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A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
- A. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company.
- B. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
- C. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
- D. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
Correct Answer: B
Rationale: The correct answer is B. The DRG payment system is a fixed reimbursement amount for a specific diagnosis or procedure. In this case, the cost of care exceeded the DRG reimbursement amount due to the extended ICU stay caused by the client's smoking history. The hospital will only be reimbursed at the set fee specified by the DRG, regardless of the actual cost incurred.
Choice A is incorrect because the hospital cannot collect additional fees from the insurance company beyond the DRG reimbursement amount. Choice C is incorrect as the client is not typically held responsible for the additional costs incurred. Choice D is incorrect because physician payment is not directly impacted by the hospital's financial losses. The DRG system focuses on fixed reimbursements based on diagnoses, not individual physician payments.
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Despite the presence of safety aids such as handrails in the bathrooms at an assisted living facility, the number of fractures due to unsteady ambulation upon arising from the bed and when attempting to perform activities of daily living has increased. Which complementary alternative medicine (CAM) would be an effective intervention for this population?
- A. Yoga
- B. Acupuncture
- C. Tai chi
- D. Magnet therapy
Correct Answer: C
Rationale: Rationale: Tai chi is the correct answer because it focuses on improving balance, strength, and flexibility, which are essential for preventing falls in the elderly. Tai chi's slow, controlled movements can help improve stability and reduce the risk of fractures.
Summary:
A (Yoga) focuses more on flexibility and relaxation, not specifically on balance and stability.
B (Acupuncture) is not a physical activity and does not directly address the issue of unsteady ambulation.
D (Magnet therapy) lacks scientific evidence to support its effectiveness in improving balance and preventing falls.
An RN testifies at a trial where domestic violence is being investigated. She had previously assisted with specimen collection and had assessed the victim. The nurse is involved in nursing.
- A. triage
- B. forensic
- C. flight
- D. entrepreneurial
Correct Answer: B
Rationale: The correct answer is B: forensic. In this scenario, the nurse's involvement in specimen collection and assessment of the victim relates to forensic nursing, which involves providing healthcare in legal contexts like investigations and court proceedings. Triage (A) is the process of prioritizing patient care based on severity. Flight (C) and entrepreneurial (D) have no relevance to the situation described.
A novice nurse is in the "rejection phase" of stress and wonders if she made the right decision when deciding nursing was her chosen career. Which strategy would help the novice nurse cope with transition into practice and reduce stress?
- A. When asked by the charge nurse to accept the new admission even though she had no discharges, the novice nurse stops and considers if this request is acceptable and safe, then accepts the assignment based on two patients having a low acuity level.
- B. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and time to socialize with other staff and visitors.
- C. Avoid wasting time by listening to coworkers' problems or ideas on how to staff the unit during the upcoming holiday since the novice nurse's time is valuable and better spent getting her own work completed.
- D. Make an effort to "win over" hostile or angry coworkers who find fault with the novice nurse's work performance.
Correct Answer: A
Rationale: The correct answer is A because it demonstrates a proactive and thoughtful approach to decision-making. By stopping to consider the request and assessing its safety implications before accepting it based on patient acuity levels, the novice nurse is prioritizing patient safety and her own capabilities. This strategy helps her cope with the transition into practice by promoting critical thinking and confidence in her decision-making skills.
Summary of why the other choices are incorrect:
B: Refusing to eat anywhere but the hospital cafeteria may lead to social isolation and restrict the novice nurse's ability to engage with others outside of work.
C: Ignoring coworkers' problems or staffing ideas can create a negative work environment and hinder teamwork, potentially increasing stress levels for the novice nurse.
D: Focusing on winning over hostile coworkers may detract from the novice nurse's professional growth and cause unnecessary stress from seeking validation from others.
A nurse working in a factory performs routine hearing tests for employees. The factory uses 90 dB as the safe limit for an 8-hour day's exposure to machine noise rather than 85 dB as recommended by the Occupational Safety and Health Administration. The nurse is functioning in the role of:
- A. quality management.
- B. informatics nurse specialist.
- C. occupational health nurse.
- D. case manager.
Correct Answer: C
Rationale: The correct answer is C: occupational health nurse. This is because an occupational health nurse specializes in promoting health and safety in the workplace, including monitoring employees' exposure to occupational hazards like noise. By conducting hearing tests and recognizing the discrepancy between the factory's safe noise level and OSHA's recommendation, the nurse is fulfilling the role of an occupational health nurse.
Choice A (quality management) is incorrect as it involves ensuring high-quality care and services, not specifically focused on workplace health and safety. Choice B (informatics nurse specialist) is incorrect as it pertains to using technology and data to improve healthcare outcomes, not directly related to workplace health monitoring. Choice D (case manager) is incorrect as it involves coordinating care for individual patients, not overseeing workplace health and safety practices.
A registered nurse is on break and checking e-mails. One e-mail contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, "check out my Facebook," which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the "friend" to supervisors. Based on the action of the nurse who received the message, which statement is correct?
- A. The nurse is not at risk for having his or her license suspended since removing the photos made them temporary and invisible to all others.
- B. Because the nurse did not send the message and immediately deleted the photo, there is no risk for discipline.
- C. Failing to report receiving the message demonstrates poor ethical and legal role-modeling as well as placing the nurse at risk for discipline.
- D. Because the patient is on the same floor as the one on which the nurse works, the information can be ethically and legally shared.
Correct Answer: C
Rationale: The correct answer is C. The nurse is at risk for discipline because failing to report the receipt of the message demonstrates poor ethical and legal role-modeling. By deleting the photo and not reporting the incident, the nurse is not upholding patient confidentiality and is potentially violating privacy laws. Sharing patient information, even if the patient is on the same floor, is unethical and illegal. Choices A and B are incorrect because simply deleting the photos does not absolve the nurse from potential consequences, and not being the sender does not excuse the nurse from being responsible for maintaining patient confidentiality. Choice D is incorrect because sharing patient information without authorization is a violation of ethical and legal standards.