C HAPTER 23: Q UALITY C ONTROL
1. A client was treated in the hospital for a stroke and was the client’s
famil y members assert that the client was discharged too earl y and did not
receive sufficient reh abilitation. The client’s earl y discharge may have
been attributable to:
a. the effect of diagnosis -related groups.
b. a sentinel event.
c. the application of total qualit y management.
d. deliberate malpractice.
ANS: A
Feedback:
As a result of DRGs, hospitals became part of the prospective payment
s ystem (PPS), whereby providers are paid a fixed amount per patient
admission regardless of the actual cost to provide the care. This system
has been criticized as promoting abbreviated hospital stays. Earl y
discharge would most likel y be incompatible with the principles of
TQM. Deliberate malpractice would be highl y unlikel y. The client’s
earl y discharge would onl y be considered to a sentinel event if it were
an overt error.
PTS: 1 DIF: Moderate REF: Page: 632 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 23: Title: The
Prospective Payment S ystem KEY: Integrated Process: Nursing
, Process BLM: Cognitive Level: Anal yze NOT: Multiple
Choice
2. A nurse-manager has referred s taff members to a clinical practice
guideline (CPG) that addresses the prevention of pressure ulcers. What is
a characteristic of this CPG?
a. The CPG will lay out the criteria that the health -care organization
must meet in order to be reimbursed for treating a client’s pressure
ulcer.
b. It will describe interventions for nurses to follow in an effort to
provide evidence -based care.
c. It will describe the treatment for pressure ulcers that is provided at
the best performing organizations.
d. The CPG will summarize th e etiology and diagnosis of pressure
ulcers.
ANS: B
Feedback:
CPGs provide diagnosis -based, step-by-step interventions for nurses to
follow in an effort to promote evidence -based, high-qualit y care and
yet control resource utilization and costs. They go b eyond just
describing the etiology and diagnosis of a problem; the focus is on
treatment. Recommendations are based on evidence and not common
practices at high-performing organizations. CPGs do not directl y
address issues related to reimbursement.
PTS: 1 DIF: Moderate REF: Page: 626 OBJ: 7
NAT: Client Needs: Safe and Effective Care Environment:
, Management of Care TOP: Chapter Number: 23: Title: The
Development of Standards KEY: Integrated Process: Nursing
Process BLM: Cognitive Level: Understand NOT: Multiple
Choice
3. A nurse-manager is opposing the expansion of the prospective payment
s ystem (PPS). What argument against the PPS should the manager cite?
a. Diagnosis-related groups have caused an increase in health -care
costs.
b. The PPS has unnecessaril y increase d the length of hospital stays.
c. The PPS is linked to increased prices for pharmaceuticals.
d. The PPS has been linked to a decline in the qualit y of care.
ANS: D
Feedback:
Critics of the PPS argue that although DRGs may have helped to
contain rising health -care costs, the associated rapid declines in length
of hospital stay and services provided have resulted in declines in the
qualit y of care.
PTS: 1 DIF: Moderate REF: Page: 632–633 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 23: Title: The
Prospective Payment S ystem KEY: Integrated Process: Nursing
Process BLM: Cognitive Level: Understand NOT: Multiple
Choice
1. A client was treated in the hospital for a stroke and was the client’s
famil y members assert that the client was discharged too earl y and did not
receive sufficient reh abilitation. The client’s earl y discharge may have
been attributable to:
a. the effect of diagnosis -related groups.
b. a sentinel event.
c. the application of total qualit y management.
d. deliberate malpractice.
ANS: A
Feedback:
As a result of DRGs, hospitals became part of the prospective payment
s ystem (PPS), whereby providers are paid a fixed amount per patient
admission regardless of the actual cost to provide the care. This system
has been criticized as promoting abbreviated hospital stays. Earl y
discharge would most likel y be incompatible with the principles of
TQM. Deliberate malpractice would be highl y unlikel y. The client’s
earl y discharge would onl y be considered to a sentinel event if it were
an overt error.
PTS: 1 DIF: Moderate REF: Page: 632 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 23: Title: The
Prospective Payment S ystem KEY: Integrated Process: Nursing
, Process BLM: Cognitive Level: Anal yze NOT: Multiple
Choice
2. A nurse-manager has referred s taff members to a clinical practice
guideline (CPG) that addresses the prevention of pressure ulcers. What is
a characteristic of this CPG?
a. The CPG will lay out the criteria that the health -care organization
must meet in order to be reimbursed for treating a client’s pressure
ulcer.
b. It will describe interventions for nurses to follow in an effort to
provide evidence -based care.
c. It will describe the treatment for pressure ulcers that is provided at
the best performing organizations.
d. The CPG will summarize th e etiology and diagnosis of pressure
ulcers.
ANS: B
Feedback:
CPGs provide diagnosis -based, step-by-step interventions for nurses to
follow in an effort to promote evidence -based, high-qualit y care and
yet control resource utilization and costs. They go b eyond just
describing the etiology and diagnosis of a problem; the focus is on
treatment. Recommendations are based on evidence and not common
practices at high-performing organizations. CPGs do not directl y
address issues related to reimbursement.
PTS: 1 DIF: Moderate REF: Page: 626 OBJ: 7
NAT: Client Needs: Safe and Effective Care Environment:
, Management of Care TOP: Chapter Number: 23: Title: The
Development of Standards KEY: Integrated Process: Nursing
Process BLM: Cognitive Level: Understand NOT: Multiple
Choice
3. A nurse-manager is opposing the expansion of the prospective payment
s ystem (PPS). What argument against the PPS should the manager cite?
a. Diagnosis-related groups have caused an increase in health -care
costs.
b. The PPS has unnecessaril y increase d the length of hospital stays.
c. The PPS is linked to increased prices for pharmaceuticals.
d. The PPS has been linked to a decline in the qualit y of care.
ANS: D
Feedback:
Critics of the PPS argue that although DRGs may have helped to
contain rising health -care costs, the associated rapid declines in length
of hospital stay and services provided have resulted in declines in the
qualit y of care.
PTS: 1 DIF: Moderate REF: Page: 632–633 OBJ: 11
NAT: Client Needs: Safe and Effective Care Environment:
Management of Care TOP: Chapter Number: 23: Title: The
Prospective Payment S ystem KEY: Integrated Process: Nursing
Process BLM: Cognitive Level: Understand NOT: Multiple
Choice
