212 exam 2

A community health nurse is evaluating the current health programs in the community. Which outcome indicates a healthy community? 1) Ninety percent of members report adequate access to primary care services. 2) Immunization services are available at hospitals and clinics. 3) Affordable housing in the community is under construction. 4) Mortality rates have been stable over the past 5 years.

1 Evidence of health in a community can be judged by examining progress in the focus areas delineated in Healthy People 2020. Access to primary care services is a measurable outcome that provides evidence of effectiveness of health programs.

Which client would be most likely to complete an advance directive?1. A 55-year-old Caucasian person who is a bank president.2. A 34-year-old Asian licensed practical nurse.3. A 22-year-old Hispanic lawn care worker.4. A 65-year-old African American retired cook.

1. ADs are more frequently completed by white, middle- to upper-class individuals.

what are the three components of access to health care (SATA) a. coverage b. services c. timeliness d. prevention

A B C

You are visiting with the wife of a patient who is having difficulty making the transition to palliative care for her dying husband. What is the most desirable outcome for the couple? A. They express hope for a cure. B. They comply with treatment options. C. They set additional goals for the future. D. They acknowledge the symptoms and prognosis.

D. They acknowledge the symptoms and prognosis.The grief experience for the caregiver of the patient with a chronic illness often begins long before the death. This is called anticipatory grief. Acceptance of the expected loss is associated with more positive outcomes.

Select from the list below the phases used in the Six Sigma process. a. Define b. Measure c. Verify d. Analyze e. Implement f. Control

a b d f

Identify a type of care delivery model that focuses on the whole person and gives the nurse responsibility for all of the client's nursing needs. a. Modular nursing b. Team nursing c. Primary care nursing d. Functional nursing

c

What is the primary purpose of hospice? A. Allow patients to die at home. B. Provide better quality of care than the family can. C. Coordinate care for dying patients and their families. D. Provide comfort and support for dying patients and their families.

d D. Provide comfort and support for dying patients and their families.Hospice provides support and care at the end of life to help patients live as fully and as comfortably as possible. The emphasis is on symptom management, advance care planning, spiritual care, and family support, including bereavement.

Which response should the nurse make when asked about the advantages of home care? 1) "Care is much more comprehensive and unhurried in the home; it is more enjoyable for nurses to work in home care." 2) "Home care is much more organized than hospital care; you have access to the whole team, and there is less interference from others." 3) "A home health nurse has more autonomy and skills than a hospital nurse; I'll get to do more." 4) "In home care I can see my patients in their personal environment; this will help me understand them more and allow me to give personalized care."

d The home is the client's personal environment: a window into the patient's life. The nurse is able to see how the patient lives, interacts, and negotiates the world.

Which group represents a vulnerable population? Select all that apply. 1) Homeless persons with no known illnesses 2) Women who have experienced domestic violence 3) Fifth grade students at the local elementary school 4) Persons with type 1 diabetes mellitus 5) People with multiple sclerosis needing a walker to ambulate

1 2 4 5 vulnerable populations include those with limited economic recourses

An adult daughter who is the primary caregiver for an older client is fatigued, has stopped socializing with friends, and is saddened by the client's condition. Which nursing diagnosis is the most appropriate for this situation? a. caregiver role strain b. impaired home maintenance c. interrupted family processes d. risk for caregiver role strain

1 This caregiver is experiencing fatigue, isolation, and difficulty adjusting to role changes. These are signs of Caregiver Role Strain.

According to William Worden, which task in the grieving process takes longest to achieve? 1) Working through the pain and grief 2) Accepting the reality of the loss 3) Adjusting to the environment without the deceased 4) Investing emotional energy

1 according to worden, working through the pain and grief is usually the longest phase because we attempt to mask pain and caring friends and family attempt to remove the pain

After gathering data about a community, the nurse identifies weaknesses in the community health system that contribute to poor health outcomes. What should be the next step? 1) Prioritize the list of problems. 2) Validate the data. 3) Evaluate the effectiveness of the interventions. 4) Plan the care.

1 after a thorough assessment the nurse compiles a list of community strengths and must prioritize the lsit

The nurse reviews advance directives with a client. Which statement about an advance directive document indicates that teaching has been effective? 1) Specifies healthcare intentions if unable to make self-directed decisions 2) Identifies the activities considered to be evidence of quality care 3) Verifies understanding of the risks and benefits associated with a procedure 4) Allows the autonomy to leave the hospital even if it is against medical advice

1 an advance directive is a group of instructions stating the patients healthcare wishes should he be unable to make decisions

What is the difference between home healthcare and home hospice care? Select all that apply. 1) Home healthcare promotes independence in clients; home hospice care promotes comfort and quality of life. 2) Home healthcare promotes comfort and symptom management; hospice care promotes self-care. 3) Home healthcare is focused on teaching self-care; home hospice care is focused on teaching skilled care to caregivers. 4) Home hospice care is focused on managing symptoms; home healthcare is focused on fostering independence. 5) Home healthcare is focused on providing care to terminally ill clients; hospice care promotes self-care.

1 4

Nurses have the potential to be very influential in shaping healthcare policy. Which of the following factors contributes most to nurses' influence? 1) Nurses are the largest health professional group. 2) Nurses have a long history of serving the public. 3) Nurses have achieved some independence from physicians in recent years. 4) Political involvement has helped refute negative images portrayed in the media.

1) Nurses are the largest health professional group.Rationale:Nurses are trusted professionals and the largest health professional group. As such, they have political power to effect changes. If nursing was a small group, there would be little potential for power in shaping policies, even if all the other answers were true. Serving the public, while positive, does not necessarily help nurses to be influential in establishing health policy. Independence from physicians, although positive, does not necessarily make nurses influential in establishing healthcare policy. Refuting negative media, although a worthwhile activity, does not necessarily make nurses influential in establishing healthcare policy.

For a patient to be eligible for insurance benefits that cover hospice care, a physician must certify which of the criteria as applying to the patient? Select all that apply. 1) Life expectancy is not more than 6 months. 2) Life expectancy is not more than 12 months. 3) Condition is expected to improve slightly. 4) Condition is not expected to improve. 5) An advance directive has been written.

1,4 For a patient to be eligible for hospice care insurance benefits, a physician must certify that the patient is not expected to improve or will most likely die within 6 months.

The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional instruction when the caregiver makes which statement? 1."Palliative care interventions hasten death." 2."Palliative care promotes optimal functioning." 3."Palliative care will provide pain management." 4."Palliative care will provide symptom management."

1."Palliative care interventions hasten death."Rationale:Palliative care interventions do not serve to hasten death; rather, they provide pain and symptom management, attention to issues faced by the child and family with regard to death and dying, and promotion of optimal functioning and quality of life.

Which patient is at most risk for experiencing difficult grieving? 1) The middle-aged woman whose grandmother died of advanced Parkinson's disease 2) The young adult with three small children whose wife died suddenly in an accident 3) The middle-aged person whose spouse suffered a slow, painful death 4) The older adult whose spouse died of complications of chronic renal disease

2 although it is impossible to predict, in general those who suffer a sudden loss typically have more difficult grieving than those who have had the time to prepare for the death

The family notices that a terminally ill client is more focused and coherent and they ask whether the client is really going to die. When should the nurse recognize that a sudden surge of activity is most likely to occur? 1) Moments before death 2) Days to hours before death 3) 1 to 2 weeks before death 4) 1 to 3 months before death

2 days to hours before death patients expierence a surge of energy

A patient with a history of chronic obstructive pulmonary disease has a living will that states he does not want endotracheal intubation and mechanical ventilation as a means of respiratory resuscitation. As the patient's condition deteriorates, the patient asks whether he can change his decision. Which response by the nurse is best? 1) "I'll call your physician right away so he can discuss this with you." 2) "You have the right to change your decision about treatment at any time." 3) "Are you sure you want to change your decision?" 4) "We must follow whatever is written in your living will."

2 the patient has the right to change his decision about ANY tx at any time

A resident in a long-term care facility receiving Medicare funds requires care for a stage 2 pressure ulcer. How often must the nurse document this patient's care? 1) Every 2 weeks 2) Every shift 3) Every week 4) Every 3 months

2 when a patient requires medicare- reimbursed services such as wound care, documentation is required every shift

The nurse has been assigned to a caseload of home health clients. Before making home visits, which planning activities must be performed first? Select all that apply. 1) Order supplies for the home care services. 2) Review the cases to determine the reasons for the visits. 3) Contact the clients to arrange for the visits. 4) Develop a schedule for the day so that all visits can be made. 5) Check the bag to ensure all basic supplies are available.

2 3 5

Which client would most likely require home health services? Select all that apply. 1) 45-year-old man with an injured rotator cuff that requires surgery 2) 32-year-old terminally ill woman with a supportive family 3) 92-year-old man living independently with multiple medical problems 4) 6-year-old with a fractured hip requiring a leg and pelvic cast 5) 42-year-old client living alone recovering from spinal surgery

2 3 5 home care is appropriate for a client with health needs that exceed the abilities of family and friends. Older adults who wish to avoid placement in skilled facility who require discharge from hospital, the terminally ill and persons with chronic ilness that most be monitored to avoid hospitalization are the most likely home health clients.

A home health patient previously lived with her sister for more than 20 years. Although it has been over a year since her sister died, the patient tells the nurse, "It's no worse now, but I never feel any relief from this overwhelming sadness. I still can't sleep a full night. The house is a mess; I feel too tired even to take a bath. But, sometimes at night, she comes to me and I can see her plain as can be." The patient's clothing is not clean and her hair is not combed. She is apparently not eating adequately. It is the patient's birthday.What should the nurse conclude about the patient? 1) Grieving longer than usual because of the closeness of the relationship with her sister 2) Experiencing a depressive disorder rather than simply grieving the loss of her sister 3) Feeling guilt and worthlessness because her sister died and she is still alive 4) Interpreting the birthday as a trigger event, which is causing her to hallucinate

2 The patient is likely experiencing a depressive disorder. Her symptoms include unrelieved, overwhelming sadness; insomnia; difficulty carrying out activities of daily living; fatigue; and visual hallucinations. Note that her sadness is pervasive, not created by a trigger event (holiday). Of those symptoms, insomnia is common to both grief and depression, but the other symptoms are signs of depressive disorder.

The client tells the nurse, "Every time I come in the hospital you hand me one ofthese advance directives (AD). Why should I fill one of these out?" Which statement by the nurse is most appropriate? 1. "You must fill out this form because Medicare laws require it." 2. "An AD lets you participate in decisions about your health care." 3. "This paper will ensure no one can override your decisions." 4. "It is part of the hospital admission packet and I have to give it to you."

2. ADs allow the client to make personalhealth-care decisions about end-of-life issues, including cardiopulmonary resuscitation(CPR), ventilators, feeding tubes, and other issues concerning the client's death.

The client has just signed an AD at the bedside. Which intervention should the nurseimplement first?1. Notify the client's health-care provider about the AD.2. Instruct the client to discuss the AD with significant others.3. Place a copy of the advance directive in the client's chart.4. Give the original advance directive to the client.

2. This is the most important intervention because the legality of the document is sometimes not honored if the family members disagree and demand other action. If the client's family is aware of the client's wishes, then the health-careteam can support the client

A community health nurse gathers information about how individuals in a low-income neighborhood perceive the community and its state of health. Which assessment strategy would be appropriate? 1) Conducting a windshield survey while driving 2) Reviewing a multitude of community databases 3) Interviewing residents living on every fifth block 4) Analyzing demographic data on the community

3 To assess community perceptions, the nurse will need to interact with a cross section of the community. Interviewing residents is one way to find out about community concerns and opinions

What do the inhabitants of one zip code form? 1) Aggregate 2) Community 3) Population 4) Vulnerable population

3 a population is all of the people inhabiting a speicified area

The student nurse asks her preceptor why the patient is being discharged 2 days after surgery when he still needs wound care and help with basic hygiene. The preceptor should educate the student nurse on which concept?1) Preferred Provider Organizations (PPOs)2) Health Maintenance Organizations (HMOs)3) Diagnosis-Related Groups (DRGs)4) Point of Service (POS)

3 discharge planning begins on admission. a diagnosis related group is a prospective reimbursement system. insurance companies will reimburse hospitals on a case per case flat rate determined by patient groups (DRGs). hospitals will lose money if the patients hospital costs are greater than the amount reimbursed

What is a chief benefit of using the Clinical Care Classification (CCC) system to document home care? 1) Contains diagnoses specific to home care, whereas NANDA-I does not. 2) Is simpler to use and more readily understood by other disciplines. 3) Is linked to the OASIS reporting forms required by Medicare. 4) Uses standardized terminology, whereas NANDA-I does not.

3 home care nurses more commonly use the CCC because it is linked to the OASIS reporting forms required by Medicare

The mother of a preschool child dies suddenly of a ruptured cerebral aneurysm. What recommendation should the nurse make to the family regarding how to most therapeutically care for the child? 1) Take the child to the funeral even if he is frightened. 2) Notify the physician immediately if the child shows signs of regression. 3) Spend as much time as possible with the child. 4) Provide distraction whenever the child begins to express feelings of sadness.

3 the nurse should advise family to spend as much time as possible with the child

A patient is discharged home after sustaining injuries from a motor vehicle crash. What would be the primary goal of home care for this patient? 1) Provide comprehensive direct care. 2) Promote sleep and rest for healing. 3) Teach the patient and family how to provide care. 4) Explain how home care differs from hospital care.

3 the primary goal in home healthcare is to promote self care. nursing activities are directed at fostering independence or teaching the family or other caregivers to assist with the ongoing needs of client

The male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent and the client's wife tells the nurse, "Help him please. Do something. I am not ready to let him go." Which action should the nurse take? 1. Ask the wife if she would like to revoke her husband's AD. 2. Leave the wife at the bedside and notify the hospital chaplain. 3. Sit with the wife at the bedside and encourage her to say good-bye. 4. Request the client to tell the wife he is ready to die, and don't do anything.

3. At the time of death, loved ones become scared and find it difficult to say good-bye. The nurse should support the client's decision and acknowledge the wife's psychological state. Research states hearing is the last sense to go,and talking to the dying client is therapeutic for the client and the family

A client with respiratory failure is experiencing cyanosis and labored breathing. What action should the nurse take first? 1) Study the discharge plan. 2) Check the graphic data for vital signs. 3) Examine the history and physical. 4) Look for an advance directive.

4 the advance directive, which should be located in a special section of the patient's medical record, should be examined first because the patient's symptoms indicate that he may need to be resuscitated. The advance directive contains information about the patient's wishes for intensity of care and actions that should be taken in the event of a life-threatening event

Which intervention is appropriate for a client receiving palliative care? Select all that apply. 1) Surgically inserting a device to decrease the workload of the heart in a patient awaiting heart transplantation 2) Administering IV dopamine to raise blood pressure of a patient with end-stage lung cancer 3) Providing moisturizing eye drops to an unconscious patient whose eyes are dry 4) Administering a medication to relieve the nausea of a patient with end-stage leukemia 5) Establishing an advance directive that addresses the next 6 months of care

3,4 providing moisturizing eye drops is an example of palliative care administer antinausea medication is an example of palliative care to a pt with end stage leukemia

The client with an AD tells the nurse, "I have changed my mind about my AD. I really want everything possible done if I am near death since I have a grandchild." Which action should the nurse implement? 1. Notify the health information systems department to talk to the client. 2. Remove the AD from the client's chart and shred the document. 3. Inform the client he or she has the right to revoke the AD at any time. 4. Explain this document cannot be changed once it is signed.

3. The client must be informed the AD can be rescinded or revoked at any time for any reason verbally, in writing, or by destroying his or herown AD. The nurse cannot destroy theclient's AD, but the client can destroy his or her own.

In which client situation would the AD be consulted and used in decision making? 1. The client diagnosed with Guillain-Barré who is on a ventilator. 2. The client with a C6 spinal cord injury in the rehabilitation unit. 3. The client in end-stage renal disease who is in a comatose state. 4. The client diagnosed with cancer who has Down syndrome.

3. The client must have lost decision making capacity as a result of a condition which is not reversible or must being a condition specified under state law,such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD.

The nurse is caring for a terminally ill client who is experiencing Cheyne-Stokes respirations. Which best describes Cheyne-Stokes respirations? 1.Continuous rapid regular breathing 2.Periods of apnea followed by bradypnea 3.Periods of apnea followed by deep rapid breathing 4.Periods of bradypnea followed by periods of tachypnea

3.Periods of apnea followed by deep rapid breathing Rationale:Cheyne-Stokes respirations are characterized by alternating periods of apnea and deep rapid breathing. Therefore options 1, 2, and 4 are incorrect.

The nurse is presenting an in-service discussing do not resuscitate (DNR) orders and advance directives. Which statement should the nurse discuss with the class? 1. Advance directives must be notarized by a notary public. 2. The client must use an attorney to complete the advanced directive. 3. Once the DNR is written, it can be used for every hospital admission. 4. The health-care provider must write the DNR order in the client's chart.

4. The HCP writes the DNR order in the client's chart, and the client completes the AD.

The client asks the nurse, "When will the durable power of attorney for health caretake effect?" On which scientific rationale would the nurse base the response? 1. It goes into effect when the client needs someone to make financial decisions. 2. It will be effective when the client is under general anesthesia during surgery. 3. The client must say it is all right for it to become effective and enforced. 4. It becomes valid only when the clients cannot make their own decisions.

4. The client must have lost decision making capacity as a result of a condition which is not reversible or must be in a condition which is specified understate law, such as a terminal, persistent vegetative state; an irreversible coma;or as specified in the AD.

The nurse is moving to another state which is part of the multistate licensure compact.Which information regarding ADs should the nurse be aware of when practicingnursing in other states? 1. The laws regarding ADs are the same in all the states. 2. Advance directives can be transferred from state to state. 3. A significant other can sign a loved one's advance directive. 4. Advance directives are state regulated, not federally regulated.

4. The state determines the definition of the terms and requirements for an AD;individual states are responsible forspecific legal requirements for ADs

The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of which of the following?A. 3 months or less to live B. 6 months or less to live C. 12 months or less to live D. 18 months or less to live

B. 6 months or less to liveTwo criteria must be met to be eligible for hospice care. First, the patient must wish to receive it, and second, the physician must certify that the patient has a prognosis of 6 months or less to live.

The nurse is caring for a client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will and asks the nurse to act as one of the witnesses for the will. What is the most appropriate nursing action? 1.Agree to act as a witness. 2.Call the health care provider (HCP). 3.Ask another nurse to serve as a witness. 4.Ask the client who might be available to serve as a witness.

4.Ask the client who might be available to serve as a witness. Rationale:A living will addresses the withdrawal or withholding of life-sustaining interventions that unnaturally prolong life. It identifies the client who will make care decisions if the client is unable to take action. It is witnessed and signed by two people who are unrelated to the client. Nurses or employees of a facility in which the client is receiving care and beneficiaries of the client must not serve as a witness. There is no reason to call the HCP.

an 80 year old is receiving palliative care for heart failure. what are the primary purposes of her receiving palliative care (SATA) a. improve her quality of life b. assess her coping ability with disease c. have time to teach pt and family about disease d. focus on reducing the severity of disease symptoms e. provide care that the family is unwilling or unable to give

A, D The focus of palliative care is to reduce the severity of disease symptoms. The goals of palliative care are to prevent and relieve suffering and to improve quality of life for patients with serious, life-limiting illnesses.

During admission of a patient diagnosed with metastatic lung cancer, you assess for which of the following as a key indicator of clinical depression related to terminal illness? A. Frustration with pain B. Anorexia and nausea C. Feelings of hopelessness D. Inability to carry out activities of daily living

C. Feelings of hopelessness Feelings of hopelessness are likely in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. You should assess for depression routinely when working with patients with a terminal illness.

A patient has been receiving palliative care for the past several weeks in light of her worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient "stops breathing for a while, then breathes fast and hard, and then stops again." You recognize that the patient is experiencing A. Apnea B. Bradypnea C. Death rattle D. Cheyne-Stokes respirations

D. Cheyne-Stokes respirationsCheyne-Stokes respirations are a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.

Identify a negative effect of the centralization of health care in hospitals rather than the home setting. a. Minimized individual responsibility b. Increased concerns about the cost of health care c. Professionalization of nursing d. Increased reliance on advanced technology

a

The major advantage that preferred provider organization (PPO) payment systems have over HMOs is that the PPOs: a. Extend benefits beyond the use of their services at an increased rate b. Require copayment fees each time a service is rendered c. Have services that are used by a smaller number of clients, which reduces the wait for services d. Have a system that reduces costs more

a

What is the primary focus of nurse-run clinics? a. Health promotion b. Disease cure c. Pregnancy counseling services d. Cost control

a

9. Identify where diagnosis-related groups (DRGs) are primarily used. a. Private insurance companies b. Prospective payment systems c. Retrospective payment systems d. Current reimbursement systems

b

Cross-trained personnel are an integral part of which of the following care delivery models? a. Team nursing b. Modular nursing c. Primary care nursing d. Functional nursing

b

What is a major problem identified with self-insured health-care plans? a. Increased cost to the members b. Shielding from many state tax regulations c. Exclusion of potential employees based on their health history d. Elimination of outside regulators to supervise private insurance plans

c

What is a result of past difficulties with the Blue Cross/Blue Shield insurance plans? a. Increased emphasis on preventative health care b. Involvement of the hospital boards of directors to lower costs c. More private insurance companies administering Blue Cross/Blue Shield programs d. Transfer of more power to physicians' groups to monitor the flow of money within the program

c

During a home visit the nurse learns that a patient is inconsistent with taking prescribed medications and has a medication organizer partially filled next to a variety of medication containers. What should the nurse do? 1) Show the patient how to put the medications in the organizer for the next 2 days, and observe while he fills the rest of the organizer. 2) Arrange for a home health aide to come each day to show the patient which pills to take. 3) Administer today's medications and arrange for the pharmacy to put medications in easy-to-open containers in the future. 4) Fill the organizer for each day of the week, explain how to use it, and return in a day or two to evaluate.

d From the cues given, it seems likely the patient would not be able to accurately load the medication organizer—and, in fact, may not be able to use it properly to take the correct medications at the correct time. The nurse would need to return every day or so until he is certain that the patient can actually administer his own meds after someone else loads the organizer

During a health history, a patient whose wife died unexpectedly 6 months ago in a motor vehicle accident admits to drinking at least six whiskeys every night before going to bed. Which type of grief does this best illustrate? 1) Delayed 2) Chronic 3) Disenfranchised 4) Masked

d masked grief occurs when the person is grieving but it may look as though something else is occuring; in this case, the person is abusing alcohol

Which nursing intervention should be included in the plan of care for a patient dying of cancer? 1) Encourage at least one family member to remain at the bedside at all times. 2) Follow up with other healthcare team members during weekly meetings. 3) Avoid discussing the dying process with family (to reduce sadness). 4) Encourage family members to participate in care of the patient when possible

d the plan of care should include encouraging family members to help with the patients care when they are able

the hospice nurse identifies an abnormal grief reaction by the wife of a dying patient who says A. "I don't think that I can live without my husband to take care of me." B. "I wonder if expressing my sadness makes my husband feel worse." C. "We have shared so much that it is hard to realize that I will be alone." D. "I don't feel guilty about leaving him to go to lunch with my friends."

d Being present during a family member's dying process can be highly stressful. It is important for the hospice nurse to recognize signs and behaviors among family members who may be at risk for abnormal grief reactions and be prepared to intervene if necessary.

An older client who became a widower a year ago reports beginning to adjust to life alone. According to John Bowlby, which stage of grief does this comment most likely indicate? 1) Shock and numbness 2) Yearning and searching 3) Disorganization and despair 4) Reorganization

d according to bowlby a person adjusts to life without the deceased during the reorganization phase

An older client recovering from a stroke in an acute care facility is transferred to a nursing home for ongoing care and the inability to provide self-care at home. Which type of loss is this patient most likely experiencing? 1) Environmental loss 2) Internal loss 3) Perceived loss 4) Psychological loss

1 the client is most likely expierencing an environmental loss because of the inability to return home to a familiar setting

What is a type of care delivery model based on a decentralized organizational system that emphasizes close interdisciplinary collaboration? a. Modular nursing b. Team nursing c. Primary care nursing d. Functional nursing

a

What is the most important reason why nurses should be familiar with health-care reimbursement methods? a. It allows nurses to be informed client advocates. b. Nursing care plans can be developed based on financial incentives to lower costs. c. Nurses can decide which tests do and do not need to be conducted for particular clients. d. Decisions can be made about when a client can be discharged based on reimbursement restrictions.

a

What is the primary goal of using the Six Sigma process in the health-care setting? a. Providing a reliable process of care in all cases by eliminating errors b. Helping nurses increase the number of clients they can safely care for c. Increasing data collection used in evidenced-based practice d. Organizing client care based on a reliable statistical model

a

The spouse of a client with a terminal illness is fatigued and just wants an afternoon off from providing constant care. What should the nurse do to help the spouse? 1) Arrange for a home health aide. 2) Discuss transferring the client to a long-term care facility. 3) Coordinate the client's admission to an acute care facility. 4) Explain it won't be long now because the client is nearing death.

a arranging for a home health aide will provide spouse time away from ongoing constant care

A home health nurse has called the patient to arrange an initial home visit and has driven to the home. What is the nurse's objective in the first few minutes of the visit? 1) Develop rapport and trust with the patient and family. 2) Gather demographic data and complete the referral form. 3) Assess the patient's most important health needs. 4) Determine the patient's needs for ongoing care.

1 the first few minutes of the initial visit set the tone for the relationship between the client, nurse, family and agency. in that time the nurse focuses on developing rapport and trust

1. A family caregiver is learning to administer insulin injections to a family member. What should the nurse advise the caregiver to do with the used needles? 1) Discard the needle and syringe in a thick plastic milk jug with a lid. 2) Securely recap them and place them in a paper bag in the household trash. 3) Remove the needle and put it in a coffee can with a lid; put the syringe in the trash. 4) Do not recap the needle; break it by bending it on the tabletop.

1 the caregiver should discard the syringe and needle in a thick milk jug, metal coffee can lid or commercial sharps container

A patient with poorly controlled diabetes, hospitalized for a leg ulcer, is being discharged on insulin, new medications, and the expectation to perform capillary blood glucose measurements, which has never been done. Is a referral to home care appropriate for this patient? 1) Yes; the patient is in need of skilled services and, therefore, is eligible for home care services. 2) Yes; the patient has been unable to control the diabetes, is noncompliant, and needs to be monitored. 3) No; the patient should remain hospitalized because of too many needs for home care services. 4) No; the patient should be able to provide self-care.

1 yes all of these needs can be met with home care services

The nurse notes that the spouse of a terminally ill client stops visiting every day and talks about meeting with friends after work. Which type of grief is the spouse demonstrating? 1) Anticipatory 2) Complicated 3) Uncomplicated 4) Disenfranchised

1 Anticipatory grief is experienced before a loss occurs. A potential negative outcome of anticipatory grief is that the survivor may detach from the person

Which service is provided by home health agencies? Select all that apply. 1) Direct care of clients in the home, performing treatments 2) Indirect care such as provision of medication and supplies 3) Acute care services for clients with complex diseases 4) Respite care of clients to relieve family caregivers 5) Direct care of the client requiring ventilatory support

1 2 4

A nurse caring for patients in a primary care setting submits paperwork for reimbursement from managed care plans for services performed. Which purpose best describes managed care as a framework for health care?a) A design to control the cost of care while maintaining the quality of careb) Care coordination to maximize positive outcomes to contain costsc) The delivery of services from initial contact through ongoing cared) Based on a philosophy of ensuring death in comfort and dignity

a Managed care is a way of providing care designed to control costs while maintaining the quality of care

The nurse monitors a terminally ill client for which physical signs of approaching death? Select all that apply. 1.Increased appetite 2.Loss of consciousness 3.Loss of bowel control 4.Loss of bladder control 5.Decreased blood pressure 6.Decreased tactile sensation

2.Loss of consciousness 3.Loss of bowel control 4.Loss of bladder control 5.Decreased blood pressure 6.Decreased tactile sensation Rationale:Physical signs of approaching death include decreased appetite/thirst, decreased blood pressure, loss of consciousness, loss of bowel and bladder control, and decreased tactile sensation.

Which demographic factor has the most significant effect on the health-care delivery system of the future? a. The large numbers of babies being born to minority women b. The increasing use of alcohol and tobacco among teenagers c. The rapidly increasing average age of the population d. The oversupply of nurses

c

the hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's 'sweet 16' birthday party, I'll be ready to die." Which phase of coping is this client experiencing? 1.Anger 2.Denial 3.Bargaining 4.Depression

3.Bargaining Rationale:Denial, bargaining, anger, depression, and acceptance are recognized stages that a client facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change the prognosis or fate. Anger also may be a first response to upsetting news, and the predominant theme is "Why me?" or the blaming of others. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn.

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1.Discourage reminiscing. 2.Make the decisions for the family. 3.Encourage expression of feelings, concerns, and fears. 4.Explain everything that is happening to all family members. 5.Touch and hold the client's or family member's hand if appropriate. 6.Be honest and let the client and family know that they will not be abandoned by the nurse.

3.Encourage expression of feelings, concerns, and fears.5.Touch and hold the client's or family member's hand if appropriate.6.Be honest and let the client and family know that they will not be abandoned by the nurse. Rationale:The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know that they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.

Which intervention takes priority for the patient receiving hospice care? 1) Turning and repositioning the patient every 2 hours 2) Assisting the patient out of bed and into a chair twice a day 3) Administering pain medication to keep the patient comfortable 4) Providing the patient with small frequent, nutritious meals

c a priority intervention for the patient of the hospice team is administering pain medications to keep the patient comftorable

What emotional response is typical during Rando's confrontation phase of the grieving process? 1) Anger and bargaining 2) Shock with disbelief 3) Denial 4) Emotional upset

4 during the confrontation phase, the person faces the loss and experiences emotional upset

A home health nurse is working with a physical therapist and home health aides to work out a schedule for their visits that will best address the patient's needs. Which nursing role does this demonstrate? 1) Direct care provider 2) Client and family educator 3) Client advocate 4) Care coordinator

4 a care coordinator manages and coordinates the services of members of the healthcare team and develops a plan of care that addresses the clients needs

What is the type of nursing with a focus on the community as a whole and the health status of individuals as an aggregate? 1) School nursing 2) Community health nursing 3) Community-oriented nursing 4) Public health nursing

4 public health nursing focuses on the community at large and the eventual effect of the communitys health of the individuals, families and groups

Which unique aspect of home care do Medicare reimbursement regulations require that the nurse include in documentation? 1) Patient assessment data and interventions performed 2) Patient response to care and assessment of environment 3) Evidence of homebound status and continued need for skilled care 4) Skilled care delivered and communication with other providers

c the unique requrements of home care include documentation of homebound status and the continued need for skilled care

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply)?A. Strong spiritual beliefs B. Medical diagnosis of the patient C. Advanced age of the palliative patient D. Acceptance of the expected death of the patient E. Adequate time for the caregiver to prepare for the death

A, D, E Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of caregivers' anticipatory grief.

A hospice nurse is visiting with a dying patient. During the interaction, the patient is silent for some time. What is the best response? A. Recognize the patient's need for silence, and sit quietly at the bedside. B. Try distraction with the patient. C. Change the subject, and try to stimulate conversation. D. Leave the patient alone for a period.

A. Recognize the patient's need for silence, and sit quietly at the bedside.Frequently, silence is related to the overwhelming feelings experienced at the end of life. Silence can also allow time to gather thoughts. Listening to the silence sends a message of acceptance and comfort.

A 67-year-old man has been admitted to the hospital for a surgical procedure. During the admission process, the nurse asks whether he has a living will or a durable power of attorney. The patient asks, "What is a living will?" The best response by the nurse would be which of the following? A) "A living will and a durable power of attorney are both advance directives." B) "A living will states your wishes regarding future healthcare if you become unable to give instructions." C) "A living will identifies a person who will make healthcare decisions in the event you are unable to do so." D) "I will tell a case manager that you would like additional information."

B) "A living will states your wishes regarding future healthcare if you become unable to give instructions."Rationale:Generally, there are two types of advance directives: a living will and a durable power of attorney. A living will is a directive that declares the patient's wishes should the patient become unable to give instruction. A durable power of attorney identifies a person who will make healthcare decisions in the event the patient is unable to do so. Simply saying a living will and durable power of attorney are both advance directives is broadly stated and does not give as much information to the patient.

Select from the list below all components that are found in the Canadian Federal- Provincial Arrangements and Established Programs Financing Act. a. Per capita payments are made on the basis of previous expenditures and adjusted regularly in relation to the Gross National Product (GNP). b. No out-of-pocket expenses are required for any health care. c. Tax points are transferred by the federal government, allowing provinces to reduce their tax contribution to the federal government and at the same time increase the portion of tax collected at the provincial level. d. Equalization of tax points is distributed among poorer provinces. e. Coverage is not extended to government employees because they have their own system of health-care payment. f. Additional per capita payments are indexed to help pay for nursing home, residential care, home care, and ambulatory care.

a c d f

Identify the factor that is most important in the increased development of alternative ambulatory services. a. Increased length of hospital stays b. New technology that enables complicated and dangerous procedures to be performed on an outpatient basis c. Consumer demand for more technology in the cure of disease d. Establishment of satellite clinics in suburbs and rural communities

b

Identify the most significant element in the continued rise in health-care costs in the United States. a. Expensive new technology b. Increasing need for long-term care c. Lack of motivation for consumers to comparison shop d. Expensive new medications

b

The primary difference between HMOs and independent practice associations (IPAs) is that under the IPA system: a. Physicians lose much of their control over health-care delivery b. Clients pay on fee-for-service basis rather than prepaid premiums c. Nurses receive reimbursement on an individual basis for the care they provide d. The number of services provided is not limited

b

Which care delivery model takes a unified approach to client care, involving different levels of care providers working together to achieve client health-care goals? a. Modular nursing b. Team nursing c. Primary care nursing d. Functional nursing

b

Which element is usually excluded in the current trend toward decentralized health care? a. Provision of care on an outpatient basis b. Emphasis on the cure of illness c. Promotion of responsible self-care practices d. Cost containment measures by health-care providers

b

what is acute care of sick persons that is provided in hospitals called? a. primary intervention b. secondary intervention c. tertiary intervention d. assistive intervention

b

During a home visit the nurse reviews prescribed medications with the client. Which medication should the nurse spend additional time reviewing with the client? 1) Digoxin 2) Warfarin 3) Ibuprofen 4) Furosemide

b according to the joint commission safety goals anticoagulation medication teaching is a priority

Which intervention is most appropriate when a client develops a "death rattle"? 1) Perform nasotracheal suctioning of secretions. 2) Turn the patient on his side and raise the head of the bed. 3) Insert a nasopharyngeal airway as needed. 4) Administer morphine sulfate intravenously.

b if a death rattle occurs turn the pt on his side and elevate the HOB

When providing postmortem care, the nurse places dentures in the mouth and closes the eyes and mouth of the patient within 2 to 4 hours after death. Why is the timing of the action so important? 1) Prevent blood from settling in the head, neck, and shoulders. 2) Perform these actions more easily before rigor mortis develops. 3) Set the mouth in a natural position for viewing by the family. 4) Prevent discoloration caused by blood settling in the facial area

b rigor mortis develops 2-4 hours after death, therfore the nurse should place dentures in the mouth and close the patients eyes and mouth before that time

The spouse of a dying client who wants to be present at the time of death desires to go home to shower but is afraid the client will die during that time. Which response by the nurse is best? 1) "Certainly, go ahead; your husband will most likely hold on until you return." 2) "Your husband could live for days or a few hours; you should do whatever you are comfortable with." 3) "You need to take care of yourself; go home and shower, and I'll stay at his bedside while you are gone." 4) "Don't worry. Your husband is in good hands; I'll look out for him."

b the client is exhibiting signs that typically occur days to a few hours before death. the nurse should provide information to the spouse so that an informed decision can be made about leaving

Select from the list below the primary goals of the Patient Protection and Affordable Care Act (PPACA) of 2010. a. Increase the tax rate on the wealthy b. Addressing inequities in insurance coverage c. Helping the struggling elderly d. Providing a way to insure all Americans e. Increasing the number of large hospitals f. Breaking the insurance industry's strangle hold on health care

b c d f

A nurse is providing secondary health care to patients in a health care facility. Which patients are receiving this level of care? Select all that apply. a) A patient enters a community clinic with signs of strep throat. b) A patient is admitted to the hospital following a myocardial infarction. c) A mother brings her son to the emergency department following a seizure. d) A patient with osteogenesis imperfecta is being treated in a medical center. e) A mother brings her son to a specialist to correct a congenital heart defect. f) A woman has a hernia repair in an ambulatory care center

b, c, f Secondary health care treats problems that require specialized clinical expertise, such as an MI, a seizure, and a hernia repair. Treating strep throat is primary health care.Tertiary health care involves management of rare and complex disorders, such as osteogenesis imperfecta and congenital heart malformations.

What is the key element in the horizontal integration of health-care services? a. The use of a fee-for-service method of payment b. One hospital providing the entire scope of services, so clients can be cared for without referral outside the system c. Several health-care agencies working together to cut costs by sharing resources d. The development of clinics outside the hospital to provide services traditionally found in the hospital

c

What is the primary advantage of the case method of care delivery? a. It is inexpensive and cost effective. b. It allows several health-care providers trained at different levels to provide care at the same time. c. It gives nurses a high degree of autonomy and responsibility. d. It allows nurses with minimal education to provide high-quality care for all clients.

c

Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? Select all that apply. a) Access to care depends only on the ability to pay, not the availability of services. b) The Patient Protection and Affordable Care Act provides private health care insurance to the underserved populations. c) Every health insurance plan in the Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. d) The uninsured pay for more than one-third of their care out of pocket and are usually charged lower amounts for their care than the insured pay. e) Fifty years ago, half of the doctors in America practiced primary care, but today fewer than one in three do. f) Quality of care can be defined as the right care for the right person at the right time.

c, e, f The Marketplace is designed to help people more easily find health insurance that fits their budget. Every health insurance plan in the Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. Fifty years ago, half of the doctors in America practiced primary care, but today fewer than one in three do. Quality is the right care for the right person at the right time. Access to care depends on both the ability to pay and the availability of services. The Patient Protection and Affordable Care Act provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty. The uninsured pay for more than one-third of their care out of pocket and are often charged higher amounts for their care than the insured pay.

Identify a type of care delivery model that is task oriented in that each person performs a specific job to meet a particular need of the unit. a. Modular nursing b. Team nursing c. Primary care nursing d. Functional nursing

d

Which methods are used by health maintenance organizations (HMOs) to reduce the cost of health-care delivery? a. Increasing the number of diagnostic studies to detect diseases early b. Encouraging clients to remain in the hospital longer so that they can recover completely and not be readmitted c. Referring more clients to specialists so that complex health-care problems can be treated better d. Providing more health-promotion and illness-prevention services

d

Which two types of care delivery models are commonly used in managed care? a. Functional and team nursing b. Case management and functional nursing c. Modular nursing and primary care nursing d. Case management and primary care nursing

d