Chapter 1--The Health Care System and Contemporary Nursing MULTIPLE CHOICE 1. The nurse ensures that a client’s bedspace is neat and clean with the call light within easy reach. The nurse is focusing on which nursing theorist who realized the importance of the environment for care? 1. Florence Nightingale 2. Sister Callista Roy 3. Dorothea Orem 4. Martha Rogers ANS: 1 Florence Nightingale’s theory focused on the environment for care. Sister Callista Roy’s model is based in systems theory and an individual’s ability to adapt. Dorothea Orem’s model is the self-care deficit theory. Martha Roger’s model is the science of unitary human beings. PTS: 1 DIF: Apply REF: Emergence of Contemporary Nursing in the United States 2. The nurse is instructing a client on self-administration of insulin so that the client will not need a health care provider to do this activity. The nurse is implementing which of the following aspects of Virginia Henderson’s theory of nursing? 1. A caring relationship 2. Helping the client achieve independence from the nurse’s assistance as quickly as possible 3. Integration of objective and subjective data 4. Application of critical thinking ANS: 2 Virginia Henderson’s theory of nursing is to help people achieve health or a peaceful death so that they can be independent from the nurse’s assistance as quickly as possible. A caring relationship, integration of objective and subjective data, and application of critical thinking are included in the American Nurses Association’s essential features of professional nursing. PTS: 1 DIF: Analyze REF: Emergence of Contemporary Nursing in the United States 3. A client tells the nurse that he has an HMO for his health insurance. The nurse understands that the purpose of this type of health plan is to: 1. ensure payment is made to Medicare for services rendered. 2. maximize the utilization of health care resources. 3. efficiently manage costs while providing quality care. 4. focus on the illness when providing care. ANS: 3 Health maintenance organizations (HMOs) were created to efficiently manage health care costs while providing quality care. An HMO is a type of managed care plan with the goal of providing wellness care and not focusing on the illness during the provision of care. HMOs do not ensure payment is made to Medicare for services rendered. HMOs also do not maximize the utilization of health care resources but rather uses financial incentives to decrease care costs. PTS: 1 DIF: Understand REF: Cost of Care 4. A client tells the nurse that he does not have a primary care physician but rather makes an appointment with a doctor who specializes in the area in which he is experiencing a problem. The nurse realizes this client is at risk for which of the following? 1. Fragmented care 2. Overpayment of services 3. Inability to sustain health 4. Finding an appropriate general practitioner ANS: 1 In the 1980s, the close and trusting relationship between an individual and the individual’s physician waned and was replaced by acquaintances with specialists based upon particular health care problems. These episodes of care cause fragmentation of care. The client who utilizes specialists is not at risk for overpayment of services, the inability to sustain health, or finding an appropriate general practitioner. PTS: 1 DIF: Analyze REF: Providers of Care 5. The nurse is attending a master’s degree program in efforts to be educationally prepared to serve as a hospital leader. The nurse realizes that this educational preparation will: 1. hinder the nurse’s ability to work with physicians. 2. be viewed as not supporting the profession of nursing by other nurses. 3. ensure the nurse is biased towards clinicians’ interests. 4. prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. ANS: 4 The nurse is attending an educational program to serve as a hospital leader. This education will prepare the nurse to serve as strong clinical support with the ability to integrate business and caring. This education will not hinder the nurse’s ability to work with physicians. This education will not be viewed as unsupportive to the profession of nursing. The education will ensure that the nurse is not biased towards clinicians’ interests. PTS: 1 DIF: Analyze REF: Clinical Systems Leadership 6. A client tells the nurse that all hospitals care about is doing the minimum for a client regardless of the outcome. Which of the following should the nurse respond to this client? 1. “It does feel like that sometimes.” 2. “Health insurance companies have caused this problem.” 3. “The doctors will get paid regardless of the clients’ outcomes.” 4. “There are quality programs in place to make sure clients receive the best quality of care regardless of the cost.” ANS: 4 In response to concerns about safety and quality of care voiced by clients and providers, total quality management and continuous quality improvement programs were initiated. These programs ensure society that cost management is not compromising safety or quality. This is what the nurse should respond to the client. The other choices do not address the client’s concerns nor do they explain quality management programs. PTS: 1 DIF: Apply REF: Quality Measure Shift 7. The nurse is providing care at a time that is the most beneficial to the client. The nurse is implementing which of the following Joint Commission Dimensions of Quality Performance? 1. Safety 2. Timeliness 3. Efficiency