Question 1

A novice nurse is looking for employment and hopes to find a facility where the nursing staff participates in making,implementing,and evaluating client care policies.Which organizational chapter implements these practices?

Accepted Answer

Shared governance is a model that allows nurses to have a voice in decision-making processes, including making, implementing, and evaluating client care policies.

Question 2

The nurse is caring for an adult client from Canada who has come to the United States for a serious neurologic surgery.The client tells the nurse,"I came to this country so that I would receive the care I need." Which is the most likely rationale for the client's statement?

Accepted Answer

The client's statement suggests that they came to the U.S. specifically to receive the care they need. This implies that they believe the U.S. has better or more advanced healthcare options than Canada, not that the U.S. has a specific healthcare system or approach that Canada does not. Option A suggests that the client believes there are many choices about healthcare available in the U.S., which is a likely reason for why they believe they can receive the care they need in the country.

Question 3

An older adult client tells the nurse,"I am worried about how I will pay for my hospital bill." The client is being discharged,is being referred to home healthcare,and the new plan of care involves extremely expensive drugs.Which response by the nurse is appropriate?

Accepted Answer

A) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client's concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client's concerns. Passing the concern to the business office does not address the client's concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
B) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client's concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client's concerns. Passing the concern to the business office does not address the client's concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
C) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client's concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client's concerns. Passing the concern to the business office does not address the client's concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
D) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client's concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client's concerns. Passing the concern to the business office does not address the client's concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.

Question 4

The nurse is managing the care of an older adult client who is near the end of life but still has treatment options available.The treatment options could potentially be painful and expensive,and they would only extend the client's life approximately 2 months.What important topic should the nurse include during initial discussions with the client and family?

Accepted Answer

A)When providing case management for a client near the end of life, the case manager's first step in ensuring the client's wishes are met is to speak honestly to the client about his or her health and impending mortality. Hospice care should be presented as an option, but only if the client chooses not to receive additional treatment. The client should be given the choice of where he or she wants to die, not be encouraged to remain in the hospital until death. Grief counseling for the family would come at a later appointment, not during initial discussions.
B)When providing case management for a client near the end of life, the case manager's first step in ensuring the client's wishes are met is to speak honestly to the client about his or her health and impending mortality. Hospice care should be presented as an option, but only if the client chooses not to receive additional treatment. The client should be given the choice of where he or she wants to die, not be encouraged to remain in the hospital until death. Grief counseling for the family would come at a later appointment, not during initial discussions
C)When providing case management for a client near the end of life, the case manager's first step in ensuring the client's wishes are met is to speak honestly to the client about his or her health and impending mortality. Hospice care should be presented as an option, but only if the client chooses not to receive additional treatment. The client should be given the choice of where he or she wants to die, not be encouraged to remain in the hospital until death. Grief counseling for the family would come at a later appointment, not during initial discussions
D)When providing case management for a client near the end of life, the case manager's first step in ensuring the client's wishes are met is to speak honestly to the client about his or her health and impending mortality. Hospice care should be presented as an option, but only if the client chooses not to receive additional treatment. The client should be given the choice of where he or she wants to die, not be encouraged to remain in the hospital until death. Grief counseling for the family would come at a later appointment, not during initial discussions

Question 5

A nurse working in an outpatient OB-GYN clinic is asked to assume the case management for the clinic's adolescent clients.Which skills will the nurse need to perform this work?

Accepted Answer

Critical thinking skills are necessary for effective case management, including identifying and addressing potential barriers to care, coordinating services and resources, and developing individualized care plans. Physical assessment and relaxation training may be useful skills for a nurse to have in general, but they are not specifically necessary for case management of adolescent clients in an OB-GYN clinic. Accounting skills are not directly relevant to this role.

Question 6

The movement from a retrospective payment system to a prospective payment system using a diagnosis-related group may have what unintentional consequence for hospitals trying to contain their costs?

Accepted Answer

In a prospective payment system using a diagnosis-related group, hospitals are reimbursed a set amount for treating a patient with a specific diagnosis, regardless of the actual cost of care. This can incentivize hospitals to discharge patients as soon as possible in order to reduce costs and maximize profits. As a result, patients may be sent home before they are fully ready, which could lead to poorer health outcomes or higher readmission rates.

Question 7

The nurse is caring for a preschool-age client who suffered brain damage following a car accident.The client has a tracheostomy,is ventilator-dependent,and will be discharged from the hospital into the family's care.The family wants to care for the child at home but does not have the resources for 24-hour care.Which action by the care manager is appropriate?

Accepted Answer

Making referrals to a variety of community-based agencies that can meet the family's needs is appropriate because it provides the family with options and resources to help them care for their child at home. This approach supports the family's desire to care for their child while also addressing their need for additional support. The other options (B, C, and D) do not promote the goal of maintaining the child at home with the family.

Question 8

What nursing concept is essential to ensure continuity of client care when a nurse is managing the care of a client?

Accepted Answer

Communication is essential to ensure continuity of client care when a nurse is managing the care of a client. Effective communication between healthcare professionals and clients is necessary to ensure that everyone involved in the client's care is up-to-date with any changes or developments. This helps prevent errors and ensures that everyone is on the same page regarding the client's care.

Question 9

An instructor is teaching the class about cost-conscious nursing practice.The instructor knows that the students understand this concept when the students make which statements? Select all that apply.

Accepted Answer

Choices A, B, and E all demonstrate an understanding of cost-conscious nursing practice by emphasizing the importance of finding more efficient ways to deliver care, reducing waste, and focusing on prevention. Choice C suggests taking shortcuts, which could compromise patient care and possibly end up costing more in the long run. Similarly, choice D does not relate directly to cost-conscious nursing practice but rather to the broader issue of healthcare workforce shortages.

Question 10

What action will allow facilities to better track the cost effectiveness of various nursing actions and allocate nursing resources most efficiently?

Accepted Answer

Quantifying nursing care means measuring the amount (in time and resources) of nursing care provided to patients. This allows facilities to track the cost effectiveness of various nursing actions and allocate nursing resources most efficiently. Bundling nursing care may simplify nursing tasks, but it does not provide a way to measure their effectiveness or allocate resources. Rationing nursing care is not a desirable approach as it involves limiting access to care. Increasing demand for nursing care may indicate a need for more resources, but it does not provide a way to track cost effectiveness or allocate resources efficiently.

Question 11

A client recovering from an emergency appendectomy is a citizen of a foreign country.The client asks the nurse to explain why the United States has chosen such a different healthcare reimbursement system from other Western countries.Which American value could the nurse mention to explain the system in this country?

Accepted Answer

The American healthcare system is largely based on the value of individual freedom, with patients and healthcare providers having more control over their choices and decisions. This contrasts with many other Western countries that have universal healthcare systems with more government involvement and regulation.

Question 12

The nurse is reviewing client records to determine which clients are good candidates for case management.Which client would the nurse choose as having the highest priority for assigning a case manager?

Accepted Answer

The newborn with cerebral palsy would likely require ongoing and coordinated care from multiple healthcare providers, making them a high priority for case management. The pregnant woman with three other children, the school-age child with pneumonia, and the older adult with hypertension may benefit from case management as well, but their needs may not be as complex or urgent as those of the newborn with cerebral palsy.

Question 13

The nurse is appointed to a clinical-administrative task force studying critical staffing issues and care delivery models for the hospital.Which evidence on the effects of different staffing choices and care delivery models should the task force consider? Select all that apply.

Accepted Answer

A)Higher nurse-to-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nurse-to-client ratios result in fewer adverse outcomes for clients.
B)Higher nurse-to-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nurse-to-client ratios result in fewer adverse outcomes for clients.
C)Higher nurse-to-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nurse-to-client ratios result in fewer adverse outcomes for clients.
D)Higher nurse-to-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nurse-to-client ratios result in fewer adverse outcomes for clients.
E)Higher nurse-to-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nurse-to-client ratios result in fewer adverse outcomes for clients.

Question 14

A nurse,who works in a clinic environment,places great emphasis on cost control,customer satisfaction,health promotion,and preventive services.The primary focus of this nurse is representative of which type of healthcare system?

Accepted Answer

The nurse's focus on cost control, customer satisfaction, health promotion, and preventive services is indicative of a managed care healthcare system. In a managed care system, there is an emphasis on cost control and maximizing the value of healthcare services for patients through preventative care and health promotion. Additionally, customer satisfaction is often a key component of managed care systems, as patients are seen as clients with specific needs and preferences.

Question 15

A nurse is completing discharge teaching for a client who is hospitalized for total hip replacement.The client asks the nurse why there is a case manager involved and expresses confusion about who is in charge.The client states,"I thought my doctor manages my care." Which is the best response by the nurse?

Accepted Answer

The best response is to explain the role of the case manager, which is to coordinate all aspects of the patient's care and ensure that their needs are met. The case manager does not manage the patient's care directly, but rather facilitates communication and collaboration between the healthcare team members, including the doctor and the nurse. This helps to ensure that the patient receives the best possible care and achieves the best possible outcomes.

Question 16

The nurse delegates vital signs and daily weights of assigned clients to the unlicensed assistive personnel (UAP)on duty.Which is the reason for the nurse to assess each client throughout the shift?

Accepted Answer

The nurse remains ultimately accountable for the care provided to the clients, even if tasks are delegated to the UAP. Assessing the clients throughout the shift allows the nurse to ensure that the care being provided by the UAP is appropriate and that any changes in the clients' condition are identified and addressed in a timely manner.

Question 17

A nurse working in a large municipal hospital is appointed to a task force whose focus is addressing nursing shortages.Which factor should the task force consider?

Accepted Answer

Nursing shortages can contribute to salary fluctuations because hospitals may offer higher salaries as an incentive to attract and retain nurses. This can also lead to increased competition among hospitals for qualified nursing staff. Factors such as nurse-patient ratios, workload, job satisfaction, and opportunities for career advancement should also be considered by the task force.

Question 18

A nurse is caring for a client who had a total hip replacement 14 days ago.The client is preparing for discharge in a few days.The nurse facilitates a care conference with the primary healthcare provider,occupational therapist,physical therapist,and the client and family to develop a plan of care for the client prior to discharge.Which roles are being demonstrated by this nurse? Select all that apply.

Accepted Answer

A) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
B) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
C) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
D) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
E) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.

Question 19

A nurse is applying for a job as a case manager for a managed care insurance organization.Which responsibility is associated with this role?

Accepted Answer

Case managers in managed care insurance organizations are responsible for coordinating the care of clients over time. They work with healthcare providers to ensure that clients receive appropriate and efficient care, and they help clients navigate the healthcare system by providing education and advocacy. Providing home visits, independent treatment planning, and approving treatment decisions are not typically part of the case manager's responsibilities in this role.

Question 20

The nurse is helping with discharge planning for a client who needs extensive rehabilitation and is on a complicated medication schedule.The client and spouse currently live with their eldest son,and the family is very involved in the client's care.The nurse would want to coordinate the client's daily care by including which priority individuals? Select all that apply.

Accepted Answer

A)Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client's spouse and children would be important in this situation because of the complexity of the client's situation. The physician, pharmacist, and social worker are important for the coordination of care in general, but they would not be involved in daily care in most circumstances.
B)Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client's spouse and children would be important in this situation because of the complexity of the client's situation. The physician, pharmacist, and social worker are important for the coordination of care in general, but they would not be involved in daily care in most circumstances.
C)Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client's spouse and children would be important in this situation because of the complexity of the client's situation. The physician, pharmacist, and social worker are important for the coordination of care in general, but they would not be involved in daily care in most circumstances.
D)Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client's spouse and children would be important in this situation because of the complexity of the client's situation. The physician, pharmacist, and social worker are important for the coordination of care in general, but they would not be involved in daily care in most circumstances.
E)Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client's spouse and children would be important in this situation because of the complexity of the client's situation. The physician, pharmacist, and social worker are important for the coordination of care in general, but they would not be involved in daily care in most circumstances.

Quiz 39: Managing Care