Ch 11: The Healthcare Delivery System

A nurse is providing supportive care to a client diagnosed with a terminal illness who is not expected to live past the next 3 months or so. The nurse is likely working in which setting? a) Hospice care b) Palliative care c) Respite care d) Parish nursing

a) Hospice care

Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery? a) Hospitals b) Primary care centers c) Ambulatory care centers d) Day care centers

a) Hospitals

The hospital has developed a clinic specifically to serve people who are uninsured. Which statement(s), made by a nurse asked to transfer to working in the clinic, indicates need for additional teaching? Select all that apply. a) "I am not certain I will like working with people who are so poor." b) "Maybe my knowledge of other languages will come in handy." c) "Aren't most uninsured people illegal aliens?" d) "I understand that high cost is the reason many people choose not to purchase health insurance." e) "Why should I change my schedule to work with a group of clients who have never worked at all."

a) "I am not certain I will like working with people who are so poor." c) "Aren't most uninsured people illegal aliens?" e) "Why should I change my schedule to work with a group of clients who have never worked at all."

Which statement regarding health care reform trends is most accurate? a) "Systems are in place to pay for performance and penalize hospitals for excessive readmissions." b) "Distinctive to the United States is the dominance of the public element over the private one." c) "The United States is secnd in the world in total health care dollars spent annually." d) "Spending on medical services will rise to almost 32% of the U.S. gross domestic product by 2021."

a) "Systems are in place to pay for performance and penalize hospitals for excessive readmissions."

A nurse is providing care to several clients at the clinic. When reviewing the clients' medical records, which client would the nurse identify as meeting the criteria for Medicare reimbursement? Select all that apply. a) 66-year-old male with heart failure b) 55-year-old female with a temporary disability c) 45-year-old male with a permanent disability receiving social security benefits d) 30-year-old male with blindness from an industrial accident e) 60-year-old female with a low income

a) 66-year-old male with heart failure c) 45-year-old male with a permanent disability receiving social security benefits

The nurse is providing care to several clients. For which client should the nurse include secondary care in the nursing plan of care? a) A middle-aged client who presents with new-onset angina b) A pediatric client who tests positive for strep c) An older adult client who requires a medication refill d) An adolescent client who requires a sports physical

a) A middle-aged client who presents with new-onset angina

Which is the most accurate definition of urgent care? a) A type of ambulatory care that treats people who walk in with illnesses and minor trauma b) Care provided in an office that is staffed by several doctors c) Medical and nonmedical care for chronic illnesses d) Care provided to clients in their homes after they are discharged

a) A type of ambulatory care that treats people who walk in with illnesses and minor trauma

Which is an emerging trend in health care delivery? a) Active involvement of consumers b) Resolution of the nursing shortage c) Simplification of client care d) Reduction in the use of technology at the bedside

a) Active involvement of consumers

Which therapist is most likely to focus on teaching a client to hold a toothbrush with an adaptive device and brush the teeth? a) An occupational therapist b) A speech therapist c) A physical therapist d) A respiratory therapist

a) An occupational therapist

What are chief tasks of the home health care nurse? Select all that apply. a) Developing a nursing care plan b) Providing for a dignified death at home c) Providing client education and counseling d) Providing continuity of care e) Administering medications f) Collecting payment for nursing care

a) Developing a nursing care plan c) Providing client education and counseling d) Providing continuity of care e) Administering medications

The growth in home health care is largely attributed to which factor? a) Early discharge of clients from the hospital setting b) Nurses' desire to work in the community c) The nursing shortage in hospitals d) The inability of hospitals to care for an increasing number of clients

a) Early discharge of clients from the hospital setting

The Patient Protection and Affordable Care Act (ACA) was passed in 2010 and aims to provide affordable health care to everyone. Which are goals of the ACA? Select all that apply. a) Health care affordability b) High-quality insurance c) Ability to compare insurance options d) Accessibility to insurance services e) Decreased number of uninsured

a) Health care affordability c) Ability to compare insurance options d) Accessibility to insurance services e) Decreased number of uninsured

Which provisions are included in the Affordable Care Act (ACA)? Select all that apply. a) Improve coverage by providing health care for dependent children up to 26 years of age b) Provide access to clinical preventive services by eliminating copayments for these services c) Enhance the quality and efficiency of health care by increasing the Medicare Part D prescription drug benefit d) Mandate that all U.S. citizens and legal residents must have health care coverage e) Reduce available primary care physician education and technical assistance programs

a) Improve coverage by providing health care for dependent children up to 26 years of age b) Provide access to clinical preventive services by eliminating copayments for these services c) Enhance the quality and efficiency of health care by increasing the Medicare Part D prescription drug benefit d) Mandate that all U.S. citizens and legal residents must have health care coverage

A nurse has very strong client education skills. In which health care setting would the nurse make best use of these skills? a) Primary care center b) Emergency department c) Same-day surgery unit d) Tertiary care medical center

a) Primary care center

A client is admitted to the facility after fracturing a hip. The client has undergone surgery to repair the fracture and is receiving services to promote healing of the surgical site and regain mobility. Which discussion should the nurse have with a member of the interdisciplinary team member to promote the goal of regaining mobility? a) Speak with the physical therapist about exercises to strengthen muscles. b) Discuss oxygen administration with the respiratory therapist. c) Talk with the occupational therapist about providing assistance with activities of daily living. d) Discuss transfer to a rehabilitation facility with the social worker.

a) Speak with the physical therapist about exercises to strengthen muscles.

A client diagnosed with lung cancer has been given a prognosis of 3 to 4 months of life. The nurse discusses hospice care with the client and family. Which aspect of the client's health status indicates that hospice care is appropriate? a) The client has a life expectancy of less than 6 months b) The client has a diagnosis of metastatic cancer c) The client does not have family or a support system to provide care d) The client wishes to treat disease with complementary alternative medicine

a) The client has a life expectancy of less than 6 months

An example of primary health care is: a) a hearing screening in the school setting. b) care of the client in the intensive care unit. c) diagnostic testing for HIV/AIDS. d) care of the client on rehabilitation.

a) a hearing screening in the school setting.

A nurse demonstrates understanding of Healthy People 2020: Understanding and Improving Health by supporting which statement? a) Establish a set of nursing skills that focuses on quick resolution to clients' needs. b) A client's health is affected by social, economic, and political factors. c) Clinical care supports wellness in the environment. d) Physical therapy supports client safety at home.

b) A client's health is affected by social, economic, and political factors.

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge? a) Americans with Disabilities Act b) Affordable Care Act c) American Nurses Association Bylaws d) National Commission for Minorities

b) Affordable Care Act

Which scenario is using a prospective payment plan to reimburse for services? a) A client is hospitalized for an emergency appendectomy. Since the hospital is a preferred provider the fee for service was discounted. b) An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. c) A client with chronic heart failure is offered health care teaching and preventative services for free. d) A child is hospitalized and treated for a fractured femur. The hospital receives a preset fee for each member regardless of whether the member required services.

b) An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price.

A nurse is caring for an older adult client in the home. The nurse concludes that the client needs an X-ray to determine whether the client has pneumonia and requires oxygen for shortness of breath. The nurse calls to inform the physician of the client's status and then makes arrangements to carry out the physician's orders. In this scenario, what role does the nurse play? a) Nurse practitioner b) Case manager c) Clinical nurse specialist d) Advanced practitioner

b) Case manager

Which statement regarding spiritual care providers in hospitals is most accurate? a) Only in-hospital clergy or pastors from local churches are legally protected to provide spiritual care at hospitals. b) Clergy, lay volunteers, and those with advanced spiritual care degrees can serve on the spiritual care team at hospitals. c) Lay volunteers from local churches and similar organizations are typically the primary spiritual care providers in most hospitals. d) Spiritual care providers offer care only for clients and their families. Staff needs are met by other providers.

b) Clergy, lay volunteers, and those with advanced spiritual care degrees can serve on the spiritual care team at hospitals.

Which is the primary reason extended care facilities have proliferated in the past decade? a) Clients being discharged from the hospital too early and thus not being able to care for themselves b) Clients being discharged to a lower, less expensive level of care once they no longer require acute care c) Clients lacking family members or others to serve as caregivers for them at home d) Clients not wanting to use home health care

b) Clients being discharged to a lower, less expensive level of care once they no longer require acute care

Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role? a) Identifying individuals who are at risk of developing diabetes mellitus b) Collaborating with all agencies to provide for the client's home health needs c) Verifying that all documentation is updated prior to surgery d) Providing client education related to colostomy care

b) Collaborating with all agencies to provide for the client's home health needs

A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed? a) Refer him to the dietitian. b) Enroll the client in Meals on Wheels. c) Suggest he go to an assisted living facility. d) Have the social worker counsel him.

b) Enroll the client in Meals on Wheels.

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system? a) Medicaid b) Medicare c) Capitation d) AmeriCare

b) Medicare

What nursing function would be most commonly found in an ambulatory care facility? a) Serving as an administrator or manager b) Providing direct client care c) Educating individuals or groups d) Assessing the home environment

b) Providing direct client care

Who provides care in the primary nursing model? a) Nursing students b) Registered nurses c) Nurse assistants d) Masters' prepared nurses

b) Registered nurses

A home health nurse is scheduled to make a visit to a client who was discharged from the hospital yesterday following an appendectomy. The nurse understands that the scope of practice for a home health nurse allows the nurse to perform which psychomotor tasks? a) Assessment, wound care, teaching, and prescribing pain medications b) Wound care, medication administration, teaching, and ensuring a reasonably safe environment c) Assessment, reporting back to the agency and physician, and prescribing antibiotics d) Teaching, dietary instruction, and monitoring for infection only

b) Wound care, medication administration, teaching, and ensuring a reasonably safe environment

Medicare part A is: a) a federally funded public assistance program for low-income people. b) an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services. c) a health insurance program administered locally to cover visits to physicians, medications, and home health. d) a plan for seniors that limits providers to those within the group plan.

b) an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services.

One of the primary advantages of the managed care model is: a) increased client satisfaction. b) economic, quality care. c) an all-RN staff. d) a distinct area of care.

b) economic, quality care.

The Nursing Agenda for Health Care Reform (American Nurses Association [ANA]) identifies the recipients of health care. This reform's main focus is on: a) accurate assessment in the acute health care setting. b) health promotion. c) better connectivity through the use of technology. d) high-quality disease management.

b) health promotion.

The nurse is caring for several clients with chronic conditions that need to be evaluated for long-term care. After evaluating each client, the nurse determines which client is most appropriate to receive long-term care? a) A client newly diagnosed with rheumatoid arthritis requiring medication monitoring. b) A client with severe back injury as a result of a car accident needing ongoing physical therapy. c) A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs). d) A client diagnosed with pneumonia requiring mechanical ventilation.

c) A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs).

Which statement accurately reflects the findings of the 1999 Institute of Medicine report, "To Err Is Human"? a) A common source of medical errors and preventable death is the overly centralized nature of health care in the United States. b) The establishment of a local or regional, rather than a national, focus to create leadership in health care will improve outcomes. c) Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors. d) Encouraging health care organizations and practitioners to develop and participate in mandatory reporting systems is desirable.

c) Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors.

During a hospice visit, the client's spouse suddenly begins to cry and says, "I am so tired. I just can't do this anymore. I am not getting to sleep and I just eat sandwiches when I can." What is the nurse's best intervention? a) Request a mental health evaluation for the spouse. b) Send the spouse to the emergency department. c) Arrange for short-term inpatient care for the client. d) Have the chaplain visit with the spouse and client.

c) Arrange for short-term inpatient care for the client.

Which statement is most accurate in discussing the difference between nursing care provided in the acute care setting and that provided in the home care setting? a) The acute care setting, unlike the home care setting, focuses on the client's needs. b) The home care setting can only be initiated when the client returns to full function. c) Both settings focus on the holistic care of an individual. d) Both care settings require the participation of the client's family.

c) Both settings focus on the holistic care of an individual.

A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine whether the client is a candidate for the new "Hospital at Home" program. Which statement accurately reflects an outcome for this program? a) Disease-specific quality standards have been found to be slightly worse than when clients are treated in the hospital. b) Clients and their family members have been found to be happier with stays in the hospital in which they have 24/7 access to the healthcare team. c) Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. d) Clients in the acute care setting require fewer chemical and physical restraints.

c) Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting.

The growth in home health care is largely attributed to which factor? a) Nurses' desire to work in the community b) The nursing shortage in hospitals c) Early discharge of clients from the hospital setting d) The inability of hospitals to care for an increasing number of clients

c) Early discharge of clients from the hospital setting

A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate? a) Respite b) Extended c) Hospice d) Palliative

c) Hospice

A nurse provides care for clients in a primary care center. What are typical roles of a nurse in this type of facility? Select all that apply. a) Managing members of the health care team b) Performing in-service education c) Making health assessments d) Performing technical procedures e) Researching nursing issues f) Providing health education

c) Making health assessments d) Performing technical procedures f) Providing health education

A nurse is researching health care in rural areas. Based on a 2013 U.S. Subcommittee on Primary Health and Aging, which statement regarding access to primary health care is correct? a) Fewer than one in five physicians specializes in primary care. b) Although over half of client visits are for primary care, only 17% of the nation's medical school graduates now choose a primary care career. c) One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers. d) Over 100,000 people die each year because they do not have health insurance and do not get to a doctor on time.

c) One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers.

The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner? a) Physical therapist b) Physician c) Respiratory therapist d) Occupational therapist

c) Respiratory therapist

The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client's swallow evaluation following a cerebral vascular accident? a) Physical therapist b) Occupational therapist c) Speech pathologist/therapist d) Physician assistant

c) Speech pathologist/therapist

A nurse works with clients in a crisis intervention center. What ability would be most important for this nurse to develop? a) Well-developed technical skills b) High tolerance for frustration c) Strong communication and counseling skills d) Ability to relate to coworkers on a professional level

c) Strong communication and counseling skills

Which six trends in health care reflect the Institute of Medicine's (IOM) focus? a) "The system should be flexible, patient centered, bureaucratic, timely, safe, and efficient." b) "The system should be static, reliable, timely, equitable, efficient, and illness focused." c) "The system should be safe, efficient, centralized, wellness promoting, government driven, and patient centered." d) "The system should be safe, effective, efficient, patient centered, timely, and equitable."

d) "The system should be safe, effective, efficient, patient centered, timely, and equitable."

It is recommended that a client go to a convalescent center upon discharge following a minor stroke. The client says, "I don't want to go anywhere, I want to go home." Which information should the nurse offer? a) "You may go home if you wish." b) "You are not able to care for yourself anymore and need help." c) "There are so many activities that I think you will like the nursing home." d) "You will only stay until you are well enough to go home."

d) "You will only stay until you are well enough to go home."

Which client would a nurse correctly refer to Medicare services? a) A client with cancer b) A low-income family with infants needing immunizations c) A client with a disability d) A 66-year-old client with diabetes

d) A 66-year-old client with diabetes

The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care? a) A middle-aged client who had a knee replacement b) A client who developed sepsis after a ruptured polyp c) A client who had a cholecystectomy d) An older adult client who fell at home and required a hip replacement

d) An older adult client who fell at home and required a hip replacement

Unlicensed assistive personnel (UAP) include which workers? a) Admission clerks, technicians, and orderlies b) Housekeepers, orderlies, and certified nursing assistants c) Volunteers, telemetry technicians, and hospital transporters d) Certified nursing assistants, orderlies, attendants, and technicians

d) Certified nursing assistants, orderlies, attendants, and technicians

A new nurse is considering getting a job in either an acute care setting or a home care setting. Which statement about these care settings is most accurate? a) Nurses work more as team members in the home care setting. b) Good communication skills are unnecessary in the home care setting. c) Clients are encouraged to help each other in the acute care setting. d) Clients play a large role in helping themselves in the home care setting.

d) Clients play a large role in helping themselves in the home care setting.

Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect? a) Care provider b) Counselor c) Educator d) Coordinator of care

d) Coordinator of care

The goals of health care reform include which? a) Controlling health care costs by providing limited services for more consumers of health care b) Decreasing health care services to provide all citizens with some access to care but control escalating costs c) Improving quality of care while limiting access for the uninsured to control rising costs d) Focussing on cost containment with improved access and quality of services for everyone

d) Focussing on cost containment with improved access and quality of services for everyone

A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate? a) Parish nursing services b) Palliative care c) Hospice care d) Respite care

d) Respite care

The family of a terminally ill client asks the nurse about respite care. What should the nurse educate the family about regarding respite care? a) Respite care is covered by Medicare and Medicaid. b) Respite care is provided primarily by a registered nurse in the client's home. c) Respite care requires a referral by a health care provider. d) Respite care is often provided by volunteers.

d) Respite care is often provided by volunteers.

A client has a rare neurological disorder and will require complex management with specialists. Which level of care should the nurse anticipate this client requiring? a) Complex referral b) Primary c) Secondary d) Tertiary

d) Tertiary