Chapter 13: Managing Patient Care

Chapter 13: Managing Patient Care

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A registered nurse works as a case manager in the local hospital. What primary role will the nurse be fulfilling?

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?

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?

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?

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