Chapter 11: The Healthcare Delivery System

A nurse has been asked to speak to a high school health class about expected trends in health care. Which statement should the nurse include when speaking to this class?

"We can expect that technology is going to continue to change health care delivery."

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

parish nursing

The hospital has developed a clinic specifically to serve people who are uninsured. Which statement(s), made by a nurse asked to transfer to working in the clinic, indicates need for additional teaching?

"Why should I change my schedule to work with a group of clients who have never worked at all." "I am not certain I will like working with people who are so poor." "Aren't most uninsured people illegal aliens?"

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. Which explanation by the charge nurse is most appropriate?

"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost."

A client asks a nurse about the benefit of using diagnosis-related groups (DRGs) as a reimbursement method. Which is the nurse's best response?

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

A nurse says, "We have so many drills and safety checks for everything. It is almost like we are preoccupied with the possibility of failure." How should the charge nurse respond to this statement?

"Highly reliable organizations think about the possibility of failure and what to do to avoid it."

While at a clinic visit, a client asks the nurse, "I'm going to be eligible for Medicare soon. Can you help explain what this involves?" Which information would the nurse likely include in the explanation?

"It's good to have an extra policy to supplement what might not be covered." "Part A pays for inpatient hospital costs; Part B covers most outpatient costs."

Which statement regarding health care reform trends is most accurate?

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

It is recommended that a client go to a convalescent center upon discharge following a minor stroke. The client says, "I don't want to go anywhere, I want to go home." Which information should the nurse offer?

"You will only stay until you are well enough to go home."

A nurse demonstrates understanding of Healthy People 2030 by supporting which statement?

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

An example of primary health care is:

A hearing screening in the school setting

The nurse is providing care to several clients. For which client should the nurse include secondary care in the nursing plan of care?

A middle-aged client who presents with new-onset angina

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?

A prospective payment plan based on a predetermined fixed cost.

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?

Affordable Care Act

Which scenario is using a prospective payment plan to reimburse for services?

An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price.

The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care?

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

Which statement accurately reflects the findings of the 1999 Institute of Medicine report, "To Err Is Human"?

Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors.

Unlicensed assistive personnel (UP) include which workers?

Certified nursing assistants, orderlies, attendants, and technicians

The growth in home health care is largely attributed to which factor?

Early discharge of clients from the hospital setting

A nurse is reading a journal article about paying for health care. The nurse demonstrates understanding of the article by identifying which method as being federally funded?

Children's Health Insurance Program Medicare Veterans Health Administration Medicaid

Which statement regarding spiritual care providers in hospitals is most accurate?

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

Which is the primary reason extended care facilities have proliferated in recent years?

Clients being discharged from the hospital while their care requirements remain beyond the scope of home care

A new nurse is considering getting a job in either an acute care setting or a home care setting. Which statement about these care settings is most accurate?

Clients play a large role in helping themselves in the home care setting.

Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role?

Collaborating with all agencies to provide for the client's home health needs

Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect?

Coordinator of care

A hospital system has adopted the Institute for Healthcare Improvement's "Triple Aim" dimensions and has surveyed nurses for planning ideas. Which strategies will help the hospital comply with this framework?

Create outreach education programs to improve the overall health of the community served. Reduce redundancy in diagnostic tests. Make results of quality studies available to nurses in a timelier manner.

Which is a priority nursing function in a rehabilitation center that specializes in emotional rehabilitation related to chemical dependency?

Encouraging independent self-care

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

Fragmentation of care

A nurse is leaving a primary health care system to practice in a tertiary health care system. Which area of nursing would the nurse most likely be entering in this new job?

Hospice care nursing

A hospital system has adopted the Institute for Healthcare Improvement's "Triple Aim" dimensions and has surveyed nurses for planning ideas. Which strategies will help the hospital comply with this framework?

Make results of quality studies available to nurses in a timelier manner. Create outreach education programs to improve the overall health of the community served. Reduce redundancy in diagnostic tests.

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

Medicare

A nurse is researching health care in rural areas. Based on a 2013 U.S. Subcommittee on Primary Health and Aging, which statement regarding access to primary health care is correct?

One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers.

The state government has decided to decrease funding for the Medicaid program. Which component of care will this most impact?

Political and economic considerations

What nursing function would be most commonly found in an ambulatory care facility?

Providing direct client care

A nurse provides care for clients in a primary care center. What are typical roles of a nurse in this type of facility?

Providing health education Making health assessments Performing technical procedures

Which statement regarding pay for performance is most accurate?

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

Who provides care in the primary nursing model?

Registered nurses

A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be

Respite care

Which are trends in health care in the twenty-first century?

Rising number of outpatient and ambulatory clinics Growing number of retiring baby boomers Increased funding for genetic engineering research

A group of first semester nursing students is preparing for a class presentation on the role of the school nurse. They ask their instructor to look over the content prior to the presentation. Which inclusion will require the students to perform some additional research?

School nurses perform home visits on students.

A client is admitted to the facility after fracturing a hip. The client has undergone surgery to repair the fracture and is receiving services to promote healing of the surgical site and regain mobility. Which discussion should the nurse have with a member of the interdisciplinary team member to promote the goal of regaining mobility?

Speak with the physical therapist about exercises to strengthen muscles.

The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client's swallow evaluation following a cerebral vascular accident?

Speech Pathologist, Therapist

Which statement is true when comparing home care with acute care?

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

The nurse shares with the health care team the need for a client, diagnosed with cancer and receiving chemotherapy, to attend an adult child's wedding. What discussion does the nurse have with the health care team to advocate for the client attending the wedding?

To affirm that the decision is consistent with client goals

A home health care nurse is providing visits for a 65-year-old widower who needs some assistance with performing activities of daily living (ADLs) but is living independently. What option might the nurse recommend that would enable the client to maintain independence for as long as possible?

aging in place

Medicare part A is:

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

Which is the main focus of care for a school nurse?

community care

A nurse is caring for an older adult client in the home. The nurse concludes that the client needs an X-ray to determine whether the client has pneumonia and requires oxygen for shortness of breath. The nurse calls to inform the physician of the client's status and then makes arrangements to carry out the physician's orders. In this scenario, what role does the nurse play?

case manager

One of the primary advantages of the managed care model is;

economic, quality care.

A nurse is caring for a client with end-stage liver failure. Which healthcare agency should the nurse recommend for continuity of care?

extended care

The Nursing Agenda for Health Care Reform (American Nurses Association [ANA]) identifies the recipients of health care. This reform's main focus is on:

health promotion

What type(s) of services are provided in primary health care?

health risk screenings education related to sexually transmitted infections administration of immunizations to children and adults

A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate?

hospice

Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery?

hospitals

The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner?

respiratory therapist

A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate?

respite care

A client has a rare neurological disorder and will require complex management with specialists. Which level of care should the nurse anticipate this client requiring?

tertiary

The nurse is providing care to an older adult client approaching discharge following a surgical procedure to repair a fractured hip. The client requires continued skilled nursing care and physical therapy to improve mobility. When planning care for this client, which prescription should the nurse anticipate?

transfer to an extended care facility