Ch 2

Question 1

Which of the following is an example of the principle of patient-centered care focused on continuity and transition?

A. The nurse asks the patient who in the family should have access to patient information
B. The nurse is teaching the patient how to change the wound dressing at home
C. The nurse responds promptly to the patient’s request for pain medication
D. The nurse schedules the patient’s diagnostic scan following the physical therapy session

Answer 1

B. The nurse is teaching the patient how to change the wound dressing at home

Question 2

Which activity performed by the nurse is related to maintaining competency in nursing practice?

A. Asking another nurse about how to change the settings on a medication pump
B. Regularly attending unit staff meetings
C. Participating as a member of the professional nursing council
D. Attending a review course in preparation for the certification examination

Answer 2

D. Attending a review course in preparation for the certification examination

Question 3

The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse’s best explanation of a PPO?

A. This health plan is for people who cannot afford their own health insurance
B. This health plan is operated by the government to provide health care to older adults
C. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose
D. This is a fee-for-service plan in which you can choose any physician or hospital

Answer 3

C. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose

Question 4

Which of the following is an example of the nurse participating in primary care activities?
A. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester
B. Working with patients in a cardiac rehabilitation program
C. Assessing a patient at an emergent care facility
D. Providing home wound care to a patient

Answer 4

A. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester

Question 5

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system?
A. Patient safety
B. Evidence-based practice
C. Patient satisfaction
D. Maintenance of competency

Answer 5

A

Question 6

Which of the following statements is true regarding Magnet status recognition for a hospital?
A. Nursing is run by a Magnet manager who makes decisions for the nursing units
B. Nurses in Magnet hospitals make all of the decisions on the clinical units
C. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need
D. Magnet is a special designation for hospitals that achieve excellence in nursing practice

Answer 6

D

Question 7

Which statement made by the nurse is an example of applying the principle of patient-centered care while focusing on alleviation of a patient’s fear and anxiety?
A. “Let’s talk about the concerns that you have about going home”
B. “I’ll get the medication prescriptions for you before discharge”
C. “I’ll be back in 30 minutes to help you get cleaned up”
D. “I’ll make a referral to the home health nurse for you”

Answer 7

A

Question 8

Which of the following is/are characteristics of managed care systems? (Select all that apply.)
A. Provider receives a predetermined payment for each patient in the program.
B. Payment is based on a set fee for each service provided.
C. System includes a voluntary prescription drug program for an additional cost.
D. System tries to reduce costs while keeping patients healthy.
E. Focus of care is on prevention and early intervention.

Answer 8

A. Provider receives a predetermined payment for each patient in the program.
D. System tries to reduce costs while keeping patients healthy.
E. Focus of care is on prevention and early intervention.

Question 9

Which of the following nursing activities is found in a tertiary health care environment?

A. Administering influenza immunizations at the senior independent living facility
B. Providing well-baby care in the clinic run by the local community health department
C. Admitting a patient following open heart surgery to the cardiovascular intensive care unit
D. Working the triage desk in the emergency department

Answer 9

C. Admitting a patient following open heart surgery to the cardiovascular intensive care unit

Question 10

Which of the following activities performed by the nurse is/are focused on the patient-centered care principle of physical comfort? (Select all that apply.)

A. Asking the patient what a tolerable level of pain is for him or her following surgery
B. Providing a back rub at bedtime
C. Offering the patient a warm washcloth for his or her hands before eating
D. Teaching the patient about the new antihypertensive medication ordered
E. Scheduling the patient’s follow-up appointments on discharge
F. Changing the bed linens for a patient who is experiencing diaphoresis

Answer 10

A. Asking the patient what a tolerable level of pain is for him or her following surgery
B. Providing a back rub at bedtime
C. Offering the patient a warm washcloth for his or her hands before eating
F. Changing the bed linens for a patient who is experiencing diaphoresis

Question 11

The nursing staff is developing a quality program for the floor. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.)
A. Number of medication errors committed by registered nurses (RNs)
B. Turnover rate of nurses on the unit
C. Incidence of patient falls
D. Number of certified RNs
E. Number of emergency department admissions per year

Answer 11

B. Turnover rate of nurses on the unit
C. Incidence of patient falls
D. Number of certified RNs

Question 12

The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care?
A. Patient will be able to walk 200 feet without shortness of breath
B. Wound will heal without signs of infection
C. Patient will express concerns related to return to home
D. Patient will identify strategies to improve sleep habits

Answer 12

A. Patient will be able to walk 200 feet without shortness of breath

Question 13

A nurse is presenting information to a management class of nursing students on the topic of groups of inpatient hospital services that have a fixed reimbursement amount, with adjustments made on the basis of case severity and regional costs. The nurse is presenting information to the class on which topic?
A. Utilization review committee
B. Resource utilization group
C. Capitation payment system
D. Diagnosis-related groups

Answer 13

D. Diagnosis-related groups

Question 14

When a nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, the nurse is working in which area?
A. Integrated delivery system
B. Health care patient system
C. Nursing informatics
D. Computerized nursing network

Answer 14

C

Question 15

Which of the following are examples of the principle of patient-centered care that is focused on respect, values, preferences, and expressed needs? (Select all that apply.)
A. Administer antihypertensive medications to patient daily
B. Pulling the curtain around the patient bed before changing the wound dressing on the patient’s leg
C. Allowing the patient to ask questions and express his or her concern about surgery
D. Explaining a colonoscopy procedure to the patient
E. Working with the family to bring in ethnic foods that the patient prefers

Answer 15

B. Pulling the curtain around the patient bed before changing the wound dressing on the patient’s leg
C. Allowing the patient to ask questions and express his or her concern about surgery
E. Working with the family to bring in ethnic foods that the patient prefers

Question 16

Federally funded national health insurance program in the US for people over 65 years of age.

Answer 16

Medicare

Question 17

State medical assistance to people with low incomes, based on Title 19 of the Social Security Act. States receive matching funds to provide medical care and services to people meeting categorical and income requirements.

Answer 17

Medicaid

Question 18

A type of managed care plan that limits an enrollee’s choice to a list of “preferred” hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list.

Answer 18

PPO (Preferred Provider Organization)

Question 19

Describes health care systems in which the provider or health care system receives a predetermined captivated payment for each patient enrolled in the program.

Answer 19

Managed care

Question 20

What does CMS stand for?

Answer 20

Center for Medicare and Medicaid Services

Question 21

is a system of family-centered care that allows patients to live and remain at home with comfort, independence, and dignity while easing the pains of terminal illness

Answer 21

Hospice

Question 22

is a service that provides shot-term relief or “time off” for people providing home care to an ill, disabled, or frail older adult

Answer 22

Respite care

Question 23

Uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making

Answer 23

Nursing informatics

Question 24

*Intensive Care
*Subacute Care
Examples of what level of care?

Answer 24

Tertiary

Question 25

*Emergency care
*Acute medical - surgical care
*Radiological procedure for acute problems (x-rays, CT scans)

Examples of what level of care?

Answer 25

Secondary Acute Care

Question 26

*Blood pressure and cancer screening
*Immunizations
*Mental health counseling and crisis prevention
*Community legislation (seat belts, air bags, bike helmets)

Examples of what level of care?

Answer 26

Preventative

Question 27

*Prenatal and well-baby care
*Nutrition counseling
*Family Planning
*Exercise Classes
Empápeles of what level of care?

Answer 27

Primary (Health Promotion)

Question 28

What are the six levels of care which health care providers offer services?

Answer 28

Preventative, primary, secondary, tertiary, restorative, and continuing care.

Question 29

What will be expected of a nurse within a primary care setting?

Answer 29

-Nurses are involved in patient assessment
-Nursers will be expected rato identify changes in chronic conditions of the development of new acute conditions.
-Nurses will educate patients on how to perform self-care activities (ex. Teaching new moms to care fir babies, or ind. w/ asthma how to use inhaler)
-In continuing care setting, nurses will apply gerontological nursing principles to help patients adapt to permanent health changes so they can remain active and engaged.

Question 30

What do levels of prevention describe?

Answer 30

-Describe focus of health-related activities in a care setting.
-Includes health-promotion and disease prevention (primary prevention)
-curing or managing disease (secondary prevention)
-reducing complications (tertiary prevention)

Question 31

Examples of Health Care Services
Box 2.1

Question 32

What is IHCD?

Answer 32

-Integrated health care delivery.
-IHCD system is a network of health care organizations that work together to provide a continuum of health services to a defined population with intended outcomes of better aligning resources, improving quality, and controlling costs.

Question 33

What is primary health care?
What is preventative care?

Answer 33

-focuses on improved health outcomes for entire population by promoting regular health visitad, j health education, proper nutrition, immunizations, family planning, maternal/child healthcare, and control of diseases.
-Designed to reduce incidence of disease, minimize complications and need to use expensive health care resources.

-In contrast, preventative care is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs.

Question 34

What is secondary and tertiary care (also called acute care)?

Answer 34

-When severity of condition makes primary care insufficient, secondary and tertiary care may become necessary.
-Secondary health care is provided by a specialist or agency on referral by a primary health care provider.
-Requires more knowledge, skill, and equipment than a primary care physician or nurses practitioner can provide.
-Tertiary health care is consultative care, usually provided on referral from secondary medical personnel.
-Ex. Cardiac surgeon sees patient referred from cardiologist for possible bypass surgery.

Question 35

Evidence-based practice
EBP

Answer 35

-Ensure safe, effective care.
-Throughout the nursing process, clinical judgment requires the continual evaluation of whether patients achieve outcomes so plans of care can be revised as needed to meet patient needs.

Question 36

What is a Critical Access Hospital (CAH)?

Answer 36

-located in a state that established a rural health plan as of Feb 2018
-provides inpatient care to acutely ill or injured patients before they are transferred to better equipped care center
-provides 24/7 emergency health services with no more than 25 inpatient beds, and reports 96 hours or less as an average length of stay (LOS0 for temporary care patients needing stabilization before transfer to a larger hospital.
May operate distinct rehabilitation or psychiatric unit with up to 10 beds.
-Physicians, APRNS, or PAs staff a CAH

Question 37

What are expectations of rural hospitals?

Answer 37

-engage rural communities in developing rural healthcare services
-improve access to services, including urgent care services, and to meet health needs in isolated communities
-create protocols for coordinating care transition by aligning urban health care systems.

Question 38

Preventative and Primary Services
Table 2.1

Question 39

What is the role of a nurse in a rural hospital?

Answer 39

-function independently without physician
-must be competent in physical assessment, clinical judgment, decision making, and emergency care.
-APRNs use medical protocols and establish collaborative agreements with staff physicians.

Question 40

What is LOS?

Answer 40

Length of stay

Question 41

What is discharge planning?

Answer 41

-coordinated, Inter-professional process
-develops plan for continuing care after patient leaves health care agency
-discharge plan in f with coordination of services MUST begin the moment a patient is ADMITTED to a hospital.
-As a nurse, participate in discharge planning bu ANTICIPATING and IDENTIFYING each patient’s continuing needs before the time of discharge and coordinating efforts ti achieve appropriate discharge plan.
-in collaboration with members of the interprofessional health team (such as case managers, APRNs, physical therapists, physicians, and social workers) plan a realistic transition to another level of health care

Question 42

What is CMS?

Answer 42

Center for Medicare and Medicaid Services

Question 43

Elements of discharge planning

Answer 43

-Determining appropriate post-hospital destination for patient (case manager usually selects this based on patient’s health care needs, self-care capacity, insurance, and place of residence).
-Identifying a patient’s needs for a smooth and safe transition from the acute care hospital/post-acute care agency to the patient’s discharge destination (nurses, therapists, and dietitians usually unidentified these needs).
-Beginning the process of meeting the patient’s needs while patient is still hospitalized, with approaches such as mobility protocols, health education, and new medication regimens.

Question 44

Discharge Planning Models
Box 2.2

Question 45

Required discharge discussion topics

Answer 45

-discharge medications
-follow-up care (if needed)
-list of all medications changed and/or discontinued
-dietary needs
-follow-up tests or procedures

Question 46

What is the teach-back approach?

Answer 46

-patient describes information they have been taught, using their own words, to confirm understanding of the information.
-Helps ensure patient understands instructions
-promotes patient engagement, patient safety, adherence, and quality.

Question 47

What is restorative care?

Answer 47

-helps individuals regain maximal functional status
-enhances quality of life through promotion of independence and self-care
-ex. Patient may require ongoing wound care and activity and excessive management until they recover enough strength/function following surgery to independently resume normal activities of daily living (ADL)

Question 48

What is home care?

Answer 48

-provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness o prevention, diagnosis, and treatment of disease, rehabilitation, and palliative care.
-Home care service coordinates the access to and delivery of home health equipment

Question 49

Home care nurses

Answer 49

-Have their own patient caseloads
-deliver individualized nursing care
-help patients adapt to many permanent or temporary physical limitations so patient can assume a daily home routine that is as normal as possible
-requires strong knowledge base in many areas (such as family dynamics, cultural competence, spiritual values, and communication principles.)
-have expertise in assessment

Question 50

What is OASIS (the Outcome and Assessment Information Set)?

Answer 50

-OASIS is a comprehensive assessment
-includes a group of standardized core assessment items for adult home care patients.
-Data items within oasis include sociodemographic information on the patient’s home environment and informal caregivers, support system, health status, functional status, psychosocial status, and health service utilization.
-was designed to gather data items needed to measure outcomes and patient risk factors in home setting
-Nurses who work in Medicare-certified home care agencies conduct patient specific comprehensive assessments at the start of patient’s care, at 60-day follow-ups, at discharge and before and after an inpatient stay.

Question 51

What is rehabilitation?

Answer 51

-The WHO define rebilitation as the process aimed that enabling people with disabilities to reach and maintain optimal physical, sensory, intellectual, psychological, and social functional levels
-rehabilitation gives people with disabilities the tools they need to attain independence and self determination
-patients require rehabilitation after physical or mental illness, surgery affecting musculoskeletal function, injury, or medical addiction

Question 52

What is an extended care facility?

Answer 52

Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities

Question 53

What is an intermediate care or skilled nursing facility?

Answer 53

-Offers skilled care from a licensed nursing staff
-includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation
-patients receive extensive supportive care until they are able to move back into community or residential care
-provided round-the-clock nursing coverage
-nurses need expertise similar to that of nurses working in acute care inpatient settings, along with a background in gerontological nursing practices

Question 54

[RAI, MDS, CAA]
What is Resident Assessment Instrument (RAI)?

Answer 54

-Health nursing facility staff gather definitive information on a resident strength and needs, which must send the address in an individualized care plan

Question 55

[RAI, MDS, CAA]
What is the MDS?

Answer 55

-An initial overview of the residence healthcare needs
-a preliminary assessment identify the residence potential problems, strength, and preferences

Question 56

[RAI, MDS, CAA]
What is the CAA process?

Answer 56

-The CAAs are triggered by individual MDS item responses that revealed a need for additional assessment
-these item responses identify problems known as “triggered care areas”, which form a critical link between the MDS and decisions about care planning
-CAAs enable facilities to identify and use tools that are grounded in current clinical standards of practice, such as evidence-based or expert endorsed research, clinical practice guidelines, and resources.

Question 57

[RAI, MDS, CAA]
what are the three components of the RAI?

Answer 57

-the Minimum Data Set (MDS
-the Care Area Assessment (CAA) process
-the RAI Utilization Guidlines
-The components of the RAI yield information about a residence functional status, strength, weaknesses, and preferences, as well as offering guidance on further assessment once problems have been identified

Question 58

Components of the Resident Assessment Instrument (RAI):
Box 2.3

Question 59

What is assisted living?

Answer 59

-Offers an attractive long-term care setting with an environment more like home and greater resident autonomy
-residents require some assistance with activities of daily living but remain relatively independent within a particular protective setting a group of residents live together
-the residents usually have their own homes in church dining and social activity areas

Question 60

What is respite care?

Answer 60

-Respite care is a service that offers short-term relief by providing new environment or time to relax for family caregivers who support the ill, disabled, or frail older adult
-respite care can be provided at home by a friend, another family member, volunteer or in a care setting such as adult daycare or residential center.

Question 61

What are adult day care centers?

Answer 61

-provide a variety of health and social services to specific patient populations who live alone or with family in the community.
-patients are typically frail, cognitively impaired, or both and require some supervision but not continuous care.

Question 62

What are palliative care?

Answer 62

-A holistic, patient and family-centered care approach with a goal of improving the quality of life of patients and families who are experiencing problems related to life-threatening illnesses
-can be delivered in any health care setting
-nurse-patient and nurse-family relationship is key

Question 63

What is a hospice?

Answer 63

-a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pain of terminal illness.
-patient entering hospice cate is in terminal phase of illness, and the patient, family, and healthcare provider agree that ni further treatment will reverse the disease process.

Question 64

What is the Inpatient Prospective Payment System (IPPS)?

Answer 64

-The Social Security Act established a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (hospital insurance) based on set rate
-Under IPPS, each patient case is categorized into a diagnosis-related group (DRG)
-Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in the DRG.

Question 65

Affordable Care Act

Answer 65

-The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer.
-hospitals with lower qulality scores receive lower payments for service
-quality outcome measures include patient satisfaction and more effective management of care by reducing complications and readmissions and improving care coordination.

Question 66

Common Health Care Payers in the US
Table 2.2

Question 67

What is a HAC?

Answer 67

Hospital acquired condition

Question 68

Evidence-based practice: Impact of Nurse Staffing and Patient Outcomes
Box 2.4

Question 69

RN competencies
Box 2.5

Question 70

What is patient-centered care?

Answer 70

-IOM defines patient-centered care as “care that is respectful of and responsive to individual preferences needs, and values and ensures patient values guide all clinical decisions”
-partnering of the nurse, patient, and family caregiver ti identify the patient’s health care needs within the context of the patient’s lifestyle and to coordinate the entire health care team so that patient and family are engaged in the care process and associated decisions.

Question 71

Picker Institute’s 8 principles of person-centered care:

Answer 71

1. Fast access to reliable healthcare advice
2. Effective treatment delivered by trusted professionals
3. Continuity of care and smooth transitions
4. Involvement and support for family and cares
5. Clear information, communication, and support for self-care
6. Involvement in decisions and respect for preferences
7. Emotional support, empathy, and respect
8. Attention to physical and environmental needs

Question 72

What is the Magnet Recognition Program?

Answer 72

-Recognizes health care organizations that achieve excellence in nursing practice.

Question 73

Models and Forces of Magnetism:
Box 2.6

Question 74

What are nursing-sensitive outcomes?

Answer 74

-patient outcomes and nursing workforce characteristics that are directly related to nursing care, such as changes to patient’s symptom experiences, functional status, safety, psychological distress, RN job satisfaction, total nursing hours per patient day, and costs.
-as a nurse you assume accountability and responsibility for achieving and accepting the consequences of these outcomes.

Question 75

What are health care disparities?

Answer 75

-the differences in health care outcomes between population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, or gender and populations identified geographically.

Question 76

What is the National Database of Nursing Quality Indicators (NDNQI)?

Answer 76

-ANA developed
-measures and evaluates nursing-sensitive outcomes with the purpose of improving patient safety and quality care
-reports quarterly results on nursing outcomes at the nursing unit level’-provides a database for individual hospitals to compare their performance against national nursing performance.

Question 77

• Select one of the RN competencies identified in Box 2.5. Develop a plan for improving your knowledge, skills, and attitudes for the competency during your upcoming clinical experience.

Question 78

1. Which activity performed by a nurse is related to maintaining competency in nursing practice?
2. Asking another nurse about how to change the settings on a medication pump
3. Regularly attending unit staff meetings
4. Participating as a member of the professional nursing council
5. Attending a review course in preparation for a certification examination

Answer 78

4. Attending a review course in preparation for a certification examination

Question 79

2. Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.)
3. Providing prenatal teaching on nutrition to a pregnant woman
   during the first trimester
4. Assessing the nutritional status of older adults who come to the
   community center for lunch
5. Working with patients in a cardiac rehabilitation program
6. Providing home wound care to a patient
7. Teaching a class to parents at the local elementary school about
   the importance of immunizations

Answer 79

1, 2, 5

Question 80

3. Which of the following statements is true regarding Magnet® status recognition for a hospital?
4. Nursing is run by a Magnet® manager who makes decisions for
   the nursing units.
5. Nurses in Magnet® hospitals make all of the decisions on the
   clinical units.
6. Magnet® is a term that is used to describe hospitals that are able
   to hire the nurses they need.
7. Magnet® is a special designation for hospitals that achieve excellence
   in nursing practice.

Answer 80

4

Question 81

4. The nurse is working in a tertiary care setting. Which activity does the nurse perform while providing tertiary care?
5. Conducting blood pressure screenings at a local food bank
6. Administering influenza vaccines for older adults at the local
   senior center
7. Inserting an indwelling catheter for a patient on a medical-surgical unit
8. Performing endotracheal suctioning for a patient on a ventilator in the medical ICU

Answer 81

4

Question 82

5. A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient’s restorative care?
   1.Patient will be able to walk 200 feet without shortness of breath.
   2.Wound will heal without signs of infection.
6. Patient will express concerns related to return to home.
   4.Patient will identify strategies to improve sleep habits.

Answer 82

4

Question 83

6. Which of the following describe characteristics of an integrated health care system? (Select all that apply.)
7. The focus is holistic.
8. Participating hospitals follow the same model of health care
   delivery.
9. The system coordinates a continuum of services.
10. The focus of health care providers is finding a cure for patients.
11. Members of the health care team link electronically to use the EHR to share the patient’s health care record.

Answer 83

1, 3, 5

Question 84

7. The school nurse has been following a 9-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the student’s family to learn more about social determinants of health that might be affecting the student. Which of the following potential social determinants should the nurse assess? (Select all that apply.)
   1.The student’s seating placement in the classroom
8. The level of support parents offer when the student completes homework
9. The level of violence in the family’s neighborhood
10. The age at which the child first began having behavioral
    problems
11. The cultural values about education held by the family

Answer 84

2, 3, 5

Question 85

8. A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been addressed correctly?
9. Patient and family involvement in referral
10. Timing of referral
11. Incorporation of referral discipline recommendations into plan of care
12. Determination of discharge date

Answer 85

2

Question 86

9. Which of the following are common barriers to effective dis- charge planning? (Select all that apply.)
10. Ineffective communication among providers.
11. Lack of role clarity among health care team members 3. Number of hospital beds to manage patient volume
    4.Patients’ long-term disabilities
    5.The patient’s cultural background

Answer 86

1, 2

Question 87

10. A nurse newly hired at a community hospital learns about inten- tional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply.)
11. Reduction in nurse staffing requirements
    2.Improved patient satisfaction
12. Reduction in patient falls
13. Increased costs
14. Reduction in patient use of nurse call system

Answer 87

2, 3, 5

Question 88

Summary

Answer 88

• An integrated health care system consists of a network of health care organizations that work together to provide a continuum of coordinated health care services to a defined group of people to improve quality of care and control health care costs.
• Each of the six levels of health care describe the types of services and different settings in which health care is delivered to patients in all stages of health and illness.
• Each level of care presents different requirements and opportuni- ties for a nurse. In a primary care setting, nurses are extensively involved in patient assessment, whereas in restorative care set- tings, nurses know that success depends on their effective and early partnering with patients and their families in planning and care delivery.
• Levels of prevention are not the same as levels of care. Levels of prevention describe the focus of health-related activities in a care setting, such as health promotion and disease prevention (primary prevention) and curing or managing disease (secondary prevention)
• Health care professionals provide patient care in different set- tings. For example, primary care focuses on health promotion and tends to be provided in community settings, whereas hospi- tals provide comprehensive secondary and tertiary care to pa- tients who are acutely ill.
• Health care access is influenced by access to hospitals, clinics, and physician offices; availability of transportation; ease in scheduling appointments; availability of appointments when needed; accessi- bility of specialty services when a referral is made; and clear in- structions provided on when and how to get referrals.

• Rural Americans’ access to health care is affected by economic fac- tors (rural Americans are more likely to live below the poverty level), cultural and social differences, educational shortcomings, lack of recognition of the problem by legislators, and the isolation of living in remote rural areas.
• Discharge planning begins at admission to a health care agency, helps determine the best place for a patient to go after discharge from the hospital, and creates a smooth transition of a patient’s care from the acute care or post–acute care agency to the patient’s next environment
• Barriers to effective discharge planning include ineffective com- munication, lack of role clarity among health care team members, and lack of resources.
• “Pay for Value” ties reimbursement to quality; if hospitals perform poorly in quality scores, they receive lower payments for services from CMS.
• Nurses promote patient satisfaction through providing patient- and family-centered care and applying good interpersonal skills, including courtesy, respect, and good communication skills.
• The nursing shortage is an issue in health care that affects all aspects of nursing (e.g., patient care, nursing administration, nursing edu- cation) and opens vast opportunities to nurses. Furthering educa- tion and following trends in health care open professional options for nurses.
• Patient-centered care is care that is focused on the patient’s preferences, needs, and values and involves the patient in the clinical decision- making process. This type of care is based on the patient’s lifestyle and is coordinated with the health care team so that the patient is engaged in the care process.
• Social determinants of health contribute to health disparities, creating differences in the health status of different groups of people in a com- munity. Disparities in health status, particularly in a community in which the majority have poor health, will affect the productivity and vulnerability of a population.

Question 89

1. A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participant indicates a need for further teaching?
2. “My small company will now have to offer the 75 employees health insurance or pay a penalty.”
3. “As long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 years old.”
4. “I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance.”
5. “Since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums.”

Answer 89

2. “As long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 years old.”

Question 90

3. A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse’s best explanation of a PPO?
4. This health plan is for people who cannot afford their own health insurance.
5. This health plan is operated by the government to provide health care to older adults.
6. This health plan gives you a list of physicians and hospitals from which you can choose.
7. This is a fee-for-service plan in which you can choose any physician or hospital

Answer 90

3. This health plan gives you a list of physicians and hospitals from which you can choose.

Question 91

5. Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system?
6. Patient safety
7. Evidence-based practice
8. Patient satisfaction
9. Maintenance of competency

Answer 91

1

Question 92

7. A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate?
8. PDSA
9. Six Sigma
10. Rapid-improvement event (RIE)
11. A randomized controlled tria

Answer 92

3. Rapid-improvement event (RIE)

Question 93

8. Which of the following are characteristics of managed care systems? (Select all that apply.)
9. Provider receives a predetermined payment for each patient in the program.
10. Payment is based on a set fee for each service provided.
11. System includes a voluntary prescription drug program for an additional cost.
12. System tries to reduce costs while keeping patients healthy.
13. Focus of care is on prevention and early intervention

Answer 93

1. Provider receives a predetermined payment for each patient in the program.
2. System tries to reduce costs while keeping patients healthy
3. Focus of care is on prevention and early intervention

Question 94

9. Which of the following nursing activities is provided in a secondary health care environment?
10. Conducting blood pressure screenings for older adults at the Senior Center
11. Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques
12. Changing the postoperative dressing for a patient on a medical-surgical unit
13. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit

Answer 94

3, 4

Question 95

10. A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. Place the steps in the correct sequence for PDSA.
11. Bedside change of shift report is piloted on two medical-surgical units.
12. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change.
13. The nursing council develops a strategy for bedside change of shift report.
14. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units.

Answer 95

3. The nursing council develops a strategy for bedside change of shift report.
4. Bedside change of shift report is piloted on two medical-surgical units
5. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change
6. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units.

Question 96

11. The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.)
12. Use of physical restraints
13. Pain assessment, intervention, and reassessment
14. Patient satisfaction with food preparation
15. Registered nurse (RN) education and certification
16. Number of outpatient surgical cases per year

Answer 96

1. Use of physical restraints
2. Pain assessment, intervention, and reassessment
3. Registered nurse (RN) education and certification

Question 97

11. The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.)
12. Use of physical restraints
13. Pain assessment, intervention, and reassessment
14. Patient satisfaction with food preparation
15. Registered nurse (RN) education and certification
16. Number of outpatient surgical cases per year

Answer 97

1

Question 98

13. A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic?
14. Prospective payment system
15. Pay for performance
16. Capitation payment system
17. Managed care systems

Answer 98

2

Question 99

14. A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area?
15. Quality improvement (QI)
16. Health care patient system
17. Nursing informatics
18. Computerized nursing network

Answer 99

1

Question 100

15. The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of “Do” from that model?
16. Implementing the new skin care protocol on all medicine units
17. Reviewing the data collected on patients cared for using the protocol
18. Reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months
19. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol

Answer 100

4

Question 101

capitation

Answer 101

the providers receive a fixed amount per patient or enrollee of a health care plan

Question 102

Globalization

Answer 102

health care providers have to make services more accessible because of this