Question 1

How does managed care affect the economics of health care delivery?

Accepted Answer

The corporatization of health care amalgamates the smaller health care operations into the larger organizations to decrease duplicate and redundant health care provisions.For example,one hospital would provide a high level of cardiac care,and another hospital would focus on oncology.Managed care does not increase community tax base because the costs are paid by the patients and their insurance.Managed care is more of an incentive for larger hospitals and corporations.The focus is to reduce duplication of services,not to use corporate economics to achieve a profit.

Question 2

Which statement regarding characteristics of clinical pathways shows the nurses understanding?

Accepted Answer

Clinical pathways help reduce expensive variations in care.Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis,procedure,or symptom.Clinical pathways are not a nurse-centered orientation.

Question 3

A female patient is admitted to the labor and delivery unit,where she is assigned a registered nurse who will manage her care for the duration of her hospitalization.What type of nursing care delivery model is represented in this nursing unit?

Accepted Answer

This is an example of primary care nursing,in which the nurse is the principal or primary person to manage and coordinate the patient's care around the clock.Patient-focused care is an interdisciplinary approach to patient care.Functional care is the provision of care by nursing and nursing ancillary staff rather than by an all-nursing staff as seen in primary care nursing.Case management is a model of care delivery in which a nurse case manager coordinates and collaborates with other health services when a patient has complicated health care needs,but the case manager may not be involved in the daily care activities of the patient.

Question 4

Which of the following best describes the concept of evidence-based practice?

Accepted Answer

The IOM reported that it took 17 years for research to be reflected into daily practice.Evidence-based practice is the use of the current best evidence to provide care and make decisions regarding patient care.Evidence-based practice is not a method of improving nursing care and maintaining costs containment.Insurance companies do not review the evidence of health care practice for reimbursement.Evidence-based practice does not achieve large-scale economics while providing cost-effective care.

Question 5

Which type of nursing delivery models would be appropriate in a rural area that would require fewer numbers of registered nurses? (Select all that apply.)

Accepted Answer

When you have a limited number of nurses,then functional nursing,team nursing,and patient-focused care are useful because you can deliver quality care by using more ancillary staff.Primary care is usually 24-hour nurse coverage,and transitional care is when advanced practice nurses (APRNs)conduct assessments and-with physicians-design and coordinate patient care and discharge plans.

Question 6

Which action by the case manager would be required under the full immersion model?

Accepted Answer

Under the full immersion model,the case manager would be required to conduct a daily chart review on all patients he or she is assigned to.The nurse would then meet with the health care providers and nurses caring for these patients to discuss their care.The purpose of this model is to enhance communication and decrease cost of care by shortening hospital stays.

Question 7

The nurse assesses the quality of patient care to be higher in the Total Patient Care model because:

Accepted Answer

The quality of care is higher in the Total Patient Care model because nurses are able to focus all of their care on one patient instead of juggling the care of two or more.

Question 8

Which statement shows the nurses understanding of patient-focused care?

Accepted Answer

Patient-focused care is another type of delivery system.The level of productivity is increased through centralization of functions (e.g.,phlebotomy,diet instruction,respiratory therapy)on the unit under the direction of the nurse and cross-training ancillary workers to do more than one function.The patient comes into contact with fewer people under this organizational framework.

Question 9

A nurse is covering for a coworker who is on a lunch break.While administering medications,the nurse notices a bag of antibiotic hanging with another patient's name on it.The nurse immediately stops the infusion.What should the next step be?

Accepted Answer

The next step that the nurse should take is to speak to the coworker about the error and then fill out paperwork for documentation.The nurse needs to have a "crucial conversation" with this coworker to alert him or her about the error.This allows for a decrease in the number of errors and a safer health care environment.

Question 10

Which statement by the nurse manager is accurate regarding case management? The two tools that support case management are

Accepted Answer

Both of these tools (clinical pathways and disease management protocols)support case management by coordination and delivery of high-quality care.Clinical pathways (also known as care maps)are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis,procedure,or symptom.Disease management protocols involve a system of coordinated health care interventions and communications for persons with conditions in which self-care is important in controlling the disease.

Question 11

Which statement is true about case management?

Accepted Answer

Case management is one of the strategies to reduce costs while ensuring coordination of care.The first is the traditional model,which focuses on discharge planning and determining if the care planned throughout the patient's hospital stay is necessary and appropriate (utilization review)so that the insurer will pay for the services.The full immersion model of case management requires the case manager to review the chart and communicate with physicians and nurses caring for the patients on their case load daily.Case managers do not provide direct patient care,and it does not eliminate the need for other health care workers (LPN,CNA).Resource utilization is the examining of resources to ensure optimal allocation,such as restructuring shifts so that nurses work fewer overtime hours is an example of resource utilization.

Question 12

A nurse manager is training a new hire.Which statement shows an understanding of functional nursing?

Accepted Answer

Functional nursing is where nursing care is broke into a series of tasks performed by many people,which results in a fragmented,impersonal kind of care.Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment.Aides,vocational nurses,and licensed practical nurses are allowed to perform functions such as administration of medication and treatments.This functional kind of nursing results in a fragmented,impersonal kind of care.In team nursing,groups of patients are assigned to a team headed by a team leader,usually a nurse,who coordinates the care for a designated group of patients.In primary nursing,a nurse plans and directs the care of a patient over a 24-hour period.This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is accountable for planning the care of the patient around the clock.In a patient-focused care system,the patient comes into contact with fewer people,and the nurse,who is familiar with the patient's plan of care,supervises the delivery of care.This model also moves nurses to a higher level of functioning because they are now accountable for a fuller range of services for the patient.

Question 13

A nurse is interested in case management.Which statement indicates an understanding of the primary work environment of case manager?

Accepted Answer

Nurses who are case managers work in all types of health care institutions.They may also work for insurance or utilization review companies or in health-related areas of various types of large businesses.Registered nurses,social workers,and therapists may all be case managers,but how they perform their role depends on the scope of practice of their discipline.All case managers must be skilled at communication,critical thinking,negotiation,and collaboration.They must be knowledgeable about resources available to patients.The case manager not only deals with individual patients but also with family and other support systems of the patient; however,a case manager's work is not focused on just the community.

Question 14

A nurse has been assigned as team leader for the day and is working with two LPNs and two unlicensed personnel.What should the nurse do to ensure success in caring for patients?

Accepted Answer

To ensure success for the day,the nurse should continuously communicate with the members of the team throughout the entire day.The nurse should be sure to update all members of the team on any change in patient status.The LPN can also report changes in a patient's condition to a health care provider because it doesn't have to be the team leader.Revisions of each patient's plan of care should be done continuously has changes arise and not just once a shift.

Question 15

A new nurse is determining which hospital to apply for.The nurse has heard a lot about magnet hospitals from friends that are nurses and knows that working for a magnet hospital would mean

Accepted Answer

Magnet hospitals are known for attracting and retaining nurses because of their high satisfaction rates among nurses.These hospitals have low job turnover and low nurse vacancy even when the hospital is in an area experiencing a nursing shortage.

Question 16

Which statement is true about patient classification systems?

Accepted Answer

A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs.This system does not measure the needs of all patients,is not used an as absolute formula for unit staffing,and is not used to make patient assignments.Patient acuity is the measure of categorizing patients based on their nursing care requirements.Patient classification systems,particularly with increased computerization and the ability to access the system online,provide many benefits.Specifically,they can be used to improve patient care outcomes,identify appropriate staffing,track budget compliance and costs,and maintain nurse retention through their ability to impact staffing through assessment of patients' conditions.

Question 17

Which of the following statements shows the nurses understanding of primary nursing?

Accepted Answer

In primary nursing,the fragmentation between shifts and nurses is eliminated because one nurse is accountable for planning the care of the patient around the clock.Primary nursing is not the only method of care used today.Functional nursing is when nursing care is broke into a series of tasks performed by many people,which results in a fragmented,impersonal kind of care.Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment.In team nursing,groups of patients are assigned to a team headed by a team leader,usually an RN,who coordinates the care for a designated group of patients.In primary nursing,a nurse plans and directs the care of a patient over a 24-hour period.This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is accountable for planning the care of the patient around the clock.In a patient-focused care system,the patient comes into contact with fewer people,and the RN,who is familiar with the patient's plan of care,supervises the delivery of care.This model also moves RNs to a higher level of functioning because they are now accountable for a fuller range of services for the patient.

Question 18

Which of the following statements about evidence-based practice shows that the nurse has an adequate understanding?

Accepted Answer

The statement "Evidence-based practice is the use of current best evidence in making decision about patient care" shows that the nurse has an adequate understanding.The other statements about evidence-based practice are false.

Question 19

The nurse is reviewing upcoming discharges.Which patient would a case manager be assigned to?

Accepted Answer

Case managers become involved when patients have complicated health care needs are receiving care that is expensive or are receiving care from multiple providers.The patient that is post sepsis is likely to be seeing a team of doctors and will need that care transferred over to the nursing home setting.The case manager can bridge that care so that the transition is smooth for the patient.The other patients need minimal support and therefore would not qualify for case management.

Question 20

The nurse has an adequate understanding of patient-focused care when stating which of the following?

Accepted Answer

In patient-focused care,the nurse (not a physician)supervises delivery of care.This system increases productivity and encourages the patient to be an active member of the health care team.Patients are encouraged to be active participants in the planning of their care.

Quiz 15: The Health Care Organization and Patterns of Nursing Care Delivery