Chapter 15

Question 1

When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and in which the RNs handle all intravenous medications, admissions, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
Functional nursing.
Nurse case management.
Primary nursing.
The case method.

Answer 1

Functional nursing.

Question 2

The nurse case manager is working with a patient admitted for end-stage renal disease. The case manager’s major goal during this hospitalization is to:
Prevent the need for additional hospitalizations resulting from complications of the patient’s disease.
Provide direct nursing care throughout the hospitalization.
Supervise the nursing staff members who implement the care map.
Implement the care map on admission.

Answer 2

Prevent the need for additional hospitalizations resulting from complications of the patient’s disease.

Question 3

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager’s main responsibility is the needs of which of the following?
The department.
The unit.
Staff members.
The patient.

Answer 3

The patient.

Question 4

During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
Nurse case management.
Case method.
Functional nursing.
Team nursing.

Answer 4

Case method.

Question 5

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid—a patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to which of the following?
Implementation of an all-RN staff complement.
Orientation of staff to new roles and responsibilities.
Significant changes in the physical structure of units.
Testing and piloting technology at the patient’s bedside.

Answer 5

Significant changes in the physical structure of units.

Question 6

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:
Be able to adapt to daily changes in staffing.
Be able to effectively communicate with patients.
Build relationships with physicians.
Adapt in communicating information to the supervisor.

Answer 6

Be able to adapt to daily changes in staffing.

Question 7

In the hiring of nurses during the transition from team nursing to a primary nursing model, Benner’s (2001) work suggests that you give priority to nurses who are at least at which level of competency?
Novice.
Advanced beginner.
Proficient.
Competent

Answer 7

Competent

Question 8

Differentiated nursing practice, or staff mix, is a model of clinical nursing practice that combines different categories of health care personnel employed for the provision of direct client care. What is the biggest aspect of this model in decreasing its success?
Supports each nurse’s level of education.
Varied educational backgrounds and philosophies of nurses.
Increases satisfaction of patients.
Increases satisfaction of nurses.

Answer 8

Varied educational backgrounds and philosophies of nurses.

Question 9

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost effective?
Case management method.
Primary care method.
Team method.
Functional method.

Answer 9

Case management method.

Question 10

The chief nursing officer implements the team nursing model on the acute care units. Expectations of the team leader include which of the following? (Select all that apply.)
Having several years of clinical nursing practice.
Being newly graduated with a baccalaureate degree.
Being attentive to the needs of the staff.
Being attentive to the needs of the organization.
Being attentive to the needs of the patient.

Answer 10

Having several years of clinical nursing practice.
Being attentive to the needs of the staff.
Being attentive to the needs of the patient.

Question 11

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
Low in comparison with that in functional nursing.
Not of significance in either model.
Similar to those in functional nursing.
High in comparison with that in functional nursing

Answer 11

High in comparison with that in functional nursing

Question 12

You are the nurse manager of a nursing service organization that provides around-the-clock care to patients in their homes. To achieve an optimal outcome for a patient who is recovering from a hip replacement, the nursing staff will probably follow the nursing care guidelines presented in which of the following?
Nursing care plan.
Critical pathway.
Physician’s orders.
Clinical practice guidelines.

Answer 12

Critical pathway.

Question 13

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
Baccalaureate.
Diploma.
Licensed practical nurse/licensed vocational nurse.
Associate,

Answer 13

Baccalaureate

Question 14

The case method of care delivery could be best justified for which of the following scenarios?
Pediatric intensive care unit that heavily involves families and also patients.
Home health care environment with patients who have varying degrees of acute illness.
Stable patient population with long-term care and family needs.
Acute care surgical unit with predictable postsurgical outcomes and many technical procedures.

Answer 14

Pediatric intensive care unit that heavily involves families and also patients.

Question 15

The functional nursing model might be particularly effective in which of the following?
Promoting communication among diverse team members.
Developing competence and confidence in unlicensed workers.
Avoiding patient–provider conflict.
Facilitating multiple perspectives on the total care of a patient

Answer 15

Developing competence and confidence in unlicensed workers.

Question 16

For a nurse manager in the functional nursing model, which approach will assist in maintaining staff satisfaction in this specific model?
Orientation to job responsibilities and performance expectations.
Rotation of task assignments.
Frequent opportunities for in-service education.
Team social events in off hours.

Answer 16

Rotation of task assignments.

Question 17

In considering whether to accept a job offer in a hospital in which the synergy model of care is used, you expect that which of the following is the driver of the necessary nurse competencies for practising within this model?
Educational background of the nurse.
Interdisciplinary health care teams.
National nurse-to-patient ratios.
Patient population characteristics.

Answer 17

Interdisciplinary health care teams.

Question 18

A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one nurse for my pills, and she says, ‘That is not my job.’ I ask the pill nurse about my lab tests, and she says that I should ask another nurse.” The nursing care delivery model most likely to be employed in this situation is
Team nursing.
Functional nursing.
Differentiated practice.
Case management.

Answer 18

Functional nursing.

Question 19

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in which way?
Intention to provide holistic nursing.
Levels and types of assessment.
Breadth of nursing knowledge and expertise required.
Time period of accountability

Answer 19

Time period of accountability

Question 20

When hiring a case manager for a rehabilitation setting, you are most likely to consider which of the following?
A physiotherapist with a background in stroke rehabilitation.
A registered nurse with a master’s degree.
A health care provider with advanced background who is focused on patient and outcome.
A social worker with a background in counselling.

Answer 20

A health care provider with advanced background who is focused on patient and outcome.

Question 21

In a small rural nursing home a director of nursing decides to implement a partnership model, because of a shortage of nurses, to help with certain tasks. What combination of health care providers constitutes a partnership care delivery model?
RN and medication assistants.
RN and licensed practical nurse/licensed vocational nurse.
RN and certified nurses’ aides.
RN and RN

Answer 21

RN and medication assistants.

Question 22

In comparing team and functional models of care, a nurse manager favours the team model. In particular, she finds that the team model:
Promotes autonomy and independence of the RN.
Can be effective in recognizing individual strengths and backgrounds of staff members.
Avoids conflict because of role clarity.
Is efficient in delivering care to a large group of patients with the use of a staffing mix

Answer 22

Can be effective in recognizing individual strengths and backgrounds of staff members.

Question 23

The relief charge nurse has assigned a newly registered baccalaureate-prepared nurse to be one of the team leaders for the shift from 1500 to 2300 hours. In making this decision, the charge nurse has overlooked this nurse’s:
Leadership ability.
Clinical expertise.
Conflict-resolution skills.
Communication style.

Answer 23

Clinical expertise.

Question 24

Complex care of acutely ill patients is required on a surgical unit in which differentiated nursing practice is its model of care delivery. The concept of differentiated nursing practice is based on:
Experience in the agency.
Education and expertise.
Licensure status.
Leadership capabilities.

Answer 24

Education and expertise.

Question 25

Case-managed care may enhance profit in a for-profit health organization by:
Reducing the amount of technology used to support clinical decision-making.
Minimizing costs in areas of high resource consumption.
Increasing reimbursement from third-party payers.
Combining licensed and nonlicenced care providers in delivering patient care

Answer 25

Minimizing costs in areas of high resource consumption.

Question 26

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision-making at the patient care level:
Remains the same.
Is increased.
Is decreased.
Is relinquished.

Answer 26

Is decreased.

Question 27

Nursing case management is geared to providing comprehensive care for those with complex health problems. Which of the following supports the use of a case management model? (Select all that apply.)
Increases nurse sense of satisfaction.
Increases efficient use of services.
Decreases human resource inequities.
Decreases length of stay.

Answer 27

Increases nurse sense of satisfaction.
Increases efficient use of services.
Decreases length of stay.

Question 28

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. On the basis of her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that:
The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan.
Neither the primary nurse nor the associate nurse should make changes without first consulting you as the manager.
It is the role of the primary nurse to make alterations on the basis of assessment data and input.
It really does not matter who alters the nursing care plan because it depends on situation and time to do so

Answer 28

It is the role of the primary nurse to make alterations on the basis of assessment data and input.

Question 29

The total patient care method, or patient allocation method, of nursing care delivery is the oldest model of providing care to patients. One nurse provides total care to one or two critically ill patients, or to a group of patients. Which of the following contributes to the success of this model? (Select all that apply.)
Provides high quality care.
High costs.
Current global nursing shortage.
Engenders trust between family and nurse.

Answer 29

Provides high quality care. Engenders trust between family and nurse.