Deck 39: Managing Care

Question 1

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-to-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.

Answer 1

Higher nurse-to-client ratios have been linked to a decrease in the amount of time clients are hospitalized.
A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.

Question 2

A novice nurse is looking for employment and hopes to find a facility where the nursing staff participates in making, implementing, and evaluating client care policies. Which organizational module implements these practices?

A)Client-focused care
B)Differentiated practice
C)Managed care
D)Shared governance

Answer 2

Shared governance

Question 3

A client recovering from an emergency appendectomy is a citizen of a foreign country. 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 freedom
C)Skepticism about markets and competition
D)Universality

Answer 3

Individual freedom

Question 4

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 over time
D)Approving treatment decisions

Question 5

What nursing concept is essential to ensure continuity of client care when a nurse is managing the care of a client?

A)Ethics
B)Communication
C)Advocacy
D)Teaching and Learning

Question 6

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 7

The nurse is reviewing client records to determine which clients are good candidates for case management. Which client would the nurse choose as having the highest priority for assigning a case manager?

A)A newborn who was diagnosed with cerebral palsy
B)A pregnant woman with three other children
C)A school-age child who was diagnosed with pneumonia
D)An older adult who has been diagnosed with hypertension

Question 8

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

Question 9

The nurse is helping with discharge planning for a 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 daily 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 10

The movement from a retrospective payment system to a prospective payment system using a diagnosis-related group may have what unintentional consequence for hospitals trying to contain their costs?

A)Hospitals are now admitting more clients than previously.
B)Patients are sent home from the hospital as soon as possible.
C)Physicians order as many tests as needed to correctly diagnose the client's condition.
D)Nurses are encouraged to follow safety protocols to reduce complications.

Question 11

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 shortcuts 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 12

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

Question 13

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

A)Critical thinking
B)Physical assessment
C)Relaxation training
D)Accounting

Question 14

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

A)The U.S. has many choices about healthcare.
B)The U.S. has a universal healthcare system.
C)Healthcare rationing in the U.S. decreases cost.
D)There is very little competition in healthcare in the U.S.

Question 15

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 16

What action will allow facilities to better track the cost effectiveness of various nursing actions and allocate nursing resources most efficiently?

A)Bundling nursing care
B)Quantifying nursing care
C)Rationing nursing care
D)Increasing demand for nursing care

Question 17

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 18

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 healthcare, 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 19

The nurse is managing the care of an older adult client who is near the end of life but still has treatment options available. The treatment options could potentially be painful and expensive, and they would only extend the client's life approximately 2 months. What important topic should the nurse include during initial discussions with the client and family?

A)The need for hospice care for the client
B)Referral for grief counseling for the family
C)Reasons why the client should remain in the hospital until death
D)The client's health and impending mortality

Question 20

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 used for clinical services.
B)Nursing shortages contribute to salary fluctuations.
C)Only licensed nurses are used for all nursing duties.
D)Reductions in nursing staff encourage nurses to remain in the profession.

Question 21

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 more 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 22

A staff nurse at a hospital calls a long-term care facility that has just received transfer of care for a client. The hospital nurse reports the physician's medication orders to a nurse at the receiving facility. The hospital nurse does not have prescribing privileges. What is the responsibility of the nurse at the receiving facility in order to reduce the fear of liability?

A)Withhold medications until the facility's physician can assess the new client
B)Administer medications to the client immediately
C)Verify the order with the prescribing physician
D)Submit the medication order to the on-site pharmacy as soon as possible

Question 23

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 24

A nurse manager has created a culture of empowerment among the nursing staff. The nursing staff feels that they have the information, support, and resources to perform their tasks efficiently and effectively, and they also have opportunities for advancement, continued education, and input into nursing policies. What are the consequences of this type of environment?

A)The nurses will feel the need to find jobs elsewhere.
B)The nurses will be more committed to the institution.
C)The nurses will work independently without help from others.
D)The nurses will effectively avoid conflict.

Question 25

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

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

Question 26

The nurse is working on a unit with unlicensed assistive personnel (UAP). One nurse refuses to use 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 using 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 27

The nurse delegated to an unlicensed assistive personnel (UAP)the task of assisting a client with 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 28

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 weights 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 care of invasive lines to the UAP.

Question 29

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 and have the UAP give a return demonstration.
D)Closely observe the UAP each time the care is given.

Question 30

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 uses interpersonal skills to accomplish goals.
C)A leader always assigns and coordinates tasks.
D)A leader must use contingency planning.

Question 31

The emergency department staff is overwhelmed when multiple victims arrive from an explosion at a downtown factory. What leadership style would be most beneficial for the charge nurse to adopt in this situation to most efficiently provide nursing care to the incoming victims?

A)Autocratic
B)Democratic
C)Laissez-faire
D)Bureaucratic

Question 32

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

A)Does the delegate have the appropriate skills to perform the task safely?
B)How busy are you?
C)Is the client frequently complaining?
D)Does the task require client education?
E)Is the task unpleasant?

Question 33

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 34

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."