Community Week 6 Quiz
Describe the Social distance space
4-12 feet -interpersonal business transactions -much of the interview will be conducted at this distance
Describe the Public distance space
>12 feet -impersonal
A nurse is working with a client who has systemic lupus erythematous and recently lost her health insurance. Which of the following actions should the nurse take in the implementation phase of the case management process? A. Coordinating services to meet the clients needs B. Comparing outcomes with original goals C. Determining the clients financial constraints D. Clarifying role son inter professional team members
A
What are the six "rights" of case management? a. Care, time, provider, setting, price, and outcomes b. Patient, medication, route, time, documentation, and evaluation c. Place, setting, patient, plan, outcomes, and documentation d. Disease process, time, place, beneficence, advocate, and care provider
A Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case management.
A patient with a long history of asthma with many hospital admissions is referred to a case manager for disease management. Which of the following best describes the purpose of this referral? a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring
A Disease management activities target chronic and costly disease conditions that require long-term care interventions. Demand management seeks to control use by providing clients with correct information. Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician do not explain the referral to disease management.
what questions should a nurse ask herself during a self-assessment?
-am i aware of my culture and views about other cultures? -am i able to perform a culturally sensitive assessment? -do i have the knowledge necessary to develop culturally appropriate nursing interventions? -what is my goal in learning about diverse populations?
Latin Culture
-fail to consider greens an important source of vitamins -fail to list intake of food/food diary
Judaism Culture
-shellfish -certain birds -fish with scales -kosher diet
Describe the Intimate zone of space
0-1.5 feet -visual distortion occurs -best for addressing breath and body odors
Mutual benefit with limited loss for everyone is a goal of: a. negotiating. b. assertiveness. c. conflict management. d. cooperation.
C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal. The process of moving conflicting parties toward an outcome is called negotiation. Assertiveness is the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others.
A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.) A. Being a leading partner with decision-making authority B. Flexibility among partners when considering new ideas C. Adherence of partners to ethical principles D. Varying goals for the different partners E. Willingness of partners to negotiate roles
Flexibility among partners when considering new ideas Adherence of partners to ethical principles Willingness of partners to negotiate roles Flexibility must exist for a partnership to be successful. Integrity must exist for a partnership to be successful. Negotiation must exist for a partnership to be successful.
When making health-related decisions, clients from different cultural backgrounds depend on relationships. One type of relationship involves the client seeking assistance from other members of the family and allowing a relative to make decisions about important health-related issues. This relationship is a(n) a. lineal relationship. b. collateral relationship. c. cultural relationship. d. individual relationship.
a. lineal relationship.
Which is a goal of case management? (Select all that apply.) a.Providing high-quality care b.Decreasing fragmentation of health services c.Containing cost of health care d.Integrating specialty care e.Enhancing quality of life for clients
a.Providing high-quality care b.Decreasing fragmentation of health services c.Containing cost of health care e.Enhancing quality of life for clients
What do Magico-religious beliefs focus on?
about the link of illness to supernatural forces, or good and evil; includes belief in faith healing used by some christian religions, or voodoo and witchcraft practices used in the Caribbean.
What does case management promote?
patient safety, quality of care and cost effective outcomes
describes the significance of individual members of a family or the family as a whole
social organization
What should a nurse do prior to collecting information about a client's culture?
the nurse should perform a self-assessment
When one woman asked her friend to stay while a painful procedure was done, it was explained that only one immediate family member could be in the room. The woman asked the nurse, "How do you define family?" Which of the following would be the best response by the nurse? a. "A person's husband, wife, or children" b. "Anyone related to you by law or by blood ties" c. "Someone who lives with you and has ties of commitment" d. "Whoever you tell us is your family"
"Whoever you tell us is your family"
MULTIPLE RESPONSE A nurse would like to take action to reduce the risk of liability. Which of the following interventions should be used by the nurse? (Select all that apply.) a. Provide accurate documentation of client visits b. Inform clients of their rights of appeal c. Refer clients to the providers of their choice d. Utilize care planning whenever possible e. Promote strong community partnerships
A, B To reduce risk exposure, it is important to provide clear documentation of client encounters and inform clients of their rights of appeal. Client choice is important when choosing a provider; however, the nurse is responsible for using reasonable care when selecting referral choices for a client. Although care planning may be helpful for establishing a plan with the client, it is not necessary in reducing the risk of liability.
MULTIPLE RESPONSE What knowledge and skills are required in order to become a competent case manager? (Select all that apply.) a. Knowledge of community resources and financing mechanisms b. Written and oral communication skills c. Proficient negotiation and conflict-resolving practices d. Application of evidence-based practices and outcomes measurements e. Experience with ethical decision making
A, B, C, D The knowledge and skills required to achieve competency include knowledge of community resources and financing mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving practices, and the ability to apply evidence-based practices and outcomes measures. Experience with ethical decision making is not part of becoming a competent case manager.
A nurse is caring for a client who is experiencing alcohol withdraw. Which of the following findings should the nurse identify as a manifestation of withdraw? A. Decreased BP B. Diaphoresis C. Pinpoint pupils D. Bradycardia
B
An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is called: a. case management. b. care management. c. disease management. d. demand management.
B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.
The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, "Tell me more about how you will work full time and breastfeed." Which of the following aspects of the advocacy process is being used? a. Verification b. Clarification c. Amplification d. Affirmation
B Clarification is a process in which the nurse and client strive to understand meanings in a common way. Verification is the process used by the nurse advocate to establish accuracy and reality in the informing process. Affirmation is based on an advocate's belief that a client's decision is consistent with the client's values and goals. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client's decision.
A nurse is working with an individual who pursues neither his concerns nor another's concerns. Which of the following conflict management behaviors is being used? a. Accommodating b. Collaborating c. Avoiding d. Compromising
C The individual would be "avoiding." Avoiding is defined as when an individual pursues neither his or her concerns nor another's concerns. Accommodating occurs when an individual neglects personal concerns to satisfy the concerns of another. Collaborating is when an individual attempts to work with others toward solutions that satisfy the goals of both parties. Compromising occurs when an individual attempts to find a mutually acceptable solution that partially satisfies both parties.
What religion is the most popular?
Christianity (70.6% of US citizens)
assisting the client to maintain traditional values and practices
Cultural preservation
A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following actions should the nurse take first? A. Monitor the clients satisfaction with the referral B. Provide the client information to referral agencies C. Review available resources with the client D. Identify referrals that the client needs
D
Muslim Culture
Pork + ETOH prohibited
A nurse reviewed the treatment the surgeon recommended for a woman's breast lump. When the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the husband thanked the nurse for her time and said they would get back in touch after they speak with other family members. Which of the following actions would be most appropriate for the nurse to take? a. Ask if there was some reason the woman could not be immediately admitted for treatment b. Explain to the woman why postponing the surgery was dangerous c. Point out it that it's the woman's decision, and stress that she should go to the hospital immediately d. Recognize that the husband and other family members may need to have input into this decision
Recognize that the husband and other family members may need to have input into this decision
what do biomedical beliefs about illness focus on?
a cause for every effect on the body, the body functions like a machine
Which minority group hit an all-time low high school drop-out rate in 2018? a. African Americans b. Chinese Americans c. Polish Americans d. Italian Americans
a. African Americans
For an RN to apply for certification for case management through the Case Management Society of America (CMSA), the nurse must perform essential activities of case management. Which is not one of the required activities? a. Diagnosis b. Coordination c. Evaluation d. Outcomes e. Assessment
a. Diagnosis
The community health nurse is caring for a client who abstains from eating any form of meat. This dietary preference is commonly practiced by members of which faith? a. Hinduism b. Mormonism c. Judaism d. Islam
a. Hinduism
supporting and facilitating the clients use of cultural practices that are beneficial to the clients health
cultural accommodation
advocating, mediating, negotiating, and intervening between the clients culture and health care culture on behalf of the client
cultural brokering
While caring for a client from an Asian culture, the community health nurse might expect which behaviors? (Select all that apply.) a. The client is quiet and compliant, asking few questions. b. The client asks many questions related to the health problem and the nurse's instructions. c. The client may avert his or her eyes during the conversation. d. Folk healers and complementary health care providers may also be present. e. The client may provide the nurse with the answers he or she thinks the nurse wants to hear.
a. The client is quiet and compliant, asking few questions. c. The client may avert his or her eyes during the conversation. e. The client may provide the nurse with the answers he or she thinks the nurse wants to hear.
assisting the client to modify cultural practices that are not beneficial to the clients health
cultural repatterning
What is the process used when conceptual differences, which impact the provision of health care, exist between the client and the nurse? a. Cultural diversity b. Cultural negotiation c. Cultural competence d. Cultural imposition
b. Cultural negotiation
In which case management setting is the nurse responsible for providing primary prevention to employees to keep the work force healthy? a. High-risk clinic setting b. Occupational health setting c. Home health and hospice setting d. Public health clinic setting
b. Occupational health setting
A community health nurse is caring for a Native American client who often stares at the floor while the nurse is talking. The nurse knows this indicates which culturally appropriate behavior? a. The client is showing respect to the nurse. b. The client is listening cafefully. c. The client's religion forbids him from making eye contact with women. d. The client is depressed.
b. The client is listening cafefully.
n providing care for a client who recently had a liver transplant, a nurse case manager would focus attention on all except a. medication monitoring and management. b. provision of direct clinical skilled care (e.g., dressing changes, medication administration). c. identification of potential problems and notification of the physician. d. evaluation of progress to meeting projected outcomes or goals
b. provision of direct clinical skilled care (e.g., dressing changes, medication administration).
The case manager reviews the chart of a patient to determine appropriateness and timeliness of medical care while the patient is in the hospital. This function of case management is referred to as a. care coordination. b. utilization review. c. continuum of care. d. care management.
b. utilization review.
why shouls family members NOT be used as translators/interpreters?
because clients might need privacy and family members can lack objectivity when relaying information to or from the client
Assisting the family of a special needs child through the complex health care system is an example of what type of case management? a. Disease-specific case management b. System-centered case management c. Patient-centered case management d. Public health case management
c. Patient-centered case management
About13% of residents in the United States were born in other countries. Approximately 50/3% of these individuals were born in a. Asia. b. Europe. c. Africa. d. Mexico and Latin America.
d. Mexico and Latin America.
Vietnamese Culture
dietary intake may lack calcium, but they consume pork bones and shells providing adequate diet
what can be considered translation barriers?
differences in socioeconomic status, religious affiliation, educational level, spoken dialect
indicates the belief in how the environment affects the individual
environmental control
what are examples of contamination?
food and food products with bacteria, pesticides, radiation, and medication (growth hormone/antibiotics)
individuals who believe that the environment can be mastered to affect health status will actively engage in what?
health promotion, disease prevention, and treatment
A nurse developing a community health program is determining barriers to community resource referrals. Which of the following factors should the nurse include as an example of a resource barrier? A. Costs associated with service B. Decreased motivation C. Inadequate knowledge of resources D. Lack of transportation
A
A nurse who is using population management needs to be able to work with integrated care delivery systems. Which of the following describes the rationale for this competency? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary.
A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false.
What are examples of toxins?
lead, pesticides, mercury, solvents, asbestos, and radon
What do nurses use toxicological information for?
to understand the specific effects that environmental hazards have on populations at risk or following exposure.
What are examples of water pollution?
wastes, erosion after mining or timbering, run-off from chemicals added to the soil
What is the 2nd step of the cultural assessment?
pose questions that address the clients perceptions of their health needs
A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following groups should the nurse include as the fastest-growing segment of the homeless population. A. Families with children B. Adolescent runaways C. Intimate partner abuse survivors D. Older adults
A
A nurse carefully explained that the medication had to be taken three times a day, with each meal. The patient came to the clinic with symptoms of medication overdose. How should the nurse respond? a. "Can you explain what you believe happened to make you so ill now?" b. "Can you tell me when in the day you and your family eat?" c. "Please review with me when I taught you to take your medication." d. "Why did you take more medication than we suggested?"
"Can you tell me when in the day you and your family eat?"
Case management aims to provide a service delivery approach to ensure what?
-cost-effective care -alternatives to institutionalization -access to care -coordinated services -patients improved functional capacity
What are the roles for nurses in environmental health?
-facilitate public participation in measures to improve environment -perform individual and population risk assessments -implement risk comunication -conduct epidemiological investigations -participate in policy development
what are the 6 components to case management?
1. client identification and engagement 2. assessment 3. care plan development 4. implementation and coordination of plan of care 5. monitoring and evaluation 6. closure of professional services
Describe the personal distance space
1.5-4 feet -an extension of self "bubble" -most of the physical assessment will occur at this distance
A public health nurse (PHN) is working with the chronically ill and families with young children needing age-specific health maintenance. Which of the following models of case management is being used? a. Client-focused b. System-focused c. Social service d. Long-term care
A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. System focused models address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.
The process of moving conflicting parties toward an outcome is called: a. negotiation. b. conflict management. c. problem-purpose expansion method. d. brainstorming.
A The process of moving conflicting parties toward an outcome is called negotiation. Conflict management has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the problem and expanding the problem statement so that different solutions can be generated. In brainstorming, as many alternatives as possible are generated without placing a value on them.
A nurse is using the I PREPARE pneumonic to assess a clients potential environmental exposures. Which of the following questions should the nurse ask when assessing for "A" in the pneumonic? A. "What do you like to do for fun?" B. "What year was your residence build?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"
A (activities)
A nurse is preparing an educational program on cultural perspectives in nursing. the nurse should include that which of the following factors are influenced by an individuals culture? Select all that apply. A. Nutritional practices B. Family Structure C. Health care interactions D. Biological variations E. Views about illness
A, B, C, E
A nurse at a community clinic is conducting a well-child visit with a preschool aged child. The nurse should identify which of the following manifestations as a possible indication of child neglect? Select all that apply. A. Underweight B. Healing spiral fracture of the arm C. Genital irritation D. Burns on the palms of the hands E. Poor hygiene
A, E
A woman who spoke English was an immigrant from the Middle East, attending the clinic for the first time with two female friends. When a male nurse attempted to get a health history, the woman refused to respond to his questions. Which of the following actions should be taken by the nurse? a. Ask a female nurse to talk with the client b. Ensure that the client has privacy, with the two female friends waiting outside before trying again c. Explain that the woman cannot see a physician until the nurse obtains a health history and does an initial examination d. Stress that the clinic is free and she does not have to pay extra to see both the nurse and the physician
ANS: A He should ask a female nurse to talk with the client. Many culture groups have strong norms regarding appropriate gender behavior. Norms are the rules by which human behavior is governed and result from the cultural values held by the group. All societies have rules or norms that specify appropriate and inappropriate behavior. Individuals are rewarded or punished as they conform to, or deviate from, the established norms. Thus, this woman is likely to not deviate from these cultural norms and should be given the opportunity to speak with a female nurse. The other responses do not address the cultural needs regarding gender that this client needs to have addressed. DIF: Cognitive Level: Apply (Application) REF: pp. 225-226
In a client's culture it is exceedingly rude to ask any questions about income or wealth. Which of the following actions should be taken by the nurse to draw conclusions about the client's socioeconomic status (SES)? a. Ask about the client's education or employment position b. Ask his or her religious leader to share such information with the nurse c. Let the financial office deal with the problem d. Refer the issue to the social worker who has better sources of information
ANS: A SES may be determined by examining income, occupation, and educational level. If that is not possible, age, gender, possessions, location of residence, religion, and race may also be considered. DIF: Cognitive Level: Apply (Application) REF: p. 228
A nurse is called by a friend who complains of symptoms of a cold. Which of the following responses would be the most appropriate by the nurse? a. Ask the friend what she usually does for a cold and suggest that be done b. Tell her to go to the urgent care center for assistance c. Suggest that she make an appointment to see her health care provider d. Point out to her that nurses are unable to treat patients
ANS: A Seventy percent to 90% of all illness episodes are treated first, or exclusively, through self-care, often with significant success. Symptoms of a cold do not seem to require drastic action such as going to the urgent care center or seeing a health care provider. Engaging in traditional healing interventions, learned in the family, will be comforting and probably will help. DIF: Cognitive Level: Apply (Application) REF: p. 238
A patient had wrapped a tummy band around her newborn's abdomen. What should the nurse say to the new mother? a. "Can you explain to me the purpose of wrapping a band around the baby's tummy?" b. "In the hospital, we prefer to expose the umbilical cord to air so it's easier to put medication on it as it dries up." c. "Let me put some medication on the baby's cord, and then I'll put the tummy band back." d. "Please remove that band; it is not helpful as the umbilical cord needs to be kept clean and dry."
ANS: A Unless a particular action is harmful, the nurse should engage in culture care preservation and maintenance. Before acting, it is helpful to know why the mother is engaging in this behavior. If the mother responds, "I'm not sure; it's just always been done," the nurse can educate the mother on how to care for the cord. If the mother appears to believe the tummy band is very important, the nurse can cooperate with the behavior, because tummy bands will not hurt the baby. DIF: Cognitive Level: Apply (Application) REF: p. 223
A woman comes to the clinic, and the nurse believes that she is speaking French. She seems to understand English. A provider will need to complete a physical examination to confirm the health problem. Which of the following actions should be taken by the nurse? a. Ask the client if she prefers a male or female provider b. Ask a female provider to assume care c. Ask the physician provider to see her immediately d. Ask the secretary in the office who speaks French to assist in collecting a health history from the client
ANS: A When in doubt, the best way is to ask the client about culturally relevant aspects of male-female relationships. This should be done at the beginning of the interaction before an opportunity arises to violate culturally based practices. It is not appropriate to ask other staff members to serve as interpreters during nurse-client interactions. DIF: Cognitive Level: Apply (Application) REF: pp. 234-235
Which are considered part of the six components of case management? (Select all that apply.) a. Assessment of client needs b. Development of care plans c. Giving direct client care as needed d. Monitoring and evaluating care that is provided e. Obtaining needed resources and funding for the client f. Submitting appropriate forms to involved agencies for the client
ANS: A, B, D a. Assessment of client needs b. Development of care plans d. Monitoring and evaluating care that is provided There is a consensus in the literature that there are six components to case management: client identification and engagement, assessment, care plan development, implementation and coordination of plan of care, monitoring and evaluation, and closure of professional services. The focus of each of these functions varies depending on the case management model. Providing direct client care, obtaining resources and funding, and submitting appropriate forms are not part of the core components of case management.
Which of the following best describes the challenges when providing care to someone from a minority group? (Select all that apply.) a. Communication, both words and gestures, may be unfamiliar. b. Few members of the minority group are nurses themselves. c. Immigrants will soon adapt to the mainstream culture, but in the meantime many are clinging to "the old ways." d. So few patients are minority group members that it is difficult to remember how they prefer to receive care. e. The nurse may have to confront personal values and beliefs.
ANS: A, B, E Nurses must understand how patients define health and illness, how their cultural group cures and cares for members, and how the nurse's personal cultural background influences the way in which care is delivered. The context and process of helping people involves at least two people who often have different cultural orientations and lifestyles. Very few nurses are members of a minority group. Although immigrants may adopt some of the ideas of the mainstream culture, many will continue to use traditional practices and the nurse must be aware and respect these cultural beliefs. Many minority group members represent the patient population who receives care, so nurses must be aware and respect these cultural beliefs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 222 | p. 224 | p. 233
Which clients may be eligible for hospital-based, disease-specific case management support? (Select all that apply.) a. Those who have high-cost conditions b. Those with physicians who request such intervention for their patients c. Those who may be maintained in a stable condition in their home environment d. Those who have access to private insurance plans e. Those who have requested such services f. Those whose hospital has a collaborative agreement with a home health nursing agency
ANS: A, C a. Those who have high-cost conditions c. Those who may be maintained in a stable condition in their home environment Case management services are often provided for individuals who are identified as having medical conditions that are high-cost or high-volume acute and chronic illnesses such as congestive heart failure. The goal is to keep these clients as healthy as possible and stable in their home environment. Doing so will decrease the frequency and length of hospital stays and therefore decrease health care costs.
Which best describes how a case manager identifies people who would benefit from case management services? (Select all that apply.) a. Evidence-based criteria b. Families who express doubt that the patient is receiving adequate care c. Patient having setbacks from treatment d. Referrals from health care providers or agencies e. Risk identification from data management f. Use of health risk screening tools
ANS: A, D, E, F a. Evidence-based criteria d. Referrals from health care providers or agencies e. Risk identification from data management f. Use of health risk screening tools A variety of tools are used to identify people who would benefit from case management services. These include health risk screening tools, evidence-based criteria, risk stratification through data management, and referrals from hospitals and health care providers.
A client, accompanied by her son, spoke only Spanish while the nurse did not. Which of the following actions should be taken by the nurse to best meet the client's need? a. Ask the woman if it's OK if the son translates for her b. Call until she finds a Spanish interpreter employed by the agency c. Let the son translate because he's obviously informed about the problem d. Use gestures and pantomime to make oneself clear
ANS: B Asking the son would violate confidentiality, and gender issues may also arise. The only safe approach is to obtain a Spanish interpreter who is knowledgeable about medical terminology and procedures, as well as comfortable with cultural beliefs and health prac- tices. It is important to have an interpreter rather than trying to make gestures and pantomine so that the communication between the nurse and client is clear and accurate. DIF: Cognitive Level: Apply (Application) REF: p. 233
Which of the following statements best defines Leininger's term "culture universal"? a. The preference to be cared for by someone from their own cultural group for maximum ease and comfort b. The commonalities of values, norms, and life patterns that are held in all cultures c. The particular values, beliefs, and patterning of behavior that is universal within a particular culture d. The health care roles, norms, and behaviors that are involved when illness or injury occurs
ANS: B Culture universal is used by Leininger to refer to the commonalities of values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the basis for formulating theories for developing cross-cultural laws of human behavior. DIF: Cognitive Level: Understand (Comprehension) REF: p. 223
At a military base, a family from Qatar, a Muslim Arabic country, came in to the prenatal clinic because the wife believed she was pregnant. Which of the following providers would be the most appropriate choice for this client? a. A male obstetrician, expert in high-risk pregnancies b. The female nurse midwife c. The male obstetrician with a female nurse always in the room with the wife d. Whichever provider was on duty until the pregnancy was confirmed
ANS: B During pregnancy, many female clients will prefer female health care providers and may refuse to be examined by a man. People from Arab Muslim countries feel even more strongly about males touching a female. DIF: Cognitive Level: Apply (Application) REF: p. 234
A nurse is caring for a client from a different culture. Which of the following actions would be the most helpful for the nurse to take? a. Ask to have a nurse from that culture assigned to the patient even if the nurse must be obtained from a different clinical area b. Be aware of cultural similarities and differences between the nurse and the client c. Explain that the patient must follow the rules of the hospital while a patient d. Verbalize the nurse's own discomfort, and ask for assistance with surmounting the cultural differences
ANS: B Recognizing both similarities and differences is being culturally aware. Although it would be helpful to have a nurse from the same culture give care, that is often not feasible. A nurse from another area cannot be expected to be clinically expert, to say nothing of the legal problems of having a nurse from a different agency give care. Asking the patient for help makes the problem belong to the patient, but it is the nurse's problem. Asking the patient to comply with the hospital regulations is being culturally insensitive. DIF: Cognitive Level: Apply (Application) REF: p. 244
Before interviewing an Hispanic family, what is the most important action for the nurse to take? a. Compliment each member on some visible asset b. Establish rapport, and gain trust and confidence c. Greet them in Spanish even if badly spoken and accented d. Recognize the male as the authority figure in the family
ANS: B Regardless of the culture of the client family, it is crucial to establish rapport and gain trust and confidence before attempting to gather data. First impressions are important and the nurse should ensure a mutually respectful relationship is created. Thus, starting by providing compliments, greeting them with poor Spanish, or assuming that the male is the authority in the family may all lead to an unacceptable first impression of the nurse to the family. DIF: Cognitive Level: Apply (Application) REF: p. 231 | p. 232
A woman stood very close to the nurse and asked a question about her husband's condition. The nurse took a step back and shared the requested information. No other questions were asked. Was this a successful interaction? a. No, because the nurse should not answer any questions about a client, even if the wife is the one asking b. No, because the woman and the nurse had different perceptions of personal space c. Obviously yes, because the woman sought information, received it, and had no further questions d. Yes, because the nurse was knowledgeable and able to respond appropriately
ANS: B Sense of spatial distance is significant because culturally appropriate distance zones vary widely. Many cultures stand closer for important conversations, whereas the nurse stepped back because being so close made the nurse uncomfortable. DIF: Cognitive Level: Apply (Application) REF: p. 232
Which of the following actions was taken by the federal government to help improve health disparities among minorities? a. Created scholarships and traineeships only for minority applicants b. Created the National Center on Minority Health and Health Disparities c. Established grants that funded only minority health projects d. Legislated funds to create new colleges for preparing health professionals in minority neighborhoods
ANS: B The National Center on Minority Health and Health Disparities was developed in 2000 to assist in the investigation of factors affecting minority health. Its mission is to promote minority health and to ultimately eliminate health disparities. The federal government did not create scholarships and traineeships specifically for minority applicants, establish grants for minority health projects, or legislate funds to create new colleges to address the improvement in health disparities. DIF: Cognitive Level: Understand (Comprehension) REF: p. 241
A nurse became frustrated because after each interview question there was a long pause before the client responded. Which of the following actions should be taken by the nurse? a. Accept the hesitation before receiving an answer b. Ask the client what silence after a question means c. Copy the client's behavior; insert a pause before asking the next question d. Recognize that the client was distracted, and reschedule the home visit
ANS: B Wide cultural variation exists when interpreting silence. Some individuals find silence uncomfortable, whereas others use silence to show understanding and respect. Because the nurse is uncomfortable, action should be taken. The only way to know the meaning of the silence is to ask. DIF: Cognitive Level: Apply (Application) REF: p. 233
Which best describes the goals of nursing case management regardless of setting? (Select all that apply.) a. Ensure that all clients have a case manager b. Contain costs and control use of services c. Decrease duplication and fragmentation d. Enhance client's quality of life e. Focus on avoiding hospitalization or institutionalization f. Maintain routine communication channels
ANS: B, C, D b. Contain costs and control use of services c. Decrease duplication and fragmentation d. Enhance client's quality of life Case management programs aim to provide a service delivery approach to ensure the following: cost-effective care, alternatives to institutionalization, access to care, coordinated services, and patient's improved functional capacity (Lyon, 1993). Not all clients need case managers if they have adequate financial resources and can navigate the health care system. Although hospitalization can often be avoided, in acute cases hospitalization would be the most appropriate use of resources.
Which of the following are the most important factors in reducing disparities in health outcomes between different cultural groups? (Select all that apply.) a. A strong family structure b. Access to a health care provider c. Access to transportation d. Health care insurance e. Having ongoing employment f. Owning one's own home
ANS: B, D Disparities in health care can be reduced or even eliminated when adults have health care insurance and a medical home defined as a setting that provides patients with timely, well-organized care and enhanced access to providers. According to the Commonwealth Fund (2007), when adults have insurance and a medical home, "their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially." Thus, having a strong family structure, access to transportation, ongoing employment, and owning one's own home are not nearly as important as having health insurance and a medical home. DIF: Cognitive Level: Understand (Comprehension) REF: p. 223
A nurse felt very good about an Asian man who had responded positively to the instructions given to him. Later, the nurse heard him tell his wife that there was no way he could implement the suggestions. Which of the following best describes the problem that the client is experiencing? a. Polite response may not equal agreement. b. Men do not take instruction from women. c. His culture may value harmonious relationships over expressing disagreement. d. The nurse told him what to do but did not ask if he could do it.
ANS: C Asian clients may provide the nurse with the answers they think the nurse wants to hear. This behavior is consistent with their cultural value for harmonious relationships with others. The other responses do not recognize this cultural variation among this population that the nurse should recognize. DIF: Cognitive Level: Apply (Application) REF: p. 233
Which of the following helps to balance the fact that poverty is typically a major factor in certain groups having poorer health? a. A strong community health center in the neighborhood b. Intact families where fathers are married to children's mothers c. Strong family and community support for healthy behaviors d. The large number of programs available to be of assistance in fighting poverty
ANS: C Latino children who live in poverty enjoy relatively good health compared with children in other low socioeconomic groups. It is believed that strong family-community support fosters optimum family health behaviors. Many of these behaviors are integrated into the culture as part of the family identity, traditions, and history. Without strong family and community support having other resources in the community is insignificant. Strong support structures can exist in communities where fathers are not married to children's mothers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 240
A nurse set up a clinic appointment for Friday of the following week. An Arab patient asked to come earlier in the week. As those days were heavily booked, the nurse left the appointment on Friday. The patient was a "no show." Which of the following best explains what happened? a. A lot of people do family errands such as shopping on Fridays, Saturdays, and Sundays. b. It was inconvenient for the client so he did not come. c. A Muslim's holy day is from sunset Thursday to sunset Friday. d. Patients do not like being told what to do.
ANS: C The nurse should know the days of religious worship. Protestants usually worship on Sundays; Muslims' day of worship is from sunset Thursday to sunset on Friday; and Jews and Seventh-Day Adventists' holy day is from sunset on Friday to sunset on Saturday. The other responses do not address the recognition by the nurse of the significance of the days of worship that were indicated as a priority for the client when an appointment was requested for earlier in the week. DIF: Cognitive Level: Apply (Application) REF: p. 230
Crying, a clinic patient explained that she knew she had this breast lump because she had spread nasty gossip about her neighbor. Which of the following actions by the nurse would likely be the most successful? a. Explain the causes of a breast lump and the usual treatments b. Refer the woman for an immediate biopsy to determine the status of the lump c. Suggest that she has to repent and as much as possible undo her sin, but also make an appointment for a biopsy d. Suggest that she has to repent, apologize to her neighbor, and pray for forgiveness
ANS: C The woman has expressed a magico-religious perspective on illness. Because evil has caused her illness, she must undo the evil. However, the nurse, as a practitioner of the biomedical perspective, must also arrange for a biopsy as soon as possible so treatment can be begin. DIF: Cognitive Level: Apply (Application) REF: p. 236
The nurse made a follow-up appointment for a client at the clinic, but the client did not come. Two days later the client presented at the clinic explaining that a temporary job had come up and he could not come back until he had finished and been paid for that job. Which of the following actions should be taken by the nurse next? a. Explain that patients are seen by appointment only, and set up another appointment for the client b. Reinforce the need to plan ahead before arranging another appointment c. Stress that health is the number one priority, and try to fit the client in sometime the same day d. Understand that some clients are present oriented, and fit the client in so care can be given
ANS: D Although health care systems are set up according to the expectation that clients can plan for the future, some clients focus on the present with little attention to the future. For the patient to receive care, the nurse should try to fit him in that day. Setting up an appointment would possibly be useless because the client may not attend the future appointment either. Poverty-stricken persons would be wise to accept employment when it becomes available. DIF: Cognitive Level: Apply (Application) REF: p. 226
A nurse was assigned to create and implement a community education program with the goal of preventing diabetes among the Hispanic population. As the nurse did not speak Spanish and was just beginning to be comfortable with the neighborhood Hispanic culture, which of the following would be the best approach for the nurse to take? a. Be sure to use appropriate images in the handouts. b. Copy literature and procedures found successful in other Hispanic communities. c. Tell the supervisor the nurse is not competent for this task. d. Try to find Hispanic volunteers who may be able to do the actual teaching.
ANS: D By using volunteers, the program can disseminate culturally appropriate information in a culturally appropriate way. The success of educational efforts is often determined by the credibility of the source and the sensitivity of the speaker in communicating information in a culturally appropriate manner. DIF: Cognitive Level: Apply (Application) REF: p. 239
After being given negative news about a health problem, the client, with tears running down her face, asks, "Why did this happen to me?" Which of the following is the most appropriate response by the nurse? a. "Could someone have cursed you?" b. "Do you feel your life is out of balance?" c. "God has a plan for each of us even if we do not understand it." d. "Why do you think it might have happened?"
ANS: D Each response represents a particular belief about illness, but without knowing the patient's perspective, the wrong one could easily be chosen. It is difficult to be comforting without knowing the client's beliefs about the causation of illness. The best way to discover this is to query the patient. DIF: Cognitive Level: Apply (Application) REF: p. 235
The clinic was seeing a great number of Hmong immigrants from the mountainous regions of the Far East. If the nurse could not obtain a translator, which of the following would be the next best action? a. Require each patient to bring a family member fluent in English b. Start teaching Hmong patients English on each clinic visit c. Suggest Hmong patients might be more comfortable seeking care elsewhere d. Try to make flash cards with common phrases used during clinic visits
ANS: D If a translator is not available, the nurse can try many approaches such as pantomime, but it would also be helpful to have common phrases used with many patients on flash cards so basic information can be obtained. Other Hmong patients or family members should not be used as interpreters. It is unrealistic to teach English to patients at clinic visits. This population needs care, so suggesting that they receive care elsewhere is not a therapeutic response by the nurse. DIF: Cognitive Level: Apply (Application) REF: p. 234
A nurse made a home visit for prenatal care and teaching for an Asian woman. The nurse noted the woman was having a hot lunch of foods the nurse did not recognize. When the nurse suggested some appropriate cold protein foods be added to the meal, the woman looked horrified and distrusting. Which of the following best describes what has happened in this situation? a. The interference with eating seemed incredibly intrusive and inappropriate. b. The nurse was giving advice when advice had not been sought. c. The nurse had suggested foods unknown to the woman. d. The yin and yang theory requires only hot food be eaten when female yin energy is dominant.
ANS: D Many Asians ascribe to the yin-yang theory in which health is believed to exist when all aspects of the person are in perfect balance. Yin energy is female. Yin Yang foods are hot. Therefore to maintain balance, she has to eat hot foods. Thus, in the other responses the nurse is not considering the cultural background and needs of the client in this situation. DIF: Cognitive Level: Apply (Application) REF: pp. 235-236
A nurse was responsible for setting up a health fair with free pizza being served during lunch. The nurse observed a few people who did not eat but just talked quietly during lunch. Which of the following actions should be taken by the nurse? a. Assume it was a religious fast day, and not worry about it b. Discuss with the supervisor what are traditional foods in that neighborhood c. Offer to let those who did not eat take the leftover pizza home for a meal later in the day d. Talk to the group, and ask what foods might have been more acceptable
ANS: D Many ethnic groups prefer certain foods as part of their cultural identity. The nurse should take this opportunity to learn foods preferred by the community. It cannot be assumed a supervisor would know preferred foods of the community. Making assumptions about the community or offering the leftovers to those who did not eat would not be culturally sensitive approaches for the nurse to take with this population. DIF: Cognitive Level: Apply (Application) REF: p. 230
A nurse was explaining a problem to the client so the client could make an informed decision about alternative treatment approaches. The client responded, "The doctor will choose the best treatment. Do whatever the doctor says." Which of the following actions should be taken next by the nurse? a. Ask if the client would like to discuss the choices with her family b. Explain that the client has to decide, and wait for the client's decision c. Explain that physicians cannot decide; perhaps the client could just flip a coin? d. Nothing; simply accept that some fatalistic-oriented clients literally do not know how to choose e. Suggest that the client discuss the situation with her ancestors and wait for guidance
ANS: D One of the three ways people are oriented is destiny, in which people must endure and accept whatever comes in a fatalistic, inevitable manner, as destiny cannot be changed. The other responses do not address the perspective of destiny that has been indicated by the client in the initial response. DIF: Cognitive Level: Apply (Application) REF: p. 226
A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but the baby still seemed ill. Which of the following statements would be the most appropriate reply by the nurse? a. "Folk healers cannot cure such problems; let me give you appropriate fluids for your baby." b. "Let's go back to feeding the baby formula, and see how the baby does." c. "You continue to give the baby herbal tea, but let's put some sugar and salt in the tea." d. "Your healer is correct; fluids are crucial for your baby. Let me give you some special fluids for you to give the baby."
ANS: D Rejecting the folk healer's advice may cause the mother not to trust Western medicine. If possible, the nurse should build on what the mother is doing. It is usually helpful to include any behaviors that may be helpful or neutral in effect. In this case, the mother is encouraging fluid, which is crucial, and tea is boiled, so the water is clearly safe. Just adding salt and sugar is risky because of the need for careful measurement. Nothing in the example suggests the nurse recognizes what kind of tea is being given. It is easier to give the mother fluids with the appropriate electrolytes while supporting at least some aspect of the healer's advice. It must be remembered that most indigenous healing practices are innocuous.
An unidentified patient was injured in a hit-and-run accident and was conscious. When asked how he felt, the patient looked very confused and responded in a language the nurse did not recognize. Which of the following actions should the nurse take next? a. Look closely at the person, try to determine the patient's ethnic background, and then seek someone fluent in his language b. Report the language barrier to administration, and let them handle the problem c. Tell the unit supervisor so various translators can be brought to the floor until the language is recognized and communication can be established d. Use gestures and pantomime until the nurse is able to determine what language the patient is speaking
ANS: D The nurse can report the problem and request a translator, but in the meantime the nurse should pantomime words and simple actions while verbalizing them until communication can be established using a translator from his culture. Just looking at a patient will not allow you to assume his or her ethnic background. DIF: Cognitive Level: Apply (Application) REF: p. 234
Which best describes a key strategy that is used as part of care management? a. Align necessary services with the need of the population b. Implement services as soon as possible c. Request front line staff make appropriate referrals d. Utilize assigned case managers to complete this process
ANS: a. Align necessary services with the need of the population The purpose of care management is to reduce health risks and cost of care for a defined population. AHRQ highlights three key strategies to enhance care management for target populations: (1) Identify population(s) with modifiable risks; (2) Align CM services to the needs of the population(s); and (3) Identify, prepare, and integrate appropriate personnel to deliver the needed services.
Which best describes why nurses are increasingly becoming case managers when social workers have historically been so successful in the role? a. Because of the need for ongoing patient assessment. b. Because of a shortage of licensed social workers. c. Nurses seek such roles as being easier than direct clinical care. d. Social workers expect higher salaries than nurses in the same role.
ANS: a. Because of the need for ongoing patient assessment. Traditionally, case managers were social workers. Client health care needs became more complex, the need for ongoing patient assessment has emerged, and available resources have become more numerous and diverse. Therefore, nurses have become case managers. There is not a shortage of licensed social workers to fill these roles or a salary issue with social workers being in these roles. These roles are different than direct clinical care but may not be considered to be an easier role for the nurse.
A recently licensed registered nurse has been working as a case manager for the past 12 months and would like to become certified. Which organization should the nurse pursue certification through? a. Commission for Case Manager Certification b. American Nurses Credentialing Center (ANCC) c. American Nurses' Association (ANA) d. Centers for Medicare and Medicaid (CMS)
ANS: a. Commission for Case Manager Certification The only organization that offers a certification that this nurse is qualified to obtain is the Commission for Case Manager Certification. The CCM practice requirement is 12 months experience supervised by a CCM, 24 months as full-time case manager, or 12 months as a supervisor of individuals who provide case management. The ANCC certification requires that the nurse has practiced the equivalent of 2 years full-time as a registered nurse. The ANA and CMS do not offer certification for case managers.
The case manager gave the client a list of eight possible sources for the equipment needed for care after discharge. Which best describes why the nurse did not just tell the client the best source for the equipment? a. The client has a right to select providers of needed resources. b. The nurse did not know which source was the best resource. c. The client must make a decision independently. d. The nurse did not care which source is chosen.
ANS: a. The client has a right to select providers of needed resources. Ethical issues for case managers include the client's right to select providers of resources. As a practical matter, nurses usually offer several choices, so there is no suggestion of misconduct in pushing a particular provider.
Which elderly persons are often the targets of case management? a. Those who are homebound and have multiple complex problems b. Those who live alone without close relatives c. Those who show clear evidence of mental and physical decline d. Those with chronic long-term health problems needing pharmaceutical intervention
ANS: a. Those who are homebound and have multiple complex problems Many older people have special, population-specific health care needs. Case management services frequently target the elderly population, specifically homebound individuals or those with complex problems. However, not all older persons require a case manager. The other elderly groups are not the primary target of case management services.
Which best describes the purpose of case management from the client's perspective? a. To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care b. To help clients recognize that health care resources are limited and must be used wisely c. To help clients understand their varied health problems and the best approach to maintain their health d. To help clients obtain whatever care they need or desire
ANS: a. To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care Client-centered case management assists the patient through a fragmented and often confusing health care delivery system and to achieve specific client-centered goals. Systems-centered processes recognize that health care resources are finite. Helping clients understand their health problems is a responsibility of health education, not case management.
Which best describes why health care institutions are unhappy beyond the fact that they are not receiving the previous high reimbursement for procedures from Medicaid or Medicare? a. Because clients are well informed and know they do not really have to pay their hospital bills b. Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs c. Because it is harder to continue giving charity care when less reimbursement is received from the federal government d. Because recent legislation has required that all reimbursement be based on quality performance measures
ANS: b. Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs Although publication of quality measures is occurring, this is gradually being implemented. The Centers for Medicare and Medicaid (CMS) have established value-based purchasing programs for hospitals. The programs link Medicare payments to quality performance, utilization of evidence-based practices, costs of care, and patient experience scores. However, whatever the federal government does to hold down costs is usually quickly copied by insurance and other third-party payers.
A client has been referred to a case management program. Which action would the nurse most likely take first? a. Admit the client for services. b. Determine the appropriateness for inclusion in the program. c. Contact the physician to determine if services are necessary. d. Contact the most appropriate community agencies for additional assistance.
ANS: b. Determine the appropriateness for inclusion in the program. All clients referred for case management must undergo screening to determine their appropriateness for inclusion in the program. Thus, this is the action the nurse must take first. Not all referred clients need the services of a nurse case manager. Often, a nurse can arrange community services or instruct the client and family in the most appropriate follow-up based on client need and program design.
Which best describes why utilization review departments are becoming case management units? a. Funding is available for case management responsibilities. b. Monitoring service use alone does not improve patient outcomes. c. It facilitates using nurse experts for case management. d. It promotes the current trend of naming "utilization review" units "case management."
ANS: b. Monitoring service use alone does not improve patient outcomes. Case management programs evolved from utilization review departments when those departments demonstrated that monitoring service use alone is insufficient for managing patient populations with diverse resource needs. There is not readily available funding for case management responsibilities. Case management involves more than utilization review, so there is a changing role of the nurse associated with the change of the name of the department. Using nurse experts for case management is beneficial, but it is not the reason why these departments transitioned.
. A hospital is going to start a care management program. Which group of clients would most likely be selected to first receive such services? a. Clients who represent the most common diagnosis group to be admitted b. Clients who request such services from their local hospital c. Clients with chronic illnesses d. Clients with the least education
ANS: c. Clients with chronic illnesses The overall goal of care management is to improve the coordination of services provided to clients who are enrolled in a care management program. Examples of groups of people who may be served by care management services include the elderly, children from low-income families who receive Medicaid services, and groups of people with chronic illnesses. The other groups do not represent groups who are typically enrolled in a care management program.
A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role. Which will be most difficult for the nurse new to this role? a. Having the ability to be a leader and work autonomously b. Obtaining knowledge of community resources c. Gaining knowledge of reimbursement structures and financial strategies d. Getting practice at evaluating patient outcomes
ANS: c. Gaining knowledge of reimbursement structures and financial strategies Skills to ensure success in the role of case manager include sound knowledge of reimbursement structures, knowledge of available resources within the community, ability to evaluate patient outcomes, and an understanding of financial strategies. Such a nurse would have to be flexible, be creative, communicate well, and be able to work autonomously. Although the text does not discuss this, the typical baccalaureate program does not include courses in reimbursement and financial implications of clinical decisions.
A nurse is explaining case management to a client. Which statement would be the most appropriate for the nurse to make? a. "We assess, plan, facilitate, and advocate to save money as much as possible." b. "We coordinate your care so you obtain needed services without incurring undue costs." c. "We seek the lowest cost provider to give you what care is necessary." d. "We collaborate with you to coordinate your care for the best outcome."
ANS: d. "We collaborate with you to coordinate your care for the best outcome." There is no single definition of case management. But it is a collaborative process to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. The response "with you" shows a collaborative approach to coordinating care for the best outcome.
Which has the largest influence on the case manager's role? a. Criteria of the program for accepting clients b. Location of the program c. Population served by the program d. The specific program that employs the case manager
ANS: d. The specific program that employs the case manager The individual case manger's role will vary depending on the specific program's services. The criteria of program acceptance, location, and population served by the program will not have as large an influence on the case manager's role as do the specific services of the program.
Who first created the idea of a continuum of care, which later evolved into the term "case management"? a. Florence Nightingale, when she engaged in activities such as writing letters for the wounded. b. Lillian Wald, who created health education programs for the whole community. c. Social workers, who function as discharge planners, use the term. d. Those who coordinated services for discharged psychiatric patients after World War II (WWII) used the term.
ANS: d. Those who coordinated services for discharged psychiatric patients after World War II (WWII) used the term. The concept of continuum of care originated after WWII to describe the long-term services required for discharged psychiatric patients. The term "case management" first appeared in social welfare literature during the early 1970s. Nightingale, Wald, and social workers were not involved in the creation of the idea of the continuum of care.
Which best describes the aftermath of the deinstitutionalization of mentally ill patients into the community during the 1970s? a. Community health centers were created and gave care to such clients. b. Families were eager to accept their family members back home. c. Many mentally ill clients without social skills ended up in nursing homes. d. Without follow-up care, many clients were readmitted to care.
ANS: d. Without follow-up care, many clients were readmitted to care. Several problems resulted from deinstitutionalization of mentally ill patients, because there was no follow-up or monitoring. Many were readmitted to state hospitals. Many ended up homeless or in prison facilities, not in nursing homes or with their family members at home. Community health centers were created to provide care to these patients, but the deinstitutionalized were unable to meet their basic needs and receive proper follow-up and health care monitoring. Thus, they were readmitted to care.
A nurse is working as a case manager and is in the process of performing interdisciplinary, family and client conferences. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Planning for outcomes d. Implementation
B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of assessment include developing networks with target populations and dissemination of written materials. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions. Examples of implementation include contacting providers and coordinating care activities.
A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the clients perception of his current health status. B. Gather data about the clients cultural beliefs. C. Determine how the clients culture can effect the effectiveness of nursing actions. D. Gather information about previous client interactions with the health care system.
B
A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. "I don't drive, and my son is only available to take me places in the morning." B. "I can't take off during the day and the local after-hours clinic is not longer in operation." C. "Only one doctor in my town is a designated provider by my health maintenance organization." D. "I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."
B
A case manager provides a formal communication link among all parties concerning the plan of care management. Which of the following roles of the nurse is being implemented? a. Facilitator b. Liaison c. Coordinator d. Negotiator
B The case manager providing a formal communication link among all parties concerning the plan of care management is performing the role of liaison. As a facilitator, the nurse supports all parties in work toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and coordinates needed health care services for clients at all necessary points of services. The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator.
A nurse's excessive attention to cost containment impairs the nurse's duty to provide measures to improve health. Which of the following ethical principles is being influenced? a. Autonomy b. Beneficence c. Veracity d. Nonmaleficence
B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Autonomy is the individual's right to choose a provider. Veracity is truth telling which is important to building trusting relationships with clients. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care.
A case manager submits documentation that a nursing visit was completed at a client's home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security
B Fraud/abuse occurs when false statements of claims are made and filed. Confidentiality/security occurs when sensitive information is not secured. Negligent referral occurs when referrals or treatments are inappropriate. Liability for managing care occurs when case management is not used appropriately, when there is harassment, or when care is inappropriately delegated.
A nurse is using population management as part of the nursing care that is provided. Which of the following activities is the nurse most likely completing? a. Census taking to determine the total number of people in the population b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually
B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. Population management does not include census taking, providing case management services for all, or repeating wellness programs on an annual basis.
A nurse upholds a client's right to make a choice and to act on the choice. Which of the following best describes the action being taken by the nurse? a. Affirming b. Supporting c. Informing d. Amplifying
B Supporters approve and support clients' actions. Affirming is based on an advocate's belief that a client's decision is consistent with the client's values and goals. Informing includes educating clients about the nature of their choices, the content of those choices, and the consequences to the client and is not a one- way activity. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client's decision.
Which are examples of knowledge domains used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning and legislative change d. Grant application, bargaining contracts, and securing funding
B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research. The other domains listed are not used in case management.
A case manager uses effective collaboration and team strategies to make arrangements for services. Which of the following roles is being applied? a. Broker b. Negotiator c. Liaison d. Facilitator
B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator. The role of broker is used when acting as an agent for provider services that are needed by clients to stay within coverage according to budget and cost limits of the health care plan. When acting as a liaison, the nurse provides a formal communication link among all parties concerning the plan of care management. As a facilitator, the nurse supports all parties in work toward mutual goals.
The nurse is involved in a conflict resolution situation with the parents of a 2-year- old boy. The parents are deciding if "spanking" the child is a disciplinary method that they will employ. The mother says, "I do not believe in spanking. I see it as abusive and demeaning." Which of the following best describes the statement by the mother? a. Cooperation b. Assertiveness c. Bargaining d. Collaboration
B The mother's statement is an example of assertiveness, the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the negotiation process when debates include gathering facts based on reasoning that will generate understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent process in which people work together to share resources and a vision for a goal.
Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client-focused b. System-focused c. Social service d. Long-term care
B The system-focused model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations. The concern in client- focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.
A nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health department to provide? Select all that apply. A. Managing the Woman, Infants and Children program B. Providing education to achieve community health goals C. Coordinating directives from state personnel D. Reporting communicable diseases to the CDC E. Licensing of registered nurses
B, C
A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? Select all that apply. A. Being a leading partner with decision-making authority B. Flexibility among partners when considering new ideas C. Adherence of partners to ethical principles D. Varying goals for the different partners E. Willingness of partners to negotiate roles
B, C, E
A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? A. Providing support programs for new parents B. Screening a client whose partner recently died for risk for suicide C. Teaching a client who has schizophrenia about medication interactions D. Discussing stress reduction techniques with employees at an industrial site
C
A nurse is using a critical path when providing care for a client. Which of the following most likely describes the situation that the nurse is in? a. Implementing the six "rights" of case management b. Demonstrating competencies required for practicing case management c. Attempting to achieve a measurable outcome for a specific client d. Effectively managing conflict resolution
C A critical path is a case management tool used to achieve a measurable outcome for a specific client case. The critical path details the essential and sequential activities in care, so that the expected progress of the client was known at a point in time. A critical path does not address the six "rights" of case management or demonstrate the competencies required for practicing case management. A critical path is not used for conflict resolution.
A nurse is using life care planning when working with a client. Which of the following would be the most appropriate time for this to be used? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care
C Life care planning is a customized, medically based document that provides assessment of present and future needs. Typically, a life care plan incorporates medical, financial, psychological, vocational, built environment, and social costs during the remaining life of the client. Life care planning is a tool used in case management. A life care plan assesses the current and future needs of a client for catastrophic or chronic disease over a life span.
A case manager supports a client's decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which of the following phases of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation
C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client's decisions. The assessment/diagnosis phase is similar to the advocacy process of information exchange, gathering data, and illuminating values. The planning/outcome phase is similar to the advocacy process when generating alternatives and consequences and prioritizing actions. The evaluation phase is most similar to the advocacy processes of affirmation, evaluation, and reformulation.
A bachelor's prepared nurse is providing case management services. Which of the following activities would most likely be provided by this nurse? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes
C Working with individuals would be the role of this nurse. Working with community aggregates, systems of disease, and outcomes management processes are implemented by an advanced practice nurse (APN).
A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following information should the nurse include when discussing nicotine and smoking? A. Smoking is the 5th most preventable cause of death in the US B. Nicotine is a central nervous system depressant C. Withdraw effects from smoking are minimal D. Tolerance to nicotine develops quickly
D
A nurse is working as a case manager. Which of the following best describes the diagnoses that the case manager is most likely to encounter? a. Bankruptcy, financial distress, and depression b. Flu, colds, and frequent headaches c. Malaria, bird flu, and Dengue fever d. AIDS, spinal cord injury, and ventilator dependency
D Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions.
A nurse is assisting clients to improve their health status. Which of the following types of management is being used by the nurse? a. Care management b. Case management c. Disease management d. Demand management
D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant.
Care in a managed system is provided by less experienced providers. Which of the following ethical principles is being influenced in this situation? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice
D Justice calls for equal distribution of health care with reasonable quality. Autonomy is the individual's right to choose a provider. Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence- based practice, and monitoring processes in plans of care.
The first stage of collaboration is: a. trust building. b. consensus. c. collegiality. d. awareness.
D The first stage of collaboration is awareness, when one makes a conscious entry into a group process. This is followed by tentative exploration and mutual acknowledgement, trust building, collegiality, consensus, commitment, and collaboration.
A case manager has contacted providers and has negotiated services and prices. Which of the following phases of the nursing process is being demonstrated? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation
D The implementation phase of the nursing process occurs when a case manager advocates for clients' interests and arranges for the delivery of service. Examples of assessment include developing networks with target populations and dissemination of written materials. Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions.
A case manager is fulfilling the role of coordinator. Which of the following nursing interventions would most likely be completed? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client
D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client's situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator, and supporting all parties to work toward mutual goals is the role of facilitator.
Which of the following statements best describes how the population of the United States is changing? a. Growth will occur because of a decrease in the death rate. b. Growth will occur because of ongoing immigration. c. Growth will occur because of an increase in the birth rate. d. Growth will occur because of lengthening of the normal life span.
Growth will occur because of ongoing immigration.
A case management nurse is preparing to initiate referrals for a client as part of discharge planning. Which of the following actions should the nurse take first? A. Monitor the client's satisfaction with the referral. B. Provide the client information to referral agencies. C. Review available resources with the client. D. Identify referrals that the client needs
Identify referrals that the client needs Using the nursing process, the first action to take at this point in the referral process is to assess client needs. After gathering client data, identify referrals that the client needs and prioritize plans. This allows the nurse and client to focus on specific needs while moving forward in the referral process.
When a nurse visited a client's home, it was apparent that the client had not begun to implement the needed exercise program. Rather, the client had been doing drawings about his illness experience. Which of the following actions would be most appropriate for the nurse to take next? a. Express admiration for his artistic ability, and do not schedule future visits because the patient is noncompliant b. Point out the negative consequences that will ensue if the client does not begin exercising c. Review with the client why exercise is so crucial to his recovery d. Suggest drawing might be more forceful after exercising
Suggest drawing might be more forceful after exercising
The phrase "All Chinese people like rice" is an example of a. cultural stereotyping. b. culture-bound syndrome. c. cultural imposition. d. ethnocentrism.
a. cultural stereotyping.
A nurse is reviewing the various roles of a community health nurse. Which of the following actions is an example of a nurse functioning as a consultant? A. Advocating for federal funding of local health screening programs B. Updating state officials about health needs of the local community C. Facilitating discussion of a client's ongoing needs with an interprofessional team D. Performing health screenings for high blood pressure at a local health fair
Updating state officials about health needs of the local community Updating officials about community health needs is an example of a nurse functioning as a consultant. Community health nurses serve as a consultant regarding the health care needs of individuals, families, and groups within the community served.
What is the I PREPARE mnemonic?
a method of determining current and past environmental exposures Investigate potential exposures Present work exposures, use of personal protective equipment Residence age of home, heating, recent remodeling, chemical storage, water Environmental concerns air, water, soil, industries in the neighborhood, waste site or landill Past work:exposures, farm work, military Activities: hobbies activities Referrals and resources: environmental protection agnecy, OSHA, SDS, poison control Educate: risk reduction/follow up
What are examples of air pollution?
carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke
Which are principles of a patient-centered medical home? (Select all that apply.) a.Physician-led, team based care b.Value-based purchasing c.Integration and coordination of care d.Improved access to care e.Quality and safety
a.Physician-led, team based care c.Integration and coordination of care d.Improved access to care e.Quality and safety
Certification for registered nurses in the field of case management is provided through which professional organization? (Select all that apply.) a.American Nurses Association b.American Nurses Credentialing Center c.American Hospital Association d.Case Management Society of America e.National Association for Healthcare Quality
b.American Nurses Credentialing Center Correct d.Case Management Society of America Correct
how should a nurse address a client?
by their last name unless given permission to use other names
How can nurses contribute to environmental health?
by using environmentally-friendly practices and materials, as well as providing information to the public about environmental health
While caring for a client from a different culture, the community health nurse must assess the client's health-related beliefs. All of the following questions would be appropriate and would elicit the desired information except a. "Are there certain foods you eat when you are sick?" b. "When do you know you are sick enough to visit a health care provider?" c. "Is it OK if I speak in English?" d. "What does health mean to you?"
c. "Is it OK if I speak in English?"
Which model of care was developed to provide collaborative, quality-driven, safe, primary care? a. Community case management model b. Disease-specific case management model c. Patient-centered medical home d. Geriatric care management
c. Patient-centered medical home
Which was a result of the Patient Protection and Affordable Care Act of 2010? a. Social Security benefits were denied to selected aggregates. b. Third-party payers (e.g., preferred provider organizations and health maintenance organizations) use prospective payments systems to negotiate reimbursement. Incorrect c. Value-based purchasing programs for hospitals were established. d. Health care providers received a fixed amount of money based on the relative cost of resources they use to treat Medicare patients within each diagnosis-related group
c. Value-based purchasing programs for hospitals were established.
A community health nurse is caring for a family that includes the husband, wife, children, and other blood relatives. This type of family is called a(n) a. nuclear family. b. communal family. c. extended family. d. nuclear dyad
c. extended family.
What is the 1st step of the cultural assessment?
collection of self-identifying data about the clients ethnic background, religious preference, family structure, food patterns, and health practices
What do Naturalistic beliefs focus on?
how illness relates to the individual as a part of nature or creation; an imbalance in nature is believed to cause disease *the basis of eastern/Chinese medicine/Mexican (hot-cold theory)
What is the final step of the data collection process in a cultural assessment?
identification of how cultural factors can affect the effectiveness of nursing interventions
individuals who believe in harmony with the environment are more likely to look for what?
naturalistic solutions to correct what is perceived as an imbalance between the mind, body and spirit
which individuals are not as likely to engage in health-related behaviors?
those who feel that their outcome is predetermined and they cannot affect it
describes whether an individual focuses more on the past ,present, or the future
time orientation
