Module 39 Managing Care: Nursing: A Concept-Based Approach To Learning, 2e (Pearson)

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)
Module 39 Managing Care
The Concept of Managing Care
1) A nurse is working in a clinic environment. This nurse places great emphasis on cost control,
customer satisfaction, health promotion, and preventive services. The primary focus of this nurse
is representative of which type of healthcare system?
A) Functional method
B) Client-focused care
C) Case method
D) Managed care
Answer: D
Explanation:
A) Managed care describes a healthcare system whose goals are to provide cost-effective, quality
care that focuses on decreased costs and improved outcomes for groups of clients. The case
method of care is a client-centered model in which one nurse is assigned to care for a group of
clients during an 8- to 12-hour shift. The functional method of care focuses on jobs to be
completed and is task oriented. Client-focused care is a delivery model that brings all services
and care providers to the client.
B) Managed care describes a healthcare system whose goals are to provide cost-effective, quality
C) Managed care describes a healthcare system whose goals are to provide cost-effective, quality
D) Managed care describes a healthcare system whose goals are to provide cost-effective, quality
Page Ref: 2457
Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Nursing Process: Assessment
Learning Outcome: 1. Describe the goals and emphasis of managed care.
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2) A nurse is completing discharge teaching for a client who is about to be discharged to home
following a total hip replacement. The client asks the nurse why there is a case manager involved
and expresses confusion about who is in charge. The client states, "I thought the doctor manages
my care." Which is the best response by the nurse?
A) "No, I manage your care."
B) "You are correct; the doctor is responsible for managing your care."
C) "A case manager coordinates everyone involved in your care to ensure your needs are met."
D) "The case manager delegates your care to the nurse."
Answer: C
Explanation:
A) The case manager is responsible for assuring that all the client's healthcare needs are met in a
cost-effective manner. The nurse may be a case manager; however, a staff nurse is not the most
likely individual in the hospital setting to be the case manager. An agency usually has several
case managers, who collaborate with nursing, the physician, and any other departments involved
in the care of the client. A physician does not participate in care by being a case manager. Case
managers coordinate disciplines of care for the client and do not delegate any care to other
professionals.
B) The case manager is responsible for assuring that all the client's healthcare needs are met in a
professionals.
C) The case manager is responsible for assuring that all the client's healthcare needs are met in a
professionals.
D) The case manager is responsible for assuring that all the client's healthcare needs are met in a
professionals.
Page Ref: 2457
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 2. Examine the role of the case manager in a managed care environment.
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3) A new graduate nurse is looking for employment and hopes to find a facility where the
nursing staff participates in making, implementing, and evaluating client care policies. Which
healthcare system implements this practice?
A) Client-focused care
B) Differentiated practice
C) Managed care
D) Shared governance
Answer: D
Explanation:
A) Shared governance is an organizational model in which nursing staff are cooperative with
administrative personnel in making, implementing, and evaluating client care policies.
Differentiated practice is a system in which the best possible use of nursing personnel is based on
their educational preparation and resultant skill sets. This model consists of specific job
descriptions for nurses according to their education or training. Client-focused care is a delivery
model that brings all services and care providers to the client. Managed care focuses on cost
containment, consumer satisfaction, health promotion, and preventive services.
B) Shared governance is an organizational model in which nursing staff are cooperative with
C) Shared governance is an organizational model in which nursing staff are cooperative with
D) Shared governance is an organizational model in which nursing staff are cooperative with
Page Ref: 2457-2458
Cognitive Level: Understanding
Learning Outcome: 3. Summarize frameworks for delivering care, including the advantages and
disadvantages of each.
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4) You have been appointed to a clinical-administrative task force studying critical staffing
issues and care delivery models for your hospital. What evidence on the effects of different
staffing choices and care delivery models should your task force consider?
Select all that apply.
A) Higher nurse-client ratios have been linked to a decrease in the amount of time clients are
hospitalized.
B) Shared governance is linked to a reduction in adverse outcomes.
C) A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.
D) Research indicates that functional assignment of staff improves the likelihood of meeting
clients' emotional needs.
E) There is little or no research studying nursing ratios and client outcomes.
Answer: A, C
Explanation:
A) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer
complications. A recent study depicted a significant reduction in the risk of mortality in surgical
clients when the proportion of registered nurses was higher. There is little research on care
delivery models since it is more difficult to compare outcomes because each unit may employ
slight variations of the model. Research continues to prove that higher nursing ratios result in
fewer adverse outcomes for clients.
B) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer
C) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer
D) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer
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E) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer
Page Ref: 2458
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing Process: Planning
Learning Outcome: 3. Summarize frameworks for delivering care, including the advantages and
disadvantages of each.
5) A nurse is applying for a job as a case manager for a managed care insurance organization.
What are some of the responsibilities that can be anticipated in this role?
A) Providing home visits to clients
B) Independent treatment planning
C) Coordinating client care through all stages of treatment
D) Approving treatment decisions
Answer: C
Explanation:
A) Insurance-based case management is a labor-intensive activity that is provided typically by
telephone. Case management involves interdisciplinary teams that assume collaborative
responsibility for planning and assessing needs. Case management involves coordinating,
implementing, and evaluating care for groups of clients from preadmission through discharge or
transfer and recuperation. Approving treatment decisions is not a case management role.
B) Insurance-based case management is a labor-intensive activity that is provided typically by
C) Insurance-based case management is a labor-intensive activity that is provided typically by
D) Insurance-based case management is a labor-intensive activity that is provided typically by
Page Ref: 2457
Client Need: Health Promotion and Maintenance
Learning Outcome: 2. Examine the role of the case manager in a managed care environment.
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Exemplar 39.1 Care Coordination
1) The nurse is helping in discharge planning for a diabetic client who needs extensive
rehabilitation and is on a complicated medication schedule. The client and spouse currently live
with their eldest son and the family is very involved in the client's care. The nurse would want to
coordinate the client's care by including which individual(s) in this client's plan?
A) Pharmacist
B) Client's children
C) Physician
D) Social worker
E) Client's spouse
Answer: B, E
Explanation:
A) Effective discharge planning necessitates health team conferences and family conferences and
gives the client, family, and healthcare professionals the opportunity to plan care and set goals.
Involving the client's spouse and children would be important in this situation because of the
complexity of the client's situation. The physician, pharmacist, and social worker may also be
included, but by their own decision, not necessarily by the nurse's invitation, as is the case with
coordination.
B) Effective discharge planning necessitates health team conferences and family conferences and
coordination.
C) Effective discharge planning necessitates health team conferences and family conferences and
coordination.
D) Effective discharge planning necessitates health team conferences and family conferences and
coordination.
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E) Effective discharge planning necessitates health team conferences and family conferences and
coordination.
Page Ref: 2460
Learning Outcome: 1. Differentiate between coordination and collaboration.
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2) The nurse is caring for a 4-year-old female client who suffered brain damage following a car
accident. The client has a tracheostomy and is ventilator-dependent. The client is ready for
discharge from the hospital. The family wants to care for the child at home but does not have the
resources for 24-hour care. The case manager intervenes by:
A) Making multiple referrals to a variety of community-based agencies that can meet the family's
needs.
B) Telling the family that it is impossible to provide care at home.
C) Arranging for the child to be sent to a long-term healthcare facility.
D) Contacting local nurses in the community to provide the assistance that the family needs to
provide care for the client.
Answer: A
Explanation:
A) The referral process is a systematic problem-solving approach that helps clients to use
resources that meet their healthcare needs. The process involves knowledge of community
resources and an ability to solve problems, set priorities, coordinate, and collaborate. The
family's wishes for post-hospital care should be respected if other possibilities exist, which, in
this case, they do. The nurse would not be responsible for a fundraiser. Contacting local nurses
would not be an efficient way to coordinate care for the client.
B) The referral process is a systematic problem-solving approach that helps clients to use
C) The referral process is a systematic problem-solving approach that helps clients to use
D) The referral process is a systematic problem-solving approach that helps clients to use
Page Ref: 2461
Learning Outcome: 2. Predict potential barriers to effective coordination along with strategies to
overcome or avoid these barriers.
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3) A nurse is caring for a client who had a total hip replacement 14 days ago. The client is
preparing for discharge in a few days. The nurse facilitates a care conference with the physician,
occupational therapist, physical therapist, and the client and family to develop a plan of care for
the client prior to discharge. Which of the following roles is the nurse demonstrating?
A) Coordinator
B) Collaborator
C) Differentiated practitioner
D) Team leader
E) Expert
Answer: A, B
Explanation:
A) The nurse is solving problems and planning care for the client by coordinating and
collaborating with the other health team members who will participate in client care. All
members of the team may be experts, but the level of expertise is not the role the nurse is
exhibiting. The nurse is not responsible for how the members of the health team perform their
jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse
is planning care and coordination. Differentiated practice involves nursing care from all levels of
education and is not illustrated in this scenario.
B) The nurse is solving problems and planning care for the client by coordinating and
C) The nurse is solving problems and planning care for the client by coordinating and
D) The nurse is solving problems and planning care for the client by coordinating and
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E) The nurse is solving problems and planning care for the client by coordinating and
Page Ref: 2460-2461
Cognitive Level: Understanding
Learning Outcome: 3. Summarize skills necessary to achieve effective coordination.
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4) A client who is experiencing an exacerbation of rheumatoid arthritis (RA) is about to be
discharged after a week's stay in the hospital. The client tells the nurse, "I can't believe how
much better I am feeling now." The nurse is aware that the client's feeling is based on which of
the following?
A) The client appreciating the various levels of care given
B) Scheduling client care by all disciplines that allowed the client to rest
C) Keeping the client busy each day
D) The client's disease process having been stopped
Answer: B
Explanation:
A) When coordinating care for clients, the nurse should consider the client's ability to tolerate
activity and provide blocks of time for rest. Keeping the client busy would work against the
client's best interests and not produce the desired results for overall healing. RA is a chronic
disease from which the client will not recover. Although the client may appreciate the various
levels of care, that appreciation would not account for how much better the client is feeling after
the hospital stay.
B) When coordinating care for clients, the nurse should consider the client's ability to tolerate
the hospital stay.
C) When coordinating care for clients, the nurse should consider the client's ability to tolerate
the hospital stay.
D) When coordinating care for clients, the nurse should consider the client's ability to tolerate
the hospital stay.
Page Ref: 2461
Cognitive Level: Evaluating
Learning Outcome: 4. Illustrate the anticipated benefits when care coordination is effective.
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5) A nurse is responsible for the care coordination of a client with multiple sclerosis who is being
treated at a multiservice outpatient clinic. The nurse is informed by the occupational therapist
that the client needs specialized assistive devices in order to prepare meals but does not have the
money to purchase them. The client's insurance company has denied approval to cover the
devices. What is the most appropriate action for the nurse to take?
A) Tell the occupational therapist that she will have to come up with another plan to meet the
client's needs.
B) Advocate with the insurance company to provide the appropriate coverage.
C) Explain to the client that she will have to get family members or friends to prepare her meals.
D) Explain to the client that she will have to find other methods to pay for the devices.
Answer: B
Explanation:
A) Care coordination may involve advocating with the client's insurance company to cover the
costs of a resource. Telling the occupational therapist or client to come up with other plans or
resources is not an appropriate role for a care coordinator. The coordinator may try to find
another source to cover the cost for necessary equipment.
B) Care coordination may involve advocating with the client's insurance company to cover the
C) Care coordination may involve advocating with the client's insurance company to cover the
D) Care coordination may involve advocating with the client's insurance company to cover the
Page Ref: 2461
Learning Outcome: 2. Predict potential barriers to effective coordination along with strategies to
overcome or avoid these barriers.
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6) A nurse working in an outpatient OB-GYN clinic has been asked to assume care coordination
for the clinic's teenage clients. What skills will the nurse need to perform this work?
A) Critical thinking skills
B) Force field analysis skills
C) Relaxation training skills
D) Accounting skills
Answer: A
Explanation:
A) Critical thinking skills are crucial to the development of a well-coordinated care plan and its
execution. Specific strategic analysis skills are not necessary for this role. Relaxation training
skills and accounting skills are not a part of care coordination.
B) Critical thinking skills are crucial to the development of a well-coordinated care plan and its
C) Critical thinking skills are crucial to the development of a well-coordinated care plan and its
D) Critical thinking skills are crucial to the development of a well-coordinated care plan and its
Page Ref: 2460
Client Need Sub: Management of Care
Learning Outcome: 3. Summarize skills necessary to achieve effective coordination.
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Exemplar 39.2 Cost-Effective Care
1) A 72-year-old male client tells the nurse he is worried about how he will pay his hospital bill.
The client is being discharged and referred to home health care and the new plan of care now
involves extremely expensive drugs. Which is the best response by the nurse?
A) "You need to focus on recovering and not worry about finances."
B) "I'll have someone from the business office come and set up your payment plan."
C) "Don't worry. I'm sure everything will work out okay."
D) "Much of your care will be covered by Medicare."
Answer: D
Explanation:
A) The Medicare amendments to the Social Security Act and their subsequent expansions
provide a national and state health insurance program that includes extremely expensive hospital
care and prescription drug coverage for adults over the age of 65. Ignoring the client's concerns
by telling him not to worry is not therapeutic communication and does little, if anything, to
confront the client's concerns. Passing the concern to the business office does not address the
client's concerns. Nurses should have some knowledge about the payment sources of their
clients, especially those who have automatic coverage with Medicare because of their age.
B) The Medicare amendments to the Social Security Act and their subsequent expansions
C) The Medicare amendments to the Social Security Act and their subsequent expansions
D) The Medicare amendments to the Social Security Act and their subsequent expansions
Page Ref: 2460
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Learning Outcome: 1. Differentiate the various types of payment sources available in the United
States.
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2) The nurse is caring for a female client from Canada who has come to the United States for a
serious neurological surgery. The client tells the nurse that she came to this country because she
will receive better care because of which of the following?
A) "In America you have many choices about health care."
B) "America has a universal healthcare system."
C) "I am in favor of rationing to bring down health costs."
D) "There is very little competition in health care in the United States."
Answer: A
Explanation:
A) Americans with health insurance have more of a choice about their health care than do other
nations of the world. Canada, not the United States, has a universal healthcare system. Most
other countries do not allow for competition in health care, but the United States does. Rationing
is one reason why clients come to the United States; with rationing, an individual could wait
months for needed surgery.
B) Americans with health insurance have more of a choice about their health care than do other
C) Americans with health insurance have more of a choice about their health care than do other
D) Americans with health insurance have more of a choice about their health care than do other
Page Ref: 2463
Learning Outcome: 2. Contrast the U.S. system of health care with the healthcare systems of
other countries.
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3) An instructor is teaching the class about cost-conscious nursing practice. The instructor knows
that the students understand this concept when the students make which statement(s)?
A) "Nurses must search for more efficient ways to deliver nursing care."
B) "Careful use of supplies will reduce waste and save money."
C) "I do have to take short cuts every now and then."
D) "There are insufficient healthcare workers to meet the need right now."
E) "A new emphasis has been placed on health promotion and disease prevention."
Answer: A, B, E
Explanation:
A) Nurses at all levels face significant pressures to become more cost conscious. This level of
financial accountability is new to the nursing profession. Nurses must now compete with other
departments within organizations for limited resources. Nurses can be more cost-conscious by
carefully using supplies, by searching for more efficient ways to deliver nursing care, and by
placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead
to mistakes and client care should never be compromised. It is true that there are insufficient
healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.
B) Nurses at all levels face significant pressures to become more cost conscious. This level of
C) Nurses at all levels face significant pressures to become more cost conscious. This level of
D) Nurses at all levels face significant pressures to become more cost conscious. This level of
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E) Nurses at all levels face significant pressures to become more cost conscious. This level of
Page Ref: 2464-2465
Learning Outcome: 3. Summarize the challenges faced by the U.S. healthcare system.
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4) A veteran nurse is working on a large medical-surgical unit. The nurse is caring for a client
with MRSA who requires frequent dressing changes. The nurse makes the decision to help
control costs of care by:
A) Wiping down equipment at the end of the shift.
B) Storing equipment in the client's room.
C) Making sure the client's room is stocked with all needed supplies.
D) Placing a cart with supplies outside the client's room.
Answer: D
Explanation:
A) When a client with MRSA is discharged, everything in the room is either discarded or
terminally cleaned. By keeping needed supplies outside the room, the nurse is containing costs as
the supplies will not have to be discarded on discharge. Stocking the room with supplies that
may not be needed may increase costs of health care. Storing equipment in the appropriate room
will not necessarily reduce costs. Wiping down the equipment at the end of the shift has no effect
on cost.
B) When a client with MRSA is discharged, everything in the room is either discarded or
on cost.
C) When a client with MRSA is discharged, everything in the room is either discarded or
on cost.
D) When a client with MRSA is discharged, everything in the room is either discarded or
on cost.
Page Ref: 2466
Learning Outcome: 4. Describe the nurse's role in creating cost-conscious nursing practice.
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5) A client recovering from an emergency appendectomy is a citizen of France. He asks you to
explain why the United States has chosen such a different healthcare reimbursement system from
other Western countries. What American values could you mention to explain the system in this
country?
A) Acceptance of the role of government
B) Individual accountability
C) Skepticism about markets and competition
D) Universality
Answer: B
Explanation:
A) The American system reflects ambivalence toward the role of government. In the United
States, individual accountability is valued over equity. The U.S. system is based on market
competition. In the United States, pluralism and choice are often valued over universality.
B) The American system reflects ambivalence toward the role of government. In the United
C) The American system reflects ambivalence toward the role of government. In the United
D) The American system reflects ambivalence toward the role of government. In the United
Page Ref: 2463
Nursing Process: Analysis
Learning Outcome: 2. Contrast the U.S. system of health care with the healthcare systems of
other countries.
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6) A nurse working in a large municipal hospital has been appointed to a task force whose focus
is addressing nursing shortages. What factors should the task force consider?
A) Nurses are only utilized for clinical services.
B) Nursing shortages are often cyclical.
C) Only licensed nurses are used for all nursing duties.
D) Reductions in nursing staff encourage nurses to remain in the profession.
Answer: B
Explanation:
A) One factor in nursing shortages is the increasing demand for nurses to work in new roles.
Periods of acute shortage are often followed by periods of adequate availability of nurses.
Hospitals often have cut nursing staff and replaced them with unlicensed assistive personnel
(UAP) as a cost-containment measure. As a result of reductions in nursing staff, some nurses,
feeling they can no longer provide quality health care, experience disillusionment and leave the
profession.
B) One factor in nursing shortages is the increasing demand for nurses to work in new roles.
profession.
C) One factor in nursing shortages is the increasing demand for nurses to work in new roles.
profession.
D) One factor in nursing shortages is the increasing demand for nurses to work in new roles.
profession.
Page Ref: 2464-2466
Learning Outcome: 3. Summarize the challenges faced by the U.S. healthcare system.
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Exemplar 39.3 Delegation
1) The nurse has assigned the vital signs and daily weights of her clients to the unlicensed
assistive personnel (UAP) on duty. It is still important for the nurse to reassess each client
throughout the shift for which reason?
A) The UAP cannot report to the next shift.
B) The UAP is not trustworthy.
C) The nurse maintains the authority to care for the clients.
D) The nurse remains accountable for the clients' care.
Answer: D
Explanation:
A) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP
may be untrustworthy, but the reason the nurse checks on the clients is because the
accountability belongs to the nurse. The nurse could take a report from the UAP and report that
to the next shift. The nurse transfers the authority for the delegated care to the UAP.
B) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP
C) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP
D) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP
Page Ref: 2467-2468
Nursing Process: Evaluation
Learning Outcome: 1. Describe the need for responsibility, accountability, and authority when
delegating.
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2) A postoperative client has been transferred to the medical-surgical unit from the intensive care
unit (ICU). The client asks the assigned nurse why unlicensed assistive personnel (UAP) help
with range-of-motion exercises. Which is the best response by the nurse?
A) "Your condition has improved so I delegated that part of your care to the UAP."
B) "You do not need me to ambulate you."
C) "The charge nurse made the decision to have the UAP assist you when walking."
D) "I assigned all of your care to the UAP."
Answer: A
Explanation:
A) An assignment of care is made to a qualified individual (the RN), who then may delegate
parts of that care to a UAP. The nurse would not assign care to the UAP, but rather, delegate
certain tasks to the UAP. Saying that the client does not need the nurse is not the best approach;
it is better to explain that the client has improved to the point where the UAP can assist with
certain tasks. The UAP may be delegated tasks by a nurse assigned to care for the client. The
charge nurse does not make the assessment to delegate to the UAP; the RN assigned to the care
of the client is the decision maker.
B) An assignment of care is made to a qualified individual (the RN), who then may delegate
C) An assignment of care is made to a qualified individual (the RN), who then may delegate
D) An assignment of care is made to a qualified individual (the RN), who then may delegate
Page Ref: 2468
Cognitive Level: Applying
Learning Outcome: 2. Contrast the terms assignment and delegation. .
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3) The nurse is working on a medical-surgical unit that is short staffed due to a callout. The
manager of the unit was unable to replace the nurse, so the extra clients were assigned to the
remaining nurses. The manager was able to get the help of unlicensed assistive personnel (UAP)
from the house pool to help on the unit. In order for effective care to be given to the clients, the
nurses would do which of the following?
A) Delegate vital signs and a.m. care to the UAP.
B) Explain to the manager that care may be compromised if another nurse does not work the
shift.
C) Tell the clients their care will be sparse.
D) Assign wound care to the UAP.
Answer: A
Explanation:
A) The nurses would delegate to the UAP tasks such as taking and recording vital signs,
performing a.m. care, and ambulating clients to ensure that all clients receive appropriate care.
UAPs are not assigned care, they are delegated tasks. The goal for the unit is to meet the needs of
the clients; complaining to the manager will not accomplish this. Telling the clients their care
will be sparse is inappropriate. UAPs can be very helpful because they are trained to complete
tasks that the nurses would not have time to complete, thus accomplishing the goal of care for all
clients on the unit. To alleviate clients' anxiety, the nurse may tell them that extra help is coming
for the shift. Nurses delegate tasks directly to the UAPs rather than telling the manager what
needs to be done.
B) The nurses would delegate to the UAP tasks such as taking and recording vital signs,
UAPs are not assigned care; they are delegated tasks. The goal for the unit is to meet the needs of
needs to be done.
C) The nurses would delegate to the UAP tasks such as taking and recording vital signs,
needs to be done.
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D) The nurses would delegate to the UAP tasks such as taking and recording vital signs,
needs to be done.
Page Ref: 2468
Learning Outcome: 3. Distinguish how effective delegation benefits the delegator, the delegate,
and the organization.
4) The nurse is caring for several medical-surgical clients. The nurse has delegated skin care of
an incontinent client to new unlicensed assistive personnel (UAP) on the unit. In order to
improve effectiveness of the care given, the nurse plans to do which of the following?
A) Ask the client if the care was appropriate.
B) Ask the UAP if the care was given.
C) Demonstrate the appropriate care needed, then delegate the task for the remainder of the shift.
D) Closely observe the UAP each time the care is given.
Answer: C
Explanation:
A) The nurse would show the UAP the exact procedure the first time to avoid any confusion. The
nurse would reassess the client's skin later rather than asking the UAP if the task was done. The
nurse could possibly alarm the client by asking the client if care was appropriate. Closely
observing the UAP defeats the purpose of delegation.
B) The nurse would show the UAP the exact procedure the first time to avoid any confusion. The
C) The nurse would show the UAP the exact procedure the first time to avoid any confusion. The
D) The nurse would show the UAP the exact procedure the first time to avoid any confusion. The
Page Ref: 2469
Learning Outcome: 4. Summarize the delegation process and key behaviors when delegating
tasks.
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5) The nurse is working on a unit with unlicensed assistive personnel (UAP). One nurse refuses
to utilize the UAP and is consistently leaving nursing tasks for the next shift that have yet to be
completed. The nurse is jeopardizing effective care because of:
A) Avoidance of responsibility.
B) Overdependence on others.
C) The belief that no one else can perform a task as well as the nurse can.
D) The state nurse practice act.
Answer: C
Explanation:
A) One barrier to delegation is the belief that nobody else is capable of getting the job done for
the client. The state nurse practice act would be considered an environmental barrier. The nurse
who refuses to delegate care is not being overly dependent. The nurse is accepting too much
responsibility rather than too little.
B) One barrier to delegation is the belief that nobody else is capable of getting the job done for
C) One barrier to delegation is the belief that nobody else is capable of getting the job done for
D) One barrier to delegation is the belief that nobody else is capable of getting the job done for
Page Ref: 2471
Learning Outcome: 6. Examine obstacles that can impede effective delegation.
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6) The nurse delegated unlicensed assistive personnel (UAP) to assist a client with performing a
simple dressing change. The client was formerly able to do the procedure, but because of painful
arthritis is now unable to perform the redressing. The UAP has done this procedure before.
Which of the following must the nurse emphasize to the UAP?
A) Report to the nurse immediately anything unusual, such as bleeding or infection.
B) The nurse should demonstrate the steps of the procedure.
C) Make the client do most of the procedure and report the expected output.
D) The UAP should do health teaching while performing the procedure.
Answer: A
Explanation:
A) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's
ability. The nurse established the particular parameters outside of which immediate notification
is requested. If in pain, the client should not have to do any of the procedure. If the UAP has
done the procedure before, the nurse should not need to demonstrate it. Health teaching is
outside of the scope of practice for the UAP.
B) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's
C) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's
D) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's
Page Ref: 2470
Learning Outcome: 7. Explain the liability of delegation.
26
7) A nurse-supervisor is encouraging nurses to delegate responsibilities whenever possible. What
are some of the criteria for deciding which tasks might be delegated?
A) How complex is the task?
B) How busy are you?
C) Is the client frequently complaining?
D) Is training or education required?
E) Is the task unpleasant?
Answer: A, D
Explanation:
A) Highly technical tasks and complex client care tasks that require specific levels of licensure,
certification, or training should not be delegated. The nurse's busyness may point out the need for
delegation but it does not define which tasks may be delegated. The behavior of the client and
the unpleasant nature of the task are not criteria for delegation.
B) Highly technical tasks and complex client care tasks that require specific levels of licensure,
C) Highly technical tasks and complex client care tasks that require specific levels of licensure,
D) Highly technical tasks and complex client care tasks that require specific levels of licensure,
E) Highly technical tasks and complex client care tasks that require specific levels of licensure,
Page Ref: 2469
Learning Outcome: 4. Summarize the delegation process and key behaviors when delegating
tasks.
27
8) An experienced delegator is mentoring a newly appointed nurse in her hospital. The new nurse
says that she is hesitant to delegate tasks to unlicensed assistive personnel (UAP) because she is
afraid they will not be done correctly. How can the delegator respond to the nurse's concerns?
A) Tell her not to delegate any tasks unless she is completely confident.
B) Tell her to clearly identify the task and expectations and then to monitor the delegate's
progress.
C) Tell her that delegation often results in a decrease in job satisfaction.
D) Tell her that her job responsibility requires that she do everything herself.
Answer: B
Explanation:
A) Although this is a typical concern of inexperienced and insecure delegators, following the
delegation guidelines can increase her confidence in the process. The key to retaining control is
to clearly identify the task and expectations and then to monitor the delegate's progress and
provide feedback. If one is able to delegate some routine tasks to others, then job satisfaction
should increase because of increased opportunities. An appropriate environment supports
delegation.
B) Although this is a typical concern of inexperienced and insecure delegators, following the
delegation.
C) Although this is a typical concern of inexperienced and insecure delegators, following the
delegation.
D) Although this is a typical concern of inexperienced and insecure delegators, following the
delegation.
Page Ref: 2471-2472
Learning Outcome: 5. Examine obstacles that can impede effective delegation.
28
Exemplar 39.4 Management Principles
1) A nursing supervisor has been told to ensure that the hospital's new electronic records system
is properly implemented on her unit. The supervisor can exercise their managerial role by doing
which of the following?
A) Creating a "buddy" system that pairs staff members who are less technologically comfortable
with staff members who may require more assistance with the new system
B) Providing regular training sessions in the new system
C) Informing staff that the new system is optional
D) Establishing a regular spot check of each staff member's effective use of the system
E) Continuing to use paper records until the staff is completely comfortable with the new system
Answer: A, B, D
Explanation:
A) The manager's role includes choosing the means by which to achieve goals, assigning and
coordinating tasks and developing and motivating staff, and evaluating outcomes and providing
feedback. The manager should not undermine the organizational goals and objectives.
B) The manager's role includes choosing the means by which to achieve goals, assigning and
C) The manager's role includes choosing the means by which to achieve goals, assigning and
D) The manager's role includes choosing the means by which to achieve goals, assigning and
E) The manager's role includes choosing the means by which to achieve goals, assigning and
Page Ref: 2475
Nursing Process: Communication and Documentation
Learning Outcome: 1. Differentiate between managers and leaders.
29
2) Which are stages of the planning process for a nurse manager?
A) Establish objectives (goals).
B) Evaluate the present situation and predict future trends and events.
C) Formulate a planning statement (means).
D) Coordinate the work to be done.
E) Convert the plan into an action statement.
Answer: A, B, C, E
Explanation:
A) The nurse manager plans and develops specific goals and objectives for his or her area of
responsibility. The manager identifies and manages unplanned and unexpected events that
interfere with getting work done efficiently, effectively, and in a timely manner. The manager
must also develop operational plans for implementation, such as acquiring devices and training
staff. A plan addresses the questions of what, why, where, when, how, and by whom.
Coordination is part of organization, not planning.
B) The nurse manager plans and develops specific goals and objectives for his or her area of
C) The nurse manager plans and develops specific goals and objectives for his or her area of
D) The nurse manager plans and develops specific goals and objectives for his or her area of
E) The nurse manager plans and develops specific goals and objectives for his or her area of
Page Ref: 2475
Learning Outcome: 2. Describe the duties of a manager based on management theory.
30
3) As a nursing supervisor in a small rural hospital, you have been asked to help manage the
switch from paper to electronic records. What are some standard managerial steps you might
take in this process?
A) Planning
B) Experimenting
C) Organizing
D) Criticizing
E) Synthesizing
Answer: A, C
Explanation:
A) The nurse manager plans and develops specific goals and objectives for his or her area of
responsibility. Organizing is the process of coordinating the work to be done. Experimenting,
criticizing, and synthesizing, although they may be done by managers, are not standard
managerial functions.
B) The nurse manager plans and develops specific goals and objectives for his or her area of
C) The nurse manager plans and develops specific goals and objectives for his or her area of
D) The nurse manager plans and develops specific goals and objectives for his or her area of
E) The nurse manager plans and develops specific goals and objectives for his or her area of
Page Ref: 2475-2476
Learning Outcome: 2. Describe the duties of a manager based on management theory.
31
4) A supervisor on a medical-surgical unit excels at scheduling staff and allocating resources.
However, when new policies are being implemented, the supervisor has great difficulty getting
staff cooperation. Why is this supervisor a manager but not a leader?
A) A leader clarifies the organizational structure.
B) A leader exerts influence by using a flexible combination of personal behaviors and
strategies.
C) A leader always assigns and coordinates tasks.
D) A leader must use contingency planning.
Answer: B
Explanation:
A) A manager clarifies the organizational structure. A leader creates connections among an
organization's members to promote high levels of performance and quality outcomes. A manager
assigns and coordinates tasks. A manager must use contingency planning to identify and manage
unplanned and unexpected events that interfere with getting work done efficiently.
B) A manager clarifies the organizational structure. A leader creates connections among an
C) A manager clarifies the organizational structure. A leader creates connections among an
D) A manager clarifies the organizational structure. A leader creates connections among an
Page Ref: 274-275
Nursing Process: Communication and Documentation
Learning Outcome: 1. Differentiate between managers and leaders.
32

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