse? Select all that apply.

A) Coordinator
B) Collaborator
C) Differentiated practitioner
D) Team leader
E) Expert

Question 8

A postoperative client is transferred to the medical-surgical unit from the intensive care unit (ICU).The client asks the assigned nurse why unlicensed assistive personnel (UAP)help with range-of-motion exercises.Which is the best response by the nurse?

A) "Your condition has improved so I delegated that part of your care to the UAP."
B) "You do not need me to ambulate you."
C) "The charge nurse made the decision to have the UAP assist you when walking."
D) "I assigned all of your care to the UAP."

Question 9

A nurse working in a large municipal hospital is appointed to a task force whose focus is addressing nursing shortages.Which factor should the task force consider?

A) Nurses are only utilized for clinical services.
B) Nursing shortages are often cyclical.
C) Only licensed nurses are used for all nursing duties.
D) Reductions in nursing staff encourage nurses to remain in the profession.

Question 10

The nurse is helping in discharge planning for a diabetic client who needs extensive rehabilitation and is on a complicated medication schedule.The client and spouse currently live with their eldest son and the family is very involved in the client's care.The nurse would want to coordinate the client's care by including which priority individuals? Select all that apply.

A) Pharmacist
B) Client's children
C) Primary healthcare provider
D) Social worker
E) Client's spouse

Question 11

The nurse is caring for several medical-surgical clients.The nurse has delegated skin care of an incontinent client to new unlicensed assistive personnel (UAP)on the unit.Which action by the nurse will improve effectiveness of the client care provided?

A) Ask the client if the care was appropriate.
B) Ask the UAP if the care was given.
C) Demonstrate the appropriate care needed, then delegate the task for the remainder of the shift.
D) Closely observe the UAP each time the care is given.

Question 12

The nurse is appointed to a clinical-administrative task force studying critical staffing issues and care delivery models for the hospital.Which evidence on the effects of different staffing choices and care delivery models should the task force consider? Select all that apply.

A) Higher nurse-client ratios have been linked to a decrease in the amount of time clients are hospitalized.
B) Shared governance is linked to a reduction in adverse outcomes.
C) A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.
D) Research indicates that functional assignment of staff improves the likelihood of meeting clients' emotional needs.
E) There is little or no research studying nursing ratios and client outcomes.

Question 13

A nurse is completing discharge teaching for a client who is hospitalized for total hip replacement.The client asks the nurse why there is a case manager involved and expresses confusion about who is in charge.The client states,"I thought my doctor manages my care." Which is the best response by the nurse?

A) "No, I manage your care."
B) "You are correct; the doctor is responsible for managing your care."
C) "A case manager coordinates everyone involved in your care to ensure your needs are met."
D) "The case manager delegates your care to the nurse."

Question 14

The nurse is caring for an adult client from Canada who has come to the United States for a serious neurological surgery.The client tells the nurse,"I came to this country so that I would receive better care." Which is the most likely rationale for the client's statement?

A) America has many choices about health care.
B) America has a universal healthcare system.
C) Healthcare rationing in America decreases cost.
D) There is very little competition in health care in the United States.

Question 15

A client recovering from an emergency appendectomy is a citizen of France.The client asks the nurse to explain why the United States has chosen such a different healthcare reimbursement system from other Western countries.Which American value could the nurse mention to explain the system in this country?

A) Acceptance of the role of government
B) Individual accountability
C) Skepticism about markets and competition
D) Universality

Question 16

A veteran nurse is working on a large medical-surgical unit.The nurse is caring for a client with MRSA who requires frequent dressing changes.Which action by the nurse would help control the cost associated with this client's care?

A) Wiping down equipment at the end of the shift
B) Storing equipment in the client's room
C) Making sure the client's room is stocked with all needed supplies
D) Placing a cart with supplies outside the client's room

Question 17

The nurse delegates vital signs and daily weights of assigned clients to the unlicensed assistive personnel (UAP)on duty.Which is the reason for the nurse to assess each client throughout the shift?

A) The UAP cannot report to the next shift.
B) The UAP is not trustworthy.
C) The nurse maintains the authority to care for the clients.
D) The nurse remains accountable for the clients' care.

Question 18

The nurse is working on a medical-surgical unit that is short staffed due to a callout.The manager of the unit was unable to replace the nurse,so the extra clients were assigned to the remaining nurses.The manager was able to get the help of unlicensed assistive personnel (UAP)from the house pool to help on the unit.Which action by the nurses would ensure effective care for the client?

A) Delegate vital signs and a.m. care to the UAP.
B) Explain to the manager that care may be compromised if another nurse does not work the shift.
C) Tell the clients their care will be sparse.
D) Assign wound care to the UAP.

Question 19

An older adult client tells the nurse,"I am worried about how I will pay for my hospital bill." The client is being discharged,is being referred to home health care,and the new plan of care involves extremely expensive drugs.Which response by the nurse is appropriate?

A) "You need to focus on recovering and not worry about finances."
B) "I'll have someone from the business office come and set up your payment plan."
C) "Don't worry. I'm sure everything will work out okay."
D) "Much of your care will be covered by Medicare."

Question 20

A nurse working in an outpatient OB-GYN clinic is asked to assume care coordination for the clinic's adolescent clients.Which skills will the nurse need to perform this work?

A) Critical thinking
B) Force field analysis
C) Relaxation training
D) Accounting

Question 21

A nurse-supervisor is encouraging nurses to delegate responsibilities whenever possible.Which criteria is used to determine skills that can be delegation? Select all that apply.

A) How complex is the task?
B) How busy are you?
C) Is the client frequently complaining?
D) Is training or education required?
E) Is the task unpleasant?

Question 22

The nurse delegated unlicensed assistive personnel (UAP)to assist a client with performing a simple dressing change.The client was formerly able to do the procedure,but because of painful arthritis is now unable to perform the redressing.The UAP has done this procedure before.Which must the nurse emphasize to the UAP?

A) Report to the nurse immediately anything unusual, such as bleeding or infection.
B) The nurse should demonstrate the steps of the procedure.
C) Make the client do most of the procedure and report the expected output.
D) The UAP should do health teaching while performing the procedure.

Question 23

A nursing supervisor has been told to ensure that the hospital's new electronic records system is properly implemented on the nursing unit.Which actions by the supervisor are the best use of exercising the managerial role? Select all that apply.

A) Creating a "buddy" system that pairs staff members who are less technologically comfortable with staff members who may require more assistance with the new system
B) Providing regular training sessions in the new system
C) Informing staff that the new system is optional
D) Establishing a regular spot check of each staff member's effective use of the system
E) Continuing to use paper records until the staff is completely comfortable with the new system

Question 24

The nurse is working on a unit with unlicensed assistive personnel (UAP).One nurse refuses to utilize the UAP and is consistently leaving nursing tasks for the next shift that have yet to be completed.Which is the most likely reason the nurse is not utilizing the UAP to assist with client care?

A) Avoidance of responsibility.
B) Overdependence on others.
C) The belief that no one else can perform a task as well as the nurse can.
D) The state nurse practice act.

Question 25

The nurse manager is interested in initiating self-scheduling on the medical surgical-unit.Which are stages of the planning process for the initiative that the nurse manager will use? Select all that apply.

A) Establish objectives (goals).
B) Evaluate the present situation and predict future trends and events.
C) Formulate a planning statement (means).
D) Coordinate the work to be done.
E) Convert the plan into an action statement.

Question 26

An experienced delegator is mentoring a newly appointed nurse in the hospital.The new nurse states,"I am hesitant to delegate tasks to unlicensed assistive personnel (UAP)because I am afraid they will not be done correctly." Which response by the experienced delegator is appropriate?

A) Tell her not to delegate any tasks unless she is completely confident.
B) Tell her to clearly identify the task and expectations and then to monitor the delegate's progress.
C) Tell her that delegation often results in a decrease in job satisfaction.
D) Tell her that her job responsibility requires that she do everything herself.

Question 27

A supervisor on a medical-surgical unit excels at scheduling staff and allocating resources.However,when new policies are being implemented,the supervisor has great difficulty getting staff cooperation.Based on this data,why is the supervisor considered a manager and not a leader?

A) A leader clarifies the organizational structure.
B) A leader exerts influence by using a flexible combination of personal behaviors and strategies.
C) A leader always assigns and coordinates tasks.
D) A leader must use contingency planning.

Question 28

The nursing supervisor in a small rural hospital is asked to help manage the switch from paper to electronic records.Which standard managerial steps will the nurse supervisor take to initiate this process? Select all that apply.

A) Planning
B) Experimenting
C) Organizing
D) Criticizing
E) Synthesizing