Solutions - Chapter 6 - Kozier Erb's Fundamentals Nursing - 10 Ed

1CTC. Nurses are, and should be, taking an active role in influencing the direction of health care. Recognizing that there are finite limits to the amount of money and health care providers available, desirable outcomes often compete for resources. Consider a clinical situation such as the so-called “drive-through (or 24-hour) mastectomies” in which clients are moved through the acute care (hospital) system extremely quickly compared to previously. The ANA’s Health System Reform Agenda (ANA, 2008) states that (a) health care should be providedln settings that provide treatment and follow-up care that is reasonably priced with copayments based on the person’s ability to pay; (b) health care should be available during convenient hours, locations, and waiting times to accommodate working families, people with disabilities, and people across the life span; and (c) health care services should be culturally appropriate, respectful of clients and their families, and inclusive of client involvement in treatment decisions.

How does the mastectomy clinical example reflect or not reflect the agenda?
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1TYK. Which of the following is an example of a primary prevention activity?
1.  Antibiotic treatment of a suspected urinary tract infection
2.  Occupational therapy to assist a client in adapting his or her home environment following a stroke
3.  Nutrition counseling for young adults with a strong family history of high cholesterol
4.  Removal of tonsils for a client with recurrent tonsillitis
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2TYK. Which of the following is an example of a primary prevention activity?
1.  Antibiotic treatment of a suspected urinary tract infection
2.  Occupational therapy to assist a client in adapting his or her home environment following a stroke
3.  Nutrition counseling for young adults with a strong family history of high cholesterol
4.  Removal of tonsils for a client with recurrent tonsillitis
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3TYK. In most cases, clients must have a primary care provider in order to receive health insurance benefits. If a client is in need of a primary care brovider, it is most appropriate for the nurse to recommend which of the following?
1.  Family practice physician
2.  Physical therapist
3.  Case manager/discharge planner
4.  Pharmacist
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4CTC. Mr. Mendel is an 83-year-old married man. He has a history of severe osteoarthritis leading to bilateral hip replacements and one knee replacement. He has mild hypertension controlled by oral medication. His last orthopaedic surgery was done to replace a hip component that failed due to repeated dislocations. At that time, he developed a severe urinary tract infection resulting in weight loss, fatigue, and weakness. After stabilizing, he was sent to the skilled nursing unit of the hospital for 2 weeks until ready to go back home. Occupational therapists consulted with him and his wife during his hospitalization.
He lives in a three-story house with the bedrooms on the top floor, kitchen and living room on the middle/main floor, and family room on the bottom floor. He has not driven since the last operation, but would like to. He has smoked cigars for years and sits on the front porch to smoke. Physical therapists have come to the house three times a week for several months. A home health nurse has also been consulted periodically to assist with nutrition and elimination difficulties.
What other members of the health care profession would most likely be on the case manager’s team and why?
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4TYK. The most significant method for reducing the ongoing increase in the cost of health care in the United States includes controlling which of the following?
1.  Number of children according to the family’s income
2.  Numbers of uninsured and underinsured persons
3.  Number of physicians and nurses nationwide
4.  Competition among drug and medical equipment manufacturers
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5TYK. A client is seeking to control health care costs for both preventive and illness care. Although no system guarantees exact out-of-pocket expenditures, the most prepaid and predictable client contribution would be seen with
1.  Medicare.
2.  An individual fee-for-service insurance.
3.  A preferred provider organization (PPO).
4.  A health maintenance organization (HMO).
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