Deck 16: Managing Care in Secondary and Tertiary Health Care

Question 1

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 1

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 2

The nurse is listening to a lecture on discharge planning. Which statement indicates that the teaching has been effective?

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

Answer 2

C
Discharge planning requires assessing the patient's plan of care to determine whether the outcome criteria are met. If a need exists for continuation of the plan of care, then the RN must evaluate whether the patient and family can continue with the necessary interventions or whether they need assistance. If the patient and the family are able to continue the plan of care, discharge teaching with regard to the continued care is needed. Discharge teaching will require the RN to assess the level of the patient's understanding with regard to his or her illness state and treatment regimen. There is no need to obtain an order to begin this process.

Question 3

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

Answer 3

A
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. The RN assesses the continued needs of the patient and works with the physician to provide comfort measures for the patient. The goal of hospice care is the patient's peaceful and dignified death. Wound care and ostomy care are not discussed. 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.

Question 4

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 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

The nurse is listening to a lecture on the health maintenance focus for the patient in tertiary care. Which statement indicates that the teaching has been effective?

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

Question 7

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 8

The nurse is listening to a lecture on the acute care environment and the role of the RN. Which statement indicates that the teaching has been effective?

A) "The RN ensures more independence in self-care ability."
B) "The RN avoids discussing wait times as the patient progresses through the illness state."
C) "The RN changes the medical plan of care according to the RN's assessments."
D) "The RN delegates the majority of decisions to the medical assistants."

Question 9

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

Question 10

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 11

The nurse is listening to a lecture on the Orem's theory. Which statement indicates that teaching has been effective?

A) "Patients enter the acute health care setting when they are experiencing a dependent-care agency."
B) "Patients enter the acute health care setting when they are experiencing a community-care agency."
C) "Patients enter the acute health care setting when they are experiencing a dependent-care deficit."
D) "Patients enter the acute health care setting when they are experiencing a community-care deficit."

Question 12

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

Question 13

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 14

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