Nursing Delegation And Management Of Patient Care, 2nd Edition Test Bank

Chapter 02: Organizational Structure of Health Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. 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 In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization. DIF: Cognitive Level: Application REF: page 16 2. 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 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. The other options do not describe a fundamental element used in the decision-making process for delivery mode. DIF: Cognitive Level: Application REF: page 19 3. 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 In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models. DIF: Cognitive Level: Application REF: page 20 4. 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 Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options are incorrect because they may not allow for the autonomy required for “point-of-care” decisions. DIF: Cognitive Level: Application REF: page 21 5. 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 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. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments. DIF: Cognitive Level: Analysis REF: page 16 6. 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 In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed. DIF: Cognitive Level: Application REF: page 16 7. What should the nurse expect when working in a product-line leadership structured environment? a. b. c. d. Coordination of all services within the specialty Slow organizational response to environmental changes Individual service goals Each service area autonomous to the others ANS: A In product- or service-line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product-line leadership and is an example of leadership without coordination. DIF: Cognitive Level: Application REF: page 17 8. 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 Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed. DIF: Cognitive Level: Analysis REF: page 19 9. 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 Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other options do not necessarily promote the development of decision-making skills. DIF: Cognitive Level: Application REF: page 21 10. 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 The nurse delegates and works collaboratively with the members of the team in team nursing. Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing. DIF: Cognitive Level: Application REF: page 10 11. 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 In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models. DIF: Cognitive Level: Analysis REF: page 21 12. 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 The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models. DIF: Cognitive Level: Analysis REF: page 21 13. 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 Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing. DIF: Cognitive Level: Analysis REF: page 21 MULTIPLE RESPONSE 1. 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 According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system. DIF: Cognitive Level: Application REF: pages 18-19