Deck 21: Managing Client Care

Question 1

Accountability is a critical aspect of nursing care.An example of a specific decision-making process of accountability is demonstrated by:
1) Selecting the medication schedule for the client
2) Implementing discharge teaching plans that meet individual needs
3) Evaluating the client's outcomes following implementation of care
4) Promoting participation of all staff members in regular unit meetings

Answer 1

3
Accountability refers to individuals being responsible for their actions.It involves follow-up and a reflective analysis of one's decisions to evaluate their effectiveness.Selecting the medication schedule for the client is an example of taking responsibility.Implementing discharge teaching plans that meet individual needs is an example of autonomy.Promoting participation of all staff members in unit meetings is an example of decentralized management and of promoting authority.

Question 2

Which statement best reflects the major limitation of the team nursing model?
1) "The team really needed an extra pair of hands today."
2) "It complicates things when you have a different team each day."
3) "Getting our two new admissions stabilized took up all of my time today."
4) "My nursing assistants need to be in-serviced on how to do a bladder scan."

Answer 2

3
One of the limitations to the model is that the team leader does not spend a large amount of time with clients.Depending on the mix of staff members,this sometimes means that clients see an RN infrequently.Risks exist if an RN is unable to make necessary client assessments and be involved in important clinical decision making.The remaining options refer to less frequent problems inherent to the team nursing model.

Question 3

The most important responsibility of a nurse manager is to:
1) Foster an environment that enables staff to provide quality nursing care
2) Provide leadership and role modeling for nursing and ancillary staff
3) Evaluate the delivery of nursing care in regard to its effect on client outcomes
4) Create a unit attitude of cooperative engagement directed toward positive client outcomes

Answer 3

1
Perhaps the most important responsibility of the nurse executive is to establish a vision for nursing that enables managers and staff to provide quality nursing care.The remaining options are means by which the manager can affect the proper environment.

Question 4

Which of the following statements best reflects the autocratic style of leadership?
1) "Let's discuss this case study thoroughly and decide on a plan of action as a group."
2) "I'll try to pair you in comparable work teams,and let's evaluate the success of this approach in 2 weeks."
3) "Everyone knows their work assignment,so let's not meet together unless we have an unexpected crisis."
4) "I'll consider each of your requests,and then I'll give you the guidelines for establishing new acuity ratings for our clients."

Question 5

Which of the following actions best reflects accountability for the client's care outcomes?
1) Reassessing a client's BP when the reported value is higher than usual
2) Assisting a team member in providing a client with a complete bed bath
3) Reevaluating a client's pain 30 minutes after administering pain medication
4) Asking a client's daughter to bring her father's non-skid slippers to the hospital

Question 6

The primary benefit of achieving Magnet status is the nursing staff is empowered to make innovative changes that:
1) Promote nursing autonomy
2) Positively affect client care outcomes
3) Enhance the perception of the nursing profession
4) Strengthen the collaborative RN/MD relationship

Question 7

A threshold of 90% is identified for an outcome indicator in the quality improvement program.Which of the following situations indicates a need for further review of the quality improvement plan?
1) The waiting time for clinic appointments has decreased 96%.
2) Clients with renal dialysis expressed a 95% satisfaction with their care.
3) In 93% of clients,subjective expressions of postoperative pain have decreased.
4) Wound infections are evident in 92% of clients after care of their IV access ports.

Question 8

A unit manager on a busy multi-service medical nursing unit decides to take responsibility for the direct client care of one of the many new admissions.Later the manager decides she is too busy to give adequate client care.Which of the following situational leadership styles does the nurse manager need to apply?
1) Coaching
2) Supporting
3) Delegating
4) Directing

Question 9

As the nurse starts to perform a procedure,a peer says,"I've done that before.Would you like me to help?" The peer's leadership style is described as:
1) Directing
2) Coaching
3) Democratic
4) Laissez-faire

Question 10

One advantage of a decentralized management structure for nursing units over a centralized structure is that:
1) Communication pathways are simplified
2) Staff are not responsible for defining their roles
3) Managers handle all of the difficult decision making
4) Each staff member is accountable for evaluating the plan of care

Question 11

The nurse on the unit is determining which activities may be delegated to assistive personnel.Assuming that the nurse assistant is competent,which one of the following activities may be safely delegated by the registered nurse?
1) Vital signs on a stable client
2) An admission history on a new client
3) Initial transfer of a postoperative client
4) Administration of medications prepared by the nurse

Question 12

Which of the following statements best reflects the nurse's understanding of team nursing?
1) "The team provides the client care and I provide the leadership and decision making."
2) "I will manage the complex care and delegate the remaining care to my LPN and ancillary assistants."
3) "Everyone on the team has responsibilities and is accountable to me regarding the effective execution of that care."
4) "I delegate the care of the clients to the appropriate team members and I am responsible for coordinating and directing that care."

Question 13

In anticipation of a nursing shortage,the nursing management in a facility is investigating a nursing care delivery model that involves the division of tasks,with one nurse assuming the responsibility for particular tasks.This model is called:
1) Total patient care
2) Functional nursing
3) Team nursing
4) Primary nursing

Question 14

The student nurse is seeking to learn skills associated with priority setting.In discussing different priorities of care,an example of a second-order priority is:
1) The need to urinate
2) An obstructed airway
3) The side effects of a medication
4) Activities of daily living in the home environment

Question 15

It is necessary for the nurse manager to delegate tasks to the staff.Which of the following is a requirement of the delegation process?
1) Working alongside the staff to evaluate their care
2) Functioning from a laissez-faire style of leadership
3) Obtaining the employee's voluntary acceptance of the task
4) Communicating the work assignment in understandable terms

Question 16

Which of the following actions is the best example of a nurse exercising nursing authority?
1) Assigning team responsibilities to individual team members
2) Evaluating a team member's ability to perform a bladder scan
3) Readjusting a client's turning schedule to provide hourly repositioning
4) Determining that a client will not be ambulated based on assessment findings

Question 17

Which of the following clients would most benefit from the case manager model of nursing care?
1) A client diagnosed with end-stage renal failure
2) A client who has a chronic wound on the left foot
3) A client newly diagnosed with type 2 diabetes mellitus
4) A postoperative client who had a cholecystectomy (gallbladder removal)

Question 18

To meet the needs of assigned clients and the responsibilities associated with the position,nurses need to be aware of time management techniques.The time management skills for the nurse include:
1) Meeting all of the client's needs in the early morning hours
2) Anticipating possible interruptions by therapists and visitors
3) Leaving each day unplanned to allow for adaptations in treatments
4) Completing client assessments and treatments individually at separate times

Question 19

Indicators in a quality improvement program that evaluates the manner in which care is delivered are:
1) Structure indicators
2) Team indicators
3) Process indicators
4) Client indicators

Question 20

In anticipation of a nursing shortage,the nursing management in a facility are investigating a nursing care delivery model that involves staff members working under the direction of a registered nurse leader.This model is called:
1) Team nursing
2) Primary nursing
3) Functional nursing
4) Total patient care nursing

Question 21

Which of the following statements made by a nurse related to the organization of client care requires follow-up by the mentor?
1) "I had my LPN bring the Foley catheterization supplies into the room so they'd be there when I got there."
2) "I delegated all the stable vital signs to my nursing assistant and the treatments to the LPN."
3) "I was taking vitals on one client,dangling a second client while I had the third expelling an enema."
4) "Organization was never a strength of mine,but I believe I'm getting better at completing all my client's care."

Question 22

The nurse is prioritizing care for two postoperative abdominal surgery clients;the first is 15 hours postoperative and the second is ready for discharge.Which of the interventions should be accomplished first?
1) Discharge pain control
2) First day dangling and ambulation
3) First day post op coughing and deep breathing
4) Discharge teaching regarding the dressing change

Question 23

The primary reason the nurse asks for help when changing a client's complicated dressing is to:
1) Foster efficient client-oriented interventions
2) Facilitate a comfortable,safe dressing change
3) Minimize the amount of time spent on a specific task
4) Engage in collaborative learning with other health care professionals

Question 24

A nurse who performs a skin assessment while bathing an immobile client would be displaying:
1) Efficiency
2) Leadership
3) Organization
4) Effectiveness

Question 25

When the oncology unit's interdisciplinary team meets every Monday morning at 0830 to discuss the unit's individual clients,the group is best displaying:
1) Staff education
2) Collaborative practice
3) Team communication
4) Nursing shared governance

Question 26

Clinical nursing decisions are best made using:
1) Clinical pathways
2) Accurate assessment data
3) Previous nursing knowledge
4) Interdisciplinary collaboration

Question 27

A client has reported all of the following;which should be given priority by the nurse?
1) Pain
2) Hunger
3) Anxiety
4) Constipation

Question 28

When the nurse gathers all the equipment needed for a particular procedure and arranges the client's room for proficient implementation of the procedure,the nurse is displaying:
1) Multitasking
2) Organization
3) Effectiveness
4) Professionalism