PNC Exam 1 Practice questions Flashcards
Which of the following is in alignment with one of the Healthy People 2010 primary prevention goals?
- providing free screening to children
- Creating new pharmacological treatments
- Opening a wellness clinic
- Developing betting insurance controls
The correct answer is opening a wellness clinic.
The two primary prevention goals of Healthy People 2010 are to (1) increase quality and years of healthy life and (2) eliminate health disparities. Opening a wellness clinic, which is aimed at primary prevention, focuses on bettering health; this is in line with the primary goal.
Free screening to children occurs in most states and is secondary prevention aimed at early detection.
Pharmacological treatments are considered tertiary goals.
Developing insurance controls was a goal of health care reform during the Clinton administration.
A nurse works at a hospital that provides services in all specialty areas (medical, surgical, pediatrics, obstetrics). This hospital is classified as
- long-term care hospital
- Short-term hospital
- General hospital
- Specialty Hospital
The correct answer is: General hospitals
Hospitals are classified by the services they provide as well as by their ownership. General hospitals admit clients requiring a variety of services such as medical, surgical, obstetric, pediatric, and psychiatric services.
Some hospitals offer only specialty services such as psychiatric or pediatric.
Hospitals can also be classified as acute care or chronic care.
Acute care hospitals provide assistance to clients whose illness and need for hospitalization are relatively short-term, such as several days.
Long-term care hospitals provide services for longer periods—sometimes years or for the remainder of the client’s life.
A client diagnosed with Alzheimer’s disease, whose memory is rapidly declining, has a spouse who must continue to work full time.- Which solution should the nurse recommend?
- long-term care replacement for the client
- that the spouse considers early retirement
- placing the client in an adult day-care environment
- Increasing the client’s medications to slow the progression of the disease
The correct answer is: Placing the client in an adult day-care environment
Due to economics and the increasing age of the adult population, means other than hospitalization are needed to care for clients who cannot be cared for in the home. Day-care centers provide care and nutrition for adults who cannot be left at home alone but do not need to be in an institution.
Moving a client from an independent home situation to long-term care would be more detrimental than a gradual progression of care.
Telling the spouse to consider early retirement is neither therapeutic nor realistic.
Increasing medications is a decision that needs to be made by the client’s primary caregiver, not the nurse.
The manager of a small clinic has cross-trained the nurses to perform ECG testing, phlebotomy, and some respiratory therapy interventions. This clinic is an example of which delivery model?
- managed care
- case management
- Patient-focused care
- Critical pathways
The correct answer is: Patient-focused care
Patient-focused care is a delivery model that brings all services and care providers to the client. Activities provided by auxiliary personnel are moved close to the client, thereby decreasing the number of personnel involved and the number of steps to get the work done.
Managed care focuses on cost-effective, quality care which results in decreased costs and improved outcomes.
Case management is a way to integrate health care services for individuals or groups and involves multidisciplinary teams that assume collaborative responsibility for planning, assessing, coordinating, implementing, and evaluating care.
Critical pathways are used to track the client’s progress in case management.
According to Healthy People 2020, the steps to access health care services includes all except:
- finding providers who work for free to ensure affordable healthcare
- finding providers that the client can communicate with
- Getting access to sites of are where the client can receive needed services
- gaining entry into the healthcare system
The correct answer is: Finding providers who work for free to ensure affordable healthcare
According to Healthy People 2020, accessing health care requires two discrete steps: getting access to sites of care where the client can receive needed services, and finding providers that the client can communicate with.
Finding providers who work for free is not a step to accessing health care according to Healthy People 2020.
The nurse explains to a group of clients some of the healthcare policy changes that have been made to improve healthcare to clients. The nurse includes which policy change in the explanation?
- Flu shots are given at pharmacies
- nursing diagnoses
- Meals on Wheels
- Mandatory wheelchair ramps at health facilities
The correct answer is: Mandatory wheelchair ramps at health facilities
One factor influencing changes in national policy is access to healthcare. Government agencies and health care agencies are required to provide increased access by installing wheelchair ramps for the handicapped.
Meals on Wheels is not part of the healthcare system.
Urging clients to get flu shots is a government policy; however, it is not policy to get the shots at pharmacies.
Nursing diagnoses are required but not by the government as policy.
The nurse participating in a research project whose results will eventually affect health policy change. The nurse is taking part in which phase of policy change?
- evaluation phase
- Implementation phase
- formulation phase
- Research phase
The correct answer is: Formulation phase
The phases of health policy development closely mirror the nursing process. During the formulation phase, data is collected and problems are identified.
Research is a method of gathering the data.
Evaluation is completed after the new policy has been implemented to determine the effectiveness of the change.
The implementation phase is in place when the new policy is placed into effect.
Which agency would sponsor a program that would meet the needs of a community group deficient in health promotion education?
- local health department
- state health department
- local hospital
- federal government
The correct answer is: Local health department
The local health department is responsible for developing programs to meet the health needs of the people.
State health organizations are responsible for assisting the local health departments.
The U.S. Department of Health and Human Services is a federal agency whose functions include: conducting research and providing training in the health field, providing assistance to communities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel.
Local hospitals provide the majority of acute care services in a community.
A client is enrolled in an HMO, while their previous experience with healthcare coverage was with a PPO. The client asks the occupational health nurse to explain the difference between the HMO and PPO. The best response by the nurse is
- you will have good healthcare benefits, so don’t worry
- both the HMO and PPO are covered by your employer, so it’s not really your concern
- Both really should be happy about the HMO. You’ll pay little if any, out-of-pocket expense
- Your PPO offered you a choice in your healthcare provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care
The correct answer is: “Your PPO offered you a choice in your healthcare provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care.”
HMO plans emphasize wellness, and members choose a primary care provider who evaluates their health status and coordinates their care. Clients are limited in their ability to select healthcare providers and services, but available services are at minimal and predetermined cost to the client.
PPOs consist of a group of physicians that provides an insurance company or employer with health services at a discounted rate. One advantage of the PPO is that it provides clients with a choice of healthcare providers and services.
Telling the client not to worry does not address the client’s request, which is to explain the difference.
Even though explaining that the client will have little out-of-pocket expense may be truthful, it doesn’t answer the request.
The client tells the nurse that Medicare no longer pays for older adults to have annual physicals and the client cannot afford to pay for the service. The nurse recognizes that the client is:
- Underinsured
- uninsured
- resistant
- noncompliant
The correct answer is: Underinsured
Medicare covers some health care, but the client is underinsured when preventive care is not covered by their current insurance.
The uninsured client has no insurance health coverage.
This client does not appear to be resistant or noncompliant, but rather unable to pay for the service.
An underinsured client cannot afford to see the physician weekly as prescribed to have his or her blood pressure monitored. The nurse suggests that the client:
- go to the emergency department for a BP check once a week
- Have the BP checked once a month instead
- Have the nurse at the community health center check the BP
- Buy a blood pressure kit for the home
The correct answer is: Have the nurse at the community health center check the blood pressure.
Many communities have a health center or local health department where the client could get a blood pressure check without cost.
Sending the client to the emergency department for routine care is not appropriate because it increases costs.
Recommending that the client come in once a month instead is not in the purview of the nurse if the physician has ordered once-a-week checks.
The client may not be able to afford a kit for the home, nor to use the equipment, nor to produce reliable results.
The client asks the nurse why he is facing discharge from the rehabilitation hospital and the remaining rehabilitation from his surgery must continue at home. The best response by the nurse is:
- you do not need to be in the hospital
- it helps contain costs, and you will continue therapy in the home
- we need to open up beds for other clients
- We try to decrease hospital time for the older adult
The correct answer is: “It helps contain costs, and you will continue therapy in the home.”
The nurse would explain that rising costs of health care make it necessary to find cost-effective ways to continue care in a different setting. The nurse assures the client that there will still be care and rehabilitation in the client’s own home.
Telling the client that the hospital needs beds does not help the client feel confident about home care.
It would not be wise to tell clients that they do or do not belong in the hospital. Rather, the nurse would concentrate on giving the client the confidence to accept that the client is now well enough to take care to a different level.
It would be incorrect to tell the older adult that care for this age group is decreased because of their age.
An asthmatic client needs to follow up with the physician in two weeks after being prescribed new medication. The client’s new insurance coverage does not begin immediately and the client cannot afford to return until the insurance is in effect. The nurse recognizes this as:
- limited access to health care
- uneven distribution of services
- Resource allocation
- Lack of usual source of care
The correct answer is: Resource allocation
Many insurance companies use rationing as a means of resource allocation by having a waiting period for care for new clients.
The client is not experiencing limited access, uneven distribution, or the lack of a usual source of care.
The nurse determines that the best method of accomplishing cost-effective care is by:
- Reading articles regarding health cost containment
- making suggestions in staff meetings to increase efficiency
- Participating in health fairs
- Volunteering to give flu shots
The correct answer is: Making suggestions in staff meetings to increase efficiency
Nurses should be aware of ways to utilize cost-effective measures during the delivery of care and to make suggestions for increasing productivity to the management team.
Reading articles will not decrease costs unless the nurse takes some form of action.
Participating in health fairs and volunteering to give flu shots are not examples of cost containment.
