Chapter 11: The Healthcare Delivery System

A nurse is caring for a client with end-stage liver failure. Which healthcare agency should the nurse recommend for continuity of care? -Extended care -HMO -Emergency department -PPO

Extended care Explanation: Extended care services meet the needs of clients who no longer require acute hospital care, including rehabilitation, skilled nursing care in a person's home or nursing home, and hospice for dying clients. HMOs are corporations that provide health care for members in exchange for preset, fixed, or yearly fees. PPOs are agents for health insurance companies that control healthcare costs on the basis of competition. A client with end-stage liver failure would not require emergency care.

A client has a complex medical history related to the consequences of diabetes. As a result of having diabetic nephropathy, the client now participates in the local hospital's dialysis program and has been referred to an ophthalmologist by the primary care health care provider following the onset of vision problems. In addition, the client receives home care nursing for the treatment of a foot ulcer that is slow to heal. This client's situation characterizes which phenomenon? -Fragmentation of care -Managed care -Case management -Primary care

Fragmentation of care Explanation: Fragmentation of care occurs when multiple, specialized practitioners are involved in various aspects of a complex client's care. This creates the potential for miscommunication and conflicting advice and treatment with the lack of a unified plan of care. This situation is not indicative of primary care and it is not necessarily a consequence or manifestation of case management or managed care.

A clinical nurse specialist is preparing a presentation for a group of colleagues about the current state of the health care delivery system. As part of the presentation, the nurse is planning to address trends that may play a role in shaping health care delivery in the near future. Which information would the nurse most likely include? Select all that apply. -Reduction in the numbers of diverse individuals seeking care -Greater numbers of informed persons using health care services -Abundance of key health care professionals available -Rise in accessible health information due to technology -Increased focus on the treatment of disease

Greater numbers of informed persons using health care services Rise in accessible health information due to technology Explanation: Trends affecting health care delivery include a focus on preventive services; more knowledgeable and engaged consumers (clients); greater access to health information due to the explosion of technology; increasing diversity of client populations; and potential shortage of key health care professionals and educators.

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? -Respite -Hospice -Extended -Palliative

Hospice Explanation: Hospice is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families, and other loved ones, often provided in the client's own home. Because the client is near the end of life, hospice care would be the most appropriate referral. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older adults, to give them some time away from the responsibilities of day-to-day care. This type of care would not be appropriate for this client because the client has been hospitalized and wants to be with family. Extended-care services provide medical and nonmedical care for people with chronic illnesses or disabilities. Extended care occurs outside the home, however, which is not what the client desires. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Palliative care, which may be given in conjunction with medical treatment and in all types of health care settings, is client- and family-centered care that optimizes the quality of life by anticipating, preventing, and treating suffering. Palliative care alone is not as appropriate as hospice care in this case, given that the client is near the end of life.

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? -Hospice care -Parish nursing -Palliative care -Respite care

Hospice care Explanation: Hospice is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families, and other loved ones. The client must have a serious, progressive illness with a life expectancy of 6 months or less. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Parish nursing is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease-prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community.

Which type of facility employs the greatest number of nurses? -Long-term care facilities -Primary care centers -Hospitals -Ambulatory care centers

Hospitals Explanation: Although the trend is changing, hospitals still employ more nurses than any other type of facility. The percentage of registered nurses (RNs) working in hospitals is declining, but about 61% of RNs are still employed in hospitals (Bureau of Labor Statistics, U.S. Department of Labor, 2017).

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

Hospitals Explanation: Hospitals are the most appropriate acute care setting for people who are too ill to care for themselves at home, are severely injured, require surgery or complicated treatments, or are having babies. An ambulatory care center, which may be referred to as an outpatient care center, is a medical care facility that provides outpatient services. These include diagnosis, treatment, consultation, and intervention services. Day care centers have a variety of purposes: some care for healthy infants and children whose parents work; some care for children with minor illnesses; some provide a place for older adults to socialize and to receive care while family members work; some provide health-related services and care to people who do not need to be in a health care institution but cannot be at home alone. Primary care is the day-to-day health care given by a health care provider and can be provided in an outpatient facility.

Which is the primary criterion for admission to a long-term care facility? -Inability to provide self-care -Coexistence of multiple chronic health problems -Advanced age -Absence of family members locally

Inability to provide self-care Explanation: Long-term care facilities exist to provide care for individuals who are mentally or physically unable to care for themselves independently. These individuals are frequently older, have multiple health problems, and lack family caregivers, but these factors in and of themselves are not criteria for admission to long-term care.

Which is a current trend in health care consumers? -Increased knowledge of health care -Decreased engagement with health care providers -Decreased concern about the costs of health care services -Increased dependence on health care providers to make decisions for them

Increased knowledge of health care Explanation: Health care consumers (clients) are increasingly knowledgeable about health, prefer to control and make decisions about their own health, and want to be active participants in planning and implementing their health care. Consumers of health care services are better educated about the services they require and the services that are available, largely because so much health information is available on the Internet. Clients are also concerned about access to services, the cost of those services, and the quality of the care received. Consumers are questioning escalating costs and the proliferation and duplication of services. Consumers have become actively involved in the administration of health care facilities and have helped develop standards for care, client rights, and cost-containment measures as protection for clients when they enter a health care setting.

Which statements are true of primary health care? Select all that apply. -It is the same concept as primary care in that it refers to the delivery of health care. -It is essential health care based on sound methods and technology. -It is made universally accessible to individuals and families in the community. -It brings health care close to where people live and work. -It does not require the full participation of the individual and family.

It is essential health care based on sound methods and technology. It is made universally accessible to individuals and families in the community. It brings health care close to where people live and work. Explanation: Primary health care is defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology and made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford. It brings health care as close as possible to where people live and work. Primary health care should not be confused with primary care. Primary care refers to the delivery of health care services, including the initial contact and ongoing care.

A hospital system has adopted the Institute for Healthcare Improvement's "Triple Aim" dimensions and has surveyed nurses for planning ideas. Which strategies will help the hospital comply with this framework? Select all that apply. -Make results of quality studies available to nurses in a timelier manner. -Create outreach education programs to improve the overall health of the community served. -Reduce redundancy in diagnostic tests. -Do away with client satisfaction surveys. -Increase staff salaries.

Make results of quality studies available to nurses in a timelier manner. Create outreach education programs to improve the overall health of the community served. Reduce redundancy in diagnostic tests. Explanation: The Triple Aim framework has three dimensions: 1) improving the client experience of care (including satisfaction and quality); 2) improving the health of populations; and 3) reducing the per capita cost of health care. Making quality information available more quickly would encourage nurses to change practices that result in poorer quality. Reducing redundancy would reduce per capita costs. Educating the public would eventually increase the health of the population. Doing away with client satisfaction surveys would make satisfaction data difficult to track trends. There is no indication that increasing staff salaries would help meet these goals.

A nurse is conducting a presentation for a local community group about health care services available in the community. When describing voluntary agencies, which agency would the nurse include? Select all that apply. -Indian Health Services -American Heart Association -Centers for Disease Control and Prevention -American Lung Association -Meals on Wheels

Meals on Wheels American Heart Association American Lung Association Explanation: Community agencies are often nonprofit voluntary agencies. They are financed by private donations, grants, or fundraisers (although some may charge minimal fees). Examples of volunteer agencies are Meals on Wheels, the American Heart Association, and the American Lung Association. The Centers for Disease Control and Prevention and the Indian Health Service are part of the Public Health Service, a federal health agency.

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? -AmeriCare -Medicaid -Capitation -Medicare

Medicare Explanation: The federal government implemented a system of prospective payment in 1983 for people enrolled in Medicare. A prospective payment system uses financial incentives to decrease total health care charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group, which is a classification system used to group clients with similar diagnoses. Medicaid provides health care through funds obtained from federal, state, and local sources. In capitation strategy, a preset fee per member is paid to a health care provider, regardless of whether the member requires services. AmeriCare provides health care services through employers.

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way? -Benefits and reimbursement cannot be changed annually. -Part B of Medicare covers most inpatient and outpatient costs. -Part A of Medicare is voluntary and is paid for by a monthly premium. -Medicare pays only the amount of money preassigned to a treatment for a diagnosis.

Medicare pays only the amount of money preassigned to a treatment for a diagnosis. Explanation: The implementation of DRGs by Medicare in 1983 resulted in a system in which health care providers receive a fixed payment for services provided that is predetermined by the medical diagnosis or specific procedure, rather than the actual cost of hospitalization and care. The plan pays only the amount of money preassigned to the treatment for a diagnosis. If the cost for hospitalization is greater than that assigned, the hospital must absorb the additional cost. If the cost is less than that assigned, the hospital makes a profit. Medicare is federally funded, and benefits may change annually according to decisions related to the federal budget. Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal government. Part B, which is voluntary, is paid by a monthly premium and covers most outpatient costs.

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? -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. -Over 100,000 people die each year because they do not have health insurance and do not get to a doctor on time. -One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers. -Fewer than one in five health care providers specializes in primary care.

One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers. Explanation: One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers. It is estimated that about 45,000 people die each year in the United States due to access issues. Seven percent of the nation's medical school graduates choose a primary care career. Currently, one in three health care providers specializes in primary care.

A nurse is helping a client choose a new health care plan. The client states a preference being able to choose a health care provider. Which plan would be the best option for this client based on the stated preferences? -HMO -PPO -POS -LTC

PPO Explanation: Preferred provider organizations (PPOs) allow a third-party payer (agencies that pay health care providers for services provided to people, such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. The client may choose to use a health care provider within the PPO for a lower service fee or choose a provider outside the PPO and pay a higher service fee. A point of service (POS) plan is a mix between an HMO and PPO, but the client usually does not have the ability to choose the primary health care provider. Health maintenance organizations (HMOs) are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. The client would not be able to choose the provider in most HMOs. Long-term care (LTC) is not a type of health care plan.

Which are priority skills for nurses working in ambulatory mental health centers? -Possessing strong communication and counseling skills and being familiar with community resources -Having skills focusing on maintaining function and independence, with concern for the living environment as well as the health care provided -Being able to accurately administer medications and treatments, conduct health screenings, teach, and counsel -Being able to work collaboratively with a health care provider who approves protocols for care

Possessing strong communication and counseling skills and being familiar with community resources Explanation: Nurses who work in mental health agencies must possess strong communication and counseling skills and be familiar with community resources. Maintaining function and independence is more typical of a nurse working in an extended care facility. Administering medications and treatments, conducting health screenings, teaching, and counseling are associated with clinics that treat physiological alterations. Working collaboratively with health care providers who approve care protocols is indicative of an advanced practice registered nurse working in a rural clinic.

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

Primary care center Explanation: Primary health care provides care for common health problems and provides preventative measures. Client education is a common part of the nurse's activities in this setting. While teaching does (and should) occur in the other environments, the nurse does not have the opportunity to see the client repeatedly to teach and reinforce teaching.

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

Providing direct client care Explanation: Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

Which statement regarding pay for performance is most accurate? -Quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. -Pay for performance includes only demonstrated delivery efficiencies and improved quality and client safety. -Pay for performance is to be instituted primarily in small community hospitals with fewer than 100 beds, as client outcomes are worse there. -Financial incentives are employed to reward providers for the achievement of a range of client objectives.

Quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. Explanation: In pay for performance, quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. Financial incentives are offered to health care providers for achieving certain clinical measures established by the payer, not client objectives. These clinical measures include not only delivery efficiencies, improved quality, and client safety, but also submission of data to the payer. Pay for performance is not limited to any particular hospital size.

A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care? -Provision of a dignified death experience -Occupational therapy -Relief from physical, mental, and spiritual distress -Physical rehabilitation

Relief from physical, mental, and spiritual distress Explanation: The chief focus of palliative care is relief or management from physical, mental, and spiritual distress. The goal of palliative care is to prevent and relieve suffering by early assessment and treatment of pain and other physical problems (such as difficulty breathing, nausea, fatigue, and problems with sleeping). Like hospice care, palliative care is provided by an interdisciplinary team. Physical rehabilitation and occupational therapy would be the goal of home care, moving the client from the functional level at discharge from the hospital to a higher level of functioning, closer to the level prior to the hospitalization. Provision of a dignified death experience would be the goal of hospice.

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? -Physical therapist -Respiratory therapist -Occupational therapist -Health care provider

Respiratory therapist Explanation: A respiratory therapist is an expert in lung function and oxygenation whose expertise is needed in the care of this client. Because the client is not experiencing severe distress or respiratory arrest, the nurse is justified in foregoing contact with the health care provider in the short term. A physical therapist or occupational therapist is not likely able to provide needed interventions at this time.

During a home care visit to a home-bound older client, the client's spouse, who is the caregiver, verbalizes anger, fatigue, and sleeplessness. Which recommendations by the nurse would be most effective in relieving caregiver role strain? -Hospice care -Voluntary services -Respite care -Palliative care

Respite care Explanation: Hospice, voluntary services, and palliative care would all be helpful to the client and spouse, but only respite care directly provides the spouse with a break from caregiving duties.

A client asks a nurse about the benefit of using diagnosis-related groups (DRGs) as a reimbursement method. Which is the nurse's best response? -"DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." -"DRGs are an inefficient way for the government to manage a client's hospital recovery." -"This reimbursement method focuses on preventing illness through screening and health promotion." -"This innovative cost-cutting approach has led to a decrease in hospital admission rates."

"DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." Explanation: The DRG system has been largely responsible for marked decreases in hospital lengths of stay. If hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Decreasing hospital admission rates has not been shown to reduce the costs of health care. Health maintenance organizations (HMOs) focus on preventing illness through screening and health promotion.

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. Which explanation by the charge nurse is most appropriate? -"Cost is not a driver in quality health care delivery." -"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." -"Using evidence-based practice is the trend in providing quality care and may expose the client to better care implementation. None of our care methods are associated with cost." -"Because our clients are considered consumers of care, they often understand the need to use specific methods based on research, and they want the best care for the lowest cost."

"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." Explanation: Evidenced-based practice improves client outcomes, thereby increasing the quality of care; quality care leads to decreased cost. Cost is a driver in quality health care delivery. Evidenced-based practice is not just a trend in care; it is an expectation in health care delivery. Clients are consumers of care, but they often do not understand evidenced-based care or the cost associated with care. Today's greater focus on quality makes it less likely that clients will suffer unnecessary or harmful treatment, reduces waste, and increases safety.

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

"Systems are in place to pay for performance and penalize hospitals for excessive readmissions." Explanation: Health care trends already include paying for performance (HEDIS, HCAHPS) and penalizing hospitals for excess readmissions. In the United States, private insurers dominate over public, unlike in most countries. The United States is first in health care spending worldwide, and it is estimated that 20% of the gross domestic product will be spent on medical services by 2021.

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

"The system should be safe, effective, efficient, patient centered, timely, and equitable." Explanation: A safe, effective, efficient, client-centered, timely, and equitable system is what the IOM envisions. A bureaucratic, government-driven, illness-focused system is not advocated by the IOM.

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. -45-year-old male with a permanent disability receiving social security benefits -30-year-old male with blindness from an industrial accident -60-year-old female with a low income -66-year-old male with heart failure -55-year-old female with a temporary disability

66-year-old male with heart failure 45-year-old male with a permanent disability receiving social security benefits Explanation: The 1965 Medicare amendments to the Social Security Act established national and state health insurance programs for older adults under Title XVIII. Within a decade, almost all citizens over 65 years of age held Medicare insurance for hospital care, extended care, and home health care. Medicare coverage was increased in 1972 to include permanently disabled workers and their dependents, if they also qualified for Social Security benefits. Medicaid was established in 1965 under Title XIX of the Social Security Act. Medicaid is a federally funded public assistance program for people of any age who have low incomes; for the blind, older adults, and disabled covered by supplemental security benefits; and for beneficiaries of Aid to Families with Dependent Children.

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

A 66-year-old client with diabetes Explanation: Medicare is a federal health care plan for individuals over the age of 65. An individual with a disability might be referred to Medicare, but other federal organizations must be involved for this to occur. A low-income family with infants needing immunizations would be referred to Medicaid. The client with cancer in this question is not noted to be over age 65.

A clinic-based nurse in a sparsely populated remote area far from a regional hospital is working with other local health care team members on a plan to improve client health and outcomes. The team has decided that which health care delivery system would best meet the population's needs? -A preferred provider organization (PPO) -A health clinic run by an advanced practice registered nurse (APRN) -A multi-specialty group practice -A medical neighborhood

A health clinic run by an advanced practice registered nurse (APRN) Explanation: The APRN-run health clinic would best meet the needs of clients who live both far from each other and from regional facilities. A PPO is an insurance/provider model that does not address the question's intent. Similarly, a multi-specialty group would likely be unsustainable in a remote, sparsely populated area. A medical neighborhood is similar to a health maintenance organization model.

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

A middle-aged client who presents with new-onset angina Explanation: A middle-aged client who presents with new-onset angina requires a referral to a cardiologist and probably additional testing. Secondary care occurs when the primary caregivers refer clients for consultation and additional testing, such as with the referral of a client to a cardiac catheterization laboratory. The remainder of the clients require only primary care.

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what? -A retrospective payment plan, after the service is rendered -A payment to health care provider groups willing to take Medicare clients -A prospective payment plan based on a predetermined fixed cost -The need to cut health care costs for indigent older adults

A prospective payment plan based on a predetermined fixed cost Explanation: The nurse must understand that Medicare is a federal insurance program for older adults. It is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare does not pay health care provider groups and is not for indigent older adults. Retrospective payment plans pay for services after they have been received.

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

Active involvement of consumers Explanation: Trends in health care delivery include the active involvement of consumers, continuing nursing shortage, increased complexity of client care, and a technology explosion. Other trends include changing demographics, increasing diversity, globalization of economy and society, increasing costs of health care, and the effects of health policy and regulation.

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

Affordable Care Act Explanation: As part of the Affordable Care Act, hospitals may accrue penalties for readmissions of clients with certain diagnoses within 30 days of discharge. To improve client outcomes and avoid penalties, care transitions are being implemented to improve the continuity of services from hospital to home and to reduce readmissions. A collaborative discharge plan that includes the client's primary care services as well as any home care is essential for transitional care to be successful. The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. American Nurses Association (ANA) bylaws are rules established by the ANA to govern members of the ANA. The National Commission for Minorities is an organization based in the country of India.

A home health care nurse is providing visits for a 65-year-old widower who needs some assistance with performing activities of daily living (ADLs) but is living independently. What option might the nurse recommend that would enable the client to maintain independence for as long as possible? -Transitional subacute care facility -Medical home -Long-term care facility -Aging in place

Aging in place Explanation: The nurse might recommend for this client aging in place. In this type of care, clients remain in their homes or move to a living space, such as an apartment, while they are still physically able to care for themselves, and then have access to services that are a part of the health care community as needed. Someone who is living independently but only needs some assistance with ADLs would not be placed in a long-term care facility or transitional subacute care facility. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated client-centered care.

Which is the most accurate description of "aging in place"? -Clients have access to the healthcare community associated with aging in place up until the time they need to be hospitalized. -Aging in place communities are a form of extended care in which community members meet each other's needs. -Clients must remain in their own homes to be eligible for aging in place. -Clients are required to move to an apartment or some similar living space while they are still able to care for themselves.

Aging in place communities are a form of extended care in which community members meet each other's needs. Explanation: Clients who elect to participate in aging in place communities can stay in their own homes or move to apartments or similar places. Participation in aging in place communities does not end with hospitalization. Aging in place communities are a version of extended care in which participants help meet each other's needs.

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

An occupational therapist Explanation: An occupational therapist assists physically challenged clients to adapt to limitations and use a variety of adaptive devices and strategies in carrying out activities of daily living. The occupational therapist is the health care professional who would assist the client in using an adaptive device to brush the teeth. A speech therapist assists clients with speaking and swallowing problems. A physical therapist seeks to restore function or prevent further disability after an injury or illness. A respiratory therapist is trained in techniques that improve lung function and oxygenation.

Which scenario is using a prospective payment plan to reimburse for services? -A client with chronic heart failure is offered health care teaching and preventative services for free. -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. -An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. -A client is hospitalized for an emergency appendectomy. Since the hospital is a preferred provider the fee for service was discounted.

An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. Explanation: A prospective payment system uses financial incentives to decrease total healthcare charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group (DRG). Therefore, the scenario in which the hospital is reimbursed is an example of a prospective payment plan. The other scenarios demonstrate other types of payment plans.

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 middle-aged client who had a knee replacement -A client who developed sepsis after a ruptured polyp -An older adult client who fell at home and required a hip replacement -A client who had a cholecystectomy

An older adult client who fell at home and required a hip replacement Explanation: Extended care meets the health needs of clients who no longer require acute hospital care but require rehabilitation and skilled nursing care, such as an older adult following a hip replacement surgery, who may need additional assistance with mobility and more time for physical therapy before being ready to be discharged home. The other clients do not require, or would not benefit from, extended care.

Which statement accurately reflects the findings of the 1999 Institute of Medicine report, "To Err Is Human"? -The establishment of a local or regional, rather than a national, focus to create leadership in health care will improve outcomes. -Encouraging health care organizations and practitioners to develop and participate in mandatory reporting systems is desirable. -A common source of medical errors and preventable death is the overly centralized nature of health care in the United States. -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.

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. Explanation: The report states that 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. It is the fragmented, rather than centralized, nature of health care that has contributed to medical errors. The report recommends a national, rather than local or regional, focus on leadership to improve outcomes. Voluntary reporting is encouraged.

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? -Request a mental health evaluation for the spouse. -Arrange for short-term inpatient care for the client. -Send the spouse to the emergency department. -Have the chaplain visit with the spouse and client.

Arrange for short-term inpatient care for the client. Explanation: This spouse is exhausted and needs respite care. The hospice nurse can arrange for short-term inpatient care for the client so that the spouse can rest. The other options will not be effective for exhaustion.

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 health care provider of the client's status and then makes arrangements to carry out the health care provider's orders. In this scenario, what role does the nurse play? -Nurse practitioner -Advanced practitioner -Clinical nurse specialist -Case manager

Case manager Explanation: Case management means the nurse coordinates many resources to maximize the opportunity for people to manage their own health care at home. A nurse does not have to be nurse practitioner, clinical nurse specialist, or other type of advanced practitioner to serve as a case manager.

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

Certified nursing assistants, orderlies, attendants, and technicians Explanation: Certified nursing assistants, orderlies, attendants, and technicians are considered UAP. Volunteers, admission clerks, and housekeepers, although invaluable to hospital function, are not UAP.

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

Clergy, lay volunteers, and those with advanced spiritual care degrees can serve on the spiritual care team at hospitals. Explanation: Clergy, lay volunteers, and providers with advanced spiritual care degrees provide spiritual care to clients, families, and members of the interdisciplinary team. Spiritual care can be provided by non-clergy, but lay volunteers are not typically the primary spiritual care providers in most hospitals.

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? -Clients in the acute care setting require fewer chemical and physical restraints. -Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. -Disease-specific quality standards have been found to be slightly worse than when clients are treated in the hospital. -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.

Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. Explanation: Clients who receive care in their own homes, surrounded by familiar family and friends, have been found to recover more quickly than those in inpatient acute care settings. The other statements are not accurate.

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? -Good communication skills are unnecessary in the home care setting. -Clients are encouraged to help each other in the acute care setting. -Clients play a large role in helping themselves in the home care setting. -Nurses work more as team members in the home care setting.

Clients play a large role in helping themselves in the home care setting. Explanation: In nursing practice in the hospital, client needs include physiologic monitoring, complete or partial personal care, exercise, nutritional support, pain management, treatment and medication administration, anticipatory guidance, counseling, and education, which requires the complexity of health care teams. Nurses are involved in a variety of teams and care needs are complex. Clients are not encouraged to help each other in the acute care setting. Because of the trend toward shorter lengths of stay, the clients are discharged to home, where they may be more involved in helping meet their own care needs. Communication skills are critical in both the acute care and home care settings.

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? -Identifying individuals who are at risk of developing diabetes mellitus -Verifying that all documentation is updated prior to surgery -Collaborating with all agencies to provide for the client's home health needs -Providing client education related to colostomy care

Collaborating with all agencies to provide for the client's home health needs Explanation: As the various components of the ACA are phased in, nurses have begun to play an influential role in the implementation of new health policy. The newest opportunity is collaborating with all agencies to provide for the client's home health needs. Nurses have already been involved in screening individuals for type 2 diabetes mellitus and providing postoperative teaching for ostomy care. Nurses recheck paperwork for consent prior to surgery, but this is not just limited to nurses. Other health care providers also review consent prior to surgery.

Which is the main focus of care for a school nurse? -Rehabilitative care -Palliative care -Community care -Ambulatory care

Community care Explanation: A nurse employed as a school nurse is considered to be working in community-based care. School nurses provide many different services, including maintaining immunization records, providing emergency care for physical and mental disorders, administering prescribed medications, conducting routine health screenings (e.g., vision, hearing, scoliosis), and providing health information and education. Ambulatory care centers and clinics deliver outpatient, walk-in medical care and may be located in hospitals or may be freestanding services provided by a group of health care providers who work together. Inpatient facilities are those in which clients may be admitted and stay overnight for an indeterminate time, such as a hospital. Rehabilitation centers specialize in services for clients requiring physical or emotional rehabilitation and for treatment of chemical dependency. The goal is to return clients to optimal health and to the community as independent members of society.

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? -Educator -Counselor -Care provider -Coordinator of care

Coordinator of care Explanation: The most important role of the nurse in preventing fragmentation of care would be coordinator of care. Care coordination is the deliberate organization of client care activities between two or more participants (including the client) involved in a client's care to facilitate the appropriate delivery of health care services. The roles of care provider, counselor, and educator are all important roles, but the priority role is as the coordinator of care.

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

Early discharge of clients from the hospital setting Explanation: Home health care is one of the most rapidly growing areas of the health care system. The prospective payment system of reimbursement encourages early discharge from the hospital and has created a new, acutely ill population that needs skilled nursing care at home. Though some nurses may desire to work in the community and hospitals may have a shortage of nurses, these are not the primary factor related to the increase in home health care. It is not that hospitals cannot care for an increasing number of clients so much as it is that they will not be reimbursed by payers for costs associated with longer client stays; thus, they are motivated to discharge clients earlier even though clients are often not yet ready to provide all of their own needed care, leading to the need for and prevalence of home health care.

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? -Refer him to the dietitian. -Enroll the client in Meals on Wheels. -Have the social worker counsel him. -Suggest he go to an assisted living facility.

Enroll the client in Meals on Wheels. Explanation: The best option that can be arranged quickly is to enroll the client in Meals on Wheels, a voluntary agency. The other responses may be helpful in later planning for a long-term situation.

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? -Parish nursing services -Palliative care -Hospice care -Respite care

Respite care Explanation: Respite care is a type of care provided for caregivers of homebound ill, disabled, or older clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Although parish nursing and palliative care may be helpful in providing the spouse with support, it would not necessarily provide the respite needed. Parish nursing emphasizes holistic health care, health promotion, and disease-prevention activities and combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Palliative care, which may be given in conjunction with medical treatment and in all types of health care settings, is client- and family-centered. Hospice care is typically provided to clients with less than 6 months to live. There is no indication that the client is at this stage.

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? -Discuss oxygen administration with the respiratory therapist. -Speak with the physical therapist about exercises to strengthen muscles. -Talk with the occupational therapist about providing assistance with activities of daily living. -Discuss transfer to a rehabilitation facility with the social worker.

Speak with the physical therapist about exercises to strengthen muscles. Explanation: The nurse should discuss the goal of regaining mobility with a physical therapist. A physical therapist assists with restoring mobility, strengthens muscle groups, and teaches ambulation with new devices. Respiratory therapists are trained in techniques that improve pulmonary function and oxygenation. Occupational therapists evaluate functional level and teach activities to promote self-care in activities of daily living. Speech therapists deal with swallowing difficulties and help clients speak more clearly.

Which statement most accurately reflects the intent of secondary care? -Nurse midwives provide outpatient care. -Advanced practice nurses and specialist health care providers treat rare and complex disease states. -Specialists provide psychiatric care, same-day surgery, and general hospital care. -Primary care health care providers and nurse practitioners care for clients with common health problems.

Specialists provide psychiatric care, same-day surgery, and general hospital care. Explanation: Secondary care involves some specialists who provide care, such as psychiatric care and same-day surgery, generally in the hospital setting. Common health problems are generally consigned to primary care in an outpatient setting. Complex, rare disease states are cared for in tertiary care centers.

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? -Physical therapist -Speech pathologist/therapist -Physician assistant -Occupational therapist

Speech pathologist/therapist Explanation: It is within the speech pathologist's/therapist's scope of practice to conduct a swallow evaluation for a client but outside the scope of the occupational therapist, the physical therapist, and the physician assistant.

A nurse is a member of an interdisciplinary team providing home health care to a client who was discharged home after experiencing a stroke. The client has been receiving services to assist with swallowing. The nurse would collaborate with which member of the team to discuss the client's progress? -Physical therapist -Social worker -Occupational therapist -Speech therapist

Speech therapist Explanation: A speech therapist diagnoses and treats swallowing problems in clients who have had a head injury or a stroke. A physical therapist seeks to restore function or to prevent further disability in a client after an injury or illness. Occupational therapists evaluate the client's functional level and teach activities to promote self-care in activities of daily living. Social workers assist clients and families in dealing with the social, emotional, and environmental factors that affect their well-being.

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? -Secondary -Complex referral -Tertiary -Primary

Tertiary Explanation: The client will require tertiary health care due to the complex and rare nature of the disease process. Primary health care deals with more common health care issues and preventive measures. Secondary health care would be related to issues that require more specialized clinical expertise than those addressed by primary health care but less specialized care than those addressed by tertiary care. "Complex referral" is not a level of health care.

Which statement is true when comparing home care with acute care? -The client directs the education of all caregivers. -The nurse and the client work independently of each other. -The nurse is the guest in the client's home. -The nurse directs all aspects of the home.

The nurse is the guest in the client's home. Explanation: An essential difference in home care versus acute care is that the home care nurse is a "guest" in the client's home. In the home, clients and families retain the power and control that they give to providers in other settings. Nurses in the home usually work as members of a therapeutic team that includes the client and other members of the health care team working collaboratively. The client does not direct the education of the caregivers.

The nurse is providing care to an older adult client approaching discharge following a surgical procedure to repair a fractured hip. The client requires continued skilled nursing care and physical therapy to improve mobility. When planning care for this client, which prescription should the nurse anticipate? -Transfer to an extended care facility -Discharge to home with home health care -Admission to hospice care -Move to an intermediate care facility

Transfer to an extended care facility Explanation: The nurse should anticipate that this client will be transferred to an extended care facility, which meets the health needs of clients who no longer require acute hospital care but require rehabilitation and skilled nursing care. This client does not meet the requirements for home health care, hospice care, or an intermediate care facility.

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? -Teaching, dietary instruction, and monitoring for infection only -Assessment, reporting back to the agency and health care provider, and prescribing antibiotics -Assessment, wound care, teaching, and prescribing pain medications -Wound care, medication administration, teaching, and ensuring a reasonably safe environment

Wound care, medication administration, teaching, and ensuring a reasonably safe environment Explanation: Nurses who provide care in the home make assessments (including of home safety) and provide physical care (including wound care), administer medications, teach (including dietary instruction), and support family members. They also collaborate with other health care providers, such as physical therapists, occupational therapists, respiratory therapists, and social workers, to plan and provide client care. Home health nurses may not prescribe medications.

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

an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services. Explanation: The nurse must understand that Medicare is a federal insurance program for older people. Medicare part A is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare part A is administered federally, not locally. Medicare part B, not A, covers outpatient health care provider visits, medications, and home health. Medicare part A does not limit enrollees to certain providers with a group plan. Medicaid, not Medicare, is a federally funded public assistance program for low-income people.

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

economic, quality care. Explanation: The primary advantage of the managed care model is provision of high-quality care in the most efficient and economic manner. Managed care often results in decreased client satisfaction due to a lack of choice of health care provider. Managed care is provided by a diverse health care team with many different specialties and areas of care represented, not an all-RN staff or only one distinct area of 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: -accurate assessment in the acute health care setting. -better connectivity through the use of technology. -health promotion. -high-quality disease management.

health promotion. Explanation: Recent health care reform efforts, in particular the Affordable Care Act (ACA), have made strides toward realizing nursing's vision of health care that is focused on health promotion, delivered where the individual needs it, and focused on wellness rather than disease management; however, there is much work still to be done as the effects of the ACA become known. Health care is currently focused on high-quality disease management and technology and not the prevention of disease. Accurate assessments are already part of the admission process in all health care settings.

What type(s) of services are provided in primary health care? Select all that apply. -education related to sexually transmitted infections -emergency medical care -rehabilitation -complex disease management -health risk screenings -administration of immunizations to children and adults

health risk screenings administration of immunizations to children and adults education related to sexually transmitted infections Explanation: Screening, health promotion, and prevention (e.g., immunizations and education on sexually transmitted infections) are components of primary health care; emergency care is a component of secondary health care, and complex disease management and rehabilitation are components of tertiary health care.

When the client's primary care health care provider does not have hospital privileges, a service is available to provide the client's care and communicate with the client's health care provider. This service is provided by health care providers called: -referral specialists. -hospitalists. -admitting health care providers. -on-call health care providers.

hospitalists. Explanation: The hospitalist is a health care provider who provides care to the client in the emergency room and after admission to the hospital. The hospitalist communicates with the client's primary care health care provider but manages the hospital care. An admitting health care provider is one who is responsible for admitting a client to a hospital or inpatient health facility. A referral specialist is a health care office worker who is responsible for making sure that a client's health care insurance will cover expenses related to care from a specialist to whom the client's primary care provider has referred the client. An on-call health care provider is simply one who is scheduled to be available to come to the hospital on a moment's notice to provide emergency care to a client on an as-needed basis.

In the 1980s, the nursing care delivery model shifted from a team nursing model to a: -primary nursing model. -managed care model. -clinical specialist model. -modular care model.

primary nursing model. Explanation: In the 1980s, the nursing care delivery model shifted from a team nursing model, in which a team of nurses collaboratively provide care to a given client during a stay, to a primary nursing model, in which one registered nurse (RN) is responsible for providing all care needed by a given client during the client's stay (either directly or by delegating to others). The managed care model is an approach to health care delivery that seeks to contain the costs of health care while providing quality care. Modular nursing is similar to team nursing except that the clients assigned to a given team of nurses are grouped according to geographical location on the unit. A clinical specialist is a nurse who has additional training in a medical specialty, such as cardiology.