Module 39 Managing Care

Module 39   Managing Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

The Concept of Managing Care

 

1) A nurse is working in a clinic environment. This nurse places great emphasis on cost control, customer satisfaction, health promotion, and preventive services. The primary focus of this nurse is representative of which type of healthcare system?

1. A) Functional method
2. B) Client-focused care
3. C) Case method
4. D) Managed care

Answer:  D

Explanation:

1. A) Managed care describes a healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients. The case method of care is a client-centered model in which one nurse is assigned to care for a group of clients during an 8- to 12-hour shift. The functional method of care focuses on jobs to be completed and is task oriented. Client-focused care is a delivery model that brings all services and care providers to the client.
2. B) Managed care describes a healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients. The case method of care is a client-centered model in which one nurse is assigned to care for a group of clients during an 8- to 12-hour shift. The functional method of care focuses on jobs to be completed and is task oriented. Client-focused care is a delivery model that brings all services and care providers to the client.
3. C) Managed care describes a healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients. The case method of care is a client-centered model in which one nurse is assigned to care for a group of clients during an 8- to 12-hour shift. The functional method of care focuses on jobs to be completed and is task oriented. Client-focused care is a delivery model that brings all services and care providers to the client.
4. D) Managed care describes a healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients. The case method of care is a client-centered model in which one nurse is assigned to care for a group of clients during an 8- to 12-hour shift. The functional method of care focuses on jobs to be completed and is task oriented. Client-focused care is a delivery model that brings all services and care providers to the client.

Page Ref: 2457

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Assessment

Learning Outcome:  1. Describe the goals and emphasis of managed care.

 

2) A nurse is completing discharge teaching for a client who is about to be discharged to home following a total hip replacement. The client asks the nurse why there is a case manager involved and expresses confusion about who is in charge. The client states, “I thought the doctor manages my care.” Which is the best response by the nurse?

1. A) “No, I manage your care.”
2. B) “You are correct; the doctor is responsible for managing your care.”
3. C) “A case manager coordinates everyone involved in your care to ensure your needs are met.”
4. D) “The case manager delegates your care to the nurse.”

Answer:  C

Explanation:

1. A) The case manager is responsible for assuring that all the client’s healthcare needs are met in a cost-effective manner. The nurse may be a case manager; however, a staff nurse is not the most likely individual in the hospital setting to be the case manager. An agency usually has several case managers, who collaborate with nursing, the physician, and any other departments involved in the care of the client. A physician does not participate in care by being a case manager. Case managers coordinate disciplines of care for the client and do not delegate any care to other professionals.
2. B) The case manager is responsible for assuring that all the client’s healthcare needs are met in a cost-effective manner. The nurse may be a case manager; however, a staff nurse is not the most likely individual in the hospital setting to be the case manager. An agency usually has several case managers, who collaborate with nursing, the physician, and any other departments involved in the care of the client. A physician does not participate in care by being a case manager. Case managers coordinate disciplines of care for the client and do not delegate any care to other professionals.
3. C) The case manager is responsible for assuring that all the client’s healthcare needs are met in a cost-effective manner. The nurse may be a case manager; however, a staff nurse is not the most likely individual in the hospital setting to be the case manager. An agency usually has several case managers, who collaborate with nursing, the physician, and any other departments involved in the care of the client. A physician does not participate in care by being a case manager. Case managers coordinate disciplines of care for the client and do not delegate any care to other professionals.
4. D) The case manager is responsible for assuring that all the client’s healthcare needs are met in a cost-effective manner. The nurse may be a case manager; however, a staff nurse is not the most likely individual in the hospital setting to be the case manager. An agency usually has several case managers, who collaborate with nursing, the physician, and any other departments involved in the care of the client. A physician does not participate in care by being a case manager. Case managers coordinate disciplines of care for the client and do not delegate any care to other professionals.

Page Ref: 2457

Cognitive Level:  Analyzing

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  2. Examine the role of the case manager in a managed care environment.

 

3) A new graduate nurse is looking for employment and hopes to find a facility where the nursing staff participates in making, implementing, and evaluating client care policies. Which healthcare system implements this practice?

1. A) Client-focused care
2. B) Differentiated practice
3. C) Managed care
4. D) Shared governance

Answer:  D

Explanation:

1. A) Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This model consists of specific job descriptions for nurses according to their education or training. Client-focused care is a delivery model that brings all services and care providers to the client. Managed care focuses on cost containment, consumer satisfaction, health promotion, and preventive services.
2. B) Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This model consists of specific job descriptions for nurses according to their education or training. Client-focused care is a delivery model that brings all services and care providers to the client. Managed care focuses on cost containment, consumer satisfaction, health promotion, and preventive services.
3. C) Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This model consists of specific job descriptions for nurses according to their education or training. Client-focused care is a delivery model that brings all services and care providers to the client. Managed care focuses on cost containment, consumer satisfaction, health promotion, and preventive services.
4. D) Shared governance is an organizational model in which nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies. Differentiated practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets. This model consists of specific job descriptions for nurses according to their education or training. Client-focused care is a delivery model that brings all services and care providers to the client. Managed care focuses on cost containment, consumer satisfaction, health promotion, and preventive services.

Page Ref: 2457-2458

Cognitive Level:  Understanding

Client Need:  Safe and Effective Care Environment

Nursing Process:  Assessment

Learning Outcome:  3. Summarize frameworks for delivering care, including the advantages and disadvantages of each.

 

4) You have been appointed to a clinical-administrative task force studying critical staffing issues and care delivery models for your hospital. What evidence on the effects of different staffing choices and care delivery models should your task force consider?

Select all that apply.

1. A) Higher nurse-client ratios have been linked to a decrease in the amount of time clients are hospitalized.
2. B) Shared governance is linked to a reduction in adverse outcomes.
3. C) A higher proportion of registered nurses can reduce the risk of mortality in surgical clients.
4. D) Research indicates that functional assignment of staff improves the likelihood of meeting clients’ emotional needs.
5. E) There is little or no research studying nursing ratios and client outcomes.

Answer:  A, C

Explanation:

1. A) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nursing ratios result in fewer adverse outcomes for clients.
2. B) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nursing ratios result in fewer adverse outcomes for clients.
3. C) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nursing ratios result in fewer adverse outcomes for clients.
4. D) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nursing ratios result in fewer adverse outcomes for clients.

 

1. E) Higher nurse-client ratios have been associated with shorter lengths of stay and fewer complications. A recent study depicted a significant reduction in the risk of mortality in surgical clients when the proportion of registered nurses was higher. There is little research on care delivery models since it is more difficult to compare outcomes because each unit may employ slight variations of the model. Research continues to prove that higher nursing ratios result in fewer adverse outcomes for clients.

Page Ref: 2458

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Client Need Sub:  Reduction of Risk Potential

Nursing Process:  Planning

Learning Outcome:  3. Summarize frameworks for delivering care, including the advantages and disadvantages of each.

 

5) A nurse is applying for a job as a case manager for a managed care insurance organization. What are some of the responsibilities that can be anticipated in this role?

1. A) Providing home visits to clients
2. B) Independent treatment planning
3. C) Coordinating client care through all stages of treatment
4. D) Approving treatment decisions

Answer:  C

Explanation:

1. A) Insurance-based case management is a labor-intensive activity that is provided typically by telephone. Case management involves interdisciplinary teams that assume collaborative responsibility for planning and assessing needs. Case management involves coordinating, implementing, and evaluating care for groups of clients from preadmission through discharge or transfer and recuperation. Approving treatment decisions is not a case management role.
2. B) Insurance-based case management is a labor-intensive activity that is provided typically by telephone. Case management involves interdisciplinary teams that assume collaborative responsibility for planning and assessing needs. Case management involves coordinating, implementing, and evaluating care for groups of clients from preadmission through discharge or transfer and recuperation. Approving treatment decisions is not a case management role.
3. C) Insurance-based case management is a labor-intensive activity that is provided typically by telephone. Case management involves interdisciplinary teams that assume collaborative responsibility for planning and assessing needs. Case management involves coordinating, implementing, and evaluating care for groups of clients from preadmission through discharge or transfer and recuperation. Approving treatment decisions is not a case management role.
4. D) Insurance-based case management is a labor-intensive activity that is provided typically by telephone. Case management involves interdisciplinary teams that assume collaborative responsibility for planning and assessing needs. Case management involves coordinating, implementing, and evaluating care for groups of clients from preadmission through discharge or transfer and recuperation. Approving treatment decisions is not a case management role.

Page Ref: 2457

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  2. Examine the role of the case manager in a managed care environment.

Exemplar 39.1  Care Coordination

1) The nurse is helping in discharge planning for a diabetic client who needs extensive rehabilitation and is on a complicated medication schedule. The client and spouse currently live with their eldest son and the family is very involved in the client’s care. The nurse would want to coordinate the client’s care by including which individual(s) in this client’s plan?

Select all that apply.

1. A) Pharmacist
2. B) Client’s children
3. C) Physician
4. D) Social worker
5. E) Client’s spouse

Answer:  B, E

Explanation:

1. A) Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client’s spouse and children would be important in this situation because of the complexity of the client’s situation. The physician, pharmacist, and social worker may also be included, but by their own decision, not necessarily by the nurse’s invitation, as is the case with coordination.
2. B) Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client’s spouse and children would be important in this situation because of the complexity of the client’s situation. The physician, pharmacist, and social worker may also be included, but by their own decision, not necessarily by the nurse’s invitation, as is the case with coordination.
3. C) Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client’s spouse and children would be important in this situation because of the complexity of the client’s situation. The physician, pharmacist, and social worker may also be included, but by their own decision, not necessarily by the nurse’s invitation, as is the case with coordination.
4. D) Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client’s spouse and children would be important in this situation because of the complexity of the client’s situation. The physician, pharmacist, and social worker may also be included, but by their own decision, not necessarily by the nurse’s invitation, as is the case with coordination.

 

1. E) Effective discharge planning necessitates health team conferences and family conferences and gives the client, family, and healthcare professionals the opportunity to plan care and set goals. Involving the client’s spouse and children would be important in this situation because of the complexity of the client’s situation. The physician, pharmacist, and social worker may also be included, but by their own decision, not necessarily by the nurse’s invitation, as is the case with coordination.

Page Ref: 2460

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Differentiate between coordination and collaboration.

 

2) The nurse is caring for a 4-year-old female client who suffered brain damage following a car accident. The client has a tracheostomy and is ventilator-dependent. The client is ready for discharge from the hospital. The family wants to care for the child at home but does not have the resources for 24-hour care. The case manager intervenes by:

1. A) Making multiple referrals to a variety of community-based agencies that can meet the family’s needs.
2. B) Telling the family that it is impossible to provide care at home.
3. C) Arranging for the child to be sent to a long-term healthcare facility.
4. D) Contacting local nurses in the community to provide the assistance that the family needs to provide care for the client.

Answer:  A

Explanation:

1. A) The referral process is a systematic problem-solving approach that helps clients to use resources that meet their healthcare needs. The process involves knowledge of community resources and an ability to solve problems, set priorities, coordinate, and collaborate. The family’s wishes for post-hospital care should be respected if other possibilities exist, which, in this case, they do. The nurse would not be responsible for a fundraiser. Contacting local nurses would not be an efficient way to coordinate care for the client.
2. B) The referral process is a systematic problem-solving approach that helps clients to use resources that meet their healthcare needs. The process involves knowledge of community resources and an ability to solve problems, set priorities, coordinate, and collaborate. The family’s wishes for post-hospital care should be respected if other possibilities exist, which, in this case, they do. The nurse would not be responsible for a fundraiser. Contacting local nurses would not be an efficient way to coordinate care for the client.
3. C) The referral process is a systematic problem-solving approach that helps clients to use resources that meet their healthcare needs. The process involves knowledge of community resources and an ability to solve problems, set priorities, coordinate, and collaborate. The family’s wishes for post-hospital care should be respected if other possibilities exist, which, in this case, they do. The nurse would not be responsible for a fundraiser. Contacting local nurses would not be an efficient way to coordinate care for the client.
4. D) The referral process is a systematic problem-solving approach that helps clients to use resources that meet their healthcare needs. The process involves knowledge of community resources and an ability to solve problems, set priorities, coordinate, and collaborate. The family’s wishes for post-hospital care should be respected if other possibilities exist, which, in this case, they do. The nurse would not be responsible for a fundraiser. Contacting local nurses would not be an efficient way to coordinate care for the client.

Page Ref: 2461

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  2. Predict potential barriers to effective coordination along with strategies to overcome or avoid these barriers.

 

3) A nurse is caring for a client who had a total hip replacement 14 days ago. The client is preparing for discharge in a few days. The nurse facilitates a care conference with the physician, occupational therapist, physical therapist, and the client and family to develop a plan of care for the client prior to discharge. Which of the following roles is the nurse demonstrating?

Select all that apply.

1. A) Coordinator
2. B) Collaborator
3. C) Differentiated practitioner
4. D) Team leader
5. E) Expert

Answer:  A, B

Explanation:

1. A) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
2. B) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
3. C) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.
4. D) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.

 

1. E) The nurse is solving problems and planning care for the client by coordinating and collaborating with the other health team members who will participate in client care. All members of the team may be experts, but the level of expertise is not the role the nurse is exhibiting. The nurse is not responsible for how the members of the health team perform their jobs as a team leader would be. The nurse is not acting as an authoritarian in this case; the nurse is planning care and coordination. Differentiated practice involves nursing care from all levels of education and is not illustrated in this scenario.

Page Ref: 2460-2461

Cognitive Level:  Understanding

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  3. Summarize skills necessary to achieve effective coordination.

 

 

4) A client who is experiencing an exacerbation of rheumatoid arthritis (RA) is about to be discharged after a week’s stay in the hospital. The client tells the nurse, “I can’t believe how much better I am feeling now.” The nurse is aware that the client’s feeling is based on which of the following?

1. A) The client appreciating the various levels of care given
2. B) Scheduling client care by all disciplines that allowed the client to rest
3. C) Keeping the client busy each day
4. D) The client’s disease process having been stopped

Answer:  B

Explanation:

1. A) When coordinating care for clients, the nurse should consider the client’s ability to tolerate activity and provide blocks of time for rest. Keeping the client busy would work against the client’s best interests and not produce the desired results for overall healing. RA is a chronic disease from which the client will not recover. Although the client may appreciate the various levels of care, that appreciation would not account for how much better the client is feeling after the hospital stay.
2. B) When coordinating care for clients, the nurse should consider the client’s ability to tolerate activity and provide blocks of time for rest. Keeping the client busy would work against the client’s best interests and not produce the desired results for overall healing. RA is a chronic disease from which the client will not recover. Although the client may appreciate the various levels of care, that appreciation would not account for how much better the client is feeling after the hospital stay.
3. C) When coordinating care for clients, the nurse should consider the client’s ability to tolerate activity and provide blocks of time for rest. Keeping the client busy would work against the client’s best interests and not produce the desired results for overall healing. RA is a chronic disease from which the client will not recover. Although the client may appreciate the various levels of care, that appreciation would not account for how much better the client is feeling after the hospital stay.
4. D) When coordinating care for clients, the nurse should consider the client’s ability to tolerate activity and provide blocks of time for rest. Keeping the client busy would work against the client’s best interests and not produce the desired results for overall healing. RA is a chronic disease from which the client will not recover. Although the client may appreciate the various levels of care, that appreciation would not account for how much better the client is feeling after the hospital stay.

Page Ref: 2461

Cognitive Level:  Evaluating

Client Need:  Physiological Integrity

Nursing Process:  Planning

Learning Outcome:  4. Illustrate the anticipated benefits when care coordination is effective.

 

5) A nurse is responsible for the care coordination of a client with multiple sclerosis who is being treated at a multiservice outpatient clinic. The nurse is informed by the occupational therapist that the client needs specialized assistive devices in order to prepare meals but does not have the money to purchase them. The client’s insurance company has denied approval to cover the devices. What is the most appropriate action for the nurse to take?

1. A) Tell the occupational therapist that she will have to come up with another plan to meet the client’s needs.
2. B) Advocate with the insurance company to provide the appropriate coverage.
3. C) Explain to the client that she will have to get family members or friends to prepare her meals.
4. D) Explain to the client that she will have to find other methods to pay for the devices.

Answer:  B

Explanation:

1. A) Care coordination may involve advocating with the client’s insurance company to cover the costs of a resource. Telling the occupational therapist or client to come up with other plans or resources is not an appropriate role for a care coordinator. The coordinator may try to find another source to cover the cost for necessary equipment.
2. B) Care coordination may involve advocating with the client’s insurance company to cover the costs of a resource. Telling the occupational therapist or client to come up with other plans or resources is not an appropriate role for a care coordinator. The coordinator may try to find another source to cover the cost for necessary equipment.
3. C) Care coordination may involve advocating with the client’s insurance company to cover the costs of a resource. Telling the occupational therapist or client to come up with other plans or resources is not an appropriate role for a care coordinator. The coordinator may try to find another source to cover the cost for necessary equipment.
4. D) Care coordination may involve advocating with the client’s insurance company to cover the costs of a resource. Telling the occupational therapist or client to come up with other plans or resources is not an appropriate role for a care coordinator. The coordinator may try to find another source to cover the cost for necessary equipment.

Page Ref: 2461

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Implementation

Learning Outcome:  2. Predict potential barriers to effective coordination along with strategies to overcome or avoid these barriers.

 

6) A nurse working in an outpatient OB-GYN clinic has been asked to assume care coordination for the clinic’s teenage clients. What skills will the nurse need to perform this work?

1. A) Critical thinking skills
2. B) Force field analysis skills
3. C) Relaxation training skills
4. D) Accounting skills

Answer:  A

Explanation:

1. A) Critical thinking skills are crucial to the development of a well-coordinated care plan and its execution. Specific strategic analysis skills are not necessary for this role. Relaxation training skills and accounting skills are not a part of care coordination.
2. B) Critical thinking skills are crucial to the development of a well-coordinated care plan and its execution. Specific strategic analysis skills are not necessary for this role. Relaxation training skills and accounting skills are not a part of care coordination.
3. C) Critical thinking skills are crucial to the development of a well-coordinated care plan and its execution. Specific strategic analysis skills are not necessary for this role. Relaxation training skills and accounting skills are not a part of care coordination.
4. D) Critical thinking skills are crucial to the development of a well-coordinated care plan and its execution. Specific strategic analysis skills are not necessary for this role. Relaxation training skills and accounting skills are not a part of care coordination.

Page Ref: 2460

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Client Need Sub:  Management of Care

Nursing Process:  Planning

Learning Outcome:  3. Summarize skills necessary to achieve effective coordination.

 

Exemplar 39.2  Cost-Effective Care

 

1) A 72-year-old male client tells the nurse he is worried about how he will pay his hospital bill. The client is being discharged and referred to home health care and the new plan of care now involves extremely expensive drugs. Which is the best response by the nurse?

1. A) “You need to focus on recovering and not worry about finances.”
2. B) “I’ll have someone from the business office come and set up your payment plan.”
3. C) “Don’t worry. I’m sure everything will work out okay.”
4. D) “Much of your care will be covered by Medicare.”

Answer:  D

Explanation:

65. A) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client’s concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client’s concerns. Passing the concern to the business office does not address the client’s concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
66. B) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client’s concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client’s concerns. Passing the concern to the business office does not address the client’s concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
67. C) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client’s concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client’s concerns. Passing the concern to the business office does not address the client’s concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.
68. D) The Medicare amendments to the Social Security Act and their subsequent expansions provide a national and state health insurance program that includes extremely expensive hospital care and prescription drug coverage for adults over the age of 65. Ignoring the client’s concerns by telling him not to worry is not therapeutic communication and does little, if anything, to confront the client’s concerns. Passing the concern to the business office does not address the client’s concerns. Nurses should have some knowledge about the payment sources of their clients, especially those who have automatic coverage with Medicare because of their age.

Page Ref: 2460

Cognitive Level:  Applying

Client Need:  Psychosocial Integrity

Nursing Process:  Implementation

Learning Outcome:  1. Differentiate the various types of payment sources available in the United States.

 

2) The nurse is caring for a female client from Canada who has come to the United States for a serious neurological surgery. The client tells the nurse that she came to this country because she will receive better care because of which of the following?

1. A) “In America you have many choices about health care.”
2. B) “America has a universal healthcare system.”
3. C) “I am in favor of rationing to bring down health costs.”
4. D) “There is very little competition in health care in the United States.”

Answer:  A

Explanation:

1. A) Americans with health insurance have more of a choice about their health care than do other nations of the world. Canada, not the United States, has a universal healthcare system. Most other countries do not allow for competition in health care, but the United States does. Rationing is one reason why clients come to the United States; with rationing, an individual could wait months for needed surgery.
2. B) Americans with health insurance have more of a choice about their health care than do other nations of the world. Canada, not the United States, has a universal healthcare system. Most other countries do not allow for competition in health care, but the United States does. Rationing is one reason why clients come to the United States; with rationing, an individual could wait months for needed surgery.
3. C) Americans with health insurance have more of a choice about their health care than do other nations of the world. Canada, not the United States, has a universal healthcare system. Most other countries do not allow for competition in health care, but the United States does. Rationing is one reason why clients come to the United States; with rationing, an individual could wait months for needed surgery.
4. D) Americans with health insurance have more of a choice about their health care than do other nations of the world. Canada, not the United States, has a universal healthcare system. Most other countries do not allow for competition in health care, but the United States does. Rationing is one reason why clients come to the United States; with rationing, an individual could wait months for needed surgery.

Page Ref: 2463

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  2. Contrast the U.S. system of health care with the healthcare systems of other countries.

 

3) An instructor is teaching the class about cost-conscious nursing practice. The instructor knows that the students understand this concept when the students make which statement(s)?

Select all that apply.

1. A) “Nurses must search for more efficient ways to deliver nursing care.”
2. B) “Careful use of supplies will reduce waste and save money.”
3. C) “I do have to take short cuts every now and then.”
4. D) “There are insufficient healthcare workers to meet the need right now.”
5. E) “A new emphasis has been placed on health promotion and disease prevention.”

Answer:  A, B, E

Explanation:

1. A) Nurses at all levels face significant pressures to become more cost conscious. This level of financial accountability is new to the nursing profession. Nurses must now compete with other departments within organizations for limited resources. Nurses can be more cost-conscious by carefully using supplies, by searching for more efficient ways to deliver nursing care, and by placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead to mistakes and client care should never be compromised. It is true that there are insufficient healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.
2. B) Nurses at all levels face significant pressures to become more cost conscious. This level of financial accountability is new to the nursing profession. Nurses must now compete with other departments within organizations for limited resources. Nurses can be more cost-conscious by carefully using supplies, by searching for more efficient ways to deliver nursing care, and by placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead to mistakes and client care should never be compromised. It is true that there are insufficient healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.
3. C) Nurses at all levels face significant pressures to become more cost conscious. This level of financial accountability is new to the nursing profession. Nurses must now compete with other departments within organizations for limited resources. Nurses can be more cost-conscious by carefully using supplies, by searching for more efficient ways to deliver nursing care, and by placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead to mistakes and client care should never be compromised. It is true that there are insufficient healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.
4. D) Nurses at all levels face significant pressures to become more cost conscious. This level of financial accountability is new to the nursing profession. Nurses must now compete with other departments within organizations for limited resources. Nurses can be more cost-conscious by carefully using supplies, by searching for more efficient ways to deliver nursing care, and by placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead to mistakes and client care should never be compromised. It is true that there are insufficient healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.

 

1. E) Nurses at all levels face significant pressures to become more cost conscious. This level of financial accountability is new to the nursing profession. Nurses must now compete with other departments within organizations for limited resources. Nurses can be more cost-conscious by carefully using supplies, by searching for more efficient ways to deliver nursing care, and by placing a new emphasis on health promotion and disease prevention. Taking short cuts can lead to mistakes and client care should never be compromised. It is true that there are insufficient healthcare workers to meet needs, but this does not contribute to cost-conscious nursing care.

Page Ref: 2464-2465

Cognitive Level:  Analyzing

Client Need:  Safe and Effective Care Environment

Nursing Process:  Planning

Learning Outcome:  3. Summarize the challenges faced by the U.S. healthcare system.

 

4) A veteran nurse is working on a large medical-surgical unit. The nurse is caring for a client with MRSA who requires frequent dressing changes. The nurse makes the decision to help control costs of care by:

1. A) Wiping down equipment at the end of the shift.
2. B) Storing equipment in the client’s room.
3. C) Making sure the client’s room is stocked with all needed supplies.
4. D) Placing a cart with supplies outside the client’s room.

Answer:  D

Explanation:

1. A) When a client with MRSA is discharged, everything in the room is either discarded or terminally cleaned. By keeping needed supplies outside the room, the nurse is containing costs as the supplies will not have to be discarded on discharge. Stocking the room with supplies that may not be needed may increase costs of health care. Storing equipment in the appropriate room will not necessarily reduce costs. Wiping down the equipment at the end of the shift has no effect on cost.
2. B) When a client with MRSA is discharged, everything in the room is either discarded or terminally cleaned. By keeping needed supplies outside the room, the nurse is containing costs as the supplies will not have to be discarded on discharge. Stocking the room with supplies that may not be needed may increase costs of health care. Storing equipment in the appropriate room will not necessarily reduce costs. Wiping down the equipment at the end of the shift has no effect on cost.
3. C) When a client with MRSA is discharged, everything in the room is either discarded or terminally cleaned. By keeping needed supplies outside the room, the nurse is containing costs as the supplies will not have to be discarded on discharge. Stocking the room with supplies that may not be needed may increase costs of health care. Storing equipment in the appropriate room will not necessarily reduce costs. Wiping down the equipment at the end of the shift has no effect on cost.
4. D) When a client with MRSA is discharged, everything in the room is either discarded or terminally cleaned. By keeping needed supplies outside the room, the nurse is containing costs as the supplies will not have to be discarded on discharge. Stocking the room with supplies that may not be needed may increase costs of health care. Storing equipment in the appropriate room will not necessarily reduce costs. Wiping down the equipment at the end of the shift has no effect on cost.

Page Ref: 2466

Cognitive Level:  Evaluating

Client Need:  Safe and Effective Care Environment

Nursing Process:  Implementation

Learning Outcome:  4. Describe the nurse’s role in creating cost-conscious nursing practice.

 

5) A client recovering from an emergency appendectomy is a citizen of France. He asks you to explain why the United States has chosen such a different healthcare reimbursement system from other Western countries. What American values could you mention to explain the system in this country?

1. A) Acceptance of the role of government
2. B) Individual accountability
3. C) Skepticism about markets and competition
4. D) Universality

Answer:  B

Explanation:

1. A) The American system reflects ambivalence toward the role of government. In the United States, individual accountability is valued over equity. The U.S. system is based on market competition. In the United States, pluralism and choice are often valued over universality.
2. B) The American system reflects ambivalence toward the role of government. In the United States, individual accountability is valued over equity. The U.S. system is based on market competition. In the United States, pluralism and choice are often valued over universality.
3. C) The American system reflects ambivalence toward the role of government. In the United States, individual accountability is valued over equity. The U.S. system is based on market competition. In the United States, pluralism and choice are often valued over universality.
4. D) The American system reflects ambivalence toward the role of government. In the United States, individual accountability is valued over equity. The U.S. system is based on market competition. In the United States, pluralism and choice are often valued over universality.

Page Ref: 2463

Cognitive Level:  Analyzing

Client Need:  Health Promotion and Maintenance

Nursing Process:  Analysis

Learning Outcome:  2. Contrast the U.S. system of health care with the healthcare systems of other countries.