Chapter 1: Concepts and Trends in Healthcare.
A home care nurse is preparing a presentation for a group of nursing students about the area of practice. Which statement would the nurse most likely include when describing this practice area? "Home care requires that the nurse has an advanced degree in nursing." "The major emphasis of care involves accessing community resources." "Home care nurses need to have high-level assessment skills." "Decision-making is shared among the other health care professionals
Correct response: "Home care nurses need to have high-level assessment skills." Explanation: A nurse working in home care needs advanced knowledge and skills in general nursing practice with an emphasis on community health and acute medical-surgical nursing. The home care nurse also needs high-level assessment, critical thinking, and decision-making skills in a setting where other health care professionals are not available to validate observations, conclusions, and decisions. Home care nurses provide "high-tech, high-touch" care to those with acute health care needs. They are responsible for client and family teaching, for contacting community resources, and coordinating the continuing care of clients. An advanced nursing degree is not necessarily required.
A home care nurse is preparing a presentation for a group of nursing students about the area of practice. Which statement would the nurse most likely include when describing this practice area? "Home care requires that the nurse has an advanced degree in nursing." "The major emphasis of care involves accessing community resources." "Home care nurses need to have high-level assessment skills." "Decision-making is shared among the other health care professionals."
Correct response: "Home care nurses need to have high-level assessment skills." Explanation: A nurse working in home care needs advanced knowledge and skills in general nursing practice with an emphasis on community health and acute medical-surgical nursing. The home care nurse also needs high-level assessment, critical thinking, and decision-making skills in a setting where other health care professionals are not available to validate observations, conclusions, and decisions. Home care nurses provide "high-tech, high-touch" care to those with acute health care needs. They are responsible for client and family teaching, for contacting community resources, and coordinating the continuing care of clients. An advanced nursing degree is not necessarily required. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health Care Delivery System, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
A student nurse observes a nurse case manager coordinating discharge for a patient diagnosed with congestive heart failure (CHF). Which statement made by the patient indicates to the student that the patient understands the role of the case manager? "The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." "The nurse case manager organized my daily nursing care during my hospitalization and arranged for the dietitian to teach me the importance of consuming a diet low in sodium." "The nurse case manager worked with my physician to coordinate my admission from his office to the hospital." "The nurse case manager arranged to have a wheelchair waiting to take me to my room. I was so short of breath I could not walk very far."
Correct response: "The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." Explanation: A nurse case manager coordinates care between nurses, other health care personnel, and insurance companies. Nurse case managers coordinate patient care from the time of hospital admission to the time of discharge and often after discharge from an acute care setting. Care coordination provided by the nurse care manager is not episodic. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Effects of Cost-Driven Changes, p. 7. Chapter 1: Concepts and Trends in Healthcare - Page 7
Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s? "The quality assurance programs focus on individual incidents or errors and minimal expectations." "The quality assurance programs focus on decreasing the cost of health care for the consumer." "The quality assurance programs focus on processes used to provide care and improving those processes." "The quality assurance programs focus on coordinating care for patients."
Correct response: "The quality assurance programs focus on processes used to provide care and improving those processes." Explanation: In the 1980s, hospitals and other health care agencies implemented ongoing quality assurance programs that provided the foundation for the establishment of continuous quality improvement (CQI) programs in the 1990s. Despite these efforts to ensure the provision of quality health care, the IOM (2000) reported an alarming breakdown in quality control in the American health care system. The IOM report To Err Is Human: Building a Safer Health System (2000) noted that nearly 100,000 Americans died annually from preventable errors in hospitals, and many more suffered nonfatal injuries from errors. A subsequent IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001), envisioned a reformed health care system that is evidence based and systems oriented. Its proposed six aims for improvement included ensuring that patient care is safe, effective, patient centered, timely, efficient, and equitable (IOM, 2001).
Patterns of disease in the United States have undergone significant changes in recent decades and these changes are predicted to continue into the future. Which one of the following patients best exemplifies this changing pattern of disease? A 5-year-old child who has developed measles because her parents opted against vaccination A 22-year-old man who has suffered a traumatic brain injury in a motor vehicle accident A 77-year-old man who has developed sepsis as a result of community-acquired pneumonia A 60-year-old woman who has been diagnosed with rheumatoid arthritis
Correct response: A 60-year-old woman who has been diagnosed with rheumatoid arthritis Explanation: Chronic diseases, such as rheumatoid arthritis, have become more prevalent in recent years, and this trend is expected to continue. Injuries and acute illnesses have become less prominent. These patterns are predicted in coming decades as well. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, U.S. Nutritional Strategies, pp. 9-10. Chapter 1: Concepts and Trends in Healthcare - Page 9-10
What is the primary focus of the nurse advocacy role in managing a clinical pathway? Continuity of care Cost-containment practices Effective utilization of services A patient's progress toward desired outcomes
Correct response: A patient's progress toward desired outcomes Explanation: Evidence-based practice tools used for planning patient care may include not only bundles but also clinical guidelines, algorithms, care mapping, multidisciplinary action plans, and clinical pathways. These tools are used to move patients toward predetermined outcomes. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Future Trends and Goals for Health Care, p. 8. Chapter 1: Concepts and Trends in Healthcare - Page 8
The nurse is preparing a wellness program for seniors at a community center. Which concept of wellness should the nurse utilize when planning the program? Wellness is the absence of sickness. A person needs to be proactive in achieving wellness. Each person views wellness in the same way. Wellness is static and unchanging.
Correct response: A person needs to be proactive in achieving wellness. Explanation: Wellness is a proactive state involving self-care activities aimed at physical, psychological, social, and spiritual well-being. Wellness exists on a continuum and is not merely the absence of sickness. Wellness is subjective and, therefore, is not the same for each person. Because wellness is the ability to adjust and adapt to varying situations, the definition of wellness can change for a person over time. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare.
The view that health and illness are not static states but that they exist on a continuum is central to professional health care systems. When planning care, this view aids the nurse in understanding what fact? Care should focus primarily on the treatment of disease. A person's state of health is ever-changing. A person can transition from health to illness rapidly. Care should focus on the client's compliance with interventions.
Correct response: A person's state of health is ever-changing. Explanation: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person's state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. Client care should not focus just on the treatment of disease. Rapid declines in health and "compliance" with treatment are not key to this view of health.
A nurse is planning a medical client's care with consideration of Maslow hierarchy of needs. Within this framework of understanding, what should the nurse prioritize? Allowing the family to see a newly admitted client Ambulating the client in the hallway Administering pain medication Teaching the client to self-administer insulin safely
Correct response: Administering pain medication Explanation: In Maslow hierarchy of needs, pain relief addresses the client's basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the client to see family addresses a higher level need related to love and belonging. Teaching the client is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the client can address these higher level needs.
A 15-year-old MVA victim is being discharged two days after orthopedic surgery to repair a fractured arm. The client's guardian is quite concerned about safety due to speedy discharge. The nurse should educate the guardian that speedy discharge: All of the options are correct. lessens the possibility of nosocomial infection.
Correct response: All of the options are correct. Explanation: Integrated delivery systems provide a full range of healthcare services with a goal of achieving highly coordinated and cost-effective care. Mandated shorter hospital stays may result in fewer nosocomial (acquired in the hospital) complications and quicker return to self-care. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Effects of Cost-Driven Changes, p. 23. Chapter 1: Concepts and Trends in Healthcare - Page 23
Which is an element of nursing as defined by the American Nurses Association? Putting the patient in the best condition for nature to act upon him or her Helping people to carry out activities contributing to health, recovery, or a peaceful death Alleviating suffering by diagnosing and treating human responses to health problems Discussing what nurses would do for themselves if they had the necessary strength, will, or knowledge
Correct response: Alleviating suffering by diagnosing and treating human responses to health problems Explanation: The ANA defines nursing as "the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations." Florence Nightingale described the role of the nurse as putting "the patient in the best condition for nature to act upon him." Virginia Henderson envisioned the role of a nurse as helping people (sick or healthy) to carry out the activities that contribute to their health, recovery, or a peaceful death as well as the activities that they would do for themselves if they had the necessary strength, will, or knowledge. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare.
Which element would be included as a goal of case management? Appropriateness of services Prescriptive authority Attainment of fixed-price reimbursement Utilization of the nursing process
Correct response: Appropriateness of services Explanation: The goals of care management are to ensure the quality, appropriateness, and timeliness of services as well as to reduce costs. Case managers do not have prescriptive authority. Fixed-price reimbursement is a feature of managed care. Case managers do not use the nursing process. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Managed Care, p. 6. Chapter 1: Concepts and Trends in Healthcare - Page 6
A patient who adheres to the dietary laws of Judaism is in traction and confined to bed. The patient needs assistance with the evening meal of chicken, rice, beans, a roll, and a carton of milk. Which nursing approach is most representative of promoting wellness? Remove items from the overbed table to make room for the dinner tray. Push the overbed table toward the bed so that it will be within the patient's reach when the dinner tray arrives. Ask a family member to assist the patient with the tray and the overbed table, then straighten the area in an attempt to provide a pleasant atmosphere for eating. Ask whether the patient would like to make any substitutions in the foods and fluids received.
Correct response: Ask whether the patient would like to make any substitutions in the foods and fluids received. Explanation: Wellness involves being proactive and being involved in self-care activities aimed toward a state of physical, psychological, and spiritual well-being. With this in mind, health care providers must aim to promote positive changes that are directed toward health and well-being. The sense of wellness has a subjective aspect that addresses the importance of recognizing and responding to patient individuality and diversity in health care and nursing. Although all of the actions listed would promote the patient's comfort, addressing the patient's religious dietary needs is most representative of promoting wellness. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health and Wellness, p. 2. Chapter 1: Concepts and Trends in Healthcare - Page 2
A nurse is providing care for a client who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement? By liaising with the members of the interdisciplinary care team By critically appraising the outcomes of care that is provided By integrating the client's preferences into the plan of care By documenting care in the electronic health record in a timely fashion
Correct response: By critically appraising the outcomes of care that is provided Explanation: Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Future Trends and Goals for Health Care, p. 8. Chapter 1: Concepts and Trends in Healthcare - Page 8
A nurse in a primary care provider's office is caring for a 73-year-old female client who is interested in learning things she can do to maintain movement and flexibility while coping with osteoporosis. In what situation would this client still be considered healthy even though she has been diagnosed with a chronic disease? Clients with a chronic illness can still achieve a high quality of life within the limits of the illness if they are physiologically stable and mentally healthy. Clients with a chronic illness can never be considered healthy. Clients with a chronic illness can be considered healthy only if they carefully follow their health care provider's advice regarding medications, activity, and diet. Clients with a chronic illness are considered healthy only until the point at which primary body systems begin to lose function.
Correct response: Clients with a chronic illness can still achieve a high quality of life within the limits of the illness if they are physiologically stable and mentally healthy. Explanation: Within the health-illness continuum, clients can adapt physically, emotionally, and socially to a chronic condition and still maintain a high quality of life. There are many ways in which clients with a chronic illness can achieve a high quality of life; they are not limited to those listed. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health-Illness Continuum, p. 2. Chapter 1: Concepts and Trends in Healthcare - Page 2
Staff nurses in an ICU setting have noticed that their clients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized clients. How does this demonstrate the role of the APRN? Involving clients in their care while hospitalized Contributing to the scientific basis of nursing practice Critiquing the quality of client care Explaining medical studies to clients and RNs
Correct response: Contributing to the scientific basis of nursing practice Explanation: Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving clients in their care. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Future Trends and Goals for Health Care, pp. 8-9. Chapter 1: Concepts and Trends in Healthcare - Page 8-9
A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and self-care. Which of the following activities would best demonstrate the principles of health promotion? A discharge planning initiative between acute care and community care nurses Collaboration between several schools of nursing in an urban area Creation of a smoking prevention program undertaken in a middle school Establishment of a website where clients can check emergency department wait-times
Correct response: Creation of a smoking prevention program undertaken in a middle school Explanation: Smoking prevention is a clear example of health promotion. Each of the other listed activities has the potential to be beneficial, but none is considered health promotion.
Using the concept of the wellness-illness continuum, what would the nurse include in the development of a nursing care plan for a chronically ill patient? Educate the patient about every possible complication associated with the specific illness. Encourage positive health characteristics within the limits of the specific illness. Limit all activities because of the progressive deterioration associated with all chronic illnesses. Recommend activity beyond the scope of tolerance to prevent early deterioration.
Correct response: Encourage positive health characteristics within the limits of the specific illness. Explanation: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person's state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The use of the health-illness continuum makes it possible to regard a person as simultaneously possessing degrees of both health and illness. On the health-illness continuum, even people with a chronic illness or disability may attain a high level of wellness if they are successful in meeting their health potential within the limits of their chronic illness or disability (Manderscheid, Ryff, Freeman, et al., 2010). Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, CONCEPTS RELATED TO HEALTH, p. 2. Chapter 1: Concepts and Trends in Healthcare - Page 2
Which is not an important reason that nurses utilize research in nursing practice? Validation Dissemination Replication Financial obligation
Correct response: Financial obligation Explanation: Financial obligation is not an important reason that nurses utilize research in nursing practice. The use, validation, replication, dissemination, and evaluation of research findings further the science of nursing. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, FINANCING THE COSTS OF HEALTH CARE, pp. 4-5. Chapter 1: Concepts and Trends in Healthcare - Page 4-5
The school nurse is presenting a health promotion class to a group of high school students. How does the nurse define health? Health is being disease free. Health is having fulfilling relationships. Health is having a clean drinking source and nutritious food. Health is being connected in body, mind, and spirit.
Correct response: Health is being connected in body, mind, and spirit. Explanation: The World Health Organization (WHO) defines health in the preamble to its constitution as a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." The other options contain aspects of health; the
The National Center for Health Statistics uses data from healthcare agencies to issue quarterly and annual reports on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans? Healthy People 2030 The Joint Commission Agency for Healthcare Research and Quality Quality Indicators
Correct response: Healthy People 2030 Explanation: The Healthy People 2030 campaign provides an overall action plan to improve the health and quality of life of people living in the United States. The initiative includes leading health indicators for measuring the overall health of the U.S. population. The Joint Commission is an independent agency that accredits and certifies healthcare organizations and programs in the United States. The AHRQ is the organization that developed standardized quality indicators used to measure healthcare quality at the federal, state, and local levels. Quality indicators are not an initiative; they are standards for measuring healthcare quality. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, U.S. Nutritional Strategies, p. 9. Chapter 1: Concepts and Trends in Healthcare - Page 9
A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospital's leadership? Decreased need for physician services Improved client and family education Increased adherence to the principles of EBP Increased coordination of health services
Correct response: Increased coordination of health services Explanation: Case management is a system of coordinating health care services to ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of clients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role. eference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare.
A nurse, working in a health clinic, treats a variety of conditions on a daily basis. One disorder that is rapidly increasing and is the leading cause of secondary morbidity is: Kidney disease Coronary heart disease Obesity Pneumonia
Correct response: Obesity Explanation: Currently about 30 % of adults and 16% of children are classified as obese (CDC, 2009). Obesity is the leading cause of secondary illnesses ranging from cancer to diabetes. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare. Add a Note
Economics have dictated many significant changes in the health care delivery system. What is one major effect that economic factors have had on the patient population? Patients are in the hospital for a longer period of time. Patients have access to greater technology at lower costs. Patients with high home-care needs are being discharged into the community. Patient use of ambulatory care has decreased.
Correct response: Patients with high home-care needs are being discharged into the community. Explanation: Nurses in hospitals now care for patients who are older and sicker and require more nursing services. Nurses in the community are caring for patients who have been discharged earlier and need high-technology acute care services as well as long-term care. The use of ambulatory care has increased, and technology in health care often increases, rather than decreases, health care costs. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health Care Delivery System, pp. 3-4. Chapter 1: Concepts and Trends in Healthcare - Page 3-4
A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What characteristic should the nurse cite as necessary to possess to be an effective nurse? Sensitivity to cultural differences Ability to problem-solve independently Strict adherence to routine Ability to face criticism without being affected by it
Correct response: Sensitivity to cultural differences Explanation: To promote an effective nurse-client relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Problem-solving in nursing often requires collaboration. The ability to handle criticism is important, but it is unrealistic to expect to be unaffected by it.
Which tool is often used by case managers? Service cost measurement Bottom line Outcome criteria Standards of carev
Correct response: Standards of carev Explanation: Case managers usually make use of tools such as critical pathways, practice guidelines, and standards of care to help them plan and coordinate care. Insurance companies measure the costs of services provided to a case manager's patients as a means of assessing the case manger's effectiveness. One of the complaints about case management is that the "bottom line" will become more important than quality. For this reason, and because they are in the best position to collect outcome data, case managers usually are integral members of hospital-based and insurance-based quality improvement programs. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Measures of Quality of Care, pp. 7-8. Chapter 1: Concepts and Trends in Healthcare - Page 7-8
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Which of the following activities in the care of a female patient with a recent diagnosis of diabetes mellitus is most congruent with the philosophy of health promotion?vv Providing the patient with a new glucometer and test strips which have been recently brought to market Introducing the patient to a diabetes educator who is in charge of a diabetes support group in the community Helping the patient to schedule hemoglobin A1C testing at an outpatient laboratory Teaching the patient about measures that she can take to minimize the long
Correct response: Teaching the patient about measures that she can take to minimize the long-term health effects of her disease Explanation: The core of health promotion involves proactive measures that individuals can perform to protect and preserve their health. Patient education about managing a chronic condition is a common health promotion activity. Providing a glucometer, arranging for blood tests, and facilitating a support group are relevant activities in the care of this patient, but patient education about health preservation is paramount. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health Maintenance and Promotion, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Which of the following activities in the care of a female patient with a recent diagnosis of diabetes mellitus is most congruent with the philosophy of health promotion?vv Providing the patient with a new glucometer and test strips which have been recently brought to market Introducing the patient to a diabetes educator who is in charge of a diabetes support group in the community Helping the patient to schedule hemoglobin A1C testing at an outpatient laboratory Teaching the patient about measures that she can take to minimize the long-term health effects of her disease
Correct response: Teaching the patient about measures that she can take to minimize the long-term health effects of her disease Explanation: The core of health promotion involves proactive measures that individuals can perform to protect and preserve their health. Patient education about managing a chronic condition is a common health promotion activity. Providing a glucometer, arranging for blood tests, and facilitating a support group are relevant activities in the care of this patient, but patient education about health preservation is paramount. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health Maintenance and Promotion, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
A client has been admitted in the emergency care unit with conditions of respiratory distress and pneumonia. The client's condition worsens and requires mechanical ventilation. While visiting this client in the hospital, the family observes members of the health care team washing their hands upon entering and leaving the room. By implementing recommended hand hygiene measures, which organization's goals is the health care team supporting? The Joint Commission The National Council of State Boards of Nursing (NCSBN) Institute of Medicine (IOM) Agency for Healthcare Research and Quality (AHRQ)
Correct response: The Joint Commission Explanation: One of The Joint Commission National Patient Safety Goals (NPSGs) prioritizes the reduction of health care-associated infections. The NCSBN prioritizes matters related to public health, safety, and welfare, including the development of licensing examinations in nursing. The IOM emphasis relates to ensuring that patient care is safe, effective, patient centered, timely, efficient, and equitable. The AHRQ highlights patients' satisfaction with care. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Measures of Quality of Care, p. 8. Chapter 1: Concepts and Trends in Healthcare - Page 8
A nursing student overhears a patient talking with the rehabilitation nurse. The patient states, "I plan to recover from my stroke to the best of my ability. I know I will always have some limitations; however, I will not let the limitations slow me down." Which description of health does the patient exemplify with this statement? The concept of health wellness-illness continuum The World Health Organization's definition of health Hood's (2013) definition of health
Correct response: The concept of health wellness-illness continuum Explanation: The concept of a health-illness continuum allows for a greater range in describing a person's health than the definition provided by the WHO or by Hood (2013). On the health-illness continuum, even people with a chronic illness or disability may attain a high level of wellness if they are successful in meeting their health potential within the limits of their chronic illness or disability. The WHO definition does not allow for any variations in the degrees of wellness and illness. Hood discusses wellness as having four components. Risk reduction is a strategy of health promotion. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health-Illness Continuum, p. 2. Chapter 1: Concepts and Trends in Healthcare - Page 2
What is the primary basis for growth in home care nursing? Recent changes in healthcare legislation The growth of complementary and alternative medicine The aging of the population The discharge of patients who are more critically ill
Correct response: The discharge of patients who are more critically ill Explanation: With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health Care Delivery System, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
Changes in population demographics over the next 40 years will significantly affect the delivery of health care services. Select the one change that will have the most impact on the practice of nursing. Immigration patterns will result in a more diverse population. It is projected that, by 2030, more than 20% of Americans will be immigrants. Hispanics will become the largest minority group in the United States, constituting about 29% of the population. The non-Hispanic, white population will reach 47%. The number of adults over age 65 will double in size.
Correct response: The number of adults over age 65 will double in size. Explanation: Although the changes in racial and cultural diversity will have a serious impact on the delivery of health care in America, the most significant global impact will be an increase in the elderly population. This group will stress the demands of the health care system, from availability of providers of care to use of resources. Nurses will become more active in health promotion activities and more proficient as coordinators of care, especially in the community. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Future Trends and Goals for Health Care, pp. 8-9. Chapter 1: Concepts and Trends in Healthcare - Page 8-9
Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the client. Which of the following is the best example of a collaborative practice model? The nurse and the physician jointly making clinical decisions. The nurse accompanying the physician on rounds. The nurse making a referral on behalf of the client. The nurse attending an appointment with the client.
Correct response: The nurse and the physician jointly making clinical decisions. Explanation: The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. Collaborative practice goes beyond a nurse simply accompanying a physician. Making referrals and accompanying a client do not demonstrate interprofessional collaboration because they are independent nursing actions. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health Care Providers, pp. 3-4. Chapter 1: Concepts and Trends in Healthcare - Page 3-4 Add a Note
The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health? Being disease free or having existing diseases stabilized The state of having fulfillment in all domains of life Possessing psychological and physiologic harmony The state of being connected in body, mind, and spirit
Correct response: The state of being connected in body, mind, and spirit Explanation: The World Health Organization (WHO) defines health in the preamble to its constitution as a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." The concept goes beyond psychology and physiology to include social considerations. It does not depend on having an absence of disease. Fulfillment is consistent with health, but the concepts are not synonymous.
The purpose of the government-funded Medicare program is to provide health insurance coverage for which of the following populations? adults aged 65 years and older, certain disabled persons, and those with end-stage renal disease. low-income individuals and families. active military personnel and their dependents. military veterans who are younger than the age of 65 years.
Correct response: adults aged 65 years and older, certain disabled persons, and those with end-stage renal disease. Explanation: Medicare is the government program that provides coverage for adults aged 65 years and older, certain disabled persons, and those with end-stage renal disease. Medicare does not provide health insurance for low-income individuals or families, military personnel and their dependents, or military veterans under 65 years of age. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Government-Funded Health Care, p. 4. Chapter 1: Concepts and Trends in Healthcare - Page 4
Future healthcare policy in the United States will be significantly affected by a population that is: aging and becoming more culturally diverse. becoming sceptical about conventional medicines reliance on pharmaceuticals and surgery. becoming more knowledgeable about nutrition and more likely to undertake dietary changes. aging and includes a higher percentage of people with addictions.
Correct response: aging and becoming more culturally diverse. Explanation: The healthcare system will continue to respond to changes in the demographics and cultural diversity of the population. It is predicted that the percentage of people older than 65 years will exceed 20% of the U.S. population by 2030. Popular skepticism about conventional medicine, increased nutritional knowledge, and increased incidence of addiction may be factors, but are not major issues related to future health care policy. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Future Trends and Goals for Health Care, p. 8. Chapter 1: Concepts and Trends in Healthcare - Page 8
Traditionally, private insurance, self-insurance systems, and Medicare paid for healthcare. Healthcare costs were calculated by each procedure, test, etc. performed, which encouraged unneeded testing and procedures to increase collected fees. Medicare implemented cost controlling strategies in 1983. What system is used to classify clients with similar diagnoses? diagnosis-related groups prospective payment system Medicare Medicaid
Correct response: diagnosis-related groups Explanation: One classification system for services uses diagnosis-related groups (DRG) to group services for clients with similar diagnoses. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Prospective Payment Systems, p. 5. Chapter 1: Concepts and Trends in Healthcare - Page 5
In an attempt to control escalating healthcare costs, Medicare implemented strategies in 1983 that included a system that classifies inpatient hospital services into categories based on the client diagnosis. This classification scheme is known as: diagnosis-related groups. prospective payment system. fee-for-service scales. retrospective payment system.
Correct response: diagnosis-related groups. Explanation: Diagnosis-related groups (DRGs) are used to group services for clients with similar diagnoses. A prospective payment system is a reimbursement scheme based on predetermined fixed rates; it is not the classification system. Fee-for-service scales assign certain payments to particular services or procedures; they are not the classification system. A retrospective payment system is a reimbursement scheme in which fees are determined after services are rendered; it is not the classification system. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Prospective Payment Systems, p. 5. Chapter 1: Concepts and Trends in Healthcare - Page 5
A nurse is a member of which entity within the larger health care environment? health care team health care delivery system health maintenance organization physician hospital organization
Correct response: health care team Explanation: The healthcare team includes nurses, physicians, pharmacists, psychologists, social workers, healthcare administrators, and various other health professionals, such as physical therapists. The healthcare delivery system is the entire range of services available to clients. A health maintenance organization is a type of managed care insurance plan. A physician hospital organization is a corporate structure involving a hospital and groups of physicians. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health Care Providers, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
While managing healthcare costs is an admirable goal, what is an unintended consequence of such measures? increased acuity levels in non-critical care settings decreased nurse/client ratios increased number of hospitals increased quality of care
Correct response: increased acuity levels in non-critical care settings Explanation: As a result of managed care's influence, many regions are left with fewer, not more, hospitals; higher, not lower, nurse/client ratios; and higher client acuity levels in general medical-surgical units, skilled nursing facilities, long-term care facilities, and home health settings. This sets the stage for a decrease, not an increase, in the quality of care. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Effects of Cost-Driven Changes, p. 6. Chapter 1: Concepts and Trends in Healthcare - Page 6
The nurse has been asked to speak to members of a self-care education program. What topic would the nurse most likely address? adequate prenatal care government advocacy and lobbying judicious use of online communities management of illness
Correct response: management of illness Explanation: Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health and Wellness, p. 2. Chapter 1: Concepts and Trends in Healthcare - Page 2
A nurse plans a conference to discuss the care plan for an infant admitted to the hospital with a diagnosis of nonorganic failure to thrive. Appropriate participants in the care conference include the: registered nurse (RN), physician, social worker, and infant's parents. social worker, RN, occupational therapist, and dietitian. infant's primary caregiver, RN, physician, and occupational therapist. registered dietitian, RN, physician, and infant's primary caregiver.
Correct response: registered dietitian, RN, physician, and infant's primary caregiver. Explanation: The registered dietitian, RN, physician, and infant's primary caregiver are crucial interdisciplinary team members who should participate in this care conference. The dietitian can address nutritional needs. The primary caregiver can provide input. The social worker and occupational therapist may become involved after the infant's condition improves, but they aren't crucial members of the team at this point.
A client was discharged from the hospital 3 weeks ago following surgery and has now been contacted to complete the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey will primarily address the client's: recovery and rehabilitation following discharge. satisfaction with the care he or she received in the hospital. experiences with community health nurses following discharge. health status at the current time.
Correct response: satisfaction with the care he or she received in the hospital. Explanation: Most items on the HCAHPS survey measure patients' satisfaction with the quality of the nursing care they receive in the hospital, not their health status or care postdischarge. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Measures of Quality of Care, p. 8. Chapter 1: Concepts and Trends in Healthcare - Page 8
A client presents with a family history of heart disease and is in need of further testing. Which category represents the appropriate referral for a facility that performs cardiac catheterization? secondary care primary care tertiary care palliative care
Correct response: secondary care Explanation: Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis as well as emergency and acute care interventions. Primary care is the initial contact with a client, often provided by a family practitioner. Tertiary care is provided in hospitals where more complex interventions are available. Palliative care is provided for pain relief and client comfort; it does not affect the course of an illness. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health Care Delivery System, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
A client presents with a family history of heart disease and is in need of further testing. Which of the following facilities might be the appropriate referral for cardiac catheterization? secondary care primary care tertiary care none of the options is correct
Correct response: secondary care Explanation: Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health Care Delivery System, p
To address the needs of a chronically ill patient and promote the concept of wellness, a nursing care plan should outline steps to: Inform the patient about all the possible complications of the disease process. Encourage positive health characteristics within the limits of the disease. Restrict most activities to protect the patient from additional deterioration. Encourage activity, beyond the scope of tolerance, to prevent progressive deterioration.
Encourage positive health characteristics within the limits of the disease. Explanation: Those with chronic illnesses do have the potential to attain a high-level of wellness within the limits of their disability or illness. The focus of nursing care should be to emphasize a positive approach to coping with the illness. Therefore, the best approach for nursing care is to encourage appropriate health behaviors, promote a sense of hopefulness, and help the patient recognize when his or her limits have been reached. Discussing possible negative complications is not relevant. Also, promoting unnecessary restrictions or activities beyond a patient's ability is not necessary. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, The Health-Illness Continuum, pp. 2-3. Chapter 1: Concepts and Trends in Healthcare - Page 2-3
The nurse is developing a plan of care for a client admitted with chronic obstructive pulmonary disease. Using the Maslow hierarchy of needs, which nursing diagnosis should the nurse give the highest priority? Activity intolerance Situational low self-esteem Toileting self-care deficit Ineffective airway clearance
Ineffective airway clearance Explanation: After nursing diagnoses have been developed, the nurse assigns priorities based on the urgency of the problem. The Maslow hierarchy of needs is one framework the nurse can utilize to prioritize needs. Using the Maslow hierarchy of needs, maintaining a patent airway would have the highest priority since it satisfies a basic physiologic need. Activity intolerance, self-esteem, and inability to toilet oneself are all important problems but would be handled after clearing the airway has been addressed and oxygenation and perfusion have been assured. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Health Care Providers, p. 3. Chapter 1: Concepts and Trends in Healthcare - Page 3
A nurse working within an integrated delivery system benefits from the fact that nurses working within a network: have greater ability to take an active role in patient advocacy. can delegate all care to unlicensed assistive personnel. remain in their traditional role. None of the options are correct.
have greater ability to take an active role in patient advocacy. Explanation: Nurses have greater ability to take an active role in advocating for high-quality, nurse-provided care within an integrated delivery system. Reference: Donnelly-Moreno, L.A., Timby's Introductory Medical-Surgical Nursing, 13th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: Concepts and Trends in Healthcare, Effects of Cost-Driven Changes, p. 7. Chapter 1: Concepts and Trends in Healthcare - Page 7
