Test Bank Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition,GRADED A - $32.49   Add to cart

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Test Bank Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition,GRADED A

Test Bank Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency (EPA). d. Many Americans live in areas that do not meet current national air quality standards. ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments. Toxicologists do not often consult nurses about environmental pollutants. Pollutant exposures are not routinely reported by nurses. Although there may be problems with air quality standards in the United States, this would not be the primary reason why nurses should understand environmental health. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection ControlNURSINGTB.COM 2. Why is it important for a nurse to have knowledge of environmental health and the effects of chemical, biological, and radiological materials? a. They are a major cause of global warming. b. They are often found in the air, water, and products we use. c. They are frequently linked to the development of chronic illnesses. d. They are products that nurses work with daily. ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use. These are not a major cause of global warming. They are not frequently linked to the development of chronic illnesses. These are not products that nurses work with daily. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A nurse fulfills the environmental health competency of “assessment and referral.” Which of the following actions has the nurse most likely completed? a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health ANS: C Assessment and referral states that all nurses should be able to successfully complete an environmental health history, recognize the potential environmental hazards and sentinel illnesses, and make appropriate referrals for conditions with probable environmental causes. Advocating for public policy changes is part of advocacy. Understanding policy framework and legislation is part of legislation and regulation. Describing the scientific principles of environmental health is part of basic knowledge and concepts. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 4. How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. Extrapolation by toxicologists and biomonitoring are modern methods. Completing a chemistry course does not show how to identify these possible relationships. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM 5. What term is used to refer to the basic science applied to understanding the health effects associated with chemical exposures? a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology ANS: A Toxicology is the study of the health effects associated with chemical exposures. Pharmacology is the branch of medicine concerned with the multiple aspects of drugs. Chemistry is the branch of science with deals with the way that matter is composed. Environmental epidemiology is concerned with the discovery of environmental exposures that cause or protect against illness or disease. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. What statement accurately describes the characteristics of epidemiology? a. It is a science that studies the poisonous effects of chemicals. b. It explains the association between learning disabilities and exposure to lead-based paint at the cellular level. c. It helps nurses understand the strength of the association between exposure and health effects. d. It is a method for tracking the prevalence of health outcomes. ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects. Toxicology is the science that studies the poisonous effects of chemicals. Environmental surveillance provides data with which to track and analyze the incidence and prevalence of health outcomes. Epidemiology does not examine causes at the cellular level. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. When researching pesticides, the nurse looks at the “family” of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity ANS: B Chemicals are grouped so it’s possible to understand the actions and risks associated with each group. Although some common health risks exist within these families of chemicals, the possible health risks for each chemical should be evaluated individually when a potential human exposure exists. DIF:MSC: Cognitive level: ApplyingNCLEX: Safe and Effective Care Environment: Safety and Infection ControlNURS INGTB.TOP:COM Nursing process: Assessment 8. Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.). The other examples do not contain an agent, host, and environment. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Identifying areas with an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community ANS: B The use of a GIS allows the PHN to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness. An electronic health record (EHR) would be the most appropriate place to record client data from a foot clinic. Evaluation of effectiveness of a farm safety program would need to be done through some type of assessment or evaluation method—GIS would not be useful to collect this data. GIS is not a scheduling system and would not be helpful when scheduling health promotion programs in the community. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. A public health nurse (PHN) is organizing a multidisciplinary team to address the issue of water pollution in the community. Which group of professionals would be invited to address this issue? a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists. The other professionals are not experts in the area of water pollution in the community. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 11. A nurse would identify which as a point source of air pollution? a. A smoke stack b. The number of cars and trucks c. The amount of fossil fuel consumed in a community d. Ground ozone levels ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack. Nonpoint sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that is consumed and ground ozone levels do not identify sources of air pollution. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 12. A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first “P”? a. Present work b. Potential exposures c. Personal protective equipment use d. Past work ANS: A Present work is the first “P.” Potential exposures are part of the “I”—investigate potential exposures. Personal protective equipment use is not part of the mnemonic. Past work is the second “P.” DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 13. What is the greatest single source of air pollution in the United States? a. Waste incineration b. Power plants c. Motor vehicles d. Molds ANS: C Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States. Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 14. A nurse wants to find more information about indoor air quality. Which of the following websites would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. “Right to Know” NURSINGTB.COM d. The Occupational Safety and Health Administration (OSHA) ANS: B Indoor air quality is a growing public health concern in office buildings, schools, and homes and is reflected in the alarming rise in asthma incidence in the United States, particularly among children. Sources of information about indoor air quality include the EPA and the American Lung Association. The NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health and biomedical research. “Right to Know” is part of a workplace safety legislation. OSHA regulates safety in factories and businesses. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 15. Employees working with hazardous chemicals have the “Right to Know” about the chemicals they are working with through the creation of which resource? a. Material Safety Data Sheet (MSDS) b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency (EPA) ANS: C The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals that are used on site. Each of the chemicals should have an associated chemical information sheet known as an MSDS, which is written by the chemical manufacturer. Consumer Confidence Reports summarize the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and public laws for the safety of the environment and the population. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 16. What is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water ANS: B Nonpoint sources come from more diffuse exposures to pollution. Animal waste is the only diffuse exposure given. The others are considered point sources; point sources are individual, identifiable sources such as smoke stacks. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 17. A nurse is completing the first phase of a risk assessment. Which of the following questions would the nurse most likely try to answer? a. Has the chemical been released into the environment?NURSINGTB.COM b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm? ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans): Is the chemical known to be associated with a negative health effect? The second step is determining if the chemical has been released into the environment: Has the chemical been released into the environment? The third step is estimating how much and by which route of entry the chemical might enter the human body: How much and by which route of entry can the chemical enter the body? The final step considers the previous steps: What is the prediction for potential harm? DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 18. A nurse working at the individual level to reduce pollution in the environment would most likely be involved in what activity? a. Providing a tax incentive to factories that do not pollute b. Making laws related to allowed levels of pollution in the area c. Recycling paper, glass, cans, and plastic d. Moving to an area with less pollution ANS: C Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans, and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to reduce pollution in the environment. Moving to an area with less pollution would not help to improve the problem. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 19. What is the first step the nurse would take when addressing the problem of air pollution in the community? a. Setting standards b. Monitoring c. Permitting d. Compliance ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water. Environmental standards may describe a permitted level of emissions, a maximum containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an ongoing process after an action has happened. Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM 20. A city sets the standard of an acceptable level of emissions or a maximum contaminant level allowed for factories. Which concept is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed. Although this does help to control pollution, environmental standard is best applied in this example. Setting a standard for emissions does not impact waste minimization or land use planning. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 21. A facility is inspected after it has obtained a permit. The inspection is completed for the purpose of observing whether the plans submitted in the permit application are being implemented as approved. Which of the following environmental protection strategies is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved. Permitting is an important step in controlling pollution. Waste minimization and land use planning are activities aimed at prevention of pollution. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 22. Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters. The Safe Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or operators of public water systems to comply with primary standards. The Toxic Substance Control Act gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the United States. The Pollution Prevention Act focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials. DIF: Cognitive level: RememberingNURSING TB. COM Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. A public health nurse (PHN) working with a family living in poverty is concerned about their exposure to environmental hazards. Which of the following factors should the nurse identify as possibly putting the family at risk? (Select all that apply.) a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education e. Unsafe working conditions ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is assessing for environmental health risks in the community. Which of the following approaches would be most appropriate for the nurse to use? (Select all that apply.) a. Asking legislators to provide a list of environmental pollutants in the area b. Developing a list of exposures associated with urban, rural, or suburban settings c. Assessing the risk by medium such as air, water, soil, or food d. Dividing the environment into functional locations: home, school, workplace, and community e. Recruiting community members to sign a petition to decrease pollution ANS: B, C, D Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food, and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a list of pollutants or recruiting community members to sign a petition are not effective means to assess for environmental health risks. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM Chapter 41: The Nurse in Public Health, Home Health, Hospice, and Palliative Care Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. How are official agencies financed primarily? a. Charities b. Individual clients c. Third-party payers d. Tax funds ANS: D Official agencies are financed primarily by tax funds. These agencies are typically operated by state, county, city, or other local government units, such as health departments. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Medicare-certified home health agencies place emphasis on what type of care? a. Chronic b. Distributive c. Intermittent d. Primary ANS:As part of the Conditions of Participation, Medicare C NURSINGTB.COM -certified home health agencies must place an emphasis on intermittent care. Home care services that are provided must be intermittent and provide a skilled service. Primary care refers to the care that is often provided in a physician’s office. Medicare-certified agencies provide care following an acute hospitalization or medical change; they do not provide long- term care for chronic illnesses. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A home care nurse is employed by a proprietary agency. Which statement is true about such an agency? a. It is exempt from federal income taxes. b. It is governed by a board of directors. c. It is a profit-making agency. d. It is reimbursed primarily by tax funds. ANS: C Proprietary agencies are profit-making agencies. Proprietary agencies are free-standing, for- profit agencies that are required to pay taxes. Many are part of large chains and now dominate the home care industry. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is coordinating care to ensure a comfortable and peaceful death. Which of the following factors should be an important consideration for the nurse? a. The unique stress dying patients often experience b. The cultural values, expectations, and preferences of the family c. The communication style of each family member d. The abilities of the nurse and health care team ANS: B Cultures vary in their beliefs and responses to death. Nurses should know the differences in cultural responses so that they can effectively help people in their time of need. It will be important for the nurse to take cues from the client and the loved ones regarding their needs. The stress experienced by dying patients is different based on the client’s culture. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse has referred a home care client to hospice care. Which of the following best explains the rationale for this referral? a. To provide comfort and peace at a difficult time b. To reduce the cost of care for the terminally ill c. To keep clients at home until the end of life d. To provide care for terminally ill clients expected to live longer than 6 months ANS: A The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time. Comprehensive services emphasize continuity of care. Hospice care is provided for those NURSINGTB.COM with a life expectancy of less than 6 months. Hospice is the only Medicare benefit that includes medications, medical equipment, 24 hours/7 days a week access to care, and support for family members after death. Hospice care does not reduce the cost of care. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The nurse provides direct care services to a stroke victim to avoid complications. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Thus, direct care for a stroke victim is focusing on limiting disability and encouraging rehabilitation. Primary prevention focuses on preventing the disease before it occurs. Secondary prevention focuses on early detection and screening. Assessment is not a level of prevention. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. A nurse is providing a skilled nursing service. Which of the following best describes the intervention the nurse is performing? a. Teaching the client and family about medication administration b. Consulting with other nurses about the care of a client in the home c. Coordinating services for maximum benefit at minimal cost d. Reviewing nursing assistant charting at the end of each day ANS: A Skilled nursing service is the Medicare term that describes the duties of the registered nurse and refers to the requirement of nursing judgment. Those services involve assessment, teaching, and selected procedures. Teaching the client and family to implement a therapeutic plan, such as taking medications, is an example of a skilled nursing service. Consultation, coordination, and review of documentation do not fit the definition of a “skilled nursing service.” DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is employed in home health nursing practice. Which of the following terms best describes the care that is being provided? a. Intermittent nursing care b. Custodial care c. Family caregiving d. Palliative care ANS: A NURSINGTB.COM Provision of intermittent skilled visits is a component of home health care nursing. Custodial care refers to the care given in long-term care facilities. Family caregiving may be an important role of keeping the client at home, but it is not a necessary component of home care. Palliative care is an extended continuum of chronic serious illness to acute serious illness during which stabilization and exacerbations may occur. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which organization publishes the current scope and standards of home care practice? a. Centers for Medicare and Medicaid Services b. American Nurses Association (ANA) c. Robert Wood Johnson Foundation d. Visiting Nurse Association ANS: B The ANA publishes scope and standards for Home Health Nursing and Hospice and Palliative Nursing. The Centers for Medicare and Medicaid Services control the regulations and reimbursement mechanisms for the majority of home care services. The Robert Wood Johnson Foundation provides grant funding for a variety of projects that support nursing. The Visiting Nurse Association is a home care agency. DIF: TOP: MSC: Cognitive level: Understanding Nursing process: Evaluation NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse has discovered that a client should be receiving Meals on Wheels. Which of the following steps of the nursing process is the nurse performing? a. Diagnosis b. Planning c. Assessment d. Implementation ANS: C The Standards of Care and the Standards of Professional Performance both include the six steps of the nursing process: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. As a nurse performs an assessment, the nurse recognizes the current needs of the client. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. Which concepts are used to evaluate client outcomes when using the Omaha System Problem Rating Scale for Outcomes? a. Problem, intervention, and outcome b. Knowledge, behavior, and status c. Knowledge, skill, and attitude d. Problem, category, and modifiers ANS: B The Omaha System Problem Rating Scale for Outcomes uses the concepts of knowledge, NURSINGTB.COM behavior, and status. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. After conducting a comprehensive client assessment, the nurse would organize information about the client’s medication regimen into which domain of the Omaha System Problem Classification Scheme? a. Environmental DIF: TOP: MSC: b. Psychosocial c. Physiological d. Health-related behaviors ANS: D The Omaha System Problem Classification Scheme uses four domains to organize client information. The Health-related behaviors domain includes information related to patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease. The environmental domain includes material resources and physical surroundings both inside and outside the living area. The psychosocial domain includes patterns of behavior, emotion, communication, relationships, and development. The physiological domain includes functions and processes that maintain life. Cognitive level: Analyzing Nursing process: Implementation NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is using the Omaha System Problem Classification Scheme. Which of the following situations is the nurse most likely experiencing? a. Measuring client outcomes b. Collaborating with other professionals c. Providing health education d. Organizing a comprehensive assessment ANS: D The Omaha System Problem Classification Scheme is used to organize a comprehensive assessment according to four priority domains. It’s simple and concrete terms are used to organize a comprehensive assessment, an important standard of nursing practice. It does not measure client outcomes, promote collaboration with other professionals, or provide health education. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A community health nurse is using the Omaha System. Which of the following best describes the rationale for using this system? a. To define each health care provider’s role b. To use nursing diagnoses in community health nursing practice c. To foster collaborative practice d. To provide practitioners a method for communication DIF: TOP: MSC: ANS: C NURSINGTB.COM The goals of developing the Omaha System were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines and to foster collaborative practice. Therefore, the Omaha System was designed to guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agency-wide, multidisciplinary clinical information management system capable of meeting the daily needs of clinicians, managers, and administrators. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse? a. Understand who oversees the client’s care. b. Make appropriate referrals. c. Recognize what other professionals do and how they view their roles. d. Request assistance when performing complex skills. ANS: C The factors for successful interprofessional functioning include the categories of knowledge, skill, and attitudes with subheadings including the understanding of the roles of each professional. Cognitive level: Analyzing Nursing process: Planning NCLEX: Safe and Effective Care Environment: Management of Care 16. A home care agency has applied for accreditation from the Joint Commission. What is the next step the agency will take? a. Attend a conference to learn more about the accreditation process. b. Schedule a site visit with the Joint Commission. c. Complete a self-study of the agency. d. Improve methods of documentation of client visits. ANS: C After applying for accreditation, a lengthy self-study must be completed that addresses all aspects of the agency’s operation. Following completion of the self-study, an accreditation team schedules a site visit. Attending a conference to learn more about accreditation should be done before applying. A site visit with the Joint Commission occurs after the self-study DIF: TOP: MSC: has been reviewed. Improving methods of documentation of client visits should be addressed before applying for accreditation. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. Which historical event caused dramatic changes in home care nursing? a. Passage of Medicare legislation b. Establishment of Visiting Nurse Associations c. Creation of the Montefiore Hospital Home Care Program d. Provision of funds by the Civil Works Administration ANS: A NURSINGTB.COM Medicare introduced regulations for home care practice as well as for reimbursement mechanisms. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is using telehealth technology in the home setting. Which of the following best describes the intervention that is being used by the nurse? a. Uses Web TV to teach clients about their health. b. Shares health information using electronic communications. c. Makes regular visits to clients to check the technology. d. Risks violation of the Health Insurance Portability and Accountability Act. ANS: B Telehealth includes sharing health information between the client and clinicians using electronic communications. Telehealth may or may not include video technology for live interactions. Telehealth allows for monitoring health status and symptom recognition, providing education, increasing communication, and enabling clients to become active partners in their own care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care DIF: TOP: MSC: MULTIPLE RESPONSE 1. A nurse is coordinating care through a high-intensity transitional care program. Which of the following best describes the populations that the nurse is working with? (Select all that apply.) a. Adults with cognitive impairments b. Women with high-risk pregnancies c. Older adults with heart failure d. People who are moving from one state to another e. Men who have just experienced divorce ANS: A, B, C Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. High-intensity transitional care programs are designed for populations who have complex or high-risk health problems. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which are categories of classifying interventions according to the Omaha System Intervention Scheme? (Select all that apply.) a. Health education b. Case management c. Treatments and procedures d. Direct care services NURSINGTB.COM e. Skilled nursing care ANS: B, C The Omaha System Intervention Scheme is comprised of four broad categories of interventions: (1) teaching, guidance, and counseling; (2) treatments and procedures; (3) case management; and (4) surveillance. DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which illegal and unethical activities have occurred in health care systems in the past? (Select all that apply.) a. Inappropriate use of home health services b. Inaccurate billing for services c. Excessive administrative staff d. “Kickbacks” for referrals e. Primary care services provided in the home ANS: A, B, C, D Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, “kickbacks” for referrals, and billing for visits and/or medical supplies that are not authorized or provided. The home care nurse must abide by established federal regulations when delivering care to clients. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 25: Case Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse who is using population management needs to be able to work with integrated care delivery systems. Which of the following describes the rationale for this competency? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary. ANS: A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using population management as part of the nursing care that is provided. Which of the following activities is the nurse most likely completing? a. Census taking to determine the total number of people in the populationNURSINGTB.COM b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually ANS: B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. Population management does not include census taking, providing case management services for all, or repeating wellness programs on an annual basis. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is referred to by what term? a. Case management b. Care management c. Disease management d. Demand management ANS: B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A patient with a long history of asthma with many hospital admissions is referred to a case manager for disease management. Which of the following best describes the purpose of this referral? a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring ANS: A Disease management activities target chronic and costly disease conditions that require long- term care interventions. Demand management seeks to control use by providing clients NURSINGTB.COM with correct information. Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician do not explain the referral to disease management. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is assisting clients to improve their health status. Which of the following types of management is being used by the nurse? a. Care management b. Case management c. Disease management d. Demand management ANS: D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A bachelor’s prepared nurse is providing case management services. Which of the following activities would most likely be provided by this nurse? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes ANS: C Working with individuals would be the role of this nurse. Working with community aggregates, systems of disease, and outcomes management processes are implemented by an advanced practice nurse (APN). NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse using a critical path when providing care for a client is most likely engaged in what activity? a. Implementing the six “rights” of case management b. Demonstrating competencies required for practicing case management c. Attempting to achieve a measurable outcome for a specific client d. Effectively managing conflict resolution ANS: C A critical path is a case management tool used to achieve a measurable outcome for a specific client case. The critical path details the essential and sequential activities in care, so that the expected progress of the client was known at a point in time. A critical path does not address the six “rights” of case management or demonstrate the competencies required for practicing case management. A critical path is not used for conflict resolution. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What are the six “rights” of case management? a. Care, time, provider, setting, price, and outcomes b. Patient, medication, route, time, documentation, and evaluation c. Place, setting, patient, plan, outcomes, and documentation d. Disease process, time, place, beneficence, advocate, and care provider ANS: A Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case management. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is working as a case manager and is in the process of performing interdisciplinary, family and client conferences. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Planning for outcomes d. Implementation ANS: B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions based on assessment, and using interprofessional teams. Examples of assessment include developing networks with target populations and dissemination of written materials. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence- based interventions. Examples of implementation include contacting providers and coordinating care activities. DIF: Cognitive level: ApplyingNURS INGTB.TOP:COM Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A case manager has contacted providers and has negotiated services and prices. Which of the following phases of the nursing process is being demonstrated? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation ANS: D The implementation phase of the nursing process occurs when a case manager advocates for clients’ interests and arranges for the delivery of service. Examples of assessment include developing networks with target populations and dissemination of written materials. Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A case manager uses effective collaboration and team strategies to arrange for services. Which of the following roles is being applied? a. Broker b. Negotiator c. Liaison d. Facilitator ANS: B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator. The role of broker is used when acting as an agent for provider services that are needed by clients to stay within coverage according to budget and cost limits of the health care plan. When acting as a liaison, the nurse provides a formal communication link among all parties concerning the plan of care management. As a facilitator, the nurse supports all parties in work toward mutual goals. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A case manager provides a formal communication link among all parties concerning the plan of care management. Which of the following roles of the nurse is being implemented? a. Facilitator b. Liaison c. Coordinator d. Negotiator ANS: B The case manager providing a formal communication link among all parties concerning the NURSINGTB.COM plan of care management is performing the role of liaison. As a facilitator, the nurse supports all parties in work toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and coordinates needed health care services for clients at all necessary points of services. The case manager who uses effective collaboration and team strategies to arrange for services is performing the role of negotiator. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A case manager is fulfilling the role of coordinator. Which of the following nursing interventions would most likely be completed? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client ANS: D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client’s situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator and supporting all parties to work toward mutual goals is the role of facilitator. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. Which knowledge domains are used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning, and legislative change d. Grant application, bargaining contracts, and securing funding ANS: B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research. The other domains listed are not used in case management. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is using life care planning when working with a client. What would be the most appropriate time for planning to be used? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care ANS: C Life care planning is a customized, medically based document that provides assessment of present and future needs. Typically, a life care plan incorporates medical, financial, NURSINGTB.COM psychological, vocational, built environment, and social costs during the remaining life of the client. Life care planning is a tool used in case management. A life care plan assesses the current and future needs of a client for catastrophic or chronic disease over a life span. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is working as a case manager. Which of the following best describes the diagnoses that the case manager is most likely to encounter? a. Bankruptcy, financial distress, and depression b. Flu, colds, and frequent headaches c. Malaria, bird flu, and Dengue fever d. AIDS, spinal cord injury, and ventilator dependency ANS: D Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A public health nurse (PHN) is working with the chronically ill and families with young children needing age-specific health maintenance. Which of the following models of case management is being used? a. Client-focused b. System-focused c. Social service d. Long-term care ANS: A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. System-focused models address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client- focused b. System-focused c. Social service d. Long-term care ANS: B NURSINGTB.COM The system-focused model addresses the structure and processes of using the population- based tools of disease management and critical pathways to offer care for client populations. The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, “Tell me more about how you will work full time and breastfeed.” Which of the following aspects of the advocacy process is being used? a. Verification b. Clarification c. Amplification d. Affirmation ANS: B Clarification is a process in which the nurse and client strive to understand meanings in a common way. Verification is the process used by the nurse advocate to establish accuracy and reality in the informing process. Affirmation is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse upholds a client’s right to make a choice and to act on the choice. Which of the following best describes the action being taken by the nurse? a. Affirming b. Supporting c. Informing d. Amplifying ANS: B Supporters approve and support clients’ actions. Affirming is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Informing includes educating clients about the nature of their choices, the content of those choices, and the consequences to the client and is not a one-way activity. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 21. A case manager supports a client’s decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which of the following phases of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation ANS: C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client’s decisions. The assessment/diagnosis phase is similar to the advocacy process of information exchange, gathering data, and illuminating values. The planning/outcome phase is like the advocacy process when generating alternatives and consequences and prioritizing actions. The evaluation phase is most similar to the advocacy processes of affirmation, evaluation, and reformulation. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. What term is used to identify the process of moving conflicting parties toward an outcome? a. Negotiation b. Conflict management c. Problem-purpose-expansion method d. Brainstorming ANS: A The process of moving conflicting parties toward an outcome is called negotiation. Conflict management has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the problem and expanding the problem statement so that different solutions can be generated. In brainstorming, as many alternatives as possible are generated without placing a value on them. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity 23. Mutual benefit with limited loss for everyone is a goal of what process? a. Negotiating b. Assertiveness c. Conflict management d. Cooperation ANS: C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties’ needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal. The process of moving conflicting parties toward an outcome is called negotiation. Assertiveness is the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. NURSINGTB.COM DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity 24. The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy. The parents are deciding if “spanking” the child is a disciplinary method that they will employ. The mother says, “I do not believe in spanking. I see it as abusive and demeaning.” Which of the following best describes the statement by the mother? a. Cooperation b. Assertiveness c. Bargaining d. Collaboration ANS: B The mother’s statement is an example of assertiveness, the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the negotiation process when debates include gathering facts based on reasoning that will generate understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent process in which people work together to share resources and a vision for a goal. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity 25. A nurse is working with an individual who pursues neither his concerns nor another’s concerns. Which of the following conflict management behaviors is being used? a. Accommodating b. Collaborating c. Avoiding d. Compromising ANS: C The individual would be “avoiding.” Avoiding is defined as when an individual pursues neither his or her concerns nor another’s concerns. Accommodating occurs when an individual neglects personal concerns to satisfy the concerns of another. Collaborating is when an individual attempts to work with others toward solutions that satisfy the goals of both parties. Compromising occurs when an individual attempts to find a mutually acceptable solution that partially satisfies both parties. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity 26. What is the first stage of collaboration? a. Trust building b. Consensus c. Collegiality d. Awareness ANS: D The first stage of collaboration is awareness, when one makes a conscious entry into a group NURSINGTB.COM process. This is followed by tentative exploration and mutual acknowledgement, trust building, collegiality, consensus, commitment, and collaboration. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A case manager submits documentation that a nursing visit was completed at a client’s home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security ANS: B Fraud/abuse occurs when false statements of claims are made and filed. Confidentiality/security occurs when sensitive information is not secured. Negligent referral occurs when referrals or treatments are inappropriate. Liability for managing care occurs when case management is not used appropriately, when there is harassment, or when care is inappropriately delegated. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse’s excessive attention to cost containment impairs the nurse’s duty to provide measures to improve health. Which of the following ethical principles is being influenced? a. Autonomy b. Beneficence c. Veracity d. Nonmaleficence ANS: B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering. Autonomy is the individual’s right to choose a provider. Veracity is truth telling which is important to building trusting relationships with clients. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. Care in a managed system is provided by less experienced providers. Which of the following ethical principles is being influenced in this situation? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice ANS: D NURSINGTB.COM Justice calls for equal distribution of health care with reasonable quality. Autonomy is the individual’s right to choose a provider. Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What knowledge and skills are required in order to become a competent case manager? (Select all that apply.) a. Knowledge of community resources and financing mechanisms b. Written and oral communication skills c. Proficient negotiation and conflict-resolving practices d. Application of evidence-based practices and outcomes measurements e. Experience with ethical decision making ANS: A, B, C, D The knowledge and skills required to achieve competency include knowledge of community resources and financing mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving practices, and the ability to apply evidence- based practices and out

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