Exam 2 - Unit 14

A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using: a. a patient classification system to determine safe staffing levels. b. diagnostic-related groups for Medicare billing. c. case management to coordinate care. d. clinical pathways to determine care.

ANS: A Correct: Patient classification systems group patients according to care needs to determine safe staffing levels. Incorrect: b. Diagnostic-related groups is a classification system used to bill Medicare for patient care that is based on primary and secondary diagnoses. c. Case management is a model of care delivery in which the RN coordinates the patient's care throughout the course of an illness. d. Clinical pathways generate plans that specify major patient care activities and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that: a. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week. b. the use of part-time nurses provides the variability needed to meet diverse patient needs. c. satisfaction of the staff equates to satisfaction of patients. d. nurses provide the same level of care, regardless of the work environment.

ANS: C Correct: High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes. Incorrect: a. Errors increase with long shifts over consecutive days. b. The use of part-time nurses may result in decreased patient satisfaction and lack of continuity of care. d. Research has found that nurses who practice in positive and autonomous work environments provide cost-effective care of better quality.

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

ANS: D Correct: Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the Unlicensed Assistive Personnel provide hygiene, and the RN is assigned to task that require the nursing process. Incorrect: a. Team nursing requires an RN team leader who is assigned with four to five other staff. b. Partnership delivery models pair a RN with a partner who provides care. c. In primary nursing care delivery, the "primary nurse" assumes 24-hour responsibility for directing the patient's plan of care.

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a: a. patient outcome. b. variance. c. goal. d. standard.

ANS: B Correct: A variance is a deviation from the planned path. Incorrect: a. The patient outcome is the end result of care, not just a single specific incident or deviation. c. The goal is to provide high-quality, cost-effective care. d. A standard is the criterion from which safe, effective care is derived.

Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing: a. hospital admission rates. b. length of hospital stay. c. outpatient services. d. specialty groups.

ANS: B Correct: Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client's length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Incorrect: a. Decreasing hospital admission rates has not been shown to reduce the costs of health care. c. Decreasing outpatient services would actually drive costs up because more services would have to be performed as in-patient procedures. d. Decreasing specialty groups would not affect hospital reimbursement, which is the focus of the DRG payment system.

A nursing unit is comparing team nursing to the partnership model and finds that: a. with the partnership model, an RN does not have to be part of the mix. b. leadership abilities of the RN is a major determinant of effectiveness of care for both models. c. the RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing. d. with team nursing the RN cares for the patient while the team members work with the family or significant others.

ANS: B Correct: The RN leads regardless of whether partnership model or team nursing is practiced. Incorrect: a. An RN is the leader of the pair. c. Applying the nursing process is not an appropriate role for the LPN/LVN or UAP. d. The team is led by an RN, and the team performs those tasks that are not required by the RN; however, team members can also be additional RNs but they are not in a leader role.

A nurse who speaks at a health fair states that current attempts to increase efficiency of health care include: (Select all that apply.) a. an increase in acute care, so that specialized care can be provided. b. the growing use of outpatient services. c. shifting toward health promotion and prevention. d. allowing physicians to control health care decision making. e. the use of technology to educate the public about cost-effective measures.

ANS: B, C, E Correct: b. Economic forces are motivating the shift toward providing more services and procedures in outpatient settings. c. Economic forces are motivating the shift toward a model of health promotion and preventive. e. The Internet can inform and educate consumers (or clients) about how to access health care educational resources more effectively. Incorrect: a. Health care is shifting from acute care services to preventive and community-based services such as ambulatory care and home care. d. Physicians no longer control all health care decision making; insurance companies play an increasingly stronger role in health care decision making through requirements for preauthorization of procedures and treatment plans.

A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ____________.

ANS: never events Medicare identified 28 medical errors that were preventable and with serious consequences for which they will no longer pay. These errors are called never events.

The type of insurance that shifts the largest percentage of costs for goods and services to employees and consumers is _____________ insurance.

ANS: private Private insurance shifts amore costs to employees and consumers than does any other type of insurance.

An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as: a. diagnosis-related groups (DRGs). b. subjective symptom management. c. acuity classification system. d. organized managed care.

ANS: A Correct: DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping on the basis of his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount preestablished for that DRG. Incorrect: b. Subjective symptom management is not a reimbursement type that is based on predetermined pricing. c. Acuity classification system is not a reimbursement type that is based on predetermined pricing. d. Organized managed care is not a reimbursement type that is based on predetermined pricing.

A client who is reading a newspaper asks, "This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?" The nurse explains that: a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome. b. effective refers to competence in clinical practice and efficiency describes quick completion of the task. c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations. d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation.

ANS: A Correct: Efficiency means using the right combination of resources—energy, time, and money—to accomplish a task, and effectiveness means doing the right thing right in health care. Incorrect: b. Effective does not refer to competence in clinical practice, and efficiency does not describe quick completion of the task. c. Effective does not mean wasting and meeting a minimum standard, and effectiveness does not refer to taking all the time needed to exceed expectations. d. Efficiency does not refer to speed, and effectiveness does not refer to the usefulness of the implementation.

A patient is eligible to change health care providers and insurance and asks, "I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick"? Which, if any, health insurance plan would best meet the needs of this patient? a. Health Maintenance Organization (HMO) b. Fee for Service c. Preferred Provider Organization (PPO) d. None, because health insurance plans currently cover only disease management, not preventive care.

ANS: A Correct: HMOs encourage preventive care. Incorrect: b. Fee for Service may or may not pay for preventive care. c. Preferred Provider Organizations may or may not pay for preventive care. d. HMOs cover preventive care.

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

ANS: A Correct: In total patient care nurses provide all aspects of patient care. Incorrect: b. Partnership nursing, or co-primary nursing, pairs the RN with a partner, usually a licensed practical/vocational nurse (LPN/LVN) or unlicensed assistive personnel (UAP), allowing the RN to spend more time on tasks such as assessment and patient education. c. In team nursing an RN directs the other members of the team, which can consist of care providers at various levels. d. In functional nursing staff are assigned to tasks rather than to patients.

A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is: a. private health insurance. b. a federal insurances program known as PPACA. c. state-subsidized Medicaid insurance. d. single-payer system coverage.

ANS: A Correct: Private health insurance is a method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services and is typically the provided through an individual's employer with a portion of the cost paid by the employer and a portion paid by the employee. Incorrect: b. PPACA is a federal insurance policy but is not part of employment benefits. c. Medicaid is state subsidized but not part of state employee benefits—it is available to the poor, blind, disabled, or those on kidney dialysis. d. Single-payer systems, usually the government, pay all health care expenses for citizens, funded by taxes.

A nurse answers phone questions related to health care questions and to triage the need for urgent care of member patients. Established patient guidelines are used to educate, direct, or provide follow-up. The nurse is providing care via: a. telehealth. b. clinical pathways. c. functional nursing. d. case management.

ANS: A Correct: Telehealth involves telecommunication to deliver nursing care. Incorrect: b. Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition. c. Functional nursing is a model of care delivery in which members of the health care team are assigned "tasks" for a group of patients. d. Case management is a model of care delivery that involves an RN manager who coordinates care across an illness episode.

Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it: a. mandates that all U.S. and legal residents must secure health insurance. b. replaces current Medicare and Medicaid plans. c. requires all citizens to participate in offered preventive services. d. prohibits use of health practices outside of Western medicine.

ANS: A Correct: The PPACA is a type of national health insurance program to provide funding for U.S. citizens and legal residents to secure health insurance beyond the current programs such as Medicare and Medicaid. Incorrect: b. PPACA does not replace Medicare and Medicaid. c. PPACA does not require participation in preventive services. d. PPACA does not require participants to only adhere to principles of Western medicine.

The nurse manager is planning staffing levels and realizes that the first step is to: a. know the intensity of care needed by patients according to physical and psychosocial factors. b. examine the educational level of the staff. c. assess the skill level of caregivers. d. review the budget to determine the financial consequences of past staffing patterns.

ANS: A Correct: The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients. Incorrect: b. Educational level requirements must be matched to patients' acuity levels. c. Assessing the skill level of staff is necessary to match staff with patients according to patients' acuity level. d. Past staffing patterns cannot predict the needs of the current population.

A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching? a. "I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won't be sick as long." b. "I looked up urinary tract infection prevention on the Internet." c. "I had my weight, body fat, and blood sugar measured at a local health fair." d. "My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine."

ANS: A Correct: Ways to reduce health care costs as a consumer include choosing generic drugs whenever possible. Incorrect: b. It is a good idea to use the Internet to learn more about your health and preventing disease. c. Practicing preventive health with health screenings by taking advantage of free screenings offered at community sites, at hospitals, or at churches is an effective way to reduce health care costs. d. Taking good care of oneself, managing minor illnesses at home, and consulting a pharmacist for recommendations for over-the-counter medications are effective ways to reduce health care costs.

Medicare would be responsible for: (Select all that apply.) a. a hospital stay following a total knee replacement for a 70-year-old client. b. nursing home cost for a 67-year-old adult receiving hemodialysis. c. rehabilitation care costs for a 24-year-old client with a broken femur resulting from a fall at work. d. prescription cost for a young mother who meets eligibility for Aid to Families with Dependent Children (AFDC). e. home health services to administer heparin to a 27-year-old truck driver following a thrombus.

ANS: A, B Correct: a. Medicare coverage is based on age and Part A covers inpatient hospital services. b. Medicare eligibility is based on age and disability with hemodialysis resulting from chronic renal failure classified as a disability. Incorrect: c. The client does not meet the age or disability eligibility. d. Medicaid covers families with children meeting AFDC income eligibility. e. The client does not meet the age or employment status eligibility.

A nurse responsible for staffing a medical-surgical unit must consider: (Select all that apply.) a. the patient census. b. physical layout of the unit. c. complexity of care required. d. educational level of all staff. e. task preferences of the nurses.

ANS: A, B, C, D Correct: The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses' work life. Incorrect: e. Tasks are assigned according to educational level and experience rather than individual nurse preferences.

Which factors would be considered in the first steps in developing an effective patient classification system? (Select all that apply.) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients

ANS: A, B, E Correct: The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. Incorrect: c. The second step is to match the skill level of staff with the care needs of patients. d. The educational level of nurses is part of the second step and involves matching the educational preparation of staff with the care needs of patients.

Which industrialized countries have a national health insurance system? (Select all that apply.) a. France b. Canada c. United States d. South Africa e. Great Britain

ANS: A, B, E Correct: a. France has a substantial amount of central government planning in its health system, leading to a fully centralized or nationalized system of health care. b. Canada has a substantial amount of central government planning in its health system, leading to a fully centralized or nationalized system of health care. e. Great Britain has a substantial amount of central government planning in its health system, leading to a fully centralized or nationalized system of health care. Incorrect: b. The United States and South Africa are the only industrialized countries without a national health insurance system that covers all of their citizens. d. South Africa does not have national health care.

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur as a result of: (Select all that apply.) a. the increase in the number of minimally invasive procedures being performed for disease treatment. b. care provided for patients over an extended period in acute care settings. c. the reduction in the number of nurses and other health care professionals who are available to provide care. d. the widespread illiteracy and decreased self-efficacy of the aging patient population. e. the need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient. f. the devaluing of nursing as a means of improving patient outcomes.

ANS: A, C, E Correct: a. Invasive surgical procedures are being replaced by laparoscopic procedures. c. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. e. Care will focus on the unique lifestyles and values of a diverse population. Incorrect: b. Patients are discharged much more quickly and with more complex care needs, rather than having a longer stay in acute care settings. d. Consumers, especially the aging baby-boomer generation, are proactive about learning and participating in health care. f. Nursing is increasingly valued and has been shown to improve patient outcomes and patients' satisfaction with care.

A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a: a. patient classification system. b. clinical pathway. c. patient-centered plan of care. d. diagnosis-related group (DRG).

ANS: B Correct: A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition. Incorrect: a. A classification system categorizes patients according to specific criteria and care requirements and thus helps to quantify the amount and level of nursing care needed. c. Patient-centered, as used in this chapter, refers to a nursing care delivery model that is focused on interprofessional care, with the patient as the focus. d. A DRG places patients into a predetermined reimbursement rate on the basis of diagnosis.

A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement? a. Health maintenance organization b. Preferred provider organization c. Fee-for-service arrangement d. Philanthropic agency

ANS: B Correct: A preferred provider organization is an arrangement by which the member pays a premium for a fixed percentage of expense coverage. This method includes a required deductible and a copayment. The member may select a physician but pays less for physicians and facilities on the plan's preferred list. Incorrect: a. Health maintenance organizations (HMOs) require that the member pay a premium with a fixed copay and select a primary care physician approved by the HMO. c. The fee-for-service arrangement is one in which the member pays a premium for a fixed percentage of covered expenses and is allowed to choose physicians and specialists without restraint. d. A philanthropic agency provides care without fees, but the member does not select providers.

A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system. a. prospective b. retrospective c. diagnosis-related group d. capitated

ANS: B Correct: A retrospective payment system is a method of reimbursing health care providers (such as physicians and hospitals) in which professional services are rendered and charges are billed on the basis of each service provided; this is also known as a fee-for-service payment system. a. A prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the client's diagnosis. This is the predominant method of payment in today's health care system. c. A diagnosis-related group payment system refers to reimbursement for health care services that is based on a predetermined fixed price per case. This method of payment is also called a prospective payment method. d. A capitated payment system is a method of reimbursing providers (usually primary care providers such as physicians and nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services for the client enrolled in the insurance company's health plan.

Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as: a. charity. b. cost shifting. c. price sharing. d. governmental reimbursement.

ANS: B Correct: Cost shifting occurs when providers increase their charges against households and public and private insurers who pay for their own care while making some contribution to the care of the uninsured population. Incorrect: a. Charity is the donation or benevolent gift of money or tangible goods or services. c. Price sharing is not a standard term related to lack of insurance, uninsured populations, or uncompensated care. d. Governmental reimbursement is received when the government actually remits money to providers for services rendered.

A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system? a. Fee for Service b. Health Maintenance Organization (HMO) c. Preferred Provider Organization (PPO) d. Point of Service (POS)

ANS: B Correct: HMOs require patients to select a primary care physician approved by the HMO who then must refer or order any test/diagnostic procedures before payment is approved or preapproval must be sought. Incorrect: a. Fee for service allows members to choose physicians and specialists without restraint but may cover only usual or reasonable and customary charges for treatment and services, with members responsible for charges above that payment. c. PPO plans allow members to select physicians, but pay less for physicians and facilities on the plan's preferred list. d. POS plans allow use of providers outside plan's preferred list or network, but require higher premiums and copayments for services.

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is: a. total patient care. b. functional nursing. c. team nursing. d. primary nursing.

ANS: B Correct: In functional nursing members of the team are assigned specific tasks such as assessment or medication administration Incorrect: a. Total patient care involves an RN who provides every aspect of patient care. c. With team nursing the team leader, an RN, delegates care to other team members. d. In primary nursing the RN assumes 24-hour responsibility for the care of assigned patients.

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains, "We must determine the acuity level of the patient by: a. assessing patient satisfaction with nursing care." b. quantifying the amount and intensity of care required." c. examining the skill mix and educational preparation of the staff." d. determining the number of hospital days required by the patients."

ANS: B Correct: Patient acuity is measured by determining the amount and intensity of care required. Incorrect: a. Patient satisfaction is based on interactions or experiences while the patient is receiving care, although staffing can affect patient satisfaction. c. Examination of the skill mix and educational preparation of the staff is the criterion for delegation of care. d. The number of hospital days required by the patient is a criterion that is used on care pathways to predict required resources.

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is termed: a. partnership. b. patient-centered. c. case management. d. total patient care.

ANS: B Correct: Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs. Incorrect: a. Partnership delivery models pair the RN with a partner to deliver care. c. In case management the RN case manager coordinates the patient's care throughout the course of an illness. d. Total patient care nurses are responsible for all the care components for their assigned group of patients during the assigned shift.

A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis: a. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company. b. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee. c. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease. d. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.

ANS: B Correct: Since 1983, if hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals face strong financial incentives to reduce the client's length of stay and minimize procedures performed. Incorrect: a. The hospital will collect only the amount designated by the DRG and no additional fees will be paid. c. The hospital is eligible to collect only the maximum amount allowed by the patient's DRG. d. The physician's charges will not be reduced to cover losses by hospital: the hospital will receive only the maximum amount allowed by this DRG.

The nurse manager determines that four RNs, five LPN/LVNs, and two Unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with: a. assignments. b. staffing. c. output. d. productivity.

ANS: B Correct: Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care. Incorrect: a. Assignment is the distribution of work that each staff member is responsible for during a given work period; assigned activities must fall within the individual's scope of practice and/or job description. c. Output is the work produced, such as the number of patient care hours provided. d. Productivity is the ratio of the amount of output produced, such as patients receiving care or home visits, to the specific amount of input (i.e., nursing hours worked) and is the measure of staffing efficiency.

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) Safe Staffing Saves Lives recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost-effective; thus is it important for staffing models to limit the number of RNs assigned per shift.

ANS: B Correct: The ANA recommends that nurses have time to exercise professional judgment. Incorrect: a. Patient needs constantly change and staffing adjustments may be necessary. c. As patient acuity levels increase, the need for RN coverage increases. d. RNs have shown to be cost-effective and increase the value of care because of their contributions to improving patient outcomes.

The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a: a. nurse manager. b. case manager. c. coordinator of patient-centered care delivery. d. team leader in team nursing care delivery.

ANS: B Correct: The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness. Incorrect: a. The nurse manager is responsible for handling the day-to-day operations of the nursing unit and for ensuring that the unit's philosophy and mission are congruent with those of the parent organization. c. The coordinator of patient-centered care delivery works with an interdisciplinary team in providing a wide range of services. d. The team leader coordinates and delegates care for a specific group of patients.

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional

ANS: B Correct: The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present. Incorrect: a. In modular care delivery, a small team is assigned to a geographic location during their assigned shift. c. In team nursing the RN directs members of the team who are providing care but does not assume 24-hour responsibility. d. Functional nursing focuses on completion of tasks rather than on specific patients.

A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, "Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care." This nurse would be a candidate for which nursing role? a. Disease management program (DMP) for chronic illnesses b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients c. Case management d. Reviewer for Managed Care Organization

ANS: C Correct: Case management offers nurses the opportunity to demonstrate cost-effectiveness by coordinating patient care at the appropriate level of care across the continuum of care. Patient advocacy and understanding current health care economics are critical to this role. Incorrect: a. Disease management programs promote member self-care rather than coordinated care and focus on a defined patient population over the course of a disease. b. Utilization management nurses review medical records to determine the most appropriate DRG for patients. d. Nurses who serve as reviewers for Managed Care Organizations consider the patient's medical options and make judgments as to the necessity of the service being considered. Coverage may be denied for unnecessary, excessive, or experimental procedures.

A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual: a. is more likely to participate in mammography screening than are individuals covered by private insurance. b. has designated primary care and a specialist as sources of care. c. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier. d. has decreased access to health care when compared with the uninsured.

ANS: C Correct: Even with improved access as compared with the uninsured, Medicaid recipients are not as likely to obtain needed health services. The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. Incorrect: a. The poor are less likely to participate in preventive services. b. The poor usually do not have a usual source of care. d. Through Medicaid the client actually has enhanced access to health care resources.

The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse. a. case management b. quality assurance c. utilization review d. cost-control

ANS: C Correct: Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification. Incorrect: a. A case management nurse coordinates the client's care throughout the course of an illness. Case managers generally do not perform direct care duties but assume a planning and evaluation role and collaborate with the interdisciplinary health care team to ensure that goals are met, quality is maintained, and progress toward discharge is made. b. A quality assurance nurse facilitates client care delivery through quality monitoring and quality improvement initiatives. d. A cost-control nurse is not a standard role in hospitals.

Customer satisfaction is primarily based on: a. access to modern, up-to-date facilities. b. availability of an extensive menu selection. c. personal interactions with employees. d. having to undergo fewer invasive procedures.

ANS: C Correct: Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health. Incorrect: a. Customer satisfaction is primarily based on relations with employees. b. Interface with employees is the means to customer satisfaction. d. Patients may fear or dislike invasive procedures, but the important consideration in customer satisfaction is the quality of interactions with employees.

An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient's information: a. Medicare will cover the cost of stay since skilled services are required. b. Medicaid is only for families with dependent children. c. Medicare will pay for home health services should these additional services meet the needs of the individual. d. Medicare will pay regardless of household income or financial status for nursing home care.

ANS: C Correct: Medicare does cover home health care. Incorrect: a. Medicare does cover care in a skilled nursing home, but based on the information given, skilled care is not needed. b. Medicaid is primarily for families with dependent children but also covers individuals who are blind, disabled, or on kidney dialysis. d. Medicare will pay for nursing home services only when the individual is poor.

Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds: a. the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed. b. nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care. c. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices. d. economic issues have little or no impact on nursing practice.

ANS: C Correct: Pay for performance, where providers are reimbursed based on the quality of care, gives nurses an opportunity to reduce costs and adopt practices that improve quality of care. Incorrect: a. DRGs have created additional opportunities for nurses, giving them roles as administrators and reviewers of necessity of services ordered. b. Nursing care is moving toward preventive outpatient care rather than illness-based acute care. d. Economic issues have a tremendous impact on nursing practice, affecting both the ability of patients to access care and receive treatment and how treatment is rendered and evaluated.

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To enhance employee satisfaction related to staffing, the management team: a. negotiates for additional agency nurses. b. hires more part-time employees. c. includes participatory management into staffing decisions. d. uses "float" nurses to cover vacancies.

ANS: C Correct: Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction. Incorrect: a. The use of temporary, part-time, or agency nurses can result in a lack of continuity of care, thereby decreasing patient satisfaction, which affects employee satisfaction. b. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention. d. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention.

When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor: a. have less access than even the uninsured. b. receive many unnecessary treatments. c. lack consistent providers. d. abuse preventive services.

ANS: C Correct: The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. a. The poor and uninsured may have limited transportation, limiting their access to health care facilities. b. The poor generally receive very few treatments because of lack of payment to the provider or facility. d. The poor rarely seek preventive services, which explains why their overall health status is lower.

In the triad of health care, which would be considered the third-party payer? a. Client b. Health care provider c. Insurance company d. Government agency that sets reimbursement rules for services

ANS: C Correct: The third-party payer is an organization other than the client and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges. Incorrect: a. Neither the client nor the health care provider is considered the third party in the health care triad. b. Neither the client nor the health care provider is considered the third party in the health care triad. d. The government that sets reimbursement rules is not part of the health care triad.

Accrediting agencies such as The Joint Commission address staffing by: a. imposing maximum staffing levels. b. requiring a specific staff mix. c. stipulating nurse-patient ratios. d. looking for evidence that patients receive satisfactory care.

ANS: D Correct: Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing. Incorrect: a. Accrediting agencies do not impose maximum staffing levels. b. Staff mix is not addressed by accrediting agencies; however, long-term care facilities specify minimum RN coverage for the facility. c. Agencies do not stipulate mandatory staffing ratios, with the exception of those in California, a state that recently enacted legislation mandating specific nurse-patient ratios.

A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services? a. Prospective payment system b. Retrospective payment system c. Single-payer system d. Capitation

ANS: D Correct: Capitation is a method of reimbursing providers (usually, primary care providers such as physicians or nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services under this plan. Payment is generally received as a per-member-per-month payment. Defined health care services generally include preventive, diagnostic, and treatment services. Incorrect: a. A prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the client's diagnosis. b. A retrospective payment system is a method of reimbursing health care providers in which professional services are rendered and charges are billed according to each service provided. c. The single payer system is a method of reimbursement whereby one payer, usually the government, pays all health care expenses for all citizens with the use of funding acquired through taxes.

A nurse makes patient care assignments as follows: RN 1 has rooms 200-210; RN2 has rooms 211-221; RN3 has room 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is: a. team. b. primary. c. partnership. d. modular.

ANS: D Correct: Modular (or geographic) assignments are based on a geographic location in the nursing unit. Incorrect: a. In team nursing an RN assumes the role of leader of a small group who share the patient care assignment. b. In the primary delivery model, the nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge. c. In the partnership model the RN is paired with an LPN or UAP, and the pair work together consistently to care for an assigned group of patients.

In February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that: a. with universal health, one universal payer, usually the government, pays all expenses for health care. b. single-payer systems offer health care only to eligible persons based on income. c. single-payer systems rely on insurance companies to pay predetermined fees for services. d. with universal health, one payer is responsible for all health care costs, providing health care to all citizens.

ANS: D Correct: Universal health has one payer (usually the government) and provides health care for all citizens. Incorrect: a. Universal health can have multiple payers. b. Coverage is not based on income; rather, all citizens are eligible. c. Insurance companies do not pay costs; rather one payer (usually the government) is financially responsible.

The largest single payer of hospital charges in the United States is ___________.

Medicare Medicare is the largest health insurance program; it covers the disabled, persons with end-stage renal disease, and persons 65 years of age and older who qualify for Social Security. Since enactment of this program in 1965, the population covered by Medicare has doubled.