Chapter 11 - The Health Care Delivery System

A home health care nurse is providing visits for a 65- year-old widower who needs some assistance with ADLs but is living independently. What option might the nurse recommend that would enable the patient to maintain independence for as long as possible? A) Aging in place B) Medical home C) Long-term care facility D) Transitional subacute care facility

A

A nurse is helping a patient choose a new health care plan. The patient states that he would prefer to be able to choose his own health care provider. Which plan would be the least appropriate for this patient based on his stated preferences? A) HMO B) PPO C) POS D) LTC

A

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

A

Nurses provide care for patients in a program called "Hospital at Home." What are the characteristics of this program? (Select all that apply.) A) Higher average patient length of stay B) Lower overall costs C) Better patient outcomes D) Lower chance of developing delirium E) Higher use of sedatives and restraints F) Higher satisfaction with care

B, C, D, F

A nurse is making a visit to a client in the home. As a home health care nurse you may be expected to accomplish which of the following? Select all that apply. A) Complete an assessment on each visit. B) Provide support to the client and family. C) Administer treatments and medications. D) Document actions regarding patient, activities, and progress. E) Communicate and collaborate with other members of the health team.

A, B, C, D, E: All of the above. Home health care nurses may provide all of these activities in the home setting.

The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply. A) Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness. D) Patients realize that longer stays result in infections and other problems.

A, B, C: Shorter hospital stays direct the focus on the acute care needs of the client and have resulted from improved treatment of disease, increases in preventive care, and federal regulations and other health care reimbursement policies. Longer hospital stays are often the result of infection, as this factor is not related to shorter hospital stays.

Health care is constantly changing and becoming more complex. Select the answers that describe clients as health care consumers today. Select all that apply. A) They often have health information obtained from the Internet. B) They prefer to control the decisions made about their own health care. C) Most are less concerned about health care costs as long as they receive good care. D) They express concern regarding access to care and the quality of service. E) They have helped develop clients' rights and cost-containment measures.

A, B, D, E: Health care consumers are increasingly more knowledgeable about health, and prefer to control the decisions about their care. They express concern about access to services, and the cost and quality of care. They question duplication of services, and are actively engaged. They have helped to develop client rights and cost-containment measures as protections for clients in health care settings. Today clients are surveyed regarding their experiences with doctors and nurses in hospitals.

The Public Health Service (PHS) is a federal agency of the U.S. Department of Health and Human Services. The professional nurse is aware that the services provided by the PHS include which of the following? Select all that apply. A) Care to migrant workers B) Care in federal prisons C) Veterans Administration (VA) hospitals D) Indian Health Services

A, B, D: The Public Health Services provides all of these services and others, except the Veterans Administration Hospitals. VA hospitals are supported by government-operated health care, not the PHS.

Nurses provide care for patients as they move throughout the health care system. What are methods used to ensure continuity of care and cost-effective care during this process? (Select all that apply.) A) Managed care B) Case management C) Rural health centers D) Parish nursing E) Primary health care F) Primary care centers

A, B, E

Home health care is one of the most rapidly growing areas of the health care system. What are chief tasks of the home health care nurse? (Select all that apply.) A) Developing a nursing care plan B) Providing for a dignified death at home C) Providing patient teaching and counseling D) Providing continuity of care E) Administering medications F) Collecting payment for nursing care

A, C, D, E

Long-term care is often needed for the elderly client. Select all the services that may be provided to the resident in a long-term care facility. Select all that apply. A) Assistance with activities of daily living B) Immediate post-op care C) Mental disability services D) Non-medical care for chronic illness E) Day care meals and services

A, C, D: Acute/immediate post-op care is a specific need/care immediately following surgery/procedures and is completed at the facility. Day care meals and services are separate services and are not provided to residents in a long-term-care facility. All the others are part of what a long-term care facility provides.

Medicare reimburses in-hospital costs based on a set payment for a diagnostic related group (DRG). This means the hospital is reimbursed for a fixed amount based on the diagnosis and projected cost for care. As a result of this system the hospital can make a profit or a loss. Select the responses that describe when a profit for care of the client can be achieved. (Select all that apply). A) All of the hospitalization charges are less than projected. B) The client receives incompatible blood so the hospital does not get charged for it. C) The client is discharged before the approved discharge date. D) The nursing care results in the client reaching outcomes for recovery, without complication, after the projected timetable.

A, C: The hospital will make a profit when cost of hospitalization is less than the reimbursement assigned for the severity of illness and projected care costs. If the client is discharged earlier than projected the hospital keeps the total reimbursed. Incompatible blood is a preventable error, for which the hospital is not reimbursed. Reaching outcomes after the approved time results in additional cost to the hospital.

A nurse researcher keeps current on the trends to watch in health care delivery. What trends are likely included? Select all that apply. A) Globalization of the economy and society B) Slowdown in technology development C) Decreased diversity D) Increasing complexity of patient care E) Changing demographics F) Shortage of key health care professionals and educators

A, D, E, F: Trends to watch in health care delivery include globalization of the economy and society, increasing complexity of patient care, changing demographics, shortages of key health care professionals and educators, technology explosion, and increasing diversity.

Nurses provide care to patients as collaborative members of the health care team. Which roles may be performed by the advanced practice registered nurse? Select all that apply. A) Primary care provider B) Hospitalist C) Physical therapist D) Anesthetist E) Midwife F) Pharmacist

A, D, E: The Advanced Practice Registered Nurse (APRN) is a registered nurse educated at the master's or post-master's level in a specific role and for a specific population. Whether they are nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives, APRNs play a pivotal role in the future of health care. APRNs are often primary care providers and are at the forefront of providing preventive care to the public. Hospitalists are health care providers who provide care to patients when they visit the emergency department or are admitted to the hospital. A physical therapist completes a specific training program to learn to help patients restore function or to prevent further disability in a patient after an injury or illness. A pharmacist, prepared at the doctoral level, is licensed to formulate and dispense medications.

A nurse working in a primary care facility prepares insurance forms in which the provider is given a fixed amount per enrollee of the health plan. What is the term for this type of reimbursement? A) Capitation B) Prospective payment system C) Bundled payment D) Rate setting

A: Capitation plans give providers a fixed amount per enrollee int he health plan in an effort to build a payment plan that consists of the best standards of care at the lowest cost. The prospective payment system groups inpatient hospital services for Medicare patients into DRGs. With bundled payments, providers receive a fixed sum of money to provide a range of services. Rate setting means that the government could set targets or caps for spending on health care services.

A client has a private insurance policy that pays for most health care costs and services. Why is this plan called a third-party payer? A) The insurance company pays all or most of the costs. B) The family of the client is required to pay costs. C) The client gets the bill and pays out-of-pocket costs. D) Medicare and Medicaid will pay most of the costs.

A: Insurance for health care may be financed through private insurance, in which members pay a monthly premium. These plans are called third-party payers, because the insurance company pays all or most of the cost of care.

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

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

After many years of advanced practice nursing, a nurse has recently enrolled in a nurse practitioner program. This nurse has been attracted to the program by the potential to provide primary care for clients after graduation, an opportunity that is most likely to exist in which of the following settings? A) A rural health center B) A long-term care facility C) A university hospital D) A community hospital

A: Many rural health centers employ few health care providers, and primary care is often provided by a nurse practitioner (NP). A nurse practitioner may provide care in a long-term care facility or hospital, but in these settings, the NP is less likely to be the provider of primary care to clients.

Which of the following clients is the most appropriate candidate for receiving outpatient care? A) A client whose complaints of irregular bowel movements have necessitated a colonoscopy B) A woman who has previously borne two children and is entering the second stage of labor C) A man who is receiving treatment for sepsis after his blood cultures came back positive D) A client with a history of depression who is currently expressing suicidal ideation

A: Outpatient services are appropriate for clients who are medically stable but who require diagnostic testing, such as a colonoscopy. Clients in active labor and clients who are actively septic or suicidal require close monitoring and frequent interventions, which can only be safely provided on an inpatient basis.

Who provides physicians with the authority to admit and provide care to clients requiring hospitalization? A) The health care institution itself B) Board of Healing Arts C) American Medical Association D) State Board of Nursing

A: Physicians are granted the authority to admit clients to a health care agency or institution, and to provide care in that setting by the health care agency or institution itself. They are licensed to practice medicine by a state medical board, not a state board of nursing or a board of healing arts.

A caregiver asks a nurse to explain respite care. How would the nurse respond? A) "Respite care is a service that allows time away for caregivers." B) "Respite care is a special service for the terminally ill and their family." C) "Respite care is direct care provided to people in a long term care facility." D) "Respite care provides living units for people without regular shelter."

A: Respite care is provided to enable a primary caregiver time away from the day-to-day responsibilities of homebound patients.

One of the newest concepts in providing long-term care is called aging in place. What is the best description of this type of care? A) Clients move to an independent living apartment or home, then have access to increasing health care services as needed, provided within the health care community where they live. B) Clients move into the nursing home, and access more and more services as required in the same facility. C) A long-term-care facility, associated with a hospital, that provides acute care services as needed so the client can return to long term care. D) Clients are maintained in their own homes with home health care.

A: The best description of "aging in place" is the type of care where the client moves into an independent living space, and then has access to more services, such as assisted living and/or skilled care, that are part of the health care community in which they live.

Nurses work with various members of the health team. The nurse understands that the role of the hospitalist is best described as: A) The doctor who admits the patient, assumes the management of the patient's care, and maintains communication with the primary physician while the patient is hospitalized. B) The physician who manages the patient's care in emergency and intensive care units only. C) The doctor who notifies the primary physician that their patient has been admitted to the hospital, and transfers care to a the referral specialist. D) The specialist who admits the patient to hospital, and returns care to the primary physician for all other referrals and services.

A: The hospitalist is a physician who provides care to the patient in the emergency room and after admission to the hospital. The hospitalist communicates with the patient's primary doctor, but manages the hospital care.

A nurse provides care for patients in a primary care center. What are typical roles of a nurse in this type of facility? (Select all that apply.) A) Managing members of the health care team B) Performing in-service education C) Making health assessments D) Performing technical procedures E) Researching nursing issues F) Providing health education

C, D, F

Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system? A) Acute care B) Primary care C) Hospice D) Rehabilitation

C: The opportunity to help people maintain their ability to remain at home and deal holistically with their health and family needs at the end of their lives is home health hospice care.

Which patient would a nurse correctly refer to Medicare services? A) A patient with cancer B) A low-income family with infants needing immunizations C) A patient with a disability D) A 66-year-old patient with diabetes

D

A nurse is a manager of an ambulatory care facility. What nursing function would be most commonly found in this type of facility? A) Serving as an administrator or manager B) Providing direct patient care C) Educating individual people or groups D) Assessing the home environment

B

A nurse is caring for a patient who has a PPO health care plan. What is the greatest advantage of this type of plan? A) Ease of referrals B) Cost effectiveness C) Care coordination D) Improved health outcomes

B

Health care costs are increasing as technology and related services increase. Patients interact with many health care providers, such as RNs, LPNs, physicians, physical therapists, medical technologists, radiation technologists, specialists, and others employed in health care. As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care? (Select all that apply). A) Less confusion for clients regarding treatment. B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.

B, C, D: Fragmented care increases health care costs and the number of providers/specialists seeing the client. A lack of continuity of care often results, increasing the client's confusion, and medication errors may increase. Although clients often receive specialized care and services, there may be conflicting care plans.

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

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

A nurse and a client are discussing managed care. The nurse explains that the managed care model was designed for which of the following reasons? A) Increasing client satisfaction B) Controlling costs while maintaining quality of care C) Providing a distinct area of care D) Providing an all-RN staff

B: Case management is used in such situations to ensure optimum, high-quality care in the most efficient and economic manner. It is done by controlling costs while maintaining quality of care.

Which of the following phrases best describes hospitals today? A) Focus on chronic illnesses B) Focus on acute care needs C) Primary care centers D) Voluntary agencies

B: Hospitals have become acute care providers for people who are too ill to care for themselves at home, who are severely injured, who require surgery or complicated treatment, or who are having babies. Hospitals rarely focus on chronic illnesses, and they are not primary care centers. Hospitals are not classified as voluntary agencies.

After a stroke, a client is having difficulty swallowing. The nurse may make a referral to what member of the health care team? A) Physical therapist B) Speech therapist C) Social worker D) Respiratory therapist

B: In addition to providing services to improve oral communication, a speech therapist may also diagnose and treat swallowing problems in clients who have had a head injury or stroke. A physical therapist assists with musculoskeletal and neurological impairments, a social worker is educated to help clients with economic and social issues, and a respiratory therapist provides treatments to improve breathing.

A nurse has been hired to work as an occupational health nurse. In this position as a registered nurse, what will this nurse provide? A) Occupational therapy to schoolchildren. B) Education and safety programs in industrial settings. C) Assessment and motivation services to the unemployed. D) Activities to assist patients with ADLs in homeless shelters.

B: Industrial settings is the best answer to define/describe occupational health nursing, which focuses on employee safety and health-promotion programs. The other options do not address health needs in an employment setting.

Which of the following health care insurance programs is most suitable for a client 68 years of age? A) Medicaid B) Medicare C) Capitation D) AmeriCare

B: Medicare is a federal program that finances health care costs of persons 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease. The system is funded primarily through withholdings from an employed person's income. Capitation is a reimbursement strategy in managed care organizations. AmeriCare is a type of private insurance. Capitation and AmeriCare are not the preferred providers for the client, considering the client's old age. Medicaid is a federal program that is operated by the states, and each state decides who is eligible and the scope of health services offered. In Medicaid, eligibility may be decided by the state, which is not the case in Medicare.

A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting? A) Assist in major surgery B) Performing a health assessment C) Maintaining patients' function and independence D) Keeping student immunization records up to date

B: Performing patient health assessments is a common role of the nurse in a primary care center. Assisting with major surgery is a role of the nurse in the hospital setting. Maintaining patients' function and independence is a role of the nurse in an extended-care facility, and keeping student immunization records up to date is a role of the school nurse.

A person receiving health care insurance from his employer knows that he should check the approved list of contracted health care providers before seeking services, in order to receive them at a lower cost. What type of insurance is most likely involved? A) Medicaid B) Preferred provider organization C) Health maintenance organization D) Long-term care insurance

B: Preferred provider organizations (PPOs) allow a third-party payer (agencies that pay health care providers for services provided to individuals, such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Although clients are encouraged to use specific providers, they may also seek care outside the panel without referral by paying additional out-of-pocket expenses.

A nurse is working in a pediatric clinic provides codes for a patient's services to a third-party payer who pays all or most of the care. This is an example of what mode of health care payment? A) Out of pocket payment B) Individual private insurance C) Employer-based group private insurance D) Government financing

B: The four basic modes of paying for health care are out-of-pocket payment, individual private insurance, employer-based group private insurance, and government financing. With individual private insurance, members pay monthly premiums either by themselves or in combination with employer payments. These plans are called third-party payers because the insurance company pays all or most of the cost of care. Out-of-pocket payment is paying for health care with cash payments. Employer-based private insurance is employer-sponsored coverage and government financing is provided through Medicare and Medicaid, and other federally funded programs.

What is one of the most significant trends in health care today? A) Increased length of hospital stays B) Shift from hospitals to community-based care C) Emphasis on disease management D) Narrowing of the areas for nursing practice

B: The shift to community-based care is related to the public's desire to participate more actively in health care decisions, issues, and choices.

A nurse recommends palliative care for a patient who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care? A) Provision of a dignified death experience B) Physical rehabilitation C) Relief from physical, mental, and spiritual distress D) Occupational therapy

C

A nurse works with patients in a crisis intervention center. What ability would be most important for this nurse to develop? A) Technical skills B) Decision-making ability C) Communication and counseling skills D) Relating to coworkers on a professional level

C

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

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

Hospice nurses provide care in a variety of settings, including clients' homes, long-term-care facilities, and hospice residences. After the client dies, what happens next? A) The hospice services are provided to the families of the former residence clients only. B) The hospice services continue for family and friends during the bereavement period, up to one month after the death. C) The hospice nurse continues to care for the client's family for up to one year. D) Nurses assist the family to work through their grief during the period of mourning.

C: After the death of the patient, the hospice nurse continues to care for the client's family during the bereavement period for up to one year. Nurses help the family to work through their loss.

What population do hospice nurses provide with care? A) Those requiring care to improve health B) Children with chronic illnesses C) Dying persons and their loved ones D) Older adults requiring long-term care

C: Hospice is a program of palliative and supportive services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones. Hospice nurses do not implement care to improve health, focus on children with chronic illnesses, or care for older adults in long-term care.

What is the primary focus of health care today? A) Care of acute illnesses B) Care of chronic illnesses C) Health promotion D) Health restoration

C: In the past, health care focused on the treatment of illnesses rather than prevention through health promotion, because preventive strategies were not covered by health insurance. Health awareness and the desire to be involved in one's own health care have strongly influenced the delivery of health care services in our society.

Which of the following is true of long-term care facilities? A) They provide care only to older adults. B) They provide care for homeless adults. C) They provide care to people of any age. D) They provide care only for people with dementia.

C: Long-term care facilities provide health care, and help with the activities of daily living, for people of any age who are physically or mentally unable to care for themselves independently. They do not provide care only to older adults or those with dementia, although they do care for those populations as well as others. They do not provide care to homeless persons.

Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs? A) Locally supported health care financing, usually by donations B) A public assistance program for low-income individuals C) Predetermined payment for services based on medical diagnoses D) A private insurance plan for subscribers who pay a copayment

C: Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations; it is not a public assistance program or a private insurance plan.

A nurse in a walk-in health care setting provides technical services (e.g., administering medications), determines the priority of care needs, and provides client teaching on all aspects of care. Which of the following terms best describes this type of health care setting? A) Hospital B) Physician's office C) Ambulatory center D) Long-term care

C: Nurses in ambulatory care centers (walk-in clinics) provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. Nurses employed in hospitals have many roles, including manager of other members of the health care team providing client care, administrator, nurse practitioner, clinical nurse specialist, patient educator, in-service educator, and researcher. In physician's offices, advanced practice registered nurses (APRNs), nurse practitioners, midwives, or clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for clients who require health maintenance or health promotion activities. Long-term care provides medical and non-medical care for people with chronic illnesses or disabilities.

A nurse cares for dying patients by providing physical, psychological, social and spiritual care for the patients, their families and other loved ones. What type of care is the nurse providing? A) Respite care B) Palliative care C) Hospice care D) Extended care

C: The hospice nurse combines the skills of the home care nurse with the ability to provide daily emotional support to dying patients and their families. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older adults. Palliative care, which can be used in conjunction with medical treatment and in all types of health care settings, is focused on the relief of physical, mental, and spiritual distress. Extended-care facilities include transitional subacute care, assisted-living facilities, intermediate and long-term care, homes for medically fragile children, retirement centers, and residential institutions for mentally and developmentally or physically disabled patients of all ages.

What is one way in which nurses can help shape health care reform? A) Do their job and do it well B) Refuse to participate in organizations C) Support legislation to improve care D) Become a member of a support group

C: There are many ways in which nurses can help shape health care reform, including supporting legislation to improve care. Nurses are expected to do their job well. Refusing to participate in organizations and/or becoming a member of a support group will not help shape health care reform.

A nurse is discharging a patient who was admitted for observation following a motor vehicle accident. The patient is a single parent who is living in a new community. What service would be an appropriate referral for this patient? A) Respite care B) Hospice care C) Medical home D) Parish nursing

D

Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect? A) Care provision B) Counselor C) Teacher D) Care coordinator

D

A man is scheduled for hospital outpatient surgery. He tells the nurse, "I don't know what that word, outpatient, means." How would the nurse respond? A) "It means you will have surgery in the hospital and stay for 2 days." B) "It means the surgeon will come to your home to do the surgery." C) "Why would you ask such a question? Don't worry about it." D) "You will have surgery and go home that same day."

D: In addition to providing acute care, hospitals have many services for outpatients (those who require health care but do not need to stay in the facility). Clients who have outpatient surgery have the procedure, return to their hospital room for recovery, and then are discharged home on the same day.

In providing nursing care, it is most important to perform which of the following actions? A) Administration of prescribed medications B) Implementation of physician's orders C) Evaluation of client's responses D) Coordination of care with the health care team

D: Nurses have moved from simply observing and giving prescribed medications to coordinating clinical information for the entire health care team.

A nurse is caring for clients at an ambulatory care facility. Which care intervention is least likely to be provided by the nurse in this setting? A) Patient education B) Treatment of minor trauma C) Medication administration D) Crisis management

D: Nurses in ambulatory care centers and clinics provide technical services (e.g., administering medications), determine the priority of care needs, and provide teaching about all aspects of care. The urgent care center is a special type of ambulatory care center that provides walk-in care for illnesses and minor trauma. Crisis management or intervention is typical of mental health centers and not of ambulatory care settings.

Nurses who are employed in home care have a variety of responsibilities. Which of the following is one of those responsibilities? A) Provide all care and services B) Maintain a clean home environment C) Advise clients on financial matters D) Collaborate with other care providers

D: Nurses who provide care in the home make assessments, provide physical care, administer medications, teach, and support family members. They also collaborate with other health care providers in providing care and services. Home care nurses do not provide all care and services, maintain a clean home environment, or advise clients on financial matters.

The U.S. system of health care is based on an ability to pay for care, which leaves millions of people uninsured or underinsured, with inadequate access to health care. Nurses are often presented with ethical dilemmas when caring for patients and families. Which of the following is an example of an ethical dilemma? Select all that apply. A) All clients are entitled to care, whether they can pay or not, because health care is a right. B) You may have to pay higher insurance premiums to cover the cost of care because you smoke. C) There are free clinics and health programs to serve the poor; they should receive health care there. D) Should the uninsured person, who cannot pay for health care, receive the same care and services as someone who works and pays for insurance?

D: Only answer D suggests an ethical dilemma for which there is no easy answer. Answer A is an assumption that many have about health care. Answer B is a fact, as some health insurance programs charge more for those who smoke. Answer C is an opinion, as although there are some clinics for the poor, health care access is limited.

A grade school is preparing a series of classes on the dangers of smoking. Who would be most likely to teach the classes? A) A community health nurse B) An outside consultant C) A teacher D) The school nurse

D: School nurses provide many different services, including maintaining immunization records, providing emergency care, administering prescribed medications, conducting routine screenings, conducting health assessments, and teaching for health promotion (e.g., the dangers of smoking). Although any of the other choices may provide teaching, it is the nurse who primarily provides health-related teaching.

An elderly woman has total care of her husband, who suffers from debilitative rheumatoid arthritis. The couple voices concern over the pain and stress associated with the condition. What type of care might the nurse suggest to help the couple? A) Primary care B) Respite care C) Bereavement care D) Palliative care

D: The goal of palliative care is relief from the symptoms, pain, and stress of a serious illness, and to improve the quality of life for both the client and the family. The main purpose of respite care is to give the primary caregiver some time away from the responsibilities of day-to-day care. Primary care is found in acute care settings and physicians' offices. Bereavement care is provided to families following the death of a family member.