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An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that:
- A. the role of the LPN/LVN is the same from state to state.
- B. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided.
- C. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN.
- D. The Joint Commission has certified and established roles for the LPN/LVN.
Correct Answer: C
Rationale: The correct answer is C. When delegating tasks to an LPN/LVN, the RN must review the state's nurse practice act because each state defines the role and scope of practice of the LPN/LVN. This is crucial as the LPN/LVN scope of practice can vary significantly from state to state. By reviewing the nurse practice act, the RN ensures that the tasks being delegated fall within the legal scope of practice for the LPN/LVN in that specific state, promoting safe and effective patient care.
Choice A is incorrect because the role of the LPN/LVN can differ between states.
Choice B is incorrect because LPN/LVNs cannot perform all duties of an RN, and additional training does not change their scope of practice.
Choice D is incorrect because the Joint Commission does not establish roles for LPN/LVNs; it focuses on accreditation standards for healthcare organizations.
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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.
When deciding whether and when a task should be completed, a nurse must:
- A. complete all tasks as they are thought of to prevent having to take time to consider which is most important.
- B. procrastinate and hope that someone will volunteer to do it.
- C. ask, "What will happen if I don't complete the task now?"
- D. view large projects holistically and not as many small pieces.
Correct Answer: C
Rationale: The correct answer is C: ask, "What will happen if I don't complete the task now?" This is the best approach as it helps prioritize tasks based on their urgency and importance. By considering the consequences of not completing a task immediately, the nurse can focus on critical tasks first to ensure patient safety and efficient workflow.
Choice A is incorrect because completing all tasks as they are thought of without prioritizing can lead to neglecting important tasks and compromising patient care. Choice B is incorrect as procrastination is not a professional or effective way to manage tasks in a healthcare setting. Choice D is incorrect as viewing large projects holistically is important, but it doesn't address the immediate need to prioritize individual tasks.
Although the NCLEX-RN examination has new formats for questions, the most common format is the:
- A. fill-in-the-blank item because candidates are not provided with clues from distracters.
- B. multiple-choice question item, which allows candidates to select the one correct answer.
- C. multiple-response item because these questions require a higher level of critical thinking.
- D. hot-spot item because these questions are written at the application level of Bloom's analysis.
Correct Answer: B
Rationale: The correct answer is B: multiple-choice question item, which allows candidates to select the one correct answer. This is because the multiple-choice format is widely used in the NCLEX-RN examination as it is effective in assessing a candidate's knowledge, critical thinking skills, and ability to make decisions. The distractors in the answer choices provide clues and test the candidate's ability to differentiate between correct and incorrect information.
Choices A, C, and D are incorrect:
A: fill-in-the-blank item is not the most common format for NCLEX-RN questions as candidates are indeed provided with clues from distractors in multiple-choice questions.
C: multiple-response item, although requiring critical thinking, is not the most common format on the NCLEX-RN exam.
D: hot-spot item is not the most common format on the NCLEX-RN exam, and it is not necessarily written at the application level of Bloom's analysis.
The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a:
- A. nurse manager.
- B. case manager.
- C. coordinator of patient-centered care delivery.
- D. team leader in team nursing care delivery.
Correct Answer: B
Rationale: The correct answer is B: case manager. A case manager is responsible for coordinating care for a patient from admission to discharge, collaborating with various healthcare providers. This role involves managing the patient's overall care plan, ensuring continuity and efficiency. The other choices are incorrect because:
A: Nurse manager focuses on managing nursing staff and unit operations, not individual patient care.
C: Coordinator of patient-centered care delivery may oversee care coordination but does not necessarily follow the patient throughout the entire care journey.
D: Team leader in team nursing care delivery is focused on leading a specific nursing team, not managing the patient's entire care process.
The nurse manager is planning staffing levels and realizes that the first step is to:
- A. know the intensity of care needed by patients according to physical and psychosocial factors.
- B. examine the educational level of the staff.
- C. assess the skill level of caregivers.
- D. review the budget to determine the financial consequences of past staffing patterns.
Correct Answer: A
Rationale: The correct answer is A because knowing the intensity of care needed by patients based on physical and psychosocial factors is essential to determine appropriate staffing levels. Understanding patient needs ensures adequate staff allocation for quality care delivery. Examining staff education (B) and skill level (C) is important but comes after assessing patient needs. Reviewing the budget (D) is necessary but should not be the first step in staffing planning.