Chapter 3
1. The nurse is caring for a patient with a history of falling during hospitalization. What
should this nurse do to reduce the risk of the patient falling again?
1. Review the National Patient Safety goals for implementation strategies to reduce falls.
2. Ask the health care provider for an order for restraints.
3. Contact the staffing office to request a sitter for the patient.
4. Instruct the patient to call for help and place the bed in the high position.
Answer: Review the National Patient Safety goals for implementation strategies to reduce
falls.
Rationale:
The nurse should read the National Patient Safety goals for implementation strategies to
reduce falls. There is no indication that this patient needs a restraint order or a sitter. It is
unsafe to simply instruct the patient to call for help and then place the bed in a high position;
should the patient fall, the injury could be severe.
2. The nurse is a member of a committee that is studying the frequency of medication errors.
Other committee members are a health care provider, pharmacist, pharmacy technician, and a
nurse manager. The nurse is most likely participating in which type of quality process?
1. Continuous quality improvement
2. Quality assurance
3. Quality improvement
4. Total quality management
Answer: Continuous quality improvement
Rationale:
Continuous quality improvement is a process of improving a system and using
multidisciplinary teams to analyze the system, collect measurements, and propose changes.
Quality assurance refers to an organization’s effort to provide services according to standards
that will lead to positive patient satisfaction. Quality improvement programs are large
programs that focus on accountability to the payer and consumer. Total quality management
is a way to ensure customer satisfaction by involving all employees in the improvement of
the quality of every product or service.
3. At the end of a scheduled work shift, the nurse asks each of her patients if there was
anything that she could have been done to make their day more comfortable. The nurse is
most likely practicing which of the following?
1. Quality improvement
2. Self-assessment
3. Departmental assessment
4. Continuous quality improvement study
Answer: Quality improvement
Rationale:
At the level of the individual nurse and patient, the quality improvement process is an
appraisal of how the nurse performed in taking care of the patients. There is no evidence to
support the nurse is conducting a self-assessment or a departmental assessment. A continuous
quality improvement study is conducted by a multidisciplinary team to analyze a system,
collect data, and propose changes.
4. A patient tells the nurse that she has a type of health insurance where a certain amount of
money is paid to the doctor for a service regardless of what needs to be done. The nurse
realizes the patient is describing a(n):
1. Health maintenance organization.
2. Independent practice association.
3. Preferred provider organization.
4. Exclusive provider organization.
Answer: Health maintenance organization.
Rationale:
A health maintenance organization is a group health agency that provides basic and
supplemental health treatment with a fee being set without regard to the amount or kind of
service provided. An independent practice association is a group of health care providers who
join together to offer services to managed care organizations; the fees are collected and
distributed according to fee-for-service arrangements. A preferred provider organization
consists of health care providers who provide an insurance company or an employer with
health care services at a discount rate. An exclusive provider organization is the exclusive
provider of care; participants are not allowed to receive coverage from any other providers
and fees are dependent on services provided.
5. A patient tells the nurse that her primary care health care provider wants her to see a
specialist but the specialist is out of the network and her deductible will be higher. The nurse
realizes the patient is a member of which of the following?
1. Preferred provider organization
2. Health maintenance organization
3. Independent practice association
4. Medicare
Answer: Preferred provider organization
Rationale:
Preferred provider organizations provide reimbursement for covered care to non-network
providers but at a different rate, and the client may have to pay a higher deductible. Health
maintenance organizations deliver comprehensive care for fixed prepaid fees or capitation;
they typically restrict access to a specific network of providers. An independent practice
association is a type of health care provider business structure. Medicare is the national health
insurance program that covers people 65 years of age or older, some people under 65 with
disabilities, and people with end-stage renal disease.
6. A 46-year-old patient, unemployed and diagnosed with kidney disease, tells the nurse that
he is having difficulty with his medical bills. Which of the following should the nurse do to
help this patient?
1. Ask social services to discuss Medicare as a health care coverage option.
2. Assure the patient that the nurse will ask the health care provider if the patient can be
quickly discharged to home.
3. Work with the pharmacist to determine which medications the patient can discontinue and
still maintain an acceptable level of health.
4. Suggest the patient take prescribed medications every other day to have the prescription
last longer.
Answer: Ask social services to discuss Medicare as a health care coverage option.
Rationale:
The nurse should talk with social services to find out if the patient is eligible for Medicare
coverage. Medicare is the national health insurance program that covers people 65 years or
older, some people under age 65 with disabilities, and people with end-stage renal disease.
The nurse should not discuss an early discharge with the patient. The nurse would not work
with the pharmacist to determine which medications the patient can discontinue and maintain
an acceptable level of health. The nurse should not suggest that the patient skip medications
doses to help make the prescription last longer.
7. A patient care area is scheduled to have several rooms remodeled with the installation of
new cardiac monitoring equipment. This remodeling and equipment purchases would be
considered as which part of the organization’s budget?
1. Capital
2. Supplies
3. Purchased services
4. Overhead
Answer: Capital
Rationale:
Capital budgets determine the organization’s ability to purchase equipment and to upgrade or
expand facilities. Supplies and purchased services are a part of the operating expenses portion
of the budget. Overhead is considered a nondiscretionary expense of the budget.
8. A nurse manager is planning to send one nurse to a conference. The cost for this training
would be considered which of the following?
1. Salaries/wages
2. Charges
3. Deduction from revenue
4. Nonoperating revenue
Answer: Salaries/wages
Rationale:
Salaries/wages are expenses that include regular salaries for staff, premium pay such as
overtime, benefits, and temporary labor. Benefits can include medical care coverage,
vacation/sick time, training/orientation, and travel reimbursement. Charges are based on the
cost of supplies or services. Deductions from revenue result from charity care or payer
contracts. Nonoperating revenue relates to investment income or favorable legal actions.
9. The nurse manager tells the staff that one of the unit computer printers is being returned to
the vendor because of the cost. This expense would be considered as which part of the
budget?
1. Operating expenses
2. Revenue
3. Nondiscretionary expenses
4. Deductions from revenue
Answer: Operating expenses
Operating expenses include salaries/wages, supplies, and purchased services. An example of
a purchased service is equipment rental. Revenue includes the components of volume and
charges. Nondiscretionary expenses include overhead. Deductions from revenue are a
component of revenue.
10. A patient learns that her husband has been laid off and the health benefit is being
terminated immediately. Which of the following should the nurse do to help this patient?
1. Contact social services to help with health insurance coverage.
2. Suggest to the health care provider that the patient should be discharged.
3. Find out which treatments can be reduced.
4. Ask the patient if her husband is eligible for unemployment benefits.
Answer: Contact social services to help with health insurance coverage.
Rationale:
Nurses should assess their patients’ health care coverage for potential referrals for financial
assistance or counseling; referrals should be made to the hospital’s finance department or to
social services. The nurse should not suggest to the health care provider that the patient
should be discharged, nor should there be a discussion to reduce needed treatments. The
nurse should not discuss the husband’s unemployment with the patient.
11. A patient refuses to take any medication because he “can’t afford it.” Which of the
following should the nurse do to help this patient?
1. Find out of the patient is eligible for medication assistance counseling.
2. Call the health care provider.
3. Mark the medication as “refused” in the administration record.
4. Ask the patient how he expects to get better if he does not take the medication.
Answer: Find out if the patient is eligible for medication assistance counseling.
Nurses should assess their patients’ health care coverage or insurance plan for potential
referrals for financial assistance or counseling. Patients may be concerned about their current
coverage or may lack coverage altogether. This concern can cause significant stress that may
affect the patient’s ability to rest and recover. It is premature to call the health care provider.
Recording the patient’s refusal to take the medication does not address the underlying issue of
health care coverage. It is inappropriate to challenge the patient about taking the medication.
12. A patient brought into the emergency department tells the nurse that she does not need
anything because she cannot pay for any health services. Which of the following should the
nurse do to help this patient?
1. Find out what services are covered by Emergency Medical Treatment and Labor Act
(EMTALA) and explain that the patient’s care will be covered.
2. Provide paperwork for the patient to sign out of the hospital against medical advice.
3. Ask if there is anyone who can pick the patient up from the hospital.
4. Ask the health care provider for medication because the patient is confused.
Answer: Find out what services are covered by Emergency Medical Treatment and Labor Act
(EMTALA) and explain that the patient’s care will be covered.
Rationale:
Hospitals cannot turn patients away who require emergency care services and cannot refuse
to care for patients. The Emergency Medical Treatment and Labor Act (EMTALA) ensures
public access to emergency services regardless of patients’ ability to pay. A patient unable to
pay will be considered charity care in the hospital’s budget; however, this assistance does not
cover all costs incurred. The nurse should find out what the EMTALA law will cover and
explain that to the patient. It is premature for the nurse to provide paperwork for the patient to
sign out of the organization or to call for someone to pick her up. There is no evidence to
suggest that the patient is confused.
13. The nursing staff members at a local hospital are unable to arrive at work because of
deteriorating weather conditions. The administration realizes the lack of staff to provide care
will impact which of the following quality standards?
1. Structure
2. Process
3. Outcome
4. Improvement
Answer: Structure
Rationale:
Structure standards focus on the internal characteristics of the organization and the personnel.
Process standards focus on whether the activities within an organization are being conducted
appropriately. Outcome standards measure the effectiveness, quality, and time allocated for
care. Quality improvement is an overall umbrella term that measures and evaluates all three
quality standards.
14. The nurse is reviewing activities to assess the quality of care provided for a group of
patients. Which of the following would be used to measure a process standard?
1. Turn and reposition bed-rest patients every 2 hours and as needed.
2. Every nurse scheduled to work has current cardiopulmonary resuscitation certification.
3. A patient’s output is 2400 cc after receiving one dose of a diuretic.
4. Patient is able to ambulate without assistance.
Answer: Turn and reposition bed-rest patients every 2 hours and as needed.
Rationale:
Process standards focus on activities, interventions, and the sequence of caregiving events.
An example of this would be turn and reposition bed-rest patients every 2 hours and as
needed. Evidence of current CPR certification would be considered a structure standard. A
patient’s urine output after a medication and a patient’s ability to ambulate would be
considered outcome standards.
15. The nurse is reviewing a patient’s post-hospitalization survey, which states that the care
received was “adequate.” The nurse realizes this information is considered as which quality
standard?
1. Outcome
2. Process
3. Structure
4. Continuous quality improvement
Answer: Outcome
Rationale:
Outcome standards address the patient’s perception of quality care. Process standards focus
on activities, interventions, and the sequencing of caregiving events. Structure standards
focus on the internal characteristics of the organization and personnel. Continuous quality
improvement is a process of improving a system by collecting data and proposing changes
through the use of a multidisciplinary team.
16. The nurse is concerned about the frequency of hospital-acquired infections occurring in a
care area. The regulatory body that would investigate this issue would be the:
1. Occupational Health and Safety Administration.
2. Joint Commission.
3. Centers for Disease Control.
4. Centers for Medicare and Medicaid.
Answer: Occupational Health and Safety Administration.
Rationale:
OSHA oversees numerous health and safety requirements within health care facilities.
Examples of this oversight include bloodborne pathogen control programs, control of
biological hazards, ergonomic health/safety issues, and chemical and radiological safety.
OSHA produces guidelines and reports that help hospitals and other care facilities meet state
and national regulatory standards. The Joint Commission is the accrediting body for hospitals
focusing on patient care and safety, competency of staff, and responsibilities of the
administration and governing boards. The Centers for Disease Control focuses on protecting
the health and safety of people within and outside of health care environments. Centers for
Medicare and Medicaid certify hospitals that want to participate in the federal Medicare and
state Medicaid programs.
17. The state board of nursing notified a hospital about the changes in mandatory continuing
education requirements for the nurses employed in the hospital. The administration realizes
these changes would impact which of the following?
1. Licensure
2. Regulation
3. Accreditation
4. Life safety
Answer: Licensure
Rationale:
Licensing regulations differ from state to state and impact the delivery of care, including the
credentials and competency of employees. Regulation is a term used to describe adherence to
environmental safety. Accreditation is the process of evaluating actual care delivered to
patients, performance of the hospital as an organization, and the outcomes of treatment for
patients. Life safety standards and regulations vary from state to state and include having the
health care provider environment checked for building code compliance and safety standards.
18. A hospital has just completed renovating one section of the hospital. Before the new
section can be used, the following will need to be done:
1. Inspect for fire and life safety standards and regulations.
2. Contact the Centers for Disease Control and Prevention.
3. Inform the state board of nursing.
4. Contact the Joint Commission to schedule a survey.
Answer: Inspect for fire and life safety standards and regulations.
Rationale:
Health care facilities must meet fire and life safety standards and regulations. The building
will need to be checked for code compliance. Inspections occur during construction or
remodeling. The Centers for Disease Control and Prevention, the state board of nursing, and
the Joint Commission do not need to be contacted.
19. A patient tells the nurse that he had made some decisions about his care when he thought
he was going to die, but now that he knows he isn’t, he wants all possible medical treatment.
Which of the following should the nurse do?
1. Contact the health care provider for the patient to discuss the patient’s decision.
2. Document the patient’s wishes in the medical record.
3. Tell the patient that he cannot change is mind or treatment plan.
4. Contact social services to discuss the change in plans.
Answer: Contact the health care provider for the patient to discuss the patient’s decision.
Rationale:
Advance directives can be changed as the individual’s needs and goals change. The nurse
should contact the health care provider so that the patient’s advance directive can be provided
to the health care provider for documentation in the medical record.
20. A patient tells the nurse that if he does not wake up after surgery that his friend should be
contacted because his friend knows what should be done about his health care needs. After
referring to the patient’s medical record, the nurse realizes that the friend is considered:
1. The patient’s health care power of attorney.
2. The patient’s best friend.
3. The patient’s brother.
4. The patient’s next-door neighbor.
Answer: The patient’s health care power of attorney.
Rationale:
The health care power of attorney is a legal document that establishes a surrogate decision
maker to make medical decisions for the patient should he become incapacitated. The nurse
reviewed the patient’s medical record to ensure the information about the friend was present.
There is not enough information to determine if the friend is the patient’s best friend, brother,
or next-door neighbor.
21. A patient hands the nurse an advance directive during the admission process. Which of the
following should the nurse do?
1. Place the document in the patient’s medical record.
2. Read the document and hand it back to the patient.
3. Make a copy of the document and give the copy to the patient.
4. Call social services to collect the document.
Answer: Place the document in the patient’s medical record.
Rationale:
If the patient is submitting an advance directive to a health care provider for the first time, it
should be placed in the medical record per policy. The nurse should not read the document
and hand it back to the patient. The nurse should not make a copy of the directive and give
the copy to the patient. The nurse does not need to contact social services for involvement at
this time.
22. The nurse is planning to document a patient’s response to learning that he will need
additional surgery to correct a health problem. Which of the following would be the most
appropriate for the nurse to document?
1. Patient was nontalkative and sat in a chair for 4 hours.
2. Patient argued with everyone who came into his room today.
3. Patient was overheard telling his wife to phone his lawyer to sue the hospital.
4. Patient appeared to be angry and had a poor appetite for all meals today.
Answer: Patient was nontalkative and sat in a chair for 4 hours.
Rationale:
The nurse’s observations should be objective and factual. Opinions regarding care or
decisions are not appropriate for the legal record; therefore the nurse should not state that the
patient was arguing, that he was overhead talking with his wife about an attorney, or how the
patient appeared. Documentation of a poor appetite should be more objective and include
what was and what was not eaten.
23. A patient reviewing his medical record tells the nurse that he does not remember the name
of a person who documented the care. The nurse reviews the area in question, sees that the
name of the health care provider was not signed correctly and completely, and then should do
which of the following?
1. Explain to the patient who the health care provider is and then remind the health care
provider to document his or her full name and credentials with every documentation entry.
2. Correct the entry in the medical record.
3. Tell the patient that it is not important.
4. Ask the patient if he has found anything else wrong with the documentation.
Answer: Explain to the patient who the health care provider is and then remind the health
care provider to document his or her full name and credentials with every documentation
entry.
Rationale:
All entries in the medical record should be authenticated with the name and title of the
caregiver. The nurse should not correct the entry in the medical record or tell the patient that
it is not important. The nurse should not confront the patient about any other errors in the
documentation.
24. A patient tells the nurse that he does not understand the information in his medical record
because “it’s all a bunch of letters and numbers that don’t make sense.” Which of the
following should the nurse do to help this patient?
1. Sit with the patient and translate the information.
2. Tell the patient that it is not important.
3. Explain to the patient that that is how health care professionals write and it is not for
patients to read.
4. Tell the patient that it doesn’t make sense to her either.
Answer: Sit with the patient and translate the information.
Rationale:
Entries in the medical record should be done with approved terms and abbreviations. The
nurse should be able to translate the information for the patient. The nurse should not tell the
patient that the information is not important or tell the patient that that is how health care
professionals document. The patient has the right to read and review his medical record.
Telling the patient that the documentation does not make sense is not an appropriate response.
25. A patient tells the nurse that her brother is an employee of the hospital and she does not
want him to know anything about her care. The nurse should do which of the following with
this information?
1. Document that the brother is not permitted to review the patient’s medical record.
2. Tell the other nurses during change of shift report about the brother’s employment.
3. Ask the patient why she is concerned.
4. Nothing.
Answer: Document that the brother is not permitted to review the patient’s medical record.
Rationale:
Patients should be asked about their preferences about disclosure of their health care
information at the time of admission or when beginning a relationship with a health care
provider. The patient has control over her health information and how it is used. The nurse
should document that the brother is not permitted to review the patient’s medical record. The
nurse should not talk about the brother’s employment during change of shift report. The nurse
should not ask the patient to justify her request. Doing nothing is inappropriate.
26. The estranged husband of a patient is seen picking up and reading the patient’s medical
record. The patient later asks the nurse how her husband learned about her health status.
Which of the following should the nurse do?
1. Report this violation to the hospital administration.
2. Tell the patient that she has no idea how he learned of her health status.
3. Nothing.
4. Ask the patient how she knows that her husband is aware of her health status.
Answer: Report this violation to the hospital administration.
Rationale:
Organizations must take the implementation of and compliance with HIPAA standards
seriously. Penalties for noncompliance should be assessed. Even unintentional violations may
result in fines. The nurse should not lie to the patient, question the patient, nor do nothing.
27. A nurse is overheard telling someone about a patient who was admitted for an alcohol
problem. The information appears in the next day’s newspaper and names the nurse as the
informant. Which of the following should be done?
1. Implement the policy for an intentional violation of the HIPAA law regarding patient
privacy.
2. Contact the newspaper and ask for a retraction.
3. Ignore the information in the paper, claiming it was hearsay.
4. Nothing.
Answer: Implement the policy for an intentional violation of the HIPAA law regarding patient
privacy.
Rationale:
Organizations must take compliance with HIPAA standards seriously. Penalties for
noncompliance should be assessed and intentional violations can result in imprisonment and
fines. The hospital should not contact the paper and ask for a retraction nor should the
information be ignored. Doing nothing is inappropriate.
28. The case manager reviews a patient’s chart to see that he has been in the hospital for 8
days. The nurse realizes the case manager is working within the component of:
1. Utilization review.
2. Care planning.
3. Discharge planning.
4. Social services.
Answer: Utilization review.
Rationale:
Within utilization review, length-of-stay data is tracked. Tracking length of stay is not
included in care or discharge planning, nor is it a part of social services.
29. The nurse is planning the discharge of a patient. Which of the following activities would
be considered as discharge planning?
1. Ordering oxygen to be used at home
2. Evaluating how long the patient was in the hospital
3. Counting the number of times the patient went to physical therapy
4. Helping the patient complete health insurance paperwork
Answer: Ordering oxygen to be used in the home
Rationale:
The components of hospital-based case management are discharge planning, social services,
and utilization review. The nurse is doing discharge planning when ordering oxygen to be
used at home. Evaluating how long the patient was in the hospital and counting the number of
times the patient went to physical therapy are functions of utilization review. Helping the
patient complete health insurance paperwork is a function of social services.
30. A patient is going to be discharged but is not ready to go home. In which component of
case management will the nurse function to help with this patient’s ongoing care needs?
1. Utilization review
2. Discharge planning
3. Social services
4. Case management does not cover the client’s situation
Answer: Utilization review
Rationale:
Functions of the utilization review component of hospital-based case management include
evaluating appropriate placement and level of care needed. Discharge planning includes
arranging for health assistance or supplies as needed. Social services includes providing links
to financial services. This is a utilization component of hospital-based case management.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
