Essentials for Nursing Practice, 8th Edition by Patricia A. Potter, Anne Griffin Perry, Patricia Stockert, Amy Hall Test Bank
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Chapter 03: The Health Care Delivery System
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
1. A
nurse is teaching the importance of breast self-examination to a group of
20-year-old women. The nurse is promoting which type of care?
|
a. |
Primary |
|
b. |
Secondary |
|
c. |
Tertiary |
|
d. |
Restorative |
ANS: A
Primary care is centered on prevention of disease. Secondary and
tertiary care is administered after an illness has been diagnosed. Restorative
care occurs after a patient is recovering from an acute illness or for those
who have chronic illnesses.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF:
34
OBJ: Describe the six levels of health care.
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
2. A
patient who needs nursing and rehabilitation after a stroke would benefit most by receiving
care at which center?
|
a. |
Primary care center |
|
b. |
Restorative care center |
|
c. |
Assisted living center |
|
d. |
Respite center |
ANS: B
Restorative care centers provide rehabilitation and nursing
care. In primary care centers, health promotion is the major theme. Assisted
living centers offer long-term assistance with activities of daily living.
Respite centers offer short-term relief to persons who provide full-time care
to an older adult.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 33
OBJ: Explain the relationship between levels
of health care and levels of prevention.
TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
3. A
patient states that he or she cannot afford health care insurance for the
family because of a low income. What is the best form of insurance available for
this patient?
|
a. |
Medicaid |
|
b. |
Medicare |
|
c. |
Private insurance |
|
d. |
A managed care organization |
ANS: A
Medicaid is a form of insurance for low-income families.
Medicare is a federally funded health insurance program for people greater than
65 years of age. Private insurance is a fee-for-service plan. A managed care
organization (MCO) provides care to a specific group of voluntarily enrolled
patients.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF:
33
OBJ: Compare the various methods for financing health care.
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
4. A
nurse is teaching the staff about managed care. Which information should the
nurse include?
|
a. |
Managed care focuses on
long-term care services for skilled nursing. |
|
b. |
Managed care focuses on
hospital admissions and illnesses for a group of people. |
|
c. |
Managed care focuses on
control over primary health services for a defined population. |
|
d. |
Managed care focuses on
decreased access to care while increasing costs. |
ANS: C
The term managed
care describes systems in which the payer has control over
primary health care services delivery for a defined patient population.
Long-term care insurance focuses on skilled nursing, not managed care. Managed
care focuses on health and staying out of the hospital. Managed care aims to
increase access to care while decreasing costs.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 32
OBJ: Explain the advantages and disadvantages
of managed health care.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
5. A
nurse admits an older adult patient who states that he or she has no living
relatives and only two close friends. Upon admission to the hospital, which
action should the nurse initiate first?
|
a. |
Implement a process of
payment. |
|
b. |
Implement a discharge plan. |
|
c. |
Implement a visit with the
family. |
|
d. |
Implement a resource
utilization group. |
ANS: B
Discharge planning with coordination of services begins the
moment a patient is admitted to a health care facility. A resource utilization
group is used in long-term care settings to manage patient costs. A visit with
the family is not possible because the patient has no living relatives. Upon
admission, a process of payment is not a priority for a nurse.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 35
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
6. A
nurse is asked the most frequently cited reason for death in the world. How
should the nurse reply?
|
a. |
Technological advances |
|
b. |
Old age |
|
c. |
Cancer |
|
d. |
Poverty |
ANS: D
Poverty is still deadlier than any disease and is the most
frequently cited reason for death in the world today. Technological advances,
old age, and cancer are not the most cited reason for death.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 45
OBJ: Discuss the implications that issues
challenging the health care system have for nursing.
TOP: Nursing Process: Implementation
MSC: NCLEX: Reduction of Risk Potential
7. A
nurse is teaching the staff about the Prospective Payment System (PPS). Which
information should the nurse include in the teaching session?
|
a. |
PPS establishes cost-based
reimbursement for health care. |
|
b. |
PPS provides reimbursement
for every service the patient receives. |
|
c. |
PPS establishes
reimbursement rates based upon diagnosis-related groups (DRGs). |
|
d. |
PPS provides money to the
patient for health promotion use. |
ANS: C
PPS established diagnosis-related groups (DRGs). Established by
Congress in 1983, the PPS eliminated cost-based reimbursement, which is
reimbursement for every service the patient receives. Hospitals serving
patients using Medicare were no longer paid for all costs incurred in
delivering care to a patient. Instead, inpatient hospital services for patients
using Medicare were combined into 468 DRGs. PPS provides a preset amount of
money to hospitals and health care providers for DRGs, not for health
promotion. Managed care focuses on health promotion.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF:
32
OBJ: Compare the various methods for financing health care.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
8. A
74-year-old patient was admitted to the hospital with diabetic ketoacidosis.
How will the hospital be reimbursed by Medicare?
|
a. |
Based upon the
diagnostic-related group |
|
b. |
Based upon the cost of care |
|
c. |
Based upon the actual
length of stay |
|
d. |
Based upon the number of
medications |
ANS: A
Payment is based upon the diagnostic-related group. Established
by Congress in 1983, the prospective payment system eliminated cost-based
reimbursement. Hospitals serving patients using Medicare were no longer paid
for all costs incurred to deliver care to a patient. Instead, inpatient
hospital services for patients using Medicare were combined into 468
diagnosis-related groups. Hospitals receive a set dollar amount for each
patient based on the assigned DRG, regardless of the patient’s length of stay
or use of services in the hospital or the number of medications.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF:
32
OBJ: Compare the various methods for financing health care.
TOP: Nursing Process:
Assessment
MSC: NCLEX: Management of Care
9. A
patient tells the nurse that he or she does not understand the purpose of
capitation. What is the nurse’s best response?
|
a. |
To provide high-quality
care at the highest cost to the hospital, not the patient |
|
b. |
To provide the least
expensive care for patients regardless of outcomes |
|
c. |
To build a payment plan
that includes the best standards of care at the lowest cost |
|
d. |
To ensure that all patients
receive the same care for the same cost in all hospitals |
ANS: C
The purpose of capitation is to build a payment plan for select
diagnoses or surgical procedures that includes the best standards of care and
essential diagnostic and treatment procedures at the lowest cost. Capitation
does not cause the hospitals to pay the highest cost but to determine quality
care for the lowest cost. Capitation does not provide the least expensive care
for patients for outcomes because best standards are the outcome. Capitation
does not make all patients receive the same care for the same cost in all
hospitals.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 32
OBJ: Explain the advantages and disadvantages
of managed health care.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
10. A
single mother with three children uses the public health department services in
the county to immunize her children. Which level of health care did the mother
use?
|
a. |
Continuing care |
|
b. |
Preventative care |
|
c. |
Secondary acute care |
|
d. |
Restorative care |
ANS: B
Preventative care includes services such as immunizations,
screenings, poison control information, mental health counseling and crisis
prevention, and community legislation. Continuing care is assisted living.
Secondary acute care involves emergency and radiological procedures.
Restorative care involves rehabilitation services and home care.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF:
34
OBJ: Describe the six levels of health care.
TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
11. A
registered nurse working as a school nurse for a small poor rural school
district has noticed an increase in children arriving at school without having
eaten breakfast. The nurse has discussed this issue with the school principal
and is working on a proposal to ask the school district to explore a school
breakfast program. Which level of care did the nurse use?
|
a. |
Primary care |
|
b. |
Continuing care |
|
c. |
Restorative care |
|
d. |
Tertiary care |
ANS: A
In the settings that deliver preventative and primary care, such
as schools, physicians’ or health care providers’ offices, occupational health
clinics, and nursing centers, health promotion is a major theme. Continuing
care involves assisted living and psychiatric day care. Restorative care
involves rehabilitation and home care. Tertiary care involves intensive care
and psychiatric facilities.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 34
OBJ: Explain the relationship between levels
of health care and levels of prevention.
TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
12. A
small business owner has consulted with an occupational health nurse regarding
health promotion activities for the employees. The registered nurse explores
the possibility of providing an area outside the new office complex where
employees can walk during their breaks. Which level of care did the nurse use?
|
a. |
Continuing care |
|
b. |
Restorative care |
|
c. |
Primary care |
|
d. |
Tertiary care |
ANS: C
In the settings that deliver preventative and primary care, such
as schools, physicians’ or health care providers’ offices, occupational health
clinics, and nursing centers, health promotion is a major theme. Continuing
care involves assisted living and psychiatric day care. Restorative care
involves rehabilitation and home care. Tertiary care involves intensive care
and psychiatric facilities.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 34
OBJ: Explain the relationship between levels
of health care and levels of prevention.
TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
13. A
grocery store clerk does not have a family health care provider. The clerk has
had a sore throat for the past week and recently began running a fever. The
clerk goes to the local community hospital’s emergency room for treatment.
Which level of care did the clerk use?
|
a. |
Continuing care |
|
b. |
Restorative care |
|
c. |
Primary care |
|
d. |
Tertiary care |
ANS: D
Hospital emergency departments, urgent care centers, critical
care units, and inpatient medical-surgical units are sites that provide
secondary and tertiary levels of care. Continuing care involves assisted living
and psychiatric day care. Restorative care involves rehabilitation and home
care. Primary care involves health promotion such as prenatal care and
well-baby care.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF:
34
OBJ: Describe the six levels of health care.
TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
14. A
retired high school teacher has been admitted to the hospital with
complications of diabetes. To ensure the patient is discharged home with the
right care, at the right time, and without duplication, which health care
reform system was developed?
|
a. |
The Joint Commission |
|
b. |
National Priorities
Partnership |
|
c. |
Accountable Care
Organization |
|
d. |
Managed Care |
ANS: C
An ACO works to make sure that patients receive the right care
at the right time, without duplication of services or incidence of medical
errors. Accountable care organizations (ACO) were developed to coordinate
medical care by primary care and specialty physicians, hospitals, and other
health care providers with the goal of providing high-quality coordinated care.
The Joint Commission (2012) requires health care organizations to determine how
well an organization meets patient needs and expectations and accredits health
care organizations. Managed care focuses on health promotion. The National
Priorities Partnership is a group of 51 organizations from a variety of health
care disciplines that joined together to work toward transforming health care
by focusing on eight national priorities.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 40
OBJ: Explain the advantages and disadvantages
of managed health care.
TOP: Nursing Process:
Assessment
MSC: NCLEX: Management of Care
15. What
is the most appropriate
time for the nurse to begin discharge planning with a patient?
|
a. |
The day of patient
discharge from the health care agency |
|
b. |
As soon as the insurance
provider has been identified |
|
c. |
When the health care
provider writes the discharge order |
|
d. |
When the patient is
admitted to the health care agency |
ANS: D
Discharge planning begins the moment a patient is admitted to a
health care facility. The day of discharge, when the insurance provider has
been identified, and when the order is written are too late.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 35
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process: Implementation
MSC: NCLEX: Management of Care
16. Which
patient is most in
need of discharge planning by the nurse?
|
a. |
A 29-year-old mother with
strong family support who has a healthy newborn |
|
b. |
A 59-year-old patient with
an active lifestyle who has had an appendectomy |
|
c. |
A 64-year-old patient with
heart failure who has a limited income |
|
d. |
A 56-year-old patient with
a supporting spouse who has had a hysterectomy |
ANS: C
The 64-year-old patient with heart failure has a chronic disease
and more risks than the other patients because of age and income. Some patients
are more in need of discharge planning because of their risks. For example,
some patients have limited financial resources or limited family support;
others may have long-term disabilities or chronic illnesses. Early discharge
teaching is especially important as a way to decrease readmission to the
hospital. Appendectomy and hysterectomy are acute conditions and do not have as
many risks as heart failure. A healthy newborn is stable, whereas heart failure
is chronic.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 36
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Adaptation
17. Which
patient is in the most expensive place to deliver care per day?
|
a. |
A patient in a
rehabilitation unit |
|
b. |
A patient in a long-term
care facility |
|
c. |
A patient in an intensive
care unit |
|
d. |
A patient in a private
hospital room |
ANS: C
An intensive care unit is the most expensive delivery site for
medical care because each nurse is usually assigned to care for only one or two
patients at a time and because of the types of treatments and procedures the
patients in the intensive care unit typically require. Rehabilitation units,
long-term care facility, and a private hospital room are not as expensive per
day as an intensive care unit.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 36
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Evaluation
MSC: NCLEX: Management of Care
18. A
college student with severe depression was recently admitted to the psychiatric
ward of a local hospital. The family is concerned about the student finishing
the college term. Which is the best information for the nurse to give regarding
how long psychiatric patients are typically hospitalized?
|
a. |
A relatively short
inpatient stay is followed by outpatient treatment. |
|
b. |
A long inpatient
hospitalization is normal for the majority of patients. |
|
c. |
Patients with emotional or
behavioral problems generally are not hospitalized. |
|
d. |
Most are automatically
placed in a long-term care facility. |
ANS: A
Patients who have emotional and behavioral problems, such as
depression, violent behavior, and eating disorders, often require special
counseling and treatment in psychiatric facilities. Hospitalization involves
relatively short stays with the purpose of stabilizing patients before transfer
to outpatient treatment centers. A long inpatient hospitalization, not
hospitalized, or placed in a long-term facility are not correct for the typical
hospitalization of psychiatric patients.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 36
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
19. A
17-year-old patient was seriously injured in a motor vehicle accident and has
been transferred from an acute care hospital to a rehabilitation/restorative
facility. Which action should the nurse take to ensure the best outcome for
this patient?
|
a. |
Make sure that the patient
gets enough rest. |
|
b. |
Push the patient beyond his
or her limits. |
|
c. |
Request that nobody visit
for the first few days. |
|
d. |
Involve the family early in
the rehabilitation process. |
ANS: D
In restorative settings, nurses recognize that success is
dependent on effective and early partnering with patients and their families.
Although rest is good, family involvement is the priority. Pushing the patient
beyond his or her limit is not helpful. Not letting anybody visit is
contraindicated.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 37
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
20. A
patient who experienced a stroke 4 days ago has been discharged from the
hospital and will be undergoing outpatient rehabilitation. How should the nurse
prepare the patient for this level of care?
|
a. |
The patient will be
admitted to the rehabilitative unit of the hospital. |
|
b. |
The patient will have
scheduled appointment times for therapy. |
|
c. |
The patient will have home
visits from all members of the multidisciplinary team. |
|
d. |
The patient will be at home
for all of the treatments ordered by the primary health care provider. |
ANS: B
When patients receive rehabilitation services in outpatient
settings, patients get treatment at specified times during the week but remain
at home the rest of the time. Inpatient rehabilitation services would require
admission to an inpatient facility. Some rehabilitation is offered in the home
but usually only certain members of the health care team visit. Home rehabilitation
services would have the treatments performed in the home, but not for
outpatient rehabilitation.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 38
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process:
Implementation MSC: NCLEX: Management
of Care
21. Which
other term can the nurse use to describe the Omnibus Budget Reconciliation Act
of 1987?
|
a. |
Medicaid Act |
|
b. |
Nursing Home Reform Act |
|
c. |
Diagnostic Related Group
Act |
|
d. |
Magnet Recognition Act |
ANS: B
The nursing center industry has become one of the most highly
regulated industries in the United States. The Omnibus Budget Reconciliation
Act of 1987, also known as the Nursing Home Reform Act, raised the standard of
services provided by nursing centers. The Medicaid act provides insurance to
low-income families. The diagnostic related group was formed from the Medicare
Act. The American Nurses Credentialing Center (ANCC) established the Magnet
Recognition Program to recognize health care organizations that achieve
excellence in nursing practice.
PTS:
1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 39
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Implementation
MSC: NCLEX: Management of Care
22. A new
registered nurse who recently began working in a nursing center has been asked
to complete a Resident Assessment Instrument (RAI) on a newly admitted
resident. What is the primary purpose of this instrument?
|
a. |
To provide a database to
better understand the health care needs of this population |
|
b. |
To provide the nursing
staff with an overall physical assessment of the resident |
|
c. |
To provide statistical
evidence to support a universal health care policy |
|
d. |
To provide medications for
the residents to take on a daily basis |
ANS: A
The facility needs to complete the RAI on all residents. The RAI
consists of the Minimum Data Set (MDS), Resident Assessment Protocols (RAPs),
and utilization guidelines of each state. The RAI ultimately provides a
national database for nursing facilities so that policy makers will better
understand the health care needs of the long-term care population. Although it
does provide a physical assessment, the primary purpose is to better understand
the needs of this population. It does not provide evidence for a universal
health care policy or medications to be used for this population group.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 39
OBJ: Discuss the role of nurses in different
health care delivery settings.
TOP: Nursing Process:
Assessment
MSC: NCLEX: Management of Care
23. An
81-year-old widow with mild dementia has self-care capabilities. The widow
recently moved in with her daughter, a 46-year-old working mother with three
children. In considering how to have care for her mother when she is working,
what is the most appropriate option the nurse should suggest?
|
a. |
A rehabilitation center |
|
b. |
A nursing center |
|
c. |
An adult day care center |
|
d. |
A hospice center |
ANS: C
Services offered by adult day care centers allow family members
to maintain their lifestyles and employment and still provide home care for
their relatives. A hospice is a system of family-centered care that allows
patients to live and remain at home with comfort, independence, and dignity
while alleviating the strains caused by terminal illness; this is inappropriate
because the widow does not have a terminal illness. Rehabilitation is the use
of multiple therapies such as physical, psychological, occupational, speech,
and social services to help restore a person to the fullest physical, mental,
social, vocational, and economic usefulness possible; this is not appropriate
because the widow can provide self-care. A nursing center is a nursing home; it
is too early for this because the widow can provide self-care.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 40
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Implementation
MSC: NCLEX: Management of Care
24. A
78-year-old widow needs assistance with medications, housekeeping, and laundry,
and would like to maintain independence. Which is the best option for the nurse
to suggest?
|
a. |
Assisted living |
|
b. |
Respite care |
|
c. |
Nursing center |
|
d. |
Rehabilitation center |
ANS: A
Assisted living provides independence, security, and privacy at
the same time. These facilities promote independence and physical and
psychosocial health. Services in an assisted living facility include medication
management, exercise and educational activities, social activities, laundry,
assistance with meals and personal care, 24-hour oversight, and housekeeping.
Respite care is a service that provides short-term relief or time off for
people providing home care to an ill, disabled, or frail older adult. Nursing
center is a nursing home; this is too early to recommend because the widow
wants to maintain independence. Rehabilitation is the use of multiple therapies
such as physical, psychological, occupational, speech, and social services to
help restore a person to the fullest physical, mental, social, vocational, and
economic usefulness possible; this is not appropriate because the widow can
provide self-care.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 39
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Implementation
MSC: NCLEX: Management of Care
25. Which
patient is most suitable for admission into hospice?
|
a. |
A 63-year-old man with a
fractured femur |
|
b. |
A 45-year-old woman with
terminal end-stage renal failure |
|
c. |
A 14-year-old patient with
leukemia that is in remission |
|
d. |
A 78-year-old patient with
dementia that wanders |
ANS: B
A patient entering a hospice is at the terminal phase of
illness, and the patient, family, and physician agree that no further treatment
will reverse the disease process. A fractured femur, leukemia in remission, and
dementia are not conditions that are terminal, and so are not appropriate for
hospice.
PTS:
1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 40
OBJ: Discuss the types of settings in which
professionals provide various levels of health care.
TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
26. A
registered nurse has been working for an oncology unit for the past year and
has a passion for caring for oncology patients undergoing chemotherapy. Whose
responsibility is it for the nurse to become competent in administering
chemotherapy?
|
a. |
The hospital where the
nurse is employed |
|
b. |
The charge nurse |
|
c. |
The nurse herself or
himself |
|
d. |
The oncologist who admits
patients to the unit |
ANS: C
A nurse’s responsibility is to follow policies and procedures
and to know the most current practice standards. As a nurse progresses in a
career, it becomes his or her responsibility to obtain necessary continued
education and earn certifications when he or she chooses to practice in
specialty areas. Nurses must be accountable for their own actions; it is not
the responsibility of the hospital, charge nurse, or oncologist for the nurse
to be competent.
PTS:
1
DIF: Cognitive Level: Applying (Application)
REF: 41
OBJ: Discuss opportunities for nursing within
the changing health care delivery system.
TOP: Nursing Process:
Assessment
MSC: NCLEX: Management of Care
MULTIPLE RESPONSE
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