living environment as well as the healthcare pro-
vided. Provide direct care, supervise others, serve
as an administrator, and teach.
3.With the trend toward discharging patients earlier,
hospitals more often focus on the acute care needs
of the patient. Along with this focus has come a
proliferation of services offered by the hospital
aimed at the outpatient.
- a.Surgical procedures
b.Diagnostic tests
c. Medications
d.Physical therapy
e.Counseling
f. Health education
5.DRGs: Diagnosis-related groups: This plan pays the
hospital a predetermined, fixed amount defined by
the medical diagnosis or specific procedure rather
than by the actual cost of hospitalization and care.
DRGs were implemented by the federal government
in an effort to control rising healthcare costs. If the
cost of hospitalization is greater than that assigned,
the hospital must absorb the additional cost. How-
ever, if cost is less than that assigned, the hospital
makes a profit.
6.When patients come in contact with many different
healthcare providers (e.g., registered nurses, licensed
practical nurses, nursing assistants, nurse specialists,
physical therapists, dietitians, and students) and are
frequently seen by other physician specialists called
in on consultation or to do surgery, the patient may
become confused about care and treatment. This
fragmentation of care may result in the loss of con-
tinuity of care, resulting in conflicting plans of care,
too much or too little medication, and higher
healthcare costs.
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing interventions might the nurse
employ to assist Ms. Ritchie with her caregiver
duties?
The nurse can provide Ms. Ritchie with information
about how to access respite care and make referrals
for her. However, since Medicaid and most
insurance providers do not cover the costs of respite
care, the nurse should also check community services
that may provide respite care for free. Ms. Ritchie’s
husband may qualify for hospice care, and the nurse
can arrange for this service.
2.What would be a successful outcome for this patient?
Ms. Ritchie vocalizes the benefits of respite care and
hospice care programs and states that she will sign
up for any services available to her.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the various types of
healthcare services and settings available to meet
the needs of families caring for dying patients
Technical: ability to provide technical assistance to
meet the needs of families of patients on hospice
Interpersonal: ability to work with different
available resources to ensure everyone’s access to
safe, quality healthcare
Ethical/Legal: knowledge of ethical and legal princi-
ples related to patients with terminal illnesses
4.What resources might be helpful for Ms. Ritchie?
Respite care, hospice services, community services
CHAPTER 9
PRACTICING FOR NCLEX
MULTIPLE CHOICE QUESTIONS
1.c 2.a 3.d 4.a 5.b
6.c
ALTERNATE-FORMAT QUESTIONS
Multiple Response Questions
1.a, c, e
2.b, c, f
3.c, d, e, f
4.b, e, f
5.a, d, f
DEVELOPING YOUR KNOWLEDGE BASE
FILL-IN-THE-BLANKS
1.Community-based
2.Health Insurance Portability and Accountability Act
(HIPAA)
3.Against medical advice (AMA)
4.Discharge planning
CORRECT THE FALSE STATEMENTS
1.False—nurse
2.False—Continuity of care
3.True
4.True
5.False—patient’s name, ID number, and physician
6.False—decreasing
7.False—is indicated
8.True
9.False—remains at the hospital
10.False—physician’s order
SHORT ANSWER
1.Sample answers:
a.With patient’s permission, check with relatives,
neighbors, or fellow church or club members who
could help; if necessary, check with social agencies.
b.Describe the procedure to the patient in detail so
he/she will know what to expect.
c. Check the patient’s insurance status, Medicare,
or Medicaid; see if procedures are covered and
what amount the patient will be responsible for.
Refer to the appropriate agencies if necessary.
d.With patient’s permission, check with family; if
necessary, check into home healthcare possibili-
ties, hospice, or extended-care facilities.
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336 ANSWER KEY
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