Ch. 11 Collaborative Care

Question 1

A nurse is discussing restorative health care
with a newly licensed nurse. Which of the
following examples should the nurse include
in the teaching? (Select all that apply.)
A. Home health care
B. Rehabilitation facilities
C. Diagnostic centers
D. Skilled nursing facilities
E. Oncology centers

Answer 1

A. CORRECT: Restorative health care involves intermediate
follow‑up care for restoring health and promoting self‑care.
Home health care is a type of restorative health care.
B. CORRECT: Restorative health care involves intermediate
follow‑up care for restoring health and promoting self‑care.
Rehabilitation facilities are a type of restorative health care.
D. CORRECT: Restorative health care involves intermediate
follow‑up care for restoring health and promoting self‑care.
Skilled nursing facilities are a type of restorative health care.

Question 2

A nurse is explaining the various types of health
care coverage clients might have to a group
of nurses. Which of the following health care
financing mechanisms should the nurse include
as federally funded? (Select all that apply.)
A. Preferred provider organization (PPO)
B. Medicare
C. Long‑term care insurance
D. Exclusive provider organization (EPO)
E. Medicaid

Answer 2

B. CORRECT: Medicare is federally funded.
E. CORRECT: Medicaid is federally funded.

Question 3

A nurse manager is developing strategies to care
for the increasing number of clients who have
obesity. Which of the following actions should the
nurse include as a primary health care strategy?
A. Collaborating with providers to perform obesity
screenings during routine office visits
B. Ensuring the availability of specialized beds in
rehabilitation centers for clients who have obesity
C. Providing specialized intraoperative training
in surgical treatments for obesity
D. Educating acute care nurses about postoperative
complications related to obesity

Answer 3

A. CORRECT: Identify obesity screenings at office visits as
an example of primary health care. Primary health care
emphasizes health promotion and disease control, is often
delivered during office visits, and includes screenings.

Question 4

A nurse is discussing the purpose of regulatory
agencies during a staff meeting. Which of the
following tasks should the nurse identify as the
responsibility of state licensing boards?
A. Monitoring evidence‑based practice for
clients who have a specific diagnosis
B. Ensuring that health care providers
comply with regulations
C. Setting quality standards for accreditation
of health care facilities
D. Determining whether medications are
safe for administration to clients

Answer 4

B. CORRECT: Identify that state licensing boards are
responsible for ensuring that health care providers
and agencies comply with state regulations.

Question 5

A nurse is explaining the various levels of health care
services to a group of newly licensed nurses. Which of
the following examples of care or care settings should
the nurse classify as tertiary care? (Select all that apply.)
A. Intensive care unit
B. Oncology treatment center
C. Burn center
D. Cardiac rehabilitation
E. Home health care

Answer 5

A. CORRECT: Tertiary health care involves the provision
of specialized and highly technical care (the care
nurses deliver in intensive care units).
B. CORRECT: Tertiary health care involves the provision
of specialized and highly technical care (the care
nurses deliver in oncology treatment centers).
C. CORRECT: Tertiary health care involves the
provision of specialized and highly technical care
(the care nurses deliver in burn centers).

Question 6

A nurse is caring for a group of clients on a
medical‑surgical unit. For which of the following
client care needs should the nurse initiate a referral
for a social worker? (Select all that apply.)
A. A client who has terminal cancer
requests hospice care in the home.
B. A client asks about community resources
available for older adults.
C. A client states, “I would like to have my
child baptized before surgery.”
D. A client requests an electric wheelchair
for use after discharge.
E. A client states, “I do not understand
how to use a nebulizer.”

Answer 6

A. CORRECT: Initiate a referral for a social worker
to provide information and assistance in
coordinating hospice care for a client.
B. CORRECT: Initiate a referral for a social worker to
provide information and assistance in coordinating
care for community resources available for clients.
D. CORRECT: Initiate a referral for a social
worker to assist the client in obtaining medical
equipment for use after discharge.

Question 7

A goal for a client who has difficulty with
self‑feeding due to rheumatoid arthritis is to use
adaptive devices. The nurse caring for the client
should initiate a referral to which of the following
members of the interprofessional care team?
A. Social worker
B. Certified nursing assistant
C. Registered dietitian
D. Occupational therapist

Answer 7

D. CORRECT: An occupational therapist can assist clients
who have physical challenges to use adaptive devices
and strategies to help with self‑care activities

Question 8

A client who is postoperative following knee
arthroplasty is concerned about the adverse effects of
the medication prescribed for pain management. Which
of the following members of the interprofessional
care team can assist the client in understanding
the medication’s effects? (Select all that apply.)
A. Provider
B. Certified nursing assistant
C. Pharmacist
D. Registered nurse
E. Respiratory therapist

Answer 8

A. CORRECT: The provider must be knowledgeable
about any medication prescribed for the client,
including its actions, effects, and interactions.
C. CORRECT: A pharmacist must be knowledgeable
about any medication dispensed for the client,
including its actions, effects, and interactions.
D. CORRECT: A registered nurse must be knowledgeable
about any medication administered, including
its actions, effects, and interactions.

Question 9

A client who had a cerebrovascular accident has
persistent problems with dysphagia. The nurse caring
for the client should initiate a referral with which of the
following members of the interprofessional care team?
A. Social worker
B. Certified nursing assistant
C. Occupational therapist
D. Speech‑language pathologist

Answer 9

D. CORRECT: A speech‑language pathologist can
initiate specific therapy for clients who have difficulty
with feeding due to swallowing difficulties.

Question 10

A nurse on a medical‑surgical unit has received
change‑of‑shift report and will care for four
clients. Which of the following tasks should the
nurse assign to an assistive personnel (AP)?
A. Updating the plan of care for a
client who is postoperative
B. Reinforcing teaching with a client who is
learning to walk using a quad cane
C. Reapplying a condom catheter for a
client who has urinary incontinence
D. Applying a sterile dressing to a pressure injury

Answer 10

C. CORRECT: The application of a condom
catheter is a noninvasive, routine procedure
that can be delegated to an AP.

Question 11

A nurse manager is assigning care of a client who is
being admitted from the PACU following thoracic
surgery. The nurse manager should assign the
client to which of the following staff members?
A. Charge nurse
B. Registered nurse (RN)
C. Practical nurse (PN)
D. Assistive personnel (AP)

Answer 11

B. CORRECT: A client who is postoperative following thoracic
surgery requires professional nursing knowledge, skills, and
judgment of an RN to provide safe and effective client care.

Question 12

A nurse is delegating the ambulation of a client
who had knee arthroplasty 5 days ago to an AP.
Which of the following information should the
nurse share with the AP? (Select all that apply.)
A. The roommate ambulates independently.
B. The client ambulates wearing slippers
over antiembolic stockings.
C. The client uses a front‑wheeled
walker when ambulating.
D. The client had pain medication 30 min ago.
E. The client is allergic to codeine.
F. The client ate 50% of breakfast this morning

Answer 12

B. CORRECT: To complete this assignment safely, the AP
should make sure the client wears stockings and slippers.
C. CORRECT: To complete this assignment safely, the AP
should make sure the client uses a front‑wheeled walker.
D. CORRECT: To complete this assignment safely,
the AP should know that the client should be
feeling the effects of the pain medication.

Question 13

A charge nurse is assigning client care for
four clients. Which of the following tasks
should the nurse assign to a PN?
A. Creating a plan of care for a client who
is recovering following a stroke
B. Assessing a pressure injury on a
client who is on bed rest
C. Providing nasopharyngeal suctioning
for a client who has pneumonia
D. Teaching a client who has asthma to
use a metered‑dose inhaler

Answer 13

C. CORRECT: Providing nasopharyngeal suctioning
is within the scope of practice of the PN.

Question 14

A nurse is preparing an in‑service program about
delegation. Which of the following are components of
the five rights of delegation? (Select all that apply.)
A. Right place
B. Right supervision and evaluation
C. Right direction and communication
D. Right documentation
E. Right circumstances

Answer 14

B. CORRECT: The right supervision and evaluation
is one of the five rights of delegation. They also
include the right task and the right person.
C. CORRECT: Right direction and communication
is one of the five rights of delegation. They also
include the right task and the right person.
E. CORRECT: The right circumstances is one of
the five rights of delegation. They also include
the right task and the right person.

Question 15

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply.

Performing an admission health assessment
Evaluating the nursing plan for effectiveness of care
Participating in the transfer of the patient to the postoperative care unit
Making referrals to appropriate facilities
Maintaining records of patient satisfaction with services
Assessing the strengths and limitations of the patient and family

Answer 15

b, d, f. The primary roles of the discharge planner as patients move from acute to home care are evaluating the nursing plan for effectiveness of care, making referrals for patients, and assessing the strengths of patients and their families. Although in smaller facilities a discharge planner may perform an admission health assessment and assist with patient transfers, it is not the usual job of the discharge planner. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.

Question 16

A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan or referrals to another facility. Which patients would most likely be a candidate for these services? Select all that apply.

An older adult who is diagnosed with dementia in the hospital
A 45-year-old man who is diagnosed with Parkinson’s disease
A 35-year-old woman who is receiving chemotherapy for breast cancer
A 16-year-old boy who is being discharged with a cast on his leg
A new mother who delivered a healthy infant via a cesarean birth
A 59-year-old man who is diagnosed with end-stage bladder cancer

Answer 16

a, b, f. The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson’s disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.

Question 17

A home health care nurse is scheduled to visit a 38-year-old woman who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply.

Collect information about the patient’s diagnosis, surgery, and treatments.
Call the patient to make initial contact and schedule a visit.
Develop rapport with the patient and her family.
Assess the patient to identify her needs.
Assess the physical environment of the home.
Evaluate safety issues including the neighborhood in which she lives

Answer 17

c, d, e. In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient’s diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient’s environment for safety issues.

Question 18

A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activity could the nurse delegate to licensed assistive personnel?

Collecting information for a health history
Performing a physical assessment
Contacting the health care provider for medical orders
Preparing the bed and collecting needed supplies

Answer 18

d. The nurse may delegate preparation of the bed and collection of needed supplies to unlicensed personnel but would perform the other activities listed.

Question 19

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process?

To assist with screening tests
To provide patient teaching
To assess what has been done and what still needs to be done
To assist with hernia repair

Answer 19

c. Although all the actions may be performed by the ambulatory care nurse, it is the nurse’s primary responsibility to assess what has been done and to tailor the care plan to the patient’s needs. Screening tests and teaching are usually completed before the patient enters an ambulatory care facility.

Question 20

A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer?

Provide a verbal report to the nurse on the new unit.
Provide a detailed written report to the unit secretary.
Delegate the responsibility for providing information.
Make a copy of the patient’s medical record.

Answer 20

a. The ICU nurse gives a verbal report on the patient’s condition and nursing care needs to the nurse on the new unit. This information is not given to a unit secretary, nor is its provision delegated to others. The medical record is transferred with the patient; a copy is not made.

Question 21

Which statement or question MOST exemplifies the role of the nurse in establishing a discharge plan for a patient who has had major abdominal surgery?

“I’ll bet you will be so glad to be home in your own bed.”
“What are your expectations for recovery from your surgery?”
“Be sure to take your pain medications and change your dressing.”
“You will just be fine! Please stop worrying."

Answer 21

b. The purpose of planning for continuity of care, commonly referred to in hospitals and community facilities as discharge planning, is to ensure that patient and family needs are consistently met as the patient moves from a care setting to home. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the care plan; considering individual, family, and community resources; and evaluating the effectiveness of care. Answers a and c are not MOST reflective of the role of the nurse in discharge planning, although teaching and communication are elements of this process. The statement “You will just be fine! Please stop worrying.” is a cliché and should not be used.

Question 22

A nurse is counseling an older woman who has been hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: “I don’t like being in the hospital. There are too many bad bugs in here. I’ll probably go home sicker than I came in.” She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation?

To inform the patient that only the primary health care provider can authorize discharge from a hospital
To collect the patient’s belongings and prepare the paperwork for the patient’s discharge
To request a psychiatric consult for the patient and inform her PCP of the results
To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form

Answer 22

d. The patient is legally free to leave the hospital AMA; however, patients who leave the hospital AMA must sign a form releasing the health care provider and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.

Question 23

A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply.

Making accurate assessments
Researching new treatments for chronic diseases
Communicating effectively
Delegating tasks appropriately
Performing clinical skills effectively
Making independent decisions

Answer 23

a, c, e, f. Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.

Question 24

A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct?

The bed linens are folded back.
A hospital gown is on the bed.
Equipment for taking vital signs is in the room.
The bed is in the highest position.

Answer 24

d. A properly prepared hospital room includes a bed in the lowest position for an ambulatory patient, an open bed with top linens folded back, routine equipment and supplies and special equipment and supplies assembled, and the physical environment of the room adjusted.