(Test Bank) Introductory Medical-Surgical Nursing

Unknown, 11

Nursing

Test Bank

11th Edition

• $15.00 $50.00

---

Description

Test Bank for Introductory Medical-Surgical Nursing, The downloadable file consists of 970 pages, and the total size of the file is 8.09 MB. Purchase now only for highly discounted price.

---

---

Study Note Preview

Answer Key for Workbook for Introductory Medical -Surgical Nursing , 11e Chapter 1 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Illness 2. Client 3. Healthcare delivery system 4. Health 5. Medicaid Activity B 1. Holism 2. Healthcare team 3. Medicare 4. Diagnosis -related groups 5. Wellness Activity C 1. C 2. D 3. E 4. A 5. B Activity D 1. The major difference between illness and disease is that illness is highly individual and personal , whereas disease is something more definitive and measurable. For example, a client with arthritis presents with distinct pathologic changes associated with the disease. A person, however, may or may not be ill with arthritis. The degree of pain, suffering, and immobility varies from person to person. 2. Health maintenance refers to protecting one’s curre nt level of health by preventing illness or deteri oration, such as by complying with medication regimens, being screened for diseases such as breast cancer or colon cancer, or practicing safe sex. Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress -reduction techniques. 3. Medicare covers indiv iduals who are 65 years or older, permanently disabled workers of any age with specific disabilities, and persons with end -stage renal disease. 4. The team includes physicians, nurses, psychologists, pharmacists, dietitians, social workers, respiratory an d physical therapists, occupational therapists, nursing assistants, technicians, and insurance company staff. All members of this team collaborate on client issues (medical, social, and financial) to achieve the best possible outcomes. 5. Groups such as c hildren, older adults, ethnic minorities, and the poor are most likely to be underserved by the healthcare system. Activity E 1. Point -of-service (POS) organizations involve a network of providers. Clients select a primary care physician within the group who then serves as the gatekeeper for other healthcare services. Clients can use healthcare providers in or out of the provider group, but may pay additional fees, such as a higher deductible or copayment, for providers outside the group, unless the primar y physician approves. 2. Clients select a primary care physician within the group who then serves as the gatekeeper for other healthcare services. As with other types of managed care organizations , the focus is on prevention as the best way to manage heal thcare costs. 3. Benefits for the insurer include discounted services, reduced services, and elimination of unnecessary referrals (Chitty & Black, 2011). 4. All are types of managed care networks. They provide a number of services within the network at a controlled cost. All provide incentive to stay within the network by providing lower cost services. Seeking services outside each of the organizations would incur higher costs for the client with the exception of the point -of service (POS) plan, which all ows it if approved by the primary care physician who serves as the gatekeeper. The goal of all the organizations (POS, PPO, and PHO) is to maintain high -quality service and contain costs. SECTION 2: APPLYING YOUR KNOWLEDGE Activity F 1. Member s of an HMO must receive authorization (referral) for secondary care, such as second opinions from specialists or diagnostic testing . If members obtain unauthorized care, they are responsible for the entire bill. In this way, HMOs serve as gatekeepers for healthcare services. 2. Some individuals delay seeking early treatment for their health problems because they cannot afford to pay for services. When an illness becomes so severe that the only choice is to seek medical attention, many turn to their local hospital eme rgency departments for primary care. This expensive alternative usually involves long waits and no follow -up care. 3. Possible premature discharge of clients and increased responsibility for family members who may be unable to provide adequate care create s much criticism of the prospective payment system. These systems have also caused shifts in costs from clients with Medicare to those who have private insurance. Providers charge privately insured clients inflated amounts to make up for losses in Medicare revenues. Activity G 1. Demand for evidence that hospitals and practitioners provide high -quality, cost -effective care comes from insurers, regulatory bodies such as The Joint Commission, and consumers. One example of standardized indicators are the qua lity indicators (QIs) provided by t he Agency for Healthcare Research and Quality (AHRQ). These QIs can be used to measure healthcare quality at the federal, state, and local levels . The Joint Commission has also established National Patient Safety Goals (N PSGs), which are updated annually. Multidisciplinary teams use clinical pathways or care mapping for specific diagnoses or procedures, which standardize important aspects of care. Many other methods exist for determining quality of care. Patient satisfacti on surveys, quality -of-life questionnaires, functional assessment tools, number of hospital admissions per year for clients with chronic illnesses, and morbidity (complications) and mortality (deaths) rates are a few important measures assessed when examin ing quality. 2. Managed care involves insurers who carefully plan and closely supervise the distribution of healthcare services. The goals of managed care include the following : (i) Use healthcare resources efficiently . (ii) Deliver high -quality care at a reasonable cost . (iii) Measure, monitor, and manage fiscal and client outcomes . (iv) Prevent illness through screening and health promotion activities . (v) Provide client education to decrease the risk of the disease . (vi) Case -manage clients with chronic illnesses to minimize number of hospitalizations . 3. In an attempt to reduce redundancy of healthcare services and increase economic leverage, hospitals and other healthcare facilities are forming networks known as integrated delivery systems. Fully integrated healthcare delivery systems provide the following : (i) Wellness programs (ii) Preventive care (iii) Ambulatory care (iv) Outpatient diagnostic and laboratory services (v) Emergency care (vi) General and tertiary hospital services (vii) Rehabilit ation (viii) Long -term care (ix) Assisted living facilities (x) Psychiatric care (xi) Home healthcare services (xii) Hospice care (xii) Outpatient pharmacies 4. Illness prevention involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one’s health. E arly detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Examples include mammography and colonoscopy. Activity H What do you think? <This activity solicits in dividual responses from the students. > Activity I 1. A sign is the objective manifestation of a disease —something that can be seen, heard, measured, or felt. A symptom is a subjective manifestation of a disease or illness —the experience the client describes. One sign the nurse observed was that the client was overweight at 196 lb. The client’s laboratory test results were also signs that indicated measured characteristics of her blood. Another sign was the client’s previous experience with gestation al diabetes. The symptoms the client was experiencing were fatigue, frequent thirst, frequent urination, and increased appetite. 2. See Figure 1 -1 in Chapter 1 of the text for an example of the health -illness continuum. The client is determined to stay ac tive and healthy to reduce the possibility of future complications. She is practicing health maintenance while focusing on illness prevention. The client perceives herself in the normal to good health range on the continuum. 3. The nurse practitioner took time to address the physical problems the client was experiencing while trying to put her at ease by answering her questions, encouraging her, and planning a course of action with the client’s input and understanding. The nurse also made arrangements for follow -up care and arranged for services through the network for diabetes education classes and equipment. Holism means viewing a person’s health as a balance of body, mind, and spirit and considering a client’s psychological, sociocultural, developmental, and spiritual needs. The nurse did so in this example by providing information, encouragement, equipment, and other resources that went beyond simply addressing the client’s physical needs. 4. A preferred provider organization (PPO) operates on the princ iple that competition can control costs. Acting as agents for health insurance companies, PPOs create a community network of providers who are willing to discount their fees for service in exchange for a steady stream of referred customers. By providing th e client with the tools she needs to manage her diabetes, the PPO helps to control costs and decreases the possibility of any future illness or hospitalizations. Consumers can lower their healthcare costs if the received care is from the preferred provider s. Keeping the client healthy not only decreases her risk for future illness or hospitalizations but also adds to her quality of life. SECTION 3: GETTING READY FOR NCLEX Activity J 1. *Answer: 3 Rationale: Nurses practice from the perspective of holism, which means that they view a person’s health as a balance of body, mind, and spirit. Treating only a person’s physical needs will not necessarily restore them to optimal health. Therefore, the nurse must also look at a person’s psychological, sociocultural, developmental, and spiritual needs. Option 1 does not include a client’s spiritual or sociocultural needs. Option 2 does not include the physical needs of a client. Option 3 is correct because it includes a ll of the client’s needs. Option 4 is incorrect because it does not include the psychological and sociocultural needs. 2. *Answer: 4 Rationale: Nurses collect data ; diagnose human responses to health problems ; and plan, provide, and evaluate outcomes of c are. Diagnosing and communicating the diagnosis to the client is not the role of the nurse but the role of the physician. Nurses are not allowed to diagnose conditions, only the human responses to health problems. Prescribing medications is also not a rout ine nurse responsibility, unless the nurse is an advanced practice nurse and has prescribing authority. The nurse is an advocate for the client and not the physician. The nurse must carry out physician orders but must question them when necessary while adv ocating for the client. 3. *Answer: 2 Rationale: Many people are taking more responsibility for their health status. Health maintenance refers to protecting one’s current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancer, or practicing safe sex. Therefore, Option 2 is correct. Health promotion refers to engaging in strategies to enhance health. Such strategies include eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress -reduction techniques. H ealth prevention is not a term used in healthcare, although illness prevention is and involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one’s health. Health detection is also not applicable because the textbook identifies early detection as the use of screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Examples include mammography and colonoscopy (Chitty & Black, 2011). 4. *Answer: 1 Rationale: The nurse should recommend Medicare only for the 75 -year-old client with high blood pressure. This is because Medicare is for older Americans; it does not cover long -term care and limits covera ge for health promotion and illness prevention. It only covers individuals who are 65 years of age or older, permanently disabled workers of any age and their dependents, and individuals with end -stage renal disease. Urinary tract infection, signs of hepat ic disease, asthma, and breathlessness are not covered in this plan. 5. *Answer: 2 Rationale: Secondary care refers to referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis , making Option 2 the correct answer. Primary care includes the contact by a client with a healthcare provider such as a family practitioner, internist, or nurse practitioner in order to meet a healthcare need ; therefore, Option 3 is not the correct answer. Option 1 is incorrect becau se tertiary care is provid ed in hospitals where specialists and complex technology are used to care for the client. Hospice care relates to comfort and supportive care that is received when a client has 6 months left to live , making Option 4 an incorrect a nswer. 6. *Answer: 3 Rationale: The prospective payment system provides payment for a hospitalization at the same rate regardless of the cost of the hospital surgery and how long the client stays. For diagnosis - related group (DRG) 209, which is Total Joint Replacement, all of the above s urgeries that these clients had are reimbursed at the same rate. Therefore, Option 3 is the correct answer. Option 1 is incorrect, because a managed care organization is an insurer that carefully plans and closely supervises the distribution of healthcare services that are usually preventive in nature. Option 2 is incorrect because a preferred provider organization (PPO) operates on the principle that competition can control costs. PPOs create a community network of providers who are willing to discount the ir fees for service in exchange for a steady supply of referred customers. If the consumer goes outside the network, they pay a higher cost of the bill. Health maintenance organizations (HMOs) are group insurance plans in which participant s pay a preset, f ixed fee in exchange for healthcare services. The fee is based on the number of participants and expected services in the plan and is also referred to as capitation, which refers to the actual head or person count. 7. *Answer: 4 Rationale: Demand for evid ence that hospitals and practitioners provide high -quality, cost - effective care comes from insurers, regulatory bodies such as The Joint Commission, and consumers. To meet this demand, hospitals form performance improvement committees also known as quality improvement or outcomes management committees. These committees use standardized indicators to measure healthcare quality . Therefore, Option 4 is the correct answer. Option 1 is incorrect because identifying clients of interest to the hospital does not ne cessitate how the “interest” impacts quality. The answer is too vague. Option 2 is incorrect because surveys are not the only way to identify quality measures and are not always standardized. Option 3 is incorrect because risk management’s goal is to reduc e liability to the hospital and not ensure quality. 8. *Answer: 3 Rationale: Clinical pathways are care maps that standardize important aspects of care such as diagnostic workups, nursing care, education, physical therapy, and discharge planning across th e estimated length of stay and are used by multidisciplinary team s. Variances from the pathway can be used to identify trends that are beneficial or detrimental to a client’s care , and cha nges can be made as necessary. Option s 1, 2, and 4 are not care maps that are used in a client’s care . 9. *Answer: 2 Rationale: The U.S. Department of Health and Human Services (200 5) has identifie d national health goals that provide an overall action plan to improve the health and quality of life for people living in the United States. The Healthy People 20 20 goals include increasing the quality and years of healthy life and e liminat ing health dispa rities . The Centers for Disease Control and the U.S. Surgeon General do not have this responsibility. The Institute of Healthcare Improvement developed a project to reduce preventable deaths in hospitals, not to improve the health and quality of life for p eople living in the United States. 10. *Answer: 4 Rationale: Groups such as children, older adults, ethnic minorities, and the poor are most likely to be underserved and/or not served at all, creating an access to care issue . Many of these people delay seeking early treatment for their health problems because they cannot afford to pay for services. When an illness becomes so severe that the only choice is to seek medical attention, many turn to their local hospital emergency departments for primary care. This expensive alternative usually involves long waits and no follow -up care. The other possible responses are not access issues listed in this text. Answer Key for Workbook for Introductory Medical -Surgical Nursing , 11e Chapter 2 SECTION 1: ASSESSING YOUR UNDERSTANDING Activity A 1. Inpatient units 2. Team nursing 3. Case management Activity B 1. Case method 2. Functional nursing 3. Patient -focused care Activity C 1. C 2. G 3. E 4. I 5. A 6. K 7. H 8. D 9. F 10. J 11. B Activity D 1. These facilities are not regulated as long -term care facilities are, and there is some concern that the quality of care is not at an appropriate level. The Joint Commission is developing a voluntary accreditation process for assisted living facilities to ensure consistency and quality of care. In many instances, this type of living arrangement is very expensive. Clients must provide a large, up -front investment and then pay a high monthly fee. Some facilities may not provide services such as housekeeping, laundry, transportation, and meals. 2. Clients can maximize their independence in this setting because it maintains their privacy and dignity. Clients can maintai n a lifestyle more similar to living in their own home. They are also able to make their own decisions about future care needs. 3. Boarding homes are usually small homes with individual rooms. Some residents share rooms. Clients pay for room and board and minimal nursing services. There is usually a common dining area for meals. Residents in boarding homes may relinquish independence and privacy. Boarding home s provide a stable environment for those who cannot live independently. Assisted living facilities provide care for those who require assistance with up to three ADLs. Residents maximize their independence and maintain privacy. In many cases,