Chapter 8

A nurse is caring for a client who is experiencing pain. In assessing for pain, the nurse should use what skill in the provision of care? Observational intervention Critical thinking Quantitative analysis Evaluation

Critical thinking

The state government has decided to decrease funding for the Medicaid program. Which component of care will this most impact? Political and economic considerations Promotion of health Implementation of technology The treatment of disease

Political and economic considerations

A nurse is volunteering time at a homeless shelter in an urban setting. What service provided by the nurse would be of benefit to this population of clients? Provide financial assistance for clothing and supplies Providing an educational program about nutrition Delivering emergency services such as suturing Prescribing medication for clients that can't afford to go to a health care provider

Providing an educational program about nutrition

The wife of an elderly man with Alzheimer's disease contacts a community health nurse because she is planning to visit her sister in a neighboring state and needs assistance in arranging care for her husband while she is away. Which type of care is the wife seeking? Rehabilitation care Respite care Hospice services Parish nursing services

Respite care

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?

an older adult client who fell at home and required a hip replacement

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new graduate on the unit is frustrated because she just learned "the old way" and now has to learn a new methodology. Several other nurses commented that the change is "all about money." The charge nurse must educate her staff about the importance of this new policy. Which of the following explanations is most appropriate? "Cost is not a driver in quality health care delivery." "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." "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." "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."

"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."

A nurse-educator is discussing healthcare reform trends during hospital orientation for a group of nursing fundamentals students. The nurse is correct in stating which of the following? "The United States is secnd in the world in total health care dollars spent annually." "Spending on medical services will rise to almost 32% of the U.S. gross domestic product by 2021." "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."

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

While the student nurses are orienting to the subacute facility where the they will do their clinical rotation, they ask their instructor why extended care facilities have proliferated in the past decade. Which of the following is the instructor's best response? "These days, clients are discharged from the hospital far too early to care for themselves, so we have seen a rise in the number of these facilities." "Subacute and other extended care facilities are primarily for clients who have decided against home health care, and there are many clients." "Subacute facilities primarily provide care to patients who lack caregivers at home. Because many clients have no extended family to care for them, there are a number of extended care facilities taking the place of family." "With the scarcity of health care dollars, clients are discharged to a lower level of care that is also less expensive when they no longer meet guidelines for acute care."

"With the scarcity of health care dollars, clients are discharged to a lower level of care that is also less expensive when they no longer meet guidelines for acute 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? Payment to physician groups willing to take Medicare clients. A retrospective payment plan, after the service is rendered. The need to cut health care costs for the indigent elderly. A prospective payment plan based on a predetermined fixed cost.

A prospective payment plan based on a predetermined fixed cost.

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

APRN-run health clinic 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 (preferred provider organization) 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. The medical neighborhood is similar to an HMO model

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

Active involvement of consumers

The primary nurse shares with the health care team the need for her client, diagnosed with cancer, to go out on a pass to attend her daughter's wedding. She is serving in what role as a nurse? Advocate Caregiver Counselor Educator

Advocate

Which statement is accurate in discussing the difference in nursing care provided in the acute-care setting and home care setting? Home care setting can only be initiated when the client returns to full function. Acute care setting focuses on the client needs presented. Both care settings require the participation of the client's family. Both settings focus on the holistic care of an individual.

Both settings focus on the holistic care of an individual.

A nurse has recently decided to seek employment in a tertiary health center. Which of the following services should the nurse anticipate would be provided in tertiary care? Same-day surgery Cardiovascular surgery Chronic disease management and education Psychiatric care

Cardiovascular surgery

You are the nurse hired to work on a surgical floor at a major metropolitan hospital. The head nurse states you will be working in a primary nursing model. What does this mean? Care is provided by nursing students Care is provided by registered nurses Care is provided by masters' prepared nurses Care is provided by nurse assistants

Care is provided by registered nurses

A nurse is caring for an older adult client in the home. The nurse concludes that the client needs an x-ray to determine if he 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? Nurse practitioner Advanced practitioner Case manager Clinical nurse specialist

Case manager

During a lecture on healthcare delivery and delegation, the nurse educator discusses UAP (unlicensed assistive personnel). The nurse is correct when stating UAPs include which of the following? Housekeepers, orderlies, certified nursing assistants Certified nursing assistants, orderlies, attendants, or technicians Admission clerks, technicians, orderlies Volunteers, telemetry technicians, hospital transporters

Certified nursing assistants, orderlies, attendants, or technicians

A nurse is conducting new hospital employee orientation and is discussing spiritual care at the hospital. Which of the following is correct regarding spiritual care providers in most hospitals? Lay volunteers from local churches and similar organizations typically are the primary spiritual care providers in most hospitals Spiritual care providers offer care for patients 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

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

The nurse is conducting community education classes on the various online tools available for individuals with diabetes. Which role of a nurse does this evolve from? Manager of health care Counselor Client Advocate Educator

Client Advocate A client advocate model suggests that nurses are responsible for promoting client autonomy and self-actualization. Nurses make decisions with clients and caregivers to assist clients in achieving the best possible health outcomes and to access appropriate health services. Advocacy develops from ongoing, caring relationships with clients and families. In a three-step advocacy process, nurses initially explore personal values and beliefs and then begin the informing process (Stanhope & Lancaster, 2012).

In providing nursing care, it is most important to perform which action? Evaluation of client's responses Coordination of care with the health care team Administration of prescribed medications Implementation of physician's orders

Coordination of care with the health care team Nurses have moved from simply observing and giving prescribed medications to coordinating clinical information for the entire health care team.

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? Counselor Coordinator of care Care provision Educator

Coordinator of care

A nurse is caring for a client who has a PPO health care plan. What is the greatest advantage of this type of plan? Cost effectiveness Care coordination Ease of referrals Improved health outcomes

Cost effectiveness

A class of fundamentals nursing students is learning about ethical issues and ethical dilemmas in nursing and healthcare. Which of the following are ethical issues that will need to be considered as healthcare reform continues? Select all that apply. Should undocumented peoples in the U.S. have the same access to healthcare as its citizens? Do smokers and the obese who do not make necessary lifestyle changes deserve the same healthcare as people who lead healthier lives? Is someone who can afford to advertise for an organ donation more deserving than someone who has been waiting months for a transplant? Should hospitals and providers receive payment from health insurance entities based in part on patient satisfaction scores? Should citizens pay higher insurance premiums and/or taxes so that someone who overdoses on heroin can have intensive care?

Do smokers and the obese who do not make necessary lifestyle changes deserve the same healthcare as people who lead healthier lives? Is someone who can afford to advertise for an organ donation more deserving than someone who has been waiting months for a transplant? Should citizens pay higher insurance premiums and/or taxes so that someone who overdoses on heroin can have intensive care? Should undocumented peoples in the U.S. have the same access to healthcare as its citizens?

A priority nursing function in a rehabilitation center that specializes in emotional rehabilitation related to chemical dependency is which of the following? Facilitate lay volunteers and support groups. Making referrals to deal with co-morbid conditions. Provision of information on how to maintain health Encourage independent self-care.

Encourage independent self-care. The role of the rehabilitation nurse is to encourage and facilitate independent self-care. Facilitating lay volunteers and support groups is a mostly a parish nurse responsibility. Making referrals to deal with other medical conditions and providing information on health maintenance, while common to nurses in most settings, is primarily the function of the nurse who sees clients in a homeless shelter.

A registered nurse has returned to the local university to pursue her baccalaureate degree. During her community health course, she will gather information and present a community assessment. What role does the nurse assume when gathering this information? Oncologist Transcriptionist Epidemiologist Thanatologist

Epidemiologist A nurse epidemiologist gathers and analyzes qualitative and survey data to describe and understand unique communities.

Nurses have an important role in health care reform. The goals of health care reform include which of the following? Improving quality of care, while limiting access for the uninsured, to control rising costs. Focus on cost containment with improved access and quality of services for everyone. Controlling health care costs through limited services for more consumers of health care. Decreasing health care services to provide all citizens with some access to care, but control escalating costs.

Focus on cost containment with improved access and quality of services for everyone.

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

Fragmentation of care

The Patient Protection and Affordable Health Care Act (PPACA) was passed in 2010 and aims to provide affordable health care to everyone. Which component is true to PPACA? Select all that apply. Accessibility to insurance services High quality insurance Health care affordability Ability to compare insurance options Decreases the number of uninsured

Health care affordability Ability to compare insurance options Accessibility to insurance services Decreases the number of uninsured

A nurse is leaving a primary health care system in order to practice in the tertiary health care system. Which role will the nurse fill in this realm of health care? Education Emergency room nursing Community clinic nursing Hospice care nursing

Hospice care nursing

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

Improve coverage by providing healthcare for dependent children up to 26 years of age Provide access to clinical preventive services by eliminating co-payments for these services Enhance the quality and efficiency of healthcare by increasing the Medicare Part D prescription drug benefit Mandate that all U.S. citizens and legal residents must have healthcare coverage

The local community hospital is hosting a seminar on trends in healthcare and healthcare cost reduction. The nurse-presenter is discussing cost reduction techniques that also emphasize improved client outcomes. Which cost-cutting changes is most likely to facilitate improved client outcomes? Improving transitions across settings Comparative effectiveness analysis A prospective payment system such as DRGs Increased emphasis on capitation and managed care

Improving transitions across settings

A client at a local health fair asks the nurse what is meant by secondary health care. Which of the following reflects the intent of secondary care? Nurse-midwives provide outpatient care. Secondary care mostly involves primary care physicians and nurse practitioners caring for clients with common health problems. Advanced practice nurses and specialist physicians treat rare and complex disease states. In secondary care, one would expect that psychiatric care, same-day surgery, and general hospital care for patients be provided.

In secondary care, one would expect that psychiatric care, same-day surgery, and general hospital care for patients be provided.

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

Inability to provide self-care

A nurse whose priority tasks include conducting health assessments, teaching health promotion, such as smoking cessation, eating sensibly, using safety equipment, exercising regularly, caring for minor accidents and illnesses, and making referrals for more serious health problems is likely a healthcare team member in which setting? Industry High school Crisis intervention center Homeless shelter

Industry

Which of the following illustrates a systems view of a person's health care? John is a 20-year-old schizophrenic who lives with his parents. At times he has been found wandering through the backyards of neighbors "searching for messages that are left for me." His neighbors help John search for the messages and then bring him home. Dora is a 50-year-old schoolteacher with hyperlipidemia. Cindy is a 42-year-old woman that was admitted to the hospital yesterday after suffering from an episode of chest pain and diaphoresis. Her cardiac enzymes were slightly elevated and she is scheduled to go for a cardiac catheterization this morning. Kara is an 18-year-old with type I diabetes. During the summers she works as a counselor at a camp for children with diabetes. Marcus is an 80-year-old widower who lives in an apartment. He receives food from an organization that delivers free meals to people who cannot go out and do not have enough money to buy food every day.

John is a 20-year-old schizophrenic who lives with his parents. At times he has been found wandering through the backyards of neighbors "searching for messages that are left for me." His neighbors help John search for the messages and then bring him home. A systems view acknowledges that a person's health care occurs within the context of family, friends, and the community around them.

Nurses provide care for clients in a program called "Hospital at Home." What are the characteristics of this program? Select all that apply. Better client outcomes Lower chance of developing delirium Higher satisfaction with care Lower overall costs Higher average client length of stay Higher use of sedatives and restraints

Lower overall costs Better client outcomes Lower chance of developing delirium Higher satisfaction with care

The goal of healthcare reform is to address which of the following? Select all that apply. Improved access to health care Increased quality of health care Safety improvement Decreased centralization Manageable cost for the uninsured

Manageable cost for the uninsured Improved access to health care Increased quality of health care

What methods are used to ensure that clients have continuity of care and cost-effective care during movement throughout the health care system? Select all that apply. Managed care Rural health centers Parish nursing Primary health care Case management Primary care centers

Managed care Case management Primary health care

A nurse is researching health care in rural areas. Based on a 2013 U.S. Subcommittee on Primary Health and Aging, which of the following statements regarding access to primary health care is correct? Fewer than one in five physicians specialize in primary care. Despite the fact that over half of patient visits are for primary care, only 17% of the nation's medical school graduates now choose a primary care career. One in five Americans live in areas without adequate access to primary healthcare due to a shortage of primary care providers. 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 live in areas without adequate access to primary healthcare due to a shortage of primary care providers.

A nurse is helping a client choose a new health care plan. The client states that he would prefer to be able to choose his own physician. Which plan would be the best option for this client based on his stated preferences? PPO LTC HMO POS

PPO 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 could choose to use a physician within the PPO for a better 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.

A nurse is discharging a client who was admitted for observation following a motor vehicle accident. The client is a single parent who is living in a new community. What service would be an appropriate referral for this client? Parish nursing Respite care Hospice care Medical home

Parish nursing

Home healthcare is a rapidly growing area of the healthcare system. Factors that have influenced the growth of home healthcare include which of the following? Select all that apply. Some families do not want their relative institutionalized. Telehealth and technological support services allow home health agencies to provide complex in-home care. In-hospital reimbursement is limited by DRGs and allowed services. Patients have an increased acuity level following earlier hospital discharge. Home health nursing requires that its nurses are prepared at the advanced practice level. People are living longer with multiple chronic illnesses.

Patients have an increased acuity level following earlier hospital discharge. People are living longer with multiple chronic illnesses. In-hospital reimbursement is limited by DRGs and allowed services. Some families do not want their relative institutionalized. Telehealth and technological support services allow home health agencies to provide complex in-home care.

Priority skills for nurses working in ambulatory mental health centers would include which of the following? Possess strong communication and counseling skills and be familiar with community resources. Be able to work collaboratively with a physician who approves protocols for care Have skills focusing on maintaining function and independence, with concern for the living environment as well as the healthcare provided. Ability to accurately administer medications and treatments, conduct health screenings, teach, and counsel.

Possess strong communication and counseling skills and be familiar with community resources.

In the 1980s, the nursing care delivery model shifted from a team nursing model to a Modular care model Clinical specialist model Primary nursing model Managed care model

Primary nursing model

A client considers himself affluent and places a high priority on maintaining his freedom to choose which physicians and health care services he utilizes. Which of the following group plans is most likely to meet this client's needs? A preferred provider organization (PPO) Long-term care insurance A health maintenance organization (HMO) Private insurance

Private insurance

Several nurses from a local hospital volunteer to serve on a health care reform task force. The nurses are correct in their understanding of a prospective payment system reflected in which statement? This payment system attempts to build a payment plan for select diagnoses or procedures that consist of best standards of care at the lowest cost. Prospective payment systems change financial incentives linked to doing more in order to gain more reimbursement. With prospective payment systems, providers receive a fixed sum of money to provide a range of services. In prospective payment systems, the provider or system receives a capitated payment for each patient enrolled in the program.

Prospective payment systems change financial incentives linked to doing more in order to gain more reimbursement. Prospective payment systems seek to eliminate incentives to doing more in order to gain more reimbursement. A capitation system pays for select diagnoses cared for via best standards of care, and providers in a capitated system receive a capitated payment for each patient enrolled. A bundled system gives providers a fixed sum of money to provide a range of services.

A nurse-manager at a community hospital is discussing the concept of Pay for Performance with the medical-surgical unit's physicians, nurses, and other members of the health care team. Which of the following statements made by the nurse-manager is consistent with this concept? Pay for Performance includes only demonstrated delivery efficiencies and improved quality and patient safety. Pay for Performance is to be instituted primarily in small community hospitals with fewer than 100 beds, as patient outcomes are worse there. Financial incentives are employed to reward providers for the achievement of a range of patient objectives. Quality of care is being measured and used to evaluate hospitals and other providers and to award reimbursement.

Quality of care is being measured and used to evaluate hospitals and other providers and to award reimbursement.

During a home care visit to a home-bound elderly patient, the husband/caregiver verbalizes anger, fatigue, and sleeplessness. Which of the following recommendations by the nurse will be most effective in relieving caregiver role strain? Hospice care Respite care Palliative care Voluntary services

Respite care Hospice, voluntary services, and palliative care are helpful to the client and her husband, but respite care directly provides the husband with a break from caregiving duties.

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

Respite care is often provided by volunteers

The shift to community health nursing is due in part to which of the following factors? Rising healthcare costs Decreased accessibility to healthcare Increased need for health team members The psychosocial needs of clients

Rising healthcare costs

A group of first semester nursing students is preparing for a class presentation on the role of the school nurse. They ask their instructor to look over the content prior to the presentation. The instructor understands that the group needs to do some additional research when one of the students says which of the following? School nurses maintain immunization records. School nurses conduct routine health screenings. School nurses are responsible for dispensing medications. School nurses are sometimes the major source of emergency care for children.

School nurses are responsible for dispensing medications.

A hospital social worker speaks to a group of students orienting to a local hospital for their first medical surgical nursing rotation. Which roles is within the social worker's scope of practice? Select all that apply. Social workers assist with discharge planning Social workers provide assistance with securing medical devices and supplies Social workers make referrals to appropriate community resources Social workers provide direct, in-hospital, psychological counseling Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being

Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being Social workers make referrals to appropriate community resources Social workers provide assistance with securing medical devices and supplies Social workers assist with discharge planning

A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since he ate his minced and pureed breakfast. Auscultation of his chest reveals the presence of coarse crackles. Which practitioner should the nurse consult with in order to obtain a swallowing assessment? Physician Respiratory therapist Physical therapist Speech therapist

Speech therapist The diagnosis and treatment of dysphagia (swallowing problems) is within the purview of speech therapists. The physician should be made aware and respiratory therapy may be involved with assessing and promoting the patient's oxygenation, but swallowing assessment is a task most often performed by a speech therapist.

A new graduate nurse is interested in becoming active in health care policy and reform. What information can a nurse that has been active in this realm give to the new graduate? Select all that apply. Work overtime whenever asked Join and participate in nursing associations Stay up to date regarding new pending legislature that will determine nursing practice Advocate for the rights of all people in health care Report workers that may be impaired

Stay up to date regarding new pending legislature that will determine nursing practice Join and participate in nursing associations Advocate for the rights of all people in health care

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

The nurse is the guest in the client's home.

A nurse is considering accepting a new position in an ambulatory care center. Which of the following roles does the nurse understand are likely in this setting? Select all that apply. Prescribing medications Teaching clients about wellness and illness Performing physical assessments Triaging walk-in clients Assisting with minor surgical procedures

Triaging walk-in clients Teaching clients about wellness and illness Assisting with minor surgical procedures Performing physical assessments

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

a hearing screening in the school setting. Primary prevention or primary health care involves the screening of clients in the prevention of disease.

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

a middle-age client who presents with new onset angina -A middle-age client who presents with new onset angina will require a referral to a cardiologist and will probably need 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 instructing a group of older adults preparing for retirement, you would provide information regarding Medicare benefits. Medicare part A is: a health insurance program administered locally to cover visits to physicians, medications, and home health. a plan for seniors that limits providers to those within the group plan. a federally funded public assistance program. an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services.

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

A nurse is working in a clinic that provides primary health care. What type of services does the nurse provide in this setting? Select all that apply. Complex disease management Education related to sexually transmitted disease Emergency medical care Treatment Administration of immunizations to children and adults health risk screenings

health risk screenings Administration of immunizations to children and adults Education related to sexually transmitted disease

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. performing technical procedures performing in-service education providing health education researching nursing issues managing members of the health care team making health assessments

making health assessments performing technical procedures providing health education

What is one of the most significant trends in health care today? narrowing of the areas for nursing practice shift from hospitals to community-based care emphasis on disease management increased length of hospital stays

shift from hospitals to community-based care

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? move to an intermediate care facility admission to hospice care transfer to an extended care facility discharge to home with home health care

transfer to an extended care facility

The spouse of a client in the early stages of dementia asks the nurse if the spouse is a candidate for "aging in place." The nurse understands that which of the following statements is the most accurate description of "aging in place"? Clients will 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 where community members meet each other's needs. Patients 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 where community members meet each other's needs.

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? "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." "DRGs are an inefficient way for the government to manage a client's hospital recovery." "This reimbursement method focused on preventing illness through screening and health promotion."

"DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay."

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

Aging in place

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

A 66-year-old client with diabetes

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

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

The nurse-manager of a local hospice care agency is responsible for orienting newly hired nurses. What role with the manager inform the new nurse that will be required? The focus of hospice nursing is on prolonging life and promoting dignity. The hospice nurse cares for the client and the family from admission to service until death. Medicaid is the predominant source of payment for hospice care. After the hospice client's death, the nurse will assist the family with the bereavement process up to one year.

After the hospice client's death, the nurse will assist the family with the bereavement process up to one year.

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

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.

An ambulatory care center that facilitates socialization, and provides health-related services to seniors who are unable to fully care for themselves is best known by what name? Daycare center Hospital at Home Extended care center Ambulatory care center

Daycare center

A client with a recent total knee replacement (TKR) is about to be discharged home with home health services and states, "I think it is too soon for me to go home." What should the nurse explain to the client is the primary reason for the implementation of this level of care? Sophisticated technology generally allows client care to be managed safely in the home environment. The insurance/payment reimbursement system requires early discharge. Home health agencies are able to provide many different health care-related services. Teaching clients is more easily done in the home.

Sophisticated technology generally allows client care to be managed safely in the home environment.

A client has a rare neurological disorder and will require complex management with specialists. What type of care level does the nurse determine this client will require? Secondary Health Care Tertiary Health care Primary Health Care Complex referral

Tertiary Health care

Home health care is one of the most rapidly growing areas of the health care system. What are chief tasks of the home health care nurse? Select all that apply. collecting payment for nursing care providing continuity of care administering medications providing client education and counseling providing for a dignified death at home developing a nursing care plan

developing a nursing care plan providing client education and counseling providing continuity of care administering medications

The growth in home health care is largely attributed to which of the following? the nursing shortage in hospitals early discharge of clients from the hospital setting nurses' desire to work in the community the inability of hospitals to care for an increasing numbers of clients

early discharge of clients from the hospital setting

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

economic, quality care.

A nursing instructor is preparing to educate students about professional nursing practice in the twenty-first century, which trends in health care should be addressed? (Select all that apply.) increasing complexity of hospitalized clients developing interest in pediatrics and obstetrics rising number of outpatient and ambulatory clinics growing number of retiring baby boomers funding for genetic engineering research

funding for genetic engineering research growing number of retiring baby boomers rising number of outpatient and ambulatory clinics

When the patient's primary care physician does not have hospital privileges, there is a service to provide the patient's care and communicate to the patient's physician. This service is provided by physicians called: on-call physicians. hospitalists. admitting doctors. referral specialists.

hospitalists.