1: Chapter The Health Care System
MULTIPLE CHOICE 1. An 89-year-old man, recently discharged from a rehabilitation hospital because of his inability to concentrate and frequent memory lapses, cannot be left alone while his family works because of safety concerns. What options can the discharge planning team suggest that will give the greatest quality of life to the patient? 1. Placement in a day care center from 8 AM to 5 PM daily 2. Placement in a long-term psychiatric facility 3. Placement in a high-security nursing home 4. Admission to a general hospital for evaluation ANS: 1 Day care centers provide supervision, safety, nutritious meals, and socialization while the caregiving family works. PTS: 1 DIF: Cognitive Level: Application REF: 9 OBJ: 5 TOP: Day Care Centers KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 2. A 66-year-old hospitalized patient is anxious about how the physician will be paid now that the patient is on Medicare Part A and Part B, instead of his previous privately funded insurance plan. The nurse explains that the physician will be paid by: 1. the previously private funded insurance. 2. Medicare Part A. 3. Medicare Part B. 4. the patient or his family. ANS: 3 Part A pays skilled care facilities; Part B pays for physicians services. The previous insurance is no longer available because of the patients age. The family or patient is not responsible, because Part B is in effect. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 4 TOP: Health Care Funding Nursing Process Step: Implementation NCLEX: Psychosocial Integrity REF: 4
3. A nurse could best refer an unemployed 42-year-old renal failure patient who has lost his job-related private insurance to which health care plan for his medical care? 1. Medicare 2. Medicaid 3. Public health facility 4. Community-based outpatient clinic ANS: 2 Medicaid is available to needy low-income persons under 65 who have a permanent disability. Medicare is for persons over 65. Public health services are involved with prevention more than with chronic care.
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Comprehension 4 TOP: Health Care Funding Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment
REF: 5
4. A 50-year-old woman with terminal cancer of the lung with extensive metastasis is requesting a hospice transfer. The requirements for this transfer include: 1. the patient requesting and agreeing to the guidelines of hospice care, but not requiring a physicians order. 2. physician confirmation that the patient has 6 months or less of life remaining and a written order for hospice care. 3. proof that the family can no longer care for the patient at home. 4. a specific diagnosis on a list of accepted diseases that qualifies the patient for hospice care. ANS: 2 The four criteria for transfer to hospice care are diagnosis of any terminal illness, prognosis of less than 6 months of life, informed consent of patient, and written physicians order. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 5 TOP: Hospice Care Nursing Process Step: Implementation NCLEX: Physiological Integrity REF: 9
5. A 42-year-old patient admitted yesterday with a DRG (diagnosis-related group) diagnosis of Abdominal Pain, cause unknown, is being discharged this afternoon, because all diagnostic tests have been negative. This is an example of: 1. effective laboratory response. 2. Medicare guidelines limiting hospital stay. 3. cost containment related to DRG. 4. a patient who should not have been admitted in the first place. ANS: 3 Cost containment is a means by which the cost of hospitalization time is reduced when the need for acute hospital care is no longer necessary. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 4 TOP: Cost Containment per DRGs Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment REF: 10
6. In discussing the discharge to a transitional sub-acute facility with a 72-year-old diabetic who has had both legs amputated, the nurse informs the patient that his stay in the new facility will be: 1. limited to 25 days. 2. limited to 50 days. 3. limited to 75 days. 4. totally unlimited. ANS: 4
Medicare limitations are waived in the case of amputations. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 5 TOP: Stay in a Skilled Care Facility Nursing Process Step: Planning NCLEX: Safe, Effective Care Environment REF: 10
7. Two of the primary branches of the Department of Health and Human Services (DHHS) are the: 1. Social Security Administration and Health Care Financing Administration. 2. National Institutes of Health and Food and Drug Administration. 3. Health Services Administration and Centers for Disease Control and Prevention. 4. Health Resources Administration and Alcohol, Drug Abuse, and Mental Health Administration. ANS: 1 Two of the four branches of DHHS are the Social Security Administration (SSA) and the Health Care Financing Administration (HCFA). PTS: 1 DIF: Cognitive Level: Knowledge REF: 1 OBJ: 1 TOP: Branches of DHHS KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 8. Which of the following is true about proprietary agencies? 1. They are organized to be a nonprofit operation. 2. They are organized to make a profit on their operation. 3. Any profit they make is used immediately for better equipment and services. 4. The Balanced Budget Act affected only psychiatric state hospitals. ANS: 2 These agencies are usually owned by large corporations and established for the purpose of profit making. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 8 TOP: Proprietary Agencies Nursing Process Step: N/A NCLEX: Health Promotion and Maintenance REF: 6
9. Which patient would the nurse recognize as eligible for referral to Medicaid? 1. A military auto mechanic with severe asthma 2. A pregnant unmarried young woman employed at a discount retail store for 3 years 3. A college student on scholarship who works part time at the college library who needs medication for arthritis 4. An unemployed young mother on welfare who needs diabetic medication for one of her children ANS: 4 Medicaid covers medication and health care for welfare recipients. PTS: 1 DIF: Cognitive Level: Application REF: 5
OBJ: 1, 4 TOP: Medicaid Services Eligibility KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 10. The nurse reminds a group of parents that the program to immunize children just beginning school is an example of ____ prevention? 1. Primary 2. Secondary 3. Tertiary 4. Basic ANS: 1 Immunizations to prevent and control disease in children just beginning school is an example of primary prevention. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Levels of Prevention Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance REF: 2
11. The person who is considered the forerunner of modern public health nursing in the United States is: 1. Vincent DePaul. 2. William Rathbone. 3. Florence Nightingale. 4. Lillian Wald. ANS: 4 Lillian Wald is recognized as the forerunner of modern public health nursing. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Knowledge REF: 7 2 TOP: Leaders and Founders of Public Health Nursing Nursing Process Step: N/A NCLEX: Health Promotion and Maintenance
12. The nurse, using a colored picture of the food guide pyramid to teach proper nutrition concepts to a patient with diabetes, is using a technique of ____ prevention. 1. primary 2. secondary 3. tertiary 4. basic ANS: 2 Teaching with the use of visual aids is an example of supplying learned skills as a technique for secondary prevention. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Secondary Prevention Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance REF: 2
13. A 76-year-old man, hospitalized for treatment following a stroke, asks the nurse how long he can expect Medicare to cover his treatment. The nurses most informative response is: 1. Your Part B will cover your hospital care as long as is necessary. 2. Your care provider will determine how long your Medicare coverage will be in effect. 3. You are allowed 50 days of inpatient care annually. 4. You can receive skilled care for up to 100 days. ANS: 4 Persons hospitalized for skilled nursing care receive 100 days of Medicare coverage. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 6 TOP: Skilled Care Limitation Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance REF: 4
14. care Health benefits supported by both federal and state funding are exemplified in: 1. cost-containment prospective funding. 2. DHHS Social Security benefits for dentures. 3. CDC surveillance of persons at risk for AIDS. 4. Medicaid provision for skilled care in the home. ANS: 4 Federal and state cooperation are involved in home skilled care issues. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application REF: 5 4 TOP: Coordinating Medicaid/Medicare Benefits Nursing Process Step: Implementation NCLEX: Physiological Integrity
15. The nurse assessing a 65-year-old client who is scheduled for outpatient surgery for cataracts in 10 days will stress the: 1. need for adequate insurance. 2. provision of adequate postoperative care at home. 3. need to acquire specialized glasses. 4. need to preserve and protect his vision. ANS: 2 Outpatient surgical clients are at greater risk for postoperative complications in the absence of professional monitoring. This risk emphasizes the need for preoperative teaching and provision of postoperative support in the home. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis REF: 6 6 TOP: Postoperative Care for Outpatients Nursing Process Step: Assessment NCLEX: Health Promotion and Maintenance
16. The nurse explains that skilled nursing facilities are mandated to staff their facility with: 1. one RN serving as director and one licensed nurse on duty for at least 8 hours each
day. 2. RNs to provide complex care such as ostomy changes, IVs, or wound care. 3. RNs to supervise the patient care given by aides. 4. two LPNs and three aides per 10 patients at all times. ANS: 1 A skilled facility must have an RN as director and an RN on duty for at least 8 hours each day. Staffing in a skilled nursing facility allows the supervision by LPNs over nursing aides. LPNs may change ostomy appliances, monitor IVs, and perform wound care. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application REF: 11 1, 5 TOP: Skilled Nursing Facilities Staffing Requirements Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment
17. A long-term care facilitys purpose is to: 1. rehabilitate clients to their former level of functioning. 2. restore clients to their optimum level of independence. 3. offer care to clients who do not need hospitalization but cannot care for themselves. 4. care exclusively for clients with dementia. ANS: 3 Long-term care facilities care for clients who do not need to be hospitalized but who cannot care for themselves. Although many demented clients are found in a long-term care facility, such facilities are not exclusively for their care. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 5 TOP: Long-Term Care Facilities Nursing Process Step: N/A NCLEX: Safe, Effective Care Environment REF: 11
18. A resident in a long-term care facility has difficulty swallowing and frequently chokes on food and liquids. Because of the threat of aspiration, the nurse initiates a referral for swallowing evaluation to a: 1. doctor specializing in throat disorders. 2. dietitian. 3. nutritionist. 4. speech therapist. ANS: 4 Speech therapists are qualified to evaluate swallowing disorders. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 1 TOP: Swallowing Difficulties Nursing Process Step: Implementation NCLEX: Physiological Integrity REF: 8
MULTIPLE RESPONSE
1. The nurse clarifies the difference between an HMO (health maintenance organization) and a fee-for-service plan by pointing out that an HMO (select all that apply): 1. requires a set fee from each client. 2. allows clients to select their own health care provider. 3. permits admission to any inpatient facility. 4. offers limited referral options. 5. provides both inpatient and outpatient care. ANS: 1, 5 HMOs require a set fee from each client to use care providers specified or hired by each HMO. Inpatient and outpatient care are provided in specified facilities. HMOs have a large group of specialists to which to refer clients. Fee-for-service is more expensive, but does allow the client to choose the care provider and health care facility. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis REF: 6 5 TOP: Comparison of HMO to Fee-for-Service Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance
2. The nurse assures the parents of a newborn with congenital heart defect that the home care for their child is eased and supported by (select all that apply): 1. the availability of smaller and more compact equipment. 2. specialized diagnosis-related groups (DRGs) for home care of children. 3. Medicaid-funded care services. 4. home care services funded by private insurance. 5. grants and stipends from various drug manufacturers. ANS: 1, 2, 3, 4 Medicaid funds home care for children, specialized DRGs and home-sized equipment make home care for children more easily accomplished. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 5 TOP: Home Health Care for Children Nursing Process Step: Planning NCLEX: Health Promotion and Maintenance REF: 9
3. The nurse outlines the benefits of the utilization of a home health aide for his or her ability to assist a home-bound client with (select all that apply): 1. bathing. 2. doing laundry. 3. shopping for groceries. 4. administering medication. 5. ambulating. ANS: 1, 5 Home health aides may assist with bathing, ambulation, skin care, and minor homemaking chores. They are not qualified to administer medication. Tasks of laundry, heavy house cleaning, and grocery shopping are inappropriate for the home health aide and are more appropriately assigned to a homemaker serviceperson.
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Analysis 5 TOP: Home Health Aid Utilization Nursing Process Step: Planning NCLEX: Health Promotion and Maintenance
REF: 8
4. When the client inquires about eligibility for home health care, the nurse states that the criteria for skilled home health care are (select all that apply): 1. income less than $20,000 annually. 2. need for physical therapy or speech therapy. 3. nonavailability of transportation. 4. need for IV medication administration. 5. need for wound dressing changes. ANS: 2, 4, 5 Eligibility for skilled care from a home health care aide include the need for nursing care for IVs, respirators, wound dressing changes, and physical therapy or speech therapy. There is no requirement relative to low income or lack of transportation. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 5 TOP: Home Health Care Nursing Process Step: Planning NCLEX: Health Promotion and Maintenance REF: 7
5. The nurse explains that the mission of the Public Health Service is to (select all that apply): 1. ensure safety of foods and cosmetics. 2. provide access to health care services for low-income individuals. 3. support medical research. 4. support substance abuse prevention and treatment. 5. monitor and prevent disease outbreaks. ANS: 1, 2, 3, 4, 5 The Public Health Service (PHS) focus is on all levels of prevention for community health, both in providing treatment and supporting prevention. The PHS also supports medical research. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 2 TOP: Public Health Service Nursing Process Step: Implementation NCLEX: Safe, Effective Care Management REF: 2
6. The nurse explains that the Medicare Prescription Drug Plan will (select all that apply): 1. be included as part of Medicare A. 2. charge a $250 deductible. 3. pay approximately 25% of prescription drug expenses. 4. cover only prescriptions written by a medical doctor. 5. reimburse 95% of out-of-pocket expenses over $3600. ANS: 2, 5
Medicare Prescription Plan (Medicare Part D) requires a separate enrollment, pays 50% of drug expenses after the $250 deductible is satisfied, honors all prescriptions written by licensed medical personnel who have prescriptive power, and covers 95% of out-of-pocket expenses, up to $3600. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 4 TOP: Medicare Prescription Plan Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 5
COMPLETION 1. The nurse clarifies that the insurance plan that pays the physician in advance each month for each enrolled client, whether the client is treated by the physician or not, is a strategy known as ____________________. ANS: Capitation. PTS: 1 DIF: Cognitive Level: Analysis REF: 4 OBJ: 6 TOP: Capitation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment