FUNDAMENTALS NURSING CHAPTER 8 THE HEALTHCARE DELIVERY SYSTEM CORRECT QUESTION AND ANSWERS 100%

A client asks a nurse about the benefit of using diagnosis-related groups (DRGs) as a reimbursement method. Which is the nurse's best response? - ANSWERS-"DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." .A client at a local health fair asks the nurse what is meant by secondary health care. Which of the following reflects the intent of secondary care? - ANSWERS-In secondary care, one would expect that psychiatric care, same-day surgery, and general hospital care for patients be provided. .A client considers himself affluent and places a high priority on maintaining his freedom to choose which physicians and health care services he utilizes. Which of the following group plans is most likely to meet this client's needs? - ANSWERS-Private insurance .A client has a complex medical history involving the consequences of diabetes. As a result of his diabetic nephropathy, he is now a client of the local hospital's dialysis program and has been referred to an ophthalmologist by his primary care physician following the onset of vision problems. In addition, he receives home care nursing for the treatment of a foot ulcer that is slow to heal. This client's situation characterizes which phenomena? - ANSWERS-Fragmentation of care .A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since he ate his minced and pureed breakfast. Auscultation of his chest reveals the presence of coarse crackles. Which practitioner should the nurse consult with in order to obtain a swallowing assessment? - ANSWERS-Speech therapist .A client with a recent total knee replacement (TKR) is about to be discharged home with home health services and states, "I think it is too soon for me to go home." What should the nurse explain to the client is the primary reason for the implementation of this level of care? - ANSWERS-Sophisticated technology generally allows client care to be managed safely in the home environment. .A clinic-based nurse in a sparsely populated remote area far from a regional hospital is working with other local healthcare team members on a plan to improve client health and outcomes. The team has decided that which of the following healthcare delivery systems would best meet the population's needs? - ANSWERS-APRN-run health clinic .A group of first semester nursing students is preparing for a class presentation on the role of the school nurse. They ask their instructor to look over the content prior to the presentation. The instructor understands that the group needs to do some additional research when one of the students says which of the following? - ANSWERS-School nurses are responsible for dispensing medications. .A home health nurse is scheduled to make a visit to a client who was discharged from the hospital yesterday following an appendectomy. The nurse understands that the scope of practice for a home health nurse allows which of the following psychomotor tasks to be performed? - ANSWERS-Wound care, medication administration, teaching, reasonably ensuring a safe environment .A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which health care service referral by the nurse is most appropriate? - ANSWERS-Hospice Care .A middle-aged couple is considering enrolling in a long-term care insurance plan. What will this insurance cover? - ANSWERS-Nursing home and home care services .A new graduate nurse is interested in becoming active in health care policy and reform. What information can a nurse that has been active in this realm give to the new graduate? Select all that apply. - ANSWERS-• Stay up to date regarding new pending legislature that will determine nursing practice • Join and participate in nursing associations • Advocate for the rights of all people in health care .A new nurse is considering a job either in an acute care setting or a home-care setting. Which statement is accurately stated? - ANSWERS-Clients play a large role in helping themselves in the home-care setting. .A nurse demonstrates understanding of Healthy People 2020: Understanding and Improving Health by supporting which statement? - ANSWERS-A client's health is affected by social, economic, and political factors. .A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed? - ANSWERS-Enroll the client in Meals on Wheels. .A nurse is caring for a client who is experiencing pain. In assessing for pain, the nurse should use what skill in the provision of care? - ANSWERS-Critical thinking .A nurse is caring for a patient who has a PPO health care plan. What is the greatest advantage of this type of plan? - ANSWERS-Cost effectiveness .A nurse is caring for an older adult client in the home. The nurse concludes that the client needs an x-ray to determine if he has pneumonia and requires oxygen for shortness of breath. The nurse calls to inform the physician of the client's status and then makes arrangements to carry out the physician's orders. In this scenario, what role does the nurse play? - ANSWERS-Case manager .A nurse is conducting a class about health care trends for a group of newly graduated registered nurses at the community hospital. Which of the following six trends stated by the nurse reflects the Institute of Medicine's (IOM) focus? - ANSWERS-"The system should be safe, effective, efficient, patient centered, timely, and equitable." .A nurse is conducting new hospital employee orientation and is discussing spiritual care at the hospital. Which of the following is correct regarding spiritual care providers in most hospitals? - ANSWERS-Clergy, lay volunteers, and those with advanced spiritual care degrees can serve on the spiritual care team at hospitals .A nurse is considering accepting a new position in an ambulatory care center. What roles does the nurse understand are likely in this setting? Select all that apply. - ANSWERS-• Triaging walk-in clients • Teaching clients about wellness and illness • Assisting with minor surgical procedures • Performing physical assessments .A nurse is discharging a patient who was admitted for observation following a motor vehicle accident. The patient is a single parent who is living in a new community. What service would be an appropriate referral for this patient? - ANSWERS-Parish nursing .A nurse is helping a patient choose a new health care plan. The patient states that he would prefer to be able to choose his own physician. Which plan would be the least appropriate for this patient based on his stated preferences? - ANSWERS-HMO .A nurse is helping patients access the health insurance marketplace. What is the goal of this health insurance coverage concept? - ANSWERS-Comparison of available health care plans .A nurse is researching health care in rural areas. Based on a 2013 U.S. Subcommittee on Primary Health and Aging, which of the following statements regarding access to primary health care is correct? - ANSWERS-One in five Americans live in areas without adequate access to primary healthcare due to a shortage of primary care providers. .A nurse is talking with a client who experiences painful menstrual cycles with heavy bleeding. What is the most appropriate referral for this client? - ANSWERS-Refer the client to their primary gynecologist for a pelvic exam. .A nurse is volunteering time at a homeless shelter in an urban setting. What service provided by the nurse would be of benefit to this population of clients? - ANSWERS-Providing an educational program about nutrition .A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care? - ANSWERS-Relief from physical, mental, and spiritual distress .A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine if he is a candidate for the new "Hospital at Home" program. Which of the following accurately reflects an outcome for this program? - ANSWERS-Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting. .A nurse works with patients in a crisis intervention center. What ability would be most important for this nurse to develop? - ANSWERS-Strong communication and counseling skills .A nurse-educator is discussing healthcare reform trends during hospital orientation for a group of nursing fundamentals students. The nurse is correct in stating which of the following? - ANSWERS-"Systems are in place to pay for performance and penalize hospitals for excessive readmissions." .A nurse-manager at a community hospital is discussing the concept of Pay for Performance with the medical-surgical unit's physicians, nurses, and other members of the health care team. Which of the following statements made by the nurse-manager is consistent with this concept? - ANSWERS-Quality of care is being measured and used to evaluate hospitals and other providers and to award reimbursement. .A nursing instructor is discussing the 1999 Institute of Medicine report, "To Err Is Human," with a group of students. Which of the following statements made by the nurse accurately reflects the report's findings? - ANSWERS-Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors. .A priority nursing function in a rehabilitation center that specializes in emotional rehabilitation related to chemical dependency is which of the following? - ANSWERS-Encourage independent self-care. .An example of primary health care is: - ANSWERS-a hearing screening in a school setting .At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new graduate on the unit is frustrated because she just learned "the old way" and now has to learn a new methodology. Several other nurses commented that the change is "all about money." The charge nurse must educate her staff about the importance of this new policy. Which of the following explanations is most appropriate? - ANSWERS-"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." .Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important role in health care. Which of the following is an example of the change in the nurse's role? - ANSWERS-collaborating with all agencies to provide for the client's home health needs .During a home care visit to a home-bound elderly patient, the husband/caregiver verbalizes anger, fatigue, and sleeplessness. Which of the following recommendations by the nurse will be most effective in relieving caregiver role strain? - ANSWERS-Respite care .During a lecture on healthcare delivery and delegation, the nurse educator discusses UAP (unlicensed assistive personnel). The nurse is correct when stating UAPs include which of the following? - ANSWERS-Certified nursing assistants, orderlies, attendants, or technicians .Health care is a right for every human being. Which of the following refers to a person's ability to find and to receive care from a health care provider? - ANSWERS-Access to health care .Home health care is one of the most rapidly growing areas of the health care system. What are chief tasks of the home health care nurse? Select all that apply. - ANSWERS-• developing a nursing care plan • providing client education and counseling • providing continuity of care • administering medications .Home healthcare is a rapidly growing area of the healthcare system. Factors that have influenced the growth of home healthcare include which of the following? Select all that apply. - ANSWERS-• Patients have an increased acuity level following earlier hospital discharge. • People are living longer with multiple chronic illnesses. • In-hospital reimbursement is limited by DRGs and allowed services. • Some families do not want their relative institutionalized. • Telehealth and technological support services allow home health agencies to provide complex in-home care. .In providing nursing care, it is most important to perform which action? - ANSWERS-Coordination of care with the health care team .In the 1980s, the nursing care delivery model shifted from a team nursing model to a - ANSWERS-Primary nursing model .Nurses have an important role in health care reform. The goals of health care reform include which of the following? - ANSWERS-Focus on cost containment with improved access and quality of services for everyone. .Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect? - ANSWERS-Coordinator of care .Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect? - ANSWERS-Coordinator of care .Nurses provide care for clients in a program called "Hospital at Home." What are the characteristics of this program? Select all that apply. - ANSWERS-• Lower overall costs • Better client outcomes • Lower chance of developing delirium • Higher satisfaction with care .One of the primary advantages to the managed care model is: - ANSWERS-economic, quality care. .Priority skills for nurses working in ambulatory mental health centers would include which of the following? - ANSWERS-Possess strong communication and counseling skills and be familiar with community resources. .The growth in home health care is largely attributed to which of the following? - ANSWERS-early discharge of clients from the hospital setting .The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which of the following ways? - ANSWERS-Medicare pays only the amount of money preassigned to a treatment for a diagnosis. .The local community hospital is hosting a seminar on trends in healthcare and healthcare cost reduction. The nurse-presenter is discussing cost reduction techniques that also emphasize improved client outcomes. Which cost-cutting changes is most likely to facilitate improved client outcomes? - ANSWERS-Improving transitions across settings .The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client's swallow evaluation following a CVA (cerebral vascular accident)? - ANSWERS-Speech pathologist/therapist .The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner? - ANSWERS-Respiratory therapist .The nurse is providing care to an older adult client approaching discharge following a surgical procedure to repair a fractured hip. The client requires continued skilled nursing care and physical therapy to improve mobility. When planning care for this client, which prescription should the nurse anticipate? - ANSWERS-transfer to an extended care facility .The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care? - ANSWERS-an older adult client who fell at home and required a hip replacement .The nurse is providing care to several clients. For which client should the nurse include secondary care in the nursing plan of care? - ANSWERS-a middle-age client who presents with new onset angina .The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system? - ANSWERS-Medicare .The nurse-manager of a local hospice care agency is responsible for orienting newly hired nurses. What role with the manager inform the new nurse that will be required? - ANSWERS-After the hospice client's death, the nurse will assist the family with the bereavement process up to one year. .The Nursing Agenda for Health Care Reform (American Nurses Association [ANA]) identifies the recipients of health care. This reform's main focus is on: - ANSWERS-Health promotion .The Patient Protection and Affordable Health Care Act (PPACA) was passed in 2010 and aims to provide affordable health care to everyone. Which component is true to PPACA? Select all that apply. - ANSWERS-• Health care affordability • Ability to compare insurance options • Accessibility to insurance services • Decreases the number of uninsured .The spouse of a client in the early stages of dementia asks the nurse if the spouse is a candidate for "aging in place." The nurse understands that which of the following statements is the most accurate description of "aging in place"? - ANSWERS-"Aging in place" communities are a form of extended care where community members meet each other's needs. .The state government has decided to decrease funding for the Medicaid program. Which component of care will this most impact? - ANSWERS-Political and economic considerations .The wife of an elderly man with Alzheimer's disease contacts a community health nurse because she is planning to visit her sister in a neighboring state and needs assistance in arranging care for her husband while she is away. Which type of care is the wife seeking? - ANSWERS-Respite care .What is one of the most significant trends in health care today? - ANSWERS-shift from hospitals to community-based care .What methods are used to ensure that clients have continuity of care and cost-effective care during movement throughout the health care system? Select all that apply. - ANSWERS-• Managed care • Case management • Primary health care .What nursing function would be most commonly found in an ambulatory care facility? - ANSWERS-Providing direct patient care .When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what? - ANSWERS-A prospective payment plan based on a predetermined fixed cost. .When the patient's primary care physician does not have hospital privileges, there is a service to provide the patient's care and communicate to the patient's physician. This service is provided by physicians called: - ANSWERS-hospitalists .Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days of discharge? - ANSWERS-Affordable Care Act .Which of the following factors is the primary criterion for admission to a long-term care facility? - ANSWERS-Inability to provide self-care .Which of the following is an emerging trend in health care delivery? - ANSWERS-Active involvement of consumers .Which of the following is the acute care setting for people who are too ill to care for themselves at home, who are severely injured, or who require surgery? - ANSWERS-Hospitals .Which patient would a nurse correctly refer to Medicare services? - ANSWERS-A 66-year-old patient with diabetes .Which provisions are included in the Affordable Care Act (ACA)? Select all that apply. - ANSWERS-• Improve coverage by providing healthcare for dependent children up to 26 years of age • Provide access to clinical preventive services by eliminating co-payments for these services • Enhance the quality and efficiency of healthcare by increasing the Medicare Part D prescription drug benefit • Mandate that all U.S. citizens and legal residents must have healthcare coverage .Which scenario is using a prospective payment plan to reimburse for services? - ANSWERS-An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. .Which statement is accurate in discussing the difference in nursing care provided in the acute-care setting and home care setting? - ANSWERS-Both settings focus on the holistic care of an individual.