Chapter 6: Acute Health Care Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 6: Acute Health Care

MULTIPLE CHOICE

1. The prepayment plan developed in 1929 is

a.

Blue Cross Health Insurance.

b.

Medicare Insurance.

c.

Medicaid Insurance.

d.

Health Maintenance Organization.

ANS: A

The 1929 Blue Cross Plan offered a form of prepayment insurance. Medicare and Medicaid are government entitlement programs. Health maintenance organizations arose as cost-containment measures, and physicians are reimbursed at a fixed rate for each person enrolled.

DIF: Knowledge/Remembering REF: p. 73 OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care

2. A hospital staff nurse is collaborating with a nurse case manager in planning the care of a client with a below-the-knee amputation. The primary role of the case manager is

a.

client education on specialized care.

b.

coordination of care for the client.

c.

direct care of the clients medical problems.

d.

education of the staff nurse.

ANS: B

Case managers are nurses who coordinate the care of a group of clients, monitor the implementation of interdisciplinary care plans, and maintain communication with third-party payers and referral sources.

DIF: Comprehension/Understanding REF: p. 78 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Case Management

3. A registered nurse (RN) seeking work in a voluntary health agency would choose a

a.

church-affiliated hospital.

b.

proprietary hospital.

c.

state university hospital.

d.

veterans administration (VA) hospital.

ANS: A

Voluntary agencies are not-for-profit, tax-exempt organizations designed to meet health care needs of the public.

DIF: Knowledge/Remembering REF: p. 74 OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care

4. A client experiences chest pain with electrocardiographic changes during an appointment with the primary care physician, and the physician orders hospital admission for cardiac monitoring. This type of admission is a(n)

a.

elective admission.

b.

emergency admission.

c.

direct admission.

d.

scheduled admission.

ANS: C

A direct admission is the process followed when a client is determined to need hospital or nursing care while in a physicians office.

DIF: Comprehension/Understanding REF: p. 75 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care

5. A client for whom the nurse would provide postacute care is the

a.

38-year-old following cesarean birth.

b.

40-year-old recovering from kidney stone removal.

c.

60-year-old receiving a regulated regimen of anti-hypertensive medication.

d.

76-year-old needing rehabilitation after cardiac surgery.

ANS: D

Postacute care areas are designed for clients who are out of the fragile phase of their illness and need routine monitoring and rehabilitation. After childbirth and kidney stone removal, the client would most likely need inpatient care at a hospital. A client receiving anti-hypertensive medications would most likely be followed in an ambulatory care setting.

DIF: Comprehension/Understanding REF: p. 76 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care

6. While administering an antibiotic to a client with an infection, the nurse explains the importance of completing the full course of antibiotic therapy. This is an example of

a.

formal education.

b.

giving advice.

c.

informal education.

d.

setting an example.

ANS: C

Informal education continues throughout the course of nursing care in the form of directions and explanations. Formal education is a formal presentation.

DIF: Application/Applying REF: p. 77 OBJ: Intervention

MSC: Health Promotion and Maintenance Principles of Teaching/Learning

7. When unit staffing includes unlicensed assistive personnel, the nurse is aware that

a.

delegating tasks to unlicensed assistive personnel is not in the scope of RN practice.

b.

licensed personnel are accountable for the tasks delegated to the unlicensed personnel.

c.

unlicensed assistive personnel do not have clinical duties on a client care unit.

d.

unlicensed assistive personnel have formal training and function independently.

ANS: B

Nurses remain accountable for client outcomes whether or not the specific tasks are performed by nurses or by nurse extenders.

DIF: Comprehension/Understanding REF: pp. 78-79 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

8. When a nurse is able to work effectively in more than one care area (e.g., general medical-surgical, and cardiac care unit), the nurse is said to be

a.

cross-trained.

b.

flexibly assigned.

c.

nursing intense.

d.

skill mixed.

ANS: A

In an attempt the make the most effective use of available personnel, nurses may be cross-trained to work skillfully in two or more specialty care areas. A skill mix is the ratio of RNs to LPNs and assistive personnel to deliver the highest quality care while controlling cost.

DIF: Knowledge/Remembering REF: pp. 77, 80 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care

9. An applicant was denied employment with a health care agency because she is a recovering alcoholic. This action by the agency violates the

a.

Age Discrimination and Employment Act.

b.

Americans with Disabilities Act.

c.

Civil Rights Act.

d.

Occupational Safety and Health Act.

ANS: B

In 1990 the Americans with Disabilities Act was passed to eliminate discrimination against persons with physical or mental disabilities. The Age Discrimination and Employment Act protects individuals over the age of 65. The Civil Rights Act protects individuals from employment discrimination on the basis of qualifications unrelated to job performance (such as race) and promotes employment based on ability and merit. The Occupational Safety and Health Act requires places of employment to be free of hazards and requires they write and enact safety policies.

DIF: Comprehension/Understanding REF: p. 81 OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

10. A planned program of loss prevention and liability control best defines

a.

client satisfaction.

b.

clinical pathway.

c.

quality assurance.

d.

risk management.

ANS: D

Risk management is a planned program of loss prevention to identify and analyze risks in an effort to reduce accidents and injuries. Client satisfaction data are usually collected after a client is discharged from a hospital or other care setting. Quality assurance is a multi-leveled plan with components such as strategic planning, budgeting, performance improvement, and other elements. A clinical pathway is a plan that directs client care and recovery from predictable problems.

DIF: Knowledge/Remembering REF: p. 82 OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care

11. A client injured in an automobile accident is now stable but permanently ventilator-dependent and has little potential for further improvement. The client is to be transferred to postacute care services. The nurse manager recommends a

a.

general medical-surgical unit.

b.

long-term care unit.

c.

rehabilitation unit.

d.

transitional unit.

ANS: B

Long-term care is the option for a client who is stable and has little recovery potential. Long-term care units are more cost-effective when acute care is no longer needed. The general medical-surgical unit is for acute situations, not a chronic case. In this case, the client has little recovery potential; if the client had the potential to gain further functional ability, a rehabilitation unit would be best. A transitional unit is a type of postacute setting in between intensive care and a more general medical-surgical floor.

DIF: Comprehension/Understanding REF: p. 76 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Resource Management

12. The nurse who is delegating care to unlicensed assistive personnel should keep in mind that most of these workers have an educational background consisting of

a.

completion of high school.

b.

less than 1 year of college.

c.

more than 1 year of college.

d.

on-the-job experience.

ANS: D

Other than on-the-job experience, unlicensed assistive personnel have very little formal training.

DIF: Knowledge/Remembering REF: p. 78 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

13. Using a nursing intensity classification system, the nurse manager assesses that the client requiring the greatest amount of care is the

a.

24-year-old with a 3-day-old fractured femur in Russells traction.

b.

37-year-old in isolation for hepatitis who is vomiting.

c.

42-year-old 1 day after a craniotomy.

d.

76-year-old 4 days after a cerebrovascular accident (CVA) who is comatose.

ANS: C

The craniotomy client will need high-level assessment and highly technological procedures. The other clients, although ill, have common care problems that require no more than routine care investment.

DIF: Analysis/Analyzing REF: p. 80 OBJ: Assessment

MSC: Safe, Effective Care Environment Management of Care-Delegation

MULTIPLE RESPONSE

1. A registered nurse (RN) is considering delegating some tasks to unlicensed assistive personnel (UAP). Which of the following things should the nurse consider when making this decision? (Select all that apply.)

a.

Does the task have exact, unchanging directions?

b.

Does the UAP want to do the task?

c.

Is an RN or other licensed personnel required to do this task?

d.

Is the UAP competent to perform this task?

e.

Is there a licensed provider, such as an RN, available to supervise?

ANS: A, C, D, E

Other considerations include the following: Has there been proper direction and communication about what is expected? Is the task simple and direct? Whether or not the UAP wants to do the task is not part of the legal aspects of making the decision to delegate.

DIF: Analysis/Analyzing REF: p. 79 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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