Healthcare Systems and Exemplars
The patient tells the nurse, "I live in a flood zone and have lost my home. I am glad I have flood insurance." Which phase of emergency management has protected the patient from complete financial loss?
Emergency response Preparedness Recovery Correct Mitigation
The nurse is teaching an adolescent patient how to perform a thorough breast self-examination using a realistic model of the breast. Which type of prevention activity is the nurse performing with this patient?
Palliative prevention Correct Secondary prevention Tertiary prevention Primary prevention
The nurse is questioning the clinical nurse specialist (CNS) about the rationale for reverse triage in a disaster. Which statement by the nurse shows an understanding of the CNS's explanation?
"Reverse triage gives priority to the very young and very old." Correct "In reverse triage, the most severely injured patients are treated last." "Emergency personnel use reverse triage on a daily basis." "Triage and reverse triage are interchangeable concepts."
The school nurse prepares for responsibilities during an emergency by participating in quarterly fire drills. Which slogan best captures the nurse's responsibility?
"Scope of practice changes with circumstances." "Fastest triage for physical injuries." Correct "Greatest good for the greatest number." "Most intense help for most severe injuries."
The patient tells the nurse, "My daughter is not able to care for me any longer and I am afraid that I don't have the money to pay for a nursing home." Which response by the nurse provides the patient the essential information to make a decision on health insurance?
"Since you are over 65 years of age, Medicare will pay your nursing home charges." "The Affordable Care Act pays for nursing home care." Correct "Medicaid has a program that you may qualify for that covers nursing home charges." "You can enroll in CHIP because they help families."
The nurse is conducting a drill for a large-scale biological attack. A participant asks the nurse, "Where would the healthcare personnel obtain the vaccines after such a large-scale attack?" Which response by the nurse is appropriate?
"The CDC has the vaccines readily available to be shipped immediately to a disaster site." "The vaccine manufacturers will have the vaccines delivered within 24-36 hours." Correct "A preassembled package with the vaccines will be delivered within 12 hours." "The area hospitals have stockpiles of vaccines in case of a biological attack."
The patient in the prodromal phase of smallpox asks the nurse, "What does prodromal phase mean?" Which response by the nurse is accurate?
"This is the most contagious phase of the disease." Correct "You will have symptoms for a few days, during which you will experience a fever and body aches." "You will be developing a rash and small bumps." "You will most likely experience minimal symptoms."
A patient diagnosed with a tularemia infection asks the nurse, "Where did I get this from?" Which response by the nurse provides the patient with accurate information?
"Tularemia is spread by human contact." Correct "The bacteria are transmitted by animals and insects." "The bacteria are harbored in your intestinal tract." "The infection is a result of an animal bite."
The six principles of the Joint Principles of the Patient-Centered Medical Home include:
-Personal physician. -Physician-directed medical practice. -Whole person orientation. -Coordinated and integrated care. -Quality and safety. -Access to care.
Functional Nursing Advantages
Efficient Economical
Functional Nursing Disadvantages
Fragmentation of care Depersonalization Nursing and patient dissatisfaction
Team nursing Disadvantages
Frequent changes in assignments may result in lack of continuity of care
Steps in accessing healthcare include:
Gaining entry into the healthcare system. Getting access to sites of care where the patient can receive needed services. Finding providers with whom the patient can communicate, develop a trusting relationship, and have individual needs met.
Categories of Educational Competencies Core knowledge areas
Health promotion, risk reduction, and disease prevention Healthcare systems and policies Illness and disease management Information and healthcare technologies Ethics and human diversity
The patient in the prodromal phase of smallpox asks the nurse, "What does prodromal phase mean?" Which response by the nurse is accurate?
You will most likely experience minimal symptoms." "This is the most contagious phase of the disease." Correct "You will have symptoms for a few days, during which you will experience a fever and body aches." "You will be developing a rash and small bumps."
The nurse provides information about Medicare to a 65-year-old patient who is on Medicaid. Which patient statement indicates that further information is needed?
"I know I can use the health department for routine care until my Medicare comes through." "I understand that Medicare will not cover everything." "I have an appointment with a social worker to help me apply for Medicare." Correct "I don't want to pay a premium for Medicare every month."
The nurse is working at a facility that utilizes primary care nursing as the model for delivering nursing care. Which statement by the nurse best demonstrates an understanding of the role of the primary care nurse?
"I will be delegating tasks to others, and they will be responsible for the tasks." "I am responsible for the care of the patients assigned to my team." "I will be providing all the care for my patients and delegate tasks if necessary." Correct "I have 24/7 authority and responsibility for the patients assigned to my group."
The school nurse prepares for responsibilities during an emergency by participating in quarterly fire drills. Which slogan best captures the nurse's responsibility?
"Most intense help for most severe injuries." Correct "Greatest good for the greatest number." "Fastest triage for physical injuries." "Scope of practice changes with circumstances."
The nurse is caring for a patient who has managed care insurance. The patient states, "I am not too sure about this new insurance. I have never had this type of coverage before." Which statement by the nurse provides the patient with an accurate response?
"You will receive patient-focused care with your insurance plan." "The insurance you have allows you to go wherever you want to receive care." Correct "This type of coverage by design promotes receiving high-quality, cost-effective care." "Your new insurance is excellent in decreasing your out-of-pocket expenses."
PPO (preferred provider organizations)
Although a PPO is less restrictive, the direct costs to the patient are higher (for example, higher premiums, copayments, and deductibles).
The nurse is assessing a patient suspected to be in the prodromal phase of smallpox. Which assessment finding should the nurse anticipate?
Correct Fever Urticaria Coughing Diarrhea
Team Nursing Advantages
Decreases fragmentation of care Frees the nurse to attend to more complex patient care tasks
The nurse is assessing a patient suspected to be in the prodromal phase of smallpox. Which assessment finding should the nurse anticipate?
Diarrhea Coughing Urticaria Correct Fever
Stages of Smallpox Incubation period
During the incubation period (from 7-17 days), an infected individual has no symptoms and is not contagious.
The nurses participating on a disaster team are planning on installing a new warning system in the event of a tornado. Which phase of emergency management is the disaster team addressing?
Emergency response Correct Mitigation Recovery Preparedness
The nurse has integrated the six principles of the Joint Principles of the Patient-Centered Medical Home into practice. Which statement defines the goal when providing this type of practice?
Patient-centered care is delivered in the home setting. The cost of the care provided to the patient using this model is moderate. Correct Healthcare is a partnership with the patient and the patient's family. A team of healthcare providers will be available to care for the patient.
A patient who is visually impaired and has Parkinson disease is assigned a nurse to coordinate care from a number of specialists. Which type of framework does this care coordination indicate?
Patient-focused care Team nursing Correct Case management Managed care
Manifestations of the plague include:
Pneumonic plague developing within 1-6 days of exposure. Fever, weakness, and rapidly developing pneumonia with dyspnea, chest pain, cough, and sometimes bloody or watery sputum.
Symptoms of respiratory anthrax include the following:
Initially: sore throat, mild fever, and muscle aches Later: respiratory symptoms (for example, cough, chest discomfort, shortness of breath, tiredness, and achy muscles)
The nurse is caring for a patient who lives 50 miles from the clinic and is often unable to obtain transportation for follow-up care. Which barrier to healthcare is most likely responsible for the patient's noncompliance with follow-up clinic visits?
Lack of healthcare insurance Lack of a usual source of care Perception of need Correct Uneven distribution of services
Methods used by insurance companies to ration healthcare resources include:
Limiting the number of healthcare providers that patients can choose. Denying coverage for services. (For example, services deemed to be experimental or those that are not supported by scientific evidence that prove their efficacy).
The nurse is looking for signs of cutaneous anthrax while assessing a patient who came into contact with a white powder leaking from an envelope. Which early symptoms of anthrax should the nurse look for in this patient?
Nausea and loss of appetite Correct Small sores that become blisters Bloody diarrhea and high fever Sore throat, mild fever, and muscle aches
The nurse is planning to participate in a community dialogue regarding healthcare resource allocation. Which discussion activity would be the most appropriate choice for this nurse?
Networking with healthcare providers Correct Collaborating with legislators Speaking with the hospital administration Talking with cancer survivors
Areas in which healthcare is difficult to obtain include:
Rural. Suburban. Urban.
Which nursing care model for delivery can be the most cost effective?
Primary nursing Positive nursing Correct Functional nursing Team nursing
The nurse caring for a patient who is newly diagnosed with diabetes requests a dietary consult. Which type of care is the nurse implementing?
Primary prevention Correct Tertiary prevention Case management Secondary prevention
Stages of Smallpox Prodromal Phase
Prodromal phase (2-4 days) symptoms include a fever of 101°-104°F, head and body aches, and possibly vomiting. This phase may be contagious.
Stages of Smallpox Pustular rash
Pustular rash (duration of 5 days): Pustular bumps develop (they feel like BBs under the skin), then form a crust and scab over. The scabs fall off, leaving pitted scars. The individual is contagious until all the scabs have fallen off.
Examples of tertiary care include:
Referring a patient with a new urostomy to an RN ostomy management specialist to learn how to care for and improve life with an ostomy. Referring a patient with diabetes to a registered dietitian for education on how diet can affect the complications of diabetes. Referring individuals with severe or chronic pain to a pain specialist to manage pain with an appropriate medication regimen or alternative treatment methods. Referring individuals with mobility issues to physical therapy or rehabilitation services to promote mobility and prevent falls and other mobility-related complications.
During a simulation of a deliberate release of biological agents, the nurse is given a scenario to provide care to a patient who is exposed to inhaled anthrax. Which initial symptom should the nurse anticipate to find during the assessment of a patient who has inhaled anthrax?
Shortness of breath Chest discomfort Correct Mild fever Cough
The nurse is assessing a child who is slurring words and seeing double. The parent states, "I think that my child ate a bad batch of home canned beans yesterday." Which biological pathogen should the nurse suspect in the child?
Smallpox Correct Botulism Tularemia Anthrax
The nurse is looking for signs of cutaneous anthrax while assessing a patient who came into contact with a white powder leaking from an envelope. Which early symptoms of anthrax should the nurse look for in this patient?
Sore throat, mild fever, and muscle aches Bloody diarrhea and high fever Correct Small sores that become blisters Nausea and loss of appetite
The nurse is creating an educational program on bioterrorism and specific biological agents that have been assigned the highest priority by the Centers for Disease Control and Prevention (CDC). Which factor should the nurse give as the rationale for assigning a biological agent the highest priority?
The biological agent cannot be easily transmitted to others. The biological agent has an insignificant impact on public health. Correct The biological agent can cause public panic. The biological agent cannot be eradicated by a vaccine.
Hot zone
The hot zone is the most dangerous zone because it is located immediately adjacent to the site of the disaster.
Categories of Educational Competencies Core competencies
Critical thinking Assessment Technical skills Communication
Categories of Educational Competencies Professional role development
A description of nursing roles during MCEs Identification of the most appropriate or most likely healthcare role for oneself during an MCE
Primary Prevention
Action is taken to prevent disease in generally healthy people and populations. People are provided tools that empower them to improve their own health through positive actions such as smoking cessation and eating well.
Tertiary Prevention
Begins after a condition is treated and stabilized or recognized as incurable. Includes the restoration of function and decrease of complications of an established disease. If restoration to the previous level of function is not possible, care focuses on controlling symptoms and promoting the highest quality of life possible. Rehabilitation and palliative care are included in tertiary prevention.
Secondary Prevention
Detect and then treat identified injuries and diseases early so that they can be cured or their associated symptoms and complications can be prevented or limited.
The recovery phase of emergency management includes:
Reviewing the preparedness plan. Reconstitution of government operations and services. Rebuilding. Reemployment. Repair of essential infrastructure. Reassessing risk factors. Updating the preparedness plan. Conducting ongoing needs assessments. Planning for long-term health concerns related to the emergency.
A patient who is visually impaired and has Parkinson disease is assigned a nurse to coordinate care from a number of specialists. Which type of framework does this care coordination indicate?
Managed care Correct Case management Patient-focused care Team nursing
HMO (health maintenance organizations)
more restrictive than are PPOs and require that a patient select a primary care physician who manages the patient's secondary and tertiary services.
The goal of case management
reach and maintain the individual's optimal level of health, quality of life, and activities of daily living
The nurse is determining a nursing care delivery model for a new intensive care unit (ICU). Which model will provide the safest care for the patients?
Correct Primary care nursing Team nursing Patient-centered care nursing Functional nursing
The nurse is working at a facility that utilizes primary care nursing as the model for delivering nursing care. Which statement by the nurse best demonstrates an understanding of the role of the primary care nurse?
"I will be providing all the care for my patients and delegate tasks if necessary." "I am responsible for the care of the patients assigned to my team." Correct "I have 24/7 authority and responsibility for the patients assigned to my group." "I will be delegating tasks to others, and they will be responsible for the tasks."
The nurse is working at a facility that utilizes primary care nursing as the model for delivering nursing care. Which statement by the nurse best demonstrates an understanding of the role of the primary care nurse?
"I will be providing all the care for my patients and delegate tasks if necessary." Correct "I have 24/7 authority and responsibility for the patients assigned to my group." "I am responsible for the care of the patients assigned to my team." "I will be delegating tasks to others, and they will be responsible for the tasks."
The nurse is preparing to provide the parents of a child that is being seen for a well visit some general education. Which statement by the nurse reflects secondary prevention education?
"It is important that your child get exercise for at least 20 minutes a day." Correct "Your child should be seen by the dentist every 6 months." "You child is due for another immunization in 1 year." "It is important to include fresh fruits and vegetables in your child's diet."
The primary agents identified by the CDC as a potential bioterrorist threat include:
Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses [for example, Ebola and Marburg]) Arenaviruses (for example, Lassa and Machupo).
The nurse has integrated the six principles of the Joint Principles of the Patient-Centered Medical Home into practice. Which statement defines the goal when providing this type of practice?
Correct Healthcare is a partnership with the patient and the patient's family. Patient-centered care is delivered in the home setting. The cost of the care provided to the patient using this model is moderate. A team of healthcare providers will be available to care for the patient.
The emergency response team is performing a drill for a bioterrorism attack with pneumonic plague. Which mechanism should the nurse consider is used for propagating pneumonic plague as a biological weapon?
Correct It is released as a weaponized aerosol. It is dumped in the water supply. It is transmitted through flea bites. It is placed in the food supply.
The nurses participating on a disaster team are planning on installing a new warning system in the event of a tornado. Which phase of emergency management is the disaster team addressing?
Correct Mitigation Recovery Preparedness Emergency response
The nurse is determining a nursing care delivery model for a new intensive care unit (ICU). Which model will provide the safest care for the patients?
Correct Primary care nursing Functional nursing Patient-centered care nursing Team nursing
The school nurse prepares for responsibilities during an emergency by participating in quarterly fire drills. Which slogan best captures the nurse's responsibility?
Correct "Greatest good for the greatest number." "Scope of practice changes with circumstances." "Fastest triage for physical injuries." "Most intense help for most severe injuries."
The nurse is integrating one of the six principles from the Joint Principles of the Patient-Centered Medical Home by extending clinic hours on the weekend. Which one of the six principles is the nurse addressing?
Correct Access to care Coordinated and integrated care Quality and safety Whole person orientation
The nurse is integrating one of the six principles from the Joint Principles of the Patient-Centered Medical Home by extending clinic hours on the weekend. Which one of the six principles is the nurse addressing?
Correct Access to care Coordinated and integrated care Whole person orientation Quality and safety
The nurse is planning to participate in a community dialogue regarding healthcare resource allocation. Which discussion activity would be the most appropriate choice for this nurse?
Correct Collaborating with legislators Speaking with the hospital administration Talking with cancer survivors Networking with healthcare providers
The nurse is implementing reverse triage during a disaster. Which patient should the nurse select to receive priority treatment?
Correct The patient experiencing angina with no previous history of cardiovascular disease The patient on dialysis who has recently refused treatment The patient who utilizes an oxygen generator for chronic obstructive pulmonary disease (COPD) The patient with type 1 diabetes and severe food allergies
The nurse is caring for an older adult patient who takes many medications due to complex healthcare needs. Which statement describes the risk for the patient for prescription drug expenses when hitting the "donut hole" of Medicare?
Correct The patient may be forced to purchase fewer prescription drugs. The patient is given low-cost medications paid for with government funding. The patient is able to get a free year's worth of drugs to use before the next calendar year. The patient can only qualify for generic medications using Medicare payment.
The nurse is determining a nursing care delivery model for a new intensive care unit (ICU). Which model will provide the safest care for the patients?
Team nursing Correct Primary care nursing Patient-centered care nursing Functional nursing
Children with healthcare tend to:
Stay healthier. Do well in school. Receive preventative care. Get treated in a timely manner when ill or injured. Be seen for well-child visits. Receive treatment for reoccurring illnesses. Be more likely to attend school regularly. Focus on schoolwork.
The nurse is planning to participate in a community dialogue regarding healthcare resource allocation. Which discussion activity would be the most appropriate choice for this nurse?
Talking with cancer survivors Networking with healthcare providers Correct Collaborating with legislators Speaking with the hospital administration
The nurse is planning to participate in a community dialogue regarding healthcare resource allocation. Which discussion activity would be the most appropriate choice for this nurse?
Talking with cancer survivors Speaking with the hospital administration Networking with healthcare providers Correct Collaborating with legislators
Cold zone
The cold zone (also referred to as the green zone or support zone) is located outside of the warm zone and is the site where decontaminated victims are triaged and treated.
Stages of Smallpox Early rash phase
The early rash phase is the most contagious period. The rash first appears as spots on the tongue and in the mouth, which then progress into sores that break open, allowing large amounts of the virus to spread into the mouth and throat. The disease is highly contagious during this phase. Within 24 hours, the rash, which begins on the face, spreads down and across the entire body. By the third day of the rash, raised bumps are seen to develop. By the fourth day of the rash, the bumps fill with thick, opaque fluid and have a depression in the center that resembles a belly button—a distinguishing characteristic of smallpox. Fever increases again.
A patient tells the nurse, "I work full-time at a large company but I do not have any health insurance." Which statement best describes the nurse's understanding of why the patient may have no health insurance?
The employer may not offer health insurance due to the employee's job description. Correct The patient may not be able to afford the health insurance the employer offers. The patient may not be able to get insurance due to preexisting conditions. The patient does not understand the importance of caring for health.
The nurse volunteers to participate in the Community Emergency Response Team (CERT) program. Which statement accurately describes the role that the nurse will have when participating in CERT?
The nurse will utilize the experience gained in the emergency department to triage victims. The nurse will take the place of first responder services. Correct The nurse will act as an extension of first responder services. The nurse will be granted permission to use their nursing license in an emergency situation.
The nurse is caring for an older adult patient who takes many medications due to complex healthcare needs. Which statement describes the risk for the patient for prescription drug expenses when hitting the "donut hole" of Medicare?
The patient is able to get a free year's worth of drugs to use before the next calendar year. The patient is given low-cost medications paid for with government funding. The patient can only qualify for generic medications using Medicare payment. Correct The patient may be forced to purchase fewer prescription drugs.
A patient tells the nurse, "I work full-time at a large company but I do not have any health insurance." Which statement best describes the nurse's understanding of why the patient may have no health insurance?
The patient may not be able to get insurance due to preexisting conditions. Correct The patient may not be able to afford the health insurance the employer offers. The employer may not offer health insurance due to the employee's job description. The patient does not understand the importance of caring for health.
The six principles of the Joint Principles of the Patient-Centered Medical Home include:
The six principles of the Joint Principles of the Patient-Centered Medical Home include:
Warm zone
The warm zone (also referred to as the yellow, contamination, or contamination reduction zone) is located at least 300 feet from the outer edge of the hot zone.
The nurse is assessing a patient suspected to be in the prodromal phase of smallpox. Which assessment finding should the nurse anticipate?
Urticaria Diarrhea Correct Fever Coughing
Triage Tag Color Categories for Adults Red: Immediate
Victim can be helped by immediate intervention and transport Requires medical attention within minutes for survival (up to 60) Includes compromises to patient's airway, breathing, and circulati0n
Triage Tag Color Categories for Adults Black: Expectant
Victim unlikely to survive given severity of injuries, level of available care, or both Palliative care and pain relief should be provided
Triage Tag Color Categories for Adults Green: Minor
Victim with relatively minor injuries Status unlikely to deteriorate over days May be able to assist in own care: "walking wounded"
Triage Tag Color Categories for Adults Yellow: Delayed
Victim's transport can be delayed Includes serious and potentially life-threatening injuries but status not expected to deteriorate significantly over several hours
Reviewing the preparedness plan. Reconstitution of government operations and services. Rebuilding. Reemployment. Repair of essential infrastructure. Reassessing risk factors. Updating the preparedness plan. Conducting ongoing needs assessments. Planning for long-term health concerns related to the emergency.
Warm zone Neutral zone Correct Cold zone Hot zone
