139 Chapter 11 Questions

35. During a home visit to a client, the caregiver tells the nurse, "My spouse has been sick for so long. All this care takes so much out of me. I am physically and emotionally drained." Assessment reveals that the client's status is unchanged from previous visits. Based on the caregiver's statement, the nurse will likely make a referral for which service? A. respite care B. palliative care C. hospice care D. inpatient admission

A Rationale: Based on the client's assessment and the caregiver's statement, the nurse will likely make a referral for respite care. Respite care is a type of care provided for caregivers of clients who are homebound because of illness, are physically disabled, or are older in age. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. 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 care that optimizes the quality of life by anticipating, preventing, and treating suffering. 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. End-of-life care is not suggested by the description of the client in this situation. The client's status is unchanged, so there is no indication that the client needs acute care. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 292

14. A client has a private insurance policy that pays for most health care costs and services. Why is this plan called a third-party payer? A. The insurance company pays all or most of the costs. B. The family of the client is required to pay costs. C. The client gets the bill and pays out-of-pocket costs. D. Medicare and Medicaid will pay most of the costs.

A Rationale: Insurance for health care may be financed through private insurance, in which members pay a monthly premium. These plans are called third-party payers, because the insurance company pays all or most of the cost of care. Medicare is a federal program that provides health coverage if you are 65 and older or have a severe disability, no matter the income. Medicaid is a state and federal program that provides health coverage if a client has a very low income. The family or client will pay the bills if not covered in the private insurance. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 286

2. In which setting is a nurse practitioner most likely to have the opportunity to provide primary care for clients? A. A rural health center B. A long-term care facility C. A university hospital D. A community hospital

A Rationale: Many rural health centers employ few health care providers, and primary care is often provided by a nurse practitioner. A nurse practitioner may provide care in a long-term care facility or a university or community hospital, but in these settings, the nurse practitioner is less likely to be the provider of primary care to clients. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 291

33. A nurse is a member of a committee working to develop programs to address issues facing the uninsured population in the local community. On which group will the committee likely focus their efforts? A. families with low incomes B. non-Hispanic White individuals C. children D. documented immigrants

A Rationale: Most uninsured people have at least one worker in the family. Families with low incomes are more likely to be uninsured. Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic White people. Additionally, undocumented immigrants are ineligible for Medicaid or Marketplace coverage and are likely to be uninsured because they lack access to coverage and are ineligible for financial assistance. Documented immigrants have access to Medicaid or Marketplace coverage, if they qualify financially. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 274

1. Which client is the most appropriate candidate for receiving outpatient care? A. A client whose complaints of irregular bowel movements have necessitated a colonoscopy B. A client who has previously birthed two children and is entering the second stage of labor C. A client who is receiving treatment for sepsis after the blood cultures came back positive D. A client with a history of depression who is currently expressing suicidal ideation

A Rationale: Outpatient services are appropriate for clients who are medically stable but who require diagnostic testing, such as a colonoscopy. Clients in active labor and clients who are actively septic or suicidal require close monitoring and frequent interventions, which can only be safely provided on an inpatient basis. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 288

11. Who provides physicians with the authority to admit and provide care to clients requiring hospitalization? A. The health care institution itself B. Board of Healing Arts C. American Medical Association D. State Board of Nursing

A Rationale: Physicians are granted the authority to admit clients to a health care agency or institution, and to provide care in that setting by the health care agency or institution itself. They are licensed to practice medicine by a state medical board, not a state board of nursing or a board of healing arts. American Medical Association (AMA) is a professional group that publishes research to advance public health and advocates for the interests of registered physician-members. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 275

23. One of the newest concepts in providing long-term care is called "aging in place." What is the best description of this type of care? A. Clients remain in their home of choice and live there independently, with access to health care services as needed, provided within the community. B. Clients move into a nursing home and access more and more services as required in the same facility. C. Clients move into a long-term care facility permanently but may receive acute care at a hospital as needed and then return to the long-term care facility. D. Clients are maintained in their own homes with home health care.

A Rationale: The best description of "aging in place" is when clients remain in their home of choice and live there independently, with access to health care services as needed, provided within the community. It is not associated with clients moving into a nursing home or long-term care facility. Although clients who are aging in place may choose to have home health care as needed, simply having home health care does not constitute aging in place nor is it the only option for health care in this model. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 290

26. The role of the hospitalist is best described as: A. the physician who admits the client, assumes the management of the client's care, and maintains communication with the primary physician while the client is hospitalized. B. the physician who manages the client's care in emergency and intensive care units only. C. the physician who notifies the primary physician that the client has been admitted to the hospital and then transfers care to a referral specialist. D. the specialist who admits the client to the hospital and then returns care to the primary physician for all other referrals and services.

A Rationale: The hospitalist is a physician who admits the client, assumes the management of the client's care, and maintains communication with the primary physician while the client is hospitalized. The hospitalist may work with clients in any unit of the hospital, not just the emergency department or intensive care unit. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 296

34. A nurse is providing home care services to an older adult client who has left-sided paralysis secondary to a recent stroke. The client lives at home with an older adult spouse. The client has difficulty ambulating, bathing and dressing. The client also has underlying chronic obstructive lung disease, for which daily bronchodilator therapy and oxygen is prescribed. The following health care team members are providing care: • Registered nurse • Respiratory therapist • Physical therapist • Occupational therapist • Unlicensed assistive personnel The nurse plans to collaborate with which health care team member to promote the client's self-care in activities of daily living? A. occupational therapist B. respiratory therapist C. physical therapist D. unlicensed assistive personnel

A Rationale: The nurse will collaborate with the occupational therapist who is responsible for evaluating the client's functional level and teaching activities to promote self-care in activities of daily living. The occupational therapist assesses the home for safety and provides adaptive equipment as necessary. A physical therapist seeks to restore function or to prevent further disability in a client after an injury or illness. In this case, the physical therapist will work with the client to promote muscle strengthening and safe ambulation. A respiratory therapist is trained in techniques that improve pulmonary function and oxygenation, including the client's use of bronchodilator therapy and oxygen. The unlicensed assistive personnel helps the nurse provide direct care to client, such as with bathing, feeding and elimination. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 296

20. Which factors have led to shorter hospital stays? Select all that apply. A. Federal regulations for health care reimbursement policies B. Increased emphasis on preventive care C. Improvement in treatment of illness D. Recognition by clients that longer stays result in infections and other problems

A, B, C Rationale: Shorter hospital stays have resulted from improved treatment of disease, increased emphasis on preventive care, and federal regulations and other health care reimbursement policies. Longer hospital stays do not result in infections and other problems. Question format: Multiple Select Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 288

25. A registered nurse is making a visit to a client in the home. What actions should the home health care nurse expect to accomplish? A. Complete an assessment on each visit. B. Provide support to the client and family. C. Administer treatments and medications. D. Document actions regarding client, activities, and progress. E. Prescribe a pain medication to increase the client's comfort.

A, B, C, D Rationale: The home health care nurse may provide all of these activities in the home setting except for prescribing a pain medication, as registered nurses are not permitted to prescribe medications. Question format: Multiple Select Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 291

24. Which statements most accurately describe clients as health care consumers today? Select all that apply. A. Clients often obtain health information from the internet. B. Clients prefer to control decisions about their own health care. C. Clients are not concerned about health care costs as long as they receive good care. D. Clients express concern regarding access to care and the quality of service. E. Clients have helped develop clients' rights and cost containment measures.

A, B, D, E Rationale: Health care consumers are increasingly more knowledgeable about health (e.g., obtaining information from the internet) and prefer to control decisions about their care. They express concern about access to services and the cost and quality of care. They question duplication of services and are actively engaged. They have helped to develop clients' rights and cost containment measures as protections for clients in health care settings. Today clients are surveyed regarding their experiences with physicians and nurses in hospitals and are very concerned about the cost of health care. Question format: Multiple Select Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 297

21. Medicare reimburses in-hospital costs based on a set payment for diagnosis-related groups (DRGs). When can the hospital achieve a profit for the care of the client using DRGs? Select all that apply. A. All of the hospitalization charges are less than projected. B. The client receives incompatible blood that requires a longer hospitalization. C. The client is discharged before the approved discharge date. D. The client reaches recovery outcomes without complication after the projected timetable. E. The client had a surgical procedure and experienced a pressure injury after the surgery.

A, C Rationale: The hospital will make a profit when cost of hospitalization is less than the reimbursement assigned for the severity of illness and projected care costs. If the client is discharged earlier than projected the hospital keeps the total reimbursed. Incompatible blood and pressure injuries are preventable errors, and the hospital will not be reimbursed for such errors. Reaching outcomes after the approved time results in additional cost to the hospital. Question format: Multiple Select Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 287

19. A client is considering transfer into an extended-care facility. What services will be provided in this setting? Select all that apply. A. Assistance with activities of daily living B. Immediate care after a surgical procedure C. Assistance for mental disability D. Nonmedical care for chronic illness E. Day care meals and services

A, C, D Rationale: Acute or immediate postoperative care is a specific need, which is completed at the facility where it was performed. Day care meals and services are separate services and are not provided to residents in a long-term care facility. Long-term care facilities provide assistance with activities of daily living, assistance for mental disability, and nonmedical care for chronic illness. Question format: Multiple Select Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 290

32. A client requires treatment for breast cancer and is referred to an oncologist and a number of different health care providers for chemotherapy and other treatment. The client tells the nurse they are confused by all the different medications and treatments. Which strategy will the nurse employ to prevent confusion? A. Instruct the client to see only one health care provider. B. Coordinate services between various health care providers. C. Have a family member go to all appointments with the client. D. Educate the client about the purpose of each health care provider.

B Rationale: A client with cancer may be cared for by the family physician, an oncologist, and other health care staff. Hospitalized clients not only come in contact with many different health care providers (e.g., registered nurses, licensed practical nurses/licensed vocational nurses, unlicensed assistive personnel, nurse specialists, physical therapists, registered dietitians, and students) but also are frequently seen by other physician specialists who are called in to consult or perform surgery. When clients become confused by the situation, known as fragmentation of care, it can lead to a loss of continuity of care, conflicting plans of care, too much or too little medication, and higher health care costs. The nurse can combat care fragmentation by building partnerships with other health care professionals, coordinating services, and facilitating communication between individuals, families, and communities. Nurses should not instruct a client as to which health care providers to see or suggest the client only see one provider. Having a family member go to appointments with the client may help, but the best option is coordinating services to prevent fragmentation of care. Educating the client about the purpose of each health care provider will not necessarily prevent confusion related to medications and treatments. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 288

30. A nurse and a client are discussing managed care. The nurse explains that the managed care model was designed for which reason? A. Increasing client satisfaction B. Controlling costs while maintaining quality of care C. Providing a distinct area of care D. Providing an all-RN staff

B Rationale: Case management is used in such situations to ensure optimum, high-quality care in the most efficient and economic manner. It is done by controlling costs while maintaining quality of care. Client satisfaction is a direct benefit of case management but not the reason it was developed. Case management does not provide an all-RN staff as some case managers have degrees in other disciplines. Case management does not provide a distinct care area but uses a variety of resources to assist the client with care needs. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 279

3. Which phrase best describes hospitals today? A. Focus on chronic illnesses B. Focus on acute care needs C. Primary care centers D. Voluntary agencies

B Rationale: Hospitals have become acute care providers for people who are too ill to care for themselves at home, who are severely injured, who have an exacerbation of a chronic disease, who require surgery or complicated treatment, or who are having babies. Hospitals rarely focus on treating chronic illnesses, and they are not primary care centers. Hospitals are not classified as voluntary agencies. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 288

12. After a stroke, a client is having difficulty swallowing. The nurse may make a referral to what member of the health care team? A. Physical therapist B. Speech therapist C. Social worker D. Respiratory therapist

B Rationale: In addition to providing services to improve oral communication, a speech therapist may also diagnose and treat swallowing problems in clients who have had a head injury or stroke. A physical therapist assists with musculoskeletal and neurological impairments, a social worker is educated to help clients with economic and social issues, and a respiratory therapist provides treatments to improve breathing. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 296

17. Which health care insurance program is most suitable for a client 68 years of age? A. Medicaid B. Medicare C. Capitation D. AmeriCare

B Rationale: Medicare is a federal program that finances health care costs of persons 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease. The system is funded primarily through withholdings from an employed person's income. Capitation is a reimbursement strategy in managed care organizations. AmeriCare is a type of private insurance. Capitation and AmeriCare are not the preferred providers for the client, considering the client's older age. Medicaid is a federal program that is operated by the states, and each state decides who is eligible and the scope of health services offered. In Medicaid, eligibility may be decided by the state, which is not the case in Medicare. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 287

5. What is one responsibility of nurses who work in physicians' offices? A. Prescribing medications B. Conducting health assessments C. Performing minor surgery D. Making independent home visits

B Rationale: Nurses in physicians' offices make health assessments, perform technical procedures, assist the physician, and provide health education. They do not prescribe medications, perform minor surgery, or make independent home visits. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 296

27. A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide? A. Occupational therapy to school children B. Education and safety programs in industrial settings C. Assessment and motivation services to the unemployed D. Activities to assist clients with activities of daily living in homeless shelters

B Rationale: Occupational health nurses generally work in industrial settings, where they focus on employee safety and health-promotion programs. The other settings do not address health needs in an employment setting. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 291

22. Hospice nurses provide care in a variety of settings, including clients' homes, long-term-care facilities, and hospice residences. After the client dies, what happens next? A. If the client was in a hospice residence, hospice services continue for the family for up to 6 months, otherwise, hospice services end immediately. B. The hospice services continue for family and friends during the bereavement period, up to 1 month after the death. C. The hospice nurse continues to care for the client's family for up to 1 year. D. The hospice nurse assists the family in working through their grief during the period of mourning, for 1 week after the death.

C Rationale: After the death of the client, the hospice nurse continues to care for the client's family during the bereavement period, for up to 1 year, regardless of the setting in which the client had received hospice care. During this time, nurses help the family to work through their loss. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 292

31. The nurse is evaluating charts of clients who are to be discharged to outside care. Which client would the nurse feel is most appropriate for a referral to hospice care? A. A postoperative client with diabetes who requires wound care and monitoring for infection. B. A child diagnosed with Turner syndrome with cardiomyopathy. C. A client with terminal pancreatic cancer and loved ones. D. A frail older adult with Alzheimer disease requiring long-term care and family.

C Rationale: Hospice is a program of palliative and supportive services providing physical, psychological, social, and spiritual care for dying persons (with the expectation of 6 months or less of life), along with their families, and other loved ones. Hospice nurses do not implement care to improve health, focus on children with chronic illnesses, or care for older adults in long-term care. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 292

8. Which is true of long-term care facilities? A. They provide care only to older adult clients. B. They provide housing and care for clients experiencing homelessness. C. They provide care to clients of any age. D. They provide care only for clients with dementia.

C Rationale: Long-term care facilities provide health care and help with the activities of daily living for clients of any age who are physically or mentally unable to care for themselves independently. Long-term care facilities do not provide care only to older adult clients or clients with dementia, although they do care for those populations as well as others. Although a client experiencing homelessness may be a client at the facility, long-term care facilities do not provide housing and care to clients expressly because of their experience of homelessness. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 290

13. Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs? A. Locally supported health care financing, usually by donations B. A public assistance program for low-income individuals C. Predetermined payment for services based on medical diagnoses D. A private insurance plan for subscribers who pay a copayment

C Rationale: Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations, it is not a public assistance program or a private insurance plan. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 287

6. A nurse in a walk-in health care setting provides technical services (e.g., administering medications), determines the priority of care needs, and provides client teaching on all aspects of care. Which term best describes this type of health care setting? A. Hospital B. Physician's office C. Ambulatory center D. Long-term care

C Rationale: Nurses in ambulatory care centers (walk-in clinics) provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. Nurses employed in hospitals have many roles, including manager of other members of the health care team providing client care, administrator, nurse practitioner, clinical nurse specialist, client educator, in-service educator, and researcher. In physician's offices, advanced practice registered nurses (APRNs), nurse practitioners, midwives, or clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for clients who require health maintenance or health promotion activities. Long-term care provides medical and nonmedical care for people with chronic illnesses or disabilities. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 268

18. Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system? A. Acute care B. Primary care C. Hospice D. Rehabilitation

C Rationale: The opportunity to help people maintain their ability to remain at home and deal holistically with their health and family needs at the end of their lives is home health hospice care. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 292

16. What is one way in which nurses can help shape health care reform? A. Do their job and do it well. B. Refuse to participate in organizations. C. Support legislation to improve care. D. Become a member of a support group.

C Rationale: There are many ways in which nurses can help shape health care reform, including supporting legislation to improve care for the clients they care for. Nurses are expected to do their job well. Refusing to participate in organizations and/or becoming a member of a support group will not help shape health care reform. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 281

4. A client is scheduled for hospital outpatient surgery. The client tells the nurse, "I don't know what that word, outpatient, means." How would the nurse respond? A. "It means you will have surgery in the hospital and stay for 2 days." B. "It means the surgeon will come to your home to do the surgery." C. "Why would you ask such a question? Don't worry about it." D. "You will have surgery and go home that same day."

D Rationale: In addition to providing acute care, hospitals have many services for outpatients (those who require health care but do not need to stay in the facility). Clients who have outpatient surgery have the procedure, return to a hospital room for recovery, and then are discharged home on the same day. The surgeon does not come to the client's home to perform the surgery. Telling a client "not to worry about it" is an inappropriate message for a nurse. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 288

29. A nurse is caring for clients at an ambulatory care facility. Which care intervention is least likely to be provided by the nurse in this setting? A. Client education B. Treatment of minor trauma C. Medication administration D. Crisis management

D Rationale: Nurses in ambulatory care centers and clinics provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. The urgent care center is a special type of ambulatory care center that provides walk-in care for illnesses and minor trauma. Crisis management or intervention is typical of mental health centers and not of ambulatory care settings. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 289

7. Which is a key responsibility of a home health nurse? A. Provide all care and services. B. Maintain a clean home environment. C. Advise clients on financial matters. D. Collaborate with other care providers.

D Rationale: Nurses who provide care in the home make assessments, provide physical care, administer medications, educate, and support family members. They also collaborate with other health care providers in providing care and services. Home care nurses do not provide all care and services, maintain a clean home environment, or advise clients on financial matters. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 290

9. A series of classes on the dangers of smoking are being prepared for children between ages 8 and 10. Which professional would be the one to most likely develop the classes? A. Pediatric nurse B. Outside consultant C. Teacher D. School nurse

D Rationale: School nurses provide many different services, including maintaining immunization records, providing emergency care, administering prescribed medications, conducting routine screenings, conducting health assessments, and teaching for health promotion (e.g., the dangers of smoking). Although any of the other choices may provide education, the school nurse would be the most likely to design the course. Pediatric nurses normally provide care in hospitals. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 291

10. An older adult has total care of the spouse, who has debilitative rheumatoid arthritis. The couple voices concern over the pain and stress associated with the condition. What type of care might the nurse suggest to help the couple? A. Primary care B. Respite care C. Bereavement care D. Palliative care

D Rationale: The goal of palliative care is relief from the symptoms, pain, and stress of a serious illness, and to improve the quality of life for both the client and the family. It is not restricted to end of life. The main purpose of respite care is to give the primary caregiver some time away from the responsibilities of day-to-day care. Primary care is found in acute care settings and physicians' offices. Bereavement care is provided to families following the death of a family member. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 292

28. The U.S. system of health care is based on an ability to pay for care, which leaves millions of people uninsured or underinsured, with inadequate access to health care. Nurses are often presented with ethical dilemmas when caring for clients and families. Which scenario is an example of an ethical dilemma? A. All clients are entitled to care, whether they can pay or not, because health care is a right. B. You may have to pay higher insurance premiums to cover the cost of care because you smoke. C. There are free clinics and health programs to serve the poor, they should receive health care there. D. Should the uninsured person, who cannot pay for health care, receive the same care and services as someone who works and pays for insurance?

D Rationale: The question of whether an uninsured person receive the same care and services as an insured person is an ethical dilemma, because it poses a choice between two conflicting ethical principles for which there is no easy answer. The statement that all clients are entitled to care because it is their right is an opinion supported by one ethical principle. The answer that states that the client may have to pay higher insurance premiums because the client smokes is a fact, as some health insurance programs charge more for those who smoke. The answer stating that the poor should only receive health care from free clinics and health programs is just an opinion. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 274

15. Which is a current trend to watch in health care delivery? A. Decreasing diversity B. Lower costs of health care C. Uneducated consumers D. Current nursing shortage

D Rationale: Trends to watch in health care include changing demographics, increasing diversity, technology explosion, globalization of economy and society, educated consumers, increasing complexity of client care, higher costs of health care, effect of health policy and regulation, and the current nursing shortage. Question format: Multiple Choice Chapter 11: The Healthcare Delivery System Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 297