Kozier and Erbs Fundamentals of Nursing 10th Edition by Berman Snyder Test bank

Kozier and Erbs Fundamentals of  Nursing  10th Edition  by Berman  Snyder  Test bank
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Kozier & Erbs Fundamentals of Nursing, 10/E
Chapter 06
Question 1
Type: MCSA
The nurse is reviewing the Healthy People 2020 primary goals. Which plan should the nurse realize is in alignment with one of the goals?
1. Providing free screening to schoolchildren
2. Opening a wellness clinic
3. Developing better insurance controls
4. Developing new pharmacological treatments
Correct Answer: 2
Rationale 1: Healthy People 2020 has four overarching goals: (1) Increase quality and years of healthy life, (2) achieve health equity and eliminate health disparities, (3) create healthy environments for everyone, and (4) promote health and quality life across the life span. Free screening to schoolchildren is already being done in most states.
Rationale 2: Healthy People 2020 has four overarching goals: (1) Increase quality and years of healthy life, (2) achieve health equity and eliminate health disparities, (3) create healthy environments for everyone, and (4) promote health and quality life across the life span. Opening a wellness clinic focuses on bettering health, which would be in line with goal 1.
Rationale 3: Healthy People 2020 has four overarching goals: (1) Increase quality and years of healthy life, (2) achieve health equity and eliminate health disparities, (3) create healthy environments for everyone, and (4) promote health and quality life across the life span. Developing insurance control was a goal of health care reform during the Clinton administration.
Rationale 4: Ongoing development of pharmacological treatments is not a new initiative.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Teamwork; Practice; Clarify roles and integrate the contributions of others who play a role in helping the patient/family achieve health goals
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 1. Differentiate health care services based on primary, secondary, and tertiary disease prevention categories.
MNL Learning Outcome: 1.3.1. Use appropriate strategies to promote health.
Page Number: 89

Question 2
Type: MCSA
Several nurses are working to open a clinic that focuses on health promotion. Which activity should the nurses expect to perform once this clinic opens?
1. Teaching biofeedback techniques for stress reduction
2. Providing immunization clinics
3. Evaluating regional industrial centers for environmental pollution
4. Teaching smoking cessation classes to adolescents
Correct Answer: 1
Rationale 1: Health promotion programs address nutrition, weight control, exercise, and stress reduction. Health promotion activities emphasize the role of clients in maintaining their own health and provide encouragement in maintaining the highest level of wellness they can achieve.
Rationale 2: Providing immunization clinics is an example of illness prevention, not health promotion.
Rationale 3: Evaluating industrial centers for pollution is an example of illness prevention, not health promotion.
Rationale 4: Teaching smoking cessation classes is an example of illness prevention, not health promotion.

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 1. Differentiate health care services based on primary, secondary, and tertiary disease prevention categories.
MNL Learning Outcome: 1.3.1. Use appropriate strategies to promote health.
Page Number: 89

Question 3
Type: MCSA
A client is in the end stages of cancer. Which type of service should the nurse consider as being the best for this client?
1. Rehabilitation
2. Health restoration
3. Acute care
4. Palliative care
Correct Answer: 4
Rationale 1: Rehabilitation is a process of restoring ill or injured people to optimum and functional levels of wellness, emphasizing the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives. That is not the service this client requires.
Rationale 2: Health restoration is service that helps bring ill or injured clients back to their former state of health. That is not the service this client requires.
Rationale 3: Acute care is the typical service provided in a hospital. That is not the service this client requires.
Rationale 4: Palliative care is service that provides comfort and treatment of symptoms. This type of care is for clients who cannot be returned to health. It may be conducted in many settings, including the home.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 90

Question 4
Type: MCSA
Several nurses are looking for an agency to sponsor a program that would meet the needs of a community group lacking in health promotion education. Which agency should the nurse approach to fill this need?
1. State health department
2. Local health department
3. Local hospital
4. Federal government
Correct Answer: 2
Rationale 1: State health organizations are responsible for assisting the local health departments. This is not the agency to provide the assistance the nurses are looking for.
Rationale 2: The local health department has the responsibility for developing programs to meet the health needs of the people, providing the necessary staff and facilities to carry out those programs, evaluating their effectiveness, and monitoring changing needs.
Rationale 3: Local hospitals provide the majority of acute care services in a community. This is not the agency to provide the assistance the nurses are looking for.
Rationale 4: The U.S. Department of Health and Human Services is an agency at the federal level whose functions include conducting research and providing training in the health field, providing assistance to communities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel. This is not the agency to provide the assistance the nurses are looking for.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 90

Question 5
Type: MCSA
The nurse is hired to provide care in a hospital that offers services in all specialty areas. How should the nurse categorize this type of health care facility?
1. General hospital
2. Specialty hospital
3. Long-term care hospital
4. Short-term hospital
Correct Answer: 1
Rationale 1: Hospitals are classified by the services they provide as well as by their ownership. General hospitals admit clients requiring a variety of services, such as medical, surgical, obstetric, pediatric, and psychiatric services.
Rationale 2: Hospitals are classified by the services they provide as well as by their ownership. Some hospitals offer only specialty services, such as psychiatric or pediatric. This does not describe the facility in this scenario.
Rationale 3: Hospitals are classified by the services they provide as well as by their ownership. Long-term care hospitals provide services for longer periodssometimes years or for the remainder of the clients life. This does not describe the facility in the scenario.
Rationale 4: Acute care (or short-term) hospitals provide assistance to clients whose illness and need for hospitalization are relatively short term, such as several days. This does not describe the facility in the stem.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 91

Question 6
Type: MCSA
A client being discharged from an acute care hospital requires IV antibiotics, is not able to complete activities of daily living without assistance, and has no family available to assist in the recovery phase. Which type of recommendation should the nurse make for this client?
1. Stay in the hospital until the client is fully capable of self-care.
2. Remain in the hospital until the antibiotic course is completed.
3. Be discharged to an extended care facility.
4. Go to a nursing home.
Correct Answer: 3
Rationale 1: An acute care hospital stay is no longer required because the needs of the client could be met in another facility.
Rationale 2: The antibiotic therapy and custodial care can be provided in a more suitable facility.
Rationale 3: Extended care facilities provide care for clients who require rehabilitation and custodial care after discharge from an acute care hospital. Because this client still receives antibiotic therapy and requires some custodial care, this type of facility can provide the best care until the client is ready for discharge home.
Rationale 4: The client may require a nursing home or long-term care facility at some point, but it is too early in the recovery to make this decision.
Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 92

Question 7
Type: MCSA
An older client has no family in the same community, lives alone in a small house, and is having greater difficulty with mobility due to advanced osteoarthritis. Cognitively, this client is alert, is able to manage her own business matters, and does her own cooking, but does not enjoy cooking for one. The home health nurse who visits has noticed that the client is losing weight and does not have as much energy or interest in activities as on previous visits. What should the nurse recommend for this client?
1. See a psychiatrist because the client appears to be depressed.
2. Check out joint replacement options for the osteoarthritis.
3. Start thinking about long-term care.
4. Consider moving to an assisted living facility.
Correct Answer: 4
Rationale 1: Diagnosing depression is outside the scope of nursing practice. Other interventions can be implemented before this action is considered. It also does not meet the clients immediate needs.
Rationale 2: Joint replacement may or may not be an option, but it would not be the nurses responsibility to recommend this, nor does it meet the clients immediate needs.
Rationale 3: This client does not show any indications of requiring long-term care at this point.
Rationale 4: Assisted living facilities offer meals, laundry services, nursing care, transportation, and social activities to residents who are able to live relatively independently. They are intended to meet the needs of people who are unable to remain at home but do not require hospital or nursing home care. The client in this scenario has some physical limitations, but could benefit from socialization and interaction with peers as well as having staff available to provide limited care and health promotion activities.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 92

Question 8
Type: MCSA
The spouse of a client diagnosed with Stage I/II Alzheimers disease must continue to work full-time. The spouse tells the occupational health nurse that the client has started to wander outside the house, forgets to turn off the stove after preparing food, and tries to drive the car if the keys are available. What should the nurse recommend for this family?
1. The client should be placed in long-term care.
2. The spouse should consider early retirement.
3. The client should be placed in an adult day-care environment.
4. An increase in the clients medications should be considered to slow the progress of the disease.
Correct Answer: 3
Rationale 1: Placing a client from an independent home situation to long-term care would be more detrimental than a gradual progression of care.
Rationale 2: Telling the spouse to consider early retirement is neither therapeutic nor realistic.
Rationale 3: Day-care centers provide care and nutrition for adults who cannot be left at home alone but do not need to be in an institution. These centers often provide care involving socializing, exercise programs, and stimulation. Some provide counseling and physical therapy. Nurses who are employed in day-care centers may provide medications, treatment, and counseling.
Rationale 4: Increasing medications is a decision that needs to be made by the clients primary caregiver, not the nurse, nor does it address the spouses concerns regarding care.
Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 93

Question 9
Type: MCSA
The spouse of a client referred to hospice care asks why the client needs the change in services. How should the nurse respond to this question?
1. So we can see if theres any way to improve your spouses life.
2. There is no need for acute care any longer.
3. Its best for your spouse to be cared for at home.
4. Hospice care is cheaper than acute care.
Correct Answer: 1
Rationale 1: The central concept of the hospice movement is not saving life but improving or maintaining the quality of life until death. Hospice care provides a variety of services given to the terminally ill, their families, and support persons. The place of care varies, but includes home, hospital, or skilled nursing facilities.
Rationale 2: Acute care may be warranted as the clients condition changes.
Rationale 3: The place of hospice care varies, but includes home, hospital, or skilled nursing facilities.
Rationale 4: Hospice care may well be cheaper, but this is not the main reason for referral to hospice services.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 93

Question 10
Type: MCSA
A young adult client recovering from an injury that resulted in partial paralysis plans to live independently as before the injury. Which referral should the nurse identify as being the best for this client?
1. Paramedical technologist
2. Physical therapist
3. Occupational therapist
4. Case manager
Correct Answer: 3
Rationale 1: The term paramedical technologist includes laboratory technologists, radiological technologists, and nuclear medicine technologists. This title is given to those professionals having some connection with medicine. This referral would not meet the clients needs regarding independent living.
Rationale 2: A physical therapist helps clients regain physical strength and mobility. In this case, the client would probably also see a physical therapist, but not for the focus on independent living.
Rationale 3: An occupational therapist assists clients with impaired function to gain the skills necessary for activities of daily living. The therapist teaches skills that are therapeutic but at the same time provide fulfillment. Helping a client with paralysis learn to use equipment or different methods of doing daily tasks will enable the client to be as independent as possible.
Rationale 4: A case managers role is to ensure that clients receive fiscally sound, appropriate care in the best setting. This client may well have a case manager to coordinate all the necessary care, but the question focuses on the return to independent living.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 94

Question 11
Type: MCSA
A nurse is interviewing a client at a clinic near a shelter for the homeless. Understanding the increased risk a poor physical environment creates for this client, on what should the nurse focus during the intake phase of the interview?
1. Lack of social support
2. Recent history of chills and body aches
3. Improper nutrition
4. Few personal resources
Correct Answer: 2
Rationale 1: Lack of social support contributes to health problems in general.
Rationale 2: A poor physical environment results in increased susceptibility to infections. The clients recent history of chills and body aches should alert the nurse that this client may have an infection.
Rationale 3: Improper nutrition contributes to health problems in general.
Rationale 4: Few personal resources contributes to health problems in general.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Identify the roles of various health care professionals.
MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.
Page Number: 98

Question 12
Type: MCSA
A nurse is working in a clinic that emphasizes cost control, customer satisfaction, health promotion, and preventive services. In which type of health system is this nurse providing care?
1. Managed care
2. Case management
3. Differentiated practice
4. Patient-focused care
Correct Answer: 1
Rationale 1: Managed care describes a health care system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients.
Rationale 2: Case management describes a range of models for integrating health care services for individuals or groups. This is not the model described in the scenario.
Rationale 3: Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This is not the model described in the scenario.
Rationale 4: Patient-focused care is a delivery model that brings all services and care providers to the client. This is not the model described in the scenario.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 4. Describe the factors that affect health care delivery.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 98

Question 13
Type: MCSA
The manager of a small clinic has cross-trained the nurses to provide basic nursing care, and perform ECG testing, phlebotomy, and some respiratory therapy interventions. Which type of care delivery model has the manager implemented?
1. Managed care
2. Case management
3. Patient-focused care
4. Critical pathways
Correct Answer: 3
Rationale 1: Managed care focuses on cost-effective, quality care that results in decreased costs and improved outcomes. This is not the model described in the scenario.
Rationale 2: Case management is a way to integrate health care services for individuals or groups and involves multidisciplinary teams that assume collaborative responsibility for planning, assessing needs, and coordinating, implementing, and evaluating care. This is not the model described in the scenario.
Rationale 3: Client-focused care is a delivery model that provides services according to the clients needs. Rationale 4: Critical pathways are used to track the clients progress in case management. This is not the model described in the scenario.
Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 5. Describe frameworks for the delivery of nursing care.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 100

Question 14
Type: MCSA
A new graduate nurse is looking for employment and is hoping to find a facility that utilizes nursing personnel based on their educational preparation and skill set. In which type of facility should the new graduate apply for a position?
1. Patient-focused care
2. Shared governance
3. Differentiated practice
4. Managed care
Correct Answer: 3
Rationale 1: Patient-focused care is a delivery model that brings all services and care providers to the client. This is not the model described in the scenario.
Rationale 2: Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. This is not the model described in the stem.
Rationale 3: Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This model consists of specific job descriptions for nurses according to their education or training.
Rationale 4: Managed care focuses on cost containment, consumer satisfaction, health promotion, and preventive services. This is not the model described in the scenario.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Identify the roles of various health care professionals.
MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.
Page Number: 99

Question 15
Type: MCSA
The nurse is considering leaving a position in an organization that utilized differentiated practice. Which type of delivery system should the nurse consider as being the most similar to differentiated practice?
1. Case method
2. Shared governance
3. Functional method
4. Team nursing
Correct Answer: 4
Rationale 1: The case method is a client-centered model where one nurse is assigned to and responsible for the comprehensive care of a group of clients during a shift. In this method a client has consistent contact with one nurse during a shift, but may have different nurses on other shifts. This is not the model described in the scenario.
Rationale 2: Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. This is not the model described in the scenario.
Rationale 3: The functional nursing method focuses on the jobs to be completed. It is a task-oriented approach in which personnel with less preparation than the professional nurse perform less complex care requirements. This is not the model described in the scenario.
Rationale 4: Team nursing is the delivery of individualized nursing care to clients by a team led by a professional nurse. The nursing team consists of registered nurses, licensed practical nurses, and unlicensed assistive personnel. The registered nurse retains responsibility and authority for client care but delegates appropriate tasks to the other team members. This enables nurses to progress and assume roles and responsibilities appropriate for their level of experience, capability, and educationmuch like the differentiated practice system.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Identify the roles of various health care professionals.
MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.
Page Number: 99

Question 16
Type: MCSA
A seasoned RN is especially competent in knowledge of the computerized charting system in a facility and is able to assume the team leader role on a regular basis. In which type of care delivery system is this nurse most likely providing care?
1. Primary nursing
2. Team nursing
3. Differentiated practice
4. Case method
Correct Answer: 1
Rationale 1: Primary nursing is a system in which one nurse is responsible for total care of a number of clients, 24 hours a day, 7 days a week. It is a method of providing comprehensive, individualized, and consistent care. Primary nursing uses the nurses technical knowledge and management skills in assessing and prioritizing each clients needs, implementing the plan of care, and evaluating the plans effectiveness.
Rationale 2: Team nursing is the delivery of individualized nursing care to clients by a team led by a professional nurse and consisting of RNs, LPNs, and UAPs. This is not the model described in the scenario.
Rationale 3: Differentiated practice is a system in which the best possible use of nursing personnel is based on their education preparation and resultant skill sets. This is not the model described in the scenario.
Rationale 4: The case method is also referred to as total care, in which one nurse is assigned to and is responsible for the comprehensive care of a group of clients during an 8- or 12-hour shift. This is not the model described in the scenario.
Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3. Identify the roles of various health care professionals.
MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.
Page Number: 100

Question 17
Type: MCSA
A 68-year-old client is concerned about paying for extended hospitalization and expensive medications to treat his health problem. What should the nurse respond to this client?
1. Dont worry. Im sure everything will work out OK.
2. You need to focus on recovering, not worrying about finances.
3. Much of your care will be covered by Medicare.
4. Ill have someone from the business office come and talk to you about your bill.
Correct Answer: 3
Rationale 1: Ignoring the clients concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the clients concerns.
Rationale 2: Ignoring the clients concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the clients concerns.
Rationale 3: The Medicare amendment to the Social Security Act provided a national and state health insurance program for older adults. By the mid-1970s, virtually everyone over 65 years of age was protected by hospital insurance under Part A. In 1988, Congress expanded Medicare to include extremely expensive hospital care, catastrophic care, and expensive drugs.
Rationale 4: Giving the concern to the business office is merely passing the buck. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6. Compare various systems of payment for health care services.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 100

Question 18
Type: MCSA
A clinic in a rural area depends primarily on the services of a nurse practitioner. Which legislation provided the opportunity for the nurse practitioner to have this position?
1. Medicare
2. Medicaid
3. Rural Health Clinics Act
4. National Health Planning and Resources Development Act
Correct Answer: 3
Rationale 1: Medicare provides insurance coverage for people over age 65. This is not the legislation described in the scenario.
Rationale 2: Medicaid provides service to people who require financial assistance for health care. This is not the legislation described in the scenario.
Rationale 3: In 1978, the Rural Health Clinics Act provided for the development of health care in medically underserved rural areas. This act opened the door for nurse practitioners to provide primary care.
Rationale 4: The National Health Planning and Resources Development Act established health systems agencies throughout the United States for the development of health care in medically underserved rural areas. This is not the legislation described in the scenario.
Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 5. Describe frameworks for the delivery of nursing care.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 93

Question 19
Type: MCSA
The nurse is reviewing the principles of the Affordable Care Act with a client. What information should the nurse include when discussing the act with the client?
1. Individuals will be fined if they do not have health insurance.
2. Employers must offer health insurance if they meet identified requirements.
3. Insurance can be purchased through exchanges.
4. Individuals with preexisting health conditions cannot be denied health insurance coverage.
5. Health insurance is free.
Correct Answer: 1, 2, 3, 4
Rationale 1: A provision within the Affordable Care Act is that individuals will be fined if they do not have health insurance.
Rationale 2: A provision within the Affordable Care Act is that employers must offer health insurance if they meet identified requirements.
Rationale 3: A provision within the Affordable Care Act is that insurance can be purchased through exchanges.
Rationale 4: A provision within the Affordable Care Act is that individuals with preexisting health conditions cannot be denied health insurance coverage.
Rationale 5: Health insurance is not free.
Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Describe frameworks for the delivery of nursing care.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 100

Question 20
Type: MCSA
A client asks the nurse to explain the difference between an HMO and a PPO. What should the nurse include when responding to the client?
1. Youll have good health care benefits, so dont worry.
2. Both the HMO and PPO are covered by your employer, so its really not your concern.
3. Your PPO offered you a choice in your health care provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care.
4. You really should be happy about the HMO. Youll pay little, if any, out-of-pocket expense.
Correct Answer: 3
Rationale 1: Telling the client not to worry does not address the clients question, which is to explain the difference.
Rationale 2: Telling the client not to worry does not address the clients question, which is to explain the difference.
Rationale 3: HMO plans emphasize wellness, and members choose a primary care provider who evaluates their health status and coordinates their care. Clients are limited in their ability to select health care providers and services, but available services are at minimal and predetermined cost to the client. PPOs consist of a group of physicians that provide an insurance company or employer with health services at a discounted rate. One advantage of the PPO is that it provides clients with a choice of health care providers and services.
Rationale 4: Even though telling the client that she will have little out-of-pocket expense may be truthful, it doesnt answer the question.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Describe frameworks for the delivery of nursing care.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 102

Question 21
Type: MCMA
The nurse is reviewing changes occurring within the health care industry. What should the nurse identify as factors that have an effect on health care delivery?
Standard Text: Select all that apply.
1. Increased use of complementary and alternative medicine
2. More knowledgeable consumers
3. Increase in the number of elderly
4. Decrease in chronic disease
5. Technological advances
6. Economics
Correct Answer: 2, 3, 5, 6
Rationale 1: Although there is an increase in complementary and alternative medicine use, this does not affect how health care is delivered.
Rationale 2: With the improved availability of health-related information, consumers are more knowledgeable, and play an active role in their health care.
Rationale 3: People over age 85 are projected to be the fastest-growing population in the United States.
Rationale 4: Chronic illness is prevalent in this group.
Rationale 5: Technology related to health care is rapidly increasing, and includes improved diagnostic procedures and equipment that permits early recognition of diseases.
Rationale 6: Inflation increases all costs, and paying for health care services is becoming a greater problem.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 4. Describe the factors that affect health care delivery.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 96

Question 22
Type: MCMA
A client in the hospital is concerned about the cost of receiving hospitalized care. What should the nurse realize is causing the increase in the clients medical expenses?
Standard Text: Select all that apply.
1. Health care of the older adult
2. Number of uninsured population
3. Changes in birth rate over last 20 years
4. Cost of prescription drugs
5. State of inflation
6. Amount of diagnosed chronic illnesses
Correct Answer: 1, 2, 4, 5, 6
Rationale 1: The total population is growing, especially the older adult segment that tends to have greater health care needs compared to younger persons.
Rationale 2: The uninsured numbers are on the rise: 17% of persons under age 65.
Rationale 3: Birth rates have dropped in the last 20 years, and so do not have a major impact on health care costs.
Rationale 4: The cost of prescription drugs is increasing, and represents 19% of total health care expenditures in the United States.
Rationale 5: Inflation increases all costs.
Rationale 6: The total population is growing, especially the older adult segment that tends to have diagnosed chronic illnesses.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 4. Describe the factors that affect health care delivery.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 96

Question 23
Type: MCMA
In order to comply with the U.S. Department of Health and Human Services most current health care goals as stated in Healthy People 2020, what should the nurse do?
Standard Text: Select all that apply.
1. Plan a depression screening for senior citizens who regularly have lunch at the senior center.
2. Attend an educational in-service on the use of a new automated blood pressure monitor.
3. Advocate for psychiatric health care for those with no private insurance coverage.
4. Organize a park cleanup day to assure that the communitys children have a safe place to play.
5. Counsel older clients regarding programs available to assist them to live in their homes independently.
Correct Answer: 1, 3, 4, 5
Rationale 1: The federal-government-funded Healthy People 2020 has as one of its primary goals promoting health and quality life across the life span.
Rationale 2: This intervention is not directed toward the federal governments primary health goals as stated in Healthy People 2020.
Rationale 3: The federal-government-funded Healthy People 2020 has among its primary goals achieving health equity and eliminating health disparities.
Rationale 4: The federal-government-funded Healthy People 2020 has as one of its primary goals creating healthy environments for everyone.
Rationale 5: The federal-government-funded Healthy People 2020 has as one of its primary goals increasing quality and years of healthy life.

Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Teamwork; Practice; Clarify roles and integrate the contributions of others who play a role in helping the patient/family achieve health goals
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1. Differentiate health care services based on primary, secondary, and tertiary disease prevention categories.
MNL Learning Outcome: 1.3.1. Use appropriate strategies to promote health.
Page Number: 89

Question 24
Type: MCMA
The nurse is reviewing sources of federal funding for health care services provided to clients. For which clients should the nurse recognize as most likely having health care paid through a federal funding source?
Standard Text: Select all that apply.
1. 35-year-old self-employed house painter
2. 72-year-old retired schoolteacher
3. 52-year-old nurse who runs the family farm
4. 29-year-old mentally challenged sheltered workshop employee
5. 40-year-old factory worker
Correct Answer: 2, 4
Rationale 1: This patient would be on a private insurance plan like Blue Cross and Blue Shield.
Rationale 2: This patient would be on a federally funded insurance plan like Medicare.
Rationale 3: This patient would be on a private insurance plan like Blue Cross and Blue Shield.
Rationale 4: This patient would be on a federally funded insurance plan like Medicaid.
Rationale 5: This patient would be on a prepaid group plan: a health maintenance organization (HMO).

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5. Describe frameworks for the delivery of nursing care.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 100

Question 25
Type: MCMA

The nurse is concerned that the hospital will not receive payment for care provided to a client. Which client health problems are causing the nurse this concern?

Standard Text: Select all that apply.

1. Intravenous fluids were prescribed for 4 days.
2. X-rays of the left leg and left arm were prescribed.
3. A stage II pressure ulcer developed on the clients heels.
4. A urinary tract infection occurred because of an indwelling urinary catheter.
5. Physical therapy treatments were prescribed for 7 days for crutch walking.

Correct Answer: 3, 4

Rationale 1: There is no reason for intravenous fluids to not be paid.

Rationale 2: There is no reason for x-rays to not be paid.

Rationale 3: In efforts to decrease cost and encourage attention to preventable conditions, for discharges occurring after October 1, 2008, hospitals no longer receive additional payment for cases in which one of several identified preventable conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. Examples of hospital-acquired conditions (HACs) are pressure ulcers and urinary tract infections following catheterization.

Rationale 4: In efforts to decrease cost and encourage attention to preventable conditions, for discharges occurring after October 1, 2008, hospitals no longer receive additional payment for cases in which one of several identified preventable conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. Examples of hospital-acquired conditions (HACs) are pressure ulcers and urinary tract infections following catheterization.

Rationale 5: There is no reason for physical therapy treatments to not be paid.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 6. Compare various systems of payment for health care services.
MNL Learning Outcome: 1.2.3. Examine the factors affecting health care delivery.
Page Number: 101

Question 26
Type: MCMA

The nurse is considering a position with a home health agency. What type of care should the nurse realize will be provided when working for this type of agency?

Standard Text: Select all that apply.

1. Providing ventilatory support
2. Completing a health and wellness visit
3. Instructing about care of a surgical wound
4. Providing intravenous antibiotics once a day
5. Teaching about medications for self-management of diabetes

Correct Answer: 3, 4, 5

Rationale 1: Ventilatory support would be considered a critical illness and most likely not provided through home care.

Rationale 2: A health and wellness visit can be conducted in a community clinic or health care providers office. Home care would not be needed.

Rationale 3: Home health care nurses and other staff offer education to clients and families and also provide comprehensive care to clients who are acutely, chronically, or terminally ill. This would include teaching about surgical wound care.

Rationale 4: Home health care nurses and other staff offer education to clients and families and also provide comprehensive care to clients who are acutely, chronically, or terminally ill. This would include providing intravenous antibiotics daily.

Rationale 5: Home health care nurses and other staff offer education to clients and families and also provide comprehensive care to clients who are acutely, chronically, or terminally ill. This would include teaching about self-management of a disease process.

Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience
AACN Essentials Competencies: VII. 10. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death
NLN Competencies: Context and Environment; Practice; apply health promotion/disease prevention strategies; apply health policy
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2. Describe the functions and purposes of the health care agencies outlined in this chapter.
MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.
Page Number: 93

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