Chapter 14: Organizing Patient Care

1. Which aspect of care at a long-term care facility most clearly suggests that a functional model of care delivery is being used?

a. One nurse is assigned to provide all of a resident's care during a shift.

b. Unlicensed assistive personnels (UAPs) coordinate each resident's care and occasionally delegate to practical nurses.

c. Registered nurses perform all assessments while UAPs provide all feeding and hygiene.

d. A pairing of one registered nurse and one practical nurse provides all the care for a designated pool of residents.

c. Registered nurses perform all assessments while UAPs provide all feeding and hygiene.

2. The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of?

a. Team nursing

b. Case method nursing

c. Primary care delivery

d. Functional nursing care

d. Functional nursing care

3. A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment?

a. Planning nursing care independently of others

b. Assigning work according to the expertise of group members

c. Being responsible for care planning only during the shift when he or she works

d. Carrying out the majority of personal care for assigned patients

b. Assigning work according to the expertise of group members

4. A registered nurse is providing care in a setting that uses modular nursing. What task should the nurse perform during a shift?

a. Providing every aspect of care to one half to one third of the mini-team's assigned patients

b. Collaborating with another registered nurse to plan the care of all the mini-team's assigned patients

c. Confirming that each member of the mini-team is completing his or her assigned tasks

d. Providing total patient care to the most acutely ill patients that the mini-team is assigned

c. Confirming that each member of the mini-team is completing his or her assigned tasks

5. A nurse-manager is advocating for a switch from team nursing to primary nursing care. What characteristic of primary nursing care should the manager describe to decision makers?

a. It requires minimal RN staffing.

b. It is comparatively easy to implement.

c. Many nurses find it stimulating and challenging.

d. It eliminates the need for UAP or practical nurses

c. Many nurses find it stimulating and challenging.

6. A nurse-manager has recently learned that the health-care facility will be moving toward a case management approach. What factor is most likely driving this change?

a. The need to address cost-effective options for care

b. The need to provide challenging work for nurses and other members of the care team

c. The need to enhance professionalism throughout the organization d. The need to obtain magnet designation

a. The need to address cost-effective options for care

7. A change in the patient care delivery system has been mandated on a hospital unit. The manager can best ensure the successful introduction of a new delivery system by:

a. assigning a senior registered nurse to lead the implementation.

b. explaining the implications of the proposed change to patients and families.

c. carefully studying the best method for implementing the planned change.

d. hiring nurses who have experience in providing the new delivery system.

c. carefully studying the best method for implementing the planned change.

8. What is the primary focus of case management in prioritizing client care?

a. Assessing each client's needs individually

b. Minimizing costs to the organization

c. Minimizing costs to the patient

d. Applying the principles of team nursing

a. Assessing each client's needs individually

9. A nurse is practicing in a case management context and a patient has been following a multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the patient's health status is not improving as quickly as expected and the patient is deviating from the MAP. What is the nurse's best action?

a. Cancel the patient's current MAP and call a meeting to select a new one.

b. Document the presence of a variance in the MAP.

c. Collaborate with the care team to arrange a transfer to a new setting.

d. Cancel the current MAP and adopt customized, rather than standardized care.

b. Document the presence of a variance in the MAP.

10. The nurse is providing care in a setting that uses a team nursing approach. What should be integrated into the routines in the health-care facility?

a. Inclusion of the patient and family as members of the team

b. Opportunities for UAP and practical nurses to increase their education level

c. Frequent communication between team members

d. Use of multidisciplinary action plans (MAPs)

c. Frequent communication between team members

11. The majority of patients whose care is organized by case management have contact with the health-care system in what acute care setting?

a. Emergency department

b. Ambulatory clinics

c. Primary care provider offices

d. Perioperative settings

a. Emergency department

12. Which patient would be most likely to benefit from a disease management approach within the context of case management?

a. A client who is being treated for a ruptured tympanic membrane

b. A client who has chronic obstructive pulmonary disease (COPD)

c. A client who has been diagnosed with a postpartum hemorrhage (PPH)

d. A client being treated for a transfusion reaction after receiving packed red blood cells

b. A client who has chronic obstructive pulmonary disease (COPD)

13. What is one of the most important differences between case management and disease management?

a. Disease management referrals begin in the hospital inpatient setting.

b. Disease management is a collaborative process to meet patient needs.

c. High-cost population groups are specifically targeted in disease management.

d. Disease management treatment is episodic.

c. High-cost population groups are specifically targeted in disease management.

14. A large health-care organization is reconsidering the model of patient care delivery. What factor should be prioritized in this decision?

a. Patient needs

b. Staff expertise

c. Cost

d. Physical layout of the facility

a. Patient needs

15. A registered nurse is paired with a practical nurse and the two nurses are working together to provide all the needs for a group of patients. What type of nursing care delivery are these nurses demonstrating?

a. Total patient care

b. Functional nursing

c. Modular nursing

d. Primary care nursing

c. Modular nursing

16. Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination for the patient?

a. One

b. Two

c. Three

d. Four

a. One

17. A nurse can directly address one of the Institute of Medicine's recommendations to improve practice environment by:

a. facilitating open communication and shared decision making.

b. advocating for caps on the maximum allowable nurse-patient ratio. c. adopting a functional nursing model whenever the setting allows. d. becoming a nurse navigator who is centered on patients' needs.

a. facilitating open communication and shared decision making.

18. A nurse is following a multidisciplinary action plan (MAP) when caring for a new patient. The nurse should identify what components within the MAP? Select all that apply.

a. Cost analysis of major interventions

b. Identity of the nurse navigator

c. Critical path

d. Nursing care plan

e. Indication of times when nursing interventions occur

c. Critical path

d. Nursing care plan

e. Indication of times when nursing interventions occur

19. A patient who has just been diagnosed with lung cancer has been assigned a nurse navigator. What task should the nurse prioritize in this role?

a. Providing evidence-based guidance on treatment options and treatment decisions

b. Providing clinical leadership and ensuring quality for the patient's care

c. Guiding the patient in an effort to provide high-quality managed care

d. Guiding the patient and family through their various interactions with the health-care system

d. Guiding the patient and family through their various interactions with the health-care system

20. An experienced registered nurse has begun a position as a clinical nurse-leader (CNL). In this role, what tasks should the nurse perform? Select all that apply.

a. Collaborating with the interdisciplinary team

b. Guiding patients and families through the health-care system at various sites

c. Coaching nurses to provide evidence-based care

d. Introducing quality improvement initiatives

e. Preceptoring senior nursing students

a. Collaborating with the interdisciplinary team

c. Coaching nurses to provide evidence-based care

d. Introducing quality improvement initiatives

21. A clinical site has a diverse skill mix that includes registered nurses, practical nurses, and UAPs. Senior management is proposing a shift from team nursing to primary nursing. What effect will the skills mix have on this transition?

a. Implementation of primary nursing will likely require hiring more UAPs and laying off some RNs.

b. Implementation of primary nursing will likely require hiring more RNs, and laying off some UAPs.

c. With adequate resources, primary nursing can be successfully implemented with the existing skills mix.

d. Primary nursing is most successful if every member of the team providing direct patient care is an RN.

b. Implementation of primary nursing will likely require hiring more RNs, and laying off some UAPs.

22. Which statement demonstrates an intervention focused on the primary disadvantage of team nursing?

a. "We are working with one fewer team member today."

b. "The team will be meeting for a care report update in 5 minutes."

c. "Our patient assignment is comprised of both males and females." d. "We will be having a member of the float pool on our team today."

b. "The team will be meeting for a care report update in 5 minutes."

23. Which statements demonstrate an understanding of the factors that should be considered when a change in the care delivery system is being proposed? Select all that apply.

a. "We have determined that our level of care would improve if we provided it differently."

b. "It's questionable whether our current nursing staff is large enough to support the proposed change."

c. "We will discuss our proposed change with the multidisciplinary team members."

d. "Administration has been supportive of the planned change in our care delivery system."

e. "We're going to make our decision based on which option is newest in the literature."

a. "We have determined that our level of care would improve if we provided it differently."

b. "It's questionable whether our current nursing staff is large enough to support the proposed change."

c. "We will discuss our proposed change with the multidisciplinary team members."

d. "Administration has been supportive of the planned change in our care delivery system."

24. Which historical event is known that have had a major effect on the delivery model of nursing care?

a. Emergence of antibiotic-resistant microorganisms in the 1990s

b. Increases in patient empowerment during the 1970s and 1980s

c. High rates of infection, death, and disability during the Civil War

d. Shifts from home-based care to hospital-based care during the 1930s

d. Shifts from home-based care to hospital-based care during the 1930s

25. A nurse-manager is part of a committee that has been commissioned to change the care delivery model at a health-care facility. When planning this change, the nurse and the other committee members should be aware that this process will:

a. be difficult to implement without hiring staff who have experience with the new model.

b. affect social relationships and group functioning in the workforce. c. require equal input from every staff member during the planning stage.

d. be best conducted by objective consultants from outside the organization.

b. affect social relationships and group functioning in the workforce.

26. The emergency room nurse is assessing a patient who has presented with an exacerbation of recently diagnosed irritable bowel syndrome. The patient states that he is "overwhelmed" and "bewildered" by the mix of diagnostic tests, appointments, and consultations since he was diagnosed. What is the nurse's best action?

a. Acknowledge the difficulty of the patient's circumstances and arrange for a nurse navigator.

b. Validate the patient's concerns and liaise with the clinical nurse-leader (CNL).

c. Offer to mediate between the patient and the case manager.

d. Offer to accompany the patient to any upcoming appointments.

a. Acknowledge the difficulty of the patient's circumstances and arrange for a nurse navigator.

27. An experienced nurse is applying for a position as a clinical nurse-leader (CNL). In addition to the nurse's clinical experience, what characteristic best qualifies the nurse for this position?

a. The nurse currently sits on the hospital's ethics board.

b. The nurse has consistently adhered to the standards of practice.

c. Specialty certification in a specific area of practice.

d. The nurse has a Master of Science in nursing degree.

d. The nurse has a Master of Science in nursing degree.

28. A nurse-manager sits on the hospital's board of directors and there has been repeated discussion about the possibility of changing the care delivery model. What action should be performed first?

a. Elicit support from internal and external stakeholders.

b. Perform a cost-benefit analysis of the major alternatives for care delivery.

c. Assess the strengths and weaknesses of the current delivery model.

d. Plan a pilot project where the delivery model will be changed on one subacute unit.

c. Assess the strengths and weaknesses of the current delivery model.

29. A primary health-care teams (PHCT) has been established to coordinate the care of a patient with complex health-care needs. What should be the nurse's primary role in this team?

a. Communicate the wishes of the patient to the other team members. b. Weigh the benefits of suggested interventions with their costs.

c. Provide the patient's direct bedside care, whenever possible.

d. Emphasize improved quality of life and patient-centered care.

d. Emphasize improved quality of life and patient-centered care.