Chapter 04 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 04

Question 1

Type: MCSA

The nurse is providing care to patients for whom she has 24-hour accountability and responsibility. How would the nurse describe this care delivery system?

1. Team nursing

2. Functional nursing

3. Case method

4. Primary nursing

Correct Answer: 4

Rationale 1: In team nursing, patients are assigned to a nursing team that is usually led by an RN. The team is responsible for the patients care during the one shift of duty.

Rationale 2: Functional nursing is a delegation of tasks over one shift worked.

Rationale 3: The case method of delivering nursing care is sometimes referred to as total patient care. The RN has total care responsibility for the patient during the shift worked.

Rationale 4: Primary nursing is defined as a system in which each patient is assigned to a nurse who has 24-hour responsibility for the nursing care delivered to the patient.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-1

Question 2

Type: MCMA

The nurse works in a hospital that practices functional care delivery. Which statements represent common perceptions about this system?

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

Standard Text: Select all that apply.

1. My job is so boring.

2. My job is very satisfying.

3. Knowing that I am instrumental in my patients return to health is very joyful.

4. It is hard for me to see the impact of my work in helping patients get better.

5. As long as I do my job correctly, I am not responsible for when or how the patient gets better.

Correct Answer: 1,4,5

Rationale 1: Functional nursing requires the nurse to perform the same tasks on each shift. For example, the nurse may give medications to all patients on the unit. Nurses complain that the repetitive nature of the work becomes boring.

Rationale 2: Functional nursing is not known to produce job satisfaction. Nurses more often complain that it is tedious.

Rationale 3: In functional nursing, the nurse is not involved in the total process of helping the patient get better. Joyfulness is not a common feeling.

Rationale 4: Because tasks are fragmented, it is often difficult for the nurse to appreciate his or her role in helping the patient get well.

Rationale 5: There is a perceived lack of accountability for the patients return to health because tasks are so fragmented.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-1

Question 3

Type: MCMA

A hospital utilizes the functional nursing care delivery system, and patient satisfaction scores have been falling in each quarter of the past year. What is a likely reason for this decrease?

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

Standard Text: Select all that apply.

1. Utilization of advanced practice nurses on the unit

2. Efficient nursing staff

3. Lack of confidence in the caregivers

4. Lower health care costs

5. Fragmentation of the nursing care

Correct Answer: 3,5

Rationale 1: There is no indication that use of advanced practice nurses adversely impacts patient satisfaction.

Rationale 2: Functional nursing does result in tasks being done quickly and efficiently. This is not generally a reason patient satisfaction scores drop.

Rationale 3: Because care is distributed among so many different caregivers, the patient may not feel confident that care is individualized and appropriate. This can result in reduced patient satisfaction.

Rationale 4: Facilities choose the functional nursing model in an effort to be efficient and to lower labor costs by hiring lower-paid workers such as unlicensed assistive personnel. Lower health care costs, however, do not usually result in a decrease in patient satisfaction.

Rationale 5: Functional nursing is an industrial model of efficiency that resembles assembly-line tasking. The fragmentation of tasks among the nursing staff results in a perceived lack of accountability and increased frustration. This can result in low patient satisfaction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-1

Question 4

Type: MCSA

A registered nurse is seeking employment at a hospital with magnet status after hearing about the high nurse satisfaction at this hospital. High nursing satisfaction in a hospital with magnet status rating is a result of which commonality?

1. Unlicensed assistive personnel are used to perform direct patient care such as hygiene.

2. Charge nurses direct all care by tight control of nursing services.

3. Responsibility for care of the patient rests with the primary health care provider rather than the nurse.

4. Nurses have a great deal of professional autonomy.

Correct Answer: 4

Rationale 1: There is no evidence that using unlicensed assistive personnel increases nurse satisfaction.

Rationale 2: The focus of the magnet hospital is nurse autonomy. Charge nurses assist and manage day-to-day operations in the unit but leave most decision making about patient care to the nurse providing that care. This improves nurse satisfaction.

Rationale 3: Responsibility for care resting with the primary health care provider does not support nurse satisfaction.

Rationale 4: In a magnet hospital, nursing services are designed to provide the individual nurse with autonomy. This leads to greater nurse satisfaction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-1

Question 5

Type: MCSA

A registered nurse (RN) wants to delegate the insertion of an intravenous catheter (IV) to a licensed practical nurse (LPN/LVN). The RN bases the decision to delegate on which factor?

1. The RN does not have time to start the IV.

2. Inserting an IV catheter is within the scope of the LPN/LVN role according to the states nurse practice act.

3. The RN has not started an IV since nursing school.

4. The RN does not have time to evaluate the outcome of the procedure.

Correct Answer: 2

Rationale 1: The time involved in the procedure is not a valid criterion for delegation; delegation is based on competency, qualifications, job descriptions, and state nurse practice acts.

Rationale 2: The states nurse practice act defines the scope of responsibility and grants the authority to delegate based on the competency and qualification of the person who is receiving the delegation.

Rationale 3: The RN must know how to supervise the personnel to whom he/she delegates and must intervene when necessary.

Rationale 4: The RN retains the responsibility of evaluating the outcome of the procedure even if the UAP performs the procedure.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-3

Question 6

Type: MCMA

A registered nurse desires to work at a hospital close to her home. A nurse who works at the hospital tells her that he spends much of his day delegating to unlicensed assistive personnel (UAPs). The nurse realizes that the hospital practices one of which types of care delivery?

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

Standard Text: Select all that apply.

1. Functional nursing

2. Primary nursing

3. Team nursing

4. Case method

5. Relationship-based care

Correct Answer: 1,3

Rationale 1: Functional nursing relies heavily on unlicensed assistive personnel to complete required tasks.

Rationale 2: In primary nursing, the RN has 24-hour responsibility for all care. Care is provided by registered nurses.

Rationale 3: Team nursing often employs an RN as a team leader with other RNs, LPNs or LVNs, and UAPs providing care at the RNs direction.

Rationale 4: In the case method, the RN provides all care to a patient for the time on duty.

Rationale 5: Relationship-based care is a form of primary care. Primary care is delivered by registered nurses.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-2

Question 7

Type: MCSA

The nurse manager has been charged with evaluating whether the current system of team nursing is efficient and cost-effective for the unit. Which statement supports the cost-effectiveness of team nursing on this unit?

1. Team nursing is cost-effective because it allows for the use of unlicensed assistive personnel to provide care delegated by the registered nurse.

2. Research concludes that team nursing is the most cost-effective care delivery system.

3. Managed care organizations provide financial incentives to institutions that use team nursing as a means to decrease the high cost of registered nurse salaries.

4. The Institute of Medicines 2004 report Keeping Patients Safe identified team nursing as the most cost-effective care delivery system.

Correct Answer: 1

Rationale 1: In response to nursing shortages, health care institutions tend to utilize a nursing care delivery system that uses a variety of licensed nurses and unlicensed assistive personnel. Team nursing is a model that utilizes licensed and unlicensed personnel.

Rationale 2: Nurse researchers have not found sufficient evidence that supports any one particular model of care delivery as the most cost-effective.

Rationale 3: Managed care financial initiatives are centered on directing patients to the most cost-effective and efficient treatment center.

Rationale 4: The Institute of Medicine has not found sufficient evidence to support any one particular model of care delivery as the most cost-effective.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-4

Question 8

Type: MCSA

A state has experienced an economic downturn and a shortage of registered nurses. Which nursing care delivery model would hospital administrators be likely to avoid?

1. Case method

2. Team nursing

3. Primary care nursing

4. Functional nursing

Correct Answer: 3

Rationale 1: The case method requires a nursing staff made up exclusively of registered nurses but is generally reserved for intensive care units. It is not practiced hospital wide. The use of RNs in these units is cost-effective.

Rationale 2: Team nursing allows for the inclusion of LPNs or UAPs who are paid less than RNs.

Rationale 3: Primary care nursing may not be the preferred system during downturns in the economy and cyclical nursing shortages because of the perception that labor costs are high due to the large numbers of registered nurses employed by a facility.

Rationale 4: Functional nursing allows for the inclusion of LPNs and UAPs who are paid less than RNs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-4

Question 9

Type: MCSA

The nurse administrator is considering employing an advanced practice nurse. The administrator would refer to which documents to determine this nurses role in the hospitals nursing care delivery model?

1. The State Board of Nursing scope of practice information

2. The job description for the advanced practice nurse

3. The Joint Commission standards for nursing practice

4. The curriculum of the advanced practice nurses educational program

Correct Answer: 1

Rationale 1: The State Board of Nursing determines the scope of practice of the advanced practice nurse.

Rationale 2: The job description delineates the roles and responsibilities of individuals within an organization and is written by the nurse administrator.

Rationale 3: The Joint Commission does not determine the scope of practice for nursing.

Rationale 4: The advanced practice nurse is a registered nurse with advanced education, knowledge, and skills. The curriculum of the education program does not determine the nurses role.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-5

Question 10

Type: MCSA

The nurses chief function is to collaboratively plan, coordinate, and evaluate services in a cost-effective manner. The nurse fulfills which role within the care delivery system?

1. Nurse practitioner

2. Clinical nurse specialist

3. Clinical nurse leader

4. Case manager

Correct Answer: 4

Rationale 1: The nurse practitioner in the hospital setting extends the health care providers capabilities and offers consultative services to the registered nurse in all delivery care models.

Rationale 2: The clinical nurse specialist can provide expertise and education to the bedside nurse in all care delivery systems.

Rationale 3: The clinical nurse leader manages patient services across multidisciplinary boundaries at the bedside and can be a resource to the bedside nurse.

Rationale 4: The chief function of the case manager is to collaboratively plan, coordinate, and evaluate services in a cost-effective manner.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-5

Question 11

Type: MCMA

The nurse is considering returning to school to become a clinical nurse leader (CNL). The nurse would prepare for which characteristics of the new position?

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

Standard Text: Select all that apply.

1. Spending the majority of time away from the bedside educating other nurses

2. Having patient safety as a focus of the work

3. Serving as the director of nursing services

4. Having quality improvement as a focus of the work

5. Helping to coordinate the care provided by unit nurses

Correct Answer: 2,4,5

Rationale 1: The CNL continues to provide direct patient care.

Rationale 2: The CNL serves as a catalyst for patient safety.

Rationale 3: The CNL role is not administrative in nature.

Rationale 4: The CNL serves as a catalyst for quality improvement.

Rationale 5: The CNL role is envisioned as coordinating care.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-2

Question 12

Type: MCMA

A nurse executive is writing the job description for the hospitals newly created case manager position. Which job responsibilities should the executive include?

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

Standard Text: Select all that apply.

1. Collaborating across disciplines to plan patient care

2. Coordinating care to increase cost-effectiveness

3. Developing nursing service work schedules

4. Reducing fragmentation of care

5. Determining when the patient can be discharged from the facility

Correct Answer: 1,2,4

Rationale 1: The case manager collaborates with primary health care providers and ancillary services to plan patient care.

Rationale 2: Coordination of complex patient care helps to increase cost-effectiveness.

Rationale 3: The case manager does not develop the nurses work schedules.

Rationale 4: The case manager sees the big picture of the patients care and can offer guidance and suggestions on how to provide that care seamlessly.

Rationale 5: The case manager may work with the primary health care provider to make this determination but does not make it independently.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-2

Question 13

Type: MCSA

The nurse is uncomfortable with the technical skills demonstrated by a newly employed licensed practical nurse (LPN/LVN). A patient is to have an indwelling urinary catheter placed. How should the nurse proceed?

1. Insert the catheter without involving the LPN/LVN.

2. Delegate the task to the LPN/LVN and hope that all goes well.

3. Have the LPN/LVN observe the nurse placing the catheter.

4. Observe as the LPN/LVN completes the task.

Correct Answer: 4

Rationale 1: Inserting the catheter without involving the LPN/LVN does not improve practice for the future.

Rationale 2: The nurse must be confident in delegation.

Rationale 3: Having the LPN/LVN observe is not a good use of time and does not further the delegation process.

Rationale 4: The nurse must be confident in delegation. Observing as the LPN/LVN performs the task will either confirm the nurses concerns or prove that the LPN/LVN is competent in this skill.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-3

Question 14

Type: MCSA

Which scenario is an example of correct delegation?

1. The nurse asks the unlicensed assistant to bathe a patient before surgery.

2. The nurse asks the unlicensed assistant if a patient tolerated ambulating in the hall.

3. The nurse instructs the unlicensed assistant to check the patients lung sounds for crackles.

4. The nurse asks the unlicensed assistant to see if the patients hourly urine output is adequate.

Correct Answer: 1

Rationale 1: Provision of hygienic care is a common role of unlicensed assistants and can be delegated.

Rationale 2: The unlicensed assistant cannot evaluate the outcome of an intervention. The assistant can only give the nurse facts about the patients response, and the nurse determines if the patient tolerated the intervention.

Rationale 3: The unlicensed assistant cannot perform nursing assessment.

Rationale 4: The unlicensed assistant cannot make this evaluation. The nurse should ask for the amount of output and make the evaluation, or ask the assistant to see if the output is above a specific amount.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-3

Question 15

Type: MCSA

A hospitals nursing administration is considering moving to a patient-centered care model. What are the benefits of this model?

1. It is less expensive as it requires fewer registered nurses.

2. Care can be provided more efficiently.

3. This care delivery method increases patient satisfaction.

4. It standardizes care, therefore reducing the need for large supply or medication inventories.

Correct Answer: 3

Rationale 1: Patient-centered care does not reduce the number of registered nurses needed to provide care.

Rationale 2: Efficiency is not the goal of patient-centered care.

Rationale 3: The strong customer focus tends to increase patient satisfaction.

Rationale 4: Patient-centered care is not standardized but is individualized.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-6

Question 16

Type: MCSA

Which statement describes a nurse providing community-based care?

1. A nurse who develops curriculum for use in elementary schools across the United States

2. A nurse who monitors steel industry compliance with government health regulations

3. A nurse who establishes policy for a states homeless shelters

4. A nurse who performs physical examinations in a free clinic

Correct Answer: 4

Rationale 1: This nurse is providing care to a population rather than to a community.

Rationale 2: This nurse is providing care to a population rather than to a community.

Rationale 3: This nurse is providing care to a population rather than to a community.

Rationale 4: This nurse is focused on the patients in a community.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-6

Question 17

Type: MCMA

A clinic has instituted a program of disease management. The nurse administrator would describe the clinics work using which statements?

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

Standard Text: Select all that apply.

1. The clinic will address high-cost chronic illnesses.

2. Proactive case management will be a part of the clinics work.

3. Prevention will be a major focus.

4. Patient anonymity will be protected by clinic regulations.

5. Early detection and early intervention are among the clinics goals.

Correct Answer: 1,2,3,5

Rationale 1: The goal of disease management is to address high-cost, chronic illnesses or conditions.

Rationale 2: Proactive care management is a major aspect of disease management.

Rationale 3: Prevention is a major aspect of disease management programs.

Rationale 4: One of the important aspects of disease management is comprehensive tracking of patient outcomes. Anonymity cannot be preserved, but HIPAA regulations should be observed.

Rationale 5: A continuum of chronic illness care includes early detection and early interventions.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-6

Question 18

Type: MCSA

How would the nurse explain how acute care nursing is different from community-based care?

1. Acute care focuses on short-term nursing interventions.

2. In acute care, illness is seen as a part of living.

3. The purpose of acute care is to improve functional capacity and quality of life.

4. Nursing autonomy is greater in acute care practice.

Correct Answer: 1

Rationale 1: Patients requiring acute care rarely remain hospitalized for long periods, so nursing interventions focus on short-term goals.

Rationale 2: In acute care, illness is seen as the opposite of health. Community-based care is more likely to view illness as a part of living.

Rationale 3: The purpose of acute care is to cure illness, while community-based care focuses on returning the patient to full functional capacity and improving quality of life.

Rationale 4: Nursing practice in the community allows the nurse greater autonomy with therapeutic interventions.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-6

Question 19

Type: MCMA

Which characteristics of the primary nursing model make it a good match with the goals of the IOM and National Quality Forum?

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

Standard Text: Select all that apply.

1. There are fewer RNs, so care is less expensive.

2. Primary nursing creates new possibilities for collaborative success.

3. Primary nursing supports efforts to make patient care safer.

4. The model allows the nurse to coordinate care across many disciplines.

5. Primary nursing reduces the need for communication and documentation.

Correct Answer: 2,3,4

Rationale 1: Primary nursing uses a richer mix of RNs, which has been found to support patient safety.

Rationale 2: The primary nursing model emphasizes relationship-based care, which supports collaboration.

Rationale 3: The coordination of care possible in primary care leads to greater patient safety.

Rationale 4: Primary care nursing allows one person, the nurse, to have the big picture of the patients care. This helps the nurse coordinate and manage the multidisciplinary team of health care workers.

Rationale 5: Communication, both verbal and written, continues to be an essential part of the primary nursing model.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-6

Question 20

Type: MCMA

The nurse is aware that skill in collaboration will be necessary for success as changes occur in the delivery of health care. The nurse should develop which skills in preparation for these changes?

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

Standard Text: Select all that apply.

1. Effective communication

2. Knowledge of the history of nursing

3. A reputation for mutual respect and trust with colleagues across disciplines

4. Good decision-making skills

5. Ability to influence people and change their point of view

Correct Answer: 1,3,4

Rationale 1: Effective communication is a key part of collaboration.

Rationale 2: While respect for the history of nursing is important, it is not an essential collaborative skill.

Rationale 3: Mutual respect and trust are essential for collaboration to be successful.

Rationale 4: To be skilled at collaboration, the nurse must be skilled at making good, independent decisions about patient care and health care issues.

Rationale 5: Collaboration is not based on the ability to change another persons point of view.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-6

 

Leave a Reply