Health Care settings continuum of care- Chapter 14. 15.16

A patient tells the nurse, "I was treated for an asthma attack at a freestanding ambulatory services center." The nurse correctly identifies the treatment as taking place at a(n) a. urgent care center. b. domiciliary residence. c. intermediate care facility. d. fitness club.

ANS: A An urgent care center provides services for walk-in patients who do not have an appointment and who usually have no family physician and do not wish to go to the more expensive emergency room. The other facilities listed would not have been able to provide care to this patient.

The health care agency that provides information and support for breast-feeding mothers and breast milk for infants because of health reasons is the __________________.

ANS: La Leche League The La Leche League provides information and support for breast-feeding mothers, as well as breast milk for infants because of health reasons.

1. ____________________ are for-profit hospitals operated for the financial benefit of the owner of the hospital.

ANS: Proprietary hospitals Proprietary hospitals are for-profit hospitals operated for the financial benefit of the owner of the hospital. The owner may be an individual, a partnership, or a corporation.

Once a deductible has been met, the percentage of the total bill paid by the insured person is known as the _________________.

ANS: coinsurance 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.

The amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service is known as the ______________________.

ANS: copayment 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. The premium is the monthly fee a person must pay for health care insurance coverage

The role of the LPN/LVN in the health care team is best described as ______________________.

ANS: interdependent The LPN/LVN functions interdependently by providing care according to the established plan, collecting data, and offering input to the RN about the effectiveness of care and suggestions for care improvement.

A 78-year-old widow needs assistance with medications, housekeeping, and laundry, and would like to maintain independence. Which is the best option for the nurse to suggest? a. Assisted living b. Respite care c. Nursing center d. Rehabilitation center

ANS: A Assisted living provides independence, security, and privacy at the same time. These facilities promote independence and physical and psychosocial health. Services in an assisted living facility include medication management, exercise and educational activities, social activities, laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping. Respite care is a service that provides short-term relief or time off for people providing home care to an ill, disabled, or frail older adult. Nursing center is a nursing home; this is too early to recommend because the widow wants to maintain independence. Rehabilitation is the use of multiple therapies such as physical, psychological, occupational, speech, and social services to help restore a person to the fullest physical, mental, social, vocational, and economic usefulness possible; this is not appropriate because the widow can provide self-care.

The case method of care delivery is used on the surgical unit. The LPN/LVN asks what this means regarding work assignments. The best answer would be: a. "You will be assigned to provide care for two or three relatively stable patients with predictable care outcomes." b. "You will be assigned to perform specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on." c. "You will be assigned to provide daily total care for several patients from admission to discharge." d. "You will receive cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties."

ANS: A Case method calls for a nurse to provide complete care to several patients. Stable patients are generally assigned to LPN/LVNs. Performance of specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on, describes the team method of care delivery. Provision of daily total care for several patients from admission to discharge describes primary care nursing that uses only RN staff. Cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties describes patient-focused nursing.

. When the nurse is asked by a patient, "Why is it necessary to have deductibles and copayments when I already have health insurance?" The best response would be: a. "They are a way to improve the margin of profit in the fee-for-service method of paying for health care." b. "They prevent health care agencies from having huge deficits associated with uncompensated care." c. "They were developed to save health care dollars at the time Medicare introduced DRGs." d. "They are part of the incremental changes designed to provide more universal care."

ANS: A Deductibles and copayments require the patient to pay an increased share of the cost of treatment, thus improving the profit margin for the insurer. They benefit the insurer more than the agency. Deductibles and copayments were not developed to save health care dollars at the time Medicare introduced DRGs. Deductibles and copayments are not part of the incremental changes designed to provide more universal care.

A patient who has had a cerebrovascular accident needs nursing care, physical therapy, and speech therapy. The patient's spouse would like to provide care at home but needs assistance. During the planning conference, the nurse should suggest that the agency that could best meet the patient's needs is a. a home health agency. b. the American Red Cross. c. the American Heart Association. d. a local wellness center.

ANS: A Home health agencies provide home health services supervised by a licensed health professional in the patient's home.

A registered nurse working as a school nurse for a small poor rural school district has noticed an increase in children arriving at school without having eaten breakfast. The nurse has discussed this issue with the school principal and is working on a proposal to ask the school district to explore a school breakfast program. Which level of care did the nurse use? a. Primary care b. Continuing care c. Restorative care d. Tertiary care

ANS: A In the settings that deliver preventative and primary care, such as schools, physicians' or health care providers' offices, occupational health clinics, and nursing centers, health promotion is a major theme. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Tertiary care involves intensive care and psychiatric facilities.

A nurse is employed by a health care agency that provides an informal training session on how to properly use a new vital sign monitor. Which type of education did the nurse receive? a. In-service education b. Advanced education c. Continuing education d. Registered nurse education

ANS: A In-service education programs are instruction or training provided by a health care agency or institution designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Some roles for RNs in nursing require advanced graduate degrees, such as a clinical nurse specialist or nurse practitioner. There are various educational routes for becoming a registered nurse (RN), such as associate, diploma, and baccalaureate. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses' associations, professional nursing organizations, and educational and health care institutions.

A 70-year-old patient tells the nurse, "I can't go to the hospital for treatment because I have no hospital insurance. My Social Security and my pension pay my living expenses, but I don't have any savings." The nurse's response should be focused on a. providing information about Medicare. b. explaining the provisions of Medicaid. c. exploring the patient's ability to purchase group health insurance. d. investigating which hospitals provide free care for indigent patients.

ANS: A It is important to provide information that older adults, regardless of income, can receive federal payment for hospital and physician services through Medicare. There is not a clear need to provide information about Medicaid. It's too late to secure group health insurance for this identified health care need. In addition, health insurance companies often refuse payment for treatment of preexisting conditions. Exploring the patient's ability to purchase group health insurance should not be the initial focus.

. A patient states that he or she cannot afford health care insurance for the family because of a low income. What is the best form of insurance available for this patient? a. Medicaid b. Medicare c. Private insurance d. A managed care organization

ANS: A Medicaid is a form of insurance for low-income families. Medicare is a federally funded health insurance program for people greater than 65 years of age. Private insurance is a fee-for-service plan. A managed care organization (MCO) provides care to a specific group of voluntarily enrolled patients.

. A nurse describes the method of care delivery on a unit as "using nursing staff in varying ratios to meet patient needs and coordinating care using care pathways." This best describes a. nursing case management. b. primary nursing. c. team nursing. d. the skill mix method.

ANS: A Nursing case management care delivery uses critical paths to coordinate cost-effective care provided by nursing team members from a variety of educational backgrounds. The description of the care delivery method does not match any of the other care delivery methods mentioned in the options.

A college student with severe depression was recently admitted to the psychiatric ward of a local hospital. The family is concerned about the student finishing the college term. Which is the best information for the nurse to give regarding how long psychiatric patients are typically hospitalized? a. A relatively short inpatient stay is followed by outpatient treatment. b. A long inpatient hospitalization is normal for the majority of patients. c. Patients with emotional or behavioral problems generally are not hospitalized. d. Most are automatically placed in a long-term care facility

ANS: A Patients who have emotional and behavioral problems, such as depression, violent behavior, and eating disorders, often require special counseling and treatment in psychiatric facilities. Hospitalization involves relatively short stays with the purpose of stabilizing patients before transfer to outpatient treatment centers. A long inpatient hospitalization, not hospitalized, or placed in a long-term facility are not correct for the typical hospitalization of psychiatric patients.

A 74-year-old patient was admitted to the hospital with diabetic ketoacidosis. How will the hospital be reimbursed by Medicare? a. Based upon the diagnostic-related group b. Based upon the cost of care c. Based upon the actual length of stay d. Based upon the number of medications

ANS: A Payment is based upon the diagnostic-related group. Established by Congress in 1983, the prospective payment system eliminated cost-based reimbursement. Hospitals serving patients using Medicare were no longer paid for all costs incurred to deliver care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 diagnosis-related groups. Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of the patient's length of stay or use of services in the hospital or the number of medications.

A nurse is teaching the importance of breast self-examination to a group of 20-year-old women. The nurse is promoting which type of care? a. Primary b. Secondary c. Tertiary d. Restorative

ANS: A Primary care is centered on prevention of disease. Secondary and tertiary care is administered after an illness has been diagnosed. Restorative care occurs after a patient is recovering from an acute illness or for those who have chronic illnesses.

Which groups are members of a nursing team? a. RNs, LPN/LVNs, nursing assistants b. Radiologists, dietitians, respiratory therapists c. Occupational therapists, physical therapists, pharmacists d. Physicians, pharmacists, dietitians, physical therapists

ANS: A RNs, LPN/LVNs, and nursing assistants are members of the nursing team who have been cross-trained to perform selected nursing tasks. The groups listed in the other options are not considered part of the nursing team

After several weeks of outpatient care, a patient with a badly burned hand has been referred for rehabilitation. The patient asks the nurse what the purpose of rehabilitation is. The best answer would be a. "It will help you get back the function of your hand and will prevent further disability." b. "It's a way of keeping you under direct supervision while healing continues." c. "You'll need to learn new ways of eating and dressing using your good hand." d. "In your case, I don't know what the purpose is. Why not ask your doctor?"

ANS: A Rehabilitation services are used after patients have stabilized following an illness or injury. The focus of rehabilitation is the return of function and prevention of further disability.

. The goal of the health care team is best described as a. restoring optimal physical, emotional, and spiritual health to patients. b. preventing communicable diseases. c. selecting health care professionals who serve people with health care needs. d. attaining personal satisfaction of the need to help others.

ANS: A Restoring optimal physical, emotional, and spiritual health to patients is a frequently used statement that describes the goal of health care. Prevention of communicable diseases is a narrow statement and does not best describe the goal of the health care team. The remaining options are not goals of the health care team.

The most important reason for a student nurse to prepare adequately before providing patient care is a. to be able to give the same safe care as a nurse. b. to avoid arousing the anger of the instructor. c. to maintain self-esteem by performing well. d. to make a favorable impression on unit staff.

ANS: A Student nurses are legally and ethically responsible for giving the same safe nursing care that nurses provide. Avoidance of arousing the anger of the instructor is not a valid reason. The remaining options are not the most important reasons.

Which member of the health care team is responsible for initially teaching a patient about medication side effects? a. Registered nurse b. LPN/LVN c. Occupational therapist d. Patient care technician

ANS: A The RN initiates all health teaching. This would include education about medication effects and side effects. The LPN/LVN is able to initiate health teaching only for basic health habits, such as cleanliness. Occupational therapists and patient care technicians are not qualified to undertake medication teaching.

An example of a public sector health care agency supported primarily by U.S. taxpayer dollars is the a. U.S. Public Health Service. b. Kaiser Permanente hospitals. c. American Cancer Society. d. World Health Organization

ANS: A The U.S. Public Health Service (USPHS) is an official health care agency under the umbrella of the Department of Health and Human Services, supported by tax money and accountable to the government. Kaiser Permanente is a private health care agency. The American Cancer Society is an example of a voluntary agency. The World Health Organization is an international health organization funded through fees paid by member nations of the UN.

The U.S. Public Health Service (USPHS) is funded by a. tax money. b. lottery money. c. voluntary contributions. d. estates and endowments.

ANS: A The USPHS is an official health care agency funded by tax dollars

A nurse is an advanced practice registered nurse (APRN) who cares for geriatrics. This nurse is which type of advanced practice nurse? a. Clinical nurse specialist b. Nurse practitioner c. Certified nurse-midwife d. Certified registered nurse anesthetist

ANS: A The clinical nurse specialist (CNS) is an APRN who is an expert clinician in a specialized area of practice, such as geriatrics or pediatrics. The nurse practitioner (NP) is an APRN who provides health care to a group of patients, usually in an outpatient, ambulatory care, or community-based setting. A certified nurse-midwife (CNM) is an APRN who is educated in midwifery and is certified by the American College of Nurse-Midwives. A certified registered nurse anesthetist (CRNA) is an APRN with advanced education in a nurse anesthesia accredited program.

Which of the following is a quality improvement activity in which the LPN/LVN engages routinely? a. Collecting data for care plan development b. Identifying nursing diagnoses c. Initiating patient teaching about medications d. Evaluating patient goal attainment

ANS: A The creation of care plans is a major way to improve the quality of patient care. The LPN/LVN assists the RN in the formulation of nursing care plans by contributing relevant data. The LPN/LVN is not responsible for identifying nursing diagnoses, initiating patient teaching about medications, and evaluating goal attainment. These activities are reserved for RNs

A new registered nurse who recently began working in a nursing center has been asked to complete a Resident Assessment Instrument (RAI) on a newly admitted resident. What is the primary purpose of this instrument? a. To provide a database to better understand the health care needs of this population b. To provide the nursing staff with an overall physical assessment of the resident c. To provide statistical evidence to support a universal health care policy d. To provide medications for the residents to take on a daily basis

ANS: A The facility needs to complete the RAI on all residents. The RAI consists of the Minimum Data Set (MDS), Resident Assessment Protocols (RAPs), and utilization guidelines of each state. The RAI ultimately provides a national database for nursing facilities so that policy makers will better understand the health care needs of the long-term care population. Although it does provide a physical assessment, the primary purpose is to better understand the needs of this population. It does not provide evidence for a universal health care policy or medications to be used for this population group

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.

Nursing management and executive roles include which of the following? (Select all that apply.) a. Supervisor b. Nurse manager c. Director d. Chief nursing officer e. Charge nurse

ANS: A, B, C, D The four levels of nursing management include supervisor, nurse manager, director, and chief nursing officer (CNO). Charge nurse is not considered a level of nursing management.

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 The correct options 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

A resident who is terminally ill and his family are considering hospice. They ask the nurse for information about hospice. Which of the following would be information the nurse could correctly relay? (Select all that apply.) a. Maintaining comfort as death approaches is the hospice philosophy. b. Hospice care may be provided at home or in a freestanding agency. c. Family members are encouraged to care for the individual. d. Hospice can be tailored to meet the individual's and the family's needs. e. The cost of hospice is more than the cost of hospital care. f. Respite care is available when the individual is cared for at home.

ANS: A, B, C, D, F Relaying that the cost of hospice is more than the cost of hospital care is inappropriate for the nurse to convey to the family. Usually the nurse does not know comparative costs.

A nurse is presenting at an interdisciplinary meeting about the multiple external forces that are influencing nursing today. Which examples should the nurse include? (Select all that apply.) a. Health care reform b. Threat of bioterrorism c. Population demographics d. Role of nurse manager e. Nursing shortage

ANS: A, B, C, E Multiple external forces affect nursing today, including health care reform, demographic changes of the population, increasing numbers of medically underserved, need for emergency preparedness, threat of bioterrorism, workplace issues, and the nursing shortage. Role of nurse manager is not an external force affecting nursing, but is one role of the registered nurse.

A nurse is teaching the staff about the characteristics of a profession. Which information should the nurse include? (Select all that apply.) a. Extended education b. Theoretical body of knowledge c. Code of ethics for practice d. Practice developments e. Provision of a specific service

ANS: A, B, C, E Professions possess the following characteristics: • An extended education of members and a basic liberal education foundation • A theoretical body of knowledge leading to defined skills, abilities, and norms • Provision of a specific service • Autonomy in decision making and practice • A code of ethics for practice Practice developments are not a characteristic of a profession, but are essential for nurses to stay current by gaining new knowledge about the latest research and practice developments.

A nurse is teaching the staff about Quality and Safety Education in Nursing, which identified six competencies for nursing. Which information should the nurse include in the teaching session? (Select all that apply.) a. Informatics b. Safety c. Health policies d. Informatics e. Quality improvement

ANS: A, B, D, E The Robert Wood Johnson Foundation sponsored the Quality and Safety Education for Nurses (QSEN) initiative to respond to reports about safety and quality patient care by the IOM. The QSEN initiative encompasses the competencies of patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Health policy is health related issues at the government level, not a competency.

Which agencies are considered part of the U.S. Public Health Service? (Select all that apply.) a. National Institutes of Health b. Food and Drug Administration c. Department of Veterans Affairs d. Centers for Disease Control and Prevention e. American Cancer Society f. Alcohol, Drug Abuse, and Mental Health Administration

ANS: A, B, D, F These agencies are part of the USPHS, a division of the Department of Health and Human Services. The American Cancer Society is a voluntary agency. The Department of Veterans Affairs is an official agency, but it is not under the USPHS.

Which of the following are problems associated with the present health care delivery system that could be identified by a nursing student who is writing an essay? (Select all that apply.) a. High cost b. Insufficient number of doctors c. Widespread shortage of RNs d. Continuous quality improvement

ANS: A, C The cost of U.S. health care is higher than in any other developed country—16% of our gross national product—and there is an identified widespread shortage of professional nurses in both acute and long-term care agencies. There is no identified national shortage of physicians. Continuous quality improvement is not considered a problem but rather a means for identifying health care problems.

A nurse wants to become an advanced practice registered nurse (APRN) and have a higher degree of independence. Which advanced roles could the nurse pursue? (Select all that apply.) a. Clinical nurse specialist b. Nurse manager c. Nurse practitioner d. Nurse midwife e. Nurse anesthetist

ANS: A, C, D, E The advanced practice registered nurse (APRN) is the most independently functioning nurse. An APRN has a master's degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice. There are four core roles for the APRN: clinical nurse specialist (CNS), nurse practitioner (NP), certified nurse midwife (CNM), and certified RN anesthetist (CRNA). Nurse managers do not require an advanced degree

Which of the following phrases could be used by a nurse to characterize the present health care delivery system in the United States? (Select all that apply.) a. Responds to illness b. Is oriented to promote wellness c. Provides for universal access d. Depends on national health insurance e. Is fragmented and confusing f. Is unsafe

ANS: A, E, F The U.S. health care system responds to illness rather than health promotion. Universal access is not available. National health insurance is not available. The system is fragmented, with a variety of payment options and multiple sources of funding and only a few seamless systems in place. The U.S. health care system has been described as a poorly designed, fragmented, and disjointed maze of services that lacks preventive care, wastes resources, and is low quality, unsafe, and confusing.

Which patient is most suitable for admission into hospice? a. A 63-year-old man with a fractured femur b. A 45-year-old woman with terminal end-stage renal failure c. A 14-year-old patient with leukemia that is in remission d. A 78-year-old patient with dementia that wanders

ANS: B A patient entering a hospice is at the terminal phase of illness, and the patient, family, and physician agree that no further treatment will reverse the disease process. A fractured femur, leukemia in remission, and dementia are not conditions that are terminal, and so are not appropriate for hospice

. A nurse listens to a patient's lungs and determines that the patient needs to cough and deep breath. The nurse has the patient cough and deep breath. Which concept did the nurse demonstrate? a. Accountability b. Autonomy c. Licensure d. Certification

ANS: B Autonomy is essential to professional nursing and involves the initiation of independent nursing interventions without medical orders. Accountability means that you are professionally and legally responsible for the type and quality of nursing care provided. To obtain licensure in the United States, RN candidates must pass the NCLEX-RN® examination administered by the individual State Boards of Nursing to obtain a nursing license. Beyond the NCLEX-RN®, some nurses choose to work toward certification in a specific area of nursing practice.

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 set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services is known as a. inflation. b. capitation. c. fee-for-service. d. gross domestic product.

ANS: B Capitation is an alternative to the traditional fee-for-service method of payment. Capitation involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services. Inflation is a general rise in prices, usually persisting over several years. Fee-for-service is the traditional method of paying health care bills in which physicians are paid a fee by the patient for each service they provide. Gross domestic product is the combination of all goods and services produced in a nation's economy.

4. The skill that will be most helpful to an LPN/LVN in navigating health care system changes successfully is a. the ability to work efficiently for long hours. b. problem-solving and critical thinking abilities. c. identifying the need for comprehensive system change. d. becoming knowledgeable about CQI processes.

ANS: B Critical thinking and problem solving are important not only in patient care but also in nonclinical situations in the health care agency. The ability to work efficiently for long hours will not promote success during change. Identifying the need for comprehensive system change and becoming knowledgeable about CQI processes will be helpful but would not be assessed as most helpful.

Which of the following constitutes a problem that affects data collected by the nurse interviewing a chronically ill older adult patient? Many older adults who are covered only by Medicare Parts A and B find it difficult to pay the cost of a. hospital care for an acute short-term illness. b. prescription drugs while living at home. c. post-hospitalization rehabilitation services in a skilled nursing facility. d. doctor's office visits, Pap smears, and mammography

ANS: B Data collection should include medications prescribed for the patient and whether the patient is medication compliant. Often patients are without medication when funds are limited. The other costs mentioned in the remaining options are covered by Medicare Parts A and B.

A nurse admits an older adult patient who states that he or she has no living relatives and only two close friends. Upon admission to the hospital, which action should the nurse initiate first? a. Implement a process of payment. b. Implement a discharge plan. c. Implement a visit with the family. d. Implement a resource utilization group.

ANS: B Discharge planning with coordination of services begins the moment a patient is admitted to a health care facility. A resource utilization group is used in long-term care settings to manage patient costs. A visit with the family is not possible because the patient has no living relatives. Upon admission, a process of payment is not a priority for a nurse.

A nurse must follow legal laws that protect public health, safety, and welfare. Which law is the nurse following? a. Code of Ethics b. Nurse Practice Act c. Standards of practice d. Quality and safety education for nurses

ANS: B In the United States each State Board of Nursing oversees its Nurse Practice Act (NPA), which regulates the scope of nursing practice for the state and protects public health, safety, and welfare. The ANA's Code of Ethics for Nurses: Interpretation and Application (2010) provides a guide (not a law) for carrying out nursing responsibilities to ensure high-quality nursing care and provide for the ethical obligations of the profession. The purpose of a standard of care is to describe the common level of professional nursing care to judge the quality of nursing practice. The Robert Wood Johnson Foundation sponsored the Quality and Safety Education for Nurses (QSEN) initiative to respond to reports about safety and quality patient care by the Institute of Medicine.

5. When involved with discharge planning for a patient recovering from a mild cerebrovascular accident, the nurse should understand that Medicare provides a. longer stays for Medicare patients in acute inpatient settings. b. increased use of extended care units for rehabilitation needs. c. inappropriate early discharge of large numbers of patients. d. universal coverage for U.S. citizens and permanent residents

ANS: B Medicare provides for 20 days' post-hospitalization care in a skilled nursing facility for rehabilitation services. Medicare patients in acute inpatient settings do not have longer stays. Medicare does not provide universal coverage for U.S. citizens and permanent residents. Inappropriate early discharge of large numbers of patients is not an advantage to a patient.

A single mother with three children uses the public health department services in the county to immunize her children. Which level of health care did the mother use? a. Continuing care b. Preventative care c. Secondary acute care d. Restorative care

ANS: B Preventative care includes services such as immunizations, screenings, poison control information, mental health counseling and crisis prevention, and community legislation. Continuing care is assisted living. Secondary acute care involves emergency and radiological procedures. Restorative care involves rehabilitation services and home care.

A patient who needs nursing and rehabilitation after a stroke would benefit most by receiving care at which center? a. Primary care center b. Restorative care center c. Assisted living center d. Respite center

ANS: B Restorative care centers provide rehabilitation and nursing care. In primary care centers, health promotion is the major theme. Assisted living centers offer long-term assistance with activities of daily living. Respite centers offer short-term relief to persons who provide full-time care to an older adult.

A student nurse asks, "What determines the LPN/LVN's role and responsibilities in the practice setting?" The best answer is a. "The job analysis performed by the National Council of State Boards of Nursing." b. "The Nurse Practice Act of the state in which the LPN/LVN is employed." c. "The skill mix of the agency unit to which the nurse is assigned." d. "The degree of centralization of the unit on which the LPN/LVN works."

ANS: B The LPN/LVN's role is determined by the Nurse Practice Act of the state in which the nurse is working. The Nurse Practice Act differs from state to state but generally allows LPN/LVNs to provide care in basic and complex patient situations under the general supervision of an RN, physician, podiatrist, or dentist. The other options are not determinants of scope of practice.

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

The LPN/LVN describes herself as "working in an expanded role in a long-term care facility." What is the most correct interpretation of this statement? a. The LPN/LVN is able to administer oral medications. b. The LPN/LVN is a first-line manager responsible to the RN. c. The LPN/LVN formulates nursing diagnoses and care plans. d. The LPN/LVN interprets and implements research findings.

ANS: B The expanded role of the LPN/LVN in long-term care occurs in the role of manager of care. The LPN/LVN may be a first-line manager, supervising care given by LPN/LVNs and unlicensed assistive personnel while being directly responsible to the RN nurse manager. Oral medication administration is part of the traditional role. Formulation of nursing diagnoses and care plans and interpreting and implementing research findings are outside the LPN/LVN role. The LPN/LVN assists in implementing research findings.

How should the nurse accurately describe a nurse practitioner to a student nurse? a. "The nurse practitioner is a student nurse who is near graduation from a basic program." b. "The nurse practitioner is a registered nurse with a master's degree in nursing and specialty certification." c. "The nurse practitioner is a registered nurse with doctoral preparation in research methodology." d. "The nurse practitioner is a nurse who practices exclusively in a university medical center.

ANS: B The nurse practitioner has a minimum of a master's degree in nursing and certification in an area of specialization, such as primary care, geriatrics, pediatrics, and so on. The other options do not accurately describe the nurse practitioner's education or role.

Which other term can the nurse use to describe the Omnibus Budget Reconciliation Act of 1987? a. Medicaid Act b. Nursing Home Reform Act c. Diagnostic Related Group Act d. Magnet Recognition Act

ANS: B The nursing center industry has become one of the most highly regulated industries in the United States. The Omnibus Budget Reconciliation Act of 1987, also known as the Nursing Home Reform Act, raised the standard of services provided by nursing centers. The Medicaid act provides insurance to low-income families. The diagnostic related group was formed from the Medicare Act. The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice

An older adult patient is to be discharged from the acute care hospital with left-sided weakness, difficulty swallowing, and inability to independently perform ADLs, therefore requiring daily physical therapy. The patient has no family and lives in a high-rise apartment building. Referral to which level of long-term care would the nurse likely recommend at the care planning conference? a. Sheltered housing b. Skilled nursing facility c. Assisted living facility d. Domiciliary care

ANS: B The patient requires the ongoing assistance of trained medical professionals, including nurses, doctors, and physical therapists. A skilled nursing facility should be recommended.

Which program offers an incentive to hospitals to discharge patients as quickly as possible? a. Retrospective payment system b. Prospective payment system c. Seamless system d. Private insurance plans in effect for under 1 year

ANS: B The prospective payment system tells the hospital what it will pay for specific health care in advance. This fixed payment does not change regardless of the number of days the patient is hospitalized. Thus, early discharge can result in a profit for the hospital, creating an incentive.

A trend in health care that may negatively affect the number of practical nurses hired by an agency is a. the aging of the U.S. population. b. the increased use of unlicensed assistive personnel. c. decentralization of health care agencies. d. the emphasis on critical thinking and problem solving.

ANS: B The trend toward using the least expensive personnel to perform nursing care negatively affects the number of licensed nurses employed by an agency. The aging of the population does not negatively affect the hiring of LPN/LVNs. Decentralization of health care agencies is more likely to affect middle managers. Critical thinking and problem-solving abilities make LPN/LVNs more attractive as employees

A patient who experienced a stroke 4 days ago has been discharged from the hospital and will be undergoing outpatient rehabilitation. How should the nurse prepare the patient for this level of care? a. The patient will be admitted to the rehabilitative unit of the hospital. b. The patient will have scheduled appointment times for therapy. c. The patient will have home visits from all members of the multidisciplinary team. d. The patient will be at home for all of the treatments ordered by the primary health care provider.

ANS: B When patients receive rehabilitation services in outpatient settings, patients get treatment at specified times during the week but remain at home the rest of the time. Inpatient rehabilitation services would require admission to an inpatient facility. Some rehabilitation is offered in the home but usually only certain members of the health care team visit. Home rehabilitation services would have the treatments performed in the home, but not for outpatient rehabilitation.

. A student nurse asked to identify the types of services currently provided in the U.S. health care delivery system should mention which of the following? (Select all that apply.) a. Restructuring b. Health promotion c. Diagnosis and treatment d. Illness prevention e. Seamless systems f. Alliances and networks

ANS: B, C, D Of the options listed, those considered to be health care services are health promotion, diagnosis and treatment, and illness prevention. The other options are terms used in this chapter.

A nurse is asked about public health care agencies. Which of the following would help the nurse frame a comprehensive response? (Select all that apply.) a. Public health agencies are entirely supported by fees for services. b. There are two types of public health agencies: official and voluntary. c. Public health agencies seek to make a profit for the owners. d. Public health agencies focus on curing illness and disease. e. Public health agencies emphasize disease prevention, wellness promotion, research, and education.

ANS: B, E There are two types of public health care agencies: official, which are tax supported, and voluntary, which are supported primarily by voluntary contributions. Official agencies tend to focus on disease prevention and wellness promotion, whereas the focus of voluntary agencies is usually research and education.

Knowing that Alcoholics Anonymous is a nonprofit group that receives no taxpayer money and is aimed at meeting the needs of a selected population segment would help the nurse to classify it as a a. public agency. b. private agency. c. voluntary agency. d. proprietary agency.

ANS: C Alcoholics Anonymous (AA) is a voluntary agency. Voluntary agencies are nonprofit and often provide services complementary to official health agencies. AA meets the needs of a selected population segment and complements the official agency, Alcohol, Drug Abuse, and Mental Health Administration.

Select the person or persons who may be included on the physical therapy team. (Select all that apply.) a. RN b. LPN/LVN c. Physical therapists d. Physical therapy assistants

ANS: C, D Strictly speaking, the physical therapy team includes only those individuals who have education in physical therapy. Nurses may assist the patient to perform exercises to provide continuity of care when members of the physical therapy team are not present

A retired high school teacher has been admitted to the hospital with complications of diabetes. To ensure the patient is discharged home with the right care, at the right time, and without duplication, which health care reform system was developed? a. The Joint Commission b. National Priorities Partnership c. Accountable Care Organization d. Managed Care

ANS: C An ACO works to make sure that patients receive the right care at the right time, without duplication of services or incidence of medical errors. Accountable care organizations (ACO) were developed to coordinate medical care by primary care and specialty physicians, hospitals, and other health care providers with the goal of providing high-quality coordinated care. The Joint Commission (2012) requires health care organizations to determine how well an organization meets patient needs and expectations and accredits health care organizations. Managed care focuses on health promotion. The National Priorities Partnership is a group of 51 organizations from a variety of health care disciplines that joined together to work toward transforming health care by focusing on eight national priorities.

Which patient is in the most expensive place to deliver care per day? a. A patient in a rehabilitation unit b. A patient in a long-term care facility c. A patient in an intensive care unit d. A patient in a private hospital room

ANS: C An intensive care unit is the most expensive delivery site for medical care because each nurse is usually assigned to care for only one or two patients at a time and because of the types of treatments and procedures the patients in the intensive care unit typically require. Rehabilitation units, long-term care facility, and a private hospital room are not as expensive per day as an intensive care unit.

A patient does not want the treatment that was prescribed. The nurse helps the patient talk to the primary health care provider and even talks to the primary health care provider when needed. The nurse is acting in which professional role? a. Educator b. Manager c. Advocate d. Provider of care

ANS: C As an advocate you act on behalf of your patient, securing and standing up for your patient's health care rights. As an educator you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning. Most nurses provide direct patient care in an acute care setting, and this describes the role of provider of care. A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency.

A method of financing health care costs in which physicians are paid a fee by the patient for each service they provide is known as a. inflation. b. capitation. c. fee-for-service. d. gross domestic product

ANS: C Fee-for-service is the traditional method of paying health care bills in which physicians are paid a fee by the patient for each service they provide. Inflation is a general rise in prices, usually persisting over several years. Capitation is an alternative to the traditional fee-for-service method of payment. Capitation involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services. Gross domestic product is the combination of all goods and services produced in a nation's economy.

A small business owner has consulted with an occupational health nurse regarding health promotion activities for the employees. The registered nurse explores the possibility of providing an area outside the new office complex where employees can walk during their breaks. Which level of care did the nurse use? a. Continuing care b. Restorative care c. Primary care d. Tertiary care

ANS: C In the settings that deliver preventative and primary care, such as schools, physicians' or health care providers' offices, occupational health clinics, and nursing centers, health promotion is a major theme. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Tertiary care involves intensive care and psychiatric facilities.

An LPN/LVN offers input to the RN about the effectiveness of the patient's care plan. By doing this, the LPN/LVN is functioning in an a. entrepreneurial role. b. expanded role. c. interdependent role. d. independent role.

ANS: C Interdependence calls for the LPN/LVN to provide input and feedback to the RN planning and evaluating care for a specific patient.

A nurse is teaching the staff about the Prospective Payment System (PPS). Which information should the nurse include in the teaching session? a. PPS establishes cost-based reimbursement for health care. b. PPS provides reimbursement for every service the patient receives. c. PPS establishes reimbursement rates based upon diagnosis-related groups (DRGs). d. PPS provides money to the patient for health promotion use.

ANS: C PPS established diagnosis-related groups (DRGs). Established by Congress in 1983, the PPS eliminated cost-based reimbursement, which is reimbursement for every service the patient receives. Hospitals serving patients using Medicare were no longer paid for all costs incurred in delivering care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 DRGs. PPS provides a preset amount of money to hospitals and health care providers for DRGs, not for health promotion. Managed care focuses on health promotion.

Accountability of private health care agencies is assumed by the a. taxpayer. b. government. c. owners of the agency. d. board of directors of the agency.

ANS: C Proprietary agencies are accountable to the owners of the agency.

A nurse is asked, "What does it mean if a health care agency is described as 'proprietary'?" The nurse should respond: a. "It operates by government mandate." b. "It is funded by local tax money and government subsidies." c. "It operates for profit." d. "It uses a large number of volunteers."

ANS: C Proprietary agencies operate for profit. The remaining options describe other categories of health care agencies.

The member of the health care team responsible for performing treatments to assist the patient to breathe more efficiently and effectively is the a. occupational therapist. b. physical therapist. c. respiratory therapist. d. psychotherapist.

ANS: C Respiratory therapists are responsible for evaluating patient respiratory status and suggesting treatment to prevent or treat respiratory problems. The health care team members mentioned in the other options do not focus on patient breathing.

An 81-year-old widow with mild dementia has self-care capabilities. The widow recently moved in with her daughter, a 46-year-old working mother with three children. In considering how to have care for her mother when she is working, what is the most appropriate option the nurse should suggest? a. A rehabilitation center b. A nursing center c. An adult day care center d. A hospice center

ANS: C Services offered by adult day care centers allow family members to maintain their lifestyles and employment and still provide home care for their relatives. A hospice is a system of family-centered care that allows patients to live and remain at home with comfort, independence, and dignity while alleviating the strains caused by terminal illness; this is inappropriate because the widow does not have a terminal illness. Rehabilitation is the use of multiple therapies such as physical, psychological, occupational, speech, and social services to help restore a person to the fullest physical, mental, social, vocational, and economic usefulness possible; this is not appropriate because the widow can provide self-care. A nursing center is a nursing home; it is too early for this because the widow can provide self-care.

Which statement best describes the relationship between the student nurse assigned to a hospital unit for clinical experience and the unit staff? a. The student is under direct supervision of the nurse manager of the unit at all times. b. Students are on the clinical unit to give service to the hospital as they care for patients. c. The student applies classroom learning under the supervision of faculty members during clinical training. d. Practical nursing students form a nursing team of their own and are not a part of the larger unit team.

ANS: C Student nurses are not counted as clinical staff when receiving clinical experience on a unit. They are supervised by instructors, and their objective is to apply classroom theory in selected clinical situations. It is not an expectation that a student be under direct supervision of the nurse manager. Students are not unit employees. It is not a usual practice for practical nursing students to form a nursing team of their own and not be a part of the larger unit team on the clinical unit.

A nurse uses effective strategies to communicate and handle conflict with nurses and other health care professionals. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse demonstrating? a. Informatics b. Quality improvement c. Teamwork and collaboration d. Evidence-based practice

ANS: C Teamwork and collaboration uses effective strategies to communicate and handle conflict. Informatics includes navigating electronic health records. Quality improvement uses tools such as flow charts and diagrams to improve care. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

Which patient is most in need of discharge planning by the nurse? a. A 29-year-old mother with strong family support who has a healthy newborn b. A 59-year-old patient with an active lifestyle who has had an appendectomy c. A 64-year-old patient with heart failure who has a limited income d. A 56-year-old patient with a supporting spouse who has had a hysterectomy

ANS: C The 64-year-old patient with heart failure has a chronic disease and more risks than the other patients because of age and income. Some patients are more in need of discharge planning because of their risks. For example, some patients have limited financial resources or limited family support; others may have long-term disabilities or chronic illnesses. Early discharge teaching is especially important as a way to decrease readmission to the hospital. Appendectomy and hysterectomy are acute conditions and do not have as many risks as heart failure. A healthy newborn is stable, whereas heart failure is chronic.

Which care delivery method has the greatest potential for fragmenting patient care? a. Primary nursing b. Case method c. Functional method d. Patient-focused care

ANS: C The functional method of care delivery assigns various nursing team members to provide specific aspects of care to the patient. The RN might give medications and provide health teaching, the unlicensed assistive personnel (UAP) might provide hygiene, the LPN/LVN might take vital signs and change a dressing, lab personnel might draw blood specimens, and so on. Primary nursing provides the least fragmentation. With the case method, one nurse is responsible for most of the patient care. Patient-focused care attempts to limit fragmentation by using cross-trained personnel.

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.

A patient tells the nurse that he or she does not understand the purpose of capitation. What is the nurse's best response? a. To provide high-quality care at the highest cost to the hospital, not the patient b. To provide the least expensive care for patients regardless of outcomes c. To build a payment plan that includes the best standards of care at the lowest cost d. To ensure that all patients receive the same care for the same cost in all hospitals

ANS: C The purpose of capitation is to build a payment plan for select diagnoses or surgical procedures that includes the best standards of care and essential diagnostic and treatment procedures at the lowest cost. Capitation does not cause the hospitals to pay the highest cost but to determine quality care for the lowest cost. Capitation does not provide the least expensive care for patients for outcomes because best standards are the outcome. Capitation does not make all patients receive the same care for the same cost in all hospitals.

. A nurse is teaching the staff about managed care. Which information should the nurse include? a. Managed care focuses on long-term care services for skilled nursing. b. Managed care focuses on hospital admissions and illnesses for a group of people. c. Managed care focuses on control over primary health services for a defined population. d. Managed care focuses on decreased access to care while increasing costs.

ANS: C The term managed care describes systems in which the payer has control over primary health care services delivery for a defined patient population. Long-term care insurance focuses on skilled nursing, not managed care. Managed care focuses on health and staying out of the hospital. Managed care aims to increase access to care while decreasing costs.

Which of the following are types of health care agencies in which the LPN/LVN would most likely find work? (Select all that apply.) a. Board and care home b. Emergency unit facility c. Skilled nursing facility d. Adult day care center e. Hospice

ANS: C, E Board and care home residences offer housing and custodial care and usually do not employ licensed staff. Intermediate care facilities provide health-related care to persons who do not require acute or skilled nursing services but who need facility placement. Care is usually provided by CNAs. Skilled nursing facilities rely heavily on LPN/LVNs. Adult day care centers are more likely to hire CNAs and personal care assistants who are supervised by RNs. Hospices often employ LPN/LVNs.

A nurse is directing the care and staffing of three cardiac units. The nurse is practicing in which nursing role? a. Advanced practice registered nurse b. Nurse researcher c. Nurse educator d. Nurse administrator

ANS: D A nurse administrator manages patient care and the delivery of specific nursing services within a health care agency. An advanced practice registered nurse has a master's degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice. A nurse educator works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. The nurse researcher investigates problems to improve nursing care and further define and expand the scope of nursing practice.

Which individual is best served by receiving care at an adult day care center? a. Mr. A, who needs a nebulizer treatment to control an acute asthma attack b. Mr. B, who has been referred for carpal tunnel surgery c. Mr. C, a new diabetic who needs teaching d. Mr. D, who has first-stage Alzheimer's disease and a working wife

ANS: D Adult day care centers provide services for individuals who need supervision because of physical or safety needs but are not candidates for nursing home placement. The center would provide supervision during the day, and the patient's wife would assist at other times. The patient who needs a nebulizer treatment to control an acute asthma attack would go to an urgent care center. The person who has been referred for carpal tunnel surgery would go to an ambulatory surgical center. The patient who is a new diabetic and needs teaching could be referred to a community health nursing service or an outpatient clinic.

A patient tells the nurse, "I received a questionnaire that said my answers would be used for purposes of continuous quality improvement. I wonder if it's worth my time to fill it out?" The response that best explains continuous quality improvement is: a. "Continuous quality improvement activities are used to restructure hospital departments and personnel assignments to ensure cost savings." b. "Continuous quality improvement activities are used to provide an opportunity for staff members to participate in self-governance." c. "Continuous quality improvement activities are used to obtain appropriate reimbursement for care given to ambulatory and inpatients." d. "Continuous quality improvement activities are used to monitor and improve processes involved in providing safe, effective care for patients."

ANS: D Continuous quality improvement (CQI) activities provide information critical to total quality management. Feedback from patients is one data collection method for CQI. The other options do not describe CQI activities.

What is the most appropriate time for the nurse to begin discharge planning with a patient? a. The day of patient discharge from the health care agency b. As soon as the insurance provider has been identified c. When the health care provider writes the discharge order d. When the patient is admitted to the health care agency

ANS: D Discharge planning begins the moment a patient is admitted to a health care facility. The day of discharge, when the insurance provider has been identified, and when the order is written are too late.

A patient asks the nurse, "What do health maintenance organizations (HMOs) do to reduce health care costs?" The response giving the best example of an HMO cost-containment method would be: a. "HMOs pool individual contributions for use in catastrophic illness." b. "HMOs provide supplemental coverage for items not covered by Medicare." c. "HMOs use a retrospective payment system." d. "HMOs provide services aimed at keeping members healthy."

ANS: D HMOs attempt to reduce costs by providing services aimed at keeping members healthy, such as smoking cessation classes and weight loss programs. The other options are not factual statements.

A patient tells the nurse, "I didn't sign up for health care insurance at my job because I'm young and healthy and can use the money in other ways." The response that best explains the advantage of health insurance would be a. "With insurance a fiscal middleman pays your health care bills." b. "With insurance your individual contributions go directly to paying your personal expenses." c. "With insurance you can borrow money for unexpected health care expenses at a very low interest rate." d. "With insurance you are spreading the risk in case you have a serious health event, such as cancer or major trauma."

ANS: D Health insurance, like any insurance, spreads risk. The risk that is spread in health insurance is that the young and the healthy generally subsidize (support financially) the sick and older persons in the health insurance group. Individual contributions are pooled for the protection of individuals from financial disaster due to health care bills. A fiscal middleman does pay health care bills, but this does not address the best explanation of the advantage of health insurance. The remaining options are not factual statements.

A grocery store clerk does not have a family health care provider. The clerk has had a sore throat for the past week and recently began running a fever. The clerk goes to the local community hospital's emergency room for treatment. Which level of care did the clerk use? a. Continuing care b. Restorative care c. Primary care d. Tertiary care

ANS: D Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units are sites that provide secondary and tertiary levels of care. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Primary care involves health promotion such as prenatal care and well-baby care.

A 17-year-old patient was seriously injured in a motor vehicle accident and has been transferred from an acute care hospital to a rehabilitation/restorative facility. Which action should the nurse take to ensure the best outcome for this patient? a. Make sure that the patient gets enough rest. b. Push the patient beyond his or her limits. c. Request that nobody visit for the first few days. d. Involve the family early in the rehabilitation process.

ANS: D In restorative settings, nurses recognize that success is dependent on effective and early partnering with patients and their families. Although rest is good, family involvement is the priority. Pushing the patient beyond his or her limit is not helpful. Not letting anybody visit is contraindicated.

The role of the LPN/LVN can best be described as which of the following? a. Initiates all health teaching b. Works in an independent role c. Initiates all phases of the nursing process d. Assists with all phases of the nursing process

ANS: D Initiating health teaching, working in an independent role, and initiating all phases of the nursing process are roles of the RN. An RN initiates all health teaching; an LPN/LVN initiates health teaching for basic health habits and reinforces the health teaching of the RN in other areas. An RN works in an independent role; an LPN/LVN identifies possible new nursing problems and reports them to the RN. An RN initiates all phases of the nursing process and formulates nursing diagnoses; an LPN/LVN assists with all phases of the nursing process and works with established nursing diagnoses.

. The aspect of functioning that distinguishes RNs from LPN/LVNs is that only RNs a. plan and organize daily care for groups of patients. b. implement measures ordered to prevent complications. c. provide health information to patients and families. d. initiate independent nursing actions based on nursing diagnoses.

ANS: D LPN/LVNs function interdependently rather than independently. The LPN/LVN functions under the supervision of the RN. The LPN/LVN is able to perform the remaining options.

At a patient care planning conference, the nurse hears the remark, "We need to report this event to our official public health agency." The nurse interprets this as meaning the speaker will contact the a. American Cancer Society. b. Visiting Nurse Association. c. National Easter Seal Society. d. local health department.

ANS: D Local health departments are examples of official public health agencies.

A registered nurse is required to participate in a simulation to learn how to triage patients who are arriving to the hospital after exposure to an unknown gas. This is an example of a response to what type of influence on nursing? a. Workplace hazards b. Nursing shortage c. Professionalism d. Emergency preparedness

ANS: D Many health care agencies, schools, and communities have educational programs to prepare for nuclear, chemical, or biological attack and other types of disasters. Nurses play an active role in emergency preparedness. Workplace hazards include violence, harassment, and ergonomics. A person who acts professionally is conscientious in actions, knowledgeable in the subject, and responsible to self and others. There is an ongoing global nursing shortage, which results from insufficient qualified registered nurses (RNs) to fill vacant positions and the loss of qualified RNs to other professions.

A nurse is asked the most frequently cited reason for death in the world. How should the nurse reply? a. Technological advances b. Old age c. Cancer d. Poverty

ANS: D Poverty is still deadlier than any disease and is the most frequently cited reason for death in the world today. Technological advances, old age, and cancer are not the most cited reason for death.

A nurse working in the emergency department who must obtain data to identify the patient's primary care provider should ask the patient about a. hospital stays. b. low-cost health care providers. c. receiving specialized care aimed at restoring the function of a body part. d. the referring physician, nurse practitioner, or ambulatory care setting.

ANS: D Primary care is the term used to describe the point at which an individual enters the health care system. This is often the referring party or agency

An example of a voluntary health agency that is focused on research and education of the public is a. the Alcohol, Drug Abuse, and Mental Health Administration. b. the Visiting Nurse Association. c. St. Jude's Children's Hospital. d. the American Heart Association.

ANS: D The American Heart Association is a voluntary health agency, supported by voluntary donations, that focuses on research and education on heart disease and stroke. The Alcohol, Drug Abuse, and Mental Health Administration is an official agency. The Visiting Nurse Association is a public voluntary agency that provides home care to persons with acute and chronic diseases. St. Jude's Children's Hospital is a nonprofit hospital.

The member of the health care team responsible for assisting patients to arrange for community agencies to provide services after discharge is the a. nurse. b. physician. c. physical therapist. d. social worker.

ANS: D The social worker explores needs identified by discharge plans and works with community agencies to meet these patient needs.

A mother and her three children often seek medical services at the emergency room. The nurse realizes that they have no insurance and are unable to pay for services. The action the nurse should take that would provide the greatest assistance to the family would be to a. advise them to use urgent care centers where fees are lower. b. leave the newspaper classified ads in a visible place. c. advise the mother to seek work at the hospital personnel office. d. contact a social worker to discuss Medicaid with the mother.

ANS: D The social worker would be able to help the family explore whether they might qualify for Medicaid or the Children's Health Insurance Program. Advising the family to use urgent care centers might be considered a form of refusal of services. Leaving the newspaper classified ads in a visible place and advising the mother to seek work at the hospital personnel office assume that the uninsured mother is not working, when in fact she may have a job that does not provide the benefit of health care.

Select the method of delivering nursing care that facilitates continuity of care, individualizes care, and fosters 24-hour accountability for patient care. a. Case nursing b. Team nursing c. Functional nursing d. Primary care nursing

ANS: D This care delivery method uses RNs only. Each primary nurse cares for six patients from admission to discharge, developing the nursing diagnoses and plans of care and assuming ultimate responsibility for 24-hour care, although associate nurses may actually provide care when the primary nurse is not on duty.