Chapter 1--The Health Care System and Contemporary Nursing

MULTIPLE CHOICE

	1.	The nurse ensures that a client’s bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care?
1.	Florence Nightingale	
2.	Sister Callista Roy	
3.	Dorothea Orem	
4.	Martha Rogers	

ANS:	1
Florence Nightingale’s theory focused on the environment for care. Sister Callista Roy’s model is based in systems theory and an individual’s ability to adapt. Dorothea Orem’s model is the self-care deficit theory. Martha Roger’s model is the science of unitary human beings.

PTS:	1	DIF:	Apply	
REF:	Emergence of Contemporary Nursing in the United States		

	2.	The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Henderson’s theory of nursing?
1.	A caring relationship	
2.	Helping the client achieve independence from the nurse’s assistance as quickly as possible	
3.	Integration of objective and subjective data	
4.	Application of critical thinking	

ANS:	2
Virginia Henderson’s theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurse’s assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and application of critical thinking are included in the American Nurses Association’s essential features of professional nursing.

PTS:	1	DIF:	Analyze	
REF:	Emergence of Contemporary Nursing in the United States		

	3.	A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: 
1.	ensure payment is made to Medicare for services rendered.	
2.	maximize the utilization of health care resources.	
3.	efficiently manage costs while providing quality care.	
4.	focus on the illness when providing care.	

ANS:	3
Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs.

PTS:	1	DIF:	Understand	REF:	Cost of Care

	4.	A client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following?
1.	Fragmented care	
2.	Overpayment of services	
3.	Inability to sustain health	
4.	Finding an appropriate general practitioner	

ANS:	1
In the 1980s, the close and trusting relationship between an individual and the individual’s physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner.

PTS:	1	DIF:	Analyze	REF:	Providers of Care	

	5.	The nurse is attending a master’s degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will:
1.	hinder the nurse’s ability to work with physicians.	
2.	be viewed as not supporting the profession of nursing by other nurses.	
3.	ensure the nurse is biased towards clinicians’ interests.	
4.	prepare the nurse to serve as strong clinical support with the ability to integrate business and caring.	

ANS:	4
The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurse’s ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The education will ensure that the nurse is not biased towards clinicians’ interests.

PTS:	1	DIF:	Analyze	REF:	Clinical Systems Leadership

	6.	A client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client?
1.	“It does feel like that sometimes.”	
2.	“Health insurance companies have caused this problem.”	
3.	“The doctors will get paid regardless of the clients’ outcomes.”	
4.	“There are quality programs in place to make sure clients receive the best quality of care regardless of the cost.”	

ANS:	4
In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the client’s concerns nor do they explain quality management programs.

PTS:	1	DIF:	Apply	REF:	Quality Measure Shift	

	7.	The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance?
1.	Safety	
2.	Timeliness	
3.	Efficiency	
4.	Availability	

ANS:	2
The dimension of timeliness means the degree in which interventions are provided at the most beneficial time to the client. Safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. Efficiency means the degree in which care has the desired effect with a minimum of effort, waste, or expense. Availability means the degree in which appropriate interventions are available to meet the client’s needs.

PTS:	1	DIF:	Analyze	
REF:	Box 1-1 Joint Commission Dimensions of Quality Performance	

	8.	The nurse is providing care while adhering to safety as a Joint Commission Dimension of Quality Performance. Which of the following did the nurse provide to the client?
1.	Using a needleless device when providing intravenous medications	
2.	Keeping the siderails of the bed in the down position after providing a pain medication to a client	
3.	Having the client sit in a wheelchair with the wheels in the unlocked position	
4.	Placing cloth towels over a spill in the room of an ambulatory client	

ANS:	1
The dimension of safety means the degree in which the risk of an intervention and risk to the environment are reduced for both client and health care provider. The nurse who uses a needleless device when providing intravenous medications is adhering to this dimension. Keeping the siderails in the down position is not a safe practice. Having a client sit in a wheelchair with the wheels unlocked is not a safe practice. Placing cloth towels over a spill in the room of an ambulatory client is not a safe practice.

PTS:	1	DIF:	Analyze	
REF:	Box 1-1 Joint Commission Dimensions of Quality Performance	

	9.	The nurse is planning and providing care while adhering to the American Nurses Association definition of professional nursing. Which of the following does the nurse include when implementing client care?
1.	Follows the NANDA nursing diagnoses process	
2.	Integrates objective and subjective data	
3.	Respects cultural diversity of peers	
4.	Acknowledges the experience and training of physicians	

ANS:	2
The American Nurses Association acknowledges six essential features of professional nursing. These include: 1) a caring relationship, 2) attention to the full range of human health and illness experiences, 3) integrates objective and subjective data, 4) applies scientific knowledge and critical thinking, 5) advances nursing knowledge through scholarly inquiry, and 6) promotes social justice. The nurse integrating objective and subjective data is implementing one of the six essential features of professional nursing. The other choices are not essential features of professional nursing.

PTS:	1	DIF:	Analyze	
REF:	Emergence of Contemporary Nursing in the United States		

	10.	The nurse has shifted her practice from an illness focus to a health focus. Which of the following has this nurse implemented?
1.	Standardized care plans	
2.	Critical pathways	
3.	Instructing a client on relaxation techniques to aid with sleep	
4.	Holding around-the-clock medication when a client is asleep	

ANS:	3
The use of client education as a strategy to attain and maintain the potential for health is an example of the shift of care from an illness focus to a health focus. The nurse instructing a client on relaxation techniques to aid with sleep is implementing a health focus of care. The other choices do not support the shift from an illness focus to a health focus.

PTS:	1	DIF:	Analyze	REF:	Leadership

	11.	A client is admitted with a highly communicable disease. The nurses do not want to participate in the care of this client. Which of the following should be done to ensure the client receives the highest quality of care?
1.	Adhere to strict standard precautions.	
2.	Plan to have the client transferred to another health care organization.	
3.	Ask the physician if the client can be cared for in the home.	
4.	Suspend the nurses without pay who refuse to care for the client.	

ANS:	1
When providing care in a highly global environment, the risks of communicable diseases increases. In the event that a client is admitted with a highly communicable disease and the nurses are fearing for their own health and safety, the only safe approach is to ensure all staff adhere to strict standard precautions. The other choices do not ensure that the client will receive the highest quality of care. The nurses must learn emotional intelligence and resolve issues under fire.

PTS:	1	DIF:	Analyze	REF:	Globalization		

	12.	The nurse has been an employee of an organization for 2 years and is considering a job change. Which of the following does this nurse’s plan suggest to any future employers?
1.	The nurse moves to other jobs too frequently.	
2.	The nurse is inflexible.	
3.	The nurse is searching for a more challenging environment with career opportunities.	
4.	The nurse is willing to sacrifice home and personal life for a job.	

ANS:	3
At one point in time, job changes every 2 or 3 years was considered a red flag for employers. This does not hold true today. The nurse who changes jobs every 2 or 3 years is interested in career advancement and success. Creativity is valued and opportunities are desired. Moving to another job in 2 to 3 years does not mean the nurse is inflexible. The new generation of nurses does not want to sacrifice home and personal life for a job.

PTS:	1	DIF:	Analyze	REF:	Care Delivery Models	

	13.	The nurse is experiencing pain and fatigue in both arms when using the computer to document client care. Which of the following can the nurse do to reduce these symptoms?
1.	Refuse to use the computer and document using a pen and paper.	
2.	Stand up when using the computer.	
3.	Adjust the keyboard and chair to reduce the pressure on the wrists and arms.	
4.	Ask another nurse to input the information for client care activities.	

ANS:	3
Ergonomic hazards are increasing with health care providers and nurses in particular. Many of these hazards are because of the implementation of computers for documentation. The nurse should adjust the keyboard and chair to reduce the pressure on the wrists and arms when documenting with the computer. The nurse cannot refuse to use the computer. Standing up may not reduce the nurse’s symptoms. The nurse cannot legally ask another nurse to document client care.

PTS:	1	DIF:	Apply	REF:	Ergonomic Hazards	

MULTIPLE RESPONSE

	1.	The nurse is planning care for a client and reviewing appropriate educational materials to use for discharge instructions. Which domains of nursing is this nurse implementing? (Select all that apply.)
1.	Nursing process	
2.	Clinical practice	
3.	Education	
4.	Literature	
5.	Administration	
6.	Research	

ANS:	2, 3
The four domains of nursing are: 1) clinical practice, 2) education, 3) administration, and 4) research. When the nurse plans care for a client, the domain being implemented is clinical practice. When reviewing appropriate educational materials to use for discharge instructions, the domain being implemented is education. The nurse is not utilizing the domains of research or administration. Nursing process and literature are not domains of nursing.

PTS:	1	DIF:	Apply	
REF:	Emergence of Contemporary Nursing in the United States		

	2.	The nurse suspects that another health care colleague may be chemically dependent when which of the following is assessed? (Select all that apply.) 
1.	Prolonged work “breaks”	
2.	Clinical care omissions	
3.	Mood stability	
4.	Extraordinary accomplishments	
5.	Heavy use of fragrances	
6.	Inability to recall recent events	

ANS:	1, 2, 4, 5, 6
Clues of possible chemical dependency include tardiness, late sick calls, frequent or prolonged work “breaks,” inability to recall recent events, heavy use of fragrances, clinical care omissions or errors, patient complaints or requests for a change in care provider, mood instability, and extraordinary accomplishments. Mood stability is not a characteristic of a colleague who is experiencing chemical dependency.

PTS:	1	DIF:	Apply	
REF:	Box 1-6 Clues to the Possibility of Chemical Dependence		

	3.	The nurse is a member of a health care team that includes a physician and other health care providers. These providers work together to ensure the client is relieved of suffering, has diseases cured, and experiences enhanced health and performance. Which of the following are the levels of care represented by this team of health care providers? (Select all that apply.)
1.	Sustain life	
2.	Maintain health	
3.	Regain health	
4.	Minimize injury	
5.	Maximize cost	
6.	Attain enhanced health	

ANS:	1, 2, 3, 6
The medical team’s mission is to relieve suffering and cure disease. This involved the three levels of care: 1) sustain life, 2) regain health, and 3) maintain health. Once the shift toward health care occurred, the fourth level of attaining enhanced health was added. Minimize injury and maximize cost is not a level of care.

PTS:	1	DIF:	Analyze	REF:	Providers of Care	

	4.	A client tells the nurse that she is disappointed that her employer is offering a health maintenance organization for a health care benefit. Which of the following can the nurse use as responses to the client as advantages of this type of health plan? (Select all that apply.)
1.	“Since there is a nursing shortage, clients need to stay out of the hospital.”	
2.	“This type of plan provides wellness care at a minimal cost to keep people healthy.”	
3.	“This type of plan helps clients avoid illnesses with high costs.”	
4.	“An HMO standardizes diagnostic and treatment decisions across the nation.”	
5.	“This type of plan ensures coordinated services from wellness to death.”	
6.	“This type of plan costs as much as the traditional plans, but the insurance companies get the extra money from premiums.”	

ANS:	2, 3, 4, 5
There are several missions and visions of managed care. The first is to provide wellness care at a minimal cost to keep people healthy and avoid providing illness care at a higher cost. Another mission is to standardize diagnostic and treatment decisions across the nation. Managed care emphasizes the delivery of coordinated services across the care spectrum from wellness to death and uses financial incentives to decrease length of stay and achieve cost efficiency. Managed care was not implemented to address the nursing shortage. This type of plan does not cost as much as a traditional health plan nor do the insurance companies receive the extra money from premiums.

PTS:	1	DIF:	Apply	REF:	Cost of Care

	5.	The nurse has incorporated several criteria that are essential for being a member of a profession. Which of the following has this nurse done? (Select all that apply.)
1.	Has passed the licensure examination	
2.	Works regularly scheduled shifts	
3.	Completed a bachelor’s degree in nursing	
4.	Limits absences from work	
5.	Joined the American Nurses Association	
6.	Reads evidenced-based information to incorporate into planning client care	

ANS:	1, 3, 5, 6
There are seven essential criteria for a profession. The nurse has incorporated four of these criteria by passing the licensure examination, the nurse has implemented a code of ethics; by completing a bachelor’s degree in nursing, the nurse has been educated in an institution of higher education; by joining the American Nurses Association and reading evidenced-based information, the nurse is affiliated with a professional association that promotes and ensures quality practice. Working regularly scheduled shifts and limiting absences from work are not essential criteria for a profession.

PTS:	1	DIF:	Analyze	REF:	Box 1-3 Essential Criteria for a Profession