Chapter 11- The Health Delivery System and Chapter 12- Collaborative Practice & Care Coordination

The nurses who provide care on a medical unit are skeptical about the planned change from a traditional narcotic cupboard to a computerized medical supply and management system. Which of the following statements demonstrates mistrust about the benefits of this proposed change?

"I've heard those machines don't even cut down on med errors like they say they do."

A home health care nurse is discussing home health care during a presentation for a group of senior nursing students, as part of a Career Day seminar. One of the students asks, "How is home health care different from care in a hospital?" Which response by the nurse would be most appropriate?

"The client and family are in control of the setting, not the nurse"

A nurse is conducting a class about health care trends for a group of newly graduated registered nurses at the community hospital. Which of the following six trends stated by the nurse reflects the Institute of Medicine's (IOM) focus?

"the system should be safe, effective, efficient, patient-centered, timely, and equitable."

April and Sara are nurse managers for different units in the hospital. They are planning for a major change to occur on both units. Sara tells April she has identified a key power player on her unit. Which of the following describes what Sara means by this term?

A regular employee who is natural leader

A nurse is considering applying for a leadership role on her medical unit. She asks her colleagues what they consider to be good personal leadership skills. Which of the following would be appropriate? Choose all that apply:

Communication, self-evaluation, and problem solving

A staff nurse works on a surgical unit where the nurse leader allows the staff to make all decisions and direct themselves. The staff fill out the work schedule and sometimes there are days where the unit is short staffed. The staff nurse feels the unit needs better leadership. The nurse leader is practicing which of the following leadership styles?

Laissez-Faire

A registered nurse (RN) serves as the chair of the Nursing Practice Committee for the hospital. The meetings do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chairman's leadership style could be termed what?

Laissez-faire, coworkers develop their own goals, make their own decisions, and take responsibility for their own management

Which patient would a nurse correctly refer to Medicare services?

a 66-year-old patient with diabetes

Which of the following clients is the most appropriate candidate for receiving outpatient care?

a client whose complaints of irregular bowel movements have necessitated a colonoscopy, outpatient services are appropriate for clients who are medically stable but who require diagnostic testing

Which client is the most appropriate candidate for hospice services?

a client with lung cancer and a life expectancy of three to four months

Which of the following nurse leaders most clearly exemplifies transformational leadership?

a leader who is dynamic, inspiring, and promotes change by the power of her convictions

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 nurse is preparing to discharge a client. What education by the nurse should be performed prior to the discharge?

a review of the appointment schedule for follow up care, when to take medications, their purpose, side effects, and appropriate administration, a family member's practice of dressing changes, information about home care/physical therapy with appropriate phone numbers

Health care is a right for every human being. Which of the following refers to a person's ability to find and to receive care from a health care provider?

access to health care

Which of the following is an emerging trend in health care delivery?

active involvement of consumers

Which therapist is most likely to focus on teaching a client to hold a toothbrush with an adaptive device and brush his teeth?

an occupational therapist, assists physically challenged clients to adapt to limitations and use a variety of adaptive devices and strategies in carrying out activities

Conflict has emerged on a nursing unit due to the perception by new graduates that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict?

arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible

The nurse has recently been promoted to nurse manager on an oncology unit and has decided to be the sole decision maker regarding issues that concern the unit. Which type of leadership style is the nurse embodying?

autocratic, involves assuming control over the decisions and activities of the group

The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive personnel member. Which task is appropriate for the unlicensed personnel member to complete?

bathing a combative client

The home health care nurse is providing information to a client and family on medication changes. What role is the nurse performing?

client and family educator

A nurse manager is trying to resolve a conflict between the day and night shifts. She wants to convince the involved persons to set aside the differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which of the following types of conflict resolution.

collaborating

The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which of the following conflict resolution styles does the nurse manager display?

collaborating

A nurse is working in a public school as a school nurse. This nurse is considered to be working in which role?

community health, a nursing employed is considered to be working in community-based care

A nurse is helping patients access the health insurance marketplace. What is the goal of this health insurance coverage concept?

comparison of available health care plans, it was designed to help people more easily find health insurance that fits their budget

A nurse manager and the charge nurse have two employees who disagree with the accomplishment of client care. The manager determines a mutually agreed-upon time to discuss this situation with all the members involved. This activity is called what?

conflict resolution

The primary responsibility of the nurse manager is to...

create plans and budgets

A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style?

democratic, characterized by a sense of equality among the leader and other participants

Which activity by the nurse exhibits the role of family educator?

demonstrating how to suction the oropharynx

In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant?

dispose of the disconnected IV set

The growth in home health care is largely attributed to which of the following?

early discharge of clients from the hospital setting, created a new acutely ill population that needs skilled nursing care

What role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client?

educator, provides teaching such as demonstration of a skill to the family

How should a nurse leader best address nurses' resistance to a change in the shift-scheduling protocol on their hospital unit?

explain the benefits of the change and elicit honest feedback

Nurses have an important role in health care reform. The goals of health care reform include which of the following?

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

Which activities does the nurse engage in during the entry phase of the home visit? Select all that apply:

gather supplies for the visit, establish rapport with client and family, access the client and home situation, and educate the client

Which of the following is the acute care setting for people who are too ill to care for themselves at home, who are severely injured, or who require surgery?

hospitals

The designated charge nurse on the telemetry unit organizes and facilitates the unit meetings; however, during most of the meetings, another registered nurse runs the show and influences staff decisions just by her charisma and personality. Her power to lead is defined by which of the following terms?

implied power, leadership role by virtue of the force of his or her personality and charisma

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

inability to provide self-care, care for individuals who are mentally or physically unable to care for themselves independently

How might one define leadership?

leadership is the process of guiding, educating, motivating, and directing others.

Which health care setting provides assistance with activities of daily living (ADLs) for people of any age who are physically or mentally unable to care for themselves independently?

long-term care facilities

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, implemented a system in 1983 of prospective payment for people enrolled in Medicare

Which of the following is the largest single source of reimbursement for home health care services?

medicare, largest single source of reimbursement for home health care services

A nurse manager tells her staff that they need to increase response time to client requests by five minutes, beginning tomorrow. The time to begin this activity has been established by the manager and her staff. This action involves goal setting. What leadership style is noted with the implementation of goal setting?

participative leadership, involves followers in goal setting, problem solving, and decision making

The nurse is assigned to care for an older adult client who suffered a stroke. The client will soon be going home. When the nurse is actually doing the discharge planning, what is the nursing priority?

plan reachable goals with the client and family

A client considers himself affluent and places a high priority on maintaining his freedom to choose which physicians and health care services he utilizes. Which of the following group plans is most likely to meet this client's needs?

private insurance, normally more expensive than alternative group plans such as PPOs, HMOs, and LTC insurance

The nurse manager for a surgical unit is planning a significant change in how the unit functions. They plan to include some things that will help the staff overcome any resistance to the change. Which of the following might help overcome resistance to the nurse manager's planned change?

provide incentives, such as time off

A nurse is transferring a client from a hospital setting to a long-term care facility. Which action is most important to ensure continuity of care for this client?

providing accurate and complete communication to the new facility

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, goal is to prevent and relieve suffering by early assessment and treatment of pain and other physical problems

A nurse manager must provide care to her clients and her employees under the constraints of her resources. This involves maintaining the financial constraints of her division. What term best describes this scenario?

resource management, managers usually are responsible for accomplishing the work of the unit within the constraints of available resources

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 level 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, expert in lung function and oxygenation whose expertise is needed in the care of this client

The wife of an elderly man with Alzheimer's disease contacts a community health nurse because she is planning to visit her sister in a neighboring state and needs assistance in arranging care for her husband while she is away. Which type of care is the wife seeking?

respite care, care provided for caregivers of homebound ill, disabled, or elderly clients

A nurse in an intensive care unit places a request with the nurse manager to modify her work schedule. The nurse desires to return to college and advance her nursing degree. Which of the following illustrates that the nurse manager approaches the situation using a transformational leadership style?

she rearranges the nurse's schedule in a manner that will allow her to attend college

A nurse is caring for a 17-year-old pregnant women who needs to obtain assistance with essential baby items, such as a crib. The client mentions that she does not have an income from a job. The nurse should encourage the client to go to a

social welfare office

A nurse works with patients in a crisis intervention center. What ability would be most important for this nurse to develop?

strong communication and counseling skills, would need to be developed to work with clients in a crisis intervention center

A client is diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse discuss with the family?

the possible need for home care, include limited social, mental, or physical functioning

Following a myocardial infarction (heart attack), a client begins to recognize the need to increase exercise, eat a low-fat diet, and implement relaxation techniques. According to Lewin, this is an example of what type of change?

unfreezing, the recognition of the need for change and dissolution of previously held patterns of behavior

A client is having an increasing amount of difficulty caring for herself in her home alone. She states to the nurse, "I need more help. What am I going to do?" What would be more important for the nurse to do?

The nurse should have the social worker visit to discuss care options

A client has a complex medical history involving the consequences of diabetes. As a result of his diabetic nephropathy, he is now a client of the local hospital's dialysis program and has been referred to an ophthalmologist by his primary care physician following the onset of vision problems. In addition, he receives home care nursing for the treatment of a foot ulcer that is slow to heal. This client's situation characterizes which phenomena?

fragmentation of care, when multiple, specialized practitioners are involved in various aspects of a complex client's care

A new client arrived on the unit while the nurse was obtaining the end-of-shift report from the night nurse. This client is admitted walking and is here for a cardiac workup; the client is assigned to the nurse. The nursing assistant has settled the client in the room and oriented the client to the surroundings, call system, bathroom, bedside supplies, and where to place clothes. The priority nursing action is to:

gather information and complete admission database

The nurse is assigned to care for a middle-aged client who is very agitated and wants to go home. The client states he does not have time to waste in the hospital, and no one is doing anything anyway. Which action by the nurse is most appropriate if the client insists on leaving the hospital against medical advice (AMA)?

have the client sign the AMA form, informing the risks of leaving against medical advice (AMA)

A single parent age 17 years, with one child and pregnant with her second child, has the mental age of a 12-year-old. What is the home care nurse's greatest concern in caring for this woman?

her cognitive ability to understand

A client has had a total knee replacement and will need to walk with crutches for six weeks. The client is being discharged home with a referral for home health care. What will the home care nurse need to assess during her initial assessment?

home environment

Nurses who assist clients to deal holistically with their health care needs at the end of their lives work primarily in which health care delivery system?

hospice, help people maintain their ability to remain at home and deal holistically with their health and family needs at the end of their lives

During a home care visit to a home-bound elderly patient, the husband/caregiver verbalizes anger, fatigue, and sleeplessness. Which of the following recommendations by the nurse will be most effective in relieving caregiver role strain?

respite care, provides the husband with a break from caregiving duties

A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since he ate his minced and pureed breakfast. Auscultation of his chest reveals the presence of coarse crackles. Which practitioner should the nurse consult with in order to obtain a swallowing assessment?

speech therapist, diagnosis and treatment of dysphagia (swallowing problems) is within the purview of speech therapists.

Despite the presence of various types of public and private home health care agencies, one similarity among all home health care agencies is:

the agencies must meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs (such as Medicare)

A nurse is completing a home visit to an older adult client who is receiving regular dressing changes for the treatment of her venous ulcer. What outcome does the nurse hope to achieve in the plan of care for this client?

to maximize the independence and health of clients

A nurse is caring for a client who decides to leave the hospital against medical advice (AMA). The nurse knows that the client must sign a form before leaving. What is the purpose of the AMA form?

to release the doctors and institution from any legal responsibility

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 which of the following psychomotor tasks to be performed?

wound care, medication administration, teaching, and reasonably ensuring a safe environment

The nurse manager is concerned about the large number of teenage mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern?

enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy

A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation?

authoritarian , activities determined by the leader and dictated to the followers, with no input from the followers on decisions

A nurse manager informs the staff members during a meeting that unlicensed assistive personnel will no longer be allowed to check patients' blood glucose levels. The nurse manager informs the group this was a new policy on the unit, and discussions will not change the enforcement of this policy. What type of leadership is the nurse-manager demonstrating?

autocratic, involves the leader assuming complete control of the decisions and activities of the group

The charge nurse on a unit receives a report that a licensed practical nurse (LPN) is taking clients' narcotics and hiding them in the nurses' lounge. The charge nurse disregards the report and continues to work on a scheduled task. Which conflict resolution style is the charge nurse using?

avoiding

Karen Wolf, RN, is the charge nurse on the orthopedic unit. She believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which Karen contributes. Karen's style of leadership can be described as which of the following?

Laissez-faire, the leader relinquishes power to the group

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

Medi-care pays only the amount of money preassigned to a treatment for a diagnosis

A client diagnosed with terminal leukemia is receiving home health care services to assist in her care. After assessing the client, the home health care nurse determines the client needs assistance with financial concerns. The nurse would enlist the support of which member of the home health care team?

social worker, assists in finding and connecting the client with community resources or financial resources, and provide counseling and support

A registered nurse is providing community-based health care for a client and family. What would be most important for the nurse to do?

encourage active participation of the client and family in health care decisions

The community based nurse is assessing a new patient and their home environment. What is a responsibility of the community-based nurse at this initial visit?

encourage the patient and their family to contact appropriate community resources

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

Which of the following measures should do a home health care nurse implement into his or her practice to minimize the potential for lawsuits?

perform thorough, accurate, and timely documentation, to provide a legally acceptable record of what occurred during nurse-patient interactions

The nurse is assigned to care for a client who will be transferred to the rehabilitation unit in the hospital following his postoperative recovery from hip surgery. What is the priority nursing responsibility when transferring a client from one unit in the hospital to another?

provide a verbal report of the client's status of the admitting nurse

What activities does the nurse engage in during the pre-entry phase of the home visit? Select all that apply:

review client's treatment orders, gather supplies for the visit, and evaluate the safety of the neighborhood