Deck 3: Delivering Nursing Care

Question 1

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

A) "There has been little change in nursing care delivery over the last few years."
B) "We must look to the nursing process for guidance in nursing care."
C) "Too much time is spent deciding on a system of care."
D) "Any system is okay, as long as the nurses follow it."

Answer 1

"We must look to the nursing process for guidance in nursing care."

Question 2

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?

A) Instruct physical therapy to increase treatments to four times daily.
B) Contact the family to discuss preoperative mobility problems.
C) Inform the case manager of variance in the critical pathway.
D) Discuss the problem with the client's surgeon.

Answer 2

Inform the case manager of variance in the critical pathway.

Question 3

In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system?

A) Functional nursing
B) Differentiated practice
C) Case management
D) Primary nursing

Answer 3

Case management

Question 4

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that

A) The client may have multiple primary nurses if transfers within the facility are necessary.
B) Physician satisfaction is decreased.
C) Staff nurses cannot be held legally liable for care provided outside their work hours.
D) It requires a knowledge-based nursing practice model.
E) All persons caring for the client must have excellent communication skills.

Question 5

The RN leader of a team overhears one of the UAPs 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?

A) As a need to be more involved in direct client care when this UAP is on the team
B) As a common disadvantage of the team approach to nursing
C) As an indication that this UAP should be reported for unprofessional behavior
D) As confirmation that UAPs are poorly educated and do not work well on teams

Question 6

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?

A) Critical pathways
B) Total patient care
C) Team nursing
D) Functional nursing

Question 7

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

A) Reviewing the client's plan of care with the UAPs
B) Discussing the client's increasing shortness of breath with the LPN
C) Updating the care plan of a client who will undergo surgery tomorrow
D) Administering oral medications to clients
E) Calling the physician to discuss the client's response to a new treatment

Question 8

The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care?

A) Functional nursing
B) Team nursing
C) Total patient care
D) Modular nursing

Question 9

A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria?

A) Seniority
B) Educational level
C) Experience
D) Nurse preference
E) Affordability

Question 10

Which is the most important consideration in choosing a structure for nursing care?

A) Client need
B) Efficiency
C) Cost
D) Timeliness

Question 11

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients.

A) Continuity of care may suffer.
B) Client/staff communication may be an issue.
C) There is little cost savings to the institution.
D) Delegation is necessary.
E) Not as many professional staff are required.

Question 12

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?

A) Total patient care
B) Functional nursing
C) Team nursing
D) Patient-centered nursing

Question 13

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care?

A) "It helps to coordinate care to a group of clients."
B) "It organizes care responsibilities."
C) "It ensures that the staff doesn't get overtime."
D) "It improves physician efficiency."
E) "It provides skilled care by skilled staff."

Question 14

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

A) How to optimize use of nursing knowledge
B) The system used by competing hospitals
C) How to ensure that clients receive optimal care
D) Skill sets likely to be present in the nurses who will be employed at the hospital
E) What groups of nurses are available for employment

Question 15

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

A) The nurse commits a medication error and reports it to the charge nurse.
B) The nurse collaborates well with the rest of the health care team.
C) The nurse is able to think ahead to the client's next need.
D) The nurse who does not have good baseline knowledge of a client's disease process researches it on a day off work.

Question 16

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

A) Those who deliver the nursing care make the most educated decisions for a particular unit.
B) Clinical decisions are best made by the clients who are served by a particular unit.
C) Clinical decisions are best made by nursing leaders for all units within that particular hospital.
D) Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Question 17

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?

A) Primary nursing
B) Total nursing care
C) Functional nursing
D) Practice partnerships

Question 18

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

A) One nurse has responsibility for all the medications on the unit.
B) One nurse has responsibility for all the needs of three clients.
C) One charge nurse and one respiratory therapist have responsibility for all clients.
D) One nurse and one nursing assistant have responsibility for ten clients.

Question 19

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

A) Flexibility
B) Strict adherence
C) Persistence
D) Resistance to change

Question 20

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

A) Blood sugar is measured frequently in an attempt to achieve tight glycemic control.
B) The nurse provides the client with the URL for a new website dedicated to self-management of a chronic respiratory disease.
C) The nurse advocates for the client who has decided to forego further dialysis.
D) Client information is entered into an electronic medical record.
E) Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Question 21

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important?

A) It is the most cost-effective way to manage a hospital.
B) An environment that is better for nurses is associated with lower mortality rates.
C) Nurses are more satisfied working in an environment that is better for nursing.
D) When the environment is better for nursing, it is also better for other disciplines.
E) Most of the strategies that improve the environment for nursing do not cost anything.

Question 22

A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available?

A) Enough RN staff to provide all the care to the residents
B) A group of licensed assistants who are good at taking direction
C) A strong nurse manager
D) RNs willing to assume 24-hour accountability for the care provided to residents

Question 23

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?

A) Diagnoses given to only a few clients
B) Diagnoses that carry high risk for the client and the provider
C) Diagnoses that have low reimbursement rates
D) Diagnoses that involve as few providers as possible

Question 24

At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?

A) "We have always had the patient at the center of everything we do."
B) "We can't afford to hire more RNs."
C) "I'm concerned about the increased time and leadership our nurse managers will have to provide."
D) "I like the idea of centralizing all our care."

Question 25

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided?

A) "If we use critical pathways, we won't have physical therapy to help us ambulate clients."
B) "If a client is not able to follow the critical pathway, a variance will be written."
C) "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care."
D) "Once the client is on a critical pathway, we must follow it until discharge."
E) "Using critical pathways will help us reduce length of stay and costs to the client."

Question 26

Which nursing care delivery situation best reflects the concept of a clinical microsystem?

A) A rural free clinic housed in a church gymnasium that is staffed by volunteer nurses and physicians
B) A walk-in clinic in a local discount store that is staffed by a nurse practitioner
C) An inpatient burn unit
D) A general medical-surgical unit in a midsized hospital

Question 27

The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective?

A) Sixty percent of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them.
B) Seventy percent of respondents accurately listed their discharge medication.
C) Eighty-eight percent of respondents reported that invasive interventions were performed by an RN.
D) Thirty percent of respondents reported that their nurse sometimes seemed rushed.

Question 28

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 team nursing is not successful?

A) There are problems with delegation.
B) There are problems with the skill set of the UAPs on the teams.
C) The LPNs on the team do not accept their position of being "in the middle."
D) Communication on the team or with the nurse manager is flawed.
E) RNs and LPNs struggle with who is in control and has the power on the team.

Question 29

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

A) The nurse will determine interventions for all the disciplines needed as part of the clients' care.
B) The nurse will meet with other disciplines to agree on the choice of critical pathways for each client.
C) The nurse will work to build consensus with the physicians caring for the clients on the team.
D) The nurse will define the expected nursing outcomes for the clients on the team.
E) The nurse will collect and analyze data regarding the clients on the team.

Question 30

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?

A) Team nursing
B) Functional nursing
C) Total patient care
D) Primary care