ANSWERS AND RATIONALES
3. The third phase is called “refreezing”
and is concerned with providing feed- back, encouragement, and constructive criticism to reinforce new behavior.
employs a simple level of interaction with the patient. Although this task has the po- tential to cause harm if the critical ele- ments of the skill are not implemented, it is within the scope of practice of an unli- censed nursing assistant. It does not re- quire the more advanced competencies of a Registered Nurse.
5. Transporting a patient is not a complex task. It requires simple problem-solving skills and involves a predictable outcome and a simple level of interaction with the patient. Although this task has the poten- tial to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an
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Health-Care Delivery
KEYWORDS
The following words include nursing/medical terminology, concepts, principles, and information relevant to content specifically addressed in the chapter or associated with topics presented in it.
English dictionaries, nursing textbooks, and medical dictionaries, such as Taber’s Cyclopedic Med- ical Dictionary, are resources that can be used to expand your knowledge and understanding of these words and related information.
Acuity Advocate Baby boomers Burnout Career ladder
Case management, case manager Continuity of care
Cost containment Counselor Critical pathways Demographics
Diagnostic Related Groups (DRGs) Functional nursing
Health-care team members:
Activity Therapist Certified Social Worker Clinical Nurse Specialist Licensed Practical Nurse Nurse Anesthetist Nurse Assistant Nurse Midwife Nurse Practitioner Occupational Therapist Pastoral care provider Patient
Patient’s family members Physical Therapist Physician
Physician’s Assistant Registered Dietitian Registered Nurse Speech Therapist Health-care settings:
Acute care hospitals Adult day care
Ambulatory care centers Assisted-living residence Clinics
Extended care Home health services
Hospice (inpatient, residential, in the home)
Industrial or occupation settings Life-care community
Long-term care nursing homes
Neighborhood community health center Physician’s offices
Psychiatric facilities Rehabilitation centers School settings Urgent visit centers
Health Maintenance Organization Hospice
Levels of health care:
Primary health care Secondary health care Tertiary health care Levels of prevention:
Primary prevention Health promotion Health protection Preventive health services Secondary prevention Tertiary prevention Managed care Medicaid Medicare Multidisciplinary
Patient classification system Preauthorization
Preferred Provider Organization Primary nursing
Prospective payment system Reengineering
Reimbursement
Resource Utilization Groups (RUGs) Sandwich generation
Third-party payers Types of agencies:
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QUESTIONS
1. Which health-care team member can provide independent health care with third-party reimbursement in the emerging health-care delivery system in the United States?
1. Licensed Registered Nurse 2. Clinical Nurse Specialist 3. Physician’s Assistant 4. Nurse Practitioner
2. The nurse understands that critical pathways in health care refer to:
1. Educational career ladders for health-care professionals 2. Multidisciplinary plans with predetermined patient outcomes
3. Times during life when certain health problems are more likely to occur
4. Organizations that provide services that progress from acute care to long-term care 3. What setting is the organizational center of the United States health-care system?
1. Clinic setting 2. Acute care setting 3. Community setting 4. Long-term care setting
4. The nurse is functioning as a direct caregiver for a patient with multiple health prob- lems. Which word is most associated with the caregiver role of the nurse?
1. Facilitate 2. Evaluate 3. Counsel 4. Teach
5. What major trend in health care does the nurse identify after reviewing articles in health-care journals?
1. Social issues are taking a back seat as a result of the advances in technology 2. Striving for longevity will take on greater concern than quality-of-life issues 3. Individuals and families have primary responsibility for making health-care
decisions
4. Health-care providers control the direction and development of health-care services
6. The nurse is explaining mammography screening to a patient who is reluctant to have the diagnostic test. Which level of prevention does this diagnostic test reflect?
1. Secondary 2. Tertiary 3. Primary 4. Acute
7. The nurse should begin rehabilitative care after the patient is:
1. Conscious 2. Diagnosed 3. Discharged 4. Ambulatory
8. Why should nurses be role models for healthy living?
1. Need to be as healthy as possible to fight invasion of pathogens 2. Know that the immune system can be affected by an unhealthy lifestyle 3. Recognize that patients often look at what nurses do rather than what they say 4. Must be able to cope with the physiological demands of the profession of nursing
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9. The nurse case manager is counseling an older adult patient about resources available to assist with the cost of health care. What organization should the nurse inform the patient provides the majority of the health-care costs for people older than
65 years of age?
1. Medicare 2. Medicaid 3. Blue Cross 4. Blue Shield
10. Which result of reengineering in hospital settings has raised the greatest concerns for patient safety?
1. Decreased hospital occupancy rates 2. Increased acuity of hospitalized patients 3. Hospitals merging with larger institutions 4. Substitution of less skilled workers for nurses
11. A patient is discharged from the hospital 3 days after abdominal surgery because of the influence of Diagnostic Related Groups (DRGs). What should the nurse performing the discharge teaching be most concerned about?
1. Providing for continuity of care
2. Ordering equipment to be used in the home 3. Accepting discharge by the patient and family
4. Ensuring hospital reimbursement for services rendered
12. Together the nurse and patient are setting a goal during health-care planning. Which factor generates the most anxiety with this process?
1. Role 2. Values 3. Beliefs 4. Change
13. Three hospitals agree to work collectively to provide a full range of health-care services in their neighborhoods. What type of relationship has been entered?
1. Integrated health-care service network 2. Third-party reimbursement system 3. Health Maintenance Organization 4. Diagnostic Related Groups
14. The nurse is planning actions that address a patient’s health-care needs. Which statement is most important for the nurse to consider?
1. Health and illness clearly are separated at the middle of the health-illness continuum
2. Demographics of the population of the United States are changing drastically 3. External factors mainly are the cause of most illnesses
4. Most people view health as the absence of disease
15. The home care nurse is coordinating the delivery of health-care services to an older adult in the home. The nurse considers the factor that most affects health-care delivery to the older adult population is that older adults:
1. Live below the economic poverty level, requiring financial assistance 2. Suffer from significant cognitive deficits as they age
3. Tend to fall, requiring expensive hospital services 4. Need the services of long-term care institutions
16. Which nursing activity reflects care on the primary level of health-care delivery?
1. Arranging for hospice services
2. Delivering care in a coronary care unit 3. Providing emergency care at a local hospital
4. Encouraging attendance at a Smoke Enders’ meeting
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17. Which action is common to the majority of Registered Nurse positions in different settings in which nurses work?
1. Serving in an administrative capacity 2. Developing patient plans of care 3. Providing direct physical care 4. Assisting a practitioner
18. The nurse is planning a community outreach program about the variety of health- care professionals and the services they provide. What members of the health care team should the nurse indicate are the largest group of health-care personnel in the United States?
1. Social workers 2. Nurse aides 3. Physicians 4. Nurses
19. What is the major factor that prevents an overhaul of the health-care delivery system of the United States?
1. Need for elected officials to respond to the pressure of political constituencies 2. Explosion of technical advances within the profession of medicine
3. Complexity of the problems associated with health-care reform 4. Resistance of physicians to reform
20. Which is emphasized in the traditional health-care delivery system in the United States?
1. Health promotion 2. Illness prevention 3. Diagnosis and treatment
4. Rehabilitation and long-term care
21. At the end of a shift the nurse in charge must evaluate each patient in relation to the hospital’s classification system. A patient classification system is designed to:
1. Document resource needs for the purpose of establishing reimbursement 2. Provide data about patient acuity to help assign nursing staff
3. Establish that quality standards have been met 4. Identify standardized expected outcomes
22. The nurse identifies the major responsibilities of various health-care professionals.
Which health care professional is best prepared to track a patient’s progress through the health-care system?
1. Case Manager 2. Primary Nurse 3. Nurse Manager 4. Home Care Nurse
23. The nurse is reviewing a variety of surveys regarding the delivery of health care within the United States. Which statement reflects a significant change in the thinking of the general public about concepts related to health-care delivery?
1. “Institutional-based care will have to be increased as baby boomers age.”
2. “More services must address the secondary health-care needs of the community.”
3. “Individuals can influence their own health through behavior and lifestyle changes.”
4. “Health-care providers should be charged with the primary responsibility to provide appropriate health-care services.”
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24. Which group is the greatest challenge to the financing of health care in the United States?
1. Undocumented immigrants 2. Medically uninsured 3. Preterm infants 4. Older adults
25. A patient asks the nurse, “What is the difference between Medicare and Medicaid?”
Which is the nurse’s best response when describing the Medicaid program?
1. “A federally funded health insurance program for individuals with low incomes”
2. “A United States’ federal health insurance program for individuals aged 65 years or older”
3. “A state program requiring practitioners to be providers of care to people living below the designated poverty level”
4. “A retrospective health-care reimbursement program that pays for the costs incurred by health-care agencies for the care of the indigent”
26. The nurse is functioning as a patient advocate. What word best describes this nursing role?
1. Provider 2. Nurturer 3. Protector 4. Evaluator
27. A patient is told that preauthorization is required before surgery can be performed.
The patient asks the nurse, “What does preauthorization mean?” What is the nurse’s best response?
1. “Third-party payers have approved the surgery and the facility will be reimbursed for costs.”
2. “The preoperative checklist has been completed and verified by a nurse.”
3. “Required preoperative diagnostic tests have been performed.”
4. “You have signed the legal consent form for the surgery.”
28. A patient is to return from the operating room to a semiprivate room. Before the transfer, the nurse should ensure that the patient’s roommate is:
1. Emotionally stable 2. Able to communicate 3. In the bed by the window 4. Physiologically compatible
29. The nurse identifies and meets the health needs of a patient. Which word best describes this role of the nurse?
1. Teacher 2. Advocate 3. Surrogate 4. Counselor
30. The nurse is examining research results regarding receipt of health-care benefits in the United States. Which group of people is the most underserved?
1. Children 2. Older adults 3. Pregnant women 4. Middle-aged men
31. A patient with an infection receives medical intervention and nursing care in a hospital setting. Which level health-care service has been provided in this situation?
1. Emergency 2. Secondary 3. Tertiary 4. Primary
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32. What is the cornerstone of Nursing’s Agenda for Health Care Reform?
1. A standardized package of health-care services must be provided by the federal government
2. Advanced practice nurses should play a prominent role in the provision of primary health care
3. Services provided in environments that are accessible, familiar, and friendly 4. Nursing must provide for the central focus for the health-care delivery system 33. A home health-care nurse is functioning as a case manager for a patient recently
discharged from the hospital. What is the primary role of the nurse when functioning as a case manager?
1. Coordinator 2. Counselor 3. Provider 4. Teacher
34. Which is the best example of an inpatient care setting where nursing care is delivered?
1. Ambulatory care center 2. Extended-care facility 3. Day-care center 4. Hospice
35. Which change identified by the nurse will most affect health-care delivery in the United States in the future?
1. Less emphasis will be placed on prolonging life 2. The proportion of older adults in society will increase 3. More people will seek health care in an acute care setting
4. Genetic counseling will dramatically decrease the number of ill infants born 36. Diagnostic Related Groups (DRGs) mainly were instituted by the federal
government to reduce the:
1. Number of professionals working in hospitals 2. Focus on illness and place it on prevention 3. Fragmentation of care
4. Cost of health care
37. What characteristic is unique to the nurse–patient relationship?
1. Patient’s needs are satisfied 2. There is a social component 3. The nurse is the leader of the team 4. Both are working toward a common goal
38. A recently licensed Registered Nurse is working the night shift on an active medical unit in the hospital. What is the best way that this nurse can prevent professional burnout?
1. Challenge the how and why of one’s role 2. Get adequate sleep and exercise each day 3. Clarify expectations, strengths, and limitations
4. Seek a balance among seriousness, humor, and aloofness
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39. A patient receiving a special diet is given a meal tray that does not contain a food requested by the patient. What should the nurse do? Place these interventions in order of priority.
1. Check the diet manual
2. Verify the practitioner’s diet order 3. Schedule a conference with the dietitian
4. Explore with the practitioner the possibility of including this food preference in the diet
Answer:
40. Which are examples of an official agency? Select all that apply.
1. _____ Department of Health 2. _____ American Heart Association 3. _____ National League for Nursing 4. _____ Nonprofit community hospital 5. _____ Veterans Administration Hospital
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ANSWERS AND RATIONALES
3. 1. The clinic setting is not the organizational center of the United States health-care system.
2. The acute care setting is the organiza-