Ch.21 Managing patient care NCLEX – Flashcards
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In which nursing care model is the RN usually appointed the position of group leader? a. Total patient care b. Primary nursing c. Team nursing d. Case management
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ANS: C In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. DIF: Remember REF: 276
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1. The five rights of delegation include (Select all that apply.) a. Right task. b. Right circumstances. c. Right monetary compensation. d. Right person. e. Right direction. f. Right opinion. g. Right supervision.
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ANS: A, B, D, E, G The five rights of delegation are right task, circumstances, person, direction, and supervision.
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In which nursing care delivery model are clinicians held accountable for some standard of cost-effectiveness and quality of care? a. Total patient care b. Primary nursing c. Team nursing d. Case management
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ANS: D What is unique about case management is that clinicians, as individuals or as part of a collaborative group, oversee the management of patient groups with specific case types and usually are held accountable for some standard of cost management and quality. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. DIF: Remember REF: 276
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With the current shortage of nursing faculty and nursing programs, which nursing care delivery model is least feasible in many agencies? a. Total patient care b. Primary nursing c. Team nursing d. Case management
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ANS: A Patient satisfaction with the total patient care model is high, but total patient care is not cost-effective because it requires a large number of RNs to provide care. Total patient care involves an RN being responsible for all aspects of care for one or more patients. With the current shortage of nursing faculty and retirement of many practicing RNs, staffing enough RNs is a problem in many agencies. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. DIF: Understand REF: 276
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A nurse manager is evaluating patient outcomes on the hospital unit. The nurse manager discovers that the re-admission rate of hospitalized patients is very high on this unit. The nurse manager desires improved coordination of care and accountability for cost-effective quality care. The nursing care delivery model best suited to these needs is a. Total patient care. b. Primary nursing. c. Team nursing. d. Case management.
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ANS: D What is unique about case management is that clinicians, as individuals or as part of a collaborative group, oversee the management of patient groups with specific case types and usually are held accountable for some standard of cost management and quality. Case management is a care approach that coordinates and links health care services to patients and families while streamlining costs. In the team nursing care model, the RN assumes the role of group or team leader and leads a team made up of other RNs, licensed vocational nurses, and nurse assistants or technicians. Total patient care involves an RN being responsible for all aspects of care for one or more patients. Primary nursing places RNs at the bedside more, assuming responsibility for a caseload of patients over time. This model, however, does not require an all-RN staff as is required for total patient care. DIF: Apply REF: 303-304
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Which organizational structure approach has fewer directors with managers accountable 24 hours for staff, budget, and day-to-day management? a. Centralized management b. Decentralized management c. Business unit management d. Matrix
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ANS: B The decentralized management structure often has fewer directors, and managers are accountable around the clock for the operation of the unit. Centralized management involves having a single administrator and managers with minimal accountability for the unit operation. The matrix approach involves reorganization of hospital departments into "business units." DIF: Remember REF: 277
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A staff member verbalizes his satisfaction in working on a particular nursing unit because he appreciates the freedom of choice and responsibility for the choices. This nurse highly values which element of decentralized decision making? a. Responsibility b. Autonomy c. Accountability d. Authority
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ANS: B Autonomy is freedom of choice and responsibility for the choices. Responsibility refers to the duties and activities that an individual is employed to perform. Accountability refers to individuals being answerable for their actions. Authority refers to legitimate power to give commands and make final decisions specific to a given position.
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A staff nurse delegates a task to a nursing assistant, knowing that the assistant has never performed the task before. As a result, the patient is injured, and the nurse defensively states that the nursing assistant should have known how to perform such a simple task. This nurse is demonstrating lack of a. Responsibility. b. Autonomy. c. Authority. d. Accountability.
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D
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A nurse manager sent one of the staff nurses on the unit to a conference about new, evidence-based wound care techniques. The nurse manager asks the staff nurse to prepare a poster to present at the next unit meeting, which will be mandatory for all nursing staff on the unit. The nurse manager is providing a learning opportunity in this situation through a. Nurse/physician collaborative practice. b. Interdisciplinary collaboration. c. Staff education. d. Establishing a nursing practice committee.
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C
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A nurse is making a home visit and discovers that a patient's wound infection has gotten worse. After cleaning and re-dressing the wound, what should the nurse do? a. Ask the home health agency nurse manager to contact the health care provider. b. Document the findings and confirm with the patient the date of the next home visit. c. Notify the health care provider of the findings before leaving the home. d. Tell the patient that the health care provider will be notified before the next visit.
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C
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10. A nurse manager conducts rounds on the unit and discovers that expired stock medicine is still in the cabinet despite the e-mail she sent stating that it had to be discarded. The staff nurse dress code is not being adhered to, and the staff lounge is not kept neat and tidy as she requested in the same e-mail. Several staff nurses deny having received the e-mail. After evaluating this situation, one way the nurse manager could resolve the issue is to a. Include the findings on each staff member's annual evaluation. b. Close the staff lounge. c. Enforce a stricter dress code. d. Place a hard copy of announcements and unit policies in each staff member's mailbox.
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D
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A new nurse expresses frustration at not being to complete all interventions for a group of patients in a timely manner. The nurse leaves the rounds report sheets at the nurse's station when caring for patients and reports having to go back and forth between rooms several times looking for equipment and supplies. This nurse could benefit from practicing better _____ skills. a. Clinical decision-making b. Organizational c. Evaluation d. Interpersonal communication
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B
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Which of these approaches would be most appropriate for a nurse to take when faced with the challenge of performing many tasks in one shift? a. Evaluate the effectiveness of all tasks when all tasks are completed. b. Delegate tasks the nurse does not like doing. c. Do as much as possible by oneself before seeking assistance from others. d. Complete one task before starting another task.
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D
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Which of these assessments of a patient who is 1 day post surgery to repair a hip fracture requires immediate nursing intervention? a. Patient ate 30% of clear liquid breakfast. b. Oral temperature is 99.2° Fahrenheit. c. Patient states, "Boy, I did not realize I would be so tired after this surgery." d. Patient reports severe pain 30 minutes after receiving pain medication.
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D
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A charge nurse should instruct a new nurse taking care of a patient with hypercholesterolemia to make which of these lifestyle modifications? a. High-protein, high-fat diet b. Decreased walking frequency from three times to two times a week c. Discontinuation of antihypertensive medications d. Smoking cessation
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D
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A patient with an indwelling urinary catheter has been given a bed bath by a new nursing assistant. The nurse evaluating the cleanliness of the patient notices crusting at the urinary meatus. The best next action of this nurse is to a. Ask the nursing assistant to observe while the nurse performs catheter care. b. Leave the room and ask the nursing assistant to go back and perform proper catheter care. c. Discontinue the catheter. d. Document the incident in the patient's chart.
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A
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A nurse observes a patient care technician using all these measures when taking vital signs. Which measure requires the nurse to intervene? a. Palpates brachial artery before inflating blood pressure cuff b. Counts respirations while palpating radial pulse c. Inserts thermometer into sublingual pocket after patient sips water d. Asks patient to relax arm before taking blood pressure
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C
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A nurse is assigned to care for the following patients who all need vital signs taken right now. Which of these patients is most appropriate for the nurse to delegate vital sign measurement to nursing assistive personnel (NAP)? a. Patient scheduled for a procedure in the nuclear medicine department b. Patient transferring from the intensive care unit (ICU) c. Patient returning from cardiac catheterization d. Patient returning from hip replacement surgery
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A
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Which of these staff members does the staff nurse assign to provide morning care for an older adult patient who requires assistance with activities of daily living? a. Licensed vocational nurse b. Cardiac monitor technician c. Nursing assistive personnel (NAP) d. None of the above; the nurse needs to provide morning care to this patient.
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C
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A nursing assistant reports seeing a reddened area on the patient's hip while bathing the patient. The nurse should a. Go to the patient's room to assess the patient's skin. b. Document the finding per the nursing assistant's report. c. Request a wound nurse consult. d. Ask the nursing assistant to apply a dressing over the reddened area.
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A
