exam 3 role dev

Continuous quality improvement is best exemplified by which of the following?

Initiating evidence-based practices and training programs for safe transfer of patients. Continuous quality improvement focuses on the prevention of problems or adverse events, such as the unsafe transfer of patients because of inadequate training and improper practices.REF: pp. 227, 228

A 75-year-old male suffered a stroke with right extremity weakness and dysphasia and was hospitalized in acute care for 4 days. The most appropriate discharge plan for this patient would be to which setting? Home with home health care Home with hospice A Green House home A sub-acute rehabilitation unit

A sub-acute rehabilitation unit After suffering a stroke with weakness and difficulty swallowing, the most appropriate and beneficial plan would be to a sub-acute rehabilitation unit for comprehensive therapies, with the goal of transitioning home. This type of facility is better equipped and staffed for the patient's specific needs and provides Medicare nursing home coverage after a 3-day hospital stay. The patient does not qualify for hospice, and the Green House homes are for long-term care.REF: p. 218

The monthly fee a person must pay for health care insurance coverage is known as the a. premium. b. deductible. c. copayment. d. coinsurance.

ANS: A The premium is the monthly fee a person must pay for health care insurance coverage. The deductible is the yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share. The copayment is the amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service. Coinsurance is the percentage of the total bill paid by the insured person after a deductible has been met. The remainder is paid by the insurance company.

Which nonverbal behavior is most congruent with a nurse's assertive verbal statement? a. Firm voice, erect posture, direct eye contact b. Soft voice, shoulders relaxed, eyes down c. Loud voice, back stiff, eyes glaring d. Smile while speaking, touch person's arm, eyes lowered

ANS: A Use of a firm voice with erect posture and direct eye contact describes nonverbal behavior that is congruent with assertive verbalization. Using of a soft voice with shoulders relaxed and eyes down is passive submissive. Smiling while speaking and touching the person's arm with lowered eyes is passive submissive. Use of a loud voice, back stiff, and eyes glaring is consistent with aggressive behavior.

The LPN/LVN charge nurse has been designated to participate in the orientation of a new LPN/LVN by explaining cost-containment measures. Measures the charge nurse should mention include which of the following? (Select all that apply.) a. Charge patients for all supplies used in their care. b. Document patient care according to the policy for reimbursement. c. Use time management principles to work efficiently. d. Use supplies carefully to avoid waste. e. Implement measures to prevent complications. f. Advise insured patients to select higher tiers whenever possible.

ANS: A, B, C, D, E Charging patients for all supplies used, documenting care accurately, using time management principles, using supplies efficiently, and preventing complications all result in cost containment. Advising insured patients to select higher tiers whenever possible would not conserve health care dollars, because higher tier care and medications are more costly than those offered in lower tiers.

Diagnosis-related groups (DRGs) and prospective payment systems are most clearly the reason for a. Medicare and Medicaid. b. critical pathways and managed care. c. group health insurance and centralization. d. a shortage of nurses and unlicensed assistive personnel.

ANS: B Both DRGs and prospective payment systems have resulted in cost-containment efforts by health care agencies. Managed care and critical pathways are responses to the need to contain costs. DRGs originated with Medicare. Group health insurance existed prior to DRGs and prospective payment systems. The reason for personnel shortages in health care is not as simplistic as a shortage of nurses and unlicensed assistive personnel.

A nursing student complains about difficulty remembering information read in the text. To resolve this problem effectively, the student should address the fact that the most common reason students cannot remember information is a. information overload. b. lack of understanding of the material. c. new knowledge interferes with recall of old knowledge. d. old knowledge interferes with recall of new material.

ANS: B Reading with comprehension is required if one is to retain the information. Information overload is a fallacy. New and old knowledge interfering with recall are not the most common reasons for not remembering.

The yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share is known as the a. premium. b. deductible. c. copayment. d. coinsurance.

ANS: B The deductible is the yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share. The premium is the monthly fee a person must pay for health care insurance coverage. The copayment is the amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service. Coinsurance is the percentage of the total bill paid by the insured person after a deductible has been met. The remainder is paid by the insurance company.

A resident asks an LPN/LVN, "What is meant by the practical/vocational nurse's standard of care in a long-term care agency?" The LPN/LVN should respond, "The practical/vocational nurse who provides care for residents in a long-term care agency must implement care that is consistent with a. shortcuts acceptable to the agency that allow nurses to assume larger and more complex patient assignments." b. care that an ordinary, prudent LPN/LVN with the same education and experience would perform in similar circumstances." c. the minimum competency necessary to function as a health care giver in the state in which the nurse resides." d. customs of the agency in which the nurse is employed."

ANS: B This is the standard used by the courts, and it is the same regardless of the type of agency in which the nurse is employed. The other options do not define the nurse's standard of care.

How should an LPN/LVN explain the term accountability to a student nurse? a. "Accountability is the transfer of responsibility for wrong actions." b. "Accountability is shared responsibility with the physician for wrongdoing." c. "Accountability is assuming personal responsibility for one's nursing actions." d. "Accountability is giving up responsibility when the situation dictates."

ANS: C Accountability means that one is answerable for one's actions. The other options do not correctly reflect the meaning of accountability.

. A nursing student asks, "Are there any techniques to help me better understand difficult nursing concepts?" The best reply would be a. "Memorize as much as you possibly can." b. "Begin by learning the definition of all terms." c. "Repeat key ideas in your own terms." d. "Cram for examinations."

ANS: C Repeating key ideas in one's own words fosters understanding. Understanding is required for laying down neural traces and long-term memory storage. Memorizing is only marginally effective. Learning the definition of all terms may be an excessively large order. Cramming is never advisable.

Which LPN/LVN will be most successful in dealing with change? a. Nurse S, who always assumes that the worst will happen in any situation b. Nurse T, who agrees with whatever the administration proposes c. Nurse U, who sees change as an opportunity to improve conditions d. Nurse V, who predicts that the change will probably not work

ANS: C The nurse who sees change as an opportunity to be part of the solution to a problem is a navigator, one who feels confident and in control. The navigator fares well in change. The nurse who always assumes that the worst will happen in any situation is a victim who feels helpless during change. Victims do not fare well during times of change. The nurse who sees change as an opportunity to improve are survivors, individuals who go along with change but predict that it will be unsuccessful.

Legally, student practical/vocational nurses are held to the level of performance a. described in the job description for nursing assistants. b. described in the outline/syllabus of the course in which the student is enrolled. c. of the LPN/LVN. d. of the LPN/LVN instructor.

ANS: C The standard of practice for the SP/VN is that of the LPN/LVN. Beginning practitioners are not held to a lesser standard. SP/VNs are not held to the same level of performance as nursing assistants. Holding the student practical/vocational nurse to the level of performance described in the outline/syllabus of he course in which the student is enrolled may not correspond to the Nurse Practice Act (although it should!). The instructor would be held to the standard for RNs.

A nurse demonstrates assertive behavior by doing which of the following? a. When the physician yells at the nurse in front of the patient, the nurse is angry but refrains from speaking about it. b. The nurse plans on seeking new employment out of fear of approaching the supervisor to tell his or her side of what happened. c. When working with a patient who has had the call light on repeatedly, the nurse tells the patient, "Do not put your call light on again." d. When unexpected visitors arrive to visit the patient during breakfast, the nurse asks whether the patient would prefer to eat now or visit.

ANS: D Assertiveness is a current name for honesty; it is a way to live the truth from one's innermost being and to express this truth in thought, word, and deed. Giving the patient the choice between breakfast and visitors is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The nurse refraining from talking about being angry after a physician yells and the nurse planning on seeking new employment out of fear are examples of nonassertive behavior. Telling the patient not to put the call light on again is an example of aggressive behavior in which the rights of others are violated.

Which of the following is characteristic of a navigator of change? Confident and excited Unwilling to participate Goes along with change Experiences fear

Confident and excited Navigators feel in control of the situation. They feel confident and excited about being part of the solution to the problem. Victims fear change and are unwilling to participate in change. Survivors resist change but go along for the ride.REF: p. 230

Which of the following involves a mathematical formula that is used to arrive at the fee the government will pay for hospitalization? Medicare Medicaid Diagnosis-related group (DRG) system Capitation

Diagnosis-related group (DRG) system Under the DRG system, a math formula is used to arrive at the amount that the government will pay for hospitalization and is dependent on the DRG category (or illness) that leads to hospitalization. Medicare is a fee-for-service plan for certain populations. Medicaid provides medical assistance for eligible families and individuals with low incomes and resources. Capitation involves setting a monthly fee charged by the provider of health care services for each member of the insurance group.REF: p. 226

Which of the following medical plans provides only prescription drug coverage? Medicare Part A Medicare Part B Medicare Part D Medicare Advantage Plan

Medicare Part D Medicare Part D provides prescription drug coverage. Medicare Part A and Part B do not cover prescription drugs. Medicare drug legislation, passed in 2003, provided prescription drug coverage that helps to pay for brand-name drugs at participating pharmacies.REF: p. 225

Which of the following is true regarding the health care system in the United States?

Nearly 100,000 people die each year from errors in health care that could be prevented. In 1999, the To Err Is Human: Building a Safer Health Care System report by the Institute of Medicine found that up to 98,000 persons die each year in the United States from preventable medical errors. The life expectancy in the United States is lower than in many other industrialized countries. Costs are rising in the United States because of prescription drugs, malpractice suits, the development of technology, and delays in treatment. Emergency rooms are an expensive way to treat people with common illnesses and are intended for those who are seriously ill.REF: p. 227

Which of the following can LPNs/LVNs do to contain the costs of health care? Select all that apply. Perform nursing procedures accurately and safely. Minimize waste in use of supplies. Organize care efficiently. Provide care according to patient needs. Follow agency policy on documenting care for reimbursement.

Perform nursing procedures accurately and safely. Minimize waste in use of supplies. Organize care efficiently. Provide care according to patient needs. Follow agency policy on documenting care for reimbursement. LPNs/LVNs have an important role in providing quality care that is efficient, timely, and meets the patients' needs. Reducing waste and inefficiency is an important aim of health care agencies.REF: p. 229

Hospitals operated by the Department of Veterans Affairs are which type of hospital? Proprietary hospitals Research hospitals Public hospitals Voluntary community hospitals

Public hospitals Most proprietary hospitals, which are for-profit, are general hospitals. Research hospitals can be private or public and are almost always affiliated with medical schools. Public hospitals include those operated by the Department of Veterans Affairs, as well as state, county, and municipally owned and operated nonprofit hospitals. Voluntary community hospitals are nonprofit and provide short-term inpatient care for acute illnesses and injuries.REF: p. 214

Medicare Part B does not cover which of the following services? Routine physicals Oxygen Flu vaccine yearly Digital exam every year

Routine physicals Medicare Part B does not cover routine physicals. The services in options B, C, and D are covered by Medicare Part B.REF: p. 225

The driving force in all health care agencies is __, which is the need to hold costs within fixed limits.

cost containment Cost containment strategies are used to hold costs within fixed limits while remaining competitive in the health care marketplace.REF: p. 229

Outpatient clinics that are not attached to a hospital are called __.

freestanding Outpatient clinics are either part of health care facilities or are freestanding.REF: p. 215