Chapter 18: Managing Care in Secondary and Tertiary Health Care

Chapter 18: Managing Care in Secondary and Tertiary Health Care

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. According to Orem, people enter the acute health care setting when they are experiencing either a self-care or a:

ANS:  C

At various times in life, a person will have a health care demand, either a self-care or dependent-care demand that exceeds his or her self-care agency. When this happens, the person is said to have a self-care or dependent-care deficit. When this deficit is such that the person needs the specialized training of health care professionals, the person enters the health care setting and engages in a collaborative relationship with the RN and other health care team members. All other answer options are incorrect.

DIF:    Cognitive Level: Knowledge            REF:   Page 285

OBJ:   Discuss the theoretical framework for managing in secondary care.

TOP:   Managing Secondary Care

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

2. In the acute care environment, what is(are) the primary role(s) of the RN?

ANS:  D

Acute health care requirements vary with the progress of the disease either toward a cure or through complications that can occur. The RN uses information from many different sources to identify potential and actual problems with the patient’s progress. The overall focus is to prevent complications while promoting a higher level of health. Changing the medical plan of care is not the role of a nurse.

DIF:    Cognitive Level: Knowledge            REF:   Page 286

OBJ:   Identify outcome priorities for secondary care.                   TOP:   Managing Secondary Care

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

3. A nurse writes the diagnosis of “potential for infection” for a postoperative patient. The charge nurse makes certain not to place a patient with a diagnosed infection in the same room with the fresh postoperative patient. The nurse does this to manage which of the following?

ANS:  C

Much within the environment of the acute care setting has the potential to extend the patient’s length of stay by introducing unexpected complications. Moving the patient through the acute care setting effectively and safely requires the RN to pay attention as the patient responds to the environment, as well as to anticipate the potential effects of the environment, including staffing issues. A common nursing diagnosis is “potential for infection,” and nosocomial, or hospital-acquired, infection is just one of the problems that competent nursing management can prevent. The charge nurse can manage this environmental concern by basing bed assignments on the diagnoses of the patients and then subsequently basing caregiver assignment on qualifications. The potential for noise, the potential for complaints, and the social environment have nothing to do with infections or the potential for infections.

DIF:    Cognitive Level: Analysis                REF:   Page 287

OBJ:   Analyze factors influencing patient outcomes.                   TOP:   Managing Secondary Care

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

4. After being diagnosed with cancer, the patient appears angry. At this point it would be appropriate for the nurse to assess for which kind of distress?

ANS:  D

Patients facing stressful health care–related events may also experience spiritual distress. Illness states can place a patient in a position that forces consideration of the fragile nature of life. Resulting from a potential life-or-death experience or a life-changing event, spiritual distress may take on many manifestations. Much as in the grief process, the patient may display anger, blame, bargaining, or denial or may overtly cling to a spiritual guide. RNs assess for spiritual distress and implement interventions that will help the patient cope, such as facilitating the patient’s spiritual connection either through a referral or just by respecting personal wishes. Environmental, developmental, and physical distresses are not typically related to chronic or terminal disease situations.

DIF:    Cognitive Level: Analysis                REF:   Page 288

OBJ:   Analyze factors influencing patient outcomes.

TOP:   Managing Secondary Care: Spiritual

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

5. Some cultures see personal touching as an insult unless you are intimately related. In the acute care setting, the need for touching to administer care may produce what within the patient?

ANS:  A

Cultural strain may be manifested in the patient’s responses to the surroundings or to the plan of care. One culture-derived concept is personal space, the distance surrounding a person considered to be part of his or her identity. Personal space is generally thought to be between 1 and 3 feet around a person, depending on cultural upbringing and personal interpretation. A breach of that space by objects or another person may cause discomfort and stress. Impaired functioning, cultural insult, and increased self-care deficit are not discussed in relation to cultural needs and influences.

DIF:    Cognitive Level: Analysis                REF:   Page 289

OBJ:   Analyze factors influencing patient outcomes.

TOP:   Managing Secondary Care: Culture

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care