Exam 1 / Part 1

Question 1

T or F: Uninsured patients are more likely to skip or delay treatment for acute or chronic illnesses and die prematurely.

Answer 1

True

Question 2

Name two public, federally-funded programs.

Answer 2

Medicare - Over the age of 65 & Permanent disabilities, Diagnosis related groups (DRGs)-fixed reimbursement amount with adjustments
Medicaid - Low income families, Individual states determine eligibility requirements

Question 3

List Private Insurance Plans.

Answer 3

• • Traditional insurance reimburses for servises on a fee-for-service basis.
• • MCOs: managed care organizations (primary care providers oversee comprehensive care)
• • PPOs: preferred provider organization (clients choose from a list of providers)
• • EPOs: exclusive provider organization (clients choose from a list of providers within a certain organization)
• • Long-Term Care Insurance: for what Medicare does not cover

Question 4

T or F: Health Promotion reduces healthcare costs.

Answer 4

True

Question 5

List the Levels of Health Care

Answer 5

• • Preventive: focuses on educating and equipping clients to reduce and control risk factors for disease. (immunization, stress mgmt, seat belt)
• • Primary: emphasizes health promotion (office/clinic visits, vision/hearing/obesity screenings)
• • Secondary: diagnosis and treatment of acute illness and injury. (inpatient and ED, diagnostic centers)
• • Tertiary: specialized and highly technical care (ICU, oncology/burn units)
• • Restorative: follow up (home health, rehab, skilled nursing facilities)
• • Continuing: addresses long term or chronic health care needs. (end-of-life, palliative, hospice, adult day care, in-home respite care)

Question 6

Health Care Accreditation/Certification is earned by the entire organization or for specific programs/services within an organization. List the regulatory agencies.

Answer 6

• • The Joint Commission
• • U.S Food and Drug Administration
• • U.S. Department of Health & Human Services
• • Professional Standards Review Organizations (PSROs)
• • State licensing boards
• • State & local public health agencies
• • Utilization review committees

Question 7

Describe restorative care (rehabilitation).

Answer 7

Focus: To restore patients to their fullest physical, mental, social, vocational, and economic potential. Includes physical, occupational, and speech therapy, as well as social services. Occurs in many health care settings, both inpatient and outpatient

Question 8

Describe restorative care (skilled nursing facility)

Answer 8

Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities. Provides care for patients until they can return to their community or residential care location

Question 9

Describe continuing care

Answer 9

For people who are disabled, functionally dependent, or suffering a terminal disease. Available within institutional settings or in the home

Question 10

Describe continuing care (Nursing Centers or Facilities).

Answer 10

Provide 24-hour intermediate and custodial care. Nursing, rehabilitation, diet, social, recreational, and religious services. Residents of any age with chronic or debilitating illness. Regulated by standards: Omnibus Budget Reconciliation Act of 1987. Interdisciplinary functional assessment is the focus of clinical practice: MDS, RAIs

Question 11

Describe continuing care (Respite Care)

Answer 11

The service provides short-term relief or “time off” for persons providing home care to an ill, disabled, or frail older adult. Settings include home, day care, or health care institution with overnight care. Trained volunteers allow family caregivers to leave the home for errands or social time.

Question 12

Describe continuing care (Adult Day Care Centers)

Answer 12

Provide a variety of health and social services to specific patient populations who live alone or with family in the community. May be associated with a hospital or nursing home or may operate independently. Offer services to patients such as daily physical rehabilitation and counseling

Question 13

Describe continuing care (Hospice)

Answer 13

Family-centered care that allows patients to live and remain at home. Focuses on palliative (not curative) care: comfort, independence, and dignity. Provides patient and family support during terminal illness and time of death. Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family.

Question 14

Safety

Answer 14

The minimization of risk factors that could cause injury or harm while promoting high-quality care and maintaining a secure environment for clients, self, and others.

Question 15

Patient-Centered Care

Answer 15

The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.

Question 16

Evidence Based Practice

Answer 16

The use of current knowledge from research and other credible sources on which to base clinical judgment and client care.

Question 17

Informatics

Answer 17

The use of information technology as a communication and information-gathering tool that supports clinical decision making and scientifically based nursing practice.

Question 18

Quality Improvement

Answer 18

Care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs.

Question 19

Teamwork and Collaboration

Answer 19

The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes. The Future of Health Care

Question 20

What is Health?

Answer 20

World Health Organization (WHO) defines health as a “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”

Question 21

What is Illness?

Answer 21

A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

Question 22

What is Illness Behavior?

Answer 22

Involves how people monitor their bodies and define and interpret their symptoms. Influenced by many variables (internal & external) and must be considered by the nurse when planning care

• • Internal variables: Perception of illness and nature of illness
• • External variables: Visibility of symptoms, social group, cultural background, economics, and accessibility to health care

Question 23

List the Healthy People 2020 Goals.

Answer 23

• • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
• • Achieve health equity, eliminate disparities, and improve the health of all groups.
• • Create social and physical environments that promote good health for all.
• • Promote quality of life, healthy development, and healthy behaviors across all life stages.

Question 24

List the Models of Health and Illness

Answer 24

• • Health Belief Model: Addresses the relationship between a person’s beliefs and behaviors
• • Health Promotion Model: Directed at increasing a patient’s level of well-being
• • Basic Human Needs Model: Attempts to meet the patient’s basic needs
• • Holistic Health Model: Attempts to create conditions that promote optimal health

Question 25

1. According to Maslow’s hierarchy of needs, which of these needs would the patient seek to meet first?
A. Self-actualization
B. Psychological security
C. Shelter
D. Love and belonging

Answer 25

C. Shelter

Question 26

2. After evaluating a patient’s external variables, the nurse concludes that health beliefs and practices can be influenced by 
A. Emotional factors.
B. Intellectual background.
C. Developmental stage.
D. Socioeconomic factors.

Answer 26

D. Socioeconomic factors.

Question 27

What are Risk Factors?

Answer 27

Variables that increase the vulnerability of an individual or a group to an illness or accident. Risk factors include: Genetic and physiological factors, Age, Environment, Lifestyle

Question 28

List the stages of Changing Behaviors/ Risk Factor Modification.

Answer 28

• • Precontemplation: Not intending to make changes within the next 6 months
• • Contemplation: Considering a change within the next 6 months
• • Preparation: Making small changes in preparation for a change in the next month. Improvement in health may involve a change in health behaviors.
• • Action: Actively engaged in strategies to change behavior; lasts up to 6 months
• • Maintenance stage: Sustained change over time; begins 6 months after action has started and continues indefinitely

Question 29

Sally has decided to set aside 30 minutes a day to walk after work next week. Sally is in what stage of risk factor modification?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance

Answer 29

C. Preparation

Question 30

What is Critical Thinking?

Answer 30

A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant. Recognizing that an issue exists, analyzing information, evaluating information, and making conclusions

Question 31

List the steps of the Nursing Process (ADPIE).

Answer 31

A= assessment 
D= (nursing) diagnosis
P= plan care
I= implementation of care
E= evaluation of care

Question 32

A = Assessment

Answer 32

Assessment involves collecting information from the patient and from secondary sources (e.g., family members), “the patient’s story” along with interpreting and validating the information to form a complete database. (Obtain permission first when asking family members information).

Question 33

D = Diagnosis

Answer 33

Diagnosis involves clustering data and identify patterns and problems. Differs from medical diagnosis. Identifies health problem and which healthcare professional can best treat the problem. Nursing diagnoses include actual or potential health problems.
**NANDA: North American Nursing Diagnosis Assosication Conferences held Q 2 yrs. >201 approved, defined diagnoses. Their purpose is to Individualize care. They will affect the entire plan of care.

Question 34

What is a data cluster?

Answer 34

A set of signs or symptoms gathered during assessment that you group together in a logical way. Data clusters are patterns of data that contain defining characteristics—clinical criteria that are observable and verifiable. Each clinical criterion is an objective or subjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion.

Question 35

What is a related factor?

Answer 35

A condition, historical factor, or causative event that gives a context for the defining characteristics and shows a type of relationship with the nursing diagnosis. A related factor allows you to individualize a nursing diagnosis for a specific patient. When you are ready to form a plan of care and select nursing interventions, a concise nursing diagnosis allows you to select suitable therapies.

Question 36

P = Planning

Answer 36

Follows the nursing diagnosis. This phase consists of writing measurable patient/client outcomes and nursing interventions to accomplish the outcomes. These outcomes and interventions are designed to change the client’s nursing diagnosis/problem.

Question 37

How to establish priorities?

Answer 37

• • Follow Maslow’s Hierarchy of Needs
• • Follow the A B Cs: Airway, Breathing, Circulation
• • Priority setting begins at a holistic level when you identify and prioritize a patient’s main diagnoses or problems. Patient-centered care requires you to know a patient’s preferences, values, and expressed needs. Ethical care is a part of priority setting.

Question 38

Name the two parts of planning.

Answer 38

1. Planning the OUTCOMES or goals you want to achieve. (PO)

2. Planning the INTERVENTIONS that will make those outcomes or goals happen. (PI)

Question 39

How to plan SMART outcomes?

Answer 39

Make them

• • Singular, Specific
• • Measurable (observable)
• • Attainable
• • Realistic
• • Timely

Question 40

How to plan interventions, SIRS?

Answer 40

Make them

• • Safe
• • Individualized to the patient
• • Relevant to the nursing diagnosis
• • Specific (how frequent? when? where? ex.: Turn the patient every two hours on the even hours. NOT Turn the patient.)

Question 41

List the types of Interventions.

Answer 41

• • Assessment: Always the number one intervention listed
• • Nurse initiated: Independent actions that a nurse initiates.
• • Physician initiated: Dependent actions that require an order from a physician or other health care professional.
• • Collaborative: Interdependent actions that require combined knowledge, skill, and expertise of multiple health care professionals.
• • Teaching: Referral/Community resources/consultation
• • Pharmacology: Medications. Those involving protocols, standing orders, preventive measures

Question 42

What occurs when Consulting Other Health Care Professionals?

Answer 42

Planning involves consultation with members of the health care team. Consultation is a process by which you seek the expertise of a specialist such as your nursing instructor, a physician, or a clinical nurse educator to identify ways to handle problems in patient management or in planning and implementation of therapies. Consultation occurs at any step in the nursing process, most often during planning and implementation.

Question 43

I = Implementation of Care

Answer 43

Initiation of the nursing care plan. Performing the nursing interventions. Delegation of appropriate nursing interventions. Using skills – Psychomotor, Interpersonal, Cognitive, Performing continuous assessment.

Question 44

List the types of order.

Answer 44

• • On-Line: Specific verbal order from a qualified provider
• • Standing Order/Off-Line: a preprinted document containing orders to the conduct of routine therapies, monitoring guidelines, and diagnostic procedures for specific patients with identified clinical problems. after completed, the nurse then notifies the physician
• • Protocol: a clinical practice guideline. a suggested outline of steps for treating a particular problem. You sometimes can’t follow them by the letter, but if you deviate from them, be prepared to defend your logic

Question 45

Nurse-initiated interventions are
A. Determined by state Nurse Practice Acts.
B. Supervised by the entire health care team.
C. Made in concert with the plan of care initiated by the physician.
D. Developed after interventions for the recent medical diagnoses are evaluated.

Answer 45

A. Determined by state Nurse Practice Acts.

Question 46

What is Direct Care?

Answer 46

It includes activities that nurses perform through patient interactions, such as:

• • ADLs
• • instrumental ADLs
• • physical care techniques (like repositioning or passing meds)
• • lifesaving measures (like cardiopulmonary resuscitation, obtaining immediate counseling from a crisis center for an anxious pt)
• • counseling, teaching
• • preventive measures 1. primary = health promotion (education, immunizations, fitness activities), 2. secondary = prevent progression of illness (screening and treating at early stages), and 3. tertiary = minimize effects (rehabilitation measures)
• • controlling for adverse reactions (like after giving a medication and monitoring a pt for side effects)
• • the work of other health care team members.

Question 47

What is Indirect Care?

Answer 47

Indirect Care: 1. Communicating nursing interventions, written or oral or 2. Delegating, supervising, and evaluating
Examples include:
– documentation (electronic or written)
– delegation of activities
– medical order transcription
– infection control
– environmental safety mgmt
– telephone consults
– change of shift reports
– collecting, labeling, and transporting specimens
– transporting pts to procedural areas and other nursing units

Question 48

Isolation Precautions as a treatment intervention are an example of which type of care?
A. Direct
B. Indirect
C. Prevention
D. Safety

Answer 48

B. Indirect

Question 49

E= Evaluation of Care

Answer 49

On-going. Collaborate with the patient and family. Use evaluative measures. Interpret and summarize findings. Document results. Revise care plan. Client outcomes/goals evaluated, and labeled as Met, Partially met, or Not met

Question 50

When revising a Care Plan after a goal is not met, what must occur?

Answer 50

When a goal is not met, no matter what the reason, repeat the entire nursing process sequence for that nursing diagnosis to identify necessary changes to the plan. By consistently incorporating evaluation into practice, you minimize errors and ensure that the patient’s plan of care is appropriate and relevant

Question 51

During which of the five steps in the Nursing Process are outcomes of care determined to be achieved?
A - Diagnosis
B - Evaluation
C - Implementation
D - Planning

Answer 51

B - Evaluation

Question 52

You have finished with several nursing interventions. To evaluate interventions, you need to examine the:
A. Appropriateness of the interventions and the correct application of the implementation process.
B. Nursing diagnoses to ensure that they are not medical diagnoses.
C. Care planning process for errors in other health care team members’ judgments
D. Interventions of each nurse to enable the nurse manager to correctly evaluate performance.

Answer 52

A. Appropriateness of the interventions and the correct application of the implementation process.

Question 53

Your patient has met the goals set for improvement of ambulatory status. You would now
A. Modify the care plan.
B. Discontinue the care plan.
C. Create a new nursing diagnosis that states goals have been met.
D. Reassess the patient’s response to care and evaluate the implementation step of the nursing process.

Answer 53

B. Discontinue the care plan.