Nursing Today Transition And Trends 9th Edition By JoAnn Zerwekh, Ashley Garneau – Test Bank

Chapter 11: Building Nursing Management Skills
MULTIPLE CHOICE
1. During clinical experience, the student nurse is assigned a patient scheduled to undergo numerous treatments. The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day. The student nurse consults with the clinical instructor to
a. delegate. c. procrastinate.
b. prioritize. d. do the easiest treatment first.
ANS: B
Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient’s problems or needs so that you can provide care to the patient’s highest priority needs first. Delegation would not be the most logical or appropriate choice as the student is not working over anyone. It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management. Procrastination is never a good approach in managing patient care.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 249
OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.
TOP:Nursing time management in clinical
MSC: NCLEX®: Safe and effective care environment—management of care
2. The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment. Which activity should be scheduled?
a. Suctioning the tracheostomy tube of a patient
b. Administering medications
c. Assessing patient knowledge of colostomy care
d. Assisting a patient with personal hygiene
ANS: B
Medications are the most time sensitive issues in nursing care delivery. Scheduling is predetermined by the physician’s order. Assessment of a patient’s understanding of colostomy care can be done at any time. Personal hygiene needs can be met around non–time-sensitive issues (medications, treatments) in managing the patient care. Suctioning a tracheostomy should be performed when the patient needs it; it is not scheduled.
PTS: 1 DIF: Cognitive Level: Application REF: p. 249
OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.
TOP:Time management in clinical
MSC: NCLEX®: Safe and effective care environment—management of care
3. A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to
a. delegate one of the patients to someone else.
b. prioritize the needs of the patients and determine the sickest patient.
c. procrastinate and hope that someone will offer assistance.
d. do the easiest patients first to allow more time for sicker patients.
ANS: B
It is important to determine the least stable patient when planning care for multiple patients. Plan and complete the care for the patient who requires multiple treatments or complex nursing care. This patient is most likely to experience physiological problems if the nurse does not address his or her needs. The others are cared for in the priority order determined by their stability and needs. Procrastination and caring for the easiest patient first are not reflective of assessing patient needs and administering patient care management effectively.
PTS: 1 DIF: Cognitive Level: Application REF: p. 249
OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify time-management strategies for increasing high-payoff, high-priority activities.
TOP:Time management in clinical
MSC: NCLEX®: Safe and effective care environment—management of care
4. Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)?
a. “The increased need for health care coverage”
b. “The need for more qualified nurses”
c. “A need for a teamwork system focused on improving communication and teamwork”
d. “The increased cost of health care”
ANS: C
The Department of Defense (DoD) Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes. The team was not created to solve health care coverage concerns, search for more qualified nurses or to decrease the cost of health care. The Joint Commission accredits hospitals and health care agencies. The Institute of Medicine provides national advice on issues relating to biomedical science, medicine, and health, and its mission to serve as adviser to the nation to improve health. The Centers for Medicare is not about patient safety but about medical insurance for people older than the age of 65 years.
PTS: 1 DIF: Cognitive Level: Application REF: p. 238
OBJ:Discuss Team STEPPS Tools as an evidence-based teamwork system to optimize patient outcomes.TOP:Patient management
MSC: NCLEX®: Safe and effective care environment—management of care
5. The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is
a. “unclear, ineffective communication.”
b. “unclear chain of communication for reporting.”
c. “ineffective reporting of the untoward event.”
d. “lack of consistent supervision of nursing staff.”
ANS: A
Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported. The majority of those untoward events involved communication failure. The other options were not identified as the majority of all sentinel events.
PTS: 1 DIF: Cognitive Level: Application REF: p. 238
OBJ:Analyze effective communication as it relates to patient safety.
TOP:Communication
MSC: NCLEX®: Safe and effective care environment—management of care
6. The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider’s order is received without error?
a. Advise the health care provider that the order must be written on the chart within the next 24 hours.
b. Ask the nurse in charge to come to the phone to take the order.
c. Write the order without using any unclear or unapproved abbreviations.
d. Repeat the order, write the order verbatim, and read it back to the provider.
ANS: D
Repeat the order, write the order verbatim, and read it back to the provider are the steps recommended to confirm that the order was understood correctly, as well as communicated correctly. The question is in regard to the receiving of the order, not specifically how it is written. The nurse will write the phone order on the chart, and later the health care provider will co-sign the order. The charge nurse does not have to take the phone order; any licensed nurse can take the phone order.
PTS: 1 DIF: Cognitive Level: Application REF: p. 239
OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify current methods of transcribing physician’s orders. TOP: Communication
MSC: NCLEX®: Safe and effective care environment—management of care
7. The nurse receives report on an assigned group of patients. Which patient would the nurse assess first?
a. A patient 2 days postoperative who is complaining of pain
b. An older adult patient reported to have increasing lethargy and confusion
c. A newly admitted patient with a serum blood urea nitrogen (BUN) of 32 mg/dL
d. A hypertensive patient complaining of severe midsternum pain
ANS: D
The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately. This does not mean that the nurse will not address the needs of the other patients, but the safety of the hypertensive patient is at risk if the nurse does not see him first.
PTS: 1 DIF: Cognitive Level: Application REF: p. 249
OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.
TOP:Patient management
MSC: NCLEX®: Safe and effective care environment—management of care
8. What are critical points to communicate during a shift report or hand-off communication?
a. Patient name, current physical status, activities that have contributed to current status, problems that have occurred during the shift, nursing care to address problems, and a readback or response
b. Patient name, room number and date of birth, changes in current orders, provider’s visits, laboratory tests that have been completed, and physical activity of the patient
c. Patient name, health care provider, diagnosis, review of all current orders, family visits and involvement in care, review of history leading to hospitalization, and current status of the patient
d. Physician orders for past 24 hours, patient name and date of birth, medical and social history prior to hospitalization, and review of health problems since hospitalization
ANS: A
According to the I-SBAR-R tool—Identification (patient name), Situation (current physical status), Background (activities that contributed to current status), Assessment (problems that occurred during shift), Recommendation (nursing care to address problems), Readback or Response (receiver acknowledges information)—these are critical areas. All of the other options contain items that are not critical to a shift report.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 243-244
OBJ:Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shift-report.TOP:Communication
MSC: NCLEX®: Safe and effective care environment—management of care
9. The charge nurse is assigning patient care activities to the nursing care team. In supervising the team, what is the most effective activity to determine that the nursing care has been completed satisfactorily?
a. Have hourly checks with personnel to determine how effectively nursing care is being completed.
b. Review with personnel at the end of the shift regarding the status of patients and how care was delivered.
c. Discuss with each person the status of their assigned patients and what type of nursing care each will require.
d. Schedule routine patient care rounds to evaluate the patients and the nursing care that has been completed.
ANS: A
Supervision entails providing direction, evaluation, and follow-up by the nurse regarding the nursing care assigned. The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel) and evaluate the patient. Waiting until the end of the shift could lead to problems not being assessed early to prevent complications. Discussing with the health care provider about the patient is a good practice, but determining the outcome of the care is what needs to be evaluated not just telling them what type of care is required. Scheduling rounds allows the nurse to evaluate the patient; however, communication with the nursing team is important to determine if care is administered satisfactorily.
PTS: 1 DIF: Cognitive Level: Application REF: p. 253
OBJ: Identify criteria for supervising and evaluating care provided by others.
TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care
10. What would be a good assignment for an experienced nursing assistant?
a. Help teach patients newly diagnosed with diabetes to give themselves injections.
b. Report on the quality and quantity of urine on a continuous bladder irrigation.
c. Obtain a clean-catch urine specimen from a patient.
d. Chart a diet for a patient with an eating disorder.
ANS: C
The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient. Charting, teaching, and assessing are not assigned to the nursing assistant.
PTS: 1 DIF: Cognitive Level: Application REF: p. 252
OBJ: Identify criteria for supervising and evaluating care provided by others.
TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care