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A nurse manager has calculated that providing 75 hours of direct nursing care per day requires that 120 hours must actually be worked by nursing staff. The manager is involved in: (select all that apply)
- A. developing the capital budget.
- B. applying productivity metric.
- C. monitoring the labor budget.
- D. incremental budgeting processes.
Correct Answer: B
Rationale: The correct answer is B: applying productivity metric. The nurse manager is calculating the ratio of direct nursing care hours to total hours worked, which is a productivity metric. This metric helps assess the efficiency of the nursing staff in delivering care. Developing the capital budget (A) involves planning for long-term investments, not daily staffing calculations. Monitoring the labor budget (C) involves tracking expenses related to staff salaries and benefits, but not necessarily productivity metrics. Incremental budgeting processes (D) refer to budgeting based on past budgets with incremental changes, not specific productivity metrics. Therefore, the nurse manager is primarily involved in applying a productivity metric to assess nursing staff efficiency.
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A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
- A. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company.
- B. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
- C. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
- D. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
Correct Answer: B
Rationale: The correct answer is B. The DRG payment system is a fixed reimbursement amount for a specific diagnosis or procedure. In this case, the cost of care exceeded the DRG reimbursement amount due to the extended ICU stay caused by the client's smoking history. The hospital will only be reimbursed at the set fee specified by the DRG, regardless of the actual cost incurred.
Choice A is incorrect because the hospital cannot collect additional fees from the insurance company beyond the DRG reimbursement amount. Choice C is incorrect as the client is not typically held responsible for the additional costs incurred. Choice D is incorrect because physician payment is not directly impacted by the hospital's financial losses. The DRG system focuses on fixed reimbursements based on diagnoses, not individual physician payments.
A group of nurses meet with a state representative to explain the importance of allowing registered nurses the right to sign death certificates for patients who were under their care. As constituents and nurses, they requested that the senator vote against the bill restricting this practice. These nurses are serving as:
- A. lobbyists.
- B. policymakers.
- C. officials with regulatory power.
- D. advocates for the Patient Safety and Quality Improvement Act.
Correct Answer: A
Rationale: The correct answer is A: lobbyists. The nurses are acting as lobbyists by advocating for a specific cause (allowing RNs to sign death certificates) to the state representative. They are not policymakers (B) because they are not directly making decisions or creating policies. They are also not officials with regulatory power (C) as they are not in a position to enforce regulations. Lastly, they are not advocating for the Patient Safety and Quality Improvement Act (D) specifically in this scenario.
A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:
- A. Institute for Safe Medication Practices.
- B. Institute of Medicine.
- C. National Committee for Quality Assurance.
- D. The Joint Commission.
Correct Answer: B
Rationale: The correct answer is B: Institute of Medicine. The Institute of Medicine is known for disseminating knowledge related to health care through government agencies, the public, business, and health care professionals to improve health outcomes. The organization conducts research and provides evidence-based recommendations to address health care challenges.
A: Institute for Safe Medication Practices focuses specifically on promoting safe medication practices, not a broad range of health care knowledge dissemination.
C: National Committee for Quality Assurance primarily focuses on accrediting and certifying health care organizations based on quality standards, rather than broadly distributing health care knowledge.
D: The Joint Commission is responsible for accrediting health care organizations and institutions, ensuring they meet quality and safety standards, but not specifically for distributing health care knowledge to various stakeholders.
Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care?
- A. Martha Rogers' nursing theory
- B. Dorothea Orem's nursing theory
- C. Hildegard Peplau's nursing theory
- D. Madeleine Leininger's nursing theory
Correct Answer: D
Rationale: The correct answer is D, Madeleine Leininger's nursing theory. Leininger's Cultural Care Theory emphasizes the importance of providing culturally congruent care to individuals, taking into account their cultural beliefs, values, and practices. This theory is particularly relevant when caring for immigrants as it helps nurses understand and address their unique cultural needs.
A: Martha Rogers' nursing theory focuses on the science of unitary human beings and energy fields, not specifically on cultural care.
B: Dorothea Orem's nursing theory, the Self-Care Deficit Theory, emphasizes the individual's ability to perform self-care activities, not specifically cultural care.
C: Hildegard Peplau's nursing theory, the Theory of Interpersonal Relations, focuses on the nurse-patient relationship and therapeutic communication, not specifically on cultural care for immigrants.
An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for:
- A. delegating the task to another UAP if he or she does not have the time or skill to complete the task.
- B. keeping the RN informed of any abnormal blood pressure readings.
- C. calling the physician when the patient's vital signs are not within established parameters.
- D. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.
Correct Answer: B
Rationale: The correct answer is B because keeping the RN informed of any abnormal blood pressure readings is an essential part of the UAP's responsibility. This ensures that the RN is aware of any potential issues with the patients' health and can intervene if necessary. It is important for the UAP to communicate such vital information promptly to the RN, who has the clinical expertise to assess the situation and make appropriate decisions.
Choice A is incorrect because the UAP should not delegate tasks to another UAP without prior authorization from the RN. Choice C is incorrect because calling the physician directly is beyond the scope of practice for a UAP. Choice D is incorrect because initiating a low-sodium diet for hypertensive patients is a clinical decision that should be made by the RN or physician, not the UAP.