Health Care Delivery

Question 1

the structure of the health care delivery system

Answer 1

• services -> the health care assistance available
• consumers -> the people who require health care
• personnel (providers) -> the people and institutions that provide healthcare services to members of the public
• payment -> the method of paying for health care

Question 2

describe the financing, funding, and resource management of health care services

Answer 2

finance is the process of using financial resources to ensure health system can cover expenses
make sure there is the funding needed
make sure all have the proper resources

Question 3

describe health care disparities and the effect of social determinants of health

Answer 3

the avoidable differences that result from cumulative social disadvantage, including health outcomes, health care access, coverage and quality of care between groups of people, etc.

Question 4

discuss the role of interprofessional health care team members in the delivery of client care

Answer 4

registered nurse - oversees the nursing care given by nursing staff
provider - prescribes medications and therapies for positive outcomes
case manager -coordinates with healthcare team to coordinate needs
physical therapist - provides care directly focused on improving physical function and mobility
social worker - identifies discharge planning and solutions for afterwards
LPN - works under supervision of RN

Question 5

what were some of the goals of the Patient Protection and Affordable Care Act

Answer 5

Making affordable health insurance available to more people
providing protection to those who are ACA-funded services
expanding the Medicaid program to adults with incomes below 138% of the poverty level
lowering the costs of health care

Question 6

each state can do what

Answer 6

Each state is able to interpret federal definitions in a way that it feels is appropriate. In addition, states can regulate how funding for Medicaid is dispersed, as Medicaid dollars are administered at both state and federal levels. For example, each state has its own State Child Health Insurance Program (SCHIP). States can pass legislation related to pharmaceuticals, as covering drug costs can be a huge portion of their budget spending each year. For example, states can put a cap on pharmaceutical prices to help control market costs. The Inflation Reduction Act was passed by Congress in 2022, to decrease prescription drug costs for Medicare recipients by capping the cost of insulin and capping annual out-of-pocket costs.

Question 7

who regulates how practitioners operate

Answer 7

states, they determine eligibility requirements, issue licenses, governs policies, and review disciplinary cases.
- also provide guidance on topics related to health care and wellness.

Question 8

what do accreditation organizations do

Answer 8

• assure they have policies and procedures in place to maintain the quality of services and safety of clients
  
  • develop operational standards, policies, and procedures that relate to everyday practice, such as environmental policies, human resources, client safety, and documentation

Question 9

The Joint Commission is conducting a site visit at a facility and will be assessing client records for compliance with standards. Which of the following should the nurse be able to discuss with TJC surveyors?

Answer 9

• facility policies that address client assessment
• assessment documentation in the client record
• location of the client’s plan of care
• facility policies that address administration of medications

Question 10

list several examples of sentinel events, as defined by TJC

Answer 10

A client is given blood that has been incorrectly typed in the laboratory. An infant death. A client has the wrong arm or leg amputated during surgery.

Question 11

main goals of the magnetic recognition program

Answer 11

promoting quality in a setting that supports professional practice, identifying excellence in the delivery of nursing services to clients, and disseminating “best practices” in nursing service.

Question 12

the 5 categories of the components of the magnet program

Answer 12

the empirical outcomes are: structural empowerment, exemplary professional practice, new knowledge, innovations, or improvements, transformational leadership, empirical outcomes

Question 13

pathway to excellence program

Answer 13

a program for long-term or outpatient facilities to recognize excellence in nursing

Question 14

sentinel event

Answer 14

An adverse event that should not occur:
Injection of the wrong type of blood into a patient
Death of an infant
amputation/surgery of the wrong limb

Question 15

magnet recognition

Answer 15

• Health care organizations that provide excellence in nursing care throughout the facility
  
  • Promote quality in a setting that supports professional practice
    Identifying excellence in the delivery of nursing services to clients
    Disseminating “best practices” in nursing service

Question 16

magnet production versus pathway to excellence

Answer 16

Magnet
- Identifies innovations in professional practice
- Identifies organizations w/ quality outcomes
- Identifies client care excellence
Pathway
- Identifies a supportive practice environment
- Identifies a shared-governance structure
- Identifies contributions that affect nurses’ well-being

Question 17

medicare

Answer 17

Government health care coverage for a client who is age 65 or older, under age 65 with disabilities, or any age with End Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Question 18

the four parts of medicare

Answer 18

Part A (Hospital Insurance): Hospitalization, skilled nursing facilities, some hospice care, some home health care
Part B (Medical Insurance): Doctor’s services, physical therapy, occupational therapy, some home health care
Part C (Advantage Plan): Selected coverage that can include Medicare Parts A, B, and D
Part D (Medication Coverage): Extra coverage to lower costs of prescription medications

Question 19

medicaid

Answer 19

Government health care coverage for a client who must meet eligibility requirements based on the client’s income in relation to the poverty level.

Question 20

children’s health insurance program

Answer 20

Government health care coverage that provides for children who may not meet Medicaid’s requirements but need health coverage.

Question 21

private insurance

Answer 21

insurance not covered by a government agency

Question 22

insurance reimbursements

Answer 22

fee for service (FFS)
payment system

Question 23

diagnosis related groups (DRGs)

Answer 23

Centers for medicare & medicaid services (CMS)
Inpatient prospective payment system (IPPS)
Hospital-Acquired condition reduction program (HACRP)
Hospital Acquired Infection (HAIs)

Question 24

hospital acquired conditions included in condition reduction program

Answer 24

Central line associated bloodstream infection (CLABSI)
Catheter associated urinary tract infection (CAUTI)
Surgical Site Infection (SSI): colon & hysterectomy
Methicillin-resistant staphylococcus aureus (MRSA) bacterium
Clostridium difficile infection (CDI)

Question 25

resource utilization groups

Answer 25

a fixed payment system for reimbursement of health care services provided in the long-term setting based upon client diagnosis and services provided

Question 26

minimum data sets

Answer 26

A clinical assessment of a client s physical and cognitive status required to be conducted on nursing home residents who receive Medicare and Medicaid benefits

Question 27

social detriments of health

Answer 27

Neighborhood & built environment
Health & health care
Social & community context
Education
Economic stability
Genetics

Question 28

examples of physical determinant of health

Answer 28

the built environment
aesthetic elements
exposure to pollutants
the natural environment
- lack of green space for gardening, apartment buildings built close together

Question 29

examples of social determinant to health

Answer 29

social and community context
health and health care
positive social interactions
education
social interaction/support
- local store does not sell fresh produce, lack of transportation to medical visits, access to food that supports healthy eating, working two jobs to pay the bills

Question 30

the five main most important social determinants of health

Answer 30

economic stability
health and health care
neighborhood/built environment
education
social/ community context

Question 31

Ms. Jones is an 86-year-old female admitted to the acute care setting after sustaining a hip fracture. She has diabetes and is insulin-dependent, and she previously had a stroke and has weakness in her right arm. She will need physical therapy for her hip upon discharge. There is one flight of stairs to go up to access her home. What level of care would you recommend for a discharge plan for Ms. Jones?

Answer 31

skilled nursing facility

Question 32

skilled nursing facility

Answer 32

Sometimes referred to as a nursing home or long-term care, may provide for short term rehabilitation care such as occupational and physical therapy as well as oversight for activities of daily living.

Question 33

long-term care hospital

Answer 33

A facility that specializes in providing care for stable clients who require a lengthy period of treatment such as for severe burns, trauma, or ventilation needs.

Question 34

assisted living

Answer 34

Provides services for clients who are mostly independent in their living but who choose to live in a community setting for assistance with some part of their daily life—for example, with meals, medication management, laundry, housekeeping, or transportation.

Question 35

hospice

Answer 35

Services provided to clients when it is determined the client has less than six months to live. The goal is comfort and support services for the client and family, not curative.

Question 36

palliative

Answer 36

Services provided to clients to promote comfort while in the last stages of life. Services can be received during active treatment. A treatment approach that is focused on the management of symptoms of chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.

Question 37

respite care

Answer 37

Allows the client to be cared for apart from the caregiver, to allow the caregiver a break from the responsibilities of client care for a short time for vacations to travel or to simply stay at home without caring for the client.

Question 38

home care

Answer 38

The delivery of continued health care services within the client s home. Services can include nurse visits as well as occupational therapy, physical therapy, and social work.

Question 39

the primary six people involved with a patients care

Answer 39

the primary care physician
nurse case manager
lab, radiology, pharmacy
hospital
dietician
specialty physician

Question 40

The interprofessional team is collaborating to address Mr. Marino’s needs. What sequence of actions should the team take when applying the nursing process to Mr. Marino’s situation? (Order the options by matching each with the desired order number.)

Answer 40

1) review health history for chronic illness and cognitive deficits
2) determine as a team what is highest priority
3) identify a goal to work towards
4) Assist when needed especially when out of bed
5) meet again later on to discuss discharge

Question 41

a nurse is teaching a newly licensed nurse about medicare reimbursement. what should be taught

Answer 41

reimbursement amounts will be adjusted for clients who contract hospital-acquired conditions

Question 42

A community health nurse is teaching newly licensed nurse about the social determinants of health. Which of the following should the newly licensed nurse identify as a physical determinant of health?

Answer 42

poor air quality

Question 43

A nurse is teaching about Medicaid to a client who is concerned about paying for health care. Which of the following statements should the nurse make?

Answer 43

your income will determine if you are eligible for medicaid

Question 44

A nurse in a provider’s office is calling a client’s insurance company to obtain permission prior to scheduling a magnetic resonance imaging MRI test. Which of the following is the nurse obtaining?

Answer 44

precertification

Question 45

A home health nurse is caring for a client who is receiving hospice care. The client’s parter reports feeling overwhelmed from caring for the client. Which of the following types of facilities should the nurse recommend?

Answer 45

respite care

Question 46

A nurse is teaching a newly licensed nurse about The Joint Commission (TJC). Which of the following information should the nurse include?

Answer 46

TJC ensures organizations remain up to ate with state guidelines

Question 47

A nurse working in an acute care facility is caring for a client who has a total brain injury and is receiving mechanical ventilation. Which of the following facilities should the nurse anticipate the client to be transferred to for further treatment.

Answer 47

long term

Question 48

A nurse is teaching a client about hospice care. Which of the following statements by the client indicates an understanding of the teaching?

Answer 48

I understand that services provided will include just what is needed to keep me comfortable

Question 49

A nurse is discussing hospice care with a newly licensed nurse. Which of the following should the nurse identify as the goal of hospice care?

Answer 49

provide care for a client who has less than 6 months to live

Question 50

A graduate nurse notes that a hospital with Pathway to Excellence recognition is hiring staff. Which of the following should the nurse expect from this facility?

Answer 50

-The facility has practices in place that lead to a healthy workplace environment.
-The facility emphasizes shared governance.
-The facility emphasizes practices that positively affect a nurse’s well-being.

Question 51

A nurse at a community health center is providing an in-service for a group of residents about the Healthy People program. Which of the following information should the nurse include?

Answer 51

-Improving access to health care
-Activities to improve social determinants of health
-Initiatives to reduce health care disparities

Question 52

A nurse is reviewing a report by the Institute of Medicine (IOM). Which of the following competencies should the nurse identify health care professionals need in order to reduce errors?

Answer 52

cooperation
communication
coordination

Question 53

A nurse is hired to be a case manager in a facility. Which of the following services should the nurse expert perform?

Answer 53

facilitate transfer of clients to meet required level of care

Question 54

A nurse is competing the Minimum Data Set (MDS) assessment for a resident in a skilled-nursing facility. Which of the following information should the nurse include in the assessment?

Answer 54

-Input from members of the interdisciplinary team.
-Client’s cognitive status.
-Each physical therapy visit.
-Clients need for assistance with ADLs.

Question 55

A nurse is caring for a client who reports that they have lost their job and do not have insurance. Which of the following social determinants of health is challenging for this client?

Answer 55

economic stability

Question 56

A nurse is caring for a client who has Parkinson’s disease and needs assistance with ADL’s. Which of the following referrals should the nurse anticipate the provider to prescribe?
(Select all that apply)

Answer 56

dietician
physical therapist
occupational therapist

Question 57

A nurse is discussing social determinants of health with a newly licensed nurse. The nurse should include that which of the following factors contribute to the neighborhood and built environment determinant category? (Select all that apply)

Answer 57

Access to foods that support healthy eating patterns.
Crime and violence.
Environment conditions.

Question 58

A nurse is teaching about the Affordable Care Act. What should she include?

Answer 58

A focus of the ACA is disease prevention

Question 59

A nurse is caring for a client who is going to require 7 days of IV antibiotics and dressing changes for cellulitis. Where is this client going to be admitted to?

Answer 59

acute care