Deck 9: Managing Patient-Centered Care

Question 1

If you wanted to quickly find an evidence-based clinical guideline, where would you look?

A) National Institute of Nursing Research
B) Hospital library medical journals
C) National Guideline Clearinghouse
D) Nursing literature search

Answer 1

National Guideline Clearinghouse

Question 2

Which statement is true regarding implementation of clinical pathways?

A) Pathways replace physician orders.
B) Pathways cannot be used for patients with more than one illness or condition.
C) Using pathways is the best way to assess length of stay (LOS).
D) Disclaimers may be used with clinical pathways to convey that treatment is standardized.

Answer 2

Using pathways is the best way to assess length of stay (LOS).

Question 3

The organization has noted an increase in negative patient variances related to medication administration. What steps should be taken by the organization? Select all that apply.

A) Look for reasons for the variances.
B) Identify those at fault for the variances.
C) Document the variances in the medical records of the patients involved.
D) Try to find a resolution for the variances.
E) Rewrite the clinical pathways.

Answer 3

Look for reasons for the variances.
Try to find a resolution for the variances.

Question 4

Which statement regarding clinical reasoning and judgment is true?

A) These skills are being adequately taught in nursing curriculums.
B) Both of these skills are dependent upon the context of the situation.
C) These two terms mean the same thing.
D) These two skills are primarily used in emergency situations.

Question 5

Which statements, made by a member of the healthcare team, best demonstrate patient-centered care? Select all that apply.

A) "We have decided that you need to have surgery for your condition."
B) "What time would you like to take your bath?"
C) "I ordered apple juice for your breakfast."
D) "I brought the extra blanket that you asked for."
E) "You will need to return to the office tomorrow to get the results of these laboratory tests."

Question 6

The staff nurse has been asked to work on a committee whose task is to develop clinical pathways for the facility. What is the purpose of these pathways?

A) To provide quality healthcare with the efficient use of resources while controlling costs
B) To provide practice guidelines for the general treatment of a specific diagnosis
C) To reduce patient length of stay
D) To justify alternative treatment methods

Question 7

Which description of a clinical pathway provided by a nursing student would indicate the best understanding of the concept?

A) Clinical pathways are tools to measure patient outcomes.
B) Clinical pathways are the same as nursing care plans.
C) Clinical pathways are developed to use in acute care settings and guide the nursing care of patients as they are admitted, treated, and discharged.
D) Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.

Question 8

A patient who has a history of asthma asks about the availability of a disease management program for his illness. Which statement, made by the nurse, is appropriate?

A) There isn't a disease management program for asthma yet, but there is one under development.
B) There is no such program for asthma.
C) The program exists, but only a very few insurance companies cover it.
D) There is a program targeted specifically for asthma.

Question 9

The nurse who works for an insurance company has been asked to develop an initial set of disease management programs. What factors should this nurse consider when choosing the diseases? Select all that apply.

A) High cost problems
B) Those with high numbers of hospitalizations
C) Those with high risk for complications
D) Long-term problems
E) Those with a longer length of stay when hospitalization is required

Question 10

What is the key difficulty with implementing patient-centered care?

A) Recognizing that patient-centered care is important.
B) Implementing it effectively.
C) Paying for patient-centered care.
D) Defining patient-centered care.

Question 11

The nurse is planning patient education regarding wound care. Which concepts should the nurse use in designing this session?

A) Keep the information as broad as possible.
B) Use a standard preprinted form as a handout for the patient.
C) Ask the patient's family caregivers to be present.
D) Have the patient save all questions to the end of the session.

Question 12

What skills does the Institute of Medicine identify as important in the provision of effective patient-centered care? Select all that apply.

A) Make the patient fully responsible for his or her care.
B) Communication with patients should be open and complete.
C) The patient should be thought of as an individual.
D) Prevention and health promotion should be enhanced.
E) Focus care on self-directed patients who seek care.

Question 13

The acute care nurse finds that it is increasingly difficult to provide effective education to patients. What changes in healthcare have contributed to this difficulty? Select all that apply.

A) Patients have difficulty understanding new medical technology.
B) Patients are much sicker while they are hospitalized.
C) Nurses don't use good time management skills when planning education sessions.
D) There are fewer quality educational resources available for patients.
E) Patients don't stay in the hospital as long.

Question 14

How does self-management relate to patient-centered care?

A) The nurse who is able to self-manage anxiety is better able to provide care.
B) Patients who self-prescribe over the counter medications have a better understanding of their body.
C) It replicates the traditional model of healthcare.
D) In order for care to become patient-centered, the patient must embrace self-management.

Question 15

The nurse manager is making patient assignments for the shift. What should be the primary guiding factor in these assignments?

A) Number of staff available
B) Skill mix of the staff
C) Patient needs
D) Physical layout of the unit

Question 16

The healthcare providers in an organization have chosen not to adopt the use of clinical pathways. What are reasons to justify this decision? Select all that apply.

A) Clinical pathways development and implementation takes time and can be costly.
B) The pathway content has to be evaluated each time it is used.
C) Some believe that clinical pathways result in excessive paperwork and redundant documentation.
D) There is fear that pathways will be used in evaluating staff performance.
E) The use of clinical pathways has not been proven to make a difference in patient care.

Question 17

During a meeting to discuss the adoption of clinical pathways a nurse expresses concerns about legal problems associated with their use. Which options reflect provider responses to the use of clinical pathways that can result in legal problems? Select all that apply.

A) Nurses document most of the variances.
B) The provider does not follow the clinical pathway and does not document the variance.
C) Negligent care is provided, even though the pathway was followed.
D) The pathway does not represent evidence-based care.
E) Care is delivered based on the pathway, not the individual.

Question 18

What is the primary focus of disease management programs?

A) Curing the disease
B) Reducing the need for medications
C) The whole patient
D) Learning more about the disease

Question 19

What are the elements included in the health system in the chronic care model? Select all that apply.

A) Decision support
B) Delivery system design
C) Self-management support
D) Primary providers
E) Clinical information systems

Question 20

Which goal, set by the physician office staff, demonstrates attention to the patient-centered care attribute of care coordination?

A) Each patient will be seen by the physician within 15 minutes of the scheduled appointment time.
B) Information on treatment plans will be provided to each patient.
C) Each patient will receive a patient satisfaction survey regarding each office visit.
D) Post-hospitalization follow-up telephone calls will be made to each discharged patient on post-hospital day 1 and7

Question 21

Why are variances important?

A) Identify costs of care
B) Identify how documentation tool is ineffective
C) Offer an indication of potential problem
D) Compare cost and quality in healthcare delivery

Question 22

Which statement is a common myth about patient-centered care?

A) Patient-centered care requires a team approach.
B) Patient-centered care is not designed to solve all healthcare problems.
C) Patient-centered care can have a negative impact on infection rates.
D) Patient-centered care does not increase care time.

Question 23

The nurse is following a clinical pathway for a patient who has undergone hip replacement surgery. The nurse notices that the physician orders do not follow the clinical pathway. What should the nurse do first?

A) Follow the pathway as written.
B) Do as the physician orders, regardless of the clinical pathway.
C) Refuse the orders.
D) Notify the nursing supervisor, and document the variance.

Question 24

Which option best explains the purpose of practice guidelines?

A) To ensure optimal care
B) To assist with treatment decision making and to evaluate care
C) To reduce malpractice lawsuits
D) To define treatment

Question 25

Which example represents a negative patient variance?

A) A patient develops hospital-acquired pneumonia due to noncompliance with respiratory interventions.
B) The nurse administers a mislabeled medication.
C) A CBC was drawn on a patient instead of an ABG.
D) Difficulties were experienced in placing an older adult into long-term care.

Question 26

Differentiate between disease management programs and clinical guidelines by choosing the option that describes disease management programs.

A) The major goal is to prepare the patient to understand the disease and to increase self-management of the disease.
B) They establish standards that focus on health maintenance.
C) They have been adopted to control costs.
D) They are also called medical review criteria.