Nursing Elites

1. The type of theory that discusses how motivation works to direct a person's efforts is:

• A. Reinforcement.
• B. Operant.
• C. Conditioning.
• D. Process.

Correct answer: D

Rationale: The correct answer is D, Process. Process theory focuses on how motivation directs an individual's efforts into performance. Reinforcement theory, on the other hand, views motivation as a form of learning. It involves operant conditioning, where behavior is associated with consequences. Conditioning is a broad term that includes both classical and operant conditioning, but it does not specifically address how motivation directs efforts. Therefore, choices A, B, and C are incorrect in the context of discussing how motivation works to direct a person's efforts.

2. The staff nurse is caring for the client with total accountability and is in continual communication with the client, the family, the physicians, and other members of the health care team. This type of nursing delivery system is known as:

• A. Total patient care
• B. Qualified nurse case managers
• C. Established critical pathways
• D. Quality management system

Correct answer: A

Rationale: The correct answer is A: Total patient care. Total patient care is the original model of nursing care delivery, in which one RN has complete responsibility for all aspects of care for one or more patients. In this system, the nurse is accountable for the client's care and maintains continuous communication with the client, their family, physicians, and other healthcare team members. Choice B, Qualified nurse case managers, refers to nurses who coordinate care but do not provide direct hands-on patient care. Choice C, Established critical pathways, involves predefined care plans for specific conditions but does not imply direct accountability as in total patient care. Choice D, Quality management system, relates to processes to ensure and enhance the quality of care but is not specifically about the direct provision of patient care.

3. As a new graduate employed in a high-volume maternity unit that uses differentiated practice as its staffing model, what can the nurse expect?

• A. Evidence-based practice guides risk management principles.
• B. Client teaching is the responsibility of the team leader.
• C. The initial level of practice responsibility will be limited.
• D. Seniority is the main determinant of client assignments.

Correct answer: C

Rationale: In a differentiated practice model, the scope of nursing practice and responsibility are tailored to different levels of experience. As a new graduate with limited experience, the nurse can expect that the initial level of practice responsibility will be limited to match their skill level and knowledge. This allows for a gradual increase in responsibilities as the nurse gains more experience and expertise. Choice A is incorrect because evidence-based practice is related to clinical decision-making, not the staffing model. Choice B is incorrect as client teaching is typically a shared responsibility among the healthcare team, not solely the team leader's. Choice D is incorrect as differentiated practice models focus on skill level and competence rather than seniority when determining client assignments.

4. The charge nurse role has negatively affected your relationship with your friends and made you feel tense and isolated. You decide that you will delegate more time-consuming tasks to staff who are not your friends, who then complain to your nurse manager about your perceived unfairness. You decide to:

• A. Talk with your friends individually to let them know that you will be assigning patients to all staff in an equitable manner.
• B. Not express your angry feelings.
• C. Talk about staff who are annoying you with staff on other units.
• D. Ignore your feelings of uncertainty, hoping they will diminish.

Correct answer: A

Rationale: In this scenario, it is essential to address the perceived unfairness in task delegation. Talking with your friends individually to explain that patients will be assigned equitably is the most appropriate course of action. This approach promotes transparency and fairness in task allocation, helping to maintain professional relationships. Choices B, C, and D are not suitable responses. Choice B ignores the issue, choice C involves unprofessional behavior by gossiping about colleagues, and choice D neglects addressing the root cause of the problem.

5. Which of the following best describes the role of a nurse case manager?

• A. To provide direct patient care
• B. To manage healthcare facilities
• C. To advocate for patient rights
• D. To coordinate long-term care services

Correct answer: D

Rationale: The correct answer is D: 'To coordinate long-term care services.' A nurse case manager's primary role is to coordinate and manage long-term care services for patients, ensuring continuity and quality of care. Choice A is incorrect because providing direct patient care is typically the responsibility of nurses, not nurse case managers. Choice B is incorrect as managing healthcare facilities is a role usually fulfilled by healthcare administrators. Choice C is incorrect as advocating for patient rights is important but not the primary role of a nurse case manager.

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