Ch.8 Healthcare Delivery Systems PrepU

When the patient's primary care physician does not have hospital privileges, there is a service to provide the patient's care and communicate to the patient's physician. This service is provided by physicians called:

hospitalists.

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

A prospective payment plan based on a predetermined fixed cost.

After many years of advanced practice nursing, a nurse has recently enrolled in a nurse practitioner program. This nurse has been attracted to the program by the potential to provide primary care for clients after graduation, an opportunity that is most likely to exist in which of the following settings?

A rural health center

The quality of nursing care is a major factor in reaching patient outcomes. Medicare has published a list of preventable errors for which hospitals will no longer be reimbursed. Which scenario describes an in-hospital situation for which the care is not reimbursed?

A cancer patient receiving multiple and repeated IV injections of medications who develops signs of infection from the central venous line.

Which of the following clients is the most appropriate candidate for receiving outpatient care?

A client whose complaints of irregular bowel movements have necessitated a colonoscopy

Which of the following clients is the most appropriate candidate for hospice services?

A client with lung cancer and a life expectancy of three to four months

An example of primary healthcare is

A hearing screening in the school setting

Health care is a right for every human being. Which of the following refers to a person's ability to find and to receive care from a health care provider?

Access to health care

Which of the following is an emerging trend in health care delivery?

Active involvement of consumers

Nursing students are reviewing information about the changes in the healthcare industry and the effects on the scope of nursing practice. The students demonstrate understanding of this information when they identify which of the following as having significantly affected the delivery of home healthcare?

Advances in technology

The primary nurse shares with the healthcare team the need for her client, diagnosed with cancer, to go out on pass to attend her daughter's wedding. She is serving in what role as a nurse?

Advocate

Which of the following factors is the primary criterion for eligibility in the federally funded Medicare program?

Age greater than 65

Which therapist is most likely to focus on teaching a client to hold a toothbrush with an adaptive device and brush his teeth?

An occupational therapist

You are the nurse hired to work on a surgical floor at a major metropolitan hospital. The head nurse states you will be working in a primary nursing model. What does this mean?

Care is provided by registered nurses

Nursing practice is based on different models of care, each aiming to enhance the effectiveness of nursing care. In which of the following models of care does the nurse coordinate many resources to maximize the opportunity for people to manage their own healthcare at home?

Case management

A nurse is caring for an elderly client in the home. He concludes that the client needs an x-ray to determine if the client has pneumonia and requires oxygen for shortness of breath. He 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

Which agency focuses on the epidemiology, prevention, control, and treatment of communicable diseases?

Centers for Disease Control and Prevention

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?

Clients move to an independent living apartment or home, then have access to increasing health care services as needed, provided within the health care community where they live.

A nurse is working in a public school as the school nurse. This nurse is considered to be working in which role?

Community health

A nursing student is caring for a client who is experiencing pain. In assessing for pain, the nursing student should use what skill in the provision of care?

Critical thinking

The growth in home health care is largely attributed to which of the following?

Early discharge of clients from the hospital setting

One of the primary advantages to the managed care model is

Economic quality care

A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide?

Education and safety programs in industrial settings.

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

Fragmentation of care

A nurse has an elderly 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?

Enroll the client in Meals on Wheels.

A nurse is caring for clients at an ambulatory care facility. Which of the following is a hallmark of good ambulatory care?

Focus on client education

Nurses have an important role in health care reform. The goals of health care reform include which of the following?

Focus on cost containment with improved access and quality of services for everyone.

A nurse is employed with an emergency medical service. Consulting nurses triage specific calls and prioritize them in order of importance. Which of the following calls should the nurse place on priority?

Head injury

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?

Hospice

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

Hospitals

Which health care setting provides care with activities of daily living for people of any age who are physically or mentally unable to care for themselves independently?

Long-term care facilities Correct

Which of the following factors is the primary criterion for admission to a long-term care facility?

Inability to provide self-care

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

Medicare

Which of the following health care insurance programs is most suitable for a client 68 years of age?

Medicare

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which of the following ways?

Medicare pays only the amount of money preassigned to a treatment for a diagnosis.

A student nurse is anticipating graduation and is aware of the changing nature of healthcare and nursing practice. Which of the following statements most accurately describes an aspect of contemporary nursing practice in the United States?

Most nurses are still employed in hospitals.

A healthcare team consists of members from all disciplines of healthcare. Which of the following healthcare professionals physically assess clients, consult with various team members, design plans of care, and implement interventions?

Nurses

A middle-aged couple is considering enrolling in a long-term care insurance plan. What will this insurance cover?

Nursing home and home care services

A client considers himself affluent and places a high priority on maintaining his freedom to choose which physicians and health care services he utilizes. Which of the following group plans is most likely to meet this client's needs?

Private insurance

A client undergoes a knee replacement surgery and is included in the DRG 209. Which of the following is true about knee replacement surgery under the DRG system?

Replacement and surgeries are reimbursed at the same rate.

The nurse is providing care for a client who has a tracheotomy 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 of the following practitioners?

Respiratory therapist

During a home care visit to a home-bound elderly patient, the husband/caregiver verbalizes anger, fatigue, and sleeplessness. Which of the following recommendations by the nurse will be most effective in relieving caregiver role strain?

Respite Care

During a home care visit to a home-bound elderly patient, the husband/caregiver verbalizes anger, fatigue, and sleeplessness. Which of the following recommendations by the nurse will be most effective in relieving caregiver role strain?

Respite care

The wife of an elderly man with Alzheimer's disease contacts a community health nurse because she is planning to visit her sister in a neighboring state and needs assistance in arranging care for her husband while she is away. Which type of care is the wife seeking?

Respite care

The shift to community health nursing is due in part to which of the following factors?

Rising healthcare costs Correct

What is one of the most significant trends in health care today?

Shift from hospitals to community-based care

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 patients and families. Which of the following is an example of an ethical dilemma? Select all that apply.

Should the uninsured person, who cannot pay for health care, receive the same care and services as someone who works and pays for insurance?

You are the nurse employed in an acute care hospital. The head nurse states that you will be caring for 12 clients with the help of two nurse assistants. This is considered to be what type of nursing care delivery?

Team nursing

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?

The hospice nurse continues to care for the client's family for up to one year.

A client with a terminal illness has been placed in hospice care. Under which of the following circumstances can hospice care be discontinued?

When the client no longer meets the Medicare criteria

It is important for members of the nursing profession to understand and be able to interpret managed care to patients and families. The nurse describes managed care as:

a healthcare system that is aimed at controlling healthcare costs while maintaining quality of care.

You are employed in a large urban hospital. On your unit there is a nurse manager, a charge nurse, a nursing case manager, two team leaders, with nurses (RNs and LPNs) and auxiliary personnel who are assigned to provide care on each team. It is important for the nurse to understand the role of the case manager. The best description of the nursing case manager's role is to:

develop critical pathways to guide care and to reach patient outcomes in a specific time frame.

In 1978, the World Health Organization (WHO) first conceived of the concept of decreasing illness and death by simple local measures with inexpensive solutions to health problems, often combined with social and economic development. This strategy led to the global health focus known as:

primary healthcare.

Home healthcare is a rapidly growing area of the healthcare system. Factors that have influenced the growth of home healthcare include which of the following? Select all that apply.

• Patients have an increased acuity level following earlier hospital discharge. • People are living longer with multiple chronic illnesses. • In-hospital reimbursement is limited by DRGs and allowed services. • Some families do not want their relative institutionalized. • Telehealth and technological support services allow home health agencies to provide complex in-home care.

Nurses work with various members of the health team. The nurse understands that the role of the hospitalist is best described as:

the doctor who admits the patient, assumes the management of the patient's care, and maintains communication with the primary physician while the patient is hospitalized.

Medicare reimburses in-hospital costs based on a set payment for a diagnostic related group (DRG). This means the hospital is reimbursed for a fixed amount based on the diagnosis and projected cost for care. As a result of this system the hospital can make a profit or a loss. Select the responses that describe when a profit for care of the client can be achieved.

• All of the hospitalization charges are less than projected. • The client is discharged before the approved discharge date.

Long-term care is often needed for the elderly client. Select all the services that may be provided to the resident in a long-term care facility.

• Assistance with activities of daily living • Mental disability services • Nonmedical care for chronic illness

The Public Health Service (PHS) is a federal agency of the U.S. Department of Health and Human Services. The professional nurse is aware that the services provided by the PHS include which of the following? Select all that apply.

• Care to migrant workers • Care in federal prisons • Indian Health Services

A nurse is making a visit to a client in the home. As a home health care nurse you may be expected to accomplish which of the following?

• Complete an assessment on each visit. • Provide support to the client and family. • Administer treatments and medications. • Document actions regarding patient, activities, and progress. • Communicate and collaborate with other members of the health team.

The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply.

• Federal regulations for health care reimbursement policies. • Improvement in treatment of illness. • Increased emphasis on preventive care.

The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply.

• Federal regulations for health care reimbursement policies. • Increased emphasis on preventive care. • Improvement in treatment of illness.

Health care costs are increasing as technology and related services increase. Patients interact with many health care providers, such as RNs, LPNs, physicians, physical therapists, medical technologists, radiation technologists, specialists, and others employed in health care. As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care?

• Increased medication errors. • Clients receive more specialized care. • Lack of continuity of care.

Which of the following is a characteristic of primary healthcare? Select all that apply.

• It is essential healthcare based on sound methods and technology. • It is made universally accessible to individuals and families in the community. • It brings healthcare as close as possible to where people live and work.

Health care is constantly changing and becoming more complex. Select the answers that describe clients as health care consumers today. Select all that apply.

• They often have health information obtained from the Internet. • They prefer to control the decisions made about their own health care. • They express concern regarding access to care and the quality of service. • They have helped develop clients' rights and cost-containment measures.

The National Academy of Sciences (2003) has proposed five core competencies necessary for healthcare professionals to meet the needs of the 21st-century healthcare system. Which of the following are among these competencies? Select all that apply.

• Using informatics • Using evidence-based practice • Providing patient-centered care • Working in interdisciplinary teams