Deck 18: Managing Care in Secondary and Tertiary Health Care

Question 1

A stroke patient has been discharged from the hospital and requires care at home. Family support includes the patient's husband and one adult child who lives 90 minutes away with her family, who helps as often as possible. The husband has had to miss work often and has stopped playing golf weekly to care for his wife. What tertiary care service may be a benefit not only to the family members but to also the patient?

A) Home health care
B) Respite care
C) Hospice care
D) Extended care

Answer 1

B
Long-term care of a patient can take a toll on family members. Respite care describes services provided by trained individuals for the care of people with special needs and can be given within the home or through adult day care centers. It is intended to offer the patient's family members time off from their dependent-care duties. Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly. Hospice care helps patients and family cope with the end-of-life experience. Patients are referred to hospice when a patient has approximately 6 months or less to live.

Question 2

After being diagnosed with cancer, the patient appears angry. At this point it would be appropriate for the nurse to assess for which kind of distress?

A) Environmental
B) Developmental
C) Physical
D) Spiritual

Answer 2

D
Patients facing stressful health care-related events may also experience spiritual distress. Illness states can place a patient in a position that forces consideration of the fragile nature of life. Resulting from a potential life-or-death experience or a life-changing event, spiritual distress may take on many manifestations. Much as in the grief process, the patient may display anger, blame, bargaining, or denial or may overtly cling to a spiritual guide. RNs assess for spiritual distress and implement interventions that will help the patient cope, such as facilitating the patient's spiritual connection either through a referral or just by respecting personal wishes. Environmental, developmental, and physical distresses are not typically related to chronic or terminal disease situations.

Question 3

Spiritual assessment is not usually a part of a formal assessment tool, with the exception of asking about religious practices that may be important to continue in the hospital. Which question addresses religious practices?

A) "Would you like a chaplain to come pray with you?"
B) "Do you turn to spiritual guidance as a source of strength in illness?"
C) "What helps you most when you feel afraid?"
D) "What is most frightening about your situation?"

Answer 3

A
Asking about a chaplain is assessing whether the patient requires a spiritual guide by his or her side. Religious beliefs may affect the patient's willingness to participate in the medical plan of care. The plan of care must be respectful of the patient's beliefs while still providing the optimal environment for recovery. Asking about spiritual guidance as a source of strength, what helps most when afraid, and what is most frightening are not specific to religious beliefs.

Question 4

The health maintenance focus for the patient in tertiary care is to:

A) regain or attain as much independence as possible.
B) extend the time in tertiary care as long as possible.
C) ensure total independence with self-care.
D) avoid acquired infections while in the tertiary facility.

Question 5

A nurse writes the diagnosis of "potential for infection" for a postoperative patient. The charge nurse makes certain not to place a patient with a diagnosed infection in the same room with the fresh postoperative patient. The nurse does this to manage which of the following?

A) The potential for noise in the room
B) The potential for patient complaints related to odors
C) The physical environment of the secondary health setting
D) The social environment within the secondary health setting

Question 6

Which of the following is an example of a responsible resource manager in an acute care facility?

A) Listens to staff input about implementing a new procedure
B) Consumes foods and drinks kept on the unit for patients
C) Considers the unit's patient census when determining staffing
D) Uses supplies that are not accounted for

Question 7

The extended care meant to provide health restoration after discharge from an acute care facility is also known as _____ care.

A) primary
B) tertiary
C) acute
D) quaternary

Question 8

A patient has been discharged home after being hospitalized for a fractured foot following a motor vehicle accident. The doctor has ordered physical therapy for the patient to help gain strength and flexibility after the cast can be removed. This patient will likely receive a referral for what tertiary service?

A) Respite care
B) Home health care
C) Wound care
D) Rehabilitation care

Question 9

According to Orem, people enter the acute health care setting when they are experiencing either a self-care or a:

A) dependent-care agency.
B) community-care agency.
C) dependent-care deficit.
D) community-care deficit.

Question 10

Discharge planning requires all of the following except:

A) assessing the patient's plan of care to determine whether the outcome criteria are met.
B) evaluation of whether the patient and family can continue with the necessary interventions or whether they need assistance.
C) obtaining specific orders from the physician to begin the process of discharge planning.
D) assessing the level of the patient's understanding with regard to his or her illness state and treatment regimen.

Question 11

In what way(s) do clinical pathways help nurses to manage patient care? (Select all that apply.)

A) Evaluate long-term care facilities.
B) Enable consistently safe care.
C) Manage the resources of the health care facility.
D) Define standard assessment data and frequency for data collection.
E) Review patient charts for quality improvement opportunities.

Question 12

A patient has endured 3 years of treatment for colon cancer but recently learned that the cancer has spread to her liver and bone. The patient and her family have learned she may have less than 6 months to live and there is nothing medically to consider. What tertiary service can the RN suggest to the patient and family?

A) Hospice care
B) Wound care
C) Home health care
D) Ostomy care

Question 13

Some cultures see personal touching as an insult unless you are intimately related. In the acute care setting, the need for touching to administer care may produce what within the patient?

A) Cultural strain
B) Impaired functioning
C) Cultural insult
D) Increased self-care deficit

Question 14

By allowing the ICU patient's family to visit as often as the patient's condition will allow, the nurse is considering which type of need within the patient and his family?

A) Trust
B) Social support
C) Environmental
D) Dependence

Question 15

In the acute care environment, what is(are) the primary role(s) of the RN?

A) Ensure more independence in self-care ability.
B) Avoid complications as the patient progresses through the illness state.
C) Change the medical plan of care according to the RN's assessments.
D) Both a and b are correct.