Chapter 4 health and illness
7. A nurse is caring for a client who has undergone total hip replacement and is advised to continue physiotherapy after discharge. Which of the following levels of care is the outpatient physiotherapy center? A) Continuity of care B) Extended care C) Secondary care D) Tertiary care
Ans: B Feedback: Physiotherapy is an example of extended care. It does not involve acute care and is not compulsorily done on hospital premises. The hospital providing surgical facilities is a tertiary care center. The client, after being discharged from tertiary care, joins a physiotherapy unit for extended care.
8. A client arrives at a health care facility complaining of diarrhea and abdominal pain for the past 24 hours. The physician diagnoses the client with gastritis, an acute illness. Why is gastritis considered an acute illness? A) The onset is sudden. B) It lasts for a long time. C) It is difficult to treat. D) It is not curable.
Ans: A Feedback: Gastritis in this case is an acute illness because the onset is sudden. Acute illnesses affect for a short duration and are cured in a short time. Acute illnesses are not necessarily difficult to treat and are often curable. On the other hand, chronic illnesses have a gradual onset and require a longer period to be cured. In some cases, the illness may remain for a lifetime.
20. A nurse had learned that more than 8% of Americans are currently living with diabetes mellitus. This statistic represents what epidemiological concept? A) Morbidity B) Mortality C) Distribution D) Onset
Ans: A Feedback: Morbidity is the incidence of a specific disease, disorder, or injury and refers to the rate or numbers of people affected. Mortality denotes the number of people who died from a particular disease or condition. Onset and distribution are not concepts that are central to epidemiology.
15. A client experiencing symptoms of cardiomyopathy is referred to the cardiac specialist for diagnosis and consultation. Consultation and diagnostic tests are included in which level of the health care system? A) Primary care B) Secondary care C) Tertiary care D) Extended care
Ans: B Feedback: Consultation and diagnostic tests are included in the secondary level of health care. The first contact with a general physician is the primary care, and the reference to a highly specialized facility for desensitization is the tertiary care level. The secondary and tertiary care facilities are equipped to provide highly specialized care. Extended care is the care provided to clients who no longer require acute hospital care.
18. A nurse has become involved in political efforts to ensure that a greater percentage of Americans have access to affordable health care, regardless of their individual circumstances. This view of health is reflective of what belief? A) Health is a limited resource. B) Health is a right. C) Health is inevitable. D) Health is personal responsibility.
Ans: B Feedback: Efforts to eradicate health disparities are often rooted in the belief that health care is a right. The belief that health care is a limited resource underlies views of the preciousness of preserving health. Personal responsibility is foundational to the view of individual ownership of one's health status. It is unrealistic to believe that health is inevitable.
13. In a nursing unit, the nurse-in-charge delegates the tasks in the shift. A nursing assistant is assigned to make beds and help the clients ambulate. Another nurse is assigned to assist clients with changing positions, and another nurse to administer drugs. Which type of nursing care is being implemented? A) Team nursing B) Functional nursing C) Primary nursing D) Nurse-managed care
Ans: B Feedback: Functional nursing is a pattern in which each nurse on a client unit is assigned specific tasks. The nurse-in-charge delegates the major responsibilities to the staff and continuously does the assessment and evaluation of nursing care provided by the staff members. The team nursing pattern has many nursing staff providing care in a group. Primary nursing is different from all, with the admitting nurse responsible for nursing care of an individual client. Nurse-managed care is a pattern where the nurse manager plans the nursing care of clients based on their type of case and medical diagnosis.
11. A client undergoes a knee replacement surgery and is included in the diagnostic-related group (DRG) 209. Which of the following is true about knee replacement surgery under the DRG system? A) Replacement and surgeries are not reimbursed. B) Replacement and surgeries are reimbursed at a predetermined rate. C) Replacement and surgeries are reimbursed after 1 year. D) Replacement and surgeries are not insured.
Ans: B Feedback: If a group of diseases falls in the same diagnosis-related group category, it means that all the procedures are reimbursed at basically the same rate. If actual costs are less than the reimbursed amount, the hospital keeps the difference. If costs exceed the reimbursed amount, the hospital is left with the deficit. In a DRG system, the procedures and surgeries are grouped together and the reimbursements are done at flat rate within a group. The replacement and the surgeries are reimbursed after an appropriate time and not after 1 year. Also, the replacement and the surgeries are insured
2. A nurse is caring for a client diagnosed with pancreatitis. Which of the following is a priority need for nursing management? A) Acute pain in the abdomen B) Depression due to recurrent symptoms C) Inability to take care of family D) Lack of self-confidence
A Feedback: Acute pain in the abdomen is a physiologic need of the client that receives attention on a priority basis. According to Maslow's hierarchy of human needs, physiologic needs are the most important. These needs are to be fulfilled before seeking to fulfill the other needs. The needs for safety and security, love and belonging, esteem and self-esteem, and self-actualization can only be met if the basic physiologic needs are fulfilled.
3. A nurse is caring for a client who is confined to bed due to paralysis. The client has a medical history of stroke, hypertension, and diabetes mellitus for the past 5 years, besides having asthma since childhood. Which of the following is the best example of a secondary illness seen in the client? A) Diabetes mellitus B) Asthma C) Hypertension D) Stroke
Ans: D Feedback: Stroke is a secondary illness caused by high blood pressure and diabetes. Secondary illness is a disorder that develops from a preexisting condition. In this case, the client had a history of hypertension, which is a primary illness that caused a stroke. Diabetes mellitus and asthma represent primary illnesses in the client, as there are no preexisting conditions predisposing the client to asthma and diabetes mellitus.
17. A middle-aged client is distraught at receiving a diagnosis of type 2 diabetes in spite of being conscientious about her health for the majority of her adult life. The client tells the nurse, "I can't believe I no longer have my health." The nurse should be aware that the World Health Organization defines health as A) The absence of acute and chronic health issues that affect the client's quality of life. B) A level of function that is equal to or superior to individuals of similar age. C) The ability to contribute unimpeded to the quality of life on oneself and others. D) A state of physical, mental, and social well-being.
Ans: D Feedback: The WHO defines health as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." This definition does not preclude the other listed aspects of health, but none of these is considered definitive by the WHO.
21. A client with medically complicated pregnancy has expressed frustration about the disparities in advice and treatment that she has received at various sites over the past several months. How can the nurse best ensure that there is continuity in the care that the client receives? A) Communicate clearly and frequently with other care providers B) Ensure that client education is provided whenever possible C) Explain the rationale for each assessment and treatment that the client receives D) Maximize the number of people who contribute to a client's care
Ans: A Feedback: Continuity of care can be fostered by providing detailed and timely communication between different individuals who contribute to a client's care. Maximizing the number of people who contribute to a client's care is likely to reduce rather than enhance continuity of care. Client education is beneficial to care, but does not necessarily provide continuity of care.
A client who is disabled due to stroke is discharged from a health care unit and an LPN is assigned to provide nursing care to the client at home. This is an example of which kind of care? A) Extended care B) Secondary care C) Tertiary care D) Primary care
Ans: A Feedback: Extended care represents services that meet the health needs of clients who no longer require acute hospital care. It includes skilled nursing care in a person's home or in a nursing home, and hospice care for dying clients. Primary care is provided by the family physician, the nurse, or any health care facility that is the first contact for the client. Secondary and tertiary care are provided at specialized health care units.
10. Which of the following health care insurance programs is likely the most suitable for a 68-year-old client? A) Medicaid B) Medicare C) Capitation D) AmeriCare
Ans: B Feedback: Medicare is a federal program that finances health care costs of persons aged 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease. The system is funded primarily through withholdings from an employed person's income. Capitation is a reimbursement strategy in managed care organizations. AmeriCare is a type of private insurance. Capitation and AmeriCare are not the preferred providers for the client, considering the client's age. Medicaid is a federal program that is operated by the states, and each state decides who is eligible and the scope of health services offered. In Medicaid, eligibility may be decided by the state, which is not the case in Medicare.
An LPN is newly recruited to the hospital. As a part of the orientation program, the nurse is informed that the nursing staff follows the primary nursing approach of the nursing model. Which of the following nursing models describes primary care nursing? A) The nursing staff is headed by a team leader. B) A single nurse plans and provides nursing care. C) A head nurse assigns tasks to other members. D) A nurse manager plans the nursing care of clients.
Ans: B Feedback: Primary nursing is an approach of the nursing model wherein a single nurse plans and provides client care and evaluates the client's progress. This is unlike team nursing, where the team leader plans and evaluates nursing care. In team nursing, there is a team of nursing staff that plans and provides care together. The nursing model where the head nurse assigns specific tasks to each nurse is called the functional nursing model. Primary nursing is also different from nurse-managed care, where nursing care is based on predicted outcomes under the nursing care of a nurse manager.
4. A client with Crohn's disease in remission is admitted to the nursing unit for follow-up care. The remission state is characterized by which of the following? A) Permanent relief from the signs and symptoms B) Temporary disappearance of signs and symptoms associated with the disease C) Periodic occurrence in clients with long-standing diseases D) Reactivation of the disease and presence of symptoms
Ans: B Feedback: Remission is a temporary state of disappearance of the signs and symptoms related to a particular disease. It is of short duration, but the duration is unpredictable. It is a condition opposite to exacerbation, which is characterized by reactivation of symptoms. Remission is not permanent, but is rather a temporary relief from signs and symptoms. Exacerbation is the periodic occurrence of disease in clients with chronic diseases.
5. A client admitted for hernioplasty is discharged 2 days later than the calculated time due to postoperative complications. The client is insured through a capitation scheme. In the event of late discharge of the client, who is at loss? A) The client B) The hospital C) The insurers D) The physicians
Ans: B Feedback: The hospital is at loss if the client is discharged late from the hospital. The client is insured through a capitation scheme, which provides a preset fee per member to the health care provider, regardless of whether the member requires services. If a client is discharged earlier, the hospital keeps the difference; if the client is discharged late, the hospital is at loss. The client is not at loss because he pays a fixed amount to the provider whether he utilizes the care or not. The doctors and the health care workers are not affected.
A nurse is caring for a child with Huntington's chorea, a hereditary condition. Which of the following statements is true of hereditary conditions? A) The symptoms are manifested immediately after birth. B) The condition is due to maternal exposure to toxins. C) The condition is acquired from genes of one or both parents. D) The course is associated with exacerbations and remissions.
Ans: C Feedback: Hereditary conditions are acquired from genes of one or both parents. The symptoms may or may not be manifested immediately after birth. Some hereditary diseases, including Huntington's chorea, remain asymptomatic and undiagnosed until adulthood. Hereditary conditions are not necessarily due to abnormalities in embryonic development.
14. A client with quadriplegia is admitted to the health care facility. The client requires highly individualized care. Which of the following nursing care approaches is likely most suitable for this client? A) Functional nursing B) Case-method nursing C) Primary nursing D) Team nursing
Ans: C Feedback: Primary nursing ensures highly individualized care. It is the pattern in which the admitting nurse assumes responsibility for planning client care and evaluating the client's progress. Functional nursing does not provide individualized care; rather, it aims to finish the task. Case-method nursing addresses the health needs of a group of clients. In team nursing, a team of nurses is responsible for a group of clients.
9. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse explains to the client that COPD is a chronic disease. Why is COPD considered a chronic disease? A) It has a late onset in life. B) It is a sequel (consequence) of acute illness and is preventable. C) It is resistant to treatment. D) It has a gradual onset and lasts for a long time.
Ans: D Feedback: Chronic illness has a gradual onset and lasts for a long time. It is usually seen in old age but this is not a defining characteristic. It may or may not be due to acute illness. Chronic diseases are a major cause of morbidity in the population.
19. After experiencing an ST-wave elevation myocardial infarction, a 64-year-old man has been admitted to the cardiac unit of the hospital for care. The nurse has completed a comprehensive assessment and is creating a plan of care that is holistic in its focus. How can the nurse best integrate the principles of holism into the client's care? A) By creating a plan of care that utilizes the knowledge and skills of disciplines other than nursing B) By continually evaluating the efficacy of nursing interventions and by making changes as needed C) By prioritizing the client's spiritual and psychosocial needs over his physical needs D) By integrating each of the various dimensions of the client's identity into his care
Ans: D Feedback: Holism is considered to be the sum of physical, emotional, social, and spiritual health. Care that reflects this multidimensional nature of individuals can be considered to be holistic. Interdisciplinary care and continual evaluation are congruent with holistic care but they are not definitive. It is not appropriate to prioritize nonphysical needs in every client; prioritization of needs should be determined on an individual basis.
16. A nurse is reading the goals stated in the Healthy People 2020 report. Which of the following goals is targeted in the Healthy People 2020 report? A) Ensuring equal access to health services between urban and rural areas B) Eradicating sexually transmitted infections C) Providing free treatment to clients with cancer D) Reducing infections caused by key food-borne pathogens
Ans: D Feedback: One of the goals stated in the Healthy People 2020 report is to reduce infections caused by key food-borne pathogens. Providing free treatment to clients with cancer is not a targeted goal of the Healthy People 2020 report, but reducing the number of new cases of cancer as well as the illness, disability, and death caused by cancer are targeted goals. Complete eradication of sexually transmitted infections is not a stated goal, nor is equalizing access to health services.
