NUR104 11/30

What is one responsibility of nurses who work in a health care providers' offices?

• Prescribing medications

• Conducting health assessments

• Performing minor surgery

• Making independent home visits

Answer explanation

Nurses in health care providers' offices make health assessments, perform technical procedures, assist the health care provider, and provide health education. They do not prescribe medications, perform minor surgery, or make independent home visits.

The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way?

• Medicare pays only the amount of money preassigned to a treatment for a diagnosis.

• • Benefits and reimbursement cannot be changed annually.

• Part B of Medicare covers most inpatient and outpatient costs.

• • Part A of Medicare is voluntary and is paid for by a monthly premium.

Which client would a nurse correctly refer to Medicare services?

• • A client with cancer

• A low-income family with infants needing immunizations

• A client with a disability

• A 66-year-old client with diabetes

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?

• A retrospective payment plan, after the service is rendered

• A payment to health care provider groups willing to take Medicare clients

• A prospective payment plan based on a predetermined fixed cost

• The need to cut health care costs for indigent older adults

Answer explanation

The nurse must understand that Medicare is a federal insurance program for older adults. It is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare does not pay health care provider groups and is not for indigent older adults. Retrospective payment plans pay for services after they have been received.

Which statement regarding hospice care and the role of a hospice nurse is most accurate?

• The hospice nurse's role in caring for the client and the family ends at the time of the client's death.

• After the hospice client's death, the nurse assists the family with the bereavement process up to one year.

• The focus of hospice nursing is on prolonging life and promoting dignity.

• Medicaid is the predominant source of payment for hospice care.

Answer explanation

Hospice nurses are involved with clients and families from the time of admission until up to one year after the death of the client. The focus of hospice nursing is on client dignity and easing suffering, not on prolonging life. Medicare, not Medicaid, is the primary source of payment for hospice care.

An informatics nurse specialist is working on a team that is considering a new technological system for the facility. Which aspect would be most important for the team to do as the first step?

• Determine the need or problem to be solved

• Identify the use of standard terminology

• Conduct testing of the system

• Train those who will be using the system

Answer explanation

Before considering the use of any new technology or an update to the system, analysis and planning must occur. This involves determining the need for the technology or update or identifying the problem to be solved. Once that step is completed, then design (such as using standard terminology), testing and training would occur.

An informatics nurse is evaluating a new clinical information system for usability. The nurse notes that the system requires the user to complete a maximum of 3 steps to complete a task. The system also provides shortcuts to frequent users of the system. The nurse would determine that which concept of usability is being addressed?

• Consistency

• Minimizing cognitive load

• Efficient interactions

• Naturalness

Answer explanation

Efficient interactions is demonstrated by actions that facilitate efficient user interactions. An example is to minimize the number of steps it takes to complete tasks and to provide shortcuts for use by frequent and/or experienced users. Consistency involves the ability of the users to apply prior experience to a new system so that the lower the learning curve, the more effective their usage, and the fewer their errors. Naturalness refers to how automatically “familiar” and easy to use (intuitive) the application feels to the user.

Prior to the discharge of a client who is recovering from a stroke from an acute care facility, the nursing case manager has the nursing staff, client, client's family, physical therapist, and home health nurse meet. The nurse will identify what priority purpose for this meeting?

• Provide client education

• Evaluate the effectiveness of the hospitalization

• Determine hospital-based services needed by the client

• Prepare the client to receive home care

Answer explanation

Given that this client is being discharged from the acute care facility following a stroke, it is most likely that the nurse is calling a meeting of the entire health care team and the client and family to prepare the client for home care. Simply providing client education or evaluating the effectiveness of hospitalization could be done by the nurse alone and would not warrant calling a meeting with the entire health care team. As the client is being discharged, there is no reason to discuss hospital-based resources that the client might need.

A nurse is preparing for handoff communication for a client who is being discharged from the hospital to home health care. Which example is not an action performed during this process?

• The nurse determines who should be involved in the handoff communication.

• The nurse prepares the new room for the client.

• The nurse asks the other health care professionals if they have any questions.

• The nurse uses the SBAR technique during the handoff.

Answer explanation

The nurse prepares the new room for a client prior to admission, not during the discharge process. The client handoff refers to transferring responsibility for a client from one caregiver to another with the goal of providing timely, accurate information about a client’s plan of care, treatment, current condition and anticipated changes. The nurse determines who she needs to communicate with during the discharge and asks those health care professionals if they have any questions in order to provide continuity of care. SBAR (Situation-Background-Assessment-Recommendation) is an outline that many facilities follow to ensure that proper communication occurs during the handoff procedure.

A nurse is providing community-based health care for a client diagnosed with early onset dementia. Which strategy is best for the nurse to employ to facilitate the family participating in the client’s care?

• Reinforce the care plan to the family if it is determined the client is not properly cared for.

• Provide referrals for health care professionals to perform the client’s activities of daily living (ADLs).

• • Encourage active participation of the client and family in health care decisions.

• Create a care plan based on the client’s requests and inform the family of the client’s wishes.

Answer explanation

In a community-based health care setting, the nurse should involve the client and the family in all health care decisions for the client. The nature of the relationship is that of a partnership based on respect, appreciation, and cooperation. Reinforcing to the family that the client is not well-cared for should be done, but it is more important to involve the client and family in the care. The client and family should be encouraged to provide ADLs as they are able. Client care decisions should be made in conjunction with the family, and the family should be encouraged to participate in those decisions. The client’s plan of care should include input from the family.