Ch. 11 PrepU
A client asks a nurse about the benefit of using diagnosis-related groups (DRGs) as a reimbursement method. Which is the nurse's best response?
"DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay."
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."
Which statement regarding health care reform trends is most accurate?
"Systems are in place to pay for performance and penalize hospitals for excessive readmissions."
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."
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.
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?"
It is recommended that a client go to a convalescent center upon discharge following a minor stroke. The client says, "I don't want to go anywhere, I want to go home." Which information should the nurse offer?
"You will only stay until you are well enough to go home."
A nurse is providing care to several clients at the clinic. When reviewing the clients' medical records, which client would the nurse identify as meeting the criteria for Medicare reimbursement? Select all that apply.
66-year-old male with heart failure 45-year-old male with a permanent disability receiving social security benefits
Which client would a nurse correctly refer to Medicare services?
A 66-year-old client with diabetes
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).
A nurse demonstrates understanding of Healthy People 2030 by supporting which statement?
A client's health is affected by social, economic, and political factors.
A newly licensed nurse would like to work in a hospital that is innovative in the provision of nursing services. The nurse should apply to which institution?
A hospital that is Magnet recognized
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
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
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
Which is an emerging trend in health care delivery?
Active involvement of consumers
Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?
Affordable Care Act
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
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.
During a hospice visit, the client's spouse suddenly begins to cry and says, "I am so tired. I just can't do this anymore. I am not getting to sleep and I just eat sandwiches when I can." What is the nurse's best intervention?
Arrange for short-term inpatient care for the client.
A nurse is caring for an older adult client in the home. The nurse concludes that the client needs an X-ray to determine whether the client has pneumonia and requires oxygen for shortness of breath. The nurse calls to inform the physician of the client's status and then makes arrangements to carry out the physician's orders. In this scenario, what role does the nurse play?
Case manager
A nurse manager is working as part of a quality improvement team to address issues that could impact reimbursement by Medicare. Which situation would warrant the team's attention? Select all that apply.
Catheter-related urinary tract infections Retained surgical instruments Client falls
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.
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.
The growth in home health care is largely attributed to which factor?
Early discharge of clients from the hospital setting
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
In the 1980s, the nursing care delivery model shifted from a team nursing model to a:
primary nursing model.
Which is the main focus of care for a school nurse?
Community care
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
What are chief tasks of the home health care nurse? Select all that apply.
Developing a nursing care plan Providing client education and counseling Providing continuity of care Administering medications
Which are ethical issues that need to be considered as health care reform continues? Select all that apply.
Do smokers and the obese who do not make necessary lifestyle changes deserve the same health care as people who lead healthier lives? Is someone who can afford to advertise for an organ donation more deserving than someone who has been waiting months for a transplant? Should citizens pay higher insurance premiums and/or taxes so that someone who overdoses on heroin can have intensive care? Should undocumented peoples in the U.S. have the same access to health care as its citizens?
A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed?
Enroll the client in Meals on Wheels.
What role does the nurse assume when gathering information for a community assessment?
Epidemiologist
A nurse is caring for a client with end-stage liver failure. Which healthcare agency should the nurse recommend for continuity of care?
Extended care
The goals of health care reform include which?
Focusing on cost containment with improved access and quality of services for everyone
A nurse is researching health care in rural areas. Based on a 2013 U.S. Subcommittee on Primary Health and Aging, which statement regarding access to primary health care is correct?
One in five Americans lives in an area without adequate access to primary health care due to a shortage of primary care providers.
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 and aims to provide affordable health care to everyone. Which are goals of the ACA? Select all that apply.
Health care affordability Ability to compare insurance options Accessibility to insurance services Decreased number of uninsured
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
A nurse is providing supportive care to a client diagnosed with a terminal illness who is not expected to live past the next 3 months or so. The nurse is likely working in which setting?
Hospice care
Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery?
Hospitals
Which type of facility employs the greatest number of nurses?
Hospitals
Which is the primary criterion for admission to a long-term care facility?
Inability to provide self-care
Which is a current trend in health care consumers?
Increased knowledge of health care
A nurse whose priority tasks include conducting health assessments, teaching health promotion, such as smoking cessation, eating sensibly, using safety equipment, exercising regularly, caring for minor accidents and illnesses, and making referrals for more serious health problems is likely a healthcare team member in which setting?
Industry
A hospital system has adopted the Institute for Healthcare Improvement's "Triple Aim" dimensions and has surveyed nurses for planning ideas. Which strategies will help the hospital comply with this framework? Select all that apply.
Make results of quality studies available to nurses in a timelier manner. Create outreach education programs to improve the overall health of the community served. Reduce redundancy in diagnostic tests.
A nurse is conducting a presentation for a local community group about health care services available in the community. When describing voluntary agencies, which agency would the nurse include? Select all that apply.
Meals on Wheels American Heart Association American Lung Association
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
A nurse has very strong client education skills. In which health care setting would the nurse make best use of these skills?
Primary care center
A client who is affluent and places a high priority on maintaining freedom to choose which physicians and health care services the client uses would most likely be best served by which group plan?
Private insurance
What nursing function would be most commonly found in an ambulatory care facility?
Providing direct client care
Who provides care in the primary nursing model?
Registered nurses
A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Since the early introduction of stroke rehabilitation, the client has seen significant improvements in both medical status and activities of daily living (ADLs). This morning, however, the nurse notes that the client has been coughing since eating a minced and pureed breakfast. Auscultation of the client's chest reveals the presence of coarse crackles. Which practitioner should the nurse consult with to obtain a swallowing assessment?
Speech therapist
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
During a home care visit to a home-bound older client, the client's spouse, who is the caregiver, verbalizes anger, fatigue, and sleeplessness. Which recommendations by the nurse would be most effective in relieving caregiver role strain?
Respite care
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
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.
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
The nurse is providing care to an older adult client approaching discharge following a surgical procedure to repair a fractured hip. The client requires continued skilled nursing care and physical therapy to improve mobility. When planning care for this client, which prescription should the nurse anticipate?
Transfer to an extended care facility
A home health nurse is scheduled to make a visit to a client who was discharged from the hospital yesterday following an appendectomy. The nurse understands that the scope of practice for a home health nurse allows the nurse to perform which psychomotor tasks?
Wound care, medication administration, teaching, and ensuring a reasonably safe environment
An example of primary health care is:
a hearing screening in the school setting.
Medicare part A is:
an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services.
One of the primary advantages of the managed care model is:
economic, quality care.
The Nursing Agenda for Health Care Reform (American Nurses Association [ANA]) identifies the recipients of health care. This reform's main focus is on:
health promotion.
