NU 270 Health Care Systems/Health Care Organizations

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Palliative care provides relief from pain and other distressing symptoms." "Palliative care affirms life and regards dying as a normal process." "Hospice care programs focus on quality rather than length of life." "In hospice care, the nurses make most of the care decisions for the clients."

"In hospice care, the nurses make most of the care decisions for the clients." Explanation: The philosophy of hospice is that clients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting clients with a life expectancy of 6 months or less, rather than years, and their families. However, palliative care may be given at any time during a client's illness, from diagnosis to end of life.

The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished? "This inpatient surgical procedure requires me to be at the hospital the morning of surgery." "I will talk with the anesthesiologist about anesthesia." "The provider will perform this laser surgery in an ambulatory care setting." "I will plan to be hospitalized several days following the procedure." Exit quiz

"The provider will perform this laser surgery in an ambulatory care setting." Explanation: Tattoos are often removed via laser surgery in an ambulatory setting. This type of outpatient procedure does not commonly require anesthesia, nor hospitalization.

Which six trends in health care reflect the Institute of Medicine's (IOM) focus? "The system should be safe, effective, efficient, patient centered, timely, and equitable." "The system should be safe, efficient, centralized, wellness promoting, government driven, and patient centered." "The system should be static, reliable, timely, equitable, efficient, and illness focused." "The system should be flexible, patient centered, bureaucratic, timely, safe, and efficient."

"The system should be safe, effective, efficient, patient centered, timely, and equitable." Explanation: A safe, effective, efficient, patient-centered, timely, and equitable system is what the IOM envisions. A bureaucratic, government-driven, illness-focused system is not advocated by the IOM.

Which client is the most appropriate candidate for outpatient care? A client who is receiving treatment for sepsis after their blood culture came back positive. A woman who has previously borne two children and is entering the second stage of labor. A client with a history of depression who is currently expressing suicidal ideation. A client whose reports of irregular bowel movements have necessitated a colonoscopy.

A client whose reports of irregular bowel movements have necessitated a colonoscopy. Explanation: Outpatient services are appropriate for those who are medically stable but require diagnostic testing, such as a colonoscopy. Clients who are in active labor, have sepsis, or are suicidal require close monitoring and frequent interventions that can be safely provided only on an inpatient basis.

Which client is the most appropriate candidate for outpatient care? A woman who has previously borne two children and is entering the second stage of labor. A client who is receiving treatment for sepsis after their blood culture came back positive. A client with a history of depression who is currently expressing suicidal ideation. A client whose reports of irregular bowel movements have necessitated a colonoscopy.

A client whose reports of irregular bowel movements have necessitated a colonoscopy. Explanation: Outpatient services are appropriate for those who are medically stable but require diagnostic testing, such as a colonoscopy. Clients who are in active labor, have sepsis, or are suicidal require close monitoring and frequent interventions that can be safely provided only on an inpatient basis.

What is the priority assessment for the nurse when developing a plan of care for a client living in poverty? Access to care Access to financial assistance Access to affordable housing Access to health insurance

Access to care Explanation: Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.Democratic Explanation: The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.

The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care? Better patient outcomes Higher nurse retention Improved job satisfaction scores Longer patient stays

Better patient outcomes Explanation: Magnet® hospitals have better patient outcomes than facilities without the recognition. Magnet® hospitals have higher nurse retention and job satisfaction scores, but these do not have a direct effect on client care. Magnet® hospitals have shorter, not longer, patient stays.

A new nurse is considering getting a job in either an acute care setting or a home care setting. Which statement about these care settings is most accurate? Good communication skills are unnecessary in the home care setting. Clients are encouraged to help each other in the acute care setting. Nurses work more as team members in the home care setting. Clients play a large role in helping themselves in the home care setting.

Clients play a large role in helping themselves in the home care setting. Explanation: In nursing practice in the hospital, client needs include physiologic monitoring, complete or partial personal care, exercise, nutritional support, pain management, treatment and medication administration, anticipatory guidance, counseling, and education, which requires the complexity of health care teams. Nurses are involved in a variety of teams and care needs are complex. Clients are not encouraged to help each other in the acute care setting. Because of the trend toward shorter lengths of stay, the clients are discharged to home, where they may be more involved in helping meet their own care needs. Communication skills are critical in both the acute care and home care settings.

Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role? Identifying individuals who are at risk of developing diabetes mellitus Collaborating with all agencies to provide for the client's home health needs Verifying that all documentation is updated prior to surgery Providing client education related to colostomy care

Collaborating with all agencies to provide for the client's home health needs Explanation: As the various components of the ACA are phased in, nurses have begun to play an influential role in the implementation of new health policy. The newest opportunity is collaborating with all agencies to provide for the client's home health needs. Nurses have already been involved in screening individuals for type 2 diabetes mellitus and providing postoperative teaching for ostomy care. Nurses recheck paperwork for consent prior to surgery, but this is not just limited to nurses. Other health care providers also review consent prior to surgery.

A nurse is helping clients access the health insurance marketplace. What is the goal of this health insurance coverage concept? Insurance assistance for women and children Comparison of available health care plans Insurance coverage for people needing orphan drugs Insurance for older adults

Comparison of available health care plans Explanation: The health insurance marketplace was designed to help people more easily find health insurance that fits their budget. Every health insurance plan in the new marketplace must offer comprehensive coverage, from doctors to medications to hospital visits. People can compare all their insurance options in terms of price, benefits, quality, and other features that may be important to them, in plain language that makes sense. Plans available on the marketplace are for people of all ages and genders, not just older people, women, or children. Providing insurance coverage specifically for people needing orphan drugs is not a goal of the marketplace.

The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and physicians is exhibiting what style of leadership? Transactional Laissez-faire Democratic Autocratic

Democratic Explanation: The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.

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

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

According to the Joint Commission, which of the following is a focus of assessment related to quality of pain? Period of time pain has existed Site of pain Rating for present pain Description in the client's own words

Description in the client's own words Explanation: The focus of pain assessment is the description in the client's own words.

A nurse is conducting a community education class on genetics. The nurse sees that the class understands the information when they say that the Human Genome Project involved sequencing of which of the following? Role of DNA in cancer Genetic control of cell function Entire human genetic complement Patterns of inheritance

Entire human genetic complement Explanation: The nurse sees that the class understands the information when they identify that the Human Genome Project involved sequencing of the entire human genetic complement. Reference:

After reading about an international effort organized to develop a map to link genetic variations and complex diseases, a client asks the nurse what this effort is called. What is the nurse's best response? Endonucleases Codons Polymorphisms HapMap

HapMap Explanation: The nurse should reply that the HapMap is the map that provides a link between genetic variations and complex diseases; it was developed in the early to mid-2000s as part of an international effort.

A nurse implements a healthcare facility's disaster plan. Which action should be performed first? Turn off all cellular phones and pagers. Instruct all essential off-duty personnel to report to the facility within 24 hours. Identify a command center at which activities are coordinated. Provide treatment for incoming clients according to time of admission.

Identify a command center at which activities are coordinated. Explanation: During a disaster, having a command center to provide direction and coordinate activities is crucial. Cellular phones and pagers may be essential communication tools during a disaster. Essential off-duty personnel should respond to a disaster as quickly as possible. Admitted clients should be triaged and treated in accordance with the facility's triage policy.

Which is the primary criterion for admission to a long-term care facility? Coexistence of multiple chronic health problems Inability to provide self-care Absence of family members locally Advanced age

Inability to provide self-care Explanation: Long-term care facilities exist to provide care for individuals who are mentally or physically unable to care for themselves independently. These individuals are frequently older, have multiple health problems, and lack family caregivers, but these factors in and of themselves are not criteria for admission to long-term care.

The father of a 5-year-old child reports that he uses a series of local urgent care centers for routine care. What is the greatest concern about this practice? Seeking routine care at this type of facility often will not be covered by health insurance. These facilities are not well versed in the care of children. It is difficult to have continuity of care with these practices. The cost of using these options for medical treatment is excessive. Exit quiz

It is difficult to have continuity of care with these practices. Explanation: The American Academy of Pediatrics discourages children and families from using urgent care centers or the emergency department for routine care, since it is difficult to provide coordinated, comprehensive family-centered care consistent with a "medical home" concept.

Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses? Laissez-faire Transformational Democratic Autocratic

Laissez-faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Autocratic leadership, also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. Transformational is often described as charismatic; transformational leaders are unique in their ability to inspire and motivate others. Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants.

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way? Part A of Medicare is voluntary and is paid for by a monthly premium. Part B of Medicare covers most inpatient and outpatient costs. Medicare pays only the amount of money preassigned to a treatment for a diagnosis. Benefits and reimbursement cannot be changed annually.

Medicare pays only the amount of money preassigned to a treatment for a diagnosis. Explanation: The implementation of DRGs by Medicare in 1983 resulted in a system in which health care providers receive a fixed payment for services provided that is predetermined by the medical diagnosis or specific procedure, rather than the actual cost of hospitalization and care. The plan pays only the amount of money preassigned to the treatment for a diagnosis. If the cost for hospitalization is greater than that assigned, the hospital must absorb the additional cost. If the cost is less than that assigned, the hospital makes a profit. Medicare is federally funded, and benefits may change annually according to decisions related to the federal budget. Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal government. Part B, which is voluntary, is paid by a monthly premium and covers most outpatient costs.

A client cannot afford the treatment prescribed. Who would be the most appropriate professional for the nurse to involve with the client's care? Nurse case manager Physician Insurance company Nurse manager

Nurse case manager Explanation: The nurse case manager is the expert on resources available for the client's care. The nurse manager is responsible for the operation of the nursing unit. The physician is concerned with the client's medical needs. The insurance company is a possible resource, if the client has insurance coverage.

Which sets professional standards of care? Provinces Professional nursing organizations Hospitals States

Professional nursing organizations Explanation: States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.

What nursing function would be most commonly found in an ambulatory care facility? Serving as an administrator or manager Assessing the home environment Providing direct client care Educating individuals or groups

Providing direct client care Explanation: Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

What nursing function would be most commonly found in an ambulatory care facility? Serving as an administrator or manager Educating individuals or groups Providing direct client care Assessing the home environment

Providing direct client care Explanation: Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

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

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

A client diagnosed with terminal leukemia is receiving home health care services to assist in the client's care. After assessing the client, the home health care nurse determines that the client is unable to afford needed medical supplies. Which is the best strategy for the nurse to implement to assist the client? Discuss the client situation with the provider for possible therapies that are more cost-conscious. Enlist the services of the client's family for some components of care, such as dressing changes and physical therapy. Refer the client to a local religious organization or non-profit agency for support. Refer the client to a social worker to determine eligibility for assistance.

Refer the client to a social worker to determine eligibility for assistance. Explanation: Social workers assist in finding and connecting the client with community resources or financial resources and provide counseling and support. A social worker is better equipped to find community resources or financial resources than a health care provider. Discussing alternative therapies with the provider may be beneficial, but typically this does not apply to some medical supplies that the client needs. Likewise, having the client's family participate in dressing changes is helpful, but will not particularly offset certain medical supplies that may be needed. Local non-profit organizations and religious organizations may be able to offer some assistance, but a social worker would be the best person to find resources and make referrals.

The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client's swallow evaluation following a cerebral vascular accident? Speech pathologist/therapist Physician assistant Occupational therapist Physical therapist

Speech pathologist/therapist Explanation: It is within the speech pathologist's/therapist's scope of practice to conduct a swallow evaluation for a client but outside the scope of the occupational therapist, the physical therapist, and the physician assistant.Access to care Explanation: Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.

Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? Most client outcomes have improved but are not at target range. Staff nurses are developing innovative solutions to problems. Nursing administration is in control of all decision-making. There is a decreased rate of retention among the nursing staff.

Staff nurses are developing innovative solutions to problems. Explanation: A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.

A nurse is working on a labor and delivery unit that requires all visitors to pass a screening protocol prior to entry. What is the nurse's priority action when a person gains access to the unit after bypassing the screening protocol? Call security personnel to remove the visitor. Stop the visitor, and ask for identification. Note the time and a detailed description of the individual. Check to make sure each neonate is with its parent.

Stop the visitor, and ask for identification. Explanation: Labor and delivery units are locked to prevent neonate abduction. All visitors should be stopped at the door, identified, and matched to a current client. If an unidentified visitor gains entry without having gone through this process, it is appropriate to stop the person to ask for identification and confirm who the visitor is there to see. Calling security, making sure that each neonate is with its parent and noting the time and a description of the individual would not be the priority actions in this case; but rather what one would do for an attempted abduction.

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

Team nursing Explanation: Team nursing is the provision of care with a nurse supervising the work of one or more aides.

A nurse refers an HIV-positive client to a local support group. This is an example of what level of preventive care? Tertiary Chronic Primary Secondary

Tertiary Explanation: Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. Referring an HIV-positive client to a local support group would be an example of tertiary preventive care. Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. The term chronic is not related to health promotion.

One of the fastest growing venues of practice for the nurse is home health care. What is the basis for the growth in this health care setting? The preference of nurses to work during the day instead of evening or night shifts The discharge home of clients who are more critically ill The chronic nursing shortage The focus on treatment of disease

The discharge home of clients who are more critically ill Explanation: With shorter hospital stays and increased use of outpatient health care services, more clients who are critically ill require nursing care 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. The chronic nursing shortage and the focus on the treatment of disease do not affect the growth in home health care, because both of these factors have no more or less of an effect on home health care than they do care provided in an acute care facility. Nurses, as a whole, do not necessarily prefer to work during the day rather than at night; some prefer to work in the day and some prefer to work at night. In any case, nurses work both day and night shifts in home health care just as in an acute care facility.

The nurse is making an initial home visit to assess a patient for home health services. Which patients most frequently require home health services? Children with chronic, debilitating disorders Young adults on prolonged intravenous therapy The frail and elderly who need skilled care Newborns who are sent home with apnea monitors

The frail and elderly who need skilled care Explanation: Older adults are the most frequent users of home care expenditures financed by Medicare, which allows nurses to manage and evaluate care of seriously ill patients who have complex, labile conditions and are at high risk for rehospitalization.

A client who is enrolled in Medicare and who has been recovering in the hospital from a stroke has developed a pressure injury on the coccyx, an event that the Centers for Medicare & Medicaid Services (CMS) has identified as a "never event." The nurse should recognize what implication of this CMS designation? CMS may choose to divert clients to other health care facilities in the future. CMS will bear the hospital's costs if the client chooses to sue the hospital. The hospital must bear any costs incurred for treating the client's injury. The hospital will be fined by CMS because the client developed a pressure injury.

The hospital must bear any costs incurred for treating the client's injury. Explanation: If "never events" occur while a client is hospitalized, the cost of the care associated with that event will not be paid by CMS, but will be borne by the hospital. Fines are not levied against the hospital, however, and CMS does not actively divert clients to other facilities. CMS does not pay damages on behalf of hospitals.

A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the dosage of atenolol to 12.5 mg. However, because the physician is late for another visit, the physician requests that the nurse write down the order for the physician. What should be the appropriate nursing action in this situation? The nurse should inform the client of the change in medication. The nurse should ask the physician to come back and write the order. The nurse should write the order and implement it. The nurse should remind the physician later to write the work order.

The nurse should ask the physician to come back and write the order. Explanation: The nurse should ask the physician to come back and write down the order. Nurses are discouraged from following any verbal orders, except in an emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.

Which of the following is a true statement regarding safety during a home visit? The nurse should take reactive measures. The nurse should park his or her car away from the home. The nurse should schedule visits according to the patient's lifestyle. The nurse should never walk into a patient's home uninvited.

The nurse should never walk into a patient's home uninvited. Explanation: The nurse should never walk into a patient's home uninvited. A plan of action should always be established in case of emergencies. The nurse should park his or her car close to the home. The scheduled visits should be only in the daylight hours.

The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit? a chemical burn a superficial or first-degree burn on the upper arm a superficial or first-degree burn on the hand a superficial or first-degree burn on the chest

a chemical burn Explanation: According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness or second-degree burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial or first-degree burn on the chest or hands does not warrant a referral to a burn unit.

A nurse is arranging for home care for clients and reviews the Medicare reimbursement requirements. Which client meets one of these requirements? a client who is not making progress in expected outcomes of care a client whose status is stabilized a client who is homebound and needs skilled nursing care a client whose rehabilitation potential is not good

a client who is homebound and needs skilled nursing care Explanation: Home care Medicare reimbursement requirements would necessitate the client meet the following qualifications: the client is homebound and still needs skilled nursing care, rehabilitation potential is good (or the client is dying), the client's status is not stabilized, and the client is making progress in expected outcomes of care.

Which intervention is an example of primary prevention? obtaining a Papanicolaou (Pap) test to screen for cervical cancer administering a measles, mumps, and rubella immunization to an infant using occupational therapy to help a client cope with arthritis administering digoxin to a client with heart failure

administering a measles, mumps, and rubella immunization to an infant Explanation: Immunizing an infant is an example of primary prevention, which aims to prevent health problems. Administering digoxin to treat heart failure and obtaining a Pap test for screening are examples of secondary prevention, which promotes early detection and treatment of disease. Using occupational therapy to help a client cope with arthritis is an example of tertiary prevention, which aims to help a client deal with the residual consequences of a problem or to prevent the problem from recurring.

A nurse mentoring second-year nursing students from a community college plans clinical experiences for them. These students will most likely graduate in which time frame? in 2 more years in 1 more year at the end of the year in 3 more years

at the end of the year Explanation: Nursing students from a community college are most likely students attempting to obtain an associate degree, which is a 2-year program. Therefore, the nurse should plan clinical experiences for students who will most likely graduate at the end of the year, as this is their second year.

A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses also face unique issues and challenges. What is one of the unique aspects of community-based nursing? autonomous action disease-oriented teamwork less holistic focus

autonomous action Explanation: Community-based nursing practice is autonomous. There are often no other members of the health care team to consult, or no members within the area to consult with. Teamwork is important in community-based nursing, but it is not a unique aspect of this type of nursing. Disease orientation is the medical model of health care. Community-based nursing takes in all aspects of the client, including community aspects such as education—not just the disease process. Therefore, it is more holistic rather than less holistic.

Which tools do case managers commonly rely on to plan and coordinate client care? clinical pathways, practice guidelines, and standards of care standards of care, HIPAA regulations, and electronic medical records practice guidelines, outcome data, and staff rosters clinical pathways and drug formularies

clinical pathways, practice guidelines, and standards of care Explanation: Case managers make use of tools such as clinical pathways, practice guidelines, and standards of care to help them plan and coordinate care. Hospitals and insurance companies may develop their own or rely on published protocols for guidance. Drug formularies are not tools used by case managers in planning and coordinating care. HIPAA regulations and EMRs are not tools used by case managers in planning and coordinating care. Outcome data and staff rosters are not tools used by case managers in planning and coordinating care.

A severe winter storm has prevented most staff members from getting to work on a busy medical-surgical unit. One registered nurse, two licensed practical nurses, and three nursing assistants have been able to get to work. A nurse-manager must decide which nursing care delivery system (model) (NCDS) should be implemented for the best possible client care during this staffing crisis. The nurse-manager directs the staff to implement which NCDS (NCDM)? functional nursing primary nursing team nursing case management

functional nursing Explanation: Functional nursing best uses the skills of all staff in a timely manner during this crisis. This delivery system (model) requires the fewest staff and delegates tasks to those who can best perform them. Team nursing doesn't allow for the best use of a limited number of staff who must care for a large number of clients. Primary nursing and case management require more registered nurses than are currently available.

After several years of providing bedside care in an inpatient setting, a nurse has taken a position with the state board of nursing. In this role, the nurse may contribute to which activity of a state board of nursing? promoting the visibility of the nursing profession within the state allocating financial resources within clinics and hospitals in the state providing consultation on ethically challenging clinical situations issuing and transferring nursing licenses within the state

issuing and transferring nursing licenses within the state Explanation: State boards of nursing perform multiple roles including issuing and transferring licenses of nurses in the state. Consultations on ethics, allocation of resources, and promotion of the nursing profession are not typical activities of state boards of nursing.

In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the client. This is an example of which step in discharge planning? developing goals with the client making home healthcare referrals assessing the client's needs and identifying problems providing client teaching

providing client teaching Explanation: The nurse is teaching the client important information about self-care at home prior to discharge. The initial step in discharge planning is collecting and organizing data about the client because this provides information on the client's healthcare needs. Home referrals may be made after the teaching process based upon orders provided by the physician. Developing goals may occur after the teaching process because the goals need to be realistic.

Which action demonstrates the role of the psychiatric nurse in primary prevention? handling crisis intervention in an outpatient setting providing sexual education classes for adolescents visiting a client's home to discuss medication management conducting a postdischarge support group

providing sexual education classes for adolescents Explanation: The psychiatric nurse participates in primary, secondary, and tertiary prevention activities. Primary prevention includes education programs that promote mental health and prevent future psychiatric episodes such as sexual education classes for adolescents. Secondary prevention involves treatment to reduce psychiatric problems (for example, handling crisis intervention in an outpatient setting, administering and supervising medication regimens, and participating in the therapeutic milieu). Tertiary prevention involves helping clients who are recovering from psychiatric illness; activities directed toward providing aftercare and rehabilitation are part of this role. Conducting a postdischarge support group is a tertiary prevention activity.

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

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