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Potter: Basic Nursing, 7th Edition

Chapter 02: The Health Care Delivery System

Test Bank

MULTIPLE CHOICE

1. A nurse is teaching the importance of self-breast examination to a group of 20-year-old women. The nurse is promoting _____ care.
A. primary
B. secondary
C. tertiary
D. restorative

ANS: A
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. Primary care is centered on prevention of disease.

PTS: 1 DIF: Cognitive Level: Analysis REF: 21
OBJ: Describe the six levels of health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

2. A patient who needs nursing and rehabilitation after a stroke would benefit most by receiving care at a(n):
A. primary care center.
B. restorative care setting.
C. assisted living center.
D. respite center.

ANS: B
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. Restorative care settings provide rehabilitation and nursing care.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 23
OBJ: Describe the six levels of health care
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

3. A patient states that he cannot afford health care insurance. What is the best form of insurance available to him?
A. Medicaid
B. Medicare
C. Private insurance
D. A managed care organization

ANS: A
Medicare is a federally funded health insurance program. Private insurance is a fee-for-service plan. A managed care organization (MCO) provides care to a specific group of voluntarily enrolled patients. Medicaid is for those who cannot afford insurance.

PTS: 1 DIF: Cognitive Level: Analysis REF: 19
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

4. A managed care system focuses on:
A. customer service and patient choices.
B. admissions, diagnostic testing, and treatments.
C. control over primary health services of a defined population.
D. comprehensive rather than fragmented approaches to health.

ANS: C
Managed care focuses on control over primary services of a defined population. The remaining answers describe levels of health care.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 18
OBJ: Explain the advantages and disadvantages of managed health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

5. A nurse admits an older adult patient who states that she has no living relatives and only friends of her own age. One of the nurse’s immediate considerations for this patient will be to implement a:
A. critical pathway.
B. discharge plan.
C. patient-focused care model.
D. resource utilization group.

ANS: B
A critical pathway is a multidisciplinary treatment plan for the hospitalized patient. A discharge plan 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.

PTS: 1 DIF: Cognitive Level: Application REF: 22
OBJ: Explain the advantages and disadvantages of managed health care
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

6. Technological advances in health care:
A. make a nurse’s job easier.
B. depersonalize bedside patient care.
C. threaten the integrity of the health care industry.
D. do not replace sound personal judgment.

ANS: D
Technological advances influence how and where nurses provide patient care; however, technology does not replace a nurse’s critical eye and clinical judgment.

PTS: 1 DIF: Cognitive Level: Analysis REF: 30, 32
OBJ: Discuss the implications of issues in the health care system on nursing
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

7. In 1983 Congress established the Prospective Payment System (PPS) to:
A. establish cost-based reimbursement for health care.
B. provide reimbursement for patient medications.
C. establish reimbursement rates based upon diagnosis-related groups (DRGs).
D. establish quality improvement measures.

ANS: C
Established by Congress in 1983, the PPS eliminated cost-based reimbursement. 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 diagnosis-related groups (DRGs).

PTS: 1 DIF: Cognitive Level: Knowledge REF: 18
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

8. A 74-year-old man was admitted to the hospital with diabetic ketoacidosis. The hospital where he was admitted will be reimbursed by Medicare according to:
A. his diagnostic-related group.
B. the cost of his care.
C. his length of stay.
D. his clinical outcome.

ANS: A
Established by Congress in 1983, the PPS 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 18
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

9. Capitation is the payment mechanism in which health care providers receive a fixed amount of money for each patient. What is the purpose of capitation?
A. To balance the quality of care with the cost of providing care
B. To provide the least expensive care for patients
C. To build a payment plan that includes professional standards of care
D. To ensure that all patients receive the same care for the same cost

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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 18
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

10. A single mother with three children utilizes the public health department services in her county to immunize her children. Which of the following best describes this level of health care?
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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 21
OBJ: Describe the six levels of health care
TOP: Nursing Process: Assessment
MSC: Client Needs: 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. She has discussed this issue with the school principle and is working on a proposal to ask the school district to explore a school breakfast program. This is an example of which of the following?
A. Primary care
B. Continuing care
C. Restorative care
D. Tertiary care

ANS: A
In the settings that deliver preventive and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme.

PTS: 1 DIF: Cognitive Level: Analysis REF: 21
OBJ: Describe the six levels of health care
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

12. A small business owner has consulted with an occupational health nurse regarding health promotion activities for his employees. The registered nurse explores with him the possibility of providing an area outside the new office complex where employees can walk during their breaks. This an example of which of the following?
A. Continuing care
B. Restorative care
C. Primary care
D. Tertiary care

ANS: C
In the settings that deliver preventive and primary care, such as schools, physicians’ or health care providers’ offices, occupational health clinics, and nursing centers, health promotion is a major theme.

PTS: 1 DIF: Cognitive Level: Application REF: 21
OBJ: Describe the six levels of health care
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

13. A 43-year-old grocery store clerk does not have a family health care provider. She has had a sore throat for the past week and recently began running a fever. Her husband takes her to the local community hospital’s emergency room for treatment. This is an example of what level of care?
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.

PTS: 1 DIF: Cognitive Level: Application REF: 21
OBJ: Describe the six levels of health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

14. A retired high school teacher has been admitted to the hospital with complications of his diabetes. The hospital where he has been admitted uses a case management model to coordinate care. His discharge planning will be coordinated by which of the following?
A. Physician
B. Insurance company representative
C. Case manager
D. Dietitian

ANS: C
In a case management model of care, a case manager, usually a nurse or a social worker, coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care for the patient.

PTS: 1 DIF: Cognitive Level: Application REF: 22
OBJ: Explain the advantages and disadvantages of managed health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

15. Discharge planning is a centralized, coordinated, multidisciplinary process that ensures that a patient has a plan for continuing care after leaving a health care agency. What is the most appropriate time to begin discharge planning?
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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 22
OBJ: Explain the advantages and disadvantages of managed health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

16. Which of the following patients is most in need of discharge planning?
A. 29-year-old mother with a healthy newborn
B. 59-year-old patient after appendectomy
C. 43-year-old patient with heart failure
D. 56-year-old patient after hysterectomy

ANS: C
Some patients are more in need of discharge planning because of the risks they have. 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: 22
OBJ: Explain the advantages and disadvantages of managed health care
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

17. Which of the following is considered the most expensive place to deliver care?
A. Rehabilitation unit
B. Long-term care facility
C. Intensive care unit
D. 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.

PTS: 1 DIF: Cognitive Level: Application REF: 23
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

18. A 23-year-old college student with severe depression was recently admitted to the psychiatric ward of a local hospital. His family is concerned about him finishing his college term. Which of the following 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.
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.

PTS: 1 DIF: Cognitive Level: Application REF: 23
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

19. A 17-year-old girl was seriously injured in a motor vehicle accident and has been transferred from an acute care hospital to a rehabilitation facility. Which of the following options will ensure the best outcome for her?
A. Making sure that she gets enough rest
B. Pushing her beyond her limits
C. Requesting that the family not visit for the first few days
D. Involving her 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.

PTS: 1 DIF: Cognitive Level: Application REF: 25
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

20. A 54-year-old businessman who experienced a stroke four days ago has been discharged from the hospital and will be undergoing outpatient rehabilitation. He should expect which of the following with this level of care?
A. Admission to the rehabilitative unit of the hospital
B. Scheduled appointment times for therapy
C. Home visits from all members of the multidisciplinary team
D. House calls from his 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.

PTS: 1 DIF: Cognitive Level: Application REF: 25
OBJ: Describe the six levels of health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

21. The Omnibus Budget Reconciliation Act of 1987 is also referred to as the _____ Act.
A. Medicaid
B. Nursing Home Reform
C. Diagnostic Related Group
D. Universal Healthcare

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 25
OBJ: Compare the various methods for financing health care
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

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. She knows the purpose of this instrument is to:
A. provide a database to better understand the healthcare needs of this population.
B. provide the nursing staff with an overall physical assessment of the resident.
C. provide statistical evidence to support a universal healthcare policy.
D. determine how many health care resources this population consumes.

ANS: A
The facility needs to complete the RAI on all residents. The RAI consists of the Minimum Data Set (MDS) (Box 2-4), 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 26
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

23. Gladys, an 81-year-old widow with dementia, recently moved in with her daughter Cecilia, 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?
A. A rehabilitation center
B. A nursing center
C. An adult day care center
D. Respite care

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.

PTS: 1 DIF: Cognitive Level: Application REF: 27
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

24. A 78-year-old widow needs assistance with her medications, housekeeping, and laundry. She would like to maintain her independence. Of the following, which is the best option for her to consider?
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.

PTS: 1 DIF: Cognitive Level: Application REF: 26
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

25. Which of the following patients is most suitable for admission into a hospice?
A. 63-year-old man with a fractured femur
B. 45-year-old woman with end-stage renal failure
C. 14-year-old patient with leukemia
D. 78-year-old patient with dementia

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.

PTS: 1 DIF: Cognitive Level: Application REF: 27
OBJ: Discuss the types of settings in which professionals provide various levels of health care TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

26. A registered nurse has been working for an oncology unit for the past year. She 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 she works
B. The charge nurse
C. Her own
D. The oncologist who admits patients to the unit where she works

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 to earn certifications when he or she chooses to practice in specialty areas.

PTS: 1 DIF: Cognitive Level: Application REF: 27
OBJ: Discuss opportunities for nursing within the changing health care delivery system
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

SHORT ANSWER

1. Changes in the health care delivery system are being driven by _____________________.

ANS:
increasing health care costs

Changes in health care are being driven by increasing health care costs.

PTS: 1 DIF: Cognitive Level: Application REF: 33
OBJ: Discuss opportunities for nursing within the changing health care delivery system
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A registered nurse working in a restorative care setting will focus on which of the following? 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

ANS: C, D
A secondary care setting provides in-depth diagnosis and treatment of illnesses that require extensive, one-on-one complex treatments.

PTS: 1 DIF: Cognitive Level: Application REF: 23
OBJ: Describe the six levels of health care
TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance

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