Motacki: Nursing Delegation and Management of Patient Care

Chapter 01: Patient Care Management

Test Bank

MULTIPLE CHOICE

	1.	Nurses can be leaders without being managers. Which nursing actions demonstrate leadership?
a.	Assisting a new nurse with enteral tube feedings	
b.	Counseling a new nurse regarding attendance	
c.	Adjusting assignments after a staff member calls in sick	
d.	Calling a physician for new order clarification	

ANS:	A

	Feedback	
A	Leaders act as role models and mentor new staff.	
B	Because they are management responsibilities and not leadership roles.	
C	Because they are management responsibilities and not leadership roles.	
D	Because they are management responsibilities and not leadership roles.	

DIF:	Cognitive Level: Application

	2.	Which nursing actions demonstrate the role of management in nursing?
a.	Encouraging autonomous decision making	
b.	Observing the documentation of appropriate charges to patients	
c.	Assisting in a code	
d.	Asking the patient/family about advance directives	

ANS:	B

	Feedback	
A	Because those are leadership or mentoring roles.	
B	Managers are responsible for the budget of their units.	
C	Because those are leadership or mentoring roles.	
D	Because those are leadership or mentoring roles.	

DIF:	Cognitive Level: Application

	3.	In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has:
a.	Infrequent “floating.”	
b.	Self-scheduling.	
c.	Cover of another nurse’s assignment while she or he is on break.	
d.	Hourly pay differential for the night shift.	

ANS:	B

	Feedback	
A	Because it does not address autonomy.	
B	In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling.	
C	Because they are decisions made by the organization and are practiced throughout the organization.	
D	Because they are decisions made by the organization and practiced throughout the organization.	

DIF:	Cognitive Level: Application

	4.	The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to:
a.	Alterations in available staff due to weather emergencies.	
b.	The financial environment of the patient population.	
c.	A wide range of ages among the staff.	
d.	A limited number of unlicensed staff on the unit.	

ANS:	A

	Feedback	
A	Patient delivery models are instituted based on various elements including clinical decision making and work allocation; thus, changes may need to be made in an emergency based on availability of staff.	
B	Because it is not a fundamental element used in the decision-making process for delivery mode.	
C	Because it is not a fundamental element used in the decision-making process for delivery mode.	
D	Because it is not a fundamental element used in the decision-making process for delivery mode.	

DIF:	Cognitive Level: Application

	5.	An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment?
a.	UAP taking vital signs and giving baths	
b.	RN taking vital signs and giving baths	
c.	RN delegating patient care delivery to a group of patients	
d.	Charge nurse delegating care delivery	

ANS:	C

	Feedback	
A	Because it is practiced in a functional model environment.	
B	Because it is seen in primary nursing.	
C	In a team nursing environment, an RN delegates patient care to a group of patients .	
D	Because it may be seen in all types of health care delivery models.	

DIF:	Cognitive Level: Application

	6.	In which health care delivery model would the nurse expect to see “point-of-care” decision making occur?
a.	Primary care nursing	
b.	Team nursing	
c.	Functional nursing	
d.	Modular nursing	

ANS:	A

	Feedback	
A	Primary nursing allows the nurse to practice autonomously and make most bedside decisions.	
B	Because it may not allow for the autonomy required for “point-of-care” decisions.	
C	Because it may not allow for the autonomy required for “point-of-care” decisions.	
D	Because it may not allow for the autonomy required for “point-of-care” decisions.	

DIF:	Cognitive Level: Application

	7.	Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities?
a.	A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients.	
b.	A staff nurse acts quickly when a cardiac arrest is called on her patient.	
c.	A staff nurse notifies another staff member that she is being “pulled” today.	
d.	A new nurse volunteers to work when another staff member must leave work because her child is ill.	

ANS:	A

	Feedback	
A	Nurse leaders are interested in changing practice based on evidence.	
B	Because it is an action taken by nurses as part of the functional structure of the unit.	
C	Because it is an action taken by a manager.	
D	Because it is an action taken by nurses as part of the functional structure of the unit.	

DIF:	Cognitive Level: Analysis

	8.	A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager?
a.	A nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients.	
b.	A nurse acts quickly when a cardiac arrest is called on her patient.	
c.	A nurse notifies another staff member that she is being “pulled” today.	
d.	A nurse volunteers to work when another staff member must leave work because her child is ill.	

ANS:	C

	Feedback	
A	Because it is a role taken by a nurse leader.	
B	Because it is an action taken by staff as part of the functional structure of the unit.	
C	Determining who gets “pulled” is a management decision.	
D	Because it is an action taken by staff as part of the functional structure of the unit.	

DIF:	Cognitive Level: Analysis

	9.	A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit?
a.	Nurse manager mandates changes.	
b.	Staff takes responsibility for assignments.	
c.	Staff participates on hospital committees.	
d.	Nurses are recognized for excellence in practice.	

ANS:	C

	Feedback	
A	Because this is not an environment in which staff are encouraged to participate in decision making.	
B	Because it should be seen in all environments regardless of autonomy.	
C	Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made.	
D	Is not seen solely in autonomous environments.	

DIF:	Cognitive Level: Analysis

	10.	Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs?
a.	All organizational decisions must be approved by the CEO.	
b.	Changes can be made rapidly based on immediate needs.	
c.	Nurses must work under a dual-authority structure.	
d.	Decisions can be made at the “point of care.”	

ANS:	A

	Feedback	
A	In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff.	
B	Is an example of a decentralized environment in which decisions can be made more quickly as needed.	
C	Is an example of a decentralized environment in which decisions can be made more quickly as needed.	
D	Is an example of a decentralized environment in which decisions can be made more quickly as needed.	

DIF:	Cognitive Level: Application

	11.	What should the nurse expect when working in a product-line leadership structured environment?
a.	Coordination of all services within the specialty	
b.	Slow organizational response to environmental changes	
c.	Individual service goals	
d.	Each service area autonomous to the others	

ANS:	A

	Feedback	
A	In product- or service-line leadership structures, it is necessary to have coordination of services.	
B	Is not an example of product-line leadership and is an example of leadership without coordination.	
C	Is not an example of product-line leadership and is an example of leadership without coordination.	
D	Is not an example of product-line leadership and is an example of leadership without coordination.	

DIF:	Cognitive Level: Application

	12.	The fundamental element of any patient care delivery combines work allocation with:
a.	Patient acuity.	
b.	Leadership.	
c.	Clinical decision making.	
d.	Delegation.	

ANS:	C

	Feedback	
A	Because it is not necessarily useful in determining the appropriate patient care delivery systems needed.	
B	Because it is not necessarily useful in determining the appropriate patient care delivery systems needed.	
C	Work allocation is necessary in any patient care delivery system.	
D	Because it is not necessarily useful in determining the appropriate patient care delivery systems needed.	

DIF:	Cognitive Level: Analysis

	13.	The student nurse, shadowing on a medical-surgical unit, observes the charge nurse. Which action would the student identify as a leadership quality in the nurse’s actions?
a.	Making patient care assignments distributed equally to staff	
b.	Sitting with a confused combative patient	
c.	Calling the nursing office for extra staff when an RN calls in sick	
d.	Assisting in a code	

ANS:	B

	Feedback	
A	Because it is expected as part of the functioning of the unit.	
B	Leaders act as role models and do what is right for the patient.	
C	Because it is expected as part of the functioning of the unit.	
D	Because it is expected as part of the functioning of the unit.	

DIF:	Cognitive Level: Analysis

	14.	A nurse who is interested in developing clinical decision-making skills would look for a unit that practices which model for health care delivery?
a.	Primary nursing	
b.	Team nursing	
c.	Functional nursing	
d.	Case management	

ANS:	A

	Feedback	
A	Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive.	
B	Does not necessarily promote the development of decision-making skills.	
C	Does not necessarily promote the development of decision-making skills.	
D	Does not necessarily promote the development of decision-making skills.	

DIF:	Cognitive Level: Application

	15.	A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery?
a.	The nurse makes patient care decisions at the bedside.	
b.	The nurse delegates patient care to other team members.	
c.	The nurse works on discharge plans on admission.	
d.	The UAP takes vital signs on the patients on one hallway.	

ANS:	B

	Feedback	
A	Because it is an example of primary nursing.	
B	The nurse delegates and works collaboratively with the members of the team in team nursing.	
C	Because it is an example of case management nursing.	
D	Because it is an example of functional nursing.	

DIF:	Cognitive Level: Application

	16.	A nurse working on a unit using the primary care delivery model would expect to observe which practice specific to primary care delivery?
a.	The UAP measures blood sugar levels on all patients.	
b.	The RN administers medications to a team of patients.	
c.	The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg.	
d.	The RN holds the morning dose of insulin for a patient scheduled for surgery later that day.	

ANS:	D

	Feedback	
A	Because it is an example of functional nursing.	
B	Because it is seen in team nursing.	
C	Because it is seen in all patient care delivery models.	
D	In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside.	

DIF:	Cognitive Level: Analysis

	17.	Which action by the nurse indicates a primary care delivery model environment?
a.	Development of the plan of care by primary RN to be used on all shifts	
b.	Calling the physician for clarification after an illegible order is written	
c.	The unit secretary takes off all orders initially.	
d.	The charge nurse makes all patient care assignments.	

ANS:	A

	Feedback	
A	The nurse develops the plan of care on admission for the remainder of the admission.	
B	Because it is seen in many delivery care models.	
C	Because it is seen in many delivery care models.	
D	Because it is seen in many delivery care models.	

DIF:	Cognitive Level: Analysis

	18.	In a team nursing health care delivery model environment, the nurse would observe for which action by the staff?
a.	The UAPs answer all call lights.	
b.	The charge nurse is notified when there are patient complaints about care.	
c.	The UAPs answer their patients’ call lights.	
d.	The RN is notified when there are patient care complaints.	

ANS:	D

	Feedback	
A	Because it is seen in functional nursing.	
B	Because it can be seen in models other than primary nursing.	
C	Because it is seen in team nursing.	
D	Nurses are completely responsible for the needs of their patients in a primary care delivery model.	

DIF:	Cognitive Level: Analysis

	19.	Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business?
a.	Ability to pressure staff to do what you want	
b.	Resource utilization	
c.	Cutting corners to make money	
d.	Providing bonuses to staff members who help the organization to save money	

ANS:	B

	Feedback	
A	Because it is only a perception of the public regarding successful managers.	
B	The ability to manage a budget is essential to being a manager in health care today.	
C	Because it is only a perception of the public regarding successful managers.	
D	Because it is only a perception of the public regarding successful managers.	

DIF:	Cognitive Level: Application

	20.	The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict?
a.	Coordinating institutional goals with the immediate demands of the clinical area	
b.	Determining which of the staff members should get better raises than other members	
c.	Deciding which employees should be recommended for promotion	
d.	Determining which staff members get Christmas day off	

ANS:	A

	Feedback	
A	Many times the goals of the institution conflict with the goals of the individual employees of a particular clinical area and the nurse manager must implement institutional changes regardless of the nurse’s personal opinion.	
B	Because it should not provoke as much conflict.	
C	Because it should not provoke as much conflict.	
D	Because it should not provoke as much conflict.	

DIF:	Cognitive Level: Application

	21.	Nurse managers can best be described as people who:
a.	Develop institutional goals based on staff suggestions.	
b.	Develop institutional goals based on a personal theory.	
c.	Motivate staff to meet institutional goals through positional power.	
d.	Inspire staff to meet institutional goals through personal power.	

ANS:	C

	Feedback	
A	Nurse managers usually do not make institutional goals.	
B	Nurse managers usually do not make institutional goals.	
C	Managers motivate staff to make changes.	
D	Leaders inspire, not managers.	

DIF:	Cognitive Level: Application

MULTIPLE RESPONSE

	1.	To become a leader, one must develop certain personal aspects. Which of the following can be identified as competencies expected in creating leadership in oneself? Select all that apply.
a.	Asking for overtime	
b.	Asking for certain patient assignments	
c.	Personal and professional accountability	
d.	Acquiring advanced degrees	
e.	Personal discipline	

ANS:	C, D, E

	Feedback	
Correct	Because it is a competency identified in the text for developing leadership in oneself.
Because it is a competency identified in the text for developing leadership in oneself.
Because it is a competency identified in the text for developing leadership in oneself.	
Incorrect	Because it may be associated with a good work ethic, but it does not apply to the development of leadership competencies.
Because it may be associated with a good work ethic, but it does not apply to the development of leadership competencies.	

DIF:	Cognitive Level: Analysis

	2.	The patient care delivery system used by an institution should be based on which fundamental elements? Select all that apply.
a.	Work allocation	
b.	Accountability	
c.	Allocation of resources	
d.	Mission statement	
e.	Leadership style	
f.	Cultural diversity of patients	

ANS:	A, B, D

	Feedback	
Correct	According to the text, these are fundamental elements of any patient care delivery system.
According to the text, these are fundamental elements of any patient care delivery system.
According to the text, these are fundamental elements of any patient care delivery system.	
Incorrect	Are not fundamental elements of a patient care delivery system.
Are not fundamental elements of a patient care delivery system.
Are not fundamental elements of a patient care delivery system.	

DIF:	Cognitive Level: Application

	3.	A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which (select all that apply):
a.	A staff nurse provides advice and guidance to new nurses.	
b.	A clinical ladder is used for advancement.	
c.	A staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them.	
d.	Annual performance appraisals are provided with competitive raises.	
e.	Decisions are made from the top down.	

ANS:	A, B, C

	Feedback	
Correct	A transformational leadership environment encourages consultation and collaboration, empowering and motivating staff.
A transformational leadership environment encourages consultation and collaboration, empowering and motivating staff.
A transformational leadership environment encourages consultation and collaboration, empowering and motivating staff.	
Incorrect	An example of transactional leadership.
An example of transactional leadership.	

DIF:	Cognitive Level: Analysis

	4.	A nurse leader, according to the American Organization of Nurse Executives (AOEN), is competent in the areas of (select all that apply):
a.	Knowledge of the health care environment.	
b.	Communication.	
c.	Business management.	
d.	Demanding participation by the staff.	
e.	Providing a financial incentive.	

ANS:	A, B, C

	Feedback	
Correct	The AOEN identifies this as a competency of nurse leaders.
The AOEN identifies this as a competency of nurse leaders.
The AOEN identifies this as a competency of nurse leaders.	
Incorrect	Because it is not a competency recommended by the AOEN.
Because it is not a competency recommended by the AOEN.	

DIF:	Cognitive Level: Analysis

	5.	The organizational hierarchy is used in which of the following situations? Select all that apply.
a.	A staff member is observed taking money from a patient’s bedside table.	
b.	A staff member is found to be drinking alcohol while at work.	
c.	A nurse refuses to care for a patient receiving peritoneal dialysis because he has not been trained on this procedure.	
d.	A nurse refuses to be floated to the ICU while still in orientation.	
e.	A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient.	

ANS:	A, B, E

	Feedback	
Correct	Inappropriate actions by staff are managed by the hierarchy of any organization.
Inappropriate actions by staff are managed by the hierarchy of any organization.
Inappropriate actions by staff are managed by the hierarchy of any organization.	
Incorrect	Because it would require actions not relegated to the hierarchy of the organization.
Because it would require actions not relegated to the hierarchy of the organization.	

DIF:	Cognitive Level: Analysis