EFFECTIVE LEADERSHIP AND MANAGEMENT IN NURSING 9TH EDITION BY SULLIVAN - TEST BANK

Effective Leadership And Management in Nursing 9th Edition by Sullivan – Test Bank Sample Questions Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 3 Delivering Nursing Care 1) The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? 1. One nurse has responsibility for all the medications on the unit. 2. One nurse has responsibility for all the needs of three clients. 3. One charge nurse and one respiratory therapist have responsibility for all clients. 4. One nurse and one nursing assistant have responsibility for 10 clients. Answer: 1 Explanation: 1. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the “med nurse”) administering all the medications on the unit. 2. Total client care is given by one nurse assigned to a few clients. 3. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. 4. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care EFFECTIVE LEADERSHIP AND MANAGEMENT IN NURSING 9TH EDITION BY SULLIVAN - TEST BANK Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 2) The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital? 1. Critical pathways 2. Total client care 3. Team nursing 4. Functional nursing Answer: 3 Explanation: 1. Critical pathways are a set of strategies used by healthcare providers to attain expected outcomes. Critical pathways are not a nursing care delivery system, and there are insufficient data to determine if they are used in this scenario. 2. Total client care is given by one nurse. 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. 4. Functional nursing breaks down the assignments into tasks. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 3) 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. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required. Answer: 1, 2, 4 Explanation: 1. Continuity of care may suffer when care is given by more than one individual. 2. Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. 3. Team nursing does save on personnel costs. 4. The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. 5. Team nursing does reduce the number of professional staff required. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 3-2: Describe the attributes of integrated models of care. 4) The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care? 1. Functional nursing 2. Team nursing 3. Total client care 4. Primary care Answer: 3 Explanation: 1. Functional nursing has the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. 2. Team nursing has the disadvantage of not having a professional nurse attending to all client care needs. 3. In total client care, one nurse cares for a client and is totally accountable for the client. This way the nurse can give continuous, holistic, and expert care. 4. Primary care is considered the client’s first encounter with the healthcare system. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Resource Utilization Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 5) 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. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All individuals caring for the client must have excellent communication skills. Answer: 1, 3, 5 Explanation: 1. If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. 2. Physician, nurse, and client satisfaction is generally increased with primary care. 3. The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. 4. Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. 5. Excellent communication must exist between the primary nurse and associate nurse. This is often difficult. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 3-2: Describe the attributes of integrated models of care. 6) A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system? 1. Primary nursing 2. Total nursing care 3. Functional nursing 4. Practice partnerships Answer: 4 Explanation: 1. The nurse providing primary nursing must be very autonomous. This is not the best environment for a newly licensed RN. 2. The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN. 3. In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role. 4. Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Collaboration Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 7) In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Practice partnerships 3. Case management 4. Primary nursing Answer: 3 Explanation: 1. Functional nursing does not focus on specific outcomes. 2. Practice partnership does not focus on specific outcomes. 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. 4. Primary nursing does not focus on specific outcomes. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Coordination of Care Learning Outcome: 3-2: Describe the attributes of integrated models of care. 8) 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? 1. Instruct physical therapy to increase treatments to four times daily. 2. Contact the family to discuss preoperative mobility problems. 3. Inform the case manager of variance in the critical pathway. 4. Discuss the problem with the client’s surgeon. Answer: 3 Explanation: 1. Ordering an increase in physical therapy is not within the scope of nursing and would not be the priority action. 2. The family may have important information about the client’s mobility, but this is not the priority action. 3. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. 4. Discussing the problem with the surgeon is not the priority action. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve. 9) A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is costeffective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Total client care 2. Functional nursing 3. Team nursing 4. Client-centered nursing Answer: 4 Explanation: 1. Total client care is costly and less efficient for nursing staff. 2. Functional nursing is cost-effective but lacks continuity of care. 3. Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction. 4. The focus of client-centered nursing is the promotion of efficiency, quality, and cost control. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 10) 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. 1. “It helps to coordinate care to a group of clients.” 2. “It organizes care responsibilities.” 3. “It ensures that the staff doesn’t get overtime.” 4. “It improves physician efficiency.” 5. “It provides skilled care by skilled staff.” Answer: 1, 2, 5 Explanation: 1. Structure is necessary to ensure that care is coordinated. 2. Structure is necessary to ensure that all care responsibilities are covered. 3. While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. 4. The objective of structuring nursing care is not to ensure physician efficiency. 5. Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each. 11) Which is the most important consideration in choosing a structure for nursing care? 1. Client need 2. Efficiency 3. Cost 4. Timeliness Answer: 1 Explanation: 1. While all four options are important, client need takes precedence over the others because nursing provides a service to the client