(Column 1)
Which management function involves a team effort to achieve patient care outcomes?
A) Time Management
B) Supervisory
C) Advocacy
D) Collaboration
D
Collaboration involves a team effort to achieve patient care outcomes. Time management involves organizing time, as well as delegating tasks to other personnel and making optimal use of time. Advocacy means promoting the cause of another person or an organization. Supervision is the process of guiding, directing, evaluating, and following up tasks delegated to others.
The nurse is making a referral to physical therapy for a client who has had a hip replacement and is going to be discharged in 2 days. The nurse understands that physical therapy as part of the client's plan of care includes the client in what discipline?
A) Inclusion in the collaborative healthcare team
B) A discipline unto themselves
C) Inclusion in the administrative team
D)Inclusion in the supervisory team
A
The healthcare team consists of specially trained personnel who work together to help clients meet their healthcare needs. The team includes physicians, nurses, psychologists, pharmacists, dietitians, social workers, respiratory and physical therapists, occupational therapists, nursing assistants, technicians, and insurance company staff.
Which type of care is used for clients with terminal illness who have a life expectancy of less than 6 months?
A) Ambulatory care
B) Skilled nursing care
C) Intermediate care
D) Hospice
D
Hospices provide care for clients with terminal illness whose life expectancy is less than 6 months. Ambulatory care is also called outpatient care. Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Intermediate care facilities are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities.
A home care nurse is approached by the client’s neighbor while walking to the car after visiting the client. The neighbor asks, “What’s wrong with Tom? Is he sick?” How should the nurse respond?
A) “I’m a nurse caring for Tom. I can say he is improving dramatically.”
B) “I’m a nurse caring for Tom, but you should ask his wife about his condition.”
C) “I’m a nurse caring for Tom, but I cannot tell you anything about his condition.”
D) “I’m a nurse caring for Tom but can't talk now. Here is my contact information for questions.”
C
Friends, neighbors, or family members may ask the nurse about the client’s condition. The nurse must remember that the client has a right to confidentiality, and information should only be shared with the client’s consent. The nurse should tell the neighbor that the nurse cannot say anything about the client’s condition. Asking the neighbor for to call the nurse or to ask the client’s wife are not the correct responses.
A patient comes to the emergency department complaining of severe chest pain. The nurse asks the patient questions and takes vital signs. Which step of the nursing process is the nurse demonstrating?
A) Planning
B) Assessment
C) Implementation
D) Diagnosing
B
Assessing is the step in which nurses assess the patient to determine the need for nursing care. When assessing, the nurse systematically collects patient data.
A client who has no health insurance asks if there is any chance that they will benefit from healthcare reform. What should the nurse tell the client about the goal of the Patient Protection and Affordable Care Act?
A) The goal of the Patient Protection and Affordable Care Act is to provide affordable healthcare to U.S. citizens who previously had no access to health insurance.
B) The Patient Protection and Affordable Care Act applies only to people who are eligible for Medicaid, so it will not apply to the client's situation.
C) The Patient Protection and Affordable Care Act applies only to people who are eligible for Medicare, so it will not apply to the client's situation.
D) The goal of the Patient Protection and Affordable Care Act is to provide affordable healthcare to U.S. citizens who have at least three dependents.
A
It is estimated that more than 30 million Americans who previously had no health insurance will be able to obtain affordable coverage under the provisions of healthcare reform. While some parts of healthcare reform affect Medicaid, others are concerned with workers such as this client who earn too much to qualify for Medicaid yet have not been able to afford health insurance. The Patient Protection and Affordable Care Act is not focused on the Medicare program. The provisions of healthcare reform are not based on the number of dependents.
When providing care to clients, which of the following would be most important for the nurse to keep in mind?
A) Regardless of health problem or status, clients' needs commonly are consistently identical.
B) The fact that a client is seeking care indicates that the person is considered dependent.
C) Clients seeking care often have little understanding about their health care options.
D) Clients must be viewed as individual persons, members of a family, and part of a community.
D
When providing care to a client, the nurse must remember to view the client as an individual person, a member of a family, and a member of a larger community. Many clients seeking health care have become more knowledgeable about health care options and are assuming a collaborative approach with the nurse in seeking health, therefore demonstrating interdependency, not dependency. Although needs may be similar, clients' needs do vary depending on their problem, associated circumstances, and past experiences.
A client experienced a stroke approximately 2 weeks previously and has residual left side hemiparesis. What facility would best meet the needs of this client in order to help regain independence with activities of daily living?
A) Rehabilitation care
B) Hospice care
C) Ambulatory care
D) Acute care
A
Rehabilitation care provides physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Hospices provide care for clients diagnosed with a terminal illness whose life expectancy is fewer than 6 months. Ambulatory care is also a short-term outpatient care. Acute care facilities are facilities that provide care to clients of higher acuity.
A nurse fulfills many roles. Which tasks are nursing responsibilities?
A) advocating the best care for clients
B) changing client briefs
C) bathing clients
D) All of the above
D
While nursing has many roles and responsibilities, none of the options are outside the nurse's responsibility. Regardless of educational experience, all client needs fall within the nurse's role and the client's well-being should always be the prime motivation for nursing care. Nurses attend to client needs related to hygiene, activity, diet, the environment, medical treatment, and physical, emotional, and spiritual comfort.
Which of the following patient care concerns is clearly a nursing responsibility?
A) monitoring health status changes
B) prescribing medications
C) ordering diagnostic examinations
D) performing surgical procedures
A
Monitoring for health status changes is clearly a nursing responsibility. The other options are medical responsibilities, although in some instances an advanced practice nurse practitioner may be responsible for A and C.
Managed care organizations are insurers that carefully plan and closely supervise the distribution of healthcare services. What is one of the goals of managed care?
A) Improving training of healthcare professionals
B) Eliminating health disparities between segments of the population
C)Preventing illness through screening and promotion of health activities
D) Providing hospice or home hospice care
C
Preventing illness through screening and promotion of health activities is one of the goals of managed care. Improved training of healthcare professionals is the priority for international health and not the goal of managed care. Eliminating health disparities between the segments of population is a goal of Healthy People 2020. Providing hospice or home hospice care is only for terminally ill clients.
The financial stability of Health Maintenance Organizations (HMOs) is based on:
A) maintaining the statistics and records of all the clients admitted in hospitals on a regular basis.
B) keeping clients healthy and out of the hospital through periodic screening, health education, and preventive services.
C) keeping clients satisfied by providing them with regular financial assistance and looking after their medical requirements.
D) providing entertainment programs for clients in order to distract clients from their illness.
B
The financial stability of HMOs is based on their ability to keep their members healthy and out of the hospital through periodic screening, health education, and preventive services.
Discharge planning begins during which portion of a client's hospital stay?
A) 24 hours before discharge
B) The shift before discharge
C) Admission
D) By the third hospital day
C
To prepare for early discharge and the possible need for follow-up in the home, discharge planning begins with the patient's admission. Discharge planning requires identification of patient needs and anticipatory guidance and is not relegated to a specific time for beginning. Discharge planning requires communication with and the cooperation of the client, family, and health care team and does not begin at a specific time. Discharge planning may need to involve personnel and agencies in the planning process and is not relegated to a specific day of hospital stay.
An older adult client is being transferred to another facility in order to continue physical therapy after having a total right hip replacement. What type of facility will provide skilled nursing and rehabilitative care for this client who will go home after the rehabilitation?
A) Long-term acute care
B) Acute care facility
C) Skilled nursing care
D) Rehab care
A
Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Acute care facilities are for clients who have a higher level of acuity. Long-term acute care are for clients who require long-term wound care of ventilator support or who have other conditions that are potentially unstable but do not have rapid changes. Intermediate care facilities provide custodial care for people who cannot care for themselves because of mental or physical disabilities.
When the nurse is administering Lasix 20 mg. to a client in congestive heart failure, what phase of the nursing process does this represent?
A) Assessments
B) Planning
C) Implementation
D) Diagnosing
C
Implementation refers to the action phase of the nursing process in which nursing care is provided.
What statement by the nurse shows an understanding of the vision of Healthy People 2030?
A) "The vision is that they will find a cure for diabetes."
B) "The vision is a society in which all people can achieve their full potential for health"
C) "The vision is that everyone be within a normal weight."
D) "The vision is that everyone will exercise once daily."
B
The Healthy People 2030 campaign provides an overall action plan to improve the health and quality of life for all people living the United States. The U.S. Department of Health and Human Services identified these overarching health goals: Attain healthy, thriving lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all. Healthy People 2030 is not focused on an individual disease process, a "normal" weight, or exercise for the individual as the overall goal.
Which of these statements best defines the term culture?
A) A group of people distinguished by genetically transmitted material
B) The status of belonging to a particular region by origin, birth, or naturalization
C) The learned patterns of behavior, beliefs, and values that can be attributed to a particular group of people
D) The classification of a group based upon certain distinctive characteristics
C
Included among characteristics that distinguish cultural groups are manner of dress, values, artifacts, and health beliefs and practices. A group of people distinguished by genetically transmitted material describes the term race. The status of belonging to a particular region by origin, birth, or naturalization describes the term nationality. The classification of a group based upon certain distinctive characteristics describes the term ethnicity.
A client is unable to care for her needs and requires assistance with activities of daily living. The son calls the clinic and informs the LPN that he wants his mother to be able to remain in her home but must work and is unable to care for her 24 hours per day. What options can the LPN suggest for the care of his mother?
A) He must admit his mother to a nursing home.
B) Employ private duty nurses to care for the parent.
C) He will have to quit his job and stay home to care for her.
D) Take her to an adult day care center.
B
A modern version of the case method is private duty nurse where care is provided in the home and many household duties are performed as well. The son does not have to admit his parent to the nursing home if he chooses not to, and he will not have to quit his job if he can have a nurse come into the home. Adult day care would not assist with after-hour care.
A home care nurse is visiting a new client and notes that the client’s home is very messy. There are dirty dishes piled everywhere, the house smells of garbage, and there are very few surfaces that are clean. How should the nurse respond?
A) Stand at the door and assess the client.
B) Enter the home and continue to treat the client.
C) Leave the home and call adult protective services.
D) Ask the client nicely to clean the home prior to another visit.
B
The cleanliness of a client’s home may not meet the standards of a hospital. The nurse may provide the client and client’s family on the importance of cleanliness in the home; however, the client and client’s family may choose not to implement the nurse’s suggestions. It is the nurse’s role to treat the client despite how the client chooses to keep their home. If there is a significant threat to the health of the inhabitants of the home, adult protective services may be called; however, this is not indicated in this scenario.
Which of the following group of terms best describes the nursing process?
A) nursing goals, medical terminology, linear
B) nurse-centered, single focus, blended skills
C) family-centered, single point in time, intuitive
D) patient-centered, systematic, outcomes-oriented
D
The nursing process is a patient-centered, systematic, outcomes-oriented method of caring that provides a framework for nursing practice. It is nursing practice in action.
A client complaining of bloody urine has scheduled an appointment with a family practitioner. What type of care is the client receiving?
A) Tertiary
B) Primary
C) Secondary
D) Skilled nursing care
B
The first provider that clients contact about a health need provides primary care; this person is typically a family practitioner or nurse practitioner. Secondary care includes referrals to facilities for additional testing. Tertiary care focuses on more complex medical and surgical intervention. Skilled nursing care occurs in facilities or units that offer prolonged health maintenance or rehabilitative services.
The nurse is providing care for a patient in the hospital scheduled for discharge in the morning. The patient will require further services after discharge since recovery is not complete. What can the nurse do to ensure quality care delivery for this patient?
A) Inform the family members that someone will have to stay with the patient after discharge.
B) Inform the physician that the patient is not ready to go home yet.
C) Contact the case manager for coordination of care prior to discharge of the patient.
D) Call social services to check on the patient after discharge.
B
Coordination of care for patients from the time of hospital admission to discharge—and in many cases after discharge to the home care and community settings—is vitally important to ensure that they continue to achieve benchmarks of quality. Care coordination failure occurs when a patient is readmitted to the hospital shortly after discharge with the same condition for which he or she had been originally hospitalized. Health insurance plans are increasingly holding hospitals accountable for readmissions to the hospital within 30 days of hospital discharge, and many times the plans will not reimburse hospitals for costs associated with these readmissions. Therefore, patient care must be coordinated seamlessly from the inpatient hospital environment through the community care system. However, the current U.S. health care system has been frequently criticized for its fragmented system of delivery. Two roles have evolved to provide improved care coordination: the case manager and the clinical nurse leader (CNL).
Which nursing action is appropriate for a home care nurse?
A) Writing a grant to obtain funding to establish a homeless shelter
B) Teaching pursed-lip breathing to a client diagnosed with chronic obstructive pulmonary disease (COPD)
C) Organizing a free breast cancer screening for homeless women
D) Volunteering to administer flu vaccinations and the local free clinic
B
Tertiary prevention, focusing on rehabilitation and restoring maximum health function, is a goal for home care nurses. Pursed lipped breathing allows the client with COPD to control shortness of breath, making each breath more effective, and improves quality of life. Promoting the health of populations is a focus of community/public health nursing. The homeless population is increasing in the United States. Minimizing the progression of disease through early detection is one method that a community/public health nurse could use. Maintaining the health of populations through immunization clinics is a focus of the community/public health nurse.
An LPN has returned to school to complete a bachelor’s degree on the way to licensure as an RN. As an RN, the nurse will:
A) perform many of the same tasks but will have much more extensive reporting and continuing education requirements.
B) work longer shifts and be responsible for the care of a higher number of patients.
C) have a largely unchanged role, but will have better pay, better benefits, and a choice of shifts.
D) have more complex responsibilities involving the management and coordination of care provided to a group of clients.
D
The RN's role is more complex than that of an LPN, involving fewer technical tasks and more responsibility for the planning, supervision, and management of care. While RN compensation is generally higher than that of LPNs, the role and responsibilities do differ. RNs may or may not work different shifts than LPNs. RNs may perform some of the same tasks, but their expanded role includes additional duties that differ from those of the LPN.
Based on an established plan of care, a nurse turns a patient every 2 hours. What part of the nursing process is the nurse using?
A) Planning
B) Implementing
C) Evaluating
D) Assessing
A
During the implementing step of the nursing process, the nurse carries out interventions that were developed during the planning step.