Nursing Fundamentals Practice

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Chapter 03: The Health Care Delivery System

Potter: Essentials for Nursing Practice, 9th Edition
MULTIPLE CHOICE
1. Which is an example of tertiary care?

a. The patient has annual mammograms to screen for breast cancer.
b. The patient sees the podiatrist monthly to prevent diabetic foot ulcers.
c. The patient is seen at an urgent care clinic to treat a badly sprained wrist.
d. The patient is treated in the intensive care unit following a gunshot injury.
ANS: D
Tertiary care includes intensive care after a gunshot injury. Primary care is centered on
prevention of disease such as annual mammograms and podiatry visits. Secondary acute care
treats existing disease such as sprained wrist care.
DIF: Cognitive Level: Apply (Application)

OBJ: Describe the six levels of health care.
TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care
2. Which agency would be most appropriate for a patient who requires rehabilitation services for
right-sided hemiplegia after a stroke?
a. Respite center
b. Primary care center
c. Restorative care center
d. Assisted-living center
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ANS: C
Restorative care centers provide rehabilitation and nursing care. In primary care centers,
health promotion is the major theme. Assisted-living centers offer long-term assistance with
activities of daily living. Respite centers offer short-term relief to people who provide
full-time care to an older adult.

OBJ: Discuss the role of nurses in various health care settings.
3. Which form of insurance is appropriate for a single mother who is unable to work and her
three children?
a. State Medicaid
b. Federal Medicare
c. Private insurance
d. Managed care program
ANS: A
Medicaid is a form of insurance for low-income families. Medicare is a federally funded
health insurance program for people greater than 65 years of age. Private insurance is a
fee-for-service plan. A managed care organization (MCO) provides care to a specific group of
voluntarily enrolled patients.
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OBJ: Discuss the factors that affect a person’s access to health care.
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
4. Which is an example of a patient-centered medical home team?

a. Occupational and physical therapists come to the patient’s home to provide
rehabilitation services.
b. The patient’s primary care physician coordinates care with the patient’s social
worker and respiratory therapist.
c. The nurse assesses the patient’s home environment for irritants that can worsen the
patient’s respiratory status.
d. A home care company is employed to provide the patient with a nebulizer and
supplemental oxygen equipment.
ANS: B
The patient-centered medical home model focuses on smooth coordination of care between
various health care disciplines. An example of this would be the physician’s coordination of
care with the social worker and respiratory therapist. The patient-centered medical home does
not focus on care provided at the patient’s home.

OBJ: Discuss the features of an integrated health care system.
5. Which is an example of a tertiary health care provider?

a. An outpatient rehabilitation center
b. A nurse-managed urgent care clinic
c. A university-based research hospital
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d. A community center offering ANKday
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ANS: C
A university-based teaching hospital is an example of a tertiary health care provider as it
provides care from specialized consultants. A nurse-managed urgent care clinic is a primary
health care provider. An outpatient rehabilitation center is a secondary health care provider. A
community center offering adult day care services is a continuing care provider.
DIF: Cognitive Level: Understand (Comprehension)

6. Which assessment question allows an administrator to determine the level of patient

satisfaction after hospitalization?
a. “Did the nursing staff treat you with respect and maintain your privacy?”
b. “Were you able to keep the follow-up appointment with your physician?”
c. “Did you have any difficulty filling your prescriptions after discharge?”
d. “Has the occupational therapist come to your home to start therapy yet?”
ANS: A
Asking the patient about treatment by the nursing staff during hospitalization is an excellent
way for the administrator to determine the level of patient satisfaction. Asking about
follow-up appointments, prescriptions, and home therapy will not determine the level of
patient satisfaction.
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OBJ: Explain approaches nurses can use to improve patient satisfaction.
TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care
7. The patient is nauseated and vomiting when the nurse attempts to provide discharge teaching.
Which is the most appropriate action of the nurse?
a. Administer antinausea medication and provide discharge teaching later.
b. Provide written materials to the patient to read when the nausea has subsided.
c. Provide discharge teaching to the family members while the patient rests.
d. Assist the patient with mouth care and proceed with the discharge teaching.
ANS: A
Patients cannot effectively learn when they are in discomfort or nauseated. The nurse should
administer antinausea medication and provide discharge teaching later when the patient is
ready. Providing written materials, teaching family members, and proceeding with teaching
after mouth care are not appropriate actions of the nurse in this situation.

OBJ: Describe the elements of discharge planning.
8. How will the hospital be reimbursed by Medicare for an elderly patient admitted with
pneumonia?
a. Based upon the DRG for pneumonia
b. Based upon the cost of the patient’s care
c. Based upon the patient’s length of stay
d. Based upon the types of therapies required
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ANS: A
Payment is based upon the diagnostic-related group. Established by Congress in 1983, the
prospective payment system eliminated cost-based reimbursement. Hospitals serving patients
using Medicare were no longer paid for all costs incurred to deliver care to a patient. Instead,
inpatient hospital services for patients using Medicare were combined into 468
diagnosis-related groups. Hospitals receive a set dollar amount for each patient based on the
assigned DRG, regardless of the patient’s length of stay or use of services in the hospital or
the number of medications.

OBJ: Explain the concept of “pay for value” used to reward hospitals financially.
9. Which is an example of capitation in health care?

a. The patient’s rheumatologist is reimbursed for services provided at each
consultation appointment with the patient.
b. The discharge planner arranges for a home respiratory care company to deliver
home oxygen supplies before the patient leaves the hospital.
c. The patient’s care is managed by a nurse practitioner rather than an attending
physician.
d. The patient’s primary care physician is paid a flat monthly fee no matter how
many appointments are scheduled with the patient.
ANS: D
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The purpose of capitation is to build a payment plan for a provider that is not dependent upon
the amount of health care services provided to the patient. An example of capitation is a flat
monthly fee paid to the physician no matter how many appointments are scheduled with the
patient. Reimbursement for individual appointments with the patient is referred to as fee for
service. Capitation does not refer to care management by nurse practitioners or discharge
planning.

10. A single mother with three children uses the public health department services in the county to
immunize her children. Which level of health care did the mother use?
a. Continuing care
b. Preventative care
c. Secondary acute care
d. Restorative care
ANS: B
Preventative care includes services such as immunizations, screenings, poison control
information, mental health counseling and crisis prevention, and community legislation.
Continuing care is assisted living. Secondary acute care involves emergency and radiological
procedures. Restorative care involves rehabilitation services and home care.

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
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11. The nurse has taught the patient about how to perform sterile dressing changes. Which action
by the nurse best assesses whether or not the patient’s discharge teaching was effective?
a. The nurse watches the patient perform the sterile dressing change and provides
feedback as needed.
b. The nurse provides additional written instructions as a reminder of how to
correctly perform the procedure.
c. The nurse includes the patient’s spouse when teaching the patient how to perform
the sterile procedure.
d. The nurse asks the patient and spouse if they have any further questions about how
to perform the procedure.
ANS: A
Return demonstration is the most effective way for the nurse to determine that the patient is
able to perform the procedure correctly. Providing additional instructions, teaching the
spouse, or asking if there are additional questions will not allow the nurse to determine that
the patient is able to perform the procedure correctly.

OBJ: Describe the elements of discharge planning. TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
12. Which patient will be treated in a Critical Access Hospital (CAH)?

a. The cancer patient who requires a bone marrow transplant
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b. The victim of a serious car accident that occurred in a remote area

c. The pregnant patient whose baby will require neonatal intensive care
d. The patient who requires minimally invasive heart valve replacement
ANS: B
A Critical Access Hospital (CAH) is designed to provide emergent care to patients in rural
areas before they are transferred to larger urban facilities. The CAH will not provide bone
marrow transplant, heart surgery, or neonatal intensive care services.

13. Which type of patient is an appropriate candidate for restorative care services?
a. A patient who uses supplemental oxygen for emphysema
b. A patient who is actively dying of metastatic cancer
c. A patient with right-sided hemiplegia after a recent stroke
d. A patient with depression who tried to commit suicide
ANS: C
A patient with right-sided hemiplegia after a recent stroke is an appropriate candidate for
restorative care services to hopefully regain lost function. Patients who are actively dying
should be referred to hospice care. Suicidal patients require mental health services. A patient
who uses supplemental oxygen requires delivery of equipment from a home respiratory
therapy company.

OBJ: Describe the six levelsTof
EShealth
TBAcare.
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14. Which information is included in the Minimum Data Set?

a. The patient has a history of gout and macular degeneration.
b. The average length of stay for pneumonia is 3 days in the hospital.
c. The hospital has a 14% nosocomial urinary tract infection rate.
d. Approximately 40% of American adults exercise at least 30 minutes daily.
ANS: A
The Minimum Data Set is a comprehensive patient assessment that is utilized to create the
plan of care for residents in nursing homes. The Minimum Data Set does not include
information about hospital infection rates, American exercise habits, or average length of stay.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
15. Which patient is appropriate for an assisted-living agency?

a. A patient who requires tube feeding and frequent tracheostomy suctioning after a
massive stroke
b. A patient with dementia who requires supervision during the day when family
members are at work
c. A patient with severe depression who has made three suicide attempts in the last 6
months
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d. A patient who can perform activities of daily living independently but requires
assistance with daily medications
ANS: D
A patient who can perform activities of daily living independently but requires assistance with
daily medications is an appropriate candidate for an assisted-living agency. A patient who
requires tube feeding and frequent tracheostomy suctioning after a massive stroke requires
placement in a skilled nursing facility. A patient with dementia who requires supervision
during the day when family members are at work requires adult day care services. A patient
with severe depression who has made three suicide attempts in the last 6 months requires
placement in a mental health agency.

16. Which patient is the highest priority for the discharge planner?
a. A patient who will require home IV antibiotics for the next 6 weeks
b. A patient who will be taking antihypertensive medications after discharge
c. A patient who will be discharged after routine tonsillectomy surgery
d. A patient who will be returning to a local skilled nursing facility
ANS: A
The patient who will require home IV antibiotics for the next 6 weeks is the highest priority
for the discharge planner as several home care services will have to be arranged prior to
discharge. Patients with new prescriptions, patients who are returning to skilled nursing
facilities, and patients going home after routine surgeries are lower priority for the discharge
planner. TESTBANKSELLER.COM
DIF: Cognitive Level: Analyze (Analysis)
OBJ: Describe the elements of discharge planning. TOP: Nursing Process: Planning
MSC: NCLEX: Management of Care
17. Which is an example of respite care?

a. A patient with dementia attends an adult day care center so that the patient’s
family can go to work.
b. The respiratory therapist comes to the patient’s house to ensure that the oxygen
equipment is functioning correctly.
c. The nurse teaches the patient’s spouse how to check blood sugar levels and
administer insulin to the patient.
d. The patient is seen in an urgent care clinic for stitches and wound care after being
bitten by a dog.
ANS: A
Respite care allows caregivers a break from caring for the patient. A patient with dementia
attends an adult day care center so that the patient’s family can go to work is an example of
respite care. Respiratory home care services, urgent care services, and patient education are
not examples of respite care.

OBJ: Discuss the types of settings in which professionals provide various levels of health care.
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18. Which is the expected action of the nurse who is caring for a patient in a hospice agency?
a. The nurse teaches the patient how to administer home IV antibiotics through an
intravenous line.
b. The nurse educates the patient’s family about what to expect as the patient
progresses through the dying process.
c. The nurse reviews the patient’s daily laboratory results before preparing to
administer the next dose of chemotherapy.
d. The nurse teaches the patient about the importance of swallow precautions to avoid
the development of aspiration pneumonia.
ANS: B
Hospice nurses assist patients and families through the end stages of terminal illness. The
nurse works to keep the patient comfortable and educates the patient’s family about what to
expect as the patient progresses through the dying process. Hospice nurses do not administer
chemotherapy, teach patients how to administer home IV antibiotics, or teach the importance
of swallow precautions.

19. Which is an example of a diagnosis-related group (DRG)?

a. Patients recovering from orthopedic surgery are placed on the same nursing unit.
b. Specialty hospitals are utilized to treat patients with life-threatening illnesses.
c. The speech therapist is consulted to see every patient admitted with dysphagia.
d. Hospitals will be paid $4500 to care for patients with uncomplicated pneumonia
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ANS: D
When a diagnosis-related group (DRG) is used, the hospital is reimbursed a flat fee for
treatment of patients with each diagnosis. For instance, a hospital will be paid $4500 to care
for patients with uncomplicated pneumonia. Consulting the speech therapist for dysphagia,
placing patients with similar surgeries on the same unit and specialty hospital use are not
examples of DRGs.

20. Which is a responsibility of the Centers for Medicare and Medicaid (CMS)?
a. Create teaching materials to educate health care professionals.
b. Research evidenced-based practices to improve health care for patients.
c. Accredit and certify hospitals in order to ensure safe health care for patients.
d. Manage health insurance coverage for elderly, disabled, and low-income patients.
ANS: D
The Centers for Medicare and Medicaid (CMS) manage health insurance coverage for elderly,
disabled, and low-income patients. CMS is not responsible for educating health care
providers, researching evidence-based practices, or accrediting hospitals.

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21. Which action by the nurse helps to achieve the goals of the Hospital Readmissions Reduction
Program?
a. The nurse ensures that the patient understands how to take prescribed medications
correctly.
b. The nurse develops a close therapeutic relationship with the patient and provides
privacy when care is provided.
c. The nurse uses therapeutic touch to promote relaxation, reduce anxiety, and
promote healing.
d. The nurse elevates the head of the patient’s bed and administers oxygen when the
patient feels short of breath.
ANS: A
The goal of the Hospital Readmissions Reduction Program is to prevent patients from
returning to the hospital after discharge. The nurse can do this by ensuring that the patient
understands how to take prescribed medications correctly. Developing a therapeutic
relationship with the patient, using therapeutic touch, and elevating the head of the bed during
dyspneic episodes will not help prevent readmission after discharge.

22. Which is an example of a Bundled Payment for Care Improvement?

a. The insurance company combines services for several patients into one single
payment.
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b. The hospital is paid a predetermined ELLsum
ER.for
COallM costs related to the patient’s
open-heart surgery.
c. The hospital is paid an additional bonus if the patient’s surgical outcome exceeds
national standards.
d. The insurance company will withhold all payments for the patient until
accreditation is achieved.
ANS: B
Insurance companies may bundle payments together in order to improve health care and
reduce costs. All of the costs for a patient’s surgical procedure are bundled together into one
predetermined lump sum. Combining services for several patients into one single payment is
not an example of a Bundled Payment for Care Improvement. Patients do not receive bonuses
if the patient’s surgical outcome exceeds national standards. Bundled payments do not lead
insurance companies to withhold payment until accreditation is achieved.

23. Which feature of the hospital enables it to qualify for Magnet Recognition Program?
a. The hospital cafeteria is open 24 hours to accommodate staff on every shift.
b. The nurses utilize evidence-based practice and flexible staffing plans.
c. The hospital radiology technicians have received additional certifications.
d. The hospital physicians provide mentoring services for interns and residents.
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ANS: B
Magnet status is awarded by the American Nurses Credentialing Center to hospitals with
excellent nursing care. This includes the use of evidence-based practice and flexible staffing
plans. Magnet status is not about radiology certification, mentoring of medical staff, or
hospital cafeteria hours.

24. The patient uses a special telephone connection to allow the cardiologist to assess the patient’s
pacemaker function while the patient stays at home. Which term is used to describe this type
of health care?
a. Capitation
b. Telemedicine
c. Magnet Recognition Program
d. Utilization review
ANS: B
Telemedicine is the use of technology to improve the patient’s health status. This includes the
use of telephone connections for pacemaker assessment. Utilization review committees
evaluate hospital admissions to ensure that resources are used appropriately. Magnet status is
achieved by hospitals with high nursing standards. Capitation is a form of insurance
reimbursement.

OBJ: Discuss the types of settings
TESTin BAwhich
NKSprofessionals
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OM various levels of health care.
25. Which is an example of health care disparity?

a. The physician treats cardiac patients with insurance more aggressively than
noninsured patients.
b. The patient takes longer to recover from surgery due to a history of aggressive
rheumatoid arthritis.
c. The nurse prioritizes care so that additional time is spent with patients who require
more intensive interventions.
d. The registered nurse is able perform more advanced interventions than the licensed
practical nurse.
ANS: A
Health care disparities occur when patients receive substandard care due to socioeconomic,
cultural, or ethnic characteristics. Delayed surgical recovery, prioritization of nursing care,
and nursing scope of practice are not examples of health care disparity.
DIF: Cognitive Level: Analyze (Analysis)

OBJ: Describe the effects of health disparities on the health of a community.
26. Which type of health care agency is appropriate for a patient who sustained a back injury
while at work?
a. Respite care center
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b. Skilled nursing facility

c. Occupational health clinic
d. Outpatient surgical center
ANS: C
The occupational health clinic is the appropriate agency for a patient who sustained a back
injury while at work. Respite care centers provide relief for caregivers. Skilled nursing
facilities are long-term care centers. There is nothing in the scenario to indicate that the patient
requires surgery.

MULTIPLE RESPONSE
1. Which goals are appropriate for a patient in a restorative care agency? (Select all that apply.)
a. The patient will be able to transfer to the wheelchair with one person assist.
b. The patient’s family will verbalize understanding of the dying process.
c. The patient will be able to eat independently using specially molded utensils.
d. The patient will be transferred to a trauma hospital within 1 hour of arrival.
e. The patient’s family will verbalize feeling of relief from strains of caregiving.
ANS: A, C
The goals of restorative care are to help an individual regain maximal functional status,
thereby enhancing his or her quality of life, and promote patient independence and self-care.
Appropriate goals for restorative care include the patient’s ability transfer to the wheelchair
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with one assist and eat independently using special utensils. Understanding of the dying
process is appropriate for hospice care. Transfer to a trauma hospital is appropriate for Critical
Access Hospitals. Respite care goals include feelings of relief for caregivers.

TOP: Nursing Process: Planning MSC: NCLEX: Management of Care
2. Which health care professionals will participate in discharge planning for the patient? (Select
all that apply.)
a. Registered nurse
b. Radiology technician
c. Social worker
d. Physical therapist
e. Laboratory technician
ANS: A, C, D
The registered nurse, social worker, and physical therapist all participate in discharge
planning for patients. Radiology and laboratory technicians provide specific services for
patients during hospitalization and do not participate in discharge planning for patients.

OBJ: Describe the elements of discharge planning. TOP: Nursing Process: Planning
MSC: NCLEX: Management of Care
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Chapter 03: The Health Care Delivery System

1. Which is an example of tertiary care?

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

4. Which is an example of a patient-centered medical home team?

DIF: Cognitive Level: Apply (Application)

5. Which is an example of a tertiary health care provider?

DIF: Cognitive Level: Understand (Comprehension)

6. Which assessment question allows an administrator to determine the level of patient

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

9. Which is an example of capitation in health care?

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

12. Which patient will be treated in a Critical Access Hospital (CAH)?

b. The victim of a serious car accident that occurred in a remote area

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

14. Which information is included in the Minimum Data Set?

DIF: Cognitive Level: Understand (Comprehension)

15. Which patient is appropriate for an assisted-living agency?

DIF: Cognitive Level: Apply (Application)

17. Which is an example of respite care?

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

19. Which is an example of a diagnosis-related group (DRG)?

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

DIF: Cognitive Level: Apply (Application)

22. Which is an example of a Bundled Payment for Care Improvement?

DIF: Cognitive Level: Understand (Comprehension)

DIF: Cognitive Level: Understand (Comprehension)

DIF: Cognitive Level: Apply (Application)

25. Which is an example of health care disparity?

DIF: Cognitive Level: Analyze (Analysis)

b. Skilled nursing facility

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Apply (Application)

DIF: Cognitive Level: Understand (Comprehension)

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