Chapter 11: The Healthcare Delivery System

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? A. A client who developed sepsis after a ruptured polyp B. A middle-aged client who had a knee replacement C. An older adult client who fell at home and required a hip replacement D. A client who had a cholecystectomy

C. An older adult client who fell at home and required a hip replacement Extended care meets the health needs of clients who no longer require acute hospital care but require rehabilitation and skilled nursing care, such as an older adult following a hip replacement surgery, who may need additional assistance with mobility and more time for physical therapy before being ready to be discharged home. The other clients do not require, or would not benefit from, extended care.

A client is approaching 65 years of age and says, "I will be glad when I am eligible for Medicare so I won't have to worry about insurance anymore." How should the nurse respond to this statement? Select all that apply. A. "The federal government pays for Part A of Medicare." B. "You may want to pay for a Medicare supplement." C. "Part A of Medicare pays for your doctor visits, but not hospital charges." D. "Medicaid is the government insurance for older adults." E. "You don't have to carry Part B of Medicare unless you want to."

A, B, E. Part A of Medicare is paid for by the federal government and covers most inpatient hospital costs. Part B is voluntary and is paid by monthly premium. Many people carry a Medicare supplement to cover the portion of costs not covered by Medicare. Medicare is the major insurance for older adults; Medicaid is assistance for those with low incomes and some other qualifying situations.

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? A. "You will only stay until you are well enough to go home." B. "There are so many activities that I think you will like the nursing home." C. "You may go home if you wish." D. "You are not able to care for yourself anymore and need help."

A. "You will only stay until you are well enough to go home." Those entering convalescent centers remain only until they have recovered. The nurse should explain this even though the client does have the right to refuse. There is no indication that the client will not be able to care for oneself again. There is a difference between a convalescent center and a nursing home.

A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine whether the client is a candidate for the new "Hospital at Home" program. Which statement accurately reflects an outcome for this program? A. Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. B. Disease-specific quality standards have been found to be slightly worse than when clients are treated in the hospital. C. Clients in the acute care setting require fewer chemical and physical restraints. D. Clients and their family members have been found to be happier with stays in the hospital in which they have 24/7 access to the healthcare team.

A. Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting Clients who receive care in their own homes, surrounded by familiar family and friends, have been found to recover more quickly than those in inpatient acute care settings. The other statements are not accurate.

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? A. Collaborating with all agencies to provide for the client's home health needs B. Identifying individuals who are at risk of developing diabetes mellitus C. Providing client education related to colostomy care D. Verifying that all documentation is updated prior to surgery

A. Collaborating with all agencies to provide for the client's home health needs As the various components of the ACA are phased in, nurses have begun to play an influential role in the implementation of new health policy. The newest opportunity is collaborating with all agencies to provide for the client's home health needs. Nurses have already been involved in screening individuals for type 2 diabetes mellitus and providing postoperative teaching for ostomy care. Nurses recheck paperwork for consent prior to surgery, but this is not just limited to nurses. Other health care providers also review consent prior to surgery.

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? A. Hospice B. Palliative C. Respite D. Extended

A. Hospice Hospice is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families, and other loved ones, often provided in the client's own home. Because the client is near the end of life, hospice care would be the most appropriate referral. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older adults, to give them some time away from the responsibilities of day-to-day care. This type of care would not be appropriate for this client because the client has been hospitalized and wants to be with family. Extended-care services provide medical and nonmedical care for people with chronic illnesses or disabilities. Extended care occurs outside the home, however, which is not what the client desires. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Palliative care, which may be given in conjunction with medical treatment and in all types of health care settings, is patient- and family-centered care that optimizes the quality of life by anticipating, preventing, and treating suffering. Palliative care alone is not as appropriate as hospice care in this case, given that the client is near the end of life.

Which cost-cutting measure in health care is most likely to facilitate improved client outcomes? A. Improving transitions across settings B. Increased emphasis on capitation and managed care C. Comparative effectiveness analysis D. A prospective payment system, such as diagnosis-related groups (DRGs)

A. Improving transitions across settings Improving transitions across settings is most likely to improve client outcomes because it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve patient outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting.

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. A payment to physician groups willing to take Medicare clients B. A prospective payment plan based on a predetermined fixed cost C. The need to cut health care costs for indigent older adults D. A retrospective payment plan, after the service is rendered

B. A prospective payment plan based on a predetermined fixed cost The nurse must understand that Medicare is a federal insurance program for older adults. It is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare does not pay physician groups and is not for indigent older adults. Retrospective payment plans pay for services after they have been received.

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way? A. Medicare pays only the amount of money preassigned to a treatment for a diagnosis. B. Benefits and reimbursement cannot be changed annually. C. Part A of Medicare is voluntary and is paid for by a monthly premium. D. Part B of Medicare covers most inpatient and outpatient costs.

A. Medicare pays only the amount of money preassigned to a treatment for a diagnosis. The implementation of DRGs by Medicare in 1983 resulted in a system in which health care providers receive a fixed payment for services provided that is predetermined by the medical diagnosis or specific procedure, rather than the actual cost of hospitalization and care. The plan pays only the amount of money preassigned to the treatment for a diagnosis. If the cost for hospitalization is greater than that assigned, the hospital must absorb the additional cost. If the cost is less than that assigned, the hospital makes a profit. Medicare is federally funded, and benefits may change annually according to decisions related to the federal budget. Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal government. Part B, which is voluntary, is paid by a monthly premium and covers most outpatient costs.

What nursing function would be most commonly found in an ambulatory care facility? A. Providing direct client care B. Assessing the home environment C. Educating individuals or groups D. Serving as an administrator or manager

A. Providing direct client care Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

Who provides care in the primary nursing model? A. Registered nurses B. Masters' prepared nurses C. Nursing students D. Nurse assistants

A. Registered nurses In the primary nursing model, one registered nurse (RN), frequently with the assistance of a licensed practical or vocational nurse or nursing assistant, is responsible for providing (either directly or by delegating to others) all care for a group of clients throughout their stay in a hospital unit or department. Nursing students, who are not yet licensed, cannot independently provide care to clients. Nursing assistants assist RNs in providing care to clients, but the RN is responsible for the client's care. An RN need not have a Master's degree to provide care in the primary nursing model.

Medicare part A is: A. an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services. B. a federally funded public assistance program for low-income people. C. a plan for seniors that limits providers to those within the group plan. D. a health insurance program administered locally to cover visits to physicians, medications, and home health.

A. an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services. The nurse must understand that Medicare is a federal insurance program for older people. Medicare part A is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare part A is administered federally, not locally. Medicare part B, not A, covers outpatient physician visits, medications, and home health. Medicare part A does not limit enrollees to certain providers with a group plan. Medicaid, not Medicare, is a federally funded public assistance program for low-income people.

Which six trends in health care reflect the Institute of Medicine's (IOM) focus? A. "The system should be static, reliable, timely, equitable, efficient, and illness focused." B. "The system should be safe, effective, efficient, patient centered, timely, and equitable." C. "The system should be safe, efficient, centralized, wellness promoting, government driven, and patient centered." D. "The system should be flexible, patient centered, bureaucratic, timely, safe, and efficient."

B. "The system should be safe, effective, efficient, patient centered, timely, and equitable." A safe, effective, efficient, patient-centered, timely, and equitable system is what the IOM envisions. A bureaucratic, government-driven, illness-focused system is not advocated by the IOM.

A nurse demonstrates understanding of Healthy People 2030 by supporting which statement? A. Establish a set of nursing skills that focuses on quick resolution to clients' needs. B. A client's health is affected by social, economic, and political factors. C. Clinical care supports wellness in the environment. D. Physical therapy supports client safety at home.

B. A client's health is affected by social, economic, and political factors. People believe "quality of life" to be synonymous with a healthy community. There is growing recognition that to achieve the goals of Healthy People 2030 a model inclusive of multiple health determinants is needed. Clinical care has typically focused on diagnosing and treating symptoms. Understanding health in relation to personal behaviors, social factors, and other determinants provides a holistic context and not a quick resolution of needs. As an example, it is important to know whether an individual has access to a grocery store with fresh fruits and vegetables to comprehend that client's nutritional needs. To affect social, economic, political, and educational health determinants, health initiatives are more effective if they are based in the community and incorporate community collaboration. While physical therapy can be helpful for a client in the home, it does not have a basis for the community emphasis in Health People 2030.

Which is the primary reason extended care facilities have proliferated in recent years? A. Clients seeking increased social activity that is unavailable to them at home B. Clients being discharged from the hospital while their care requirements remain beyond the scope of home care C. Clients not wanting to use home health care D. Increased concerns about chemical dependency in the elder population

B. Clients being discharged from the hospital while their care requirements remain beyond the scope of home care Extended-care facilities have proliferated in recent years for two reasons. First, as many patients are discharged from the hospital earlier in their recovery period, they require care that is beyond the scope of home care. These patients receive transitional, subacute care in an extended-care facility. Second, as the population ages, many older adults will not have caregivers available and would be unable to carry out activities of daily living independently.

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? A. Educator B. Coordinator of care C. Counselor D. Care provider

B. Coordinator of care The most important role of the nurse in preventing fragmentation of care would be coordinator of care. Care coordination is the deliberate organization of client care activities between two or more participants (including the client) involved in a client's care to facilitate the appropriate delivery of health care services. The roles of care provider, counselor, and educator are all important roles, but the priority role is as the coordinator of care.

The growth in home health care is largely attributed to which factor? A. The nursing shortage in hospitals B. Early discharge of clients from the hospital setting C. The inability of hospitals to care for an increasing number of clients D. Nurses' desire to work in the community

B. Early discharge of clients from the hospital setting Home health care is one of the most rapidly growing areas of the health care system. The prospective payment system of reimbursement encourages early discharge from the hospital and has created a new, acutely ill population that needs skilled nursing care at home. Though some nurses may desire to work in the community and hospitals may have a shortage of nurses, these are not the primary factor related to the increase in home health care. It is not that hospitals cannot care for an increasing number of clients so much as it is that they will not be reimbursed by payers for costs associated with longer client stays; thus, they are motivated to discharge clients earlier even though clients are often not yet ready to provide all of their own needed care, leading to the need for and prevalence of home health care.

Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery? A. Hospitals B. Primary care centers C. Ambulatory care centers D. Day care centers

B. Hospitals Hospitals are the most appropriate acute care setting for people who are too ill to care for themselves at home, are severely injured, require surgery or complicated treatments, or are having babies. An ambulatory care center, which may be referred to as an outpatient care center, is a medical care facility that provides outpatient services. These include diagnosis, treatment, consultation, and intervention services. Day care centers have a variety of purposes: some care for healthy infants and children whose parents work; some care for children with minor illnesses; some provide a place for older adults to socialize and to receive care while family members work; some provide health-related services and care to people who do not need to be in a health care institution but cannot be at home alone. Primary care is the day-to-day health care given by a health care provider and can be provided in an outpatient facility.

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge? A. American Nurses Association Bylaws B. Affordable Care Act C. Americans with Disabilities Act D. National Commission for Minorities

B. Improving transitions across settings is most likely to improve client outcomes because it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve patient outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting.

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? A. Physical therapist B. Respiratory therapist C. Occupational therapist D. Physician

B. Respiratory therapist A respiratory therapist is an expert in lung function and oxygenation whose expertise is needed in the care of this client. Because the client is not experiencing severe distress or respiratory arrest, the nurse is justified in foregoing contact with the physician in the short term. A physical therapist or occupational therapist is not likely able to provide needed interventions at this time.

During a home care visit to a home-bound older client, the client's spouse, who is the caregiver, verbalizes anger, fatigue, and sleeplessness. Which recommendations by the nurse would be most effective in relieving caregiver role strain? A. Palliative care B. Respite care C. Hospice care D. Voluntary services

B. Respite care Hospice, voluntary services, and palliative care would all be helpful to the client and spouse, but only respite care directly provides the spouse with a break from caregiving duties.

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

C. A 66-year-old client with diabetes Medicare is a federal health care plan for individuals over the age of 65. An individual with a disability might be referred to Medicare, but other federal organizations must be involved for this to occur. A low-income family with infants needing immunizations would be referred to Medicaid. The client with cancer in this question is not noted to be over age 65.

Which statement is most accurate in comparing nursing care provided in the acute care setting and that provided in the home care setting? A. The home care setting can only be initiated when the client returns to full function. B. Both care settings require the participation of the client's family. C. Both settings focus on the holistic care of an individual. D. The acute care setting, unlike the home care setting, focuses on the client's needs.

C. Both settings focus on the holistic care of an individual. Although the setting for care and the type of intervention may change, the nursing focus is always the same: the holistic care of an individual. Wherever the nurse practices, the primary concern is to provide for health care that focuses not only on physiologic needs but also psychosocial and spiritual needs of the person in relation to the environment. Both care settings require the participation of the client, but only the home care setting requires the participation of the client's family. The home care setting can be initiated before the client returns to full function. Both settings focus on the client's needs.

The goals of health care reform include which? A. Controlling health care costs by providing limited services for more consumers of health care B. Improving quality of care while limiting access for the uninsured to control rising costs C. Focusing on cost containment with improved access and quality of services for everyone D. Decreasing health care services to provide all citizens with some access to care but control escalating costs

C. Focusing on cost containment with improved access and quality of services for everyone The goals of health care reform focus on cost containment, improved access, and increased quality of services for all citizens. Health care reform seeks to increase, rather than decrease, the number and quality of services provided.

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

C. Inability to provide self-care Long-term care facilities exist to provide care for individuals who are mentally or physically unable to care for themselves independently. These individuals are frequently older, have multiple health problems, and lack family caregivers, but these factors in and of themselves are not criteria for admission to long-term care.

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

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

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? A. "This innovative cost-cutting approach has led to a decrease in hospital admission rates." B. "This reimbursement method focuses on preventing illness through screening and health promotion." C. "DRGs are an inefficient way for the government to manage a client's hospital recovery." D. "DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay."

D. "DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." The DRG system has been largely responsible for marked decreases in hospital lengths of stay. 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. Decreasing hospital admission rates has not been shown to reduce the costs of health care. Health maintenance organizations (HMOs) focus on preventing illness through screening and health promotion.

Which is the most accurate description of "aging in place"? A. Clients are required to move to an apartment or some similar living space while they are still able to care for themselves. B. Clients must remain in their own homes to be eligible for aging in place. C. Clients have access to the healthcare community associated with aging in place up until the time they need to be hospitalized. D. Aging in place communities are a form of extended care in which community members meet each other's needs.

D. Aging in place communities are a form of extended care in which community members meet each other's needs. Clients who elect to participate in aging in place communities can stay in their own homes or move to apartments or similar places. Participation in aging in place communities does not end with hospitalization. Aging in place communities are a version of extended care in which participants help meet each other's needs.

Which scenario is using a prospective payment plan to reimburse for services? A. A client with chronic heart failure is offered health care teaching and preventative services for free. B. A child is hospitalized and treated for a fractured femur. The hospital receives a preset fee for each member regardless of whether the member required services. C. A client is hospitalized for an emergency appendectomy. Since the hospital is a preferred provider the fee for service was discounted. D. An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price.

D. An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. A prospective payment system uses financial incentives to decrease total healthcare charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group (DRG). Therefore, the scenario in which the hospital is reimbursed is an example of a prospective payment plan. The other scenarios demonstrate other types of payment plans.

Which is the main focus of care for a school nurse? A. Palliative care B. Rehabilitative care C. Ambulatory care D. Community care

D. Community care A nurse employed as a school nurse is considered to be working in community-based care. School nurses provide many different services, including maintaining immunization records, providing emergency care for physical and mental disorders, administering prescribed medications, conducting routine health screenings (e.g., vision, hearing, scoliosis), and providing health information and education. Ambulatory care centers and clinics deliver outpatient, walk-in medical care and may be located in hospitals or may be freestanding services provided by a group of health care providers who work together. Inpatient facilities are those in which clients may be admitted and stay overnight for an indeterminate time, such as a hospital. Rehabilitation centers specialize in services for clients requiring physical or emotional rehabilitation and for treatment of chemical dependency. The goal is to return clients to optimal health and to the community as independent members of society.

A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed? A. Have the social worker counsel him. B. Refer him to the dietitian. C. Suggest he go to an assisted living facility. D. Enroll the client in Meals on Wheels.

D. Enroll the client in Meals on Wheels. The best option that can be arranged quickly is to enroll the client in Meals on Wheels, a voluntary agency. The other responses may be helpful in later planning for a long-term situation.

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? A. Parish nursing services B. Palliative care C. Hospice care D. Respite care

D. Respite care Respite care is a type of care provided for caregivers of homebound ill, disabled, or older clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Although parish nursing and palliative care may be helpful in providing the spouse with support, it would not necessarily provide the respite needed. Parish nursing emphasizes holistic health care, health promotion, and disease-prevention activities and combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Palliative care, which may be given in conjunction with medical treatment and in all types of health care settings, is client- and family-centered. Hospice care is typically provided to clients with less than 6 months to live. There is no indication that the client is at this stage.

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? A. Discuss transfer to a rehabilitation facility with the social worker. B. Discuss oxygen administration with the respiratory therapist. C. Talk with the occupational therapist about providing assistance with activities of daily living. D. Speak with the physical therapist about exercises to strengthen muscles.

D. Speak with the physical therapist about exercises to strengthen muscles. The nurse should discuss the goal of regaining mobility with a physical therapist. A physical therapist assists with restoring mobility, strengthens muscle groups, and teaches ambulation with new devices. Respiratory therapists are trained in techniques that improve pulmonary function and oxygenation. Occupational therapists evaluate functional level and teach activities to promote self-care in activities of daily living. Speech therapists deal with swallowing difficulties and help clients speak more clearly.

Which statement most accurately reflects the intent of secondary care? A. Advanced practice nurses and specialist physicians treat rare and complex disease states. B. Nurse midwives provide outpatient care. C. Primary care physicians and nurse practitioners care for clients with common health problems. D. Specialists provide psychiatric care, same-day surgery, and general hospital care.

D. Specialists provide psychiatric care, same-day surgery, and general hospital care. Secondary care involves some specialists who provide care, such as psychiatric care and same-day surgery, generally in the hospital setting. Common health problems are generally consigned to primary care in an outpatient setting. Complex, rare disease states are cared for in tertiary care centers.

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

D. The nurse is the guest in the client's home. An essential difference in home care versus acute care is that the home care nurse is a "guest" in the client's home. In the home, clients and families retain the power and control that they give to providers in other settings. Nurses in the home usually work as members of a therapeutic team that includes the client and other members of the health care team working collaboratively. The client does not direct the education of the caregivers.

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? A. Physician assistant B. Physical therapist C. Speech pathologist/therapist D. Occupational therapist

Speech pathologist/therapist It is within the speech pathologist's/therapist's scope of practice to conduct a swallow evaluation for a client but outside the scope of the occupational therapist, the physical therapist, and the physician assistant.