Exam 3 Questions

1. What is the purpose of implementing total quality management? a. To provide quality care within an organization b. To provide cost-efficient care across all age groups c. To provide necessary care to clients in a cost-effective system d. To provide efficient systems of primary care

A

13. An example of a voluntary approach to quality control used primarily for institutions is: a. Accreditation b. Licensure c. Certification d. Credentialing

A

16. A staff development program to teach nurses and other providers about how to reduce risk by properly documenting interventions provided is an example of which level of prevention? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quality care

A

8. Which organization monitors implementation of the prospective reimbursement system for Medicare clients? a. Professional Review Organizations (PROs) b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) c. National Health Quality Improvement Act d. Diagnostic Related Groups (DRGs)

A

2. Which statement about records is true? Select all that apply. a. Records provide complete information about the client. b. Records resolve legal issues in malpractice suits. c. Records provide information for education and research. d. Records allow anyone interested in a clients progress to view a chart.

A, B, C

1. In which situations would a nurse use a clinical practice guideline? Select all that apply. a. When recommending the administration of the influenza vaccination to a client b. When creating agency policies and procedures c. When developing a program targeting obesity prevention d. When researching interventions that would improve care for a tuberculosis client

A, C, D

A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case

ANS: A A suspected case is a clinically compatible case of illness without isolation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation. A prolonged case and identified case are not types of cases discussed in the text.

5. A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled homebound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. The ethical dilemma faced by the case manager is: a. beneficence. b. justice. c. nonmaleficence. d. veracity.

ANS: A Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goal of containing costs supersedes the case manager's duty to improve health and relieve suffering. This ethical tenet of nursing practice to act in the best interest of the client also involves fidelity to the nurse-client trust relationship. Duty to clients to secure benefits on their behalf and to limit unnecessary expenditures can create dilemmas when the goals are not uniform. Advocacy on this client's behalf with accurate and updated information based on sound assessment, evidence-based practice, and liability risk management could produce a favorable outcome for all parties. The incorrect action would be to do nothing.

2. During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. The case manager's most logical next step would be to: a. assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services. b. call the client, reintroduce himself or herself, and explain his or her role as a case manager for homebound clients. c. discuss with the family their schedule of availability to offer care in the client's home; ensure that the client has daily visits by family members. d. investigate the availability of local support and rehabilitation services for clients with congestive heart failure; contact the client's family.

ANS: A Case management has been described as a set of logical steps and process of interaction within a service network that ensures that a client receives needed services in a supportive, effective, efficient, and cost-effective manner. The National Case Management Task Force defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual's needs, using communication and available resources to promote quality cost-effective outcomes. Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care they need to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers (broker). If necessary services or equipment is not covered by insurance, the nurse may act as an advocate (facilitator) and connect the client with other resources in the community (coordinator) if available.

7. In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. These statements relate to the sequential process of: a. collaboration. b. communication. c. cooperation. d. negotiation.

ANS: A Collaboration is achieved through a developmental process carried out in a sequence, yet it is reciprocal among those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required for all aspects. Synergy among all parties involved is required. Although communication is essential to collaboration, it is not sufficient to create or maintain collaboration.

3. A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be: a. cost studies. b. Mobilizing for Action through Planning and Partnerships (MAPP) model. c. Planning Approach to Community Health (PATCH) method. d. Tracer method.

ANS: A Cost studies are essential to show the value of nursing in the marketplace now and in the future. All cost studies involve three major tasks: financial, research, and statistical. The financial tasks include identifying total program costs. The statistical tasks include identifying appropriate, quantifiable measures for analyzing data. The research tasks include setting up an appropriate study design to answer questions about benefit, efficiency, or effectiveness. Types of cost studies include cost-accounting, cost-benefit, cost-effectiveness, and cost-efficiency studies.

6. The nurse engaging in a formative program evaluation would most likely: a. conduct medical record audits for quality assurance. b. make a home visit before a client is discharged from the program. c. participate in a new client evaluation. d. write a policy for risk management.

ANS: A Process evaluation, also referred to as formative evaluation, occurs during program implementation and makes it possible to make midterm corrections to ensure the achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it will address the efficiency and effectiveness of the program in meeting its goals. Quality assurance programs are examples of program evaluation in health care delivery.

3. A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? a. Consultant and coordinator b. Mentor and liaison c. Monitor and reporter d. Standardization monitor and negotiator

ANS: A The case manager is responsible for fulfilling a variety of roles. The nurse is acting as a consultant when working with suppliers to arrange for the apnea monitor. The nurse is acting as a coordinator when arranging for needed heath care services such as daily home visits by a specially trained pediatric registered nurse.

7. Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse (PHN) determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: a. cost-benefit analysis. b. cost-efficiency analysis. c. relevance assessment. d. school records audit.

ANS: A The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriate sex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors. To perform a cost-benefit study, the evaluator must decide which costs and which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.

7. What are the five "rights" of case management? a. Care, time, provider, setting, price b. Patient, medication, route, time, documentation c. Place, setting, patient, plan, outcomes d. Disease process, time, place, beneficence, advocate

ANS: A Care, time, provider, setting, and price are used to judge the effectiveness of case management

What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated b. Who is to blame for a disease outbreak c. What shelters will be used and by whom d. How political action will be necessary to ensure public health

ANS: A Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

3. A patient with a long history of asthma with many hospital admissions is referred to a case manager to assist in the management of her disease. Disease management targets: a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring

ANS: A Disease management activities target chronic and costly disease conditions that require long-term care interventions. The other answers are false and/or describe other types of management.

A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

ANS: A In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

5. Why must a nurse who is using population management be able to work with integrated care delivery systems? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary.

ANS: A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false.

Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs

ANS: A One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

16. The public health nurse working with the chronically ill and families with young children needing age-specific health maintenance is using which model of case management? a. Client-focused b. System-focused c. Social service d. Long-term care

ANS: A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care.

What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases? a. Some diseases were underreported and others were overreported. b. There was no central office to collect data. c. Some people refused to notify officials when diseases were seen. d. No one knew where to report the information that was collected.

ANS: A The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

20. The process of moving conflicting parties toward an outcome is called: a. Negotiation b. Conflict management c. Problem-purpose expansion method d. Brainstorming

ANS: A The process of moving conflicting parties toward an outcome is called negotiation.

17. In case management, the process of performing interdisciplinary, family, and client conferences would occur during which phase of the nursing process? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation

ANS: B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams.

10. Which of the following are the major sources of information for program evaluation? (Select all that apply.) a. Community indices b. Media reports c. Program clients d. Program providers e. Program records

ANS: A, C, E Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiologic data).

8. The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: a. cost-benefit analysis. b. cost-effectiveness analysis. c. cost-efficiency analysis. d. Multi-Attribute Utility Technique.

ANS: B An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).

9. The insurer's risk manager has informed an independently contracted case manager that a liability risk related to experimental treatment and technology was identified in a recent recommendation made by the case manager. Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? a. Inappropriately recommending that treatment be curtailed when treatment was actually needed b. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy c. Substituting the case manager's clinical judgment for that of the insurer's medical director d. Upcoding intensity of care or intervention requirements

ANS: B For case managers, liability concerns exist when three conditions are met: (1) the provider had a duty to treat (i.e., provide reasonable care); (2) a breach of contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology, breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply the contractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document between the insurer and the insured.

4. When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: a. finding the lay leaders in the community. b. identifying the target population's health problems and needs. c. outlining the major causes of mortality in the community. d. prioritizing the community's problems.

ANS: B The program management process is parallel to the nursing process and consists of a rational decision making system designed to help nurses know when to make a decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

2. A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? a. Community forum b. Focus group c. Indicators approach d. Survey

ANS: B There are several types of needs assessment tools, including community forums, focus groups, key informants, indicators approach, survey of existing agencies, and general surveys. Both community forums and focus groups are low-cost tools. The focus group provides clients with the opportunity to participate in identification of needs and can help increase community support for a program. The focus group method has several disadvantages, such as being time consuming to carry out and tending to focus on irrelevant or political "hot button" issues. Leading focus groups requires strong skills in group process to maintain the focus of the group.

The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. Which of the following terms describes what happened? a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic

ANS: B A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly acquired early in life.

27. Which principle of justice is influenced when excessive attention to cost containment impairs the nurse's duty to provide measures to improve health? a. Autonomy b. Beneficence c. Confidentiality d. Justice

ANS: B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering.

1. An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is called: a. Case management b. Care management c. Advocacy d. Continuity of care

ANS: B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population.

23. The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, "Tell me more about how you will work full time and breastfeed." Asking this question is an example of which aspect of the advocacy process? a. Verification b. Clarification c. Amplification d. Affirmation

ANS: B Clarification is a process in which the nurse and client strive to understand meanings in a common way.

A nurse is conducting disease surveillance. Which of the following describes the rationale for this action? a. To eradicate a disease before it starts b. To establish a baseline rate of disease occurrence and patterns of spread c. To target populations for triage d. To reduce the incidence of heart disease in a community

ANS: B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

29. A case manager submits documentation that a nursing visit was completed at a client's home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security

ANS: B Fraud/abuse occurs when false statements of claims are made and filed.

A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

ANS: B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

6. Which activity would a nurse engage in when using population management? a. Census taking to determine the total number of people in the population b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually

ANS: B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors.

Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of disease d. Cases of the common cold and pneumonia

ANS: B Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

26. The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy. The parents are deciding if "spanking" the child is a disciplinary method that they will employ. The mother says, "I do not believe in spanking. I see it as abusive and demeaning." The mother's statement is an example of: a. Cooperation b. Assertiveness c. Bargaining d. Collaboration

ANS: B The mother's statement is an example of assertiveness, the ability to present one's own needs.

18. A nurse is working with a team to learn more about what its most important accomplishments have been and to identify what changes are desired. What is the best method to use to accomplish this task? a. Compare job descriptions. b. Analyze mission and goals. c. Brainstorm. d. Develop charts and diagrams.

C

A person has returned from overseas and it is determined that he has Q fever. Which of the following must occur? a. This is not a disease that is on the notifiable list; nothing need be reported. b. The case must be reported to the state and local health departments. c. The patient must be isolated immediately. d. The patient will probably die, so it is not reportable.

ANS: B Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or probable death.

24. Upholding a client's right to make a choice and to act on the choice involves: a. Affirming b. Supporting c. Informing d. Decision making

ANS: B Supporters approve and support clients' actions.

9. Which are examples of knowledge domains used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning and legislative change d. Grant application, bargaining contracts, and securing funding

ANS: B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research.

13. When case managers provide a formal communication link among all parties concerning the plan of care management, they are assuming the role of: a. Facilitator b. Liaison c. Coordinator d. Negotiator

ANS: B The case manager provides a formal communication link among all parties concerning the plan of care management is performing the role of liaison.

11. The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of: a. Broker b. Negotiator c. Liaison d. Facilitator

ANS: B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator.

A nurse is applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance. Which of the following describes the initial action that the nurse would take? a. Analyze data b. Consider whether surveillance is appropriate to the situation c. Evaluate the impact of the surveillance d. Collect data

ANS: B The first step in this model considers whether the surveillance was appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model

8. Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client-focused b. System-focused c. Social service d. Long-term care

ANS: B The system-focused model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations.

6. A community health nurse involved in care management would most likely: a. develop, conduct, and evaluate health teaching programs in primary care. b. manage the staff at a free clinic. c. monitor the health status, resources, and outcomes for an aggregate. d. provide immunizations to migrant workers.

ANS: C Care management is a continuing process in which a case manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or group.

1. Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: a. applying for grants. b. identifying clients and soliciting board members' support. c. identifying resources, activities, and needs. d. increasing the visibility of the program.

ANS: C Community health program planning is population focused and puts the well-being of the public above private interests. Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.

9. The nurse program manager is determining the direct client care costs as well as the cost of indirect nursing activities for home visits for a home health agency. Analysis of this information along with nursing workload information and client needs can best provide an agency evaluation measure for: a. program decision making. b. cost-effectiveness. c. cost-efficiency. d. perceived value.

ANS: C Cost-efficiency analysis determines the actual cost of performing a number of program services, both direct and indirect, by addressing the productivity of the workforce in achieving specific objectives. The relationship between direct and indirect activities, workforce, caseloads, client needs, and actual costs determines the productivity of the program.

5. A nurse who is the program director for a new antismoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? a. Cost-benefit analysis b. Perspectives on the program c. Plan for the evaluation process d. Process evaluation

ANS: C When the planning process begins, the plan for evaluating the program should also begin. Everyone who will be involved in implementing a program should be given the opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and the program is designed, the nurse must continue plans for program evaluation, such as ongoing process evaluation (formative evaluation) and summative evaluation.

2. When would a nurse use a critical path? a. When implementing the five "rights" of case management b. When demonstrating competencies required for practicing case management c. When attempting to achieve a measurable outcome for a specific client d. When effectively managing conflict resolution

ANS: C A critical path is a case management tool used to achieve a measurable outcome for a specific client case.

A college student goes to the Student Health Center with an extremely swollen neck. The advanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. Which of the following defines these two students? a. Mixed outbreak b. Common source c. Point source d. Propagated outbreak

ANS: C A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

A large amount of data related to hypertension rates is collected in a community. The data is analyzed. Which of the following describes the next step in the surveillance process? a. Collecting data from multiple valid sources b. Evaluating the impact on the surveillance system c. Interpreting the data and disseminating it to decision makers d. Asking political officials to finance a hypertension clinic

ANS: C After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the impact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

What does each state do with the information that it receives about notifiable diseases? a. Uses the information for surveillance purposes b. Reports the information to the local branch of the World Health Organization (WHO) c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC) d. Does nothing with the information

ANS: C Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.

A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia

ANS: C Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of ventilator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

12. When working with a client, when would it be most appropriate for a nurse to use life care planning? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care

ANS: C Life care planning is a customized, medically-based document that provides assessment of present and future needs.

22. Mutual benefit with limited loss for everyone is a goal of: a. Negotiating b. Assertiveness c. Conflict management d. Cooperation

ANS: C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal.

A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidence-based protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community

ANS: C Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

21. When developing a quality improvement program, what is the most important aspect of the program that should be considered? a. Vision and values of the agency b. Standards used to provide care c. Results of nursing care d. Evaluation of process changes

C

19. A case manager supports a client's decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which phase of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation

ANS: C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client's decisions.

25. An individual who pursues neither his or her concerns nor another's concerns is using which conflict management behavior? a. Accommodating b. Collaborating c. Avoiding d. Compromising

ANS: C The individual would be "avoiding."

10. Which case management activity would most likely be implemented by a bachelor's prepared nurse rather than an advanced practice nurse (APN)? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes

ANS: C Working with community aggregates, systems of disease, and outcomes management processes are implemented by an APN.

1. A home health case manager is charged with identifying opportunities for health promotion and illness prevention. The fulfillment of this charge would best be demonstrated when the case manager: a. collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. b. refers a new diabetic client to a nutrition counselor for dietary teaching. c. teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. d. tracks the immunization status of clients and facilitates access to immunization when needed.

ANS: D Case management involves assessment—in this case, screening—and arrangement for delivery of services. Primary prevention includes case management to identify at-risk clients and arrange for services to prevent disease. Through nurse management activities, general community deficiencies in the quality or quantity of health services are often discovered. Case management activities with individual clients and families will reveal the broader picture of health services in and health status of the community. Community assessment, policy development, and assurance activities that frame the core functions of public health actions are often the logical next step in the nurse case manager's practice to intervene at the community level to make changes. Therefore, the core components of case management and the nursing process are complementary. The nursing process function of assessment is complementary to the case management process function of case finding and includes such activities as applying screening tools according to program goals and objectives.

8. Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has developed indications of advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. The nurse is demonstrating a knowledge of the strategic process of: a. advocating. b. clarifying. c. cooperating. d. negotiating.

ANS: D Techniques for conflict management involve a range of active communication skills. These skills are directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching the goal of mutual benefit with limited loss. Negotiating is a strategic process used to move conflicting parties toward an outcome and has several stages that allow the parties to develop trust, credibility, and distance from the issue, while retaining personal dignity. All of these factors are important when attempting to move parties toward the creation of new solutions or options through relearning, brainstorming, reflective thinking, and problem-purpose-expansion techniques (systematic problem solving approaches).

4. A community health nurse is the case manager for a homebound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? a. Assessment and planning/outcome b. Diagnosis and planning c. Implementation d. Planning/outcome

ANS: D The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursing process.

What occurs during biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins

ANS: D An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

21. The first stage of collaboration is: a. Trust building b. Consensus c. Collegiality d. Awareness

ANS: D Awareness is when one makes a conscious entry into a group process.

15. Which are examples of case-managed conditions? a. Bankruptcy, financial distress, depression b. Flu, colds, frequent headaches c. Malaria, bird flu, Dengue fever d. AIDS, spinal cord injury, ventilator dependency

ANS: D Case-managed conditions include many chronic conditions.

4. Which type of management would be most appropriate for a nurse to use when helping clients improve their health status? a. Utilization management b. Case management c. Disease management d. Demand management

ANS: D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system

What information is included in a case definition? a. The precise point of contact b. Laboratory confirmation c. Source of contamination d. Clinical symptoms

ANS: D Each case has a unique set of criteria based on what is known about the particular disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

28. Which ethical principle is influenced when care in a managed system is provided by less-experienced providers? a. Autonomy b. Beneficence c. Confidentiality d. Justice

ANS: D Justice calls for equal distribution of health care with reasonable quality.

A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children b. Teach parents that obesity will not be tolerated in this community c. Educate children on surveillance techniques d. Demonstrate that new clinical and effective protocols need to be developed

ANS: D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

18. When the case manager contacts providers and negotiates services and price, which phase of the nursing process is used? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation

ANS: D The implementation phase of the nursing process occurs when a case manager advocates for clients' interests and arranges for the delivery of service.

14. Which nursing intervention does the case manager implement when fulfilling the role of coordinator? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client

ANS: D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client's situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator, and supporting all parties to work toward mutual goals is the role of facilitator

A nurse is collecting morbidity data. Which of the following would be the source that the nurse would use? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries

ANS: D There are many sources of morbidity data (rate of disease incidence), including specialized disease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

A nurse is investigating a potential bioterrorism attack. Which of the following evidence would a nurse find if a bioterrorism attack occurred? a. A large number of cases of influenza b. A case of cholera in a local politician following a trip to India c. Dengue fever in a group of students who just returned from a mission trip d. An unusual illness in a population

ANS: D Unusual illness in a population should trigger an investigation that may signal a covert bioterrorism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

12. A nurse implements the Institute of Medicines definition of quality health care when providing care that is: a. Licensedall health care workers must have a license b. Safeavoiding injuries to patients from the care intended to help them c. Timelyno waiting or delay for health care d. Innovativenew innovations must be used when they become available

B

19. Which action would a nurse take when using the specific approach to quality improvement? a. Evaluate an agencys ability to meet criteria or standards. b. Implement the plan/do/check/act cycle. c. Provide care to individual citizens. d. Use criteria set forth by regulatory agencies.

B

23. A nurse records the number of clients seen daily as well as the mode of transportation and miles driven. What type of record is being used? a. Clinical record b. Provider service record c. Financial record d. Central index system

B

4. How can public health nurses provide the core function of assurance to the community? a. By providing the same services to all citizens b. By maintaining quality in the public health workforce c. By eliminating low-quality services d. By contracting with outside agencies to evaluate effectiveness

B

7. A public health agency is transitioning from a traditional management model for quality assurance to a total quality management (TQM) approach. What change will occur within the agency? a. Increased administrative authority b. Increased participation by all staff c. Additional focus on quality assurance d. Specialized accountability for services provided

B

10. A student has obtained a Bachelor of Science in Nursing degree. Why must the student be licensed as a registered nurse before beginning practice? a. To formally recognize the student as a competent professional b. To define the scope of professional practice c. To control the quality of professional practice d. To establish standards for educational programs

C

14. When a nurse assesses the necessity of receiving care before providing services, it is called a: a. Concurrent audit b. Retrospective audit c. Prospective utilization review d. Retrospective utilization review

C

15. An elderly female client was receiving home care after hospitalization for a cerebrovascular accident. After several weeks of physical and speech therapy, the client showed few signs of progress. The utilization review committee considered the clients condition to be stable and declined reimbursement for further home care. This client may reverse the decision through a process called: a. Development of explicit criteria b. Appeal mechanism c. Concurrent utilization review d. Medicare reversal process

C

22. While implementing Plan-Do-Check-Act, which action is the nurse most likely to perform? a. Documentation of client care b. Obtain certification in a specialty area c. Review data after changing practice d. Provide equal access to care

C

3. What is one performance area where quality improvement is used to effect process and outcomes of health care? a. Provision of appropriate and effective care b. Elimination of access barriers c. Reduction of unjustified geographic variation in care d. Application of managed care to all citizens

C

5. Which statement about the quality assurance process is accurate? a. Processes are implemented to maintain quality. b. Community needs are assessed while implementing quality programs. c. Accountability of the provider is the primary concern. d. Standards for care are established and evaluated.

C

11. A nurse is given formal recognition as a professional with technical competence in a certain area of nursing practice. This is known as: a. Licensure b. Accreditation c. Registration d. Credentialing

D

17. A nurse is using a concurrent audit to review documentation following home health visits. Why is this type of audit most appropriate in this situation? a. It is less costly than a retrospective audit. b. It represents the total picture of care that the client receives. c. It provides more accurate data for planning corrective action. d. It identifies problems at the time that care is given.

D

2. What is the purpose of the National Health Quality Report (NHQR)? a. To report on the Agency for Healthcare Research and Qualitys goals for the year b. To describe the yearly activities of the agency c. To ensure national quality of services d. To document if health care quality is stable, improving, or declining over time

D

20. A quality assurance manager does an audit and six months later returns to see if the problem has been eliminated. This step: a. Involves selecting explicit criteria for quality care b. Includes the review of records c. Requires a peer review of all cases that do not meet criteria d. Completes the audit process

D

24. Which type of record is most appropriate to use when profiling the clients who are served by an agency as well as documenting services requested and provided? a. Clinical record b. Provider service record c. Financial record d. Central index system

D

6. A nurse is concerned that there is an overuse of services by clients receiving care from a local physician. What is occurring in this situation? a. Treatment decisions are made conservatively. b. Disability and mortality are being reduced. c. Disparities in quality of care provided are increasing. d. Unnecessary tests, surgeries, and treatments are being ordered.

D

9. Which resource would a public health nurse measuring quality assurance in the 1960s most likely have used? a. American Nurses Association Standards of Practice b. Joint Commission of Accreditation of Hospitals Nursing Audit Criteria c. Community Health Nursing Practice Standards d. Phaneuf nursing audit method

D