Chapter 11
A nurse says, "We have so many drills and safety checks for everything. It is almost like we are preoccupied with the possibility of failure." How should the charge nurse respond to this statement? "Which drills and safety checks do you think we could eliminate?" "I agree with you. We need to focus more on the positive things we do instead of what could go wrong." "I am afraid that there may be an issue when our next accreditation visit occurs." "Highly reliable organizations think about the possibility of failure and what to do to avoid it."
"Highly reliable organizations think about the possibility of failure and what to do to avoid it."
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." "Using evidence-based practice is the trend in providing quality care and may expose the client to better care implementation. None of our care methods are associated with cost." "Because our clients are considered consumers of care, they often understand the need to use specific methods based on research, and they want the best care for the lowest cost." "Cost is not a driver in quality health care delivery."
"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 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." "The system should be flexible, patient centered, bureaucratic, timely, safe, and efficient." "The system should be static, reliable, timely, equitable, efficient, and illness focused." "The system should be safe, efficient, centralized, wellness promoting, government driven, and patient centered."
"The system should be safe, effective, efficient, patient centered, timely, and equitable."
A client is approaching 65 years of age and says, "I will be glad when I am eligible for Medicare so I won't have to worry about insurance anymore." How should the nurse respond to this statement? Select all that apply. "You may want to pay for a Medicare supplement." "Part A of Medicare pays for your doctor visits, but not hospital charges." "Medicaid is the government insurance for older adults." "You don't have to carry Part B of Medicare unless you want to." "The federal government pays for Part A of Medicare."
"You may want to pay for a Medicare supplement." "You don't have to carry Part B of Medicare unless you want to." "The federal government pays for Part A of Medicare."
Which client would a nurse correctly refer to Medicare services? A 66-year-old client with diabetes A client with a disability A low-income family with infants needing immunizations A client with cancer
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 mostappropriate to receive long-term care? A client with severe back injury as a result of a car accident needing ongoing physical therapy. A client newly diagnosed with rheumatoid arthritis requiring medication monitoring. A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs). A client diagnosed with pneumonia requiring mechanical ventilation.
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? Establish a set of nursing skills that focuses on quick resolution to clients' needs. Physical therapy supports client safety at home. A client's health is affected by social, economic, and political factors. Clinical care supports wellness in the environment.
A client's health is affected by social, economic, and political factors.
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 The need to cut health care costs for indigent older adults A payment to physician groups willing to take Medicare clients A retrospective payment plan, after the service is rendered
A prospective payment plan based on a predetermined fixed cost
Which refers to a person's ability to find and to receive care from a health care provider? Access to health care Access to nurses Access to doctors Access to clinics
Access to health care
Which is an emerging trend in health care delivery? Resolution of the nursing shortage Simplification of client care Active involvement of consumers Reduction in the use of technology at the bedside
Active involvement of consumers
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. A client with chronic heart failure is offered health care teaching and preventative services for free. A client is hospitalized for an emergency appendectomy. Since the hospital is a preferred provider the fee for service was discounted. A child is hospitalized and treated for a fractured femur. The hospital receives a preset fee for each member regardless of whether the member required 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 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? A client who had a cholecystectomy A client who developed sepsis after a ruptured polyp A middle-aged client who had a knee replacement An older adult client who fell at home and required a hip replacement
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"? The establishment of a local or regional, rather than a national, focus to create leadership in health care will improve outcomes. 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. Encouraging health care organizations and practitioners to develop and participate in mandatory reporting systems is desirable. A common source of medical errors and preventable death is the overly centralized nature of health care in the United States.
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? Have the chaplain visit with the spouse and client. Request a mental health evaluation for the spouse. Arrange for short-term inpatient care for the client. Send the spouse to the emergency department.
Arrange for short-term inpatient care for the client.
Which is the primary reason extended care facilities have proliferated in recent years? Clients not wanting to use home health care Increased concerns about chemical dependency in the elder population Clients being discharged from the hospital while their care requirements remain beyond the scope of home care Clients seeking increased social activity that is unavailable to them at home
Clients being discharged from the hospital while their care requirements remain beyond the scope of home care
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. Clients and their family members have been found to be happier with stays in the hospital in which they have 24/7 access to the healthcare team. Disease-specific quality standards have been found to be slightly worse than when clients are treated in the hospital. Clients in the acute care setting require fewer chemical and physical restraints.
Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care 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? Identifying individuals who are at risk of developing diabetes mellitus Providing client education related to colostomy care Verifying that all documentation is updated prior to surgery Collaborating with all agencies to provide for the client's home health needs
Collaborating with all agencies to provide for the client's home health needs
A nurse would like to work in a mental health center. The nurse should work to strengthen which skills prior to applying for this position? Select all that apply. Documentation Communication Referral Assessment Counseling
Communication Referral Counseling
Which is the main focus of care for a school nurse? Rehabilitative care Palliative care Ambulatory care Community care
Community care
A nurse is helping clients access the health insurance marketplace. What is the goal of this health insurance coverage concept? Insurance for older adults Comparison of available health care plans Insurance coverage for people needing orphan drugs Insurance assistance for women and children
Comparison of available health care plans
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 mostimportant in preventing this effect? Educator Coordinator of care Care provider Counselor
Coordinator of care
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. Suggest he go to an assisted living facility. Refer him to the dietitian. Have the social worker counsel him.
Enroll the client in Meals on Wheels.
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 HMO Emergency department PPO
Extended care
The goals of health care reform include which? Focusing on cost containment with improved access and quality of services for everyone Controlling health care costs by providing limited services for more consumers of health care Improving quality of care while limiting access for the uninsured to control rising costs Decreasing health care services to provide all citizens with some access to care but control escalating costs
Focusing on cost containment with improved access and quality of services for everyone
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 Decreased number of uninsured High-quality insurance Ability to compare insurance options Accessibility to insurance services
Health care affordability Decreased number of uninsured Ability to compare insurance options Accessibility to insurance services
A nurse is reviewing the different types of health care delivery services available in the community. Which method would the nurse identify as having the primary care goal of reducing costs by preventing illness? Community health center Accountable care organization (ACO) Health maintenance organization (HMO) Preferred provider organization (PPO)
Health maintenance organization (HMO) Preferre
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 Primary care centers Ambulatory care centers Day care centers
Hospitals
Which are the goals of health care reform? Select all that apply. Improve safety Make costs for the uninsured manageable Improve access to health care Increase the quality of health care Decrease centralization
Make costs for the uninsured manageable Improve access to health care Increase the quality of health care
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? Medicaid AmeriCare Capitation Medicare
Medicare
A nurse has very strong client education skills. In which health care setting would the nurse make best use of these skills? Tertiary care medical center Same-day surgery unit Emergency department Primary care center
Primary care center
What nursing function would be most commonly found in an ambulatory care facility? Serving as an administrator or manager Providing direct client care Assessing the home environment Educating individuals or groups
Providing direct client care
A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care? Relief from physical, mental, and spiritual distress Provision of a dignified death experience Occupational therapy Physical rehabilitation
Relief from physical, mental, and spiritual distress
The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner? Respiratory therapist Physical therapist Occupational therapist Physician
Respiratory 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 Hospice care Palliative care Parish nursing services
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 Voluntary services Palliative care Hospice care
Respite care
A group of first semester nursing students is preparing for a class presentation on the role of the school nurse. They ask their instructor to look over the content prior to the presentation. Which inclusion will require the students to perform some additional research? School nurses are sometimes the major source of emergency care for children. School nurses conduct routine health screenings. School nurses perform home visits on students. School nurses maintain immunization records.
School nurses perform home visits on students.
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? Talk with the occupational therapist about providing assistance with activities of daily living. Discuss oxygen administration with the respiratory therapist. Discuss transfer to a rehabilitation facility with the social worker. Speak with the physical therapist about exercises to strengthen muscles.
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? Occupational therapist Speech pathologist/therapist Physician assistant Physical therapist
Speech pathologist/therapist
One of the primary advantages of the managed care model is: economic, quality care. increased client satisfaction. a distinct area of care. an all-RN staff.
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: accurate assessment in the acute health care setting. health promotion. better connectivity through the use of technology. high-quality disease management.
health promotion.
