Question 1

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system?

Accepted Answer

Correct:In total patient care nurses provide all aspects of patient care.
Incorrect:b.Partnership nursing,or coprimary nursing,pairs the RN with a partner,usually a licensed practical/vocational nurse (LPN/LVN) or unlicensed assistive personnel (UAP),allowing the RN to spend more time on tasks such as assessment and patient education.
c.In team nursing an RN directs the other members of the team,which can consist of care providers at various levels.
d.In functional nursing staff are assigned to tasks rather than to patients.

Question 2

The nurse manager is planning staffing levels and realizes that the first step is to:

Accepted Answer

Correct:The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.
Incorrect:b.Educational level requirements must be matched to patients' acuity levels.
c.Assessing the skill level of staff is necessary to match staff with patients according to patients' acuity level.
d.Past staffing patterns cannot predict the needs of the current population.

Question 3

A nursing unit is comparing team nursing to the partnership model and finds that:

Accepted Answer

Correct:The RN leads regardless of whether partnership model or team nursing is practiced.
Incorrect:a.An RN is the leader of the pair.
c.Applying the nursing process is not an appropriate role for the LPN/LVN or UAP.
d.The team is led by an RN,and the team performs those tasks that are not required by the RN; however,team members can also be additional RNs but they are not in a leader role.

Question 4

A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using:

Accepted Answer

Correct:Patient classification systems group patients according to care needs to determine safe staffing levels.
Incorrect:b.Diagnostic-related groups is a classification system used to bill Medicare for patient care that is based on primary and secondary diagnoses.
c.Case management is a model of care delivery in which the RN coordinates the patient's care throughout the course of an illness.
d.Clinical pathways generate plans that specify major patient care activities and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

Question 5

A nurse makes patient care assignments as follows: RN 1 has rooms 200-210; RN2 has rooms 211-221; RN3 has room 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is:

Accepted Answer

Correct:Modular (or geographic) assignments are based on a geographic location in the nursing unit.
Incorrect:a.In team nursing an RN assumes the role of leader of a small group who share the patient care assignment.
b.In the primary delivery model,the nurse assumes 24-hour responsibility for planning,directing,and evaluating the patient's care from admission through discharge.
c.In the partnership model the RN is paired with an LPN or UAP,and the pair work together consistently to care for an assigned group of patients.

Question 6

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's ( ANA ) Safe Staffing Saves Lives recommendations?

Accepted Answer

Correct:The ANA recommends that nurses have time to exercise professional judgment.
Incorrect:a.Patient needs constantly change and staffing adjustments may be necessary.
c.As patient acuity levels increase,the need for RN coverage increases.
d.RNs have shown to be cost-effective and increase the value of care because of their contributions to improving patient outcomes.

Question 7

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery?

Accepted Answer

Correct:The primary nurse assumes 24-hour responsibility for planning,directing,and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present.
Incorrect:a.In modular care delivery,a small team is assigned to a geographic location during their assigned shift.
c.In team nursing the RN directs members of the team who are providing care but does not assume 24-hour responsibility.
d.Functional nursing focuses on completion of tasks rather than on specific patients.

Question 8

The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a:

Accepted Answer

Correct:The case manager,in collaboration with an interdisciplinary team,oversees the use of health care services by clients throughout a course of illness.
Incorrect:a.The nurse manager is responsible for handling the day-to-day operations of the nursing unit and for ensuring that the unit's philosophy and mission are congruent with those of the parent organization.
c.The coordinator of patient-centered care delivery works with an interdisciplinary team in providing a wide range of services.
d.The team leader coordinates and delegates care for a specific group of patients.

Question 9

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains, "We must determine the acuity level of the patient by:

Accepted Answer

Correct:Patient acuity is measured by determining the amount and intensity of care required.
Incorrect:a.Patient satisfaction is based on interactions or experiences while the patient is receiving care,although staffing can affect patient satisfaction.
c.Examination of the skill mix and educational preparation of the staff is the criterion for delegation of care.
d.The number of hospital days required by the patient is a criterion that is used on care pathways to predict required resources.

Question 10

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a:

Accepted Answer

Correct:A variance is a deviation from the planned path.
Incorrect:a.The patient outcome is the end result of care,not just a single specific incident or deviation.
c.The goal is to provide high-quality,cost-effective care.
d.A standard is the criterion from which safe,effective care is derived.

Question 11

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is termed:

Accepted Answer

Correct:Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants,needs,and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.
Incorrect:a.Partnership delivery models pair the RN with a partner to deliver care.
c.In case management the RN case manager coordinates the patient's care throughout the course of an illness.
d.Total patient care nurses are responsible for all the care components for their assigned group of patients during the assigned shift.

Question 12

Customer satisfaction is primarily based on:

Accepted Answer

Correct:Interactions between employees and patients/families actually affect clinical outcomes,functional status,and even physiologic measures of health.
Incorrect:a.Customer satisfaction is primarily based on relations with employees.
b.Interface with employees is the means to customer satisfaction.
d.Patients may fear or dislike invasive procedures,but the important consideration in customer satisfaction is the quality of interactions with employees.

Question 13

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur as a result of: (Select all that apply.)

Accepted Answer

Correct:a.Invasive surgical procedures are being replaced by laparoscopic procedures.
c.The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population.
e.Care will focus on the unique lifestyles and values of a diverse population.
Incorrect:b.Patients are discharged much more quickly and with more complex care needs,rather than having a longer stay in acute care settings.
d.Consumers,especially the aging baby-boomer generation,are proactive about learning and participating in health care.
f.Nursing is increasingly valued and has been shown to improve patient outcomes and patients' satisfaction with care.

Question 14

Accrediting agencies such as The Joint Commission address staffing by:

Accepted Answer

Correct:Accrediting agencies do not address minimum staffing levels; however,they do look for evidence that patients receive adequate care,and this can occur only with adequate staffing.
Incorrect:a.Accrediting agencies do not impose maximum staffing levels.
b.Staff mix is not addressed by accrediting agencies; however,long-term care facilities specify minimum RN coverage for the facility.
c.Agencies do not stipulate mandatory staffing ratios,with the exception of those in California,a state that recently enacted legislation mandating specific nurse-patient ratios.

Question 15

A nurse solve  phone questions related to health care questions and to triage the need for urgent care of member patients. Established patient guidelines are used to educate, direct, or provide follow-up. The nurse is providing care via:

Accepted Answer

Correct:Functional care delivery models assign tasks to each provider.In the above visual,the LPN is responsible for oral medication administration,the Unlicensed Assistive Personnel provide hygiene,and the RN is assigned to task that require the nursing process.
Incorrect:a.Team nursing requires an RN team leader who is assigned with four to five other staff.
b.Partnership delivery models pair a RN with a partner who provides care.
c.In primary nursing care delivery,the "primary nurse" assumes 24-hour responsibility for directing the patient's plan of care.

Question 16

The nurse manager determines that four RNs, five LPN/LVNs, and two Unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with:

Accepted Answer

Correct:Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe,high-quality patient care.
Incorrect:a.Assignment is the distribution of work that each staff member is responsible for during a given work period; assigned activities must fall within the individual's scope of practice and/or job description.
c.Output is the work produced,such as the number of patient care hours provided.
d.Productivity is the ratio of the amount of output produced,such as patients receiving care or home visits,to the specific amount of input (i.e.,nursing hours worked) and is the measure of staffing efficiency.

Question 17

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To enhance employee satisfaction related to staffing, the management team:

Accepted Answer

Correct:Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.
Incorrect:a.The use of temporary,part-time,or agency nurses can result in a lack of continuity of care,thereby decreasing patient satisfaction,which affects employee satisfaction.
b.Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention.
d.Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention.

Question 18

A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a:

Accepted Answer

Correct:A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis,procedure,or health condition.
Incorrect:a.A classification system categorizes patients according to specific criteria and care requirements and thus helps to quantify the amount and level of nursing care needed.
c.Patient-centered,as used in this chapter,refers to a nursing care delivery model that is focused on interprofessional care,with the patient as the focus.
d.A DRG places patients into a predetermined reimbursement rate on the basis of diagnosis.

Question 19

When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that:

Accepted Answer

Correct:High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.
Incorrect:a.Errors increase with long shifts over consecutive days.
b.The use of part-time nurses may result in decreased patient satisfaction and lack of continuity of care.
d.Research has found that nurses who practice in positive and autonomous work environments provide cost-effective care of better quality.

Question 20

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is:

Accepted Answer

Correct:In functional nursing members of the team are assigned specific tasks such as assessment or medication administration
Incorrect:a.Total patient care involves an RN who provides every aspect of patient care.
c.With team nursing the team leader,an RN,delegates care to other team members.
d.In primary nursing the RN assumes 24-hour responsibility for the care of assigned patients.

Quiz 20: Staffing and Nursing Care Delivery Models