Ch 2 Intro Health Care delivery
Which statement made by the nurse is an example of applying the principle of patient-centered care while focusing on alleviating the patient's fear and anxiety? 1 "Let's talk about the concerns that you have about going home." 2 "I'll get the medication prescriptions for you before discharge." 3 "I'll be back in 30 minutes to help you get cleaned up." 4 "I'll make a referral to the home health nurse for you."
1 "Let's talk about the concerns that you have about going home." Interventions that focus on the alleviation of fear and anxiety are related to allowing the patient and family time to express fears and concerns, understand the impact that illness will have on the patient's ability to care for himself or herself, and express worries about their ability to pay for medical care. Identifying staff that can help with payment plans alleviates fear and anxiety.
Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? 1 Client safety 2 Evidence-based practice 3 Client satisfaction 4 Maintenance of competency
1 Client safety Near-miss events are events that could have caused a problem with patient safety had they not been stopped before patient harm occurred. Nurses who investigate ways to prevent near-miss events work on issues surrounding patient safety.
A patient has leukemia and is in the terminal stage. The patient has opted for a service that provides palliative care at home. Which service has the patient selected? 1 Hospice 2 Respite care 3 Assisted living 4 Adult day care
1 Hospice Hospice is a service in which palliative care is provided to terminally ill patients in their homes. Respite care is a service that provides short-term relief to the family and caregivers of ill patients. Assisted living is an example of a service offered in a long-term care setting. Adult day care is a service that provides care to patients in a facility when their caregivers have other commitments.
A patient is diagnosed with pneumonia, and during data collection, the nurse finds that the patient is economically disadvantaged. Which type of health care plan would be beneficial for the patient's treatment? 1 Medicaid 2 Private insurance 3 Long-term care (LTC) insurance 4 Preferred provider organization (PPO)
1 Medicaid Medicaid is a federally funded, state-operated program that provides health insurance to low-income families diagnosed with long-term disabilities such as pneumonia. Therefore, a Medicaid health care plan would be beneficial for the patient's treatment. Private insurance policies are typically expensive, and patients have to meet deductibles before insurance pays. LTC insurance is very expensive, so this health care plan is not suitable. A preferred provider organization (PPO) health care plan limits an enrollee's choices to a list of preferred hospitals, physicians, and providers. It is also expensive and, therefore, not suitable for patients who are economically disadvantaged.
Which policy covers medical expenses for very poor children? 1 Medicaid 2 Medicare 3 Long-term care (LTC) insurance 4 State Children's Health Insurance Program (SCHIP
1 Medicaid Medicaid is a federally funded, state-operated program that provides health insurance to the low-income population. Medicare is a policy for the elderly and disabled. LTC is supplemental insurance for long-term care services. The state children's health insurance policy (SCHIP) is a federally funded, state-operated program to provide health coverage for uninsured children. Children not poor enough to be covered by Medicaid are covered by this policy.
The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which option is an appropriate goal for restorative care? 1 Patient will be able to walk 200 feet without shortness of breath. 2 Wound will heal without signs of infection. 3 Patient will express concerns related to return to home. 4 Patient will identify strategies to improve sleep habits
1 Patient will be able to walk 200 feet without shortness of breath. Restorative interventions focus on returning a patient to his or her previous level of functioning or a new level of function limited by his or her illness or disability. The goal of restorative care is to help individuals regain maximal functional status and enhance quality of life by promoting independence.
Which option below is an example of the nurse participating in primary care activities? 1 Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2 Working with patients in a cardiac rehabilitation program 3 Assessing a patient at an emergent care facility 4 Providing home wound care to a patient
1 Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities keep people healthy through exercise, good nutrition, rest, and the adoption of positive health attitudes.
Which force of magnetism is associated with the component that focuses on structure and processes, and demonstration of positive clinical, workforce, patient, and organizational outcomes? 1 Quality of Care 2 Image of Nursing 3 Management Style 4 Quality Improvement
1 Quality of Care Empirical Quality Results is the component of the Magnet model that focuses on structure and processes, and demonstration of positive clinical, workforce, and patient and organizational outcomes. The force of magnetism associated with this component is Quality of Care. Image of Nursing is the force of magnetism associated with the component Structural Empowerment. Management Style is the force of magnetism associated with the component Transformational Leadership. Quality Improvement is the force of magnetism associated with the component New Knowledge, Innovations, and Improvements.
An elderly patient in a long-term care facility complains of abdominal pain. The patient has been on calcium supplements for the past 3 years. The patient worked as a flight attendant for an airline several years before, and she traveled to Egypt many times in her youth. She also has had liposuction. Which components of this information should the nurse include in the minimum data set (MDS)? Select all that apply. 1 Abdominal pain 2 Vacation to Egypt 3 Calcium supplements 4 History of liposuction 5 Occupation-flight attendant
1 Abdominal pain 3 Calcium supplements 4 History of liposuction 5 Occupation-flight attendant The MDS serves as an information source for nurses to help determine the best intervention for the patient. In this scenario, the patient's physical complaint, medication history, and history of liposuction are relevant for the MDS. The patient's occupation gives an idea of her lifestyle and possible cause of the trouble. The trips to Egypt were taken long ago and are not relevant for the MDS.
Which activities performed by the nurse are focused on the patient-centered care principle of physical comfort? Select all that apply. 1 Asking the patient what a tolerable level of pain is for him or her following surgery 2 Providing a back rub at bedtime 3 Offering the patient a warm washcloth for his or her hands before eating 4 Teaching the patient about the new antihypertensive medication ordered 5 Scheduling the patient's follow-up appointments on discharge 6 Changing the bed linens for a patient who is experiencing diaphoresis
1 Asking the patient what a tolerable level of pain is for him or her following surgery 2 Providing a back rub at bedtime 3 Offering the patient a warm washcloth for his or her hands before eating 6 Changing the bed linens for a patient who is experiencing diaphoresis Interventions for the patient-centered care principle of physical comfort are focused on care that increases the comfort of the patient. Responding to patient's need for pain medications and using nursing interventions that increase comfort are important. Teaching is focused on the principle of continuity and transition; scheduling appointments is an intervention for access to care.
A patient is on Medicare, a national health insurance program of the United States. What care costs are covered by part A of Medicare? Select all that apply. 1 Basic medical care costs 2 Basic surgical care costs 3 Basic outpatient care costs 4 Basic psychiatric care costs 5 Premium prescription drug costs
1 Basic medical care costs 2 Basic surgical care costs 3 Basic outpatient care costs Medicare is a national health insurance program in the United States for people aged 65 and older. Part A of Medicare provides basic protection for medical, surgical, and psychiatric care based on diagnosis-related groups. Part B of Medicare covers outpatient care costs and provides voluntary medical insurance for additional benefits. Part D of Medicare is the voluntary plan that provides improved drug coverage.
A patient is being discharged from the hospital following a surgical procedure. What is the role of the nurse in discharge planning? Select all that apply. 1 Develop a plan for further care. 2 Ensure a smooth transition from the hospital to another health care level. 3 Exclude referrals to other disciplines. 4 Anticipate and identify patient needs. 5 Begin planning immediately once the discharge instruction is given.
1 Develop a plan for further care. 2 Ensure a smooth transition from the hospital to another health care level. 4 Anticipate and identify patient needs. Discharge planning is an important nursing activity that requires critical thinking. When planning a discharge, the nurse develops a plan for further care of the patient ensuring that there is a smooth transition from the hospital to another level of health care such as a nursing home. The nurse anticipates and identifies the patient's needs so that the plan includes the care needed once the patient leaves the hospital setting. Referrals are important in ensuring that all the patient's needs are met. Discharge planning starts as soon as the patient is admitted.
The nurse is explaining to a nursing student about discharge planning. Which objectives are included in the discharge planning? Select all that apply. 1 Encourage the patient to seek medical help if complications arise. 2 Identify appropriate resources to ensure continuity of care. 3 Help the patient learn safe and effective use of medication. 4 Teach the patient self-administration of intravenous fluids. 5 Teach rehabilitation techniques to support adaptation.
1 Encourage the patient to seek medical help if complications arise. 2 Identify appropriate resources to ensure continuity of care. 3 Help the patient learn safe and effective use of medication. 5 Teach rehabilitation techniques to support adaptation. Discharge planning is based on anticipating the patient's needs once he or she leaves the health care establishment. The patient should be encouraged to identify complications and seek timely help. The patient should be referred to appropriate resources to maintain continuity of care. The patient should be taught about safe use of medications. Teaching rehabilitation techniques is important to help the patient adapt to a new lifestyle or resume daily activities. Intravenous fluids should be administered only by a professional. The patient should not be encouraged to self-administer IV fluids.
The nurse is learning about the different health care plans for the benefit of patients. Which provisions does the nurse classify under Managed Care Organization (MCO)? Select all that apply. 1 Health care providers are considered salaried employees. 2 An MCO contracts with a single group practice. 3 An MCO contracts with multiple group practices. 4 An MCO offers a funded program for old people. 5 An MCO limits an enrollee's choice to preferred hospitals.
1 Health care providers are considered salaried employees. 2 An MCO contracts with a single group practice. 3 An MCO contracts with multiple group practices. A Managed Care Organization (MCO) provides comprehensive preventive and treatment services to a specific group of people voluntarily enrolled in the plan. MCOs can have different structural models. Under the staff model, physicians are salaried employees of an MCO. An MCO with a group model contracts with a single group practice. An MCO with a network model may contract with multiple group practices. Medicare is a funded program for people in the United States who are above 65 years of age. In the case of a Preferred Provider Organization (PPO), the enrollee's choice is limited to the list of preferred hospitals.
The nurse understands that the health care system has many challenges. What are the current challenges facing leaders in health care? Select all that apply. 1 Improving access to health care 2 Generating profits 3 Providing high-quality care 4 Reducing the cost of health care 5 Increasing the focus on rehabilitation
1 Improving access to health care 3 Providing high-quality care 4 Reducing the cost of health care The challenges to health care leaders include reducing costs while maintaining high-quality care for patients, and improving access and coverage. Improving access to health care involves increasing the number of health care facilities and changing appropriate health policies to include more people. Reducing health care costs involves many elements from reforming insurance to changing incentives. Generating profits and focusing on rehabilitation are not major challenges for health care leaders.
A patient wishes to know about managed care organizations (MCO) in anticipation of enrolling in one. What does the nurse tell the patient? Select all that apply. 1 In an MCO, the focus is on health maintenance and primary care. 2 In an MCO, all the care is provided by a primary health care practitioner. 3 An MCO provides basic protection for medical, surgical, and psychiatric care costs. 4 Generally, an MCO provides health assistance to low-income people with long-term care disabilities. 5 MCOs provide comprehensive preventive and treatment services to those who are voluntarily enrolled.
1 In an MCO, the focus is on health maintenance and primary care. 2 In an MCO, all the care is provided by a primary health care practitioner. 5 MCOs provide comprehensive preventive and treatment services to those who are voluntarily enrolled. In MCOs, the focus is on health maintenance and primary care. In an MCO, all of the care is provided by a primary health care practitioner, who is a salaried employee of the MCO. MCOs provide comprehensive preventive and treatment services to a group of voluntarily enrolled people. Medicare provides basic protection for medical, surgical, and psychiatric care costs for those who are age 65 and above. Medicaid is health assistance to low-income people, including those with long-term care disabilities.
The nursing department of a 600-bed urban hospital is planning to apply to the American Nurses Credentialing Center for Magnet status. Before applying, the administration decides to examine the quality of the nursing care provided in the hospital. Which data should be collected to assess the quality of nursing care? Select all that apply. 1 Incidence of pressure ulcers 2 Nursing hours per patient per day 3 Number of patients admitted to the hospital per day 4 Average duration from admission to discharge of patients 5 Education and certifications of the nurses working in the hospital
1 Incidence of pressure ulcers 2 Nursing hours per patient per day 5 Education and certifications of the nurses working in the hospital Achievement of Magnet status in a health care establishment requires excellence in nursing practice. This depends on quality patient care, nursing excellence, and innovations in professional practice. Assessment of the quality of nursing is important before an establishment applies for Magnet status. Quality indicators of nursing are the incidence of pressure ulcers, nursing hours per patient per day, and education and certification status of the nurses. The number of patients admitted to the hospital and duration of admission of the patient do not indicate nursing quality.
Which relevant data would be collected when working to assess and improve the quality of health care delivery in a large urban hospital? Select all that apply. 1 Infection rate following surgery 2 Patient readmission rate 3 Time frame for returning to regular activity after discharge 4 The number of health care providers employed by the hospital 5 Average number of patients admitted to the hospital per day
1 Infection rate following surgery 2 Patient readmission rate 3 Time frame for returning to regular activity after discharge The meaning of quality in a health care delivery system is the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (IOM, 2001). To assess the quality of health care delivery, the data on the infection rates following surgery would be collected, which would indicate the sanitation of the hospital and whether proper aseptic methods are used during procedures. The readmission rates and time frame for returning to baseline activity after discharge indicate the effectiveness of health care delivery. The number of health care providers employed and the number of patients admitted to the hospital daily are not indicators of the quality of health care delivery.
What information should the nurse include when providing information about Medicaid to a patient? Select all that apply. 1 It provides health insurance to low-income families. 2 It includes supplemental coverage and long-term care assistance to older adults. 3 The payment for Medicaid is deducted from the individual's account every month. 4 It provides health assistance to low-income people with disabilities who require long-term care. 5 It provides comprehensive preventive and treatment services to a group of volunteers.
1 It provides health insurance to low-income families. 2 It includes supplemental coverage and long-term care assistance to older adults. 4 It provides health assistance to low-income people with disabilities who require long-term care. Medicaid is a state-operated and federally funded program. It provides health insurance to low-income families. It also provides supplemental coverage and long-term care assistance to older adults and health assistance to low-income people with disabilities who require long-term care. It is a federally funded program; the payment is not deducted from the person's account. Managed care organizations (MCOs) provide comprehensive preventive and treatment services to a group of voluntarily enrolled people.
A state nurse's association is evaluating nursing-sensitive outcomes at a nursing unit level of a hospital. What will be considered nursing quality indicators during evaluation? Select all that apply. 1 Number of patient falls 2 Hospital turnover 3 Restraint prevalence 4 Nursing hours per patient 5 Number of patients admitted in the hospital at a given point in time
1 Number of patient falls 3 Restraint prevalence 4 Nursing hours per patient The National Database of Nursing Quality Indicators (NDNQI) was developed by the American Nurses Association. The objective of NDNQI is to improve patient safety and quality care by measuring nursing-sensitive outcomes. The nursing-sensitive outcomes include patient falls, restraint prevalence, and nursing hours per patient. Hospital turnover and number of patients admitted are not included in the database, because these factors are not dependent on nursing-sensitive outcomes.
As part of a quality training program, the nurse prepares a report on patient management. According to the National Database of Nursing Quality Indicators (NDNQI), what indicators of quality nursing should the nurse include in the report? Select all that apply. 1 Patient falls 2 Number of beds available 3 Hospital-acquired infections 4 Patients developing pressure ulcers 5 Number of health care practitioners available
1 Patient falls 3 Hospital-acquired infections 4 Patients developing pressure ulcers The National Database of Nursing Quality Indicators (NDNQI) was developed by the American Nurses Association. It helps measure nursing-related outcomes to improve the standard of care and patient safety. According to NDNQI, the indicators for quality nursing are patient falls, development of hospital-acquired infections, and development of pressure ulcers. Other indicators are nurse turnover, staff mix, registered nurse certification, psychiatric patient assault rate, and restraint prevalence. The number of beds in the hospital and the number of health care practitioners are not indicators of quality nursing.
Managed Care Organizations (MCOs) are important components of the health care system. What are the services provided by MCOs? Select all that apply. 1 Preventive services 2 Treatment services 3 Direct specialist care 4 Tertiary care 5 Coverage of the whole population
1 Preventive services 2 Treatment services Managed care organizations (MCOs) provide comprehensive preventive and treatment services. MCOs do not include direct specialist care; a referral is needed to access specialists. The focus of MCOs is on primary care, not on tertiary care. MCOs do not cover the whole population; they serve groups of voluntarily enrolled people.
The nurse works in a long-term care unit. Which rules of performance should the nurse keep in mind? Select all that apply. 1 Sharing of knowledge 2 Individualization of care 3 Exclusion of the patient from decision-making 4 Transparency with the patient 5 Patient needs are not anticipated but expressed
1 Sharing of knowledge 2 Individualization of care 4 Transparency with the patient The Institute of Medicine (IOM) has identified 10 important rules of performance for a health care system to follow to better meet patient needs. As per the rules, knowledge is shared with the patient and information flows freely. Patient care is individualized based on needs and values. The patient should be encouraged to actively participate in decision making and take control of his or her own health. Patient needs should be anticipated through planning and met effectively.
A patient is admitted to the hospital for cardiac surgery. The patient is very apprehensive and emotionally overwhelmed. Based on the eight dimensions of patient care, what does the nurse do while providing emotional support to the patient? Select all that apply. 1 Talk to the patient and share the patient's fears and concerns. 2 Explain to the patient and his or her family how to manage care independently. 3 Help the patient understand the impact of the illness on the patient and his or her family. 4 Explain the procedures and tests in a language that the patient can understand. 5 Identify staff that can alleviate the patient's fear about paying for medical care needs.
1 Talk to the patient and share the patient's fears and concerns. 3 Help the patient understand the impact of the illness on the patient and his or her family. 5 Identify staff that can alleviate the patient's fear about paying for medical care needs. According to the eight dimensions of patient care, it is necessary to provide emotional support to the patient. Emotional support includes talking to the patient and sharing the patient's fears and concerns. The nurse should also help the patient understand the impact of the illness onthe patient's and his or her family's life. Many times this fear may be about paying the medical care bills, so the nurse should identify staff that can alleviate the patient's fear about paying for medical care. Explaining to the patient and the family how to manage care independently is included in the informational, communicational, and educational aspects of patient care. Similarly, explaining procedures and tests in a language the patient can understand is a part of the informational, communicational, and educational aspects of patient care.
The nurse administrator in a 600-bed urban hospital is addressing a group of nurses and explaining strategies to improve patient-centered care. Which strategies proposed by the nurse administrator are appropriate? Select all that apply. 1 The nurse should provide thorough information about health care delivery and encourage the patient to participate in the decision-making process. 2 The nurse should administer analgesics whenever a patient complains of pain. 3 The nurse should be able to diminish all fears and concerns of the patient about the health care provided. 4 The nurse should always involve the family members in the decision-making process regarding the patient's care. 5 The patient should be assured that the nursing professional would be around to help.
1 The nurse should provide thorough information about health care delivery and encourage the patient to participate in the decision-making process. 3 The nurse should be able to diminish all fears and concerns of the patient about the health care provided. 5 The patient should be assured that the nursing professional would be around to help. To improve patient-centered care, it is important that the nurse treat the patient with respect and dignity. The patient should be informed about every step of the health care delivery process. Another strategy to improve patient-centered care is to provide emotional support to the patient and relieve his or her anxiety. The nurse should be able to alleviate all doubts or fears related to the patient's condition and the care provided. The nurse should ensure that patient issues are addressed as soon as possible. Whenever a patient complains of pain, it is important that the nurse assess the pain first before administering any medication. Alternative, nonpharmacological pain treatment is preferred over pain-relieving drugs. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family.
The nurse is teaching a group of nursing students about improvements in health care systems through managed care. Which statements are true about managed care? Select all that apply. 1 The provider receives a predetermined capitated payment for each patient. 2 The provider assumes financial risk in addition to providing patient care. 3 The focus of care shifts to individual illness care. 4 The services focus on improving the functional status of individuals. 5 The services focus on reducing patient costs and improving patient satisfaction.
1 The provider receives a predetermined capitated payment for each patient. 2 The provider assumes financial risk in addition to providing patient care. 4 The services focus on improving the functional status of individuals. 5 The services focus on reducing patient costs and improving patient satisfaction.
Which options are characteristics of managed care systems? Select all that apply. 1 The provider receives a predetermined payment for each patient in the program. 2 Payment is based on a set fee for each service provided. 3 The system includes a voluntary prescription drug program for an additional cost. 4 The system tries to reduce costs while keeping patients healthy. 5 The focus of care is on prevention and early intervention.
1 The provider receives a predetermined payment for each patient in the program. 4 The system tries to reduce costs while keeping patients healthy. 5 The focus of care is on prevention and early intervention. Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case, the managed care organization assumes the financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people remain healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.
To control rising health care costs, the federal government created professional standard review organizations (PSRO). What are the functions of PSROs? Select all that apply. 1 To review the quality of hospital care 2 To review the quantity of hospital care required 3 To review admissions 4 To review the cost of hospital care 5 To identify and eliminate overuse of diagnostic and treatment services
1 To review the quality of hospital care 2 To review the quantity of hospital care required 4 To review the cost of hospital care The functions of a professional standard review organization (PSRO) are to review the quality of hospital care provided, the quantity of hospital care required, and the overall cost of hospital care. Reviewing admissions, and identifying and eliminating overuse of diagnostic and treatment services are functions of utilization review (UR) committees.
Which population does Medicaid cover? Select all that apply. 1 Very poor children 2 All pregnant women 3 All children under age 10 4 Low-income individuals with disabilities 5 Low-income pregnant women
1 Very poor children 4 Low-income individuals with disabilities 5 Low-income pregnant women Medicaid is a federally funded program that covers health care for low-income individuals. This program finances care for very poor children, low-income people with disabilities, and low-income pregnant women. Pregnant women and children who do not belong to low-income groups do not benefit from this program.
The nurse is caring for a patient and finds that the patient is uncomfortable in the hospital. Which intervention is most appropriate to ensure the patient's comfort? 1 Leave the patient alone and give him or her time to adjust. 2 Give adequate privacy to the patient. 3 Administer pain medication. 4 Allow visitors throughout the day to keep the patient engaged
2 Give adequate privacy to the patient. In order to make the patient physically comfortable, the nurse must provide adequate privacy for the patient. At the same time, the nurse must regularly check on the patient and should be easily accessible to the patient. The nurse should not leave the patient completely alone, because it may make the patient feel isolated. Pain medications should be given only when necessary. The patient should have access to his family, but visitation should be controlled.
The nurse works in a primary health care center. For which service might the nurse be responsible in this health care setup? 1 Respite care 2 Health screening 3 Mental health counseling 4 Environmental surveillance
2 Health screening The primary health care center offers services such as health screening, routine physical examinations, diagnostic studies, and management of medical conditions. Respite care, mental health counseling, and environmental surveillance are not provided by primary health care centers. Respite care is provided by certain community agencies. Mental health counseling is provided by mental health care centers. Environmental surveillance is a part of community health in general.
A patient is shifted to a tertiary care center for further management. Which service is a part of tertiary care? 1 Home care 2 Subacute care 3 Mental health counseling 4 Spinal cord injury programs
2 Subacute care Secondary and tertiary care are mainly concerned with diagnosis and treatment of various medical conditions. Subacute care is an example of a tertiary service. Home care is an example of restorative care, which is provided to help a patient regain maximum functional status. Mental health counseling is an example of preventive care, which helps prevent the onset or progression of a disease. A spinal cord injury program is an example of restorative care.
Which option is an example of the principle of patient-centered care that is focused on continuity and transition? 1 The nurse asks the patient which family member should have access to patient information. 2 The nurse teaches the patient how to change the wound dressing at home. 3 The nurse responds promptly to the patient's request for pain medication. 4 The nurse schedules the patient's diagnostic scan following the physical therapy session.
2 The nurse teaches the patient how to change the wound dressing at home. Nursing interventions focused on transition and continuity provide patients with information about medications to take, dietary or treatment plans to follow, and which danger signals to look for after hospitalization or treatment. These interventions also provide patients and families with health care resources after discharge.
While evaluating a student nurse's performance, the head nurse finds that the student nurse has identified errors and hazards in care and has designed and tested interventions. What does the head nurse infer from this evaluation? 1 The student nurse is using evidence-based practice. 2 The student nurse is applying quality improvement. 3 The student nurse is providing patient-centered care. 4 The student nurse is working in an interdisciplinary team.
2 The student nurse is applying quality improvement. Identifying errors and hazards in care, and designing and testing interventions to change processes means that the student nurse is applying quality improvement in practice. If the student nurse integrates the best research with clinical practice and patient values, it indicates the use of an evidence-based practice. If the student nurse coordinates continuous care, communicates effectively, and educates patients, the nurse is providing patient-centered care. If the student nurse integrates care and ensures continuous and reliable care, he or she is working in an interdisciplinary team.
A patient tells the nurse about receiving green card status in the United States and wishes to learn about the health care system in the country. The nurse is educating this patient about the types of health care services available in the United States. The nurse says that the health care services are divided into categories. What are some examples of primary health care centers? Select all that apply. 1 Immunization centers 2 Family planning centers 3 Mental health counseling centers 4 Spinal injury rehabilitation centers 5 Prenatal and well-baby care centers
2 Family planning centers 5 Prenatal and well-baby care centers
The nurse works in a nurse-managed clinic. What is the purpose of nurse-managed clinics? Select all that apply. 1 Illness management 2 Health education 3 Diagnosis and treatment 4 Health promotion 5 Support for self-care and caregivers
2 Health education 4 Health promotion 5 Support for self-care and caregivers Nurse-managed clinics are managed by nurses. The nursing services focus on educating patients and promoting healthy practices. Nurse-managed clinics also provide services to assess and manage chronic diseases. They also provide assistance for self-care and support for caregivers. Illness management, diagnosis, and treatment are not performed in these clinics, because these activities require hospital-based care.
The nurse is learning about health care settings and levels of health care services. Which actions should the nurse perform under preventive care? Select all that apply. 1 Intensive care 2 Immunizations 3 Family planning 4 Cancer screening 5 Mental health counseling
2 Immunizations 4 Cancer screening 5 Mental health counseling
The nurse is learning about rehabilitation services that are provided to patients in different settings. Which actions should the nurse perform as a part of rehabilitation services? Select all that apply. 1 Wound care 2 Physical therapy 3 Administration of IV fluids 4 Speech therapy 5 Drug-dependence counseling
2 Physical therapy 4 Speech therapy 5 Drug-dependence counseling
Which options are examples of the principle of patient-centered care that are focused on respect, values, preferences, and expressed needs? Select all that apply. 1 Administering antihypertensive medications to the patient daily 2 Pulling the curtain around the patient's bed before changing the wound dressing on the patient's leg 3 Allowing the patient to ask questions and express his or her concern about surgery 4 Explaining a colonoscopy procedure to the patient 5 Working with the family to bring in ethnic foods that the patient prefers
2 Pulling the curtain around the patient's bed before changing the wound dressing on the patient's leg 3 Allowing the patient to ask questions and express his or her concern about surgery 5 Working with the family to bring in ethnic foods that the patient prefer Patient-centered care that is focused on respect, values, preferences, and expressed needs focuses on treating the patient with dignity and respect. A component is keeping the patient informed and involved in decision making. Consider patient preferences and perspectives when planning care. An environment where the patient is respected focuses on quality of life.
A patient admitted to the hospital wants to know about respite care. What does the nurse explain to this patient about respite care? Select all that apply. 1 Respite care is included in Medicare. 2 Respite care gives the caregiver time to run errands or socialize. 3 Respite care is provided only in the long-term care facility, which resembles the home. 4 Respite care provides the caregiver some time off from providing care to the ill person. 5 Respite care can include overnight care.
2 Respite care gives the caregiver time to run errands or socialize 4 Respite care provides the caregiver some time off from providing care to the ill person. 5 Respite care can include overnight care. Respite care is a program in which the caregiver can get some time off from providing care to the ill person. This provides short-term relief to the caregiver. Respite care can include overnight care, and it can be provided at home, in a day care setting, or in a health care institution. The caregiver can use this time to care for himself or herself, to run errands, or have some social time. Respite care is not included in Medicare.
The nursing staff is developing a quality program for the floor. Which options are nursing-sensitive indicators from the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit? Select all that apply. 1 Number of medication errors committed by registered nurses (RNs) 2 Turnover rate of nurses on the unit 3 Incidence of patient falls 4 Number of certified RNs 5 Number of emergency department admissions per year
2 Turnover rate of nurses on the unit 3 Incidence of patient falls 4 Number of certified RNs Nursing-sensitive outcomes include voluntary nurse turnover, patient falls, and RN education/certification numbers per nursing unit. Number of medication errors and number of emergency department admissions per year are not included on the National Database of Nursing Quality Indicators (NDNQI).
The nurse is explaining Medicare to a patient. Which statement about Medicare is true? 1 All medical expenses are funded by the hospital. 2 All medical expenses are funded by the government. 3 A monthly deduction is taken from the payroll of all working people. 4 The medical expenses are funded by the government and hospital jointly.
3 A monthly deduction is taken from the payroll of all working people Medicare is a federally administered health care funded program. The program is funded by a payroll deduction. In Medicare, medical expenses are not funded by the hospital, the government, or a joint effort of the government and the hospital.
The caregiver of a patient with terminal illness is receiving respite care. Which type of primary and preventive care service offers this kind of care? 1 Physicians' offices 2 Nurse-managed clinics 3 Block and parish nursing 4 Community health centers
3 Block and parish nursing Block and parish nursing is a preventive and primary care service that provides services for respite care, homemaker aides, spiritual health, help with errands, and transportation. Respite care provides short-term relief or time off for people providing home care to an ill, disabled, or frail older adult. Physicians' offices offer services such as routine physical examinations and treatment of acute and chronic illnesses. Nurse-managed clinics help in wellness counseling and acute and chronic care management. Community health centers offer services such as health screenings, disease management, counseling, and physical assessments.
A community health nurse is explaining the levels of health care to a group of patients. Which service is included in primary health care? 1 Intensive care 2 Assisted living 3 Family planning 4 Sports medicine
3 Family planning The aim of primary health care is to improve health outcomes for the entire population. It includes services like health education, proper nutrition, maternal/child health care, family planning, and immunizations. Intensive care is a tertiary service that includes diagnosis and treatment of illness. Assisted living is included under continuing care, which is provided when a person leaves the health care facility and goes home or to a subacute care facility. Sports medicine is a type of restorative care that helps individuals regain functional status.
The nurse is reviewing the reports of four patients scheduled for different programs. According to the chart, which patient requires secondary acute care? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4
3 Patient 3 Secondary acute care is required when a patient receives short-term treatment for an urgent medical condition or during recovery from surgery. The patient with acute problems is usually scheduled for radiological procedures such as an x-ray or CT scan. Therefore, patient 3 requires secondary acute care. Patient 1, scheduled for nutritional counseling, requires primary care, which focuses on improving health outcomes by providing counseling regarding nutrition. Patient 2, scheduled for blood pressure and cancer screening, requires preventive care, which focuses on measures to prevent the progression of hypertension or cancer. Patient 4, scheduled for cardiovascular and pulmonary rehabilitation, requires restorative care, which focuses on helping each patient obtain and maintain the highest level of function.
The nurse is caring for a patient with hypertension. Which nursing intervention indicates that the nurse is providing patient-centered care focused on transition and continuity? 1 Involving the patient's family members in decision making 2 Respecting the patient's cultural values while providing care 3 Teaching the patient about the administration of medications 4 In simple language, explaining the tests and procedures required
3 Teaching the patient about the administration of medications Teaching the patient about medication administration indicates that the nurse is providing patient-centered care focused on transition and continuity. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family. Respecting the cultural values of the patient while providing care indicates patient-centered care focused on physical comfort. Explaining, in simple language, the tests and procedures required indicates patient-centered care focused on information, communication, and education.
Which parameter indicates a high quality of nursing care provided in the care unit? 1 The high number of patient falls 2 The high number of patients developing pressure ulcers 3 The low rate of hospital-acquired infections 4 The low rate of patient admissions
3 The low rate of hospital-acquired infections As per the National Database of Nursing Quality Indicators (NDNQI), there are some parameters on which the quality of care offered by nurses can be judged. Some of these parameters are falls, falls with injury, hospital-acquired infections, pressure ulcers, psychiatric patient assault rate, and restraint prevalence. A low rate of hospital-acquired infections indicates that the quality of nursing care is good. A high number of patient falls and high number of patients developing pressure ulcers indicate subpar nursing care. The low rate of patient admissions is not related to the quality of nursing care being provided.
The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? 1 This health plan is for people who cannot afford their own health insurance. 2 This health plan is operated by the government to provide health care to older adults. 3 This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose. 4 This is a fee-for-service plan in which you can choose any physician or hospital.
3 This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose. Preferred provider organization (PPO) plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance.
A patient tells the nurse that he has just received green card status in the United States and wishes to learn about the health care system in the country. The nurse explains to this patient about the various health care plans available in the United States. Which statements are true for the Medicare plan? Select all that apply. 1 It provides health coverage for children. 2 It reimburses for all home health care services. 3 It is a funded national health insurance program in the United States. 4 It has the minimum waiting period for payment to health care providers. 5 The payment for the plan is deducted on a monthly basis from the patient's social security check.
3 It is a funded national health insurance program in the United States. 5 The payment for the plan is deducted on a monthly basis from the patient's social security check. Medicare is a federally administered program by the Commonwealth Fund or the Centers for Medicare and Medicaid Services (CMS). Medicare is a national health insurance program in the United States that is funded by through payroll deductions. Medicare reimburses for only selected home health services. The payment for this plan is deducted on a monthly basis from the patient's social security check. Medicare provides health coverage for people who are 65 years or older. It has a long waiting period (around 2 years) for payment to health care providers.
The nurse is discussing dimensions of patient-centered care identified by the Picker Institute. What could be said about the Physical Comfort dimension in patient-centered care? Select all that apply. 1 Patients need to know at all times whom to call for help. 2 Patients look to care providers to share their fears and concerns. 3 Patients often need help with completing activities of daily living. 4 Patients expect privacy and to have their cultural values respected. 5 Patients want to be informed and share in decisions about their care.
3 Patients often need help with completing activities of daily living. 4 Patients expect privacy and to have their cultural values respected. The Physical Comfort dimension states that patients often need help with completing activities of daily living and expect privacy and to have their cultural values respected. The Coordination and Integration of Care dimension states that patients need to know at all times whom to call for help. The Emotional Support and Relief of Fear and Anxiety dimension states that patients look to care providers to share their fears and concerns. The Respect for Patients' Values, Preferences, and Expressed Needs dimension states that patients want to be informed and share in decisions about their care.
A patient tells the nurse that she has just received green card status in the United States and does not have much awareness of the health care system in the country. She asks the nurse whether it is best to have minor surgery in an urban hospital or a stand-alone clinic of an individual health care provider. The nurse answers that physicians perform simple surgeries in office surgical suites. It is preferable to go to them for a minor surgery rather than to a large urban hospital. Why does the nurse give this advice to the patient? 1 Nursing quality is better in private in-office surgical suites as compared to urban hospitals. 2 Surgeries done in office surgical suites use better technology than urban hospitals. 3 The cost of surgeries done in office surgical suites is far less than that in urban hospitals. 4 Surgeries done in office surgical suites have better outcomes than those done in urban hospitals.
3 The cost of surgeries done in office surgical suites is far less than that in urban hospitals. Costs for surgeries are high in the United States. Health care providers have opened their own small surgical suites for minor procedures. The cost of surgeries in such establishments is less than in urban hospitals. There are no relevant differences in the nursing quality, use of technology, or patient outcomes between in-office surgical suites and urban hospitals.
What roles do nurses play in providing quality care to all populations? Select all that apply. 1 They partner with political decision makers. 2 They partner with major insurance providers. 3 They practice to the full extent of their education and training. 4 They partner with physicians and other health care providers. 5 They improve data collection for planning and policy making.
3 They practice to the full extent of their education and training. 4 They partner with physicians and other health care providers. 5 They improve data collection for planning and policy making. To have a health care system with quality care for all populations, nurses need to practice to the full extent of their education and training, become full partners with physicians and other health care providers, and improve data collection, which in turn helps workforce planning and policy making. Partnering with political decision makers and major insurance providers is not a nursing role.
Which activity performed by the nurse is related to maintaining competency in nursing practice? 1 Asking another nurse about how to change the settings on a medication pump 2 Regularly attending unit staff meetings 3 Participating as a member of the professional nursing council 4 Earning certification in a specialty area
4 Earning certification in a specialty area Maintaining ongoing competency is the nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.
A patient who works in a coal mine is referred to an occupational health center. Which services are provided to ensure the safety of the patient? 1 It provides coverage to pay the bills of patients who get ill or injured. 2 It provides health promotion services through a school curriculum. 3 It provides services to older patients or those unable to leave their homes. 4 It provides services for health promotion, and accident and illness prevention.
4 It provides services for health promotion, and accident and illness prevention. Occupational care centers provide services for health promotion and accident and illness prevention in the workplace. Health insurance pays a portion of the bills of a patient who gets ill or injured. School health is a program that includes health promotion through the school curriculum. Block and parish nursing provide services to older patients or those unable to leave their homes.
Which statement is true regarding Magnet status recognition for a hospital? 1 Nursing is run by a Magnet manager who makes decisions for the nursing units. 2 Nurses in Magnet hospitals make all of the decisions on the clinical units. 3 Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. 4 Magnet is a special designation for hospitals that achieve excellence in nursing practice.
4 Magnet is a special designation for hospitals that achieve excellence in nursing practice. Through a review process, hospitals that can demonstrate achievement of excellence in nursing practice can achieve Magnet status. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.
The nurse is learning about the effects of globalization of health care on nursing. Which factors should the nurse evaluate while considering globalization and increased worldwide communication? Select all that apply. 1 Well-informed health care consumers 2 Smaller number of health care consumers 3 More negligent health care consumers 4 Preference for accessible health care provider 5 Increasing demand for quality by health care consumers
4 Preference for accessible health care provider 5 Increasing demand for quality by health care consumers As an effect of globalization, consumers read information available on the Internet and are well informed about their medical conditions. With the use of the Internet, health care consumers can easily get information and choose their health care service providers, and so, the most accessible providers are preferred by consumers. With increasing worldwide communication and sharing of health information, health care consumers demand quality and service from health care providers. It is not accurate to say there fewer health care consumers; with increased health awareness, a greater number of informed patients are being seen. With globalization, health care consumers are more knowledgeable and well informed.
When the nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, in which area is the nurse is working? 1 Integrated delivery system 2 Health care patient system 3 Nursing informatics 4 Computerized nursing network
Health care patient system 3 Nursing informatics Nursing informatics is the use of information, data, and technology to communicate, manage knowledge, mitigate errors, and support decision making. It requires knowledge, skills, and attitudes from the nurse to be able to effectively use information and technology. Nursing informatics is focused on the organization, analysis, and dissemination of information.
A patient's caregiver wants to know if there are support services that would give him some time off from caregiving. Which services can the nurse suggest? 1 Hospice 2 Respite care 3 Nursing clinics 4 Assisted living
Respite care is a service that gives time off to the caregivers of patients. This service can be provided at home or in a day care center. Professionals take care of the patient while the caregiver completes his or her chores or handles other responsibilities. Hospice is a service in which terminally ill patients receive palliative care in their homes. Nursing clinics diagnose and treat medical conditions. Assisted living is associated with long-term care facilities where patients live with other individuals in a home-like surrounding.
Which parameters are included in the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol? Select all that apply. 1 Fatigue Correct2 Schizophrenia Incorrect3 Patient age above 40 Correct4 Fracture of femur Correct5 Urinary incontinence
The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol is used to determine the functional ability and overall well-being of a patient in a care facility. It consists of assessments of mood, behavior, activity pattern, and psychosocial well-being. Therefore, schizophrenia, fracture of femur, and presence of urinary incontinence are parameters assessed in an RAI/MDS. The age of the patient and presence of fatigue are not included in the assessment.
