Test Bank Nursing Delegation and Management of Patient Care 2nd Edition Motacki

Test Bank Nursing Delegation and Management of Patient Care 2nd Edition Motacki Table of Contents Chapter 01: Leadership and Management .............................................................................................2 Chapter 02: Organizational Structure of Health Care .............................................................................8 Chapter 03: Strategic Management and Planning ............................................................................... 12 Chapter 04: Financial Management in Health Care ............................................................................. 19 Chapter 05: Healthcare Regulatory and Certifying Agencies ............................................................... 24 Chapter 06: Organizational Decision Making and Shared Governance ............................................... 29 Chapter 07: Professional Decision Making and Advocacy ................................................................... 32 Chapter 08: Communication in the Work Environment ........................................................................ 34 Chapter 09: Personnel Policies and Programs in the Workplace ......................................................... 41 Chapter 10: Professional Development ............................................................................................... 54 Chapter 11: Professional Practice and Care Delivery Models and Emerging Practice Models .............. 56 Chapter 12: Staffing and Scheduling ................................................................................................... 59 Chapter 13: Delegation of Nursing Tasks ............................................................................................ 68 Chapter 14: Providing Competent Staff ............................................................................................... 76 Chapter 15: Group Management for Effective Outcomes .................................................................... 81 Chapter 16: Hospital Information Systems ........................................................................................... 87 Chapter 17: Ethical and Legal Issues in Patient Care .......................................................................... 94 Chapter 18: Improving Organizational Performance .......................................................................... 100 Chapter 19: Evidence-Based Practice ............................................................................................... 105 Chapter 20: Monitoring Outcomes and the Use of Data for Improvement .......................................... 112 Chapter 21: New Graduates: The Immediate Future: Job Interviewing, NCLEX, and Continuing Education .......................................................................................................................................... 115 1 | P a g eChapter 01: Leadership and Management MULTIPLE CHOICE 1. Nurses can be leaders without being managers. Which nursing actions demonstrate leadership? a. Assisting a new nurse with enteral tube feedings b. Counseling a new nurse regarding attendance c. Adjusting assignments after a staff member calls in sick d. Calling a physician for new order clarification ANS: A Leaders act as role models and mentor new staff. The other options are incorrect because they are management responsibilities and not leadership roles. DIF: Cognitive Level: Application REF: page 6 2. Which nursing actions demonstrate the role of management in nursing? a. Encouraging autonomous decision making b. Observing the documentation of appropriate charges to patients c. Assisting in a code d. Asking the patient/family about advance directives ANS: B Managers are responsible for the budget of their units. The other options are incorrect because those are leadership or mentoring role DIF: Cognitive Level: Application REF: page 6 3. Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities? a. A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A staff nurse acts quickly when a cardiac arrest is called on her patient. c. A staff nurse notifies another staff member that she is being “pulled” today. d. A new nurse volunteers to work when another staff member must leave work because her child is ill. ANS: A Nurse leaders are interested in changing practice based on evidence. Options B and D are incorrect because they are actions taken by nurses as part of the functional structure of the unit. Option C is incorrect because it is an action taken by a manager. DIF: Cognitive Level: Analysis REF: page 6 4. A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager? a. A nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A nurse acts quickly when a cardiac arrest is called on her patient. c. A nurse notifies another staff member that she is being “pulled” today. d. A nurse volunteers to work when another staff member must leave work because her child is ill. 2 | P a g eANS: C Determining who gets “pulled” is a management decision. Option A is incorrect because it is a role taken by a nurse leader. Option B is incorrect because it is an action taken by staff as part of the functional structure of the unit. Option D is incorrect because it is an action taken by staff as part of the functional structure of the unit. DIF: Cognitive Level: Analysis REF: page 6 5. A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice. ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because excellence in practice is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 6 6. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation. ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because it is not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 10 7. The student nurse, shadowing on a medical-surgical unit, observes the charge nurse. Which action would the student identify as a leadership quality in the nurse’s actions? a. Making patient care assignments distributed equally to staff b. Sitting with a confused combative patient c. Calling the nursing office for extra staff when an RN calls in sick d. Assisting in a code ANS: B Leaders act as role models and do what is right for the patient. The other options are incorrect because these actions are expected as part of the functioning of the unit. DIF: Cognitive Level: Analysis REF: page 5 8. Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business? a. Ability to pressure staff to do what you want 3 | P a g eb. Resource utilization c. Cutting corners to make money d. Providing bonuses to staff members who help the organization to save money ANS: B The ability to manage a budget is essential to being a manager in health care today. The other options are incorrect because they are only a perception of the public regarding successful managers. DIF: Cognitive Level: Application REF: page 3 | page 7 9. The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict? a. Coordinating institutional goals with the immediate demands of the clinical area b. Determining which of the staff members should get better raises than other members c. Deciding which employees should be recommended for promotion d. Determining which staff members get Christmas day off ANS: A Many times the goals of the institution conflict with the goals of the individual employees of a particular clinical area and the nurse manager must implement institutional changes regardless of the nurse’s personal opinion. The other options are incorrect because those roles should not provoke as much conflict. DIF: Cognitive Level: Application REF: pages 7-8 10. Nurse managers can best be described as people who a. develop institutional goals based on staff suggestions. b. develop institutional goals based on a personal theory. c. motivate staff to meet institutional goals through positional power. d. inspire staff to meet institutional goals through personal power. ANS: C Managers motivate staff to make changes. Options A and B are incorrect because nurse managers usually do not make institutional goals. Option C is incorrect because leaders inspire, not managers. DIF: Cognitive Level: Application REF: page 6 11. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because reevaluating the nursing policy permitting IV push of certain medications by RNs is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because designating assignment of new 4 | P a g eadmissions would be the responsibility of the charge nurse. DIF: Cognitive Level: Analysis REF: page 7 12. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A Establishing objectives should be seen in the planning step following identification of the problem. Option B is the organizing step. Option C is the directing step. Option D is the controlling step. DIF: Cognitive Level: Application REF: page 7 13. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit ANS: D Decision making is a result of the other steps. The other options are different steps in the management process. DIF: Cognitive Level: Application REF: page 7 14. First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds ANS: B Managing the unit budget is the sole responsibility of the nurse manager and first- level manager. The other activities are not specific to first-level managers. DIF: Cognitive Level: Application REF: page 7 15. Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B The middle-level manager is solely responsible for planning changes and presenting them 5 | P a g eto upper-level managers. The other activities are not the exclusive responsibility of the middle-level manager. DIF: Cognitive Level: Application REF: pages 8-9 16. Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels. DIF: Cognitive Level: Application REF: page 9 17. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff. ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other actions may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills. DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. To become a leader, one must develop certain personal aspects. Which of the following can be identified as competencies expected in creating leadership in oneself? (Select all that apply.) a. Asking for overtime b. Asking for certain patient assignments c. Personal and professional accountability d. Acquiring advanced degrees e. Personal discipline ANS: C, D, E Options C, D, and E are competencies identified in the text for developing leadership in oneself. Although they may be associated with a good work ethic, the other options do not apply to the development of leadership competencies. DIF: Cognitive Level: Analysis REF: page 11 2. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) a. Work allocation 6 | P a g e REF: page 9b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D Options A, B, and D are correct because the text lists these as fundamental elements of any patient care delivery system. Options C, E, and F are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: Application REF: page 7 3. A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which (Select all that apply.) a. a staff nurse provides advice and guidance to new nurses. b. a clinical ladder is used for advancement. c. a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them. d. annual performance appraisals are provided with competitive raises. e. decisions are made from the top down. ANS: A, B, C Options A, B, and C are correct because a transformational leadership environment encourages consultation and collaboration, empowering and motivating staff. The other options are examples of transactional leadership. DIF: Cognitive Level: Analysis REF: page 5 4. A nurse leader, according to the American Organization of Nurse Executives (AONE), is competent in the areas of (Select all that apply.) a. knowledge of the health care environment. b. communication. c. business management. d. demanding participation by the staff. e. providing a financial incentive. ANS: A, B, C Options A, B, and C are identified by AOEN as a competencies of nurse leaders. The other options are not competencies recommended by the AOEN. DIF: Cognitive Level: Analysis REF: pages 8-9 5. The organizational hierarchy is used in which of the following situations? (Select all that apply.) a. A staff member is observed taking money from a patient’s bedside table. b. A staff member is found to be drinking alcohol while at work. c. A nurse refuses to care for a patient receiving peritoneal dialysis because he has not been trained on this procedure. d. A nurse refuses to be floated to the ICU while still in orientation. e. A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient. ANS: A, B, E Options A, B, and E are correct because inappropriate actions by staff are managed by the hierarchy of any organization. Options C and D are incorrect because they are 7 | P a g escenarios requiring actions not relegated to the hierarchy of the organization. DIF: Cognitive Level: Analysis REF: page 5 Chapter 02: Organizational Structure of Health Care MULTIPLE CHOICE 1. In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent “floating.” b. self-scheduling. c. cover of another nurse’s assignment while she or he is on break. d. hourly pay differential for the night shift. ANS: B In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization. DIF: Cognitive Level: Application REF: page 16 2. The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies. b. the financial environment of the patient population c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit. ANS: A Patient delivery models are instituted based on various elements including clinical decision-making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options do not describe a fundamental element used in the decision-making process for delivery mode. DIF: Cognitive Level: Application REF: page 19 3. An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths b. RN taking vital signs and giving baths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery ANS: C In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all 8 | P a g etypes of health care delivery models. DIF: Cognitive Level: Application REF: page 20 4. In which health care delivery model would the nurse expect to see “point-of-care” decision making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing ANS: A Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options are incorrect because they may not allow for the autonomy required for “point-of-care” decisions. DIF: Cognitive Level: Application REF: page 21 5. A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice. ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 16 6. Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Changes can be made rapidly based on immediate needs. c. Nurses must work under a dual-authority structure. d. Decisions can be made at the “point of care.” ANS: A In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed. DIF: Cognitive Level: Application REF: page 16 7. What should the nurse expect when working in a product-line leadership structured environment? a. Coordination of all services within the specialty 9 | P a g eb. Slow organizational response to environmental changes c. Individual service goals d. Each service area autonomous to the others ANS: A In product- or service-line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product-line leadership and is an example of leadership without coordination. DIF: Cognitive Level: Application REF: page 17 8. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation. ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 19 9. A nurse who is interested in developing clinical decision-making skills would look for a unit that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management ANS: A Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other options do not necessarily promote the development of decision-making skills. DIF: Cognitive Level: Application REF: page 21 10. A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway. ANS: B The nurse delegates and works collaboratively with the members of the team in team nursing. Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing. DIF: Cognitive Level: Application REF: page 10 11. A nurse working on a unit using the primary care delivery model would expect to observe which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. 10 | P a g eb. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morning dose of insulin for a patient scheduled for surgery later that day. ANS: D In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models. DIF: Cognitive Level: Analysis REF: page 21 12. Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments. ANS: A The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models. DIF: Cognitive Level: Analysis REF: page 21 13. In a team nursing health care delivery model environment, the nurse would observe for which action by the staff? a. The UAPs answer all call lights. b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients’ call lights. d. The RN is notified when there are patient care complaints. ANS: D Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing. DIF: Cognitive Level: Analysis MULTIPLE RESPONSE 1. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: Application 11 | P a g e REF: pages 18-19 REF: page 21Chapter 03: Strategic Management and Planning MULTIPLE CHOICE 1. When applying for a management position, the nurse should ask about the goals and plans of the hospital. Strategic plans must be developed around a. the mission statement. b. patient population. c. staff input. d. infection rates. ANS: A The strategic plan of an organization must comply with the mission statement. The other factors are incorrect because although they may influence the overall plan, the plan can never stray from the mission statement. DIF: Cognitive Level: Application REF: page 28 2. The strategic plan of an organization includes all stakeholders of the organization, including nurse managers. Which explains the benefit of including nurse managers in developing plans for the organization? a. Nurse managers own stock in the business. b. Nurse managers understand the clinical areas. c. Nurse managers will be involved in implementing the changes. d. Nurse managers have had business courses. ANS: C Nurse managers will be important in the implementation of the plan at the unit level. Option A is not true. Option B is not a reason for including nurse managers. Option D is not a reason for including nurse managers. DIF: Cognitive Level: Analysis REF: page 28 3. Nurse managers are included in strategic planning for the institution because of which principle? 12 | P a g ea. Nurse managers have the authority to terminate employees. b. Nurse managers encourage “buy-in” from staff. c. Nurse managers understand the need for the plan. d. Nurse managers understand the