PrepU: Chapter 11 - Fundamentals
Correct response: Fragmentation of care Explanation: Fragmentation of care occurs when multiple, specialized practitioners are involved in various aspects of a complex client's care. This creates the potential for miscommunication and conflicting advice and treatment with the lack of a unified plan of care. This situation is not indicative of primary care and it is not necessarily a consequence or manifestation of case management or managed 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 Managed care Case management Primary care
speech therapist
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? Speech therapist Respiratory therapist Physical therapist Physician
Correct response: Aging in place Explanation: The nurse might recommend for this client aging in place. In this type of care, clients remain in their homes or move to a living space, such as an apartment, while they are still physically able to care for themselves, and then have access to services that are a part of the health care community as needed. Someone who is living independently but only needs some assistance with ADLs would not be placed in a long-term care facility or transitional subacute care facility. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated client-centered care.
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 -Medical home -Long-term care facility -Transitional subacute care facility
Correct response: Case manager Explanation: Case management means the nurse coordinates many resources to maximize the opportunity for people to manage their own health care at home. A nurse does not have to be nurse practitioner, clinical nurse specialist, or other type of advanced practitioner to serve as a case manager.
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 Nurse practitioner Clinical nurse specialist Advanced practitioner
Correct response: a hearing screening in the school setting. Explanation: Primary prevention or primary health care involves health promotion, basic care, and health prevention, including screening clients to detect disease early and prevent it from developing further. Care of a client in the intensive care unit or on rehabilitation is secondary care. Diagnostic testing for HIV/AIDS is tertiary care.
An example of primary health care is: -a hearing screening in the school setting. -care of the client in the intensive care unit. -diagnostic testing for HIV/AIDS. -care of the client on rehabilitation.
Correct response: "You will only stay until you are well enough to go home." Explanation: 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.
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 may go home if you wish." -"You are not able to care for yourself anymore and need help." -"There are so many activities that I think you will like the nursing home." -"You will only stay until you are well enough to go home."
Correct response: Coordinator of care Explanation: 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.
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? Care provider Counselor Educator Coordinator of care
Correct response: Transfer to an extended care facility Explanation: The nurse should anticipate that this client will be transferred to an extended care facility, which meets the health needs of clients who no longer require acute hospital care but require rehabilitation and skilled nursing care. This client does not meet the requirements for home health care, hospice care, or an intermediate care facility.
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? -Discharge to home with home health care -Transfer to an extended care facility -Admission to hospice care -Move to an intermediate care facility
Correct response: Providing direct client care Explanation: 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.
What nursing function would be most commonly found in an ambulatory care facility? Serving as an administrator or manager Providing direct client care Educating individuals or groups Assessing the home environment
Correct response: Improving transitions across settings Explanation: 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.
Which cost-cutting measure in health care is most likely to facilitate improved client outcomes? A prospective payment system, such as diagnosis-related groups (DRGs) Comparative effectiveness analysis Improving transitions across settings Increased emphasis on capitation and managed care
Correct response: 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. Explanation: The report states that 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. It is the fragmented, rather than centralized, nature of health care that has contributed to medical errors. The report recommends a national, rather than local or regional, focus on leadership to improve outcomes. Voluntary reporting is encouraged.
Which statement accurately reflects the findings of the 1999 Institute of Medicine report, "To Err Is Human"? a. 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. b. A common source of medical errors and preventable death is the overly centralized nature of health care in the United States. c. The establishment of a local or regional, rather than a national, focus to create leadership in health care will improve outcomes. d. Encouraging health care organizations and practitioners to develop and participate in mandatory reporting systems is desirable.
Correct response: Specialists provide psychiatric care, same-day surgery, and general hospital care. Explanation: 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 most accurately reflects the intent of secondary care? -Primary care physicians and nurse practitioners care for clients with common health problems. -Advanced practice nurses and specialist physicians treat rare and complex disease states. -Specialists provide psychiatric care, same-day surgery, and general hospital care. -Nurse midwives provide outpatient care.
Correct response: "Systems are in place to pay for performance and penalize hospitals for excessive readmissions." Explanation: Health care trends already include paying for performance (HEDIS, HCAHPS) and penalizing hospitals for excess readmissions. In the United States, private insurers dominate over public, unlike in most countries. The United States is first in health care spending worldwide, and it is estimated that 20% of the gross domestic product will be spent on medical services by 2021.
Which statement regarding health care reform trends is most accurate? -"Systems are in place to pay for performance and penalize hospitals for excessive readmissions." -"Distinctive to the United States is the dominance of the public element over the private one." -"The United States is second in the world in total health care dollars spent annually." -"Spending on medical services will rise to almost 3rds 2% of the U.S. gross domestic product by 2021."
Correct response: Quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. Explanation: In pay for performance, quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. Financial incentives are offered to health care providers for achieving certain clinical measures established by the payer, not client objectives. These clinical measures include not only delivery efficiencies, improved quality, and patient safety, but also submission of data to the payer. Pay for performance is not limited to any particular hospital size.
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. -Financial incentives are employed to reward providers for the achievement of a range of client objectives. -Pay for performance includes only demonstrated delivery efficiencies and improved quality and client safety. -Pay for performance is to be instituted primarily in small community hospitals with fewer than 100 beds, as client outcomes are worse there.
