Essentials for Nursing Practice 8th Edition by Patricia A. Potter, Anne Griffin Perry, Patricia Stockert, Amy Hall - Test Bank

Chapter 04: Community-Based Nursing Practice Potter: Essentials for Nursing Practice, 8th Edition MULTIPLE CHOICE 1. A student nurse is beginning the community-based primary care rotation. The student nurse anticipates that the assignment in community-based health care will most likely be at which organization? a. An acute care hospital b. A rehabilitation hospital c. A nursing home d. A high school ANS: D High schools focus on primary rather than acute care and provide knowledge about health and health promotion that occurs outside traditional health care institutions, such as hospitals, rehabilitation hospitals, and nursing homes. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 50 | 51 OBJ: Explain the relationship between public and community health nursing. TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 2. A nurse is practicing as a community health nurse. What is the primary focus of care for this nurse? a. Providing care to subpopulations b. Practicing care in existing services c. Being a specialist in public health science d. Having a case management certification ANS: A The community health nurse provides direct care services to subpopulations within that community. Community health nursing is nursing care provided in the community, with the primary focus on the health care of individuals, families, and groups in the community. A community health nurse is not the same thing as a specialist in public health nursing. A community health nurse does not have to have case management certification. Although the community health nurse may practice care in existing services, the primary focus is on the subpopulation’s care. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 52 OBJ: Differentiate community health nursing from community-based nursing. TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. A community health nurse is using the goals of the Healthy People 2020 to focus care. Which goal is the priority? a. To increase the life expectancy of people in the United States b. To increase the health status of people throughout the world c. To eradicate the human immunodeficiency virus (HIV) d. To reduce health care costs ANS: A The overall goals of Healthy People 2020 are to increase the life expectancy and quality of life and to eliminate health disparities through an improved delivery of health care services to people in the United States. The focus is on the United States, not the world. It does not focus on one disease or on reducing health care costs. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 51 OBJ: Describe the role of the community health nurse. TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 4. The teen pregnancy rate in one community significantly increased; as a result, the school system was seeing an increase in the dropout rate of teenage mothers. A nurse recently worked with the local school system to develop a day care program for the children of high school students so that they could return to school. Which technique did the nurse use? a. Incorporating immunizations for the infants and mothers b. Responding to changes within the community c. Influencing chronic environmental factors d. Managing disease ANS: B Successful community health nursing practice involves building relationships with the community and responding to changes within the community. No immunizations were given. There was no mention of managing disease in this scenario. The nurse did not influence chronic factors. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 53 OBJ: Describe the role of the community health nurse. TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 5. A nurse notices that a particular area of the community had food poisoning. The nurse collected data from the people who were affected, identified a local restaurant that served all the people, and determined it was the chicken dish that caused the poisoning. Which community health nurse competency did the nurse demonstrate? a. Public health b. Educator c. Epidemiologist d. Case manager ANS: C As epidemiologist, community health nurses use basic principles of epidemiology such as tracking health problems; collecting and analyzing data to identify disease trends, outbreaks of illnesses, and disease incidence rates; and planning strategies to prevent or contain outbreaks. With the goal of helping patients assume responsibility for their own health care, the role of educator is important in a community-based setting. Case management means making an appropriate plan of care based on assessment of patients and families and coordinating needed resources and services for the patient’s well-being across a continuum of care. A community health nurse is not the same thing as a public health nurse and is not a competency of community health nursing. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 58 OBJ: Describe selected competencies important for success in community-based nursing practice. TOP: Nursing Process: Evaluation MSC: NCLEX: Safety and Infection Control 6. Upon assessment the nurse finds the following: a 46-year-old immigrant patient from the Czech Republic has diabetes and hypertension and just recently moved in to live with a family member who must travel frequently. The patient speaks English very well. The community health nurse knows that this patient may be vulnerable because of which assessment finding? a. Age b. Immigration status c. Diabetes d. Language ANS: B Vulnerable populations include individuals living in poverty, elderly people, homeless individuals, those in abusive relationships, people with substance abuse problems and/or mental illnesses, and new immigrants. For some immigrants access to health care is limited because of legal status, language barriers and lack of benefits, resources, and transportation. Being 46 years old does not place the patient in the elderly category. Diabetes does not make the patient vulnerable. The patient speaks English, so that is not an issue. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 54 OBJ: Explain the characteristics of patients from selected vulnerable populations that influence a nurse’s approach to care. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 7. A nurse wants to use the most important competency in community nursing. Which competency should the nurse use? a. Caregiver b. Case manager c. Educator d. Epidemiologist ANS: A The most important role is caregiving. Using the nursing process and critical thinking skills, a nurse develops appropriate, individualized nursing care for specific patients and their families. Case management means making an appropriate plan of care based on assessment of patients and families and coordinating needed resources and services for the patient’s well-being across a continuum of care. Community-based nurses teach their patients individually or in groups. Community health nurses use basic principles of epidemiology, such as tracking health problems; collecting and analyzing data to identify disease trends, outbreaks of illnesses, and disease incidence rates; and planning strategies to prevent or contain outbreaks. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 56 OBJ: Describe selected competencies important for success in community-based nursing practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 8. A community health nurse is assessing the structure of a community. Which component will the nurse assess? a. Available health systems b. Available colleges and schools c. Geographical boundaries d. Predominant religious groups ANS: C Geographical boundaries are a component of the structure of a community. Health systems, and available colleges and schools are social systems. Predominant religious groups are a component of the population of a community. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 58 OBJ: Describe elements of a community assessment. TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse in community-based practice needs a variety of skills and talents while rendering care to patients in the community. Which are competencies of the community health nurse? (Select all that apply.) a. Case manager b. Care giver c. Educator d. Advocate e. Counselor ANS: A, B, C Selected competencies, such as caregiver, case manager, epidemiologist, and educator, are used in the community-based setting. Advocate and counselor are not competencies. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 56 | 58 OBJ: Describe selected competencies important for success in community-based nursing practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 2. A community health nurse is caring for vulnerable populations. The nurse is caring for which patients? (Select all that apply.) a. Patients living at home b. Patients with abusive habits c. Immigration patients d. Middle-aged patients e. Patients living in poverty ANS: B, C, E Individuals living in poverty, elderly people, homeless individuals, those in abusive relationships, people with substance abuse problems and/or mental illnesses, and new immigrants are examples of vulnerable populations. Living at home and being middle-aged are not examples of vulnerable populations. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 54 | 56 OBJ: Explain the characteristics of patients from selected vulnerable populations that influence a nurse’s approach to care. TOP: Nursing Process: Implementation MSC: NCLEX: Safety and Infection Control 3. A nurse is performing a community assessment. Which areas should the nurse include? (Select all that apply.) a. Structure b. Population c. Social systems d. Environment e. Vital signs ANS: A, B, C A complete assessment examines structure or locale, population or people, and social systems. The principles of public health practice aim at achieving a healthy environment in which all individuals may live. Environment and vital signs are not components of a community assessment. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 58 OBJ: Describe elements of a community assessment. TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. A community-based nurse is working with a family. The nurse needs to be knowledgeable in what key areas? (Select all that apply.) a. Family theory b. Group dynamics c. Political affiliations d. Cultural diversity e. Communication principles ANS: A, B, D, E The context of community-based nursing is family-centered care within the community. This focus requires the nurse to be knowledgeable about family theory, principles of communication, and group dynamics and cultural diversity. Political affiliations are not a key component of family-centered care. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 54 OBJ: Discuss the role of the nurse in community-based practice. TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance Chapter 07: Evidence-Based Practice Potter: Essentials for Nursing Practice, 8th Edition MULTIPLE CHOICE 1. Which organization is preparing future nurses to have the knowledge, skills, and attitudes (KSAs) of evidence-based practices necessary to continuously improve the quality and safety of the health care systems within which they work? a. The Joint Commission b. Quality and Safety Education for Nurses’ (QSEN) c. The National Database of Nursing Quality Improvement (NDNQI) d. The Agency for Health care Research and Quality (AHRQ) ANS: B Evidence-based practice is also one of the Quality and Safety Education for Nurses’ (QSEN) competencies, with the overall goal for the QSEN project being to meet the challenge of preparing future nurses to have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work (QSEN, 2012). The Joint Commission provides Patient Safety Goals. All magnet-designated hospitals maintain the National Database of Nursing Quality Improvement (NDNQI). The database has information on falls, pressure ulcer incidence, and nurse satisfaction. The AHRQ is a national agency that provides important sources of new scientific information that include standards and practice guidelines. PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: 91 OBJ: Discuss the QSEN competencies for evidence-based practice. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 2. A registered nurse questioned the nurses on the neonatal intensive care unit about the practice of kangaroo care for neonates. The nurse had read literature supporting the practice, but the nurses that work on the neonatal unit stated that they had never done anything like that at their institution. The nurse continued to ask questions and began a literature review. Which behavior was the nurse demonstrating? a. Variables b. Peer review c. Evidence-based practice d. Process measurement ANS: C Evidence-based practices (EBP) guide nurses and other health care providers in making effective, timely, and appropriate clinical decisions. Nurses and other health care providers can no longer accept and practice the status quo. Greater attention must be given to why certain health care approaches are used, which ones work, and which ones do not. Hypotheses are predictions made about the relationship among study variables (e.g., characteristics or traits that vary among subjects). An example of a research question is: Does the use of chlorhexidine 2% compared with povidone-iodine reduce CLABSI in patients with CVCs? Within that question the author is studying the variables (independent) of chlorhexidine and povidone-iodine solutions as they affect the outcome (dependent variable) of CLABSI in patients. Peer review is the practice of nurses evaluating nurses. A peer-reviewed article is one submitted for publication and reviewed by a panel of experts familiar with the topic or subject matter of the article. When you implement a practice change, you sometimes want to monitor whether or not the process or protocol was implemented. This requires a process measurement. The nurse has not implemented kangaroo care (only reviewed literature), so there is no need for a process measurement. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 89-90 OBJ: Discuss ways to apply evidence in nursing practice. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 3. A registered nurse wants to review the latest information regarding prevention of a health care acquired infection. Where is the best place for the nurse to obtain this information? a. Online information b. Peer-reviewed nursing journal c. Latest edition of a nursing textbook d. Most recent edition of a popular magazine ANS: C The best scientific evidence comes from well-designed, systematically conducted research studies, usually found in peer-reviewed scientific journals. A good textbook incorporates current evidence into the practice guidelines and procedures it describes. However, a textbook relies on the scientific literature, and sometimes information on a particular topic is outdated by the time a book is published. Peer-reviewed material is better than online information or recent popular magazines. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 91 OBJ: Discuss the levels of evidence in the literature. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 4. A 15-year-old patient was admitted to the hospital with a bowel obstruction. The patient underwent surgery and was experiencing postoperative pain. The nurse caring for the patient had recently read a research article in which a study had been done with neonatal (infant) patients and the use of therapeutic touch to assist with pain control. Which factor is most important for the nurse to consider in this case when applying research to clinical practice? a. The patient’s gender b. The patient’s preference c. The patient’s allergies d. The patient’s roommate ANS: B Using clinical expertise and considering patients’ values and preferences ensures that a nurse will apply the available evidence to practice both safely and appropriately. Even when you use the best evidence available, application and outcomes differ based on your patients’ values, state of health, preferences, concerns, and/or expectations. Patient’s allergies, gender, and roommate are not important in this scenario as it does not affect therapeutic touch. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 91 OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 5. A nurse is using evidence-based practice (EBP) to provide care. Which action should the nurse take first? a. Collect the most relevant and best evidence. b. Integrate evidence with one’s clinical expertise. c. Critically appraise the evidence gathered. d. Ask a clinical question. ANS: D EBP is a systematic approach to determine the most current and relevant evidence on which to base patient care decisions. Melnyk and Fineout-Overholt recommend a six-step process for EBP: (1) Ask a clinical question; (2) Collect the most relevant and best evidence; (3) Critically review and evaluate/appraise the evidence gathered; (4) Combine/Integrate evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change; (5) Evaluate the practice decision or change; (6) Communicate results of the change. Collecting the best evidence is step 2. Integrating evidence is step 4. Critically appraising the evidence is step 3. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 91 OBJ: Describe the steps of evidence-based practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 6. The nurse manager of a 30-bed medical surgical unit has noticed that the fall rate of postoperative patients has increased in the past 2 months. The nurse manager wants to address this situation using evidence-based practice. Which type of trigger did the nurse manager use? a. Literature-focused trigger b. Problem-focused trigger c. Knowledge-focused trigger d. Expectations-focused trigger ANS: B A problem-focused trigger is one you face while caring for patients or a trend you see on a nursing unit. A knowledge-focused trigger is a question that arises as a result of new information available on a topic, such as current information in literature. Titler et al. (2001) suggest using problem- and knowledge-focused triggers to think critically about clinical and operational nursing-unit issues. It does not include literature or an expectations trigger. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 91-92 OBJ: Describe the steps of evidence-based practice. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 7. A registered nurse who works for a surgical intensive care unit (ICU) has recently read several articles in professional nursing journals about the use of quiet time in the ICU to enhance patient outcomes. The nurse would like to apply the research findings to the unit. How did the nurse formulate the clinical question? a. Measurement-focused trigger b. Problem-focused trigger c. Knowledge-focused trigger d. Expectations-focused trigger ANS: C A knowledge-focused trigger is a question that arises as a result of new information available on the topic. For example, “What is the current evidence for the best way to educate patients with low health literacy?” A problem-focused trigger is one you face while caring for patients or a trend you see on a nursing unit. Titler et al. (2001) suggest using problem- and knowledge-focused triggers to think critically about clinical and operational nursing-unit issues. It does not include measurement or expectation focuses. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 91-92 OBJ: Describe the steps of evidence-based practice. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 8. A nurse’s manager has suggested that a nurse formulate a PICO question to clarify the topic before doing a literature review. When the nurse asks what the acronym PICO stands for, how should the nurse manager respond? a. Policy, information, comparison, outcome b. Patient, information, collection, outcome c. Patient, intervention, comparison, outcome d. Policy, intervention, communication, outcome ANS: C P: Patient population of interest. Identify patients by age, gender, ethnicity, disease, or health problem. I: Intervention of interest. Which intervention do you want to use in practice (e.g., a treatment, diagnostic test, educational approach)? C: Comparison of interest. What is the usual standard of care or current intervention that you now use in practice? O: Outcome. What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, patient perception)? Policy, information, comparison, collection, and communication are not included in PICO. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 92 OBJ: Develop a PICO or PICOT question. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 9. A nurse working on a PICO question has found a large amount of literature available on the topic with multiple studies that have been published. Which type of study should have the best evidence? a. Meta-analysis of randomized control trials b. Opinion of an expert committee c. One well-designed randomized control trial d. Systematic review of descriptive and qualitative studies ANS: A Systematic reviews or meta-analyses are state-of-the-science summaries from an individual researcher or panel of experts and are on the highest level of the hierarchy. These research summaries are the perfect answers to PICO(T) questions because the researchers have rigorously summarized all current evidence on the question. A single RCT is not as conclusive as a review of several RCTs on the same question. Opinion of an expert committee is on the lowest level of the hierarchy of evidence. Systematic review is above opinions but is below meta-analysis on the hierarchy of evidence. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 93-94 OBJ: Discuss the levels of evidence in the literature. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 10. A registered nurse is concerned about the patients’ perceptions and feelings about the quality of life that they experience after a diagnosis of liver cancer. Which is the most appropriate type of research study the nurse should use to gather information about this situation? a. Quantitative study b. Randomized trial c. Qualitative study d. Case controlled study ANS: C Qualitative research offers analysis of interviews, observations, and/or surveys to measure people’s perceptions, feelings, or views of phenomena about which little is known. Randomized trial has participants divided into groups to test for the same outcome to determine if there is a difference in the effect of a treatment or intervention compared with a standard of care. A case control study compares patients who have a disease or outcome of interest with patients who do not have the disease or outcome. The researcher looks back to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and disease. If quantitative data such as physical measurements and scores on surveys are collected, statistical results from the study are explained. Quantitative data do not focus on perceptions and feelings. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 94 OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 11. A nurse works for a facility in which the facility sends information to The National Data Base for Nursing Quality Improvement (NDNQI) regarding patient falls, pressure ulcer incidence, and nursing satisfaction. The nurse works at which facility? a. The Joint Commission b. A magnet-designated hospital c. The Centers for Disease Control and Prevention d. The American Association of Critical Care Nurses ANS: B All magnet-designated hospitals maintain the National Database of Nursing Quality Improvement (NDNQI). The database includes information from Magnet hospitals on falls, pressure ulcer incidence, and nurse satisfaction. The Joint Commission produces patient safety goals. The Centers for Disease Control and Prevention help produce guidelines for clinical practice. American Association of Critical Care Nurses provides standards and practice guidelines for critical care nurses. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 92 OBJ: Explain the relationship among nursing research, evidence-based practice, and quality improvement. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 12. A student nurse is looking for research articles that can be used to complete a research paper. Where can the nursing student look to quickly find out if an article is research or clinically based? a. p value b. Abstract c. Analysis d. Literature review ANS: B An abstract is a brief summary of the article that quickly shows whether the article is research or clinically based. An abstract summarizes the purpose of the study or clinical review, the major themes or findings, and the implications for nursing practice. A good author offers a detailed background of previous studies and the level of evidence or clinical information that exists about the topic of the article, which is called the literature review. Analysis is the section that explains how the data collected in a study are analyzed. The p value (usually set at 0.05) is a probability level that tells you whether the difference between two groups was likely related to the intervention or if it was simply a difference by chance. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 95 OBJ: Explain how critiquing the scientific literature leads to best evidence for practice changes. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 13. A nurse working in an acute care setting wanted to determine the most accurate way to take patients temperatures. The nurse noticed that the tympanic thermometers used by the unit were often not accurate. The nurse found that the literature showed tympanic thermometers were not the most accurate method of obtaining a temperature. The nurse wants to change the nursing practice of the unit. What is the nurse’s most logical next step? a. Discuss the findings with a patient to gain support. b. Tell the aides to stop taking temperatures. c. Share the findings with the nursing policy and procedure committee. d. Write an editorial in the public newspaper to bring the community into the process. ANS: C A key feature of a practice environment that supports the use of best evidence is requiring clinical practice policies and procedures to be evidence based. Many organizations involve staff nurses and research-prepared advanced practice nurses in reviewing scientific articles relevant to policies and procedures and then making appropriate revisions. Policies and procedures are important tools for supporting hospital-based nurses in using evidence in their everyday practice and promoting positive patient outcomes. Discussing results with the patient will not get the procedure changed. Telling the aides to stop taking the temperatures is dangerous. Writing an editorial in the public newspaper is inappropriate to effect change on the unit. First follow policies and procedures of the agency in which one works. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 97 OBJ: Identify ways to sustain knowledge in evidence-based practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 14. After a practice change has taken place in an organization because of a nurse following evidence-based practice in a task force, which final step should the nurse take? a. Evaluate b. Encourage c. Engage d. Execute ANS: A After applying evidence in practice, the next step is to evaluate the effect. Newhouse and White (2011) recommend that to be successful in changing practice within an organization, it is essential to Engage, Educate, Execute, and Evaluate. Engage and execute have already occurred because the change has taken place. Encourage is not a step in the evidence-based process. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 96-97 OBJ: Identify ways to sustain knowledge in evidence-based practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 15. The nursing unit staff has used evidence-based practice to implement a practice change. What is the next step in the process the nursing staff should implement? a. Review literature. b. Engage companies. c. Measure outcomes. d. Ask a clinical question. ANS: C After implementing the change, the practice decision or change should be evaluated by using outcome or process measurements. Remember the “O” in your PICO(T) question. It represents the outcomes you choose to measure as you integrate the evidence. These outcomes tell you how well the evidence-based intervention works. Reviewing literature and asking a clinical question occurred before the change. Companies are not a part of this process. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 91 | 97 OBJ: Describe the steps of evidence-based practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 16. At a health care organization, patients are turned every 2 hours to help prevent pressure ulcers. Because of this nursing intervention, patients exhibit far fewer pressure ulcers than the national average. Which term should the nurse use to describe this finding? a. Sentinel event b. Qualitative research c. Manuscript narrative d. Nursing-sensitive outcome ANS: D A nursing-sensitive outcome focuses on how patients and their health care problems are affected by nursing interventions (ONS, 2012). Nursing-sensitive outcomes look at the effects of interventions within the scope of nursing practice. Sometimes a problem is presented to a committee in the form of a sentinel event, an unexpected occurrence involving death or serious physical or psychological injury of a patient. Qualitative research is analysis of interviews, observations, and/or surveys to measure people’s perceptions, feelings, or views of phenomena about which little is known. Manuscript narrative is the “middle section” or narrative of a manuscript that differs according to the type of evidence-based article it is. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 98 OBJ: Discuss ways to measure outcomes for an evidence-based practice change. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 17. The quality improvement or performance improvement (QI/PI) process should begin at which level of nursing? a. Staff nurse b. Nurse manager c. Nurse administrator d. Advanced practice registered nurse ANS: A The QI/PI process begins at the staff level, where all disciplines become involved in identifying quality problems. Although all those listed can do QI/PI, the process begins at the staff level. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 100 OBJ: Explain the relationship among nursing research, evidence-based practice, and quality improvement. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care MULTIPLE RESPONSE 1. The nurse is investigating an area of practice in which no research evidence is available. What types of non-research information should the nurse consider? (Select all that apply.) a. Performance improvement and risk management data b. International, national and local standards of care c. Study with pre- and post-test design d. Benchmarking e. Retrospective or concurrent chart reviews ANS: A, B, D, E Other sources of information from non-research evidence include: performance improvement and risk management data, international, national and local standards of care, infection control data, benchmarking, clinicians’ expertise, and retrospective or concurrent chart reviews. Study with a pre- and post-test design is a research study. The question asked for non-research information. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 91 OBJ: Discuss the levels of evidence in the literature. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 2. A nurse is describing types of performance improvement models. Which information should the nurse include? (Select all that apply.) a. Six Sigma b. Balanced scorecard c. Plan-Do-Study-Act d. Root cause analysis e. Human subjects committee ANS: A, B, C, D Performance improvement models include Six Sigma, balanced scorecard, Plan-Do-Study-Act, and root cause analysis. Research studies must be approved by an institutional review board (IRB), also called a human subjects committee, which is not involved with performance improvement models but with research. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 101 OBJ: Discuss the relationship between evidence-based practice and the improvement of the safety and quality of nursing practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care Chapter 13: Managing Patient Care Potter: Essentials for Nursing Practice, 8th Edition MULTIPLE CHOICE 1. A registered nurse works as a case manager in the local hospital. What primary role will the nurse be fulfilling? a. Coordinating care for patients with a specific condition b. Only working with primary health care providers c. Directing care of all patients in the hospital setting d. Providing direct care to specific patients ANS: A What is unique about case management is that clinicians, either as individuals or as part of a collaborative group, oversee the management of patients with specific case types, focusing on length of stay and improving clinical outcomes (e.g., patients with specific diagnoses presenting complex nursing and medical problems such as heart failure or diabetes). Case managers work with social services, dietitians, and physical therapists to name a few. Case managers do not care for all patients, just a specific case type. Case managers do not provide direct care. Instead they collaborate with and supervise the care that other staff members deliver. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 228 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 2. A nurse manager is interested in supporting more involvement of the staff nurses on the unit. What is one approach the nurse manager can take to facilitate this involvement? a. Inform the staff of decisions made. b. Use decentralized management. c. Avoid unit goals. d. Discourage input from other personnel. ANS: B Decentralized management, in which decision making is made at the staff level, is very common within health care organizations. Advantages of decentralization include increased morale and improved interpersonal relationships among staff. Staff members feel more important and are more willing to contribute. The staff should be making the decisions, not being informed of decisions made. To make decentralized decision making work, managers need to move it down to the staff level. On a nursing unit it is important for all staff members (RNs, LPNs, and LVNs), nursing assistive personnel (NAP), and unit secretaries to feel involved, particularly with issues affecting their ability to care for patients. One of the responsibilities of a nurse manager is to help the staff establish annual goals for the unit. Avoiding unit goals will decrease involvement, not increase the participation. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 228 OBJ: Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 3. A primary nurse caring for a patient with kidney failure develops a plan of care for the patient after consulting with the patient on the best way to manage the patient’s diet. As the staff delivers the plan of care the primary nurse evaluates whether the plan is working. Which attribute is the primary nurse displaying? a. Responsibility b. Interprofessional collaboration c. Delegation d. Staff involvement ANS: A Responsibility refers to the duties and activities that an individual is employed to perform. For example, a primary nurse is responsible for completing a nursing assessment of all assigned patients and developing a plan of care that addresses each of the patient’s nursing diagnoses. As the staff delivers the plan of care, the primary nurse is responsible for evaluating whether the plan is successful and what to do when it is not successful. Staff involvement is not the attribute the primary nurse is displaying. This is the nurse’s responsibility. Delegation is the process of assigning part of one person’s responsibility to another qualified person in a specific situation. The nurse developed the care plan and followed up, which is responsibility, not delegation. Interprofessional collaboration involves bringing representatives of the various disciplines together to work with patients and families to deliver quality care. This scenario did not use other health professionals; it involved just the nursing aspect. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 228-229 OBJ: Describe the elements of decentralized decision making. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 4. A registered nurse delegates vital signs on a patient to the unlicensed assistive personnel (UAP). The nurse reviews the documented vital signs from the UAP to determine if they are within normal parameters for the patient. The nurse in this example is demonstrating which attribute when following up on the vital signs? a. Interprofessional collaboration b. Staff education c. Accountability d. Delegation ANS: C Accountability refers to liability or individuals being answerable for their actions. It involves follow up and a reflective analysis of your decisions to evaluate their effectiveness. A primary nurse delegates responsibility but is accountable for his or her patients’ outcomes. Interprofessional collaboration involves bringing representatives of the various disciplines together to work with patients and families to deliver quality care. A nurse and a UAP are not from different disciplines. Following up is not an example of delegation; the nurse did it. Delegation is the process of assigning part of one person’s responsibility to another qualified person in a specific situation. When the nurse assigned the vital signs that is delegation. Staff education involves planning in-service training sessions, sending staff members to professional conferences, and having staff members present case studies or practice issues during staff meetings. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 229 OBJ: Describe the elements of decentralized decision making. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 5. A nurse is using SBAR. Which information will the nurse report for the “B”? a. The patient had a broken right leg with a cast applied 2 days ago. b. The toes are cool and pale. c. The patient is reporting severe pain—10 out of 10—even after pain medication was given. d. The nurse requests that the primary health care provider examine the patient. ANS: A “B” stands for background. The information for the patient’s background is the following: the patient had a broken right leg with a cast applied 2 days ago. Structured communication techniques used by health care teams that improve communication include: briefings or short discussions among team member; group rounds on patients; and use of Situation-Background-Assessment-Recommendation (SBAR) when sharing information. “S” is the situation. The patient is reporting severe pain—10 out of 10—even after pain medication was given. “A” is assessment. The patient’s toes are cool and pale. “R” is the recommendation. The nurse requests that the primary health care provider examine the patient. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 233 OBJ: Describe the process of interprofessional collaboration among nurses and health care providers. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 6. A patient admitted to the intensive care unit was placed on ventilator support. The nurse caring for this patient identified on the plan of care that one of the outcomes was that the patient would not develop ventilator-acquired pneumonia (VAP). To achieve this outcome, the nurse delegates the following to the unlicensed assistive personnel: “Please perform oral care on the patient every 2 hours. In this situation oral care would include using the special swabs we have for our patients on VAP precautions so we can prevent pneumonia.” Which of the five rights of delegation did the nurse use? a. Right route b. Right direction/communication c. Right dose d. Right supervision ANS: B The nurse used right direction/communication. Give a clear, concise description of the task, including its objective, limits, and expectations. Communication must be ongoing between the nurse and nursing assistive personnel during a shift of care. The nurse did not use right supervision in this scenario. To provide right supervision, provide appropriate monitoring, evaluation, intervention as needed, and feedback. Nursing assistive personnel should feel comfortable asking questions and seeking assistance. There is no right dose or route in the five rights of delegation; right dose and route are included in the rights of medication administration. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 234 OBJ: Discuss principles to follow in the appropriate delegation of patient care activities. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 7. A patient is admitted to the hospital for hip replacement surgery after falling at home and breaking a hip. The patient has developed pneumonia while in the hospital and has required frequent suctioning from the tracheostomy. The nurse decides to delegate I&O to the unlicensed assistive personnel but does not delegate suctioning. This is an example of which of the five rights of delegation? a. Right task b. Right direction/communication c. Right intervention d. Right supervision ANS: A This is the right task because the nurse delegated I&O, but not tracheostomy suctioning. The right task is one that you can delegate for a specific patient, such as tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have minimal potential risk. Right direction/communication involves the following: Give a clear, concise description of the task, including its objective, limits, and expectations. Communication must be ongoing between the nurse and nursing assistive personnel during a shift of care. There is no “right” for an intervention. Right supervision includes the following: Provide appropriate monitoring, evaluation, intervention as needed, and feedback. Nursing assistive personnel should feel comfortable asking questions and seeking assistance. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 234 OBJ: Discuss principles to follow in the appropriate delegation of patient care activities. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 8. A nurse is in the acute care unit caring for a 67-year-old patient with a varicose ulcer in the right lower leg. The wound has been healing well but will require a dressing change during the shift. What priority level should the nurse classify this problem? a. High priority b. Low priority c. Mid priority d. Intermediate priority ANS: D Intermediate priority problems are nonemergency, non–life-threatening actual or potential needs that the patient and family are experiencing. Anticipating teaching needs of patients related to a new drug or taking measures to decrease postoperative complications are examples of intermediate priorities. High priority is an immediate threat to a patient’s survival or safety, such as a physiological episode of obstructed airway, loss of consciousness, or a psychological episode of an anxiety attack. Low priority problems are actual or potential problems that may not be directly related to the patient’s illness or disease. They are often related to the patient’s developmental and/or long-term health care needs (e.g., teaching for self-care in the home before discharge of a patient who has just been admitted to the hospital). There is no mid priority label. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 231 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 9. A new nurse would like to work where clinical performance is valued and in an environment that uses evidence-based practice. Given the new nurse’s goals, which organization would be the best for this nurse? a. Private hospitals b. Community hospitals c. Not-for-profit hospitals d. Magnet-designated hospitals ANS: D A magnet-designated hospital will fit this new nurse’s goals better than a private, community, or not-for-profit hospital. Typically a magnet hospital has a system to recognize and reward nurses for clinical performance, has research programs, and uses evidence-based practice. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 226 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 10. A nurse has worked in a variety of nursing areas and would like to find a unit within the hospital that mirrors the nurse’s own professional values. The best way for the nurse to find a unit that would be a good fit is for the nurse to examine which document? a. Hospital mission statement b. Unit policies and procedures c. Unit philosophy of care d. Hospital vision statement ANS: C A philosophy of care incorporates the professional nursing staff’s values and concerns for the way that they view and care for patients. For example, a philosophy addresses the nursing unit’s purpose, how staff will work with patients and families, and the standards of care for the work unit. A philosophy is a vision for how to practice nursing. A hospital’s mission statement and/or philosophy are for the entire hospital, not just the specific nursing unit. Unit policies and procedures will not give the nurse a good idea about the unit’s values and beliefs. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 226 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 11. A registered nurse (RN) works on a unit with other registered nurses, licensed practical nurses (LPN), and nursing assistive technicians. Usually a RN, LPN, and nursing assistive technician provide direct care for a group of patients. The RN coordinates all of the care the others provide. Which type of nursing care delivery models is the RN using? a. Team nursing b. Case management c. Primary nursing d. Total patient care ANS: A In team nursing the RN leads a team of other RNs, practical nurses, and unlicensed assistive personnel (UAP). Team members provide direct patient care under supervision of the RN. The team leader develops patient care plans, coordinates care among team members, and provides care requiring complex nursing skills. Total patient care is a nurse delivering total care to one or two patients. Case management is one nurse managing care for a specific type of patient from admission to discharge to home. The case management nurse does not provide direct patient care. When one primary RN assumes responsibility for a caseload of patients with the help of associate nurses, primary nursing is being implemented. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 227 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 12. A nurse works in a critical care area caring for two patients during a day shift and is accountable for all their care. Which type of nursing care delivery model is the nurse using? a. Team nursing b. Case management c. Primary nursing d. Total patient care ANS: D During total patient care, a registered nurse is responsible for all aspects of care for one or more patients during an assigned shift. In team nursing the RN leads a team of other RNs, practical nurses, and unlicensed assistive personnel (UAP). Team members provide direct patient care under the supervision of an RN. The team leader develops patient care plans, coordinates care among team members, and provides care requiring complex nursing skills. Case management is one nurse managing care for a specific type of patient from admission to discharge to home. The case management nurse does not provide direct patient care. When one primary RN assumes responsibility for a caseload of patients with the help of associate nurses, primary nursing is being implemented. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 227 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 13. A registered nurse who works in a women’s hospital assumes care for the same patients from the time they are admitted to the time they are discharged home. The nurse has associate nurses helping with the care. Which type of nursing care delivery model is the nurse using? a. Team nursing b. Primary care nursing c. Case management d. Total care ANS: B Primary nursing is a model of care delivery in which a registered nurse assumes responsibility for a caseload of patients over time (e.g., a length of stay in a hospital or a series of home care visits). Typically the registered nurse selects the patients for his or her caseload and cares for the same patients during their hospitalization or stay in the health care setting. Associate nurses help with patient care. During total patient care, a registered nurse is responsible for all aspects of care for one or more patients during an assigned shift. In team nursing the RN leads a team of other RNs, practical nurses, and unlicensed assistive personnel (UAP). Team members provide direct patient care under the supervision of the RN. The team leader develops patient care plans, coordinates care among team members, and provides care requiring complex nursing skills. Case management is one nurse managing care for a specific type of patient from admission to discharge to home. The case management nurse does not provide direct patient care. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 227 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 14. A registered nurse has a patient assignment of caring for six postoperative patients in the orthopedic unit. The nurse completes the patient assessments, distributes medications, and provides care to the patients as outlined within the job (position) description. Which term best describes the nurse’s behavior? a. Interprofessional collaboration b. Responsibility c. Interprofessional rounding d. Case management ANS: B Responsibility refers to the duties and activities that an individual is employed to perform. A position description outlines a professional nurse’s responsibilities in patient care and in participating as a member of the nursing unit. Interprofessional collaboration involves bringing representatives of the various disciplines together to work with patients and families to deliver quality care. Members of the health care team round on patients and share patient information, answer questions asked by other team members, discuss patients’ clinical progress, plan of discharge, and focus all team members on the same patient goals during interprofessional rounding. What is unique about case management is that clinicians, either as individuals or as part of a collaborative group, oversee the management of patients with specific case types. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 228 OBJ: Describe the elements of decentralized decision making. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 15. A nurse works in a trauma intensive care unit in a busy urban hospital. Once a week, staff members from all the disciplines caring for the trauma patients get together to discuss their progress. The patient’s family can be included in the discussion if it is approved by the patient. This is best described as which of the following? a. Nursing practice b. Staff communication c. Interprofessional collaboration d. Staff education ANS: C Interprofessional collaboration involves bringing representatives of the various disciplines together to work with patients and families to deliver quality care. This brings different points of view to the table to identify, clarify, and solve complex patient problems. Nursing practice is all nursing areas involved in one’s professional career. Staff communication involves sending a clear, accurate, and timely message to all members of the nursing staff; it focuses on nurses. Staff education involves planning in-service training sessions, sending staff members to professional conferences, and having staff members present case studies or practice issues during staff meetings. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 229 OBJ: Describe the process of interprofessional collaboration among nurses and health care providers. TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 16. A nursing student is seeing a patient for the first time this morning. Which action should the nursing student perform first? a. Focused patient assessment b. Patient health history c. Medication administration d. Documentation ANS: A When beginning a patient assignment, always conduct a focused but complete assessment of the patient’s condition and ask what outcomes the patient expects in his or her care. A patient health history is usually taken upon admission. Medication administration and documentation will occur after an assessment. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 231 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 17. A registered nurse is prioritizing care for four patients. Which patient should the nurse see first? a. A 44-year-old woman 1 day postoperative b. A 64-year-old man who had a stroke 2 days ago c. A 56-year-old woman with an acute asthma attack d. A 67-year-old man with a fractured hip ANS: C An acute asthma attack is a disruption in oxygen and must be addressed first. According to Maslow, meet the patient’s physiological needs such as oxygen, food, water, sleep, and elimination first. After meeting the physiological needs, meet the patient’s higher-level needs of safety, security, belonging, esteem, and self-actualization. A postoperative patient, a stroke, and a fractured hip are not as important as an acute asthma attack. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 231 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Planning MSC: NCLEX: Management of Care 18. A new nurse is learning how to prioritize time. One of the best ways that this can be accomplished is for the new nurse to focus on which of the following? a. Nursing tasks b. Patient priorities c. Medication schedule d. Ancillary procedures ANS: B Because nurses have a limited amount of time with patients, it is essential to remain goal oriented and focused on patients’ priorities. For example, priorities of care help you determine which procedures you perform first, patient assessments that you will do on an ongoing basis, and the anticipated response of your patient to care activities. The better you manage yourself leads to better management of your time. Patient priorities take precedence over nursing tasks, medication schedules, and ancillary procedures. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 232 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care 19. A staff nurse is caring for six patients and is working with nursing assistive personnel. Which task can the nurse safely delegate to the nursing assistive personnel? a. Patient assessment b. Patient discharge teaching c. Patient bed bath d. Patient medication administration ANS: C Daily, repetitive tasks of care such as basic hygiene, specimen collection, and feeding patients can be delegated. Delegation is the process of assigning part of one person’s responsibility to another qualified person in a specific situation. The nurse cannot delegate assessments or discharge teaching. Some medication administration can be delegated to licensed practical nurses, but not to nursing assistive personnel. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 234-235 OBJ: Discuss principles to follow in the appropriate delegation of patient care activities. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 20. A registered nurse requests that a nursing assistant give a patient a bath in the morning because the patient is going to surgery. As the nurse prepares the patient for surgery, the nurse notes that the patient has not received the bath, and it is too late to give one because surgery is calling for the patient. The nurse needs to give feedback to the nursing assistant. Where would be the most appropriate place for the nurse to provide the nursing assistant this feedback? a. In the hallway b. At the nurse’s station c. In the patient’s room d. In a private conference room ANS: D Give feedback in private to preserve the staff member’s dignity. If the staff member’s performance is not satisfactory, give constructive and appropriate feedback. Feedback given should be specific in regard to any mistakes that the staff members make, explaining how to avoid the mistake or a better way to handle the situation. When giving feedback, make sure to focus on things that are changeable, choose only one issue at a time, and give specific details. The hallway, nurse’s station, and patient’s room are too public for effective constructive feedback. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 235 OBJ: Discuss principles to follow in the appropriate delegation of patient care activities. TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care 21. A nurse is teaching a patient the side effects of a medication as the nurse is giving the medication to the patient. Which attribute did the nurse display? a. Efficient care b. Effective care c. Using resources d. Using team communication ANS: A The nurse used efficient care. Efficient care conserves effort and minimizes interruptions. One way to be efficient is by combining various nursing activities (i.e., doing more than one thing at a time). This takes practice. For example, during medication administration or while obtaining a specimen, combine therapeutic communication skills, teaching interventions, and assessment and evaluation. Effective care is doing the right things, whereas efficient care is doing things right. The nurse did not use resources (equipment, other staff nurses) or team communication (talking to other nursing personnel) in this scenario. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 231-232 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 22. Which action indicates the new nurse is fulfilling entry-level competencies? a. Acts as a patient advocate b. Develops a theoretical framework for how to practice c. Manages care of one patient d. Establishes a quality improvement plan for the unit ANS: A One of the competencies of an entry-level nurse is to be a patient advocate. Developing a theoretical framework is not a competency of a new nurse; that comes with experience and advanced education. An entry-level nurse should be able to care for several patients, not one. Establishing a quality improvement plan for the unit is a nurse manager’s role, not an entry-level competency. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 226 OBJ: Discuss ways to apply clinical care coordination skills in nursing practice. TOP: Nursing Process: Evaluation MSC: NCLEX: Safety and Infection Control 23. A nurse is assuming responsibility for a caseload of patients over a period of time. Which type of nursing care delivery models is the nurse practicing? a. Team nursing b. Primary nursing c. Interprofessional collaboration d. Decentralized management ANS: B Primary nursing is a model of care delivery in which a registered nurse assumes responsibility for a caseload of patients over time (e.g., a length of stay in a hospital or a series of home care visits). In team nursing, licensed vocational nurses/licensed practical nurses and assistive personnel work under the direction of the registered nurse. Interprofessional collaboration involves bringing representatives of the various disciplines together to work with patients and families to deliver quality care. Decentralized management includes decision making, which is moved down to the level of staff, involving all employees at all levels of activities. PTS: 1 DIF: Cognitive Level: Applying (Application) REF: 227 OBJ: Differentiate among the types of nursing care delivery models. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care 24. A nurse must give feedback to a nursing assistant that did not take vital signs. How should the nurse give feedback? a. “How can I trust you when things don’t get done like I asked?” b. “You are a bad assistant because you didn’t do your tasks.” c. “The vital signs were not taken. What happened?” d. “Where did you learn to take vital signs?” ANS: C The best approach is: “The vital signs were not taken. What happened?” When you give feedback, make sure to focus on things that are changeable, choose only one issue at a time, and give specific details. Feedback given should be specific regarding any mistakes that staff members make, explaining how to avoid the mistake or a better way to handle the situation. Saying, “How can I trust you?” and “You are a bad assistant.” are both derogatory and they do not tell what specific task was not done. Where did you learn to take vital signs is not something that can be changed. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) REF: 235 OBJ: Discuss principles to follow in the appropriate delegation of patient care activities. TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care MULTIPLE RESPONSE 1. A newly graduated nurse has been assigned to work with one assistive personnel staff member. When delegating skills, which guidelines should the nurse use? (Select all that apply.) a. Assign just bed making skills and feeding tasks. b. Assess the knowledge of the assistive personnel. c. Match tasks to the assistant’s skills. d. Have the nursing assistant document assessment findings. e. Assess skill levels of assistive personnel. AN