Chapter 12, Interprofessional Collaborative Practice and Care Coordination
Across Settings
Test Bank, Chapter Assignments, Discussions Plus Case Studies and Answers
Fundamentals of Nursing: The Art and Science of Person-Centered Care (10th Edition Taylor)
1. What role will the nurse play in transferring a client to a long-term care facility?
A. Provide a verbal report to the nurse at the long-term care facility on the client, the
hospital care, and the client's current condition.
B. Assure that the client's original chart accompanies the client.
C. Arrange for the client's belongings to remain at the hospital until discharge from the
long-term care facility.
D. Inform the client that transferring should be a stress-free situation.
Answer: A
Rationale: The nurse at the hospital will provide a verbal report to the nurse at the long-
term facility. The client's belongings will accompany the client to the long-term facility,
and the nurse should assure that this occurs. The original chart will not accompany the
client, but copies of the chart or sections of the chart may be sent based upon agency
protocols. The nurse should also recognize and inform the client that while a transfer
may be a welcome event, it can also be stressful.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Reference: p. 324
2. The nurse recognizes that the goals established for a client's discharge are more likely
to be accomplished when:
A. the client assists in developing the goals.
B. the physician develops the goals.
C. the nurse develops the goals.
D. the multidisciplinary team develops the goals.
Answer: A
Rationale: If the client is involved in establishing the goals, it is more likely that the
expected outcomes of the discharge plan will be met. The client may fail to follow the
plan if the goals are not mutually agreed on, or are not based on a complete assessment
of the client's needs. The physician, nurse, and interdisciplinary members are helpful to
provide guidance for the client to make the goals necessary for the discharge plan.
Question format: Multiple Choice
,Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 325
3. Which phrase best describes continuity of care?
A. Focusing on acute care in the hospital
B. Serving the needs of children
C. Facilitating transition between settings
D. Providing single-episode care services
Answer: C
Rationale: Continuity of care is a process by which health care providers give appropriate
uninterrupted care and facilitate the client's transition between different settings and
levels of care. The other choices do not describe continuity of care, as they focus on only
one area--such as an acute care setting or hospital, the needs of children, and single-
episode care services--rather than on the transition between settings.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 312
4. What is the result of increasing health care costs on hospital admissions?
A. The length of hospital stay has decreased.
B. The number of surgeries has decreased.
C. There is an increase in hospital admissions.
D. Fewer surgeries are being performed at ambulatory centers.
Answer: A
Rationale: As a result of increasing costs and of health care cost reimbursement programs
that are prospective rather than retrospective (meaning that costs are predetermined for
specific illnesses or treatments, including severity of illness and costs of care), hospital
admissions and lengths of hospital stay have decreased. Increasing numbers of clients are
having surgery, diagnostic tests, and emergency care in ambulatory care settings or on a
hospital outpatient basis.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
,Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
5. A nurse is admitting an older client named Grace Staples to a long-term care facility.
How should the nurse address the client?
A. "We will just call you Grace while you live here. Okay?"
B. "I know you have lots of grandchildren, Grandma."
C. "What name do you want us to use for you?"
D. "I think you will enjoy living here, Sweetie."
Answer: C
Rationale: The nurse should communicate with the client as an individual so that the
client can maintain the client's own identity. Ask clients how you should address them.
Do not call older adults Grandma or Grandpa or assume they will enjoy living at the
facility. It is inappropriate to automatically call someone by the first name or by
nicknames such as "Sweetie" or "Honey" as this may be interpreted as disrespectful or
condescending.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Apply
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Reference: p. 321
6. Which is the major goal of ambulatory care facilities?
A. To reduce costs by providing care at a lower rate than hospital rates
B. To provide care to clients capable of self-care at home
C. To perform major surgery in a community setting
D. To perform tests prior to the client being admitted to the hospital
Answer: B
Rationale: An individual may receive care in many different kinds of ambulatory
facilities, including physician offices, clinics, hospital outpatient services, emergency
rooms, and same-day surgery centers. The goal of these facilities is to provide health care
services to clients who are able to provide self-care at home. Although using ambulatory
care rather than in-patient hospital care reduces care costs, this is not the primary purpose
of ambulatory facilities. Major surgery and pretesting for surgery are not usually done at
these centers.
Question format: Multiple Choice
, Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
7. According to established standards, which health care provider should conduct a
holistic assessment for all clients admitted to the hospital?
A. Physician
B. Admission clerk
C. Licensed practical nurse
D. Registered nurse
Answer: D
Rationale: The Joint Commission has established standards for hospital admission. These
standards include assessment of each client's need for nursing care by a registered nurse
and biophysical, psychosocial, environmental, self-care, educational, and discharge
planning factors. The admission health assessment is not the responsibility of the
physician, licensed practical nurse, or admission clerk.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
8. Regardless of the type of ambulatory care facility, what need is common to all clients
who are given care?
A. Referrals
B. Education
C. Stress reduction
D. Surgery
Answer: B
Rationale: All clients in ambulatory care settings require education, which should include
written instructions about care at home, health promotion activities, and how to contact
someone for further questions. Referrals, stress-reduction, and surgery are not necessarily
needed by all clients.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Across Settings
Test Bank, Chapter Assignments, Discussions Plus Case Studies and Answers
Fundamentals of Nursing: The Art and Science of Person-Centered Care (10th Edition Taylor)
1. What role will the nurse play in transferring a client to a long-term care facility?
A. Provide a verbal report to the nurse at the long-term care facility on the client, the
hospital care, and the client's current condition.
B. Assure that the client's original chart accompanies the client.
C. Arrange for the client's belongings to remain at the hospital until discharge from the
long-term care facility.
D. Inform the client that transferring should be a stress-free situation.
Answer: A
Rationale: The nurse at the hospital will provide a verbal report to the nurse at the long-
term facility. The client's belongings will accompany the client to the long-term facility,
and the nurse should assure that this occurs. The original chart will not accompany the
client, but copies of the chart or sections of the chart may be sent based upon agency
protocols. The nurse should also recognize and inform the client that while a transfer
may be a welcome event, it can also be stressful.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Reference: p. 324
2. The nurse recognizes that the goals established for a client's discharge are more likely
to be accomplished when:
A. the client assists in developing the goals.
B. the physician develops the goals.
C. the nurse develops the goals.
D. the multidisciplinary team develops the goals.
Answer: A
Rationale: If the client is involved in establishing the goals, it is more likely that the
expected outcomes of the discharge plan will be met. The client may fail to follow the
plan if the goals are not mutually agreed on, or are not based on a complete assessment
of the client's needs. The physician, nurse, and interdisciplinary members are helpful to
provide guidance for the client to make the goals necessary for the discharge plan.
Question format: Multiple Choice
,Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 325
3. Which phrase best describes continuity of care?
A. Focusing on acute care in the hospital
B. Serving the needs of children
C. Facilitating transition between settings
D. Providing single-episode care services
Answer: C
Rationale: Continuity of care is a process by which health care providers give appropriate
uninterrupted care and facilitate the client's transition between different settings and
levels of care. The other choices do not describe continuity of care, as they focus on only
one area--such as an acute care setting or hospital, the needs of children, and single-
episode care services--rather than on the transition between settings.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 312
4. What is the result of increasing health care costs on hospital admissions?
A. The length of hospital stay has decreased.
B. The number of surgeries has decreased.
C. There is an increase in hospital admissions.
D. Fewer surgeries are being performed at ambulatory centers.
Answer: A
Rationale: As a result of increasing costs and of health care cost reimbursement programs
that are prospective rather than retrospective (meaning that costs are predetermined for
specific illnesses or treatments, including severity of illness and costs of care), hospital
admissions and lengths of hospital stay have decreased. Increasing numbers of clients are
having surgery, diagnostic tests, and emergency care in ambulatory care settings or on a
hospital outpatient basis.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
,Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
5. A nurse is admitting an older client named Grace Staples to a long-term care facility.
How should the nurse address the client?
A. "We will just call you Grace while you live here. Okay?"
B. "I know you have lots of grandchildren, Grandma."
C. "What name do you want us to use for you?"
D. "I think you will enjoy living here, Sweetie."
Answer: C
Rationale: The nurse should communicate with the client as an individual so that the
client can maintain the client's own identity. Ask clients how you should address them.
Do not call older adults Grandma or Grandpa or assume they will enjoy living at the
facility. It is inappropriate to automatically call someone by the first name or by
nicknames such as "Sweetie" or "Honey" as this may be interpreted as disrespectful or
condescending.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Apply
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Reference: p. 321
6. Which is the major goal of ambulatory care facilities?
A. To reduce costs by providing care at a lower rate than hospital rates
B. To provide care to clients capable of self-care at home
C. To perform major surgery in a community setting
D. To perform tests prior to the client being admitted to the hospital
Answer: B
Rationale: An individual may receive care in many different kinds of ambulatory
facilities, including physician offices, clinics, hospital outpatient services, emergency
rooms, and same-day surgery centers. The goal of these facilities is to provide health care
services to clients who are able to provide self-care at home. Although using ambulatory
care rather than in-patient hospital care reduces care costs, this is not the primary purpose
of ambulatory facilities. Major surgery and pretesting for surgery are not usually done at
these centers.
Question format: Multiple Choice
, Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
7. According to established standards, which health care provider should conduct a
holistic assessment for all clients admitted to the hospital?
A. Physician
B. Admission clerk
C. Licensed practical nurse
D. Registered nurse
Answer: D
Rationale: The Joint Commission has established standards for hospital admission. These
standards include assessment of each client's need for nursing care by a registered nurse
and biophysical, psychosocial, environmental, self-care, educational, and discharge
planning factors. The admission health assessment is not the responsibility of the
physician, licensed practical nurse, or admission clerk.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 321
8. Regardless of the type of ambulatory care facility, what need is common to all clients
who are given care?
A. Referrals
B. Education
C. Stress reduction
D. Surgery
Answer: B
Rationale: All clients in ambulatory care settings require education, which should include
written instructions about care at home, health promotion activities, and how to contact
someone for further questions. Referrals, stress-reduction, and surgery are not necessarily
needed by all clients.
Question format: Multiple Choice
Chapter 12: Interprofessional Collaborative Practice and Care Coordination Across
Settings
