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Which statements describe characteristics of case management? Select all that apply.
- A. A case manager usually does not provide direct care.
- B. Critical pathways and CareMaps are types of case management.
- C. A case manager does not need to be concerned with standards of cost management.
- D. A case manager collaborates with and supervises the care delivered by other staff members.
- E. The evaluation process involves continuous monitoring and analysis of the needs of the client and services provided.
- F. A case manager coordinates a hospitalized client's acute care and follows up with the client after discharge to home.
Correct Answer: A,D,E,F
Rationale: Case management is a care management approach that coordinates health care services to clients and their families while maintaining quality of care and minimizing health care costs. Case managers usually do not provide direct care; instead, they collaborate with and supervise the care delivered by other staff members and actively coordinate client discharge planning. A case manager is usually held accountable for some standard of cost management. A case manager coordinates a hospitalized client's acute care, follows up with the client after discharge to home, and is responsible and accountable for appraising the overall usefulness and effectiveness of the case-managed services. This evaluation process involves continuous monitoring and analysis of the client's needs and services provided. Critical pathways or CareMaps are not types of case management; rather, they are multidisciplinary treatment plans used in a case management delivery system to implement timely interventions in a coordinated care plan.
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A registered nurse (RN) delegates the changing of a client's colostomy bag to a licensed practical nurse (LPN) who has never performed the procedure on a client. Which is the most appropriate action for the RN to implement?
- A. Perform the procedure with the LPN.
- B. Request that the LPN observe another LPN perform the procedure.
- C. Ask the LPN to review the materials from the in-service before performing the procedure.
- D. Instruct the LPN to review the procedure in the hospital manual and use the written procedure as a reference.
Correct Answer: A
Rationale: The RN must remember that, even though a task may be delegated to someone, the nurse who delegates maintains accountability for the overall nursing care of the client. Only the task, not the ultimate accountability may be delegated to another. The RN is responsible for ensuring that competent and accurate care is delivered to the client. Because colostomy bag change is a new procedure for this LPN, the RN should accompany the LPN, provide guidance, and answer questions after the procedure. Requesting that the LPN observe another LPN perform the procedure does not ensure that the procedure will be done correctly. Although it is appropriate to review the in-service materials and the hospital procedure manual, it is best for the RN to accompany the LPN to perform the procedure.
The nurse documents a written entry regarding client care in the client's medical record. When checking the entry, the nurse notices that some of the documented information was incorrect. Which action should the nurse implement at this time?
- A. Obliterate the incorrect information with a black marker.
- B. Use correction fluid to cover up the incorrect information.
- C. Erase the error completely and write in the correct information.
- D. Draw a line through the incorrect information and initial the change.
Correct Answer: D
Rationale: To correct a written error documented in a medical record, the nurse draws one line through the incorrect information and then initials the error. The information remains visible and properly labeled as incorrect. Errors are never erased, and correction fluid or black markers are never used on a legal document such as the medical record.
The nurse caring for a chronically ill client with a poor prognosis shows an understanding of the basic values that guide the implementation of a living will by asking which questions? Select all that apply.
- A. Are you planning to become an organ donor?
- B. Do you feel the need to discuss your end-of-life decisions with your family?
- C. Did you have the discussion with your son about being your health care surrogate?
- D. Can we discuss what will happen if you decide to refuse antibiotics if you get an infection?
- E. Have you given thought to whether you want cardiopulmonary resuscitation (CPR) measures if your condition worsens?
Correct Answer: B,D,E
Rationale: A living will lists the treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill. The client may want to discuss her or his decisions with the family. Although both the living will and durable powers of attorney for health care are based on values of informed consent, autonomy over end-of-life decisions, and control over the dying process, living wills do not involve health care surrogates or the decision to donate organs.
The nurse is planning care for a client admitted with suicidal ideations. To best assure client safety the nurse will implement additional precautions during which time period?
- A. During the day shift
- B. On weekday evenings
- C. Between 8 am and 10 am
- D. During the unit shift change
Correct Answer: D
Rationale: At shift change, there is often less availability of staff. The psychiatric nurse and staff should increase precautions for suicidal clients at that time. The night shift also presents a high-risk time, as do weekends, not weekdays.
The nurse should implement which safety measures to prevent an electrical shock when using electrical equipment? Select all that apply.
- A. Use a two-prong outlet.
- B. Check the electrical cord for fraying.
- C. Keep the electrical cord away from the sink.
- D. Place the excess electrical cord under a small carpet.
- E. Grasp the electrical cord when unplugging the equipment.
- F. Disconnect the electrical cord from the wall socket when cleaning the equipment.
Correct Answer: B,C,F
Rationale: The nurse needs to implement measures to prevent an electrical shock when using electrical equipment. These measures include using a three-prong plug that is grounded, checking the electrical cord for fraying or other damage, keeping the electrical cord away from the sink or other sources of water, using electrical tape to secure the excess electrical cord to the floor where it will not be stepped on (the cord should not be placed under carpet), grasping the plug (not the electrical cord) when unplugging the equipment, and disconnecting the electrical cord from the wall socket when cleaning the equipment.