Effective Leadership And Management in Nursing 9th Edition -Test Bank

 

 

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Sample Test

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

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 cost-effective 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.

2.    Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.

3.    Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration.

4.    Timeliness of care can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.

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:  3-1: Differentiate the models of nursing care delivery systems and the disadvantages of each.

 

12) Which nursing interventions would be in line with the chronic care model?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1.    Blood sugar is measured frequently in an attempt to achieve tight glycemic control.

2.    The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease.

3.    The nurse advocates for the client who has decided to forego further dialysis.

4.    Client information is entered into an electronic medical record.

5.    Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Answer:  2, 3, 4, 5

Explanation:  1. The chronic care model manages how care is delivered, not a specific disease.

2.    Self-management is one of the six components of the chronic care model.

3.    Decision support is one of the six components of the chronic care model.

4.    Use of clinical information systems is essential to the chronic care model.

5.    Use of community resources is one of the six components of the chronic care model.

Cognitive Level:  Analyzing

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.

 

13) What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?

1.    Those who deliver the nursing care make the most educated decisions for a particular unit.

2.    Clinical decisions are best made by the clients who are served by a particular unit.

3.    Clinical decisions are best made by nursing leaders for all units within that particular hospital.

4.    Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Answer:  1

Explanation:  1. The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit.

2.    Clinical decisions should be made by professional healthcare providers, with client input.

3.    Decision making “from the top” is not reflected in the clinical microsystem structure.

4.    Clinical microsystems involve a core team of caregivers, not all the nurses working in a particular service area.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Evidence-Based Practice

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

 

14) One of the nurse competencies of the synergy care delivery model is “moral agency.” Which action is an example of that trait?

1.    The nurse commits a medication error and reports it to the charge nurse.

2.    The nurse collaborates well with the rest of the healthcare team.

3.    The nurse is able to think ahead to the client’s next need.

4.    The nurse who does not have good baseline knowledge of a client’s disease process researches it on a day off work.

Answer:  1

Explanation:  1. Moral agency is “doing the right thing.” Reporting a medication error is the right thing to do.

2.    Collaboration is a desirable characteristic but does not describe moral agency.

3.    Systems thinking is a desirable characteristic but does not describe moral agency.

4.    This is a description of clinical inquiry, not moral agency.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Ethics

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

 

15) Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?

1.    Flexibility

2.    Strict adherence

3.    Persistence

4.    Resistance to change

Answer:  1

Explanation:  1. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to achieve the desired effects.

2.    Strict adherence to a set of rules or structure is not appropriate in today’s healthcare environment, where adaptability is essential.

3.    The nurse should be persistent in learning new roles, but persistence is not the best answer to this question.

4.    Resistance to change is not a desirable skill in today’s healthcare environment.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

 

 

16) What should the nurse executive consider when planning the nursing care delivery system of a new hospital?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1.    How to optimize use of nursing knowledge

2.    The system used by competing hospitals

3.    How to ensure that clients receive optimal care

4.    Skill sets likely to be present in the nurses who will be employed at the hospital

5.    What groups of nurses are available for employment

Answer:  1, 3, 4, 5

Explanation:  1. Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system.

2.    The system used by competing hospitals is not of great importance in choosing the system for a new hospital.

3.    The provision of safe and effective nursing care is the most important of all considerations.

4.    Optimizing nursing skills is an important consideration when choosing a nursing care delivery system.

5.    The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ.

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.

17) A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?

1.    “There has been little change in nursing care delivery over the last few years.”

2.    “We must look to the nursing process for guidance in nursing care.”

3.    “Too much time is spent deciding on a system of care.”

4.    “Any system is okay, as long as the nurses follow it.”

Answer:  2

Explanation:  1. Nursing care delivery systems are in continual revision as nurses strive to find the perfect system for providing care to clients with varying degrees of need.

2.    The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation.

3.    A comfortable and efficient system for delivery of care is important to client outcomes.

4.    The system must be safe, efficient, and effective.

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.

 

18) A nursing team consists of an RN, two LPNs, and two UAP. Which work would be completed by the RN?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1.    Reviewing the client’s plan of care with the UAP

2.    Discussing the client’s increasing shortness of breath with the LPN

3.    Updating the care plan of a client who will undergo surgery tomorrow

4.    Administering oral medications to clients

5.    Calling the physician to discuss the client’s response to a new treatment

Answer:  1, 2, 3, 5

Explanation:  1. The RN team leader is responsible for conducting the nursing care conference and reviewing the client’s plan of care with the team.

2.    The RN team leader guides the client care and helps to resolve any problems that may occur.

3.    Developing and updating nursing care plans is the work of the RN team leader.

4.    Typically, the team leader is involved in indirect client care activities.

5.    Communicating and collaborating with physicians is generally the responsibility of the team leader.

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.

19) The RN leader of a team overhears one of the UAP on the team say, “I’ll sure be glad when I get my RN license. All they do is sit around doing paperwork.” How does the RN interpret this comment?

1.    As a need to be more involved in direct client care when this UAP is on the team

2.    As a common disadvantage of the team approach to nursing

3.    As an indication that this UAP should be reported for unprofessional behavior

4.    As confirmation that UAP are poorly educated and do not work well on teams

Answer:  2

Explanation:  1. The RN must focus on the work that requires RN skills. In some cases, this work consumes much of the shift. The RN should not ignore that work to placate the UAP.

2.    Resentment against the team leader for not doing “real nursing” is a common drawback of team nursing.

3.    Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse.

4.    There is no indication that this UAP is not educated or does not work well on a team. The UAP may not understand the roles on the team.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Coordination of Care

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

 

20) A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons that team nursing is not successful?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1.    There are problems with delegation.

2.    There are problems with the skill set of the UAP on the teams.

3.    The LPNs on the team do not accept their position of being “in the middle.”

4.    Communication on the team or with the nurse manager is flawed.

5.    RNs and LPNs struggle with who is in control and has the power on the team.

Answer:  1, 4

Explanation:  1. If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective.

2.    Problems with UAP skill sets can be overcome by education. This is not a common reason that team nursing does not work.

3.    While LPNs can be “in the middle” between the UAP and the RN, there is no indication that this is a common problem.

4.    Poor communication is a common problem and can make the team approach ineffective.

5.    There is no indication that this is a common issue.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Quality of Practice

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.

 

21) A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1.    The nurse will determine interventions for all the disciplines needed as part of the clients’ care.

2.    The nurse will meet with other disciplines to agree on the choice of critical pathways for each client.

3.    The nurse will work to build consensus with the physicians caring for the clients on the team.

4.    The nurse will define the expected nursing outcomes for the clients on the team.

5.    The nurse will collect and analyze data regarding the clients on the team.

Answer:  2, 3, 4, 5

Explanation:  1. Each discipline determines its own interventions. The disciplines collaborate to design care.

2.    Collaboration with other disciplines is a critical component of case management.

3.    A main emphasis of case management is building consensus with physicians caring for the clients.

4.    The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work.

5.    Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Coordination of Care

Learning Outcome:  3-3: Compare three evolving models of care and explain why care delivery systems will continue to evolve.