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:

1. nurse manager.
2. case manager.
3. coordinator of patient-centered care delivery.
4. team leader in team nursing care delivery.

B

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:

1. patient outcome.
2. variance.
3. goal.
4. standard.

B

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:

1. patient classification system.
2. clinical pathway.
3. patient-centered plan of care.
4. diagnosis-related group (DRG).

B

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:
a. assignments.

b. staffing.
c. output.
d. productivity.

B

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:

1. assessing patient satisfaction with nursing care.”
2. quantifying the amount and intensity of care required.”
3. examining the skill mix and educational preparation of the staff.”
4. determining the number of hospital days required by the patients.”

B

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

1. know the intensity of care needed by patients according to physical and psychosocial factors.
2. examine the educational level of the staff.
3. assess the skill level of caregivers.
4. review the budget to determine the financial consequences of past staffing patterns.

A

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:

1. negotiates for additional agency nurses.
2. hires more part-time employees.
3. includes participatory management into staffing decisions.
4. uses “float” nurses to cover vacancies.

C

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?

a. Modular

b. Primary
c. Team
d. Functional

B

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

1. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week.
2. the use of part-time nurses provides the variability needed to meet diverse patient needs.
3. satisfaction of the staff equates to satisfaction of patients.
4. nurses provide the same level of care, regardless of the work environment.

C

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) recommendations?

1. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care.
2. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes.
3. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix.
4. RN staffing is not cost-effective; thus is it important for staffing models to limit the number of RNs assigned per shift.

B

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

1. with the partnership model, an RN does not have to be part of the mix.
2. leadership abilities of the RN is a major determinant of effectiveness of care for both models.
3. the RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing.
4. with team nursing the RN cares for the patient while the team members work with the family or significant others.

B

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:

1. a patient classification system to determine safe staffing levels.
2. diagnostic-related groups for Medicare billing.
3. case management to coordinate care.
4. clinical pathways to determine care.

A

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 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:

a. team.
b. primary.
c. partnership.

d. modular.

D

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:

1. partnership.
2. patient-centered.
3. case management.
4. total patient care.

B

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via:

1. patient classification systems.
2. clinical pathways.
3. functional nursing.
4. case management.

B

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery?
a. Team
b. Partnership
c. Primary
d. Functional

D

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.)

1. the increase in the number of minimally invasive procedures being performed for disease treatment.
2. care provided for patients over an extended period in acute care settings.
3. the reduction in the number of nurses and other health care professionals who are available to provide care.
4. the widespread illiteracy and decreased self-efficacy of the aging patient population.
5. the need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient.
6. the devaluing of nursing as a means of improving patient outcomes.

A, C, E

Which factors would be considered in the first steps in developing an effective patient classification system? (select all that apply)

1. Planned procedures
2. Ethnic diversity of patients
3. Clinical competency of staff
4. Educational level of nurses
5. Age of patients

A, B, E

A nurse responsible for staffing a medical-surgical unit must consider: (select all that apply)

1. the patient census.
2. physical layout of the unit.
3. complexity of care required.
4. educational level of all staff.
5. task preferences of the nurses.

A, B, C, D