Health Care Systems / Healthcare Organizations

A nurse is working within the managed care delivery model. Which of the following is true regarding managed care? a) All systems reflect the values of efficiency and effectiveness. b) Their values are not reflected in the decision making. c) All plans have the same values underlying the delivery of care. d) There are no conflicts between cost-effectiveness and respectful care.

A. All systems reflect the values of efficiency and effectiveness. All systems in the managed care delivery model reflect the values of efficiency and effectiveness. Different plans may have different values underlying the delivery of care. However, they all reflect the business plan values of efficiency and effectiveness. Their values are reflected in the decision making and the policy development of the organization. Value conflicts between cost-effectiveness and respectful care may be seen.

Which of the following circumstances likely requires the most documentation and communication by the nurse? a) An older adult is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. b) A client is being transferred from one medical unit of the hospital to another to accommodate another client on isolation precautions. c) A client is returning to her assisted-living facility following her colonoscopy earlier that day. d) A client is being discharged home following a laparoscopic appendectomy 2 days earlier.

A. An older adult is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. Transfer from the hospital setting to a long-term care facility is likely to require significant documentation and communication from the nurses facilitating the transfer. This may include copying the chart or summarizing a large amount of relevant data. Transfers within a hospital typically require somewhat less documentation and communication, while discharges home or to an existing facility may not require a formal report of any type.

A client has received numerous different antibiotics and now is experiencing diarrhea. The physician has ordered the following of transmission-based precautions. Which of the following types of precautions would be most appropriate for all personnel to use? a) Contact precautions b) Needlestick precautions c) Airborne precautions d) Droplet precautions

A. Contact precautions Airborne precautions are required for clients with presumed or proven pulmonary tuberculosis (TB), chickenpox, or other airborne pathogens. Contact precautions are used for organisms that are spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile. Droplet precautions are used for organisms, such as influenza or meningococcus, that can be transmitted by close respiratory or mucous membrane contact with respiratory secretions. The most important aspect of reducing the risk of bloodborne infection is avoidance of percutaneous injury. Extreme care is essential when needles, scalpels, and other sharp objects are handled.

During the entry phase of a home visit, the nurse is likely to perform which of the following tasks? a) The nurse establishes nursing diagnoses for the client. b) The nurse obtains directions to the client's home. c) The nurse gathers supplies and equipment needed for the first visit. d) The nurse calls to make initial contact with the client and schedule a visit.

A. The nurse establishes nursing diagnoses for the client. During the entry phase of a home visit, the nurse develops rapport with the client and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. The pre-entry phase includes making initial contact, scheduling a visit, gathering supplies needed for the first visit, and obtaining directions to the client's home.

The nurse is transferring a child who has had open heart surgery from the pediatric intensive care unit (PICU) to the pediatric unit. The child's blood pressure has been fluctuating but stable during the last 2 hours. The nurse from the PCIU should include which of the following information in the report to the nurse on the pediatric unit? Select all that apply. a) Time of the most recent dose of pain medication. b) Potential for blood pressure to drop. c) Drip rate for the intravenous infusion. d) Medications being used. e) Current vital signs.

A. Time of the most recent dose of pain medication. B. Potential for blood pressure to drop. C. Drip rate for the intravenous infusion. D. Medications being used. E. Current vital signs. The report made when nurses are "handing off" a client from one nursing unit to another must include information about the condition of the client, potential for changes in the client's condition, current medications, and care and services received.

In anticipation of discharge, a nurse is teaching the daughter of an elderly woman how to change the dressing on her mother's venous ulcer. Which of the following teaching strategies is most likely to be effective? a) Use a multimedia strategy that combines animation with narration. b) Demonstrate and explain the procedure, and then have the daughter perform it. c) Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions. d) Provide explicit written and verbal instructions, and ask the daughter to explain back to the nurse how she would perform the dressing change.

B. Demonstrate and explain the procedure, and then have the daughter perform it. All steps of a procedure such as a dressing change should be demonstrated, practiced, and provided in writing. The client or caregiver should then perform the procedure or treatment in the presence of the nurse to demonstrate his or her understanding and ability to carry out the procedure. This is more likely to facilitate success than providing a passive multimedia resource, explaining, or providing written instructions alone without reciprocal demonstration.

The nurse is developing a primary disease prevention program for older adults. Which of the following is the most appropriate topic? a) Diet and exercise for people with heart disease. b) Immunizations for influenza. c) Blood glucose screening for diabetes. d) Range-of-motion exercises.

B. Immunizations for influenza. The nurse is developing a program to discuss primary prevention, and receiving immunizations such as influenza, pneumonia, and shingles are necessary to prevent disease. The three levels of prevention are primary, secondary, and tertiary. Primary prevention refers to specific actions taken to optimize the health of the older individual by making the client more resistant to disease or to ensure that the environment will be less harmful. Secondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity. Examples include public education to promote breast self-examination or screening programs for hypertension or diabetes. Tertiary prevention involves treatments aimed to reduce the negative effects of established disease by restoring function and reducing disease-related complications. Examples include administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility, and assisting with passive and active range-of-motion exercises to prevent disability.

A client is to have a below-the-knee amputation. Prior to surgery, the circulating nurse in the operating room should: a) Verify that the surgeon possesses the degree of expertise needed. b) Initiate a time-out. c) Start an intravenous infusion. d) Insert a Foley catheter.

B. Initiate a time-out. The Universal Protocol is used to prevent wrong site, wrong procedure, or wrong person during surgery. Actions included in the Protocol are to conduct a pre-procedure verification process, mark the procedure site, and perform a time out. Exceptions to the Universal Protocol are routine or "minor" procedures, such as venipunctures, peripheral IV line placement, insertion of oral/nasal drainage or feeding tubes, or Foley catheter insertion. Prior to closure, the physician or circulating nurse will initiate a time-out to verbally confirm a review of consent and procedures completed; that all specimens are identified, accounted for, and accurately labeled; and that all foreign bodies have been removed. The Chief of Surgery and Medical Director are the ones who will verify the surgeons' levels of expertise.

A client who just underwent a mastectomy is due to arrive at the post-surgical care unit. Which of the following actions should the nurse prioritize when attempting to establish an effective relationship with the client? a) Address the client's potential learning needs. b) Recognize and address the client's anxiety. c) Explain and answer questions about the Health Insurance Portability and Accountability Act (HIPAA). d) Assess the client's knowledge of her activity limitations.

B. Recognize and address the client's anxiety. An early priority when admitting a client to a unit and establishing a relationship is to recognize and take steps to reduce anxiety. Assessing and addressing learning needs are important goals but should be addressed after the client has been settled on the unit. HIPAA should have been explained to the client earlier in her admission.

A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since eating a minced and pureed breakfast. Auscultation of the chest reveals coarse crackles. Which of the following practitioners should the nurse liaise with to obtain a swallowing assessment? a) Physician. b) Speech therapist. c) Respiratory therapist. d) Physical therapist.

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

The nurse should remind family members who are visiting a client with granulocytopenia to: a) Visit only if they do not have a cold. b) Wash their hands. c) Avoid kissing the client on the lips. d) Leave the children at home.

B. Wash their hands. Washing hands before, during, and after care has a significant effect in reducing infections. It is advisable to avoid introducing a cold or children's germs and to avoid kissing on the lips, but the primary prevention technique is hand washing.

An 18-year-old pregnant woman tells the nurse that she is concerned that she may not be able to take care of herself during her pregnancy. She states that she is not sure what prenatal care is available, or if she should access it. The nurse should recognize that the client: a) may not be fit to take care of a child. b) should be referred to community resources available for pregnant women. c) may not take care of herself. d) needs to take up a second job.

B. should be referred to community resources available for pregnant women. The client needs to know that many freely available resources exist, and the nurse should help her to find such resources. It doesn't necessarily mean that the client has no interest in caring for herself or her child.

A nurse is scheduled to perform an initial home visit to a new client who is beginning home intravenous therapy. As the nurse is getting out of her car and beginning to approach the client's building, a group of men begin following and jeering at her. Which of the following is the nurse's best response to this situation? a) Confront the group of men in an assertive but non-aggressive manner. b) Call out to attract attention from bystanders. c) Leave the area in her car, provided she can get to it safely. d) Perform the home visit and ensure that the group is gone before she leaves.

C. Leave the area in her car, provided she can get to it safely. The nurse's safety is paramount, and the nurse's best response to a perceived threat when performing a home visit is to remove herself from the situation, provided this can be achieved without incurring further risk.

After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond? a) Not provide the information because it's beyond the scope of nursing practice. b) Tell the client that the information should come from the physician who first presented it to him. c) Provide the information requested. d) Encourage the client to withdraw from the trial.

C. Provide the information requested. As part of the multidisciplinary team, the nurse is empowered to assist the client to better understand the process, as long as the nurse has an understanding of the treatment plan. The nurse shouldn't discourage the client from participating in the research study. Providing information to the client about the clinical trial isn't beyond the scope of nursing practice. The information doesn't need to come from the physician who originally presented the material to the client.

A nurse-manager on an oncology unit has been informed that she must determine which nursing care delivery system (NCDS)/nursing care delivery model (NCDM) is best for efficient client care, client satisfaction, and cost reduction. Knowing that two or three registered nurses, four licensed practical nurses, and five nursing assistants are generally on duty on each shift and that the clients can easily be grouped by geographic location and client care needs, the nurse-manager and her staff appropriately decide to implement which NCDS/NCDM? a) Case management b) Functional nursing c) Team nursing d) Primary nursing

C. Team nursing Team nursing is efficient and less costly to implement than primary or case management systems. Because staff members know each other well, they can function effectively as a team. Although functional nursing is the most cost-effective, care is commonly fragmented and clients are less satisfied. Case management and primary nursing require more registered nurses than are available.

Which of the following is a cultural norm of the healthcare system? a) There is a tolerance of tardiness, disorderliness, and disorganization. b) The omnipotence of technology is yet to be recognized. c) There is the use of a systematic approach and problem-solving methodology. d) There is high flexibility in certain procedures attending birth and death.

C. There is the use of a systematic approach and problem-solving methodology. Cultural norms of the healthcare system include the use of a systematic approach and problem-solving methodology; the omnipotence of technology; the dislike of tardiness, disorderliness, and disorganization; and the use of certain procedures attending birth and death.

The wife of a client with end-stage acquired immunodeficiency syndrome (AIDS) is caring for her husband at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about an advance directive. During the next day's visit, the client states that since he and his wife filled out the advance directive form, he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns? a) "Many people first feel that way when they are admitted into hospice. Although the focus of your care has changed from curative to supportive, your physician will still continue directing it." b) "You don't need to feel that way. Your physician is required by law to sign your orders and the hospice nurses will be contacting him with updates on your condition." c) "It's understandable to feel that way. But clients with end-stage AIDS who have advanced directives generally experience a less painful death that those individuals who don't." d) "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so he will be able to provide it if you can't tell him yourself."

D. "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so he will be able to provide it if you can't tell him yourself." Option 1 provides correct information about advance directives. The advance directive outlines the client's treatment wishes should he be unable to communicate his wishes at any time during his illness. The physician continues to provide care for clients admitted to hospice care. Option 2 invalidates the client's fears and doesn't emphasize the physician's role or the client's role in his care plan. Option 3 doesn't address the purpose of the advance directive, and it discusses treatment options that may not have been discussed with the client. Option 4 doesn't provide evidence-based information about advance directives.

Which documentation tool will the nurse use to record the client's vital signs every 4 hours? a) 24-hour fluid balance record. b) Acuity charting forms. c) Medication record. d) A graphic sheet.

D. A graphic sheet. A graphic sheet is a form used to record specific client variables such as pulse, respiratory rate, blood pressure readings, body temperature, weight, fluid intake and output, bowel movements, and other client characteristics. Acuity charting forms allow nurses to rank clients as high to low acuity in relation to their conditions and need for nursing assistance or intervention. Medication records include documentation of all medications administered to the client. The 24-hour fluid balance record form is used to document the intake and output of fluids for a client with special needs.

A nurse enters the room of a client who does not have diabetes shortly after a group of physicians has made rounds. The client asks, "Why did the doctor tell the others that I'm not compliant with my diabetes regimen?" The nurse is aware that which of the following ethical principles has been violated? a) Respect for persons. b) Trust. c) Fidelity. d) Confidentiality.

D. Confidentiality. All nurses should be aware of the confidential nature of information obtained in daily practice. Discussion of clients with other members of the healthcare team is often necessary; these discussions should occur in a private area where it is unlikely that the discussion can be overheard. Respect for persons involves treating others in such a way that enables them to make choices. Trust is an essential element in the nurse-client relationship. Fidelity is promise keeping: the duty to be faithful to one's commitments.

A nurse-manager works for a nonprofit health care corporation whose revenues have significantly exceeded annual expenses. The nurse-manager has been told to anticipate which action? a) Identifying revenue as profit b) Reducing operating expenses to help the organization pay taxes on the revenue c) Dividing revenue among stockholders as dividends d) Receiving a portion of the revenue to improve client services on the unit

D. Receiving a portion of the revenue to improve client services on the unit In a nonprofit organization, revenue exceeding expenses is tax-exempt and is usually reinvested in the organization and used to improve services. A for-profit organization calls revenue in excess of expenses a profit and divides it as a dividend among stockholders or reinvests it in the organization.