Chapter 11- The Healthcare Delivery System

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." 237

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. Which explanation by the charge nurse is most appropriate?

"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." 241

A client is approaching 65 years of age and says, "I will be glad when I am eligible for Medicare so I won't have to worry about insurance anymore." How should the nurse respond to this statement? Select all that apply.

-"The federal government pays for Part A of Medicare." -"You don't have to carry Part B of Medicare unless you want to." -"You may want to pay for a Medicare supplement." 251

The hospital has developed a clinic specifically to serve people who are uninsured. Which statement(s), made by a nurse asked to transfer to working in the clinic, indicates need for additional teaching? Select all that apply.

-"Why should I change my schedule to work with a group of clients who have never worked at all." -"I am not certain I will like working with people who are so poor." -"Aren't most uninsured people illegal aliens?"

A clinical nurse specialist is preparing a presentation for a group of colleagues about the current state of the health care delivery system. As part of the presentation, the nurse is planning to address trends that may play a role in shaping health care delivery in the near future. Which information would the nurse most likely include? Select all that apply.

-Greater numbers of informed persons using health care services -Rise in accessible health information due to technology 259

Which provisions are included in the Affordable Care Act (ACA)? Select all that apply.

-Improve coverage by providing health care for dependent children up to 26 years of age -Provide access to clinical preventive services by eliminating copayments for these services -Enhance the quality and efficiency of health care by increasing the Medicare Part D prescription drug benefit -Mandate that all U.S. citizens and legal residents must have health care coverage 239

A nurse provides care for clients in a primary care center. What are typical roles of a nurse in this type of facility? Select all that apply.

-Making health assessments -Performing technical procedures -Providing health education 246-247

The nurse is caring for several clients with chronic conditions that need to be evaluated for long-term care. After evaluating each client, the nurse determines which client is most appropriate to receive long-term care?

A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs). 253-254

A nurse demonstrates understanding of Healthy People 2020: Understanding and Improving Health by supporting which statement?

A client's health is affected by social, economic, and political factors. 260

The nurse is providing care to several clients. For which client should the nurse include secondary care in the nursing plan of care?

A middle-aged client who presents with new-onset angina 246

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?

A prospective payment plan based on a predetermined fixed cost 251

Which is the most accurate definition of urgent care?

A type of ambulatory care that treats people who walk in with illnesses and minor trauma 253

Which is an emerging trend in health care delivery?

Active involvement of consumers 259

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?

Affordable Care Act 239-240

Which is the most accurate description of "aging in place"?

Aging in place communities are a form of extended care in which community members meet each other's needs.254

Which scenario is using a prospective payment plan to reimburse for services?

An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. 251

The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care?

An older adult client who fell at home and required a hip replacement 254

Which statement accurately reflects the findings of the 1999 Institute of Medicine report, "To Err Is Human"?

Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors. 240

A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine whether the client is a candidate for the new "Hospital at Home" program. Which statement accurately reflects an outcome for this program?

Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. 254

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?

Clients play a large role in helping themselves in the home care setting. 253

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?

Collaborating with all agencies to provide for the client's home health needs 257-258

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?

Coordinator of care 247

The growth in home health care is largely attributed to which factor?

Early discharge of clients from the hospital setting 253

The goals of health care reform include which?

Focusing on cost containment with improved access and quality of services for everyone 248

A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate?

Hospice 246

Which type of facility employs the greatest number of nurses?

Hospitals 252

Which is the primary criterion for admission to a long-term care facility?

Inability to provide self-care 254

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way?

Medicare pays only the amount of money preassigned to a treatment for a diagnosis. 251

What nursing function would be most commonly found in an ambulatory care facility?

Providing direct client care 253

Which statement regarding pay for performance is most accurate?

Quality of care is measured and used to evaluate hospitals and other providers and to award reimbursement. 241

A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care?

Relief from physical, mental, and spiritual distress 256

The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner?

Respiratory therapist 258

A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate?

Respite care 256

A client is admitted to the facility after fracturing a hip. The client has undergone surgery to repair the fracture and is receiving services to promote healing of the surgical site and regain mobility. Which discussion should the nurse have with a member of the interdisciplinary team member to promote the goal of regaining mobility?

Speak with the physical therapist about exercises to strengthen muscles. 258

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 258

A nurse is a member of an interdisciplinary team providing home health care to a client who was discharged home after experiencing a stroke. The client has been receiving services to assist with swallowing. The nurse would collaborate with which member of the team to discuss the client's progress?

Speech therapist 258

Which statement is true when comparing home care with acute care?

The nurse is the guest in the client's home. 252-253

A client diagnosed with lung cancer has been given a prognosis of 3 to 4 months of life. The nurse discusses hospice care with the client and family. Which aspect of the client's health status indicates that hospice care is appropriate?

The client has a life expectancy of less than 6 months 256

Which is the main focus of care for a school nurse?

community care 255

One of the primary advantages of the managed care model is:

economic, quality care 248

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

medicare 244