The Health Care Delivery System

1.A nurse is teaching the importance of breast self-examination to a group of 20-year-old women. The nurse is promoting which type of care?

a.
Primary
b.
Secondary
c.
Tertiary
d.
Restorative

ANS: A

Primary care is centered on prevention of disease. Secondary and tertiary care is administered after an illness has been diagnosed. Restorative care occurs after a patient is recovering from an acute illness or for those who have chronic illnesses.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:34OBJ:Describe the six levels of health care.

TOP:Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2.A patient who needs nursing and rehabilitation after a stroke would benefit most by receiving care at which center?

a.
Primary care center
b.
Restorative care center
c.
Assisted living center
d.
Respite center

ANS: B

Restorative care centers provide rehabilitation and nursing care. In primary care centers, health promotion is the major theme. Assisted living centers offer long-term assistance with activities of daily living. Respite centers offer short-term relief to persons who provide full-time care to an older adult.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:33

OBJ: Explain the relationship between levels of health care and levels of prevention.

TOP:Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

3.A patient states that he or she cannot afford health care insurance for the family because of a low income. What is the best form of insurance available for this patient?

a.
Medicaid
b.
Medicare
c.
Private insurance
d.
A managed care organization

ANS: A

Medicaid is a form of insurance for low-income families. Medicare is a federally funded health insurance program for people greater than 65 years of age. Private insurance is a fee-for-service plan. A managed care organization (MCO) provides care to a specific group of voluntarily enrolled patients.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 33 OBJ: Compare the various methods for financing health care.

TOP:Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

4.A nurse is teaching the staff about managed care. Which information should the nurse include?

a.
Managed care focuses on long-term care services for skilled nursing.
b.
Managed care focuses on hospital admissions and illnesses for a group of people.
c.
Managed care focuses on control over primary health services for a defined population.
d.
Managed care focuses on decreased access to care while increasing costs.

ANS: C

The term managed care describes systems in which the payer has control over primary health care services delivery for a defined patient population. Long-term care insurance focuses on skilled nursing, not managed care. Managed care focuses on health and staying out of the hospital. Managed care aims to increase access to care while decreasing costs.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:32

OBJ:Explain the advantages and disadvantages of managed health care.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

5.A nurse admits an older adult patient who states that he or she has no living relatives and only two close friends. Upon admission to the hospital, which action should the nurse initiate first?

a.
Implement a process of payment.
b.
Implement a discharge plan.
c.
Implement a visit with the family.
d.
Implement a resource utilization group.

ANS: B

Discharge planning with coordination of services begins the moment a patient is admitted to a health care facility. A resource utilization group is used in long-term care settings to manage patient costs. A visit with the family is not possible because the patient has no living relatives. Upon admission, a process of payment is not a priority for a nurse.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:35

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

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

6.A nurse is asked the most frequently cited reason for death in the world. How should the nurse reply?

a.
Technological advances
b.
Old age
c.
Cancer
d.
Poverty

ANS: D

Poverty is still deadlier than any disease and is the most frequently cited reason for death in the world today. Technological advances, old age, and cancer are not the most cited reason for death.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:45

OBJ:Discuss the implications that issues challenging the health care system have for nursing.TOP:Nursing Process: Implementation

MSC:NCLEX: Reduction of Risk Potential

7.A nurse is teaching the staff about the Prospective Payment System (PPS). Which information should the nurse include in the teaching session?

a.
PPS establishes cost-based reimbursement for health care.
b.
PPS provides reimbursement for every service the patient receives.
c.
PPS establishes reimbursement rates based upon diagnosis-related groups (DRGs).
d.
PPS provides money to the patient for health promotion use.

ANS: C

PPS established diagnosis-related groups (DRGs). Established by Congress in 1983, the PPS eliminated cost-based reimbursement, which is reimbursement for every service the patient receives. Hospitals serving patients using Medicare were no longer paid for all costs incurred in delivering care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 DRGs. PPS provides a preset amount of money to hospitals and health care providers for DRGs, not for health promotion. Managed care focuses on health promotion.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 32 OBJ: Compare the various methods for financing health care.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

8.A 74-year-old patient was admitted to the hospital with diabetic ketoacidosis. How will the hospital be reimbursed by Medicare?

a.
Based upon the diagnostic-related group
b.
Based upon the cost of care
c.
Based upon the actual length of stay
d.
Based upon the number of medications

ANS: A

Payment is based upon the diagnostic-related group. Established by Congress in 1983, the prospective payment system eliminated cost-based reimbursement. Hospitals serving patients using Medicare were no longer paid for all costs incurred to deliver care to a patient. Instead, inpatient hospital services for patients using Medicare were combined into 468 diagnosis-related groups. Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of the patient’s length of stay or use of services in the hospital or the number of medications.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 32 OBJ: Compare the various methods for financing health care.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

9.A patient tells the nurse that he or she does not understand the purpose of capitation. What is the nurse’s best response?

a.
To provide high-quality care at the highest cost to the hospital, not the patient
b.
To provide the least expensive care for patients regardless of outcomes
c.
To build a payment plan that includes the best standards of care at the lowest cost
d.
To ensure that all patients receive the same care for the same cost in all hospitals

ANS: C

The purpose of capitation is to build a payment plan for select diagnoses or surgical procedures that includes the best standards of care and essential diagnostic and treatment procedures at the lowest cost. Capitation does not cause the hospitals to pay the highest cost but to determine quality care for the lowest cost. Capitation does not provide the least expensive care for patients for outcomes because best standards are the outcome. Capitation does not make all patients receive the same care for the same cost in all hospitals.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:32

OBJ:Explain the advantages and disadvantages of managed health care.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

10.A single mother with three children uses the public health department services in the county to immunize her children. Which level of health care did the mother use?

a.
Continuing care
b.
Preventative care
c.
Secondary acute care
d.
Restorative care

ANS: B

Preventative care includes services such as immunizations, screenings, poison control information, mental health counseling and crisis prevention, and community legislation. Continuing care is assisted living. Secondary acute care involves emergency and radiological procedures. Restorative care involves rehabilitation services and home care.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:34OBJ:Describe the six levels of health care.

TOP:Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

11.A registered nurse working as a school nurse for a small poor rural school district has noticed an increase in children arriving at school without having eaten breakfast. The nurse has discussed this issue with the school principal and is working on a proposal to ask the school district to explore a school breakfast program. Which level of care did the nurse use?

a.
Primary care
b.
Continuing care
c.
Restorative care
d.
Tertiary care

ANS: A

In the settings that deliver preventative and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Tertiary care involves intensive care and psychiatric facilities.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:34

OBJ: Explain the relationship between levels of health care and levels of prevention.

TOP:Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

12.A small business owner has consulted with an occupational health nurse regarding health promotion activities for the employees. The registered nurse explores the possibility of providing an area outside the new office complex where employees can walk during their breaks. Which level of care did the nurse use?

a.
Continuing care
b.
Restorative care
c.
Primary care
d.
Tertiary care

ANS: C

In the settings that deliver preventative and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Tertiary care involves intensive care and psychiatric facilities.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:34

OBJ: Explain the relationship between levels of health care and levels of prevention.

TOP:Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

13.A grocery store clerk does not have a family health care provider. The clerk has had a sore throat for the past week and recently began running a fever. The clerk goes to the local community hospital’s emergency room for treatment. Which level of care did the clerk use?

a.
Continuing care
b.
Restorative care
c.
Primary care
d.
Tertiary care

ANS: D

Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units are sites that provide secondary and tertiary levels of care. Continuing care involves assisted living and psychiatric day care. Restorative care involves rehabilitation and home care. Primary care involves health promotion such as prenatal care and well-baby care.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:34OBJ:Describe the six levels of health care.

TOP:Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

14.A retired high school teacher has been admitted to the hospital with complications of diabetes. To ensure the patient is discharged home with the right care, at the right time, and without duplication, which health care reform system was developed?

a.
The Joint Commission
b.
National Priorities Partnership
c.
Accountable Care Organization
d.
Managed Care

ANS: C

An ACO works to make sure that patients receive the right care at the right time, without duplication of services or incidence of medical errors. Accountable care organizations (ACO) were developed to coordinate medical care by primary care and specialty physicians, hospitals, and other health care providers with the goal of providing high-quality coordinated care. The Joint Commission (2012) requires health care organizations to determine how well an organization meets patient needs and expectations and accredits health care organizations. Managed care focuses on health promotion. The National Priorities Partnership is a group of 51 organizations from a variety of health care disciplines that joined together to work toward transforming health care by focusing on eight national priorities.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:40

OBJ:Explain the advantages and disadvantages of managed health care.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

15.What is the most appropriate time for the nurse to begin discharge planning with a patient?

a.
The day of patient discharge from the health care agency
b.
As soon as the insurance provider has been identified
c.
When the health care provider writes the discharge order
d.
When the patient is admitted to the health care agency

ANS: D

Discharge planning begins the moment a patient is admitted to a health care facility. The day of discharge, when the insurance provider has been identified, and when the order is written are too late.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:35

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

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

16.Which patient is most in need of discharge planning by the nurse?

a.
A 29-year-old mother with strong family support who has a healthy newborn
b.
A 59-year-old patient with an active lifestyle who has had an appendectomy
c.
A 64-year-old patient with heart failure who has a limited income
d.
A 56-year-old patient with a supporting spouse who has had a hysterectomy

ANS: C

The 64-year-old patient with heart failure has a chronic disease and more risks than the other patients because of age and income. Some patients are more in need of discharge planning because of their risks. For example, some patients have limited financial resources or limited family support; others may have long-term disabilities or chronic illnesses. Early discharge teaching is especially important as a way to decrease readmission to the hospital. Appendectomy and hysterectomy are acute conditions and do not have as many risks as heart failure. A healthy newborn is stable, whereas heart failure is chronic.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:36

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

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Adaptation

17.Which patient is in the most expensive place to deliver care per day?

a.
A patient in a rehabilitation unit
b.
A patient in a long-term care facility
c.
A patient in an intensive care unit
d.
A patient in a private hospital room

ANS: C

An intensive care unit is the most expensive delivery site for medical care because each nurse is usually assigned to care for only one or two patients at a time and because of the types of treatments and procedures the patients in the intensive care unit typically require. Rehabilitation units, long-term care facility, and a private hospital room are not as expensive per day as an intensive care unit.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:36

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Evaluation

MSC: NCLEX: Management of Care

18.A college student with severe depression was recently admitted to the psychiatric ward of a local hospital. The family is concerned about the student finishing the college term. Which is the best information for the nurse to give regarding how long psychiatric patients are typically hospitalized?

a.
A relatively short inpatient stay is followed by outpatient treatment.
b.
A long inpatient hospitalization is normal for the majority of patients.
c.
Patients with emotional or behavioral problems generally are not hospitalized.
d.
Most are automatically placed in a long-term care facility.

ANS: A

Patients who have emotional and behavioral problems, such as depression, violent behavior, and eating disorders, often require special counseling and treatment in psychiatric facilities. Hospitalization involves relatively short stays with the purpose of stabilizing patients before transfer to outpatient treatment centers. A long inpatient hospitalization, not hospitalized, or placed in a long-term facility are not correct for the typical hospitalization of psychiatric patients.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:36

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity

19.A 17-year-old patient was seriously injured in a motor vehicle accident and has been transferred from an acute care hospital to a rehabilitation/restorative facility. Which action should the nurse take to ensure the best outcome for this patient?

a.
Make sure that the patient gets enough rest.
b.
Push the patient beyond his or her limits.
c.
Request that nobody visit for the first few days.
d.
Involve the family early in the rehabilitation process.

ANS: D

In restorative settings, nurses recognize that success is dependent on effective and early partnering with patients and their families. Although rest is good, family involvement is the priority. Pushing the patient beyond his or her limit is not helpful. Not letting anybody visit is contraindicated.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:37

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

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

20.A patient who experienced a stroke 4 days ago has been discharged from the hospital and will be undergoing outpatient rehabilitation. How should the nurse prepare the patient for this level of care?

a.
The patient will be admitted to the rehabilitative unit of the hospital.
b.
The patient will have scheduled appointment times for therapy.
c.
The patient will have home visits from all members of the multidisciplinary team.
d.
The patient will be at home for all of the treatments ordered by the primary health care provider.

ANS: B

When patients receive rehabilitation services in outpatient settings, patients get treatment at specified times during the week but remain at home the rest of the time. Inpatient rehabilitation services would require admission to an inpatient facility. Some rehabilitation is offered in the home but usually only certain members of the health care team visit. Home rehabilitation services would have the treatments performed in the home, but not for outpatient rehabilitation.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:38

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

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

21.Which other term can the nurse use to describe the Omnibus Budget Reconciliation Act of 1987?

a.
Medicaid Act
b.
Nursing Home Reform Act
c.
Diagnostic Related Group Act
d.
Magnet Recognition Act

ANS: B

The nursing center industry has become one of the most highly regulated industries in the United States. The Omnibus Budget Reconciliation Act of 1987, also known as the Nursing Home Reform Act, raised the standard of services provided by nursing centers. The Medicaid act provides insurance to low-income families. The diagnostic related group was formed from the Medicare Act. The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:39

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Implementation

MSC: NCLEX: Management of Care

22.A new registered nurse who recently began working in a nursing center has been asked to complete a Resident Assessment Instrument (RAI) on a newly admitted resident. What is the primary purpose of this instrument?

a.
To provide a database to better understand the health care needs of this population
b.
To provide the nursing staff with an overall physical assessment of the resident
c.
To provide statistical evidence to support a universal health care policy
d.
To provide medications for the residents to take on a daily basis

ANS: A

The facility needs to complete the RAI on all residents. The RAI consists of the Minimum Data Set (MDS), Resident Assessment Protocols (RAPs), and utilization guidelines of each state. The RAI ultimately provides a national database for nursing facilities so that policy makers will better understand the health care needs of the long-term care population. Although it does provide a physical assessment, the primary purpose is to better understand the needs of this population. It does not provide evidence for a universal health care policy or medications to be used for this population group.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:39

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

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

23.An 81-year-old widow with mild dementia has self-care capabilities. The widow recently moved in with her daughter, a 46-year-old working mother with three children. In considering how to have care for her mother when she is working, what is the most appropriate option the nurse should suggest?

a.
A rehabilitation center
b.
A nursing center
c.
An adult day care center
d.
A hospice center

ANS: C

Services offered by adult day care centers allow family members to maintain their lifestyles and employment and still provide home care for their relatives. A hospice is a system of family-centered care that allows patients to live and remain at home with comfort, independence, and dignity while alleviating the strains caused by terminal illness; this is inappropriate because the widow does not have a terminal illness. Rehabilitation is the use of multiple therapies such as physical, psychological, occupational, speech, and social services to help restore a person to the fullest physical, mental, social, vocational, and economic usefulness possible; this is not appropriate because the widow can provide self-care. A nursing center is a nursing home; it is too early for this because the widow can provide self-care.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:40

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Implementation

MSC: NCLEX: Management of Care

24.A 78-year-old widow needs assistance with medications, housekeeping, and laundry, and would like to maintain independence. Which is the best option for the nurse to suggest?

a.
Assisted living
b.
Respite care
c.
Nursing center
d.
Rehabilitation center

ANS: A

Assisted living provides independence, security, and privacy at the same time. These facilities promote independence and physical and psychosocial health. Services in an assisted living facility include medication management, exercise and educational activities, social activities, laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping. Respite care is a service that provides short-term relief or time off for people providing home care to an ill, disabled, or frail older adult. Nursing center is a nursing home; this is too early to recommend because the widow wants to maintain independence. Rehabilitation is the use of multiple therapies such as physical, psychological, occupational, speech, and social services to help restore a person to the fullest physical, mental, social, vocational, and economic usefulness possible; this is not appropriate because the widow can provide self-care.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:39

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Implementation

MSC: NCLEX: Management of Care

25.Which patient is most suitable for admission into hospice?

a.
A 63-year-old man with a fractured femur
b.
A 45-year-old woman with terminal end-stage renal failure
c.
A 14-year-old patient with leukemia that is in remission
d.
A 78-year-old patient with dementia that wanders

ANS: B

A patient entering a hospice is at the terminal phase of illness, and the patient, family, and physician agree that no further treatment will reverse the disease process. A fractured femur, leukemia in remission, and dementia are not conditions that are terminal, and so are not appropriate for hospice.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:40

OBJ:Discuss the types of settings in which professionals provide various levels of health care.TOP:Nursing Process: Assessment

MSC: NCLEX: Management of Care

26.A registered nurse has been working for an oncology unit for the past year and has a passion for caring for oncology patients undergoing chemotherapy. Whose responsibility is it for the nurse to become competent in administering chemotherapy?

a.
The hospital where the nurse is employed
b.
The charge nurse
c.
The nurse herself or himself
d.
The oncologist who admits patients to the unit

ANS: C

A nurse’s responsibility is to follow policies and procedures and to know the most current practice standards. As a nurse progresses in a career, it becomes his or her responsibility to obtain necessary continued education and earn certifications when he or she chooses to practice in specialty areas. Nurses must be accountable for their own actions; it is not the responsibility of the hospital, charge nurse, or oncologist for the nurse to be competent.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:41

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

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

MULTIPLE RESPONSE

1.A registered nurse working in a restorative care setting will focus on which areas? (Select all that apply.)

a.
Providing extensive supportive care
b.
Providing one-on-one care to patients
c.
Promoting patient self-care
d.
Promoting independence
e.
Promoting dying at home

ANS: C, D

The goals of restorative care are to help an individual regain maximal functional status, thereby enhancing his or her quality of life, and promote patient independence and self-care. A secondary care setting, not a restorative care setting, provides in-depth diagnosis and treatment of illnesses that require extensive, one-on-one complex treatments. Hospice, not restorative care, allows a patient to die at home.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:37

OBJ: Explain the relationship between levels of health care and levels of prevention.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

2.A nurse wants to practice using the Institute of Medicine Competencies. Which competencies should the nurse use? (Select all that apply.)

a.
Working in interdisciplinary teams
b.
Using informatics
c.
Providing physical comfort
d.
Offering access to care
e.
Preventing catheter-associated urinary tract infections

ANS: A, B

In addressing the continued challenges facing the health care system, the Institute of Medicine (2001) identified five interrelated competencies that are essential for all health care workers in the twenty-first century: Working in interdisciplinary teams, using informatics, providing patient-centered care, applying quality management, and employing evidence-based practice. The Picker Institute (2012) identified eight dimensions of patient-centered care that most affect patients’ experiences with health care: Physical comfort is one of these, as is access to care. The National Database of Nursing Quality Indicators tracts catheter-associated urinary tract infections among other criteria to help determine quality of nursing care.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:41

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

TOP: Nursing Process: Implementation MSC: NCLEX: Basic Care and Comfort