NURSING DELEGATION AND MANAGEMENT OF PATIENT CARE 2ND EDITION BY KATHLEEN MOTACKI. KATHLEEN BURKE – TEST BANK

In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent “floating.” b. self-scheduling. c. cover of another nurse’s assignment while she or he is on break. d. hourly pay differential for the night shift. ANS: B In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization. DIF: Cognitive Level: Application REF: page 16 The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies. b. the financial environment of the patient population. c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit. ANS: A Patient delivery models are instituted based on various elements including clinical decision-making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options do not describe a fundamental element used in the decision-making process for delivery mode. DIF: Cognitive Level: Application REF: page 19 An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths b. RN taking vital signs and giving baths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery ANS: C In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models. DIF: Cognitive Level: Application REF: page 20 In which health care delivery model would the nurse expect to see “point-of-care” decision making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing ANS: A Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options are incorrect because they may not allow for the autonomy required for “point-of-care” decisions. DIF: Cognitive Level: Application REF: page 21 A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice. ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 16 Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Changes can be made rapidly based on immediate needs. c. Nurses must work under a dual-authority structure. d. Decisions can be made at the “point of care.” ANS: A In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed. DIF: Cognitive Level: Application REF: page 16 What should the nurse expect when working in a product-line leadership structured environment? a. Coordination of all services within the specialty b. Slow organizational response to environmental changes c. Individual service goals d. Each service area autonomous to the others ANS: A In product- or service-line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product-line leadership and is an example of leadership without coordination. DIF: Cognitive Level: Application REF: page 17 The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation. ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 19 A nurse who is interested in developing clinical decision-making skills would look for a unit that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management ANS: A Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other options do not necessarily promote the development of decision-making skills. DIF: Cognitive Level: Application REF: page 21 A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway. ANS: B The nurse delegates and works collaboratively with the members of the team in team nursing. Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing. DIF: Cognitive Level: Application REF: page 10 A nurse working on a unit using the primary care delivery model would expect to observe which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. b. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morning dose of insulin for a patient scheduled for surgery later that day. ANS: D In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models. DIF: Cognitive Level: Analysis REF: page 21 Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments. ANS: A The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models. DIF: Cognitive Level: Analysis REF: page 21 In a team nursing health care delivery model environment, the nurse would observe for which action by the staff? a. The UAPs answer all call lights. b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients’ call lights. d. The RN is notified when there are patient care complaints. ANS: D Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing. DIF: Cognitive Level: Analysis REF: page 21 MULTIPLE RESPONSE The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: Application REF: pages 18-19 Chapter 10: Professional Development Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE You are the charge nurse on a busy medical-surgical unit. You are also the preceptor to a novice nurse. What response would be expected from a nurse in the novice stage of clinical competence development when assigned to perform a morning assessment on a patient? a. Nurse uses Doppler to obtain pulses on a patient with no palpable peripheral pulses b. Reporting to the charge nurse that they cannot feel a patient’s peripheral pulses and the blood pressure is only palpable c. Nurse calls for help when she finds the patient with barely palpable blood pressure and hard to arouse d. Reporting to the charge nurse that she decided to let the patient sleep until the breakfast trays arrive because the patient was sleeping so soundly ANS: D A novice nurse would go into the patient’s room prepared to get vital signs in the morning and decide not to further assess a patient who is “sleeping soundly.” The other options would be the response of a nurse as she becomes more experienced. DIF: Cognitive Level: Analysis REF: page 121 You are the charge nurse on the 3 PM to 11 PM shift. The nurses on this shift range from novice to competent. What response would be expected in the beginner stage of clinical competence development when the nurse is assigned a patient on beta-blockers and scheduled for a stress test? a. Knows to hold a beta-blocker on a patient scheduled for a stress test because this happened earlier in the week on another patient b. Must be told to hold the beta-blocker for a patient scheduled for a stress test c. Understands the rationale for holding the beta-blocker prior to a stress test d. Holds all medications when the patient is NPO ANS: A The advanced beginner repeats behavior learned from an earlier similar situation but may not understand the rationale. The other options are appropriate for a nurse at a different level of experience. DIF: Cognitive Level: Analysis REF: page 121 You are the nurse manager who is preparing the annual reviews for the staff members. You are aware that the nurse in the competent stage of clinical performance development would be expected to do what when assigned a patient on beta-blockers scheduled for a stress test? a. Must be told to hold the beta-blocker for a patient scheduled for a stress test b. Holds all medications when the patient is NPO c. Calls the physician for an order to hold the beta-blocker prior to a stress test if there is no order d. Repeats behavior learned from a previous experience ANS: C The competent nurse understands the rationale for holding the medication and calls the physician when an order is needed. The other options are appropriate for a nurse at a different level of nursing. DIF: Cognitive Level: Analysis REF: page 121 You are the nurse educator on a medical unit. What action would be expected from a nurse in the proficient stage of clinical competence when assessing shortness of breath in a patient? a. Increases the oxygen concentration on a patient complaining of shortness of breath b. Places a patient complaining of shortness of breath in high Fowler’s position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Checks the oxygen saturation d. Calls the physician to notify her of the patient’s change in condition ANS: B The proficient nurse will assess and reposition a patient first before taking the next step of calling the physician. The other options are appropriate for a nurse at a different level of nursing. DIF: Cognitive Level: Analysis REF: page 121 You are the nursing supervisor on the 11 PM to 7 AM shift. When making rounds, the charge nurse on the unit reports that one of the patients is dyspneic. What action would be expected from a nurse in the expertise stage of clinical competence when assessing shortness of breath in a patient? a. Recognizes the patient may have pulmonary edema and orders (or asks the physician for an order) an IVP diuretic b. Places a patient complaining of shortness of breath in high-Fowler’s position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Increases the oxygen concentration d. Notifies the instructor of the patient’s complaints ANS: A The expert nurse typically is the advanced nurse practitioner who has the ability to make clinical judgments and direct care. The other options are appropriate for a nurse at a different level of nursing. DIF: Cognitive Level: Analysis REF: page 122 The nurse’s progression from novice to expert is usually encouraged by the organizations for which they work. Which of the following is an example of a method used to encourage nurses to progress in their level of experience? a. Rotating nurses to all shifts b. Rotating nurses into the ICU c. Quarterly Nursing Excellence awards d. Tuition reimbursement for advanced degrees ANS: C Recognition of nurses through awards gives an incentive to continually improve performance. The other examples may improve the nurse’s performance or cause burnout. DIF: Cognitive Level: Application REF: page 123 Clinical ladders for nurses are best used in what circumstance? a. Horizontal advancement for clinicians who wish to stay at the bedside b. Vertical advancement for management responsibilities c. Horizontal ladder for nurses with more than 10 years of employment d. Vertical ladder for nurses with more than 10 years of employment ANS: A The advantage to the ladder system is that the nurse can remain at the bedside and be recognized for clinical excellence without having to move into management. The other options do not apply to the clinical ladder. DIF: Cognitive Level: Application REF: pages 123-125 The clinical ladder used in some hospitals allows for recognition of both the clinical and academic growth of the individual nurse. On which of the following is this ladder based? a. The concept that people will work harder when recognized b. The concept that nurses respond to harder work c. The concept of growth in nursing from novice to expert d. The concept that nurses like to be intellectually stimulated ANS: C Benner’s work in 1984 on the novice-to-expert concept in nursing laid the groundwork for the clinical ladder. The other options are not the basis for the clinical ladder concept. DIF: Cognitive Level: Application REF: page 130 Chapter 20: Monitoring Outcomes and the Use of Data for Improvement Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE What information obtained from hospital data collection can be used for patient improvement? a. Infection rates b. Employee satisfaction c. Best practice d. Overtime costs ANS: A Infection rates are data that provide information about patient care. Employee satisfaction provides data for staffing purposes. Best practice provides data for research purposes. Overtime costs provide data for administrative purposes. DIF: Cognitive Level: Application REF: page 279 What information obtained from hospital data collection can be used for staffing purposes? a. Patient satisfaction b. Staff competency c. Best practice d. Use of agency nurses ANS: B Staff competency is data that provide information about provider staffing. Patient satisfaction provides data about patient care. Best practice provides data about research. Use of agency nurses provides data for administrative purposes. DIF: Cognitive Level: Application REF: page 291 What information obtained from hospital data collection can be used for administrative purposes? a. Unit-specific measures b. Staffing ratios c. Turnover d. Evidence-based practice ANS: C Turnover is when a staff member leaves a position and a new staff member is hired for that position. Turnover provides data used for administrative purposes. Options A and D are not appropriate. Option B is provider staffing data. DIF: Cognitive Level: Application REF: page 276 Which hospital data collection result will most likely affect nursing practice? a. Changes in staffing patterns b. Changes in patient acuity c. Introduction of the needleless system d. Changes to the interview process ANS: A Staffing may be directly affected by outcomes data. Changes in patient acuity is unaffected by data collection and is incorrect. Introduction of the needleless system was an initiative from The Joint Commission. Changes to the interview process are usually not affected by data collected. DIF: Cognitive Level: Analysis REF: page 276 Data provided by studies on patients with community-acquired pneumonia (CAP) have influenced the standards of practice for those patients. Which order should the nurse anticipate on the standard orders as a result of initiatives developed through clinical studies? a. Obtaining blood cultures within 4 hours of arrival at the hospital b. Administering antibiotics within 4 hours of arrival at the hospital c. Administration of aspirin on arrival to the hospital d. Administration of oxygen at 4 L per nasal prongs ANS: B Administration of antibiotics, along with acting on the information obtained from the blood cultures, is the standard of care developed for patients admitted with CAP. Blood cultures need to be obtained prior to administration of antibiotics. Options C and D do not apply to CAP standards. DIF: Cognitive Level: Application REF: page 280 Core measures identified by The Joint Commission include standard orders regarding care and data collection for a. infection rates. b. community-acquired pneumonia admission rates. c. rates of smokers admitted with acute myocardial infarction. d. rates of smokers admitted with hypertension. ANS: A Infection rates are required of all institutions by both federal and state health care regulating agencies. The other options are not required by TJC. DIF: Cognitive Level: Analysis REF: page 279 When reviewing outcome measurement for clinical use, the reviewers must understand that the data a. identify the improvement required. b. identify the cause of the problem. c. identify questions to be asked. d. identify the results only. ANS: D Outcome measurements provide results only. It is necessary for the reviewers to ask questions about what the data mean. The others are not factors answered by data collection. DIF: Cognitive Level: Analysis REF: page 276 One of the best indicators of clinical performance can be attributed to a. yearly census. b. patient satisfaction surveys. c. employee satisfaction surveys. d. staff turnover. ANS: B Patient satisfaction surveys are one of the best indicators of clinical performance. The others are not a measurement of clinical performance. DIF: Cognitive Level: Application REF: page 277 The best method for providing information regarding patient satisfaction surveys to the staff is by a. emailing results to all employees. b. making an announcement at the next staff meeting. c. providing results from the most current survey. d. providing comparison of current results with previous performance results. ANS: D Comparison of current results to previous results (whether good or bad) provides a visual image to which most people can relate. Options A and B are not good methods and do not allow for discussion or brainstorming. Option C does not provide a relationship to past performance. DIF: Cognitive Level: Application REF: page 281 Which are benefits to the organization are acquired from greater patient satisfaction? a. Higher employee satisfaction b. Lower acuity c. Higher employee benefits d. Fewer call lights to answer ANS: A When there is a clinical environment that provides high patient satisfaction, it is usually a reflection of the employee attitudes. The others are not a benefit of patient satisfaction. DIF: Cognitive Level: Application REF: page 277 MULTIPLE RESPONSE Patient satisfaction surveys may provide information on the clinical performance of the unit as well as the institution. Which areas are included for data collection? (Select all that apply.) a. Accessibility of services b. Number of staff per shift c. Communication d. Quality of care e. Recognition of physician in community f. Continuity ANS: A, C, D, F Patient satisfaction surveys report data on the areas in options A, C, D, and F. Options B and E are not asked on the survey. DIF: Cognitive Level: Application REF: page 291 What are the benefits to the organization from greater patient satisfaction? (Select all that apply.) a. Improvement in quality of patient care b. Lower patient acuity c. Lower mortality rates d. Improved retention e. Establishing benchmarks against other institutions ANS: A, D, E When quality of care improves, patient satisfaction improves and has a direct affect on staff satisfaction and thus retention. These improvements can then be used as benchmarks against other institutions. Improvement in patient satisfaction is usually a direct reflection of improved quality of care and other nursing-related issues, leading to nurse satisfaction and retention. Benchmarking against other institutions is a common method used for determining quality of care. Options B and C are not related to patient satisfaction.