Test Bank For Fundamentals Of Nursing 9Th ed by Potter

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Test Bank For Fundamentals Of Nursing 9Th ed by Potter

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WITH ANSWERS
Fundamentals Of Nursing 9Th ed by Potter
Test Bank
SAMPLE QUESTIONS

Test Bank Fundamentals of Nursing by Potter (9th Edition, 2016)

01: Nursing Today

Chapter 01: Nursing Today

Potter et al.: Fundamentals of Nursing, 9th Edition

MULTIPLE CHOICE

1. Which nurse most likely kept records on sanitation techniques and the effects on health?

a.
Florence Nightingale

b.
Mary Nutting

c.
Clara Barton

d.
Lillian Wald

ANS: A

Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mary Nutting, Clara Barton, and Lillian Wald came after Nightingale, each contributing to the nursing profession in her own way. Mary Nutting was instrumental in moving nursing education into universities. Clara Barton founded the American Red Cross. Lillian Wald helped open the Henry Street Settlement.

DIF:Understand (comprehension)REF:5

OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices.

TOP: Evaluation MSC: Health Promotion and Maintenance

bcdefghij87tuvwxyz{|}~  The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following?

a.    Assessment

b.    Diagnosis

c.    Planning

d.    Implementation

ANS: C

In planning, the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. During assessment, the registered nurse collects comprehensive data pertinent to the patients health and/or the situation. In diagnosis, the registered nurse analyzes the assessment data to determine the diagnoses or issues. During implementation, the registered nurse implements (carries out) the identified plan.

DIF:Understand (comprehension)REF:2

OBJ: Discuss the development of professional nursing roles. TOP: Planning

MSC:Management of Care

23 An experienced medical-surgical nurse chooses to work in obstetrics. Which level of proficiency is the nurse upon initial transition to the obstetrical floor?

a.    Novice

b.    Proficient

c.    Competent

d.    Advanced beginner

ANS: A

A beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health) is an example of a novice nurse. A proficient nurse perceives a patients clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. A competent nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). This nurse is a competent practitioner who is able to anticipate nursing care and establish long-range goals. A nurse who has had some level of experience with the situation is an advanced beginner. This experience may only

be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care.

DIF:Apply (application)REF:2

OBJ: Discuss the development of professional nursing roles. TOP: Evaluation

MSC:Management of Care

23 A nurse assesses a patients fluid status and decides that the patient needs to drink more fluids. The nurse then encourages the patient to drink more fluids. Which concept is the nurse demonstrating?

a.    Licensure

b.    Autonomy

c.    Certification

d.    Accountability

ANS: B

Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. To obtain licensure in the United States, the RN candidate must pass the NCLEX-RN. Beyond the NCLEX-RN, the nurse may choose to work toward certification in a specific area of nursing practice. Accountability means that you are responsible, professionally and legally, for the type and quality of nursing care provided.

DIF:Apply (application)REF:3

OBJ: Discuss the roles and career opportunities for nurses. TOP: Implementation

MSC:Management of Care

23 A nurse prepares the budget and policies for an intensive care unit. Which role is the nurse implementing?

a.    Educator

b.    Manager

c.    Advocate

d.    Caregiver

ANS: B

A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or facility. As an educator, you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patients progress in learning. As a patient advocate, you protect your patients human and legal rights and provide assistance in asserting these rights if the need arises. As a caregiver, you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process.

DIF:Apply (application)REF:4

OBJ: Describe the roles and career opportunities for nurses. TOP: Implementation

MSC:Management of Care

23 The nurse has been working in the clinical setting for several years as an advanced practice nurse. However, the nurse has a strong desire to pursue research and theory development. To fulfill this desire, which program should the nurse attend?

a.    Doctor of Nursing Science degree (DNSc)

b.    Doctor of Philosophy degree (PhD)

c.    Doctor of Nursing Practice degree (DNP)

d.    Doctor in the Science of Nursing degree (DSN)

ANS: B

Some doctoral programs prepare nurses for more rigorous research and theory development and award the research-oriented Doctor of Philosophy (PhD) in nursing. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners.

DIF:Understand (comprehension)REF:10

OBJ: Describe educational programs available for professional registered nurse (RN) education.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive?

a.
Graduate education

b.
Inservice education

c.
Continuing education

d.
Registered nurse education

ANS: C

Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. After obtaining a baccalaureate degree in nursing, you can pursue graduate education leading to a masters or doctoral degree in any number of graduate fields, including nursing. Inservice education programs are instruction or training provided by a health care facility or institution. Registered nurse education is the education preparation for an individual intending to be an RN.

DIF:Apply (application)REF:10

OBJ: Describe educational programs available for professional registered nurse (RN) education.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse identifies gaps between local and best practices. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse demonstrating?

a.    Safety

b.
Patient-centered care

c.
Quality improvement

d.
Teamwork and collaboration

ANS: C

Quality improvement identifies gaps between local and best practices. Safety minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Patient-centered care recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients preferences, values, and needs. Teamwork and collaboration allows effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making.

DIF:Understand (comprehension)REF:7 | 8

OBJ: Describe the roles and career opportunities for nurses. TOP: Evaluation

MSC:Management of Care

9. A nurse has compassion fatigue. What is the nurse experiencing?

a.    Lateral violence and intrapersonal conflict

b.    Burnout and secondary traumatic stress

c.    Short-term grief and single stressor

d.    Physical and mental exhaustion

ANS: B

Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress. Compassion fatigue may contribute to what is described as lateral violence (nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Stressors, not a single stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only.

DIF:Understand (comprehension)REF:6

OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices.

TOP: Assessment MSC: Health Promotion and Maintenance

23 A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, I have no idea what is going to happen. I couldnt ask any questions. The nurse does not allow the patient to sign the permit and notifies the health care provider of the situation. Which role is the nurse displaying?

a.    Manager

b.
Patient educator

c.
Patient advocate

d.
Clinical nurse specialist

ANS: C

As a patient advocate, the nurse protects the patients human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurses responsibility to notify the health care provider if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings.

DIF:Apply (application)REF:3

OBJ: Describe the roles and career opportunities for nurses. TOP: Evaluation

MSC:Management of Care

23 The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse-midwife, the patient asks for a referral to a pediatrician for the newborn. Which action should the nurse-midwife take initially?

a.    Provide the referral as requested.

b.    Offer to provide the newborn care.

c.    Refer the patient to the supervising provider.

d.    Tell the patient that is not allowed to make referrals.

ANS: B

The practice of nurse-midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. After being apprised of the midwifery role, if the patient insists on seeing a pediatrician, the nurse-midwife should provide the referral. The supervising provider is an obstetric provider, not a pediatrician. A nurse-midwife can make referrals.

DIF:Analyze (analysis)REF:4

OBJ: Describe the roles and career opportunities for nurses. TOP: Implementation

MSC:Management of Care

23 The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA?

a.    Manages gynecological services such as PAP smears

b.    Works under the guidance of an anesthesiologist

c.    Obtains a PhD degree in anesthesiology

d.    Coordinates acute medical conditions

ANS: B

Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician (health care provider) with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse-midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement.

DIF:Understand (comprehension)REF:4

OBJ: Describe the roles and career opportunities for nurses. TOP: Implementation

MSC:Management of Care

23 A nurse teaches a group of nursing students about nurse practice acts. Which information is most important to include in the teaching session about nurse practice acts?

a.
Protects the nurse

b.
Protects the public

c.
Protects the provider

d.
Protects the hospital

ANS: B

The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They do not protect the nurse, provider, or hospital.

DIF:Understand (comprehension)REF:10

OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices.

TOP: Teaching/Learning MSC: Management of Care

23 A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. What should the nurse realize?

a.    Legislation is politics beyond the nurses control.

b.    National programs have no bearing on state politics.

c.    The individual nurse can influence legislative decisions.

d.    Focusing on nursing care provides the best patient benefit.

ANS: C

Nurses can influence policy decisions at all governmental levels. One way is to get involved by participating in local and national efforts. This effort is critical in exerting nurses influence early in the political process. Legislation is not beyond the nurses control. National program can have bearing on state politics. The question is focusing on legislation and health care costs, not nursing care.

DIF:Analyze (analysis)REF:9

OBJiscuss the influence of social, historical, political, and economic changes on nursing practices.TOP:EvaluationMSC:Management of Care

23 A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which guide is the nurse using?

a.    Code of ethics

b.    Standards of practice

c.    Standards of professional performance

d.    Quality and safety education for nurses

ANS: A

The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. The Standards of Practice describe a competent level of nursing

care. The ANA Standards of Professional Performance describe a competent level of behavior in the professional role. Quality and safety education for nurses addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments.

DIF:Understand (comprehension)REF:3

OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices.

TOP: Implementation MSC: Management of Care

23 A graduate of a baccalaureate degree program is ready to start working as an RN in the emergency department. Which action must the nurse take first?

23 Obtain certification for an emergency nurse.

24 Pass the National Council Licensure Examination.

25 Take a course on genomics to provide competent emergency care.

26 Complete the Hospital Consumer Assessment of Healthcare Providers Systems.

ANS: B

Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associates degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Certification can be obtained after passing the NCLEX and working for the specified amount of time. Genomics is a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that persons environment. Consumers can also access Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) to obtain information about patients perspectives on hospital care.

DIF:Remember (knowledge)REF:9

OBJ: Describe educational programs available for professional registered nurse (RN) education.

TOP:ImplementationMSC:Management of Care

23 While providing care to a patient, the nurse is responsible, both professionally and legally. Which concept does this describe?

a.    Autonomy

b.
Accountability

c.
Patient advocacy

d.
Patient education

ANS: B

Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patients human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patients progress in learning.

DIF:Remember (knowledge)REF:3

OBJiscuss the influence of social, historical, political, and economic changes on nursing practices.TOP:EvaluationMSC:Management of Care

23 A nurse is teaching the staff about Benners levels of proficiency. In which order should the nurse place the levels from beginning level to ending level?

23 Expert

24 Novice

25 Proficient

26 Competent

27 Advanced beginner

a.
2, 4, 5, 1, 3

b.
2, 5, 4, 3, 1

c.
4, 2, 5, 3, 1

d.
4, 5, 2, 1, 3

ANS: B

Benners levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert.

DIF:Understand (comprehension)REF:2

OBJ: Discuss the development of professional nursing roles. TOP: Teaching/Learning

MSC:Management of Care

MULTIPLE RESPONSE

23 A nurse is preparing a teaching session about contemporary influences on nursing. Which examples should the nurse include? (Select all that apply.)

a.
Human rights

b.
Affordable Care Act

c.
Demographic changes

d.
Medically underserved

e.
Decreasing health care costs
ANS: A, B, C, D

Multiple external forces affect nursing, including the need for nurses self-care, Affordable Care Act (ACA) and rising (not decreasing) health care costs, demographic changes of the population, human rights, and increasing numbers of medically underserved.

DIF:Understand (comprehension)REF:6

OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices.

TOP: Teaching/Learning MSC: Management of Care

23 After licensure, the nurse wants to stay current in knowledge and skills. Which programs are the most common ways nurses can do this? (Select all that apply.)

a.    Masters degree

b.    Inservice education

c.    Doctoral preparation

d.    Continuing education

e.    National Council Licensure Examination retakes

ANS: B, D

Continuing education programs help nurses maintain current nursing skills, gain new knowledge and theory, and obtain new skills reflecting the changes in the health care delivery system. Inservice education programs are provided by a health care facility to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can help the nurse stay current. Masters degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. National Council Licensure Examination retakes are not to keep current; this test is taken to enter RN practice.

DIF:Understand (comprehension)REF:10

OBJ: Describe educational programs available for professional registered nurse (RN) education.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.)

a.
Patient advocate

b.
Nurse administrator

c.
Certified nurse-midwife

d.
Clinical nurse specialist

e.
Certified nurse practitioner

ANS: C, D, E

Although all nurses should function as patient advocates, advanced practice nurse is an umbrella term for an advanced clinical nurse such as a certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurse administrator is not an example of advanced practice.

DIF:Understand (comprehension)REF:4

OBJ: Describe the roles and career opportunities for nurses. TOP: Teaching/Learning

MSC:Management of Care

23 The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to float two of its nurses to the oncology unit if oncology can float a nursing assistant to the orthopedic unit to help with obtaining vital signs. Which concepts does this situation

entail? (Select all that apply.)

a.    Autonomy

b.    Informatics

c.    Accountability

d.
Political activism

e.
Teamwork and collaboration

ANS: A, C, E

Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. When nurses work together this is teamwork and collaboration. Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. Political activism usually involves more than day-to-day activities such as unit staffing.

DIF:Analyze (analysis)REF:3 | 8

OBJiscuss the influence of social, historical, political, and economic changes on nursing practices.TOP:EvaluationMSC:Management of Care

02: The Health Care Delivery System

Chapter 02: The Health Care Delivery System

Potter et al.: Fundamentals of Nursing, 9th Edition

MULTIPLE CHOICE

23 The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient?

23 Capitation provides the hospital with a means of recovering variable charges.

24 The hospital will be paid for the full cost of the patients hospitalization.

25 Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost.

26 Medicare will pay the national average for the patients condition.

ANS: C

In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which provides

a fixed reimbursement amount based on assigned DRG, regardless of a patients length of stay or use of services. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not national averages.

DIF:Understand (comprehension)REF:15

OBJ: Compare the various methods for financing health care. TOP: Planning

MSC:Management of Care

23 A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session?

a.    Managed care insures full coverage of health care costs.

b.    Managed care only assumes the financial risk involved.

c.    Managed care allows providers to focus on illness care.

d.    Managed care causes providers to focus on prevention.

ANS: D

Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated (fixed amount) payment for each patient enrolled in the program. Therefore, the focus of care shifts from individual illness care to prevention, early intervention, and outpatient care. The actual cost of care is the responsibility of the provider. The managed care organization (provider) assumes financial risk, in addition to providing patient care.

DIF:Understand (comprehension)REF:15

OBJ: Explain the structure of the United States health system. TOP: Teaching/Learning

MSC:Management of Care

23 A nurse is teaching a family about health care plans. Which information from the nurse indicates a correct understanding of the Affordable Care Act?

23 A family can choose whether to have health insurance with no consequences.

24 Primary care physician payments from Medicaid services can equal Medicare.

25 Adult children up to age 26 are allowed coverage on the parents plan.

26 Private insurance companies can deny coverage for any reason.

ANS: C

Adult children up to the age of 26, regardless of student status, are allowed to be covered under their parents health insurance plan. All individuals are required to have some form of health insurance by 2014 or pay a penalty through the tax code. Primary care physician payments for Medicaid services increased to equal Medicare payments. Implementation of insurance regulations prevents private insurance companies from denying insurance coverage for any reason and from charging higher premiums based on health status and gender.

DIF:Remember (knowledge)REF:15-16

OBJ: Explain the structure of the United States health system. TOP: Teaching/Learning

MSC:Management of Care

4. A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning?

a.
When the patient is ready

b.
Close to the time of discharge

c.
Upon admission to the hospital

d.
After an order is written/prescribed
ANS: C

Discharge planning begins the moment a patient is admitted to a health care facility. When the patient is ready may be too late. Close to the time of discharge and after an order is written/prescribed are too late.

DIF:Remember (knowledge)REF:19

OBJ: Discuss the role of nurses in different health care delivery settings.

TOPlanningMSC:Management of Care

23 The nurse is applying for a position with a home care organization that specializes in spinal cord injury. In which type of health care facility does the nurse want to work?

a.    Secondary acute

b.    Continuing

c.    Restorative

d.    Tertiary

ANS: C

Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Restorative care includes cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care. Secondary acute care involves emergency care, acute medical-surgical care, and radiological procedures. Continuing care involves assisted living, psychiatric care, and older-adult day care. Tertiary care includes intensive care and subacute care.

DIF:Understand (comprehension)REF:20

OBJ: Discuss the types of settings that provide various health care services.

TOP:ImplementationMSC:Management of Care

23 A nurse provides immunization to children and adults through the public health department. Which type of health care is the nurse providing?

a.
Primary care

b.
Preventive care

c.
Restorative care

d.
Continuing care

ANS: B

Preventive care includes immunizations, screenings, counseling, crisis prevention, and community safety legislation. Primary care is health promotion that includes prenatal and well-baby care, nutrition counseling, family planning, and exercise classes. Restorative care includes rehabilitation, sports medicine, spinal cord injury programs, and home care. Continuing care is assisted living and psychiatric care and older-adult day care.

DIF:Understand (comprehension)REF:17

OBJ: Discuss the types of settings that provide various health care services.

TOP: Implementation MSC: Health Promotion and Maintenance

23 A nurse is following the PDSA cycle for quality improvement. Which action will the nurse take for the letter A?

a.    Act

b.    Alter

c.    Assess

d.    Approach

ANS: A

There are many models for quality improvement and performance improvement. One model is the PDSA cycle: plan, do, study, and act. A does not stand for alter, assess, or approach.

DIF:Understand (comprehension)REF:27

OBJescribe the components of a quality improvement program.

TOP:ImplementationMSC:Management of Care

23 The nurse is trying to determine how well a certain health plan compares with other health plans. To gather this type of data, which information will the nurse utilize?

23 Pew Health Professions Commission

24 Healthcare Effectiveness Data and Information Set (HEDIS)

25 American Nurses Credentialing Center (ANCC) Magnet Recognition Program

26 Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS)

ANS: B

Health plans throughout the United States rely on the Healthcare Effectiveness Data and Information Set (HEDIS) as a quality measure. HEDIS compares how well health plans perform key areas: quality/effectiveness of care, access to care, and patient satisfaction with the health plan and doctors. The Pew Health Professions Commission, a national and interdisciplinary group of health care leaders, recommended 21 competencies for health care professionals in the twenty-first century. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure patient perceptions of their hospital experience. The Magnet Recognition Program recognizes health care organizations that achieve excellence in nursing practice.

DIF:Understand (comprehension)REF:24

OBJ: Explain the impact of quality and safety initiatives on delivery of health care.

TOP:AssessmentMSC:Management of Care

23 An older adult patient has extensive wound care needs after discharge from the hospital. Which facility should the nurse discuss with the patient?

a.
Hospice

b.
Respite care

c.
Assisted living

d.
Skilled nursing

ANS: D

An intermediate care or skilled nursing facility offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation. A hospice is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Respite care is a service that provides short-term relief or time off for people providing home care to an individual who is ill, disabled, or frail. Assisted living offers an attractive long-term care setting with an environment more like home and greater resident autonomy.

DIF:Apply (application)REF:20-21

OBJ: Discuss the types of settings that provide various health care services.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse working in a community hospitals emergency department provides care to a patient having chest pain. Which level of care is the nurse providing?

a.
Continuing care

b.
Restorative care

c.
Preventive care

d.
Tertiary care
ANS: D

Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units provide secondary and tertiary levels of care. Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Continuing care is available within institutional settings (e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice). Preventive care is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs.

DIF:Apply (application)REF:18

OBJ: Discuss the types of settings that provide various health care services.

TOP:ImplementationMSC:Management of Care

23 A nurse is teaching about the effects of globalization. Which information should the nurse include in the teaching session?

a.    Increased spread of communicable diseases

b.    Increased homogeneous mix of nursing staff

c.    Decreased poverty and increased health tourism

d.    Decreased urbanization as populations shift to the suburbs

ANS: A

Although globalization of trade, travel, and culture has improved the availability of health care services, the spread of communicable diseases such as tuberculosis and severe acute respiratory syndrome (SARS) has become more common. In an effort to improve the quality of care, health care institutions are recruiting nurses from around the world to work in the United States, forcing hospitals to better understand and work with nurses from different cultures. Poverty is still deadlier than any disease and is the most frequent reason for death in the world today. The growth of urbanization also is currently affecting the worlds health. Improved communication, easier air travel, and easing of trade restrictions are making it easier for people to engage in health tourism.

DIF:Understand (comprehension)REF:26

OBJ: Discuss the implications that changes in the health care system have on nursing.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse is using research findings to improve clinical practice. Which technique is the nurse using?

a.
Performance improvement

b.
Integrated delivery networks

c.
Nursing-sensitive outcomes

d.
Utilization review committees

ANS: A

Performance improvement activities are typically clinical projects conceived in response to identified clinical problems and designed to use research findings to improve clinical practice. Larger health care systems have integrated delivery networks (IDNs) that include a network of facilities, providers, and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting. Nursing-sensitive outcomes are patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients symptom experiences, functional status, safety, psychological distress, registered nurse (RN) job satisfaction, total nursing hours per patient day, and costs. Medicare-qualified hospitals had physician-supervised utilization review (UR) committees to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare.

DIF:Understand (comprehension)REF:27

OBJ: Explain the relationship between evidence-based practice and performance improvement.

TOP:ImplementationMSC:Management of Care

13. Which finding indicates the best quality improvement process?

23 Staff identifies the wait time in the emergency department is too long.

24 Administration identifies the design of the facilitys lobby increases patient stress.

25 Director of the hospital identifies the payment schedule does not pay enough for overtime.

26 Health care providers identify the inconsistencies of some of the facilitys policy and procedures.

ANS: A

The quality improvement process begins at the staff level, where problems are defined by the staff. It is not identified by administration, the hospital director, or health care providers.

DIF:Apply (application)REF:27

OBJescribe the components of a quality improvement program.

TOP:EvaluationMSC:Management of Care

23 A nurse is providing home care to a home-bound patient treated with intravenous (IV) therapy and enteral nutrition. What is the home health nurses primary objective?

a.    Screening

b.    Education

c.    Dependence

d.    Counseling

ANS: B

Health promotion and education are traditionally the primary objectives of home care, yet at present most patients receive home care because they need nursing care. Screening is preventive care. The home health nurse focuses on patient and family independence. Counseling is through psychiatric care.

DIF:Understand (comprehension)REF:20

OBJ: Discuss the role of nurses in different health care delivery settings.

TOPlanningMSC:Management of Care

23 A nurse hears a co-worker state that anybody could be a nurse since it is so automated with infusion devices and electronic monitoring; technology is doing the work. What is the nurses best response?

23 Technology use has to be combined with nursing judgment.

24 The focus of effective nursing care is technology.

25 If its so easy, why dont you do it?

26 That is true in the 20th century.

ANS: A

In many ways, technology makes work easier, but it does not replace nursing judgment. Technology does not replace your critical eye and clinical judgment. Most importantly, it is essential to remember that the focus of nursing care is not the machine or the technology; it is the patient. Using why is not beneficial when communicating with others. Agreeing with the statement furthers misconceptions.

DIF:Apply (application)REF:26

OBJ: Explain the impact of quality and safety initiatives on delivery of health care.

TOP: Communication and Documentation MSC: Management of Care

16. A nurse is completing a minimum data set. Which area is the nurse working?

a.
Nursing center

b.
Psychiatric facility

c.
Rehabilitation center

d.
Adult day care center

ANS: A

Nurses who work in a nursing center (nursing home or nursing facility) are required to complete a minimum data set on each patient. Minimum data set is not needed for psychiatric, rehabilitation, or adult day care centers. Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in psychiatric facilities. Rehabilitation restores a person to the fullest physical, mental, social, vocational, and economic potential possible. Patients require rehabilitation after a physical or mental illness, injury, or chemical addiction. Adult day care centers provide a variety of health and social services to specific patient populations who live alone or with family in the community. Services offered during the day allow family members to maintain their lifestyles and employment and still provide home care for their relatives.

DIF:Understand (comprehension)REF:21

OBJ: Explain the role of nurses in different health care delivery settings.

TOP:ImplementationMSC:Management of Care

MULTIPLE RESPONSE

23 Which government-instituted programs should the nurse include in a teaching session about controlling health care costs? (Select all that apply.)

a.
Professional standards review organizations

b.
Prospective payment systems

c.
Diagnosis-related groups

d.
Third-party payers

e.
Never events

ANS: A, B, C

The federal government, the biggest consumer of health care, which pays for Medicare and Medicaid, has created professional standards review organizations (PSROs) to review the quality, quantity, and costs of hospital care. One of the most significant factors that influenced payment for health care was the prospective payment system (PPS). Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patients care cost. Instead, the PPS grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs). In 2011, the National Quality Forum (not a government facility) defined a list of 29 never events that are devastating and preventable. Through most of the twentieth century, few incentives existed for controlling health care costs. Insurers or third-party payers paid for whatever health care providers ordered for a patients care and treatment.

DIF:Understand (comprehension)REF:15

OBJ: Explain the various methods for financing health care. TOP: Teaching/Learning

MSC:Management of Care

23 A nurse is teaching the staff about the Institute of Medicine competencies. Which examples indicate the staff has a correct understanding of the teaching? (Select all that apply.)

a.
Use informatics.

b.
Use transparency.

c.
Apply globalization.

d.
Apply quality improvement.

e.
Use evidence-based practice.

ANS: A, D, E

The Institute of Medicine competencies include: Provide patient-centered care; work in interdisciplinary teams; use evidence-based practice; apply quality improvement; and use

informatics. Transparency is included in the 10 rules of performance in a redesigned health care system, not a competency. While globalization is important in health care, it is not a competency.

DIF:Understand (comprehension)REF:23

OBJ: Explain the impact of quality and safety initiatives on delivery of health care.

TOP:Teaching/LearningMSC:Management of Care

23 A nurse is evaluating care based upon the nursing quality indicators. Which areas should the nurse evaluate? (Select all that apply.)

a.
Patient satisfaction level

b.
Hospital readmission rates

c.
Nursing hours per patient day

d.
Patient falls/falls with injuries

e.
Value stream analysis for quality

ANS: B, C, D

The American Nurses Association developed the National Database of Nursing Quality Indicators (NDNQI) to measure and evaluate nursing-sensitive outcomes with the purpose of improving patient safety and quality care. Nursing quality indicators include the following: Hospital readmission rates, nursing hours per patient day, and patient falls/falls with injuries. While every major health care organization measures certain aspects of patient satisfaction, it is not a nursing quality indicator. Value stream analysis is a method that focuses on improvement of processes in a health care institution.

DIF:Apply (application)REF:25

OBJ: Discuss opportunities for nursing within the changing health care delivery system.

TOP:EvaluationMSC:Management of Care

23 A nurse is working in a health care organization that has achieved Magnet status. Which components are indicators of this status? (Select all that apply.)

a.    Empirical quality results

b.    Structural empowerment

c.    Transformational leadership

d.    Exemplary professional practice

e.    Willingness to recommend the agency

ANS: A, B, C, D

The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice. The five components are Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovation, and Improvements; and Empirical Quality Results. Willingness to recommend the hospital/agency is a component of the Hospital Consumer of Assessment of Healthcare Providers and Systems survey.

DIF:Understand (comprehension)REF:24-25

OBJ: Discuss opportunities for nursing within the changing health care delivery system.

TOP:AssessmentMSC:Management of Care

MATCHING

A nurse is teaching about the different types of health care plans. Match the correct information to the type of health care plans the nurse should include in the teaching session.

23 Insurance for low-income families

24 Federal insurance for people aged 65 and older

25 Health maintenance focus to specific group of voluntarily enrolled people

23 Services at a discount for companies under contract

23 Preferred provider organization

24 Managed care organization

25 Medicaid

26 Medicare

1.ANSDIF:Understand (comprehension)REF:15-16

OBJ: Compare the various methods for financing health care. TOP: Teaching/Learning

MSC:Management of Care

2.ANS:CDIF:Understand (comprehension)REF:15-16

OBJ: Compare the various methods for financing health care. TOP: Teaching/Learning

MSC:Management of Care

3.ANS:ADIF:Understand (comprehension)REF:15-16

OBJ: Compare the various methods for financing health care. TOP: Teaching/Learning

MSC:Management of Care

4.ANS:BDIF:Understand (comprehension)REF:15-16

OBJ: Compare the various methods for financing health care. TOP: Teaching/Learning

MSC:Management of Care

03: Community-Based Nursing Practice

Chapter 03: Community-Based Nursing Practice Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE

23 A nurse is working as a public health nurse. What will be the nurses primary focus?

a.    The individual as one member of a group

b.    Individuals and families

c.    Needs of a population

d.    Health promotion

ANS: C

Public health nursing primary focus is understanding the needs of a population. Community-based care focuses on health promotion. Community health nursing focuses on health care of individuals, families, and groups within the community.

DIF:Understand (comprehension)REF:33

OBJ: Explain the relationship between public health and community health nursing.

TOP:CaringMSC:Management of Care

23 A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse have to obtain?

23 A baccalaureate degree in nursing

24 Preparation at the basic entry level

25 The same level of education as the community health nurse

26 A graduate level education with a focus in public health science

ANS: D

A specialist in public health has a graduate level education with a focus in public health science. Public health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing. A community health nurse is not the same thing as a public health nursing specialist.

DIF:Understand (comprehension)REF:33

OBJ: Explain the relationship between public health and community health nursing.

TOP:Teaching/LearningMSC:Management of Care

3. A nurse is working as a community health nurse. Which action is a priority for this nurse?

a.    Provide direct care to subpopulations.

b.    Focus on the needs of the ill individual.

c.    Provide first level of contact to health care systems.

d.    Focus on providing care in various community settings.

ANS: A

Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. In addition, the community health nurse provides direct care services to subpopulations within a community. Community-based nursing centers function as the first level of contact between members of a community and the health care system. Community-based nursing focuses on providing care in various community settings, such as the home or a clinic and involves acute and chronic care.

DIF:Apply (application)REF:33

OBJ: Differentiate community health nursing from community-based nursing.

TOP: Implementation MSC: Health Promotion and Maintenance

23 A nurse is focusing on acute and chronic care of individuals and families within a community while enhancing patient autonomy. Which type of nursing care is the nurse providing?

a.
Public health

b.
Community health

c.
Community-based

d.
Community assessment

ANS: C

Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs of a population. Community health nursing cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community assessment is the systematic data collection on the population, monitoring the health status of the population, and making information available about the health of the community.

DIF:Understand (comprehension)REF:33

OBJ: Differentiate community health nursing from community-based nursing.

TOP:ImplementationMSC:Management of Care

23 The community health nurse is administering flu shots to children at a local playground. What is the rationale for this nurses action?

a.    To prevent individual illness

b.    To prevent community outbreak of illness

c.    To prevent outbreak of illness in the family

d.    To prevent needs of the local population groups

ANS: B

The nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations (children), the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-based nursing, as opposed to community health nursing, focuses on the needs of the individual or family. Public health nursing focuses on meeting the population groups needs.

DIF:Apply (application)REF:33

OBJ: Discuss the role of the community health nurse. TOP: Planning

MSC:Health Promotion and Maintenance

23 A nurse attended a seminar on community-based health care. Which information indicates the nurse has a good understanding of community-based health care?

a.    It occurs in hospitals.

b.    Its focus is on ill individuals.

c.    Its priority is health promotion.

d.    It provides services primarily to the poor.

ANS: C

Community-based health care is a model of care that reaches everyone in the community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community. Community-based health care occurs outside traditional health care institutions such as hospitals.

DIF:Understand (comprehension)REF:31

OBJ: Explain the relationship between public health and community health nursing.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

23 A nurse is using the Healthy People 2020 to establish goals for the community. Which goal is priority?

a.    Reduce health care costs.

b.    Increase life expectancy.

c.    Provide services close to where patients live.

d.    Isolate patients to prevent the spread of disease.

ANS: B

The overall goals of Healthy People 2020 are to increase life expectancy and quality of life and eliminate health disparities through an improved delivery of health care services. It does not focus on reducing health care costs, providing services close to where patients live, or isolating patients to prevent the spread of disease.

DIF:Understand (comprehension)REF:31

OBJiscuss the role of the nurse in community-based practice.

TOPlanningMSC:Health Promotion and Maintenance

8. A nurse is working in community-based nursing. Which competency is priority for this nurse?

a.    Caregiver

b.
Collaborator

c.
Change agent

d.
Case manager

ANS: A

First and foremost is the role of caregiver. While collaborator, change agent, and case manager are important, they are not the priority.

DIF:Apply (application)REF:35

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP:ImplementationMSC:Management of Care

23 A nurse observes an outbreak of lice in a certain school district. The nurse collects data and identifies a common practice of sharing lockers, caps, and hair brushes. The nurse shares the information with the school. Which community-based nursing competency did the nurse use?

a.    Educator

b.    Caregiver

c.    Case manager

d.    Epidemiologist

ANS: D

As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness (outbreak of lice). The nurse did not teach the students about lice. The nurse did not provide care for the lice. The nurse did not coordinate needed resources and services for a group of patients well-being (case manager).

DIF:Apply (application)REF:37

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP: Implementation MSC: Safety and Infection Control

23 A nurse is providing screening at a health fair. Which finding indicates the person may be a vulnerable patient who is most likely to develop health problems?

a.    One who is pregnant

b.    One who has excessive risks

c.    One who has unlimited access to health care

d.    One who uses nontraditional healing practices

ANS: B

Vulnerable populations are the patients who are more likely to develop health problems as a result of excess risks or limits in access to health care services or who are dependent on others for care. Pregnancy is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs, or is at high risk for other reasons. A person who has unlimited access to health care is not vulnerable. Frequently, the immigrant population practices nontraditional healing practices. Many of these healing practices are effective and complement traditional therapies.

DIF:Understand (comprehension)REF:34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-

based nurses approach to care. TOP: Assessment

MSC:Health Promotion and Maintenance

23 The instructor is teaching student nurses about identifying members of vulnerable populations when the nursing student asks, Why is it that not all poor people are considered members of vulnerable populations? How should the nurse respond?

23 All poor people are members of a vulnerable population.

24 Poor people are members of a vulnerable population only if they take drugs.

25 Poor people are members of a vulnerable population only if they are homeless.

26 Members of vulnerable groups frequently have a combination of risk factors.

ANS: D

Members of vulnerable groups frequently have many risks or a combination of risk factors that make them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always overwhelming, depending on the patients beliefs and values and sources of social support.

DIF:Apply (application)REF:34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-

based nurses approach to care. TOP: Teaching/Learning

MSC:Health Promotion and Maintenance

23 The nurse is making a home visit to a Korean mother after the birth of girl. The spouse is pressing different parts of the patients hand and lower arm to relieve a headache. What is the nurses next action?

a.    Tell the spouse to stop and give the mother acetaminophen.

23 Let the spouse finish and then give the mother medication.

c.    Ask the mother and/or spouse to explain the procedure.

23 Explain to the spouse that it will not work.

ANS: C

The nurse should not judge the patients/familys beliefs and values about health. The nurse needs to understand cultural beliefs, values, and practices to determine their specific needs. Acetaminophen may not be an acceptable alternative for this family. Criticizing the familys beliefs and practices or saying they will not work may only create a barrier to care.

DIF:Analyze (analysis)REF:34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-

based nurses approach to care. TOP: Implementation

MSC: Psychosocial Integrity

13. A nurse is assessing the social system of a community. Which area should the nurse assess?

a.    Housing

b.
Economic status

c.
Volunteer programs

d.
Predominant ethnic groups

ANS: C

Social systems include volunteer programs, education system, government, and health systems. Housing and economic status are included in the structure assessment. Predominant ethnic groups are a component of the population assessment.

DIF:Understand (comprehension)REF:37-38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC: Psychosocial Integrity

23 The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse, acting as a counselor, provides the patient with information on alternatives to abortion, but after several sessions, the patient still insists on having the abortion. What should the nurse, in the counselor role, do next?

23 Encourage the patient to speak with a Right-to-Life advocate.

24 Refuse to provide a referral to an abortion service.

25 Provide referral to an abortion service.

26 Delay referral to an abortion service.

ANS: C

As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy and providing a referral to an abortion service. The nurse does not make decisions, like going to a Right-to-Life advocate, but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patients decision.

DIF:Apply (application)REF:37

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP: Implementation MSC: Psychosocial Integrity

23 Before a patient with beginning stage of Alzheimers disease is discharged, the community-based nurse is making a visit to the patients home. The patients daughter and family live in the home with the patient. What is the major focus of this visit?

23 Teach the family how to monitor blood pressure.

24 Demonstrate techniques for providing care.

23 Stress to the family how difficult it will be to provide care at home.

24 Encourage the family to send the patient to an extended care facility.

ANS: B

The role of the community health nurse, when dealing with patients with Alzheimers disease, is to maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement and emotional support to the caregiver. Monitoring blood pressure is not necessary for an Alzheimers patient; blood pressure would be for a patient with hypertension. The nurse should protect the patients rights and maintain family stability, not encourage placement in an extended care facility.

DIF:Apply (application)REF:36

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP:ImplementationMSC:Management of Care

23 While conducting a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which component of a community assessment?

a.    Structure

b.
Population

c.
Social system

d.
Welfare system

ANS: A

Economic status is part of the community structure. Population would involve age and gender distribution, growth trends, density, education level, and ethnic or religious groups. The welfare

system is part of the social system that also includes the education, government, communication, and health systems.

DIF:Understand (comprehension)REF:38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC:Health Promotion and Maintenance

23 The nurse uses statistics on increased incidence of communicable disease to influence legislatures to pass a bill for mandatory vaccinations to enroll in school. Which type of nursing will the nurse use in this process?

a.
Public health nursing

b.
Community-based nursing

c.
Community health nursing

d.
Vulnerable population nursing

ANS: A

A public health nurse understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to health and illness, and the political processes used to affect public policy. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. Community-based nursing care takes place in community settings su

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