NURSING 101Effective Leadership & Management in Nursing, 9e (Sullivan, Exams of Health sciences

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CHAPTER 1

Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 1 Introducing Nursing Management

1. A nurse manager is participating in the healthcare organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?

1. Cost of care
2. Access to care
3. Availability of care
4. Quality of care Answer: 1 Explanation: 1. While all of the options given are driving forces in today's healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality.
5. Access to care is controlled by the ability to pay.
6. Care will not be available if it cannot be funded.
7. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

2. A nurse has been invited to discuss healthcare costs at a senior citizens' club. What information should the nurse plan to include in this discussion?

1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%.
2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers.
3. The United States spends more money on healthcare than any other country.
4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA). Answer: 2 Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross domestic product.

2. Implementation of PPACA and its regulations have not been formulated.
3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country.
4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

3. A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?

1. "I wonder if there was a break of sterility when this catheter was inserted."
2. "Thankfully we can treat this with an antibiotic."
3. "This could potentially cost the hospital a lot of money."
4. "I will talk to my unlicensed assistants about proper urinary catheter care." Answer: 2 Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection.
5. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation.
6. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay.
7. The nurse has identified that improper care may result in poor outcomes for the client. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

4. Which healthcare situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. A nurse asks visitors to leave because it is after visiting hours.

2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status.
3. A nurse tells the manager that a housekeeper's work is not up to standards.
4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.
5. A nurse who has not made a medication error in two years asks for a salary increase. Answer: 2, 3, 4 Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need.
6. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management.
7. Quality management empowers the employee to evaluate quality.
8. This nurse has seen a need and is working to improve the quality of service. This is quality management.
9. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

5. A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. There is no mechanism for complaint because the client is no longer hospitalized.
2. The client can indicate dissatisfaction on the survey often sent to clients after discharge.
3. The client can call the hospital administration.
4. The client can make a formal complaint through the American Nursing Association (ANA).
5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ). Answer: 2, 3, 5 Explanation: 1. The client can still voice concerns even after discharge.

2. These client satisfaction surveys are a good mechanism for discussing care issues.
3. Telephone calls are a means of discussing client care issues.
4. ANA is not a forum for complaints about care in a specific hospitalization.
5. The AHRQ has a mechanism for reporting care issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

6. A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?

1. The hospital closest to the client's home
2. The hospital that has done the greatest number of these surgeries in the last two years
3. The hospital chosen by the client's primary healthcare provider
4. The hospital with the highest performance ratings for this procedure Answer: 4 Explanation: 1. This may or may not be the best choice of hospital for this procedure.
5. Just because a hospital is high volume does not mean it is high quality.
6. This may or may not be the best hospital for this procedure.
7. The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures. 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: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

7. The quality management director of a large healthcare conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?

1. We will compare outcome indicators with other healthcare conglomerates of similar size and organization.

2. Outcome data of hospitals within the organization will be compared to assess quality.
3. Each client care unit in the organization will establish specific unit goals for quality.
4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed. Answer: 1 Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges.
5. Because the hospitals with the organization are likely managed in a similar manner, this is not an example of benchmarking.
6. While establishing goals is a part of quality management, it is not benchmarking.
7. Setting up a quality monitor is a quality initiative, but it is not benchmarking. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

9. The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence?

1. Case study
2. Anecdotal
3. Nonexperimental design research
4. Statistical Answer: 2 Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical situations.
5. Anecdotal evidence is derived from experience.
6. Nonexperimental design research includes gathering factors related to a clinical condition.
7. Statistical evidence is built from a scientific approach. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

10. A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which of the following statements would direct these nurses to the forms of strongest clinical evidence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. "We may find studies that use only one group of participants."
2. "Look for articles that report on how to use evidence in other clinical situations."
3. "The studies we want are built around the scientific approach to solving problems."
4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness."
5. "Many articles will have information reported by someone who is an expert in the field." Answer: 3, 4 Explanation: 1. Studies using only one group of participants are done in a quasi-experimental design. This is not one of the two strongest forms of evidence.
6. An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence.
7. Using the scientific approach results in statistical evidence, which is one of the two strongest forms.
8. Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence.
9. Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

13. A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need?

1. Pediatric nursing
2. Psychiatric nursing
3. Geriatric nursing
4. Maternity nursing Answer: 3 Explanation: 1. Pediatric nursing is not likely to see as much growth as another specialty.

2. Psychiatric nursing is not likely to see as much growth as another specialty.
3. As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer.
4. Maternity nursing is not likely to see as much growth as another specialty. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Professional Practice Evaluation Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

14. The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation?

1. "There are more nurses retiring than are entering the profession."
2. "The demand for nurses is declining because of fewer hospital admissions."
3. "There are insufficient numbers of nursing faculty to teach interested students."
4. "Women still outnumber men in nursing." Answer: 2 Explanation: 1. The average age of the registered nurse (RN) is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession.
5. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow.
6. Nursing faculty members are also aging and moving into retirement.
7. Women continue to outnumber men in the nursing profession. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Communication Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

15. A healthcare organization has just achieved Magnet status. During the award ceremony, the organization's chief executive officer should give primary praise for this achievement to which employees? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Medical staff
2. Nurse executive
3. Staff nurses
4. Managers in support services such as laboratory and radiology

5. Administrative professionals overseeing services such as accounting, billing, and medical records Answer: 2, 3 Explanation: 1. Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players.
6. While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status.
7. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence.
8. While these employees would be involved in this effort, Magnet status is focused on nursing excellence.
9. While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Professional Practice Evaluation Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

17. Which strategy is most likely to increase participation in the use of evidence-based practice in nursing?

1. Ensure adequate training and encourage its use by the nursing staff.
2. Elicit employee opinions of its use at least four times per year.
3. Give those nurses willing to use it extra recognition.
4. Ensure adequate training, recognition, and easy access to the internet. Answer: 4 Explanation: 1. Ensuring adequate training by itself is not enough.
5. Asking for opinions will do little to encourage the use of evidence-based practice.
6. Recognition for those willing to use evidence-based practice is an insufficient motivator.
7. There must be training, easy access, and recognition for using evidence- based practice in nursing. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

19. The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in healthcare. Which statement is a reason for this delay?

1. Medical records professionals do not like these records.

2. The use of these records is more expensive than the use of paper records.
3. There have been concerns about privacy and confidentiality.
4. The transition to EHRs is time consuming and tedious. Answer: 3 Explanation: 1. The preference of medical records professionals is not the reason these records have had a slow adoption.
5. The cost of the records is not a primary reason they have had slow adoption.
6. The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality.
7. The transition time to EHRs is not the primary reason they have seen a slow adoption. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Communication Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

20. Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital?

1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications.
2. The nurse should get medications more quickly because the robot can work more consistently without breaks.
3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked.
4. The nurse can expect that medication administration will be easier and carry less potential for error. Answer: 2 Explanation: 1. The nurse must still complete the six rights of medication administration to ensure client safety.
5. Robots should be able to get medications to the floor more quickly.
6. The administration of medication cannot be delegated to the nursing assistant.
7. There is no assurance that medication administration will be easier. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act;

demands to reduce errors and improve patient safety; and evolving medical and communication technology.

21. A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Open access to the blog may damage recruiting efforts.
2. Blogs are difficult to use and expensive to maintain.
3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality.
4. The organization's reputation may be altered by a blog.
5. Most nurses would likely not use the blog. Answer: 1, 3, 4 Explanation: 1. Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news.
6. Blogs are inexpensive and easy to use.
7. As blogs become more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely.
8. The organization's reputation could be either enhanced or damaged by bloggers' comments.
9. Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Communication Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

22. The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. "I don't see why everyone can't just get along."
2. "Generation X nurses are just lazy."
3. "Our Generation Y nurses help keep us all up on new technology."
4. "The most loyal of all my nurses are the traditionalists."

5. "I expect that our next manager will come from my group of baby boomers." Answer: 3, 4, 5 Explanation: 1. The four generations have different values, work ethics, and skills. Conflict is inevitable.
6. The manager should not stereotype the members of a generation.
7. Generation Y is technically savvy.
8. Traditionalists are typically loyal and respectful of authority.
9. Baby boomers typically value professional and personal growth. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Assessment/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

23. The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Preparing for a surge of casualties in case of a disaster
2. How to prevent disasters from occurring
3. How to fund disaster management
4. How to reduce disaster impact on clients and staff
5. How to identify risks for disasters Answer: 1, 5 Explanation: 1. One of the primary focuses of a disaster plan is how to care for the influx of clients.
6. Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan.
7. Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay.
8. There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact.
9. Risk identification is part of a safety plan. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

27. To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ________% of nurses prepared at the baccalaureate or higher level by 2020. Answer: 80 Explanation: The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020. Cognitive Level: Understanding Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.
28. A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations?

1. "We must find ways to increase our emphasis on critical thinking."
2. "The curriculum must focus on ways nurses can quickly and accurately acquire information."
3. "Our emphasis must change to improving nursing students' clinical reasoning skills."
4. "Our clinical practicums must be graded separately from our theory presentations." Answer: 3 Explanation: 1. Critical thinking is still emphasized, but another aspect of care should receive much more emphasis.
5. Carnegie focuses on application of knowledge rather than its acquisition.
6. This is a Carnegie recommendation.
7. Carnegie recommends integration of clinical and classroom teaching. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

29. A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now?

1. Nothing until the nurse has acquired enough bedside experience to become a manager
2. Time to see how these skills will be needed in the future
3. A manager who can help with skills transfer from school to work
4. A job working as a manager in a small hospital Answer: 3 Explanation: 1. All nurses are managers.

2. The nurse will use these skills on the first job.
3. The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care.
4. The newly licensed nurse does not have the skill set and experience to work as a manager. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

30. Which manager statement reflects concern about the most important requirement for today's nurse manager?

1. "I am taking a day off tomorrow for my annual physical."
2. "I think this class will help me learn to be innovative."
3. "I am committed to being a good manager."
4. "I feel enthusiastic about our new plans for the units." Answer: 1 Explanation: 1. The most important work of the manager is to stay physically and mentally healthy.
5. Innovation is important, but not as important as other factors.
6. Commitment is important, but not as important as other factors.
7. Enthusiasm is important, but not as important as other factors. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

31. Quality and Safety Education for Nurses (QSEN) is based on quality and safety targets of knowledge, skills, and attitudes (KSAs) for nursing education. Which targets are associated with QSEN competencies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Education
2. Teamwork
3. Autonomy
4. Quality improvement
5. Client-centered care Answer: 2, 4, 5 Explanation: 1. Education is not one of the KSAs.
6. Teamwork is one of the KSAs.

3. Autonomy is not one of the KSAs.
4. Quality improvement is one of the KSAs.
5. Client-centered care is one of the KSAs. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

32. The nurse is using Evidence-based practice (EBP) to improve clinical quality. What steps should the nurse plan to include in this process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Assess the outcome
2. Discuss challenges
3. Identify the clinical question
4. Compare other models
5. Apply the evidence Answer: 1, 3, 5 Explanation: 1. Assessing the outcome is a step in EBP.
6. Discussing challenges is not a step in EBP.
7. Identifying the clinical question is a step in EBP.
8. Comparing other models is not a step in EBP.
9. Applying the evidence is a step in EBP. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future. CHAPTER 2

4. During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?

1. The nurse will have to choose a provider from within the HMO.
2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges.
3. For an additional premium, the nurse can choose any provider.
4. By joining this HMO, the nurse is entitled to unlimited treatment and services. Answer: 1

Explanation: 1. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.

2. The HMO system will not pay for services provided "out of network."
3. The ability to choose a provider who is "out of network" for an additional premium is a feature of point-of-service plans.
4. The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited. 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: 2-2: Describe traditional and emerging structures in healthcare organizations.

7. A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?

1. Long-term care facility
2. Public health department
3. Temporary service agency
4. Home health agency Answer: 4 Explanation: 1. Long-term care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery.
5. The public health department's focus is usually community health, not individual primary care.
6. Temporary service agencies are used to provide healthcare organizations with professional and nonprofessional personnel when the latter are short staffed.
7. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing. 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: 2-2: Describe traditional and emerging structures in healthcare organizations.

28. Which example of organizational structure depicts shared governance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. All the LPNs on the unit administer medications and complete dressing changes; all the RNs complete assessments and administer IV medications.
2. Clinical services are organized around clients with colostomies and colostomy teaching.
3. The nurse manager for the wound clinic reports to the vice-president of nursing and the vice-president of outpatient services.
4. Nursing councils address profession-wide issues linked to client care standards.
5. RNs are accountable for the latest standards and knowledge in the field. Answer: 4, 5 Explanation: 1. If the LPNs on the unit administer medications and complete dressing changes, and the RNs complete assessments and administer IV medications, then this scenario depicts functional structure.
6. If clinical services are organized around clients with colostomies and colostomy teaching, then this scenario depicts service-line structure.
7. If the nurse manager for the wound clinic reports to the vice-president of nursing and the vice-president of outpatient services, then this scenario depicts matrix structure.
8. If nursing councils address profession-wide issues linked to client care standards, then this scenario depicts shared governance.
9. If RNs are accountable to the latest standards and knowledge in the field, then this scenario depicts shared governance. 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: 2-2: Describe traditional and emerging structures in healthcare organizations.

Chapter 3 FREE

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.
5. 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.
5. Total client care is given by one nurse.
6. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients.
7. 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.

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.

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.
5. The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN.
6. In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role.
7. 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.

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.
5. The family may have important information about the client's mobility, but this is not the priority action.
6. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway.
7. 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.
5. Functional nursing is cost-effective but lacks continuity of care.
6. Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction.
7. 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.
6. Structure is necessary to ensure that all care responsibilities are covered.
7. While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary.
8. The objective of structuring nursing care is not to ensure physician efficiency.
9. 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.
5. Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.
6. Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration.
7. 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.
6. Self-management is one of the six components of the chronic care model.
7. Decision support is one of the six components of the chronic care model.
8. Use of clinical information systems is essential to the chronic care model.
9. 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.
5. Collaboration is a desirable characteristic but does not describe moral agency.
6. Systems thinking is a desirable characteristic but does not describe moral agency.
7. 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.
6. The system used by competing hospitals is not of great importance in choosing the system for a new hospital.
7. The provision of safe and effective nursing care is the most important of all considerations.
8. Optimizing nursing skills is an important consideration when choosing a nursing care delivery system.
9. 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.
5. The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation.
6. A comfortable and efficient system for delivery of care is important to client outcomes.
7. 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.

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.
5. Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing.
6. Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse.
7. 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.
6. Problems with UAP skill sets can be overcome by education. This is not a common reason that team nursing does not work.
7. While LPNs can be "in the middle" between the UAP and the RN, there is no indication that this is a common problem.
8. Poor communication is a common problem and can make the team approach ineffective.
9. 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.